Congenital hearing impairment associated with rubella: lessons from Bangladesh.

Infection with rubella virus during pregnancy may cause fetal death or the multiple congenital fetal abnormalities that are known as congenital rubella syndrome (CRS). Studies have demonstrated that congenital hearing impairment is the most frequent abnormality associated with intrauterine rubella infection. In the present study, the first of its kind in Bangladesh, we investigated the presence of rubella antibody in hearing-impaired children in order to understand the possible role of rubella infection in the development of hearing impairment. A total of 198 hearing-impaired children and 200 children without hearing problems were studied. After taking a detailed history from the parents, blood samples were collected from both mothers and children; sera were subjected to enzyme-linked immunosorbent assay (ELISA) for anti-rubella IgG. Rubella antibody was detected in 74% of the hearing-impaired children and in 18% of those with normal hearing: this finding correlated with the presence of rubella antibody in the mothers (67%) of rubella seropositive hearing-impaired children. In contrast, we observed rubella antibody in only 14% of the mothers of the children without hearing problems. Consistent with the presence of antibody, 41% of the seropositive mothers who had hearing-impaired children gave a history of fever and rash during early pregnancy. Our study indicates a strong association between rubella infection and hearing impairment in Bangladeshi children. In addition, it also indicates that infection by rubella virus is common in Bangladesh: this suggests that priority should be given to implementing appropriate measures for the control of rubella.

Mass closure versus layer closure of abdominal wound: a prospective clinical study.

The results of a controlled clinical trial of two currently recommended methods of abdominal closure have been reported here. OUt of 160 patients, 80 cases were randomised to have their abdominal wall closed in single layer mass closure with monofilament nylon and 80 cases in layer closure with chromic catgut. Eighteen patients (22.5%) in the former and 38 (47.5%) in the latter had wound infection (p < 0.001). Sinus formation occurred in 2 patients (2.5%) in the mass and 20 (25%) in the layered group (p < 0.001). Three cases (3.75%) of burst abdomen occurred in layer closure and none in mass closure. Wound infection was the most important denominator next to suture material influencing wound healing. There was a significant association between the rate of infection and sinus formation. Minimal complication and good patient compliance seem to justify the use of mass closure in place of layer closure in all types of abdominal operations.