A clinico-epidemiological study of the first outbreak of Nipah virus in India – report from ground zero

Introduction: The first Nipah Virus (NiV) outbreak occurred in India in the year 2001 at Siliguri. The second outbreak happened at Nadia in 2007. Nipah Virus exhibits neurological and pneumonic tropism with the predominant clinical presentation being encephalitis in humans. Material and Methods: The present study was a record based prospective study on 67 cases admitted with pyrexia of unknown origin in North Bengal Medical College during the period from 18.02.2001 to 30.02.2001 and a parallel study on epidemiological record carried out by PSM department also taken into account. All necessary investigations including autopsy examination, pathological, and microbiological study were done. Results: There was a clustering of cases around Bhaktinagar. There was a strong H/O Medinova Nursing Home Contact among the patients. 18 out of 20 cases were staff of that Nursing Home. Serum samples tested show NiV specific IgM and IgG in 9 out of 17 samples with one sample which was positive for IgG only suggesting past infection. The cases were admitted with predominant neurological symptoms (53.73% cases) but about 80% recovered with no residual neuro deficit. The natural reservoir of NiV is present in Bangladesh and in Northern India. Conclusion: When NiV infection is suspected, infection control practices must be strengthened to avoid an outbreak in a hospital setting. Here the present study is presenting the experience in the first outbreak of the Nipah virus in India at Siliguri for awareness of clinical personnel to control further outbreak at the very beginning.

Integrated nutrient management and formulation of fertilizer prescription equation for recommendation of fertilizers for potato on alluvial soils of eastern India

Aim: To develop economically viable integrated fertilizer prescription equation for recommendation of fertilizers in potato on alluvial soils of Eastern India.Methodology: Soil test crop response (STCR) experiments on potato were conducted in alluvial soils of Eastern India during 2016-17 to assess the relationship between yield and availability of plant nutrients for developing fertilizer prescriptions of desired yield targets. The decision on optimum fertilizer doses for varying yield targets were made on the basis of crop nutrient requirement per quintal of potato production, soil efficiency, fertilizer efficiency, and FYM efficiency computed from field experimental data. The optimum fertilizer doses for different yield targets were validated in farmers’ field for economic and environmental benefits as compared to general recommended doses of fertilizers and farmers’ practice. Results: Targeted yield equation for potato for alluvial soil of Eastern India was developed based on soil test values, nutrient requirement and contribution of NPK from soil and fertilizer sources as well as FYM. The prescription based fertilizer application along with FYM increased tuber yield of potato in farmers’ field. Validity of the yield target for 22 and 24 t ha-1 was tested in farmer’s fields and variation in potato yield obtained from targeted yield was 7.6% to 9.8%. Interpretation: Fertilizer prescription equations and ready reckoner developed for potato will be useful in alluvial soils of Eastern India for large scale recommendations and in regions with similar soil and agro-climatic conditions. By following ready reckoner, a farmer can save 61 kg N, 55 kg P2O5 and 44 kg K2O ha-1 over general recommended dose, approximately equal to Rs. 4800/- per hectare.

Evaluation of trans thoracic invasive diagnostic procedures in 50 adult patients of mediastinal diseases

Introduction: Mediastinum is a “Pandora’s box” with many neoplastic and nonneoplastic lesions. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, non-invasive approach to these cases sometimes leads to diagnostic dilemma. Aims: A prospective study was performed over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine‑needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and non-invasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, nature of disease and complication and cost effectiveness ofthe procedures. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Results: Among 50 patients diagnostic yield of TTUS guided FNA and Tru-cut biopsy were 60% and 63.6% respectively. Diagnostic yield of Thoracic CT guided FNA and Tru-cut biopsy were 85% and 92.3% respectively. As a whole TTUS guided invasive procedure and Thoracic CT guided invasive procedure had a diagnostic yield of 61.5% and 87.9% respectively. Complication is less in CT guided invasive procedures (9.1%) compared to Transthoracic USG guided invasive procedures (11.5%) and complication is more common in Tru-Cut biopsy (16.7%) than fine needle aspiration (5.7%). Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and have added advantage of real time guidance and is comparable with CT guided invasive procedures in respect to risk and diagnostic yields.

Use of bacterial endospore with longer shelf-life in improved retting of jute

Aim: The aim of the present study was to evaluate the retting of jute (Corchorus olitorius L. and C. capsularis L.) using the endospores of microbial consortium of three strains of Bacillus pumilus with extended shelf-life. Methodology: Endospore and vegetative cells of Bacillus pumilus were tested for viability by introducing them into different temperature, pH, UV radiation and antibiotics. Laboratory, as well as field-trials of jute retting was performed with 6 and 18-months-old endospores and vegetative cells of Bacillus pumilus with estimation of enzymatic activities for comparison of their retting efficiency. Results: Endospores of Bacillus pumilus recorded very high colony forming unit (109 to 108ml-1) compared to their vegetative cells (106 to 104ml-1) after 6 to 18 months of their preservation. Endospores also showed higher resistance to temperature, pH, UV irradiation and antibiotic than their vegetative forms. High colony forming unit and higher release of pectinolytic and xylanolytic enzymes during retting of jute by endospores resulted in complete of jute retting in 10 days with good quality jute fibre compared to talc based formulation. Interpretation: It can be concluded from the study that endospores remained highly efficient in rejuvenating higher CFU and quantitatively larger pool of enzymes to accelerate retting of jute after prolonged preservation. Therefore, the endospores of Bacillus pumilus can be used cost effectively in place of their talc based formulation for higher shelf life of the product, faster retting and better fibre quality of jute.

Circadian Variation in Frequency of Stroke in Bangladesh: a Hospital Based Cross Sectional Study.

A hospital based cross sectional study was carried out to analyze diurnal variation of stroke and their association to sleep awake cycle. Four hundred and two patients of stroke admitted in different Medicine Units of Faridpur Medical College and Dhaka Medical College Hospitals from July 2012 to June 2013 were chosen using purposive sampling technique. Enrolled patients were with their first stroke, subsequently proved by CT scan of brain. The initial clinical diagnosis of stroke was made from history and examination obtained from the patient himself or from his/her attendant. The time of onset of stroke was recorded by attending doctor at the time of assessment and recorded on a fixed proforma. Patient who could not give history properly or had no responsible attendant and who had history of head injury, intracranial space occupying lesion or bleeding disorder were excluded from the study. Age ranged from 25 years to 98 years with mean age of 62.02 years (+_SD 11.75 years). Out of 402 patients 59.7% suffered from ischemic stroke. Highest incidence of stroke (26.9%) occurred between 4:01am to 8:00 am and lowest (7.5%) between 8:01 pm to 12:00 am. Among the subtypes, ischaemic stroke has shown a single peak incidence at 4:01 to 8:00 am and lowest between 8:01 pm to 12:00 am. 50 % of ischaemic stroke cases developed between 0:01 am to 8:00 am. In this study, maximum number of patients developed hemorrhagic stroke between 4:01 am to 8:00 am (25.9%) and lowest number developed hemorrhagic stroke between 12:01 pm to 4:00 pm (9.3%). This study confirms the diurnal variation of both hemorrhagic and ischaemic stroke in Bangladesh and most of them occurs in early morning after wakening.

Primary Repair of Traumatic Gut Injury Without Diversion in Casualty Department of Dhaka Medical College Hospital.

Colon is one of the most commonly injured viscera followed by small gut and liver in abdomen for which management becomes complicated had the type and severity of injury not been assessed properly. With improved facilities in patient care and proper use of antibiotics the inclination is directed towards primary repair of colon without diversion. This study was aimed to assess the efficacy of primary repair in a tertiary hospital. A number of 50 patients of traumatic gut injury from 15-50 years (31.18 ± 9.38 years) mainly presenting with RTA with blunt trauma abdomen (54.0%) and different types of stab injury (40.0%) were managed with primary repair in the department of casualty in Dhaka Medical College Hospital, Dhaka between the period of January to June 2009. On admission more than half (52.0%) had hypotension, 70.0% distended abdomen, 84.0% tender abdomen, 58.0% presented with abdominal rigidity while 80% of them had perforation of the small and 20% had the same in large gut. After primary repair, only 6% developed chest infection and 4% developed wound infection. The findings suggest that primary repair without diversion in the treatment of traumatic gut injury can be performed among patients admitted in our hospitals.

Advanced Abdominal Pregnancy with a Full-Term Live Fetus: Case Report.

Advanced abdominal pregnancy (AAP) with a viable full-term fetus is a rarity that a few obstetricians encounter during their professional carrier. Usually it has a dramatic and catastrophic consequence both for the fetus & the mother; rather subsequent delivery of a viable full term fetus is exceptional. It is difficult to diagnose preoperatively. Though relatively rare, we received an AAP at term with live fetus in Faridpur Medical College & hospital. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. After laparotomy the diagnosis was confirmed, a healthy male baby was delivered.

Outcome of Upper Gastro Intestinal Haemorrhage - a Hospital Based Prospective Study.

Upper GI bleeding is a common medical emergency with a significant mortality, outcome of which depends upon the cause, appropriate and early intervention in a specialized center. This study was carried out to see the outcome of patient with Upper GI haemorrhage. Fifty cases with episode of upper gastrointestinal haemorrhage, admitted into medicine units of Faridpur Medical College Hospital from January 2011 to December 2011, were studied. Duodenal ulcer was the commonest cause of haematemesis and melaena followed by oesophageal varices, gastric ulcer and erosive gastritis. The peak incidence was among 35 to 45 years of age. Over all male female ratio was 4.55:1 but in case of duodenal ulcer it was 9:1. During hospital stay recurrent bleeding was noted in 10% of patients and during subsequent follow up it was 10% of the total and 50% in case of variceal bleeding group. Over all hospital mortality was 4% .

Road Traffic Accidents by 'Nasimon' and 'Karimon'-A Study in Faridpur Medical College Hospital.

Road traffic accidents in Bangladesh have been rapidly increasing with huge mortality through road accidents each year. There are many causes of road accidents in recent years; one important cause is running of locally made improvised three wheelers (flat bed tricycle) in the urban areas and also on the highways, popularly known as 'Nasimon' and 'Karimon'. This prospective study was carried out in Faridpur Medical College Hospital from January through June 2011, to study the accident patients caused by 'Nasimon' and 'Karimon'. Fifty six (12%) patients were of RTA by 'Nasimon' and 'Karimon' out of a total of 468 patients admitted into our hospital during this period. Most patients (41, 73.21%) were male, highest accidents (24, 42.86%) were observed among 21-30 years age group and most victims (33, 58.93%) were belonged to low socioeconomic status. Commonest (31, 55.36%) victims were passengers of 'Nasimon' and 'Karimon' while maximum number of accidents (46, 82.14%) took place in the urban areas and on the highways. Injury pattern of victims were similar to that found in any other road accident patients. These three wheelers 'Nasimon' and 'Karimon' are run in violating of Bangladesh Motor Vehicles Act (1983) as they are totally unfit for plying on the highways. Strict surveillance against these illegal and risky vehicles on the highways and in the urban areas by law enforcing agencies is required as a measure to reduce the burden of road accidents in our country.

Improper Inhalation Technique-A Barrier to Good Asthma Control.

Bronchial Asthma (BA) is a chronic airway disorder with significant morbidity and mortality but due to recent advances in the field of medicine most patients with BA can have complete symptom control and live a normal life. There are various routs of drug delivery for asthma control but among them aerosol inhalation is considered the optimal route. A number of pressured Metered Dose Inhalers (MDI) & Dry Powder Inhalers (DPI) are available for this purpose. However inhalation of therapeutic aerosols is not without difficulty, it requires precise instructions on the inhaler maneuvers, which is different from spontaneous normal breathing. Also, the characteristics of the inhaler device have to be suitable for the user. Available data indicate that, lack of knowledge demonstrated by health professionals & patients on the inhalation maneuvers & handling of inhalers resulting in a reduction of therapeutic benefit. The paper reviews the literature concerning the fundamental aspects of inhaler devices, inhalation maneuvers & device selection, in an attempt to increase the knowledge of and to optimize the clinical use of therapeutic inhalers. As a result of which Asthmatics can be kept under good control.

Single Stage Urethroplasty for Proximal Hypospadias with Chordee.

Proximal hypospadias with chordee usually requires two stage procedures: 1st stage is orthoplasty and ventral parking of prepucial skin and 2nd stage is urethroplasty after 6 months of 1st stage. The aim of this study is to describe and report the outcome of a single stage repair- Koyanagi Nanamura procedure for proximal hypospadias with chordee. Between January 2006 to December 2010, 44 boys with proximal hypospadias underwent repair using the Koyanagi Nanamura technique in Paediatric Surgery Department of Faridpur Medical College Hospital and Dhaka Medical College Hospital. The boys' age ranged from 1 to 7 years. The technique employs the use of lateral penile skin and extends into the inner preputial skin. This flap enjoys double blood supply from the base of the meatus as well as the preputial vessels. Follow-up period was 6 months. Satisfactory results were obtained in 39 (88.6%) patients. Three patients developed fistulae. Two patients developed meatal stenosis. Results were considered satisfactory when the boy achieves a glanular meatus, single forward stream, unimpeded voiding, good cosmesis, and no need for secondary surgery for the urethra. Koyanagi Nanamura procedure is a reliable procedure in which the lateral flaps have dual blood supply, which produces good results (88.6%) and is suitable for proximal forms of hypospadias with chordee.

Lateral Medullary Syndrome (Wallenberg’S Syndrome) - A Case Report.

The Lateral medullary syndrome is not a very common stroke. Sometimes it is under diagnosed. Mr. Ibrahim Mollah, 50 years old male person, non diabetic, non hypertensive but smoker presented with the history of sudden onset of dysphagia, dysarthria and ataxia of the gait. He is clinically and radiologically diagnosed as a case of Lateral medullary syndrome (Ischaemic stroke). With treatment this patient improved significantly. It is commonly caused by occlusion of the cranial segment of the vertebral artery or the posterior inferior cerebellar artery. The occlusion may be due to thrombosis or embolism. The emboli are coming from the heart or the great vessels. We can diagnose Lateral medullary syndrome with expert clinical eye and CT/MRI of the brain. It should be managed with appropriate treatment and physiotherapy.

Incidence of summer associated symptoms, host susceptibility and their effect on quality of life among women 18 to 40 years of age in an urban slum of Delhi.

OBJECTIVES: To study whether individual susceptibility plays a role in the occurrence of summer associated symptoms (dizziness, giddiness, fainting and weakness) among women 18-40 years of age and their effect on the quality of life. METHODS: It was a prospective community based study carried out in an urban slum of Delhi as a follow up of an earlier study. All women who had "given symptoms" during summer in the earlier study and a sample of those who were asymptomatic were included in the current study. Both the groups were studied for the occurrence of "given symptoms" and quality of life during next summer and winter using a pre structured questionnaire and WHOQOL-BREF. RESULTS: Incidence of "given symptoms" during summer was more than three times among women who were symptomatic earlier compared to women who were asymptomatic. The incidence of these symptoms was significantly higher among the former across different age groups and BMI categories. Their physical domain of quality of life was also adversely affected. CONCLUSIONS: Continued high incidence of summer associated symptoms with adverse effect on their physical quality of life, among women who were symptomatic earlier too, points to individual susceptibility rather than random occurrence. This aspect requires for further studies.

Patients choice for method of early abortion among comprehensive abortion care (CAC) clients at Kathmandu Medical College Teaching Hospital (KMCTH).

OBJECTIVE: The over all objective of the study was to determine different methods of abortion opted by CAC clients at KMCTH. The specific objective of the study was to know the reasons for pregnancy termination and to know the reasons opted for either medical or surgical method of abortion. METHODOLOGY: A hospital based prospective study was carried out for a period of six months at KMCTH from 1st January 2006 to 31st June 2006. All the patient undergoing CAC services were included for the study. Clients were provided with written and verbal information regarding the methods of terminating early abortion and its associated complications. After that they were asked to give their informed choice and decision. All the pertinent information was entered on pre-structured questionnaire. RESULTS: During the study period a total of 100 patients underwent CAC services. The commonest reason for termination pregnancy was no desire for additional children (60%) followed by youngest child too small or short spacing (21%). 74% of the patients opted for surgical abortion, 23% patient opted for medical abortion and 3% of the patient remain undecided. Reasons for favouring surgical method of abortion was that surgical abortion is complete (35), repeated visits are avoided (18), quick (10) would be with service provider and feel safe (5), lack of expectancy (2) side effect of medical treatment (1), twin pregnancy (1), easy (1), fear of pain (1). Medical method of abortion was favoured due to fear of surgery (9), easy and less painful (8) and maintains privacy (6). CONCLUSION: Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women's values and life circumstances when counselling them about an abortion method. In particular, providers should incorporate into their counselling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them. Key words: Early abortion medical methods, surgical methods, choice.

Disseminated nodular granulomatous perifolliculitis.

Nodular granulomatous perifolliculitis is a well-recognized infection of the dermal and subcutaneous tissue caused by dermatophytes, which normally do not invade beyond the epidermis. We report here one such case that occurred in an immunosuppressed individual. The patient was a 35-year-old farmer who presented with small pruritic eruption that had initially appeared on the lower leg and then had gradually spread to hair-bearing areas of the body, finally producing nodular and pustular inflammatory lesions with exacerbations and remissions. Fungal examination by direct potassium hydroxide mount and culture revealed Trichophyton rubrum. Granulomatous changes were seen on histopathological examination. The patient completely responded to systemic antifungal therapy.

Screening of wheat varieties and associated bacterial population in old alluvial soil of Burdwan, West Bengal.

In order to screen out the best variety of wheat (Triticum aestivum) out of eight varieties (viz., HP 1633, BW 11, NW 1014, Sonalika, HUW 468, K 9107, HP 1731 and HUW 234), a field experiment was conducted (from Dec. 2002 to April 2003) in a randomized block design replicated thrice at Crop Research and Seed Multiplication Farm, Burdwan University, West Bengal, India. Various morpho physiological parameters viz., plant population, length of shoot and root, leaf area index (LAI), crop growth rate (CGR), leaf area ratio (LAR), leaf area duration (LAD), net assimilation rate (NAR), yield attributes viz., length of panicles, number of grains per panicle, grain yield, straw yield, pigment content in flag leaf (chlorophyll a, b and total chlorophyll and carotenoid content) were estimated and analyzed statistically Soil bacterial populations were also estimated in the fallow land before sowing of seeds and after harvesting of crop. The HUW 468 variety records higher grain yield, maximum panicle length and maximum chlorophyll b and total chlorophyll content.