Effect of preoperative oral bisoprolol on intraoperative outcomes in endoscopic sinus surgery

Background: Endoscopic sinus surgery (ESS) presents challenges in managing intraoperative bleeding and hemodynamic stability. This study evaluates the efficacy of pre-operative oral bisoprolol in improving surgical conditions and outcomes in ESS. Methods: This study was conducted between March 2021 and June 2022 at the department of anaesthesia, Bangabandhu Sheikh Mujib medical University, Dhaka, Bangladesh. This randomized controlled trial was conducted with 50 participants undergoing elective ESS, divided into bisoprolol and placebo groups. Result: The study involved 50 participants undergoing elective ESS, with 25 in the bisoprolol group and 25 in the placebo group. While demographic characteristics, such as age, weight, height, and gender distribution, showed no statistically significant differences between the groups. The placebo group experienced significantly higher estimated blood loss (421.72 ml vs. 156.24 ml, p<0.001) and postoperative hemoglobin levels (12.88 g/dl vs. 11.07 g/dl, p<0.001) compared to the bisoprolol group. Hemodynamic parameters, particularly heart rate, exhibited significant differences at various time points, with the bisoprolol group maintaining a higher heart rate post-premedication, intra-operatively, and post-operatively (p<0.05 for all). In the assessment of intraoperative bleeding using the Fromme-Boezaart scale, the placebo group demonstrated higher incidences of severe bleeding grades (3 and 4) compared to the bisoprolol group, with these differences being statistically significant (p<0.001). Conclusions: Pre-operative oral bisoprolol in ESS patients significantly reduces intraoperative bleeding and anesthetic requirements while maintaining hemodynamic stability. These findings suggest bisoprolol as a beneficial pre-operative medication in ESS, warranting further research to optimize surgical outcomes.

Prevalence and resistant patterns of multidrug-resistant urinary tract infection caused by Escherichia coli among patients admitted to a teaching hospital

Background: Multi-drug resistant organisms, particularly in urinary tract infections, have become a significant concern in developing countries like Bangladesh. Physicians are facing challenges in treating hospitalized cases due to the ineffectiveness of conventional antibiotics and empirical treatment, as well as the emergence of multi-drug-resistant Escherichia coli. The main goal of the study was to observe the prevalence and resistant pattern of multidrug-resistant Escherichia coli urinary tract infections among patients admitted to a teaching hospital. Methods: The cross-sectional study was conducted between August 2011 to February 2012 at Uttara Adhunik Medical College Hospital (UAMCH), Dhaka, Bangladesh. It included 100 cases, and detailed information was obtained through a standardized protocol. Results: In a study of 100 UTI patients, 45 had MDR E. coli while 55 had non-MDR E. coli. Females accounted for 79% of the patients, with a mean age of 44.85±17.81 years. The majority of participants fell into the 31-40 years age group (28%) and 60 years age group (23%). Among the participants, 57% had a history of UTI while 43% had no previous UTI history. High resistance was observed against amoxicillin, amoxiclav, cephradine, cefuroxime, cefixime, ceftriaxone, ceftazidime, and nalidixic acid. However, ciprofloxacin (2.22%), levofloxacin (6.67%), and cotrimoxazole (31.11%) exhibited lower resistance rates among MDR samples. Imipenem and meropenem showed 100% effectiveness against all MDR samples. Conclusion: MDR E. coli rates were alarmingly high in a teaching hospital in Bangladesh. Excessive antimicrobial drug consumption globally has led to antibiotic-resistant E. coli isolates, posing challenges for effective UTI treatment worldwide. Antibiotic therapy remains crucial in controlling these invasive agents.

Molecular analysis of the cholera toxin gene & antibiotic sensitivity profile of Vibrio cholerae O1 & O139 associated with mixed infection.

In the context of the reemergence of V. cholerae O1 in India and the recent evidence that O139 strains could have evolved from O1 E1 Tor strains, restriction fragment length polymorphism (RFLP) of the rRNA and the ctx genes and the antibiotic sensitivity profile of the two strains of V. cholerae, one an O1 and the other an O139, associated with mixed infection, were examined to determine their relatedness. Our results demonstrate that although the strains belonged to different clones of V. cholerae, they showed similar antibiotic sensitivity, profile indicating some exchange of genetic elements.

Strategies for production of a potential candidate vaccine for cholera.

First attempt at cholera vaccination was made by Jaime Ferran in 1884. Since then, a variety of strategies and methods have been evolved to create a safe, efficacious vaccine against cholera. For the first few years emphasis was on the development of parenteral vaccines. However, as a result of accumulation of a tremendous amount of knowledge, not only on Vibrio cholerae-the causative agent, but also on its interaction with the host, emphasis has shifted towards the development of oral vaccines. Two such vaccines, one killed, a whole cell/B subunit combination vaccine and the other a live attenuated one, have shown promise. The combination vaccine in its present state of development confers only a transient protection in young children, while the live attenuated one produces adverse reaction. To combat these, various strategies are being evolved. In one attempt, a potential candidate vaccine strain has been constructed from a non-reactogenic clinical isolate of V. cholerae, which is devoid of all known major virulence genes and is also a good colonizer. In animal studies this construct has shown considerable promise. This review discusses the various strategies that have been employed so far in the quest for an ideal cholera vaccine.

Study of primary convergence insufficiency.

The present study was done to find out the incidence of primary insufficiency of involuntary convergence and evaluate the relative efficacy of synoptophore treatment against home exercise in its management. During the period of study, 2162 cases in the age group 15 to 35 years were studied for convergence in detail. It was found out that the incidence of primary convergence insufficiency is quite high (7.7% of total orthoptic clinic attendance). It commonly affects those who are constantly engaged in near work. Response to synoptophore exercises and home exercises is comparably equal. Recurrence of the ailment after stopping the exercises is not uncommon.