Diagnosis and Antimicrobial Susceptibility of Mycobacterium Tuberculosis in a Tertiary Care Hospital in Bangladesh

Background: Tuberculosis (TB) is a common condition all over the world but more common in developing countries like Bangladesh38. This is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2013, 9 million people fell ill with TB and 1.5 million died from the disease globally. Approximately 15-20 % of total TB cases are extrapulmonary in non-HIV patients. Among extrapulmonary TB, abdominal tuberculosis (ATB) accounts for 11%-16%. Abdominal TB is difficult to diagnose because of its lack of specific symptoms, low yield of acid-fast bacilli (AFB) on smear and culture due to paucibacillary lesion; and variable manifestations depending upon anatomical localization of the disease. The diagnosis of abdominal TB classically requires histopathological, microbiological and culture confirmation of Mycobacterium tuberculosis. Investigations like Imaging (Ultrasound, Barium X-Rays, and CT scan) and the Mantoux test have only supportive value. Aim of the study: The aim of the study was to diagnose modalities and antimicrobial susceptibility in abdominal tuberculosis patients.Material & Methods:This cross-sectional hospital-based observational study was carried out among 73 adult patients with the diagnosis of abdominal TB who met the selection criteria and attended in Gastroenterology department of DMCH through either admission or referral from May 2015 to April 2016.Results:The most frequent symptoms were weight loss (96.9%), abdominal pain (75%), and fever (75%). The most frequent signs were anaemia (34.4%), followed by ascites (27.9%). Basis of diagnosis in abdominal tuberculosis was histolopathogy in 37.5%, Gene Xpert in 28.1%, Positive AFB on culture in 9.4%, ADA value in ascitic fluid (Cutoff >40 IU/L) in 25%, and good clinical response (Based on weight gain and general improvement in wellbeing) to a therapeutic trial of anti-TB treatment in 18.7% patients. Drug sensitivity pattern was analyzed in all three AFB culture-positive patients; resistance was detected in one which showed multidrug resistance (MDR TB).Conclusions:The result of this study highlighted the diagnostic yield of various investigation modalities, particularly newer modalities (Gene Xpert, culture sensitivity in Bactec MGIT 960) and basis of diagnosis in abdominal TB. This study also determined the MTB culture positivity from tissue biopsies in patients with abdominal TB and demonstrated drug-resistant MTB in culture-confirmed abdominal TB.

Dual Burden of Underweight and Overweight among Women in Bangladesh: Patterns, Prevalence, and Sociodemographic Correlates.

The discourse of dual burden caused through underweight and overweight is well-documented globally but this issue and its connection with women’s health in Bangladesh is yet to be explored widely. To enrich the current debate, this study, in the context of Bangladesh, examines the patterns, prevalence, and socioeconomic factors influencing the ever-married women of being underweight and overweight over normal weight. Data used in this study have been extracted from the most recent 2011 Bangladesh Demographic and Health Survey. To achieve results connected with the research objectives, both bivariate and multivariate statistical analyses have been employed. In bivariate analysis, we used seven categories of BMI cutoff points for Asian countries as prescribed by World Health Organization (WHO). Multinomial logistic regression model was constructed to investigate the net effect of socioeconomic factors on underweight, pre-overweight, and overweight over normal weight. The results confirm the co-existence of underweight and overweight among women as we found the prevalence of underweight, normal weight, pre-overweight, overweight, and obesity to be 24.1%, 46.7%, 12.8%, 13.5%, and 2.9% respectively. Compared to the richest, the women from the poorest households were significantly (p<0.001) most likely to be underweight (OR=2.75, 95% CI 2.27-3.35) and least likely to be overweight (OR=0.15, 95% CI 0.12-0.19) over normal weight. The urban women, compared to their rural counterparts, were significantly (p<0.001) less likely to be underweight (OR=0.80, 95% CI 0.71-0.91) and more likely to be overweight (OR=1.33, 95% CI 1.18-1.51) than normal weight. The other socioeconomic grades that were most marked to be underweight and overweight are age, women’s education, marital status, age at first childbirth, parity, number of children aged ≤5 years at the household, and food security. The findings confirm the dual burden of both under- and overweight. Systematic and regular monitoring and surveillance of the social trajectory of nutritional status of women and men in Bangladesh is crucial to develop apposite strategy that addresses the persistent and chronic problem of underweight and the emerging problem of overweight. The dual existence of both types of malnutrition among women in Bangladesh must be taken into consideration so that public health interventions may be adopted through appropriate policy.

Preference for Institutional Delivery and Caesarean Sections in Bangladesh.

In Bangladesh, preference for place of delivery and socioeconomic factors associated with caesarean section are not well-understood. This paper examines the socioeconomic correlates of preference for institutional delivery and caesarean sections in Bangladesh. The study used data from the nationally-representative 2007 Bangladesh Demographic and Health Survey. Both bivariate and multivariate binary logistic regression models were constructed to assess the effect of sociodemographic factors on the use of medical facilities and caesarean section for childbirth. Overall, 15% of women underwent institutional delivery, and 8% deliveries were performed by caesarean sections. Both institutional deliveries and caesarean sections have increased in recent years. The bivariate and multivariate analyses both confirmed that place of residence, religion, birth order, frequent pregnancy, antenatal care-seeking, and wealth index were important predictors of the use of medical facilities and caesarean sections for childbirth. Women’s education appeared as the most single significant determinant for the use of both services. The findings underlie the importance of monitoring caesarean section as well as professional attendance for safe motherhood. Programmes should aim to inform women highlighting the benefits of the use of skilled maternal healthcare services and demerits of home-delivery practices.

Domestic violence, unwanted pregnancy and pregnancy termination among urban women of Bangladesh

This paper explores the relationship between domestic violence against women inflicted by husbands, unwanted pregnancy and pregnancy termination of Bangladeshi urban women. The study used the nationally representative 2007 Bangladesh Demographic and Health Survey [BDHS] data. The BDHS covered a representative sample of 10,996 ever married women from rural and urban areas. The BDHS used a separate module to collect information from women regarding domestic violence. The survey gathered information of domestic violence from 1,013 urban women which are the basis of the study. Simple cross tabulation, bivariate and multivariate statistical analyses were performed to analyzing data. Overall, the lifetime prevalence of domestic violence was 47.5%. Of the most recent pregnancies, 15.6% were unwanted and 16.0% of the women terminated pregnancy in their marital life. The multivariate binary logistic regression analyses yielded quantitatively important and reliable estimate of unwanted pregnancy and pregnancy termination. The regression analyses yielded significantly [p<0.05] increased risk of unwanted pregnancy only for physical violence [OR=2.35, 95% CI=1.28-4.32] and for both physical and sexual violence [OR=2.27, 95% CI=1.02-5.28], and higher risk of pregnancy termination for only physical violence [OR=1.41, 95% CI=0.95-2.10] and for both physical and sexual violence [OR=1.81, 95% CI=1.07-3.04] than women who were never abused. Current age, higher parity and early marriage are also important determinants of unwanted pregnancy and pregnancy termination. Violence against women inflicted by husbands is commonplace in Bangladesh. Any strategy to reduce the burden of unwanted pregnancy and induced abortion should include prevention of violence against women and strengthening women's sexual and reproductive health

Socioeconomic correlates of contraceptive use among the ethnic tribal women of Bangladesh: does sex preference matter?

To examine the relationship between socioeconomic factors affecting contraceptive use among tribal women of Bangladesh with focusing on son preference over daughter. The study used data gathered through a cross sectional survey on four tribal communities resided in the Rangamati Hill District of the Chittagong Hill Tracts, Bangladesh. A multistage random sampling procedure was applied to collect data from 865 currently married women of whom 806 women were currently married, non-pregnant and had at least one living child, which are the basis of this study. The information was recorded in a pre-structured questionnaire. Simple cross tabulation, chi-square tests and logistic regression analyses were performed to analyzing data. The contraceptive prevalence rate among the study tribal women was 73%. The multivariate analyses yielded quantitatively important and reliable estimates of likelihood of contraceptive use. Findings revealed that after controlling for other variables, the likelihood of contraceptive use was found not to be significant among women with at least one son than those who had only daughters, indicating no preference of son over daughter. Multivariate logistic regression analysis suggests that home visitations by family planning workers, tribal identity, place of residence, husband's education, and type of family, television ownership, electricity connection in the household and number of times married are important determinants of any contraceptive method use among the tribal women. The contraceptive use rate among the disadvantaged tribal women was more than that of the national level. Door-step delivery services of modern methods should be reached and available targeting the poor and remote zones

Decline in Child Marriage and Changes in Its Effect on Reproductive Outcomes in Bangladesh.

This paper explores the decline in child marriage and changes in its effect on reproductive outcomes of Bangladeshi women, using the 2007 Bangladesh Demographic and Health Survey data. Chi-square tests, negative binomial Poisson regression and binary logistic regression were performed in analyzing the data. Overall, 82% of women aged 20-49 years were married-off before 18 years of age, and 63% of the marriages took place before 16 years of age. The incidence of child marriage was significantly less among the young women aged 20-24 years compared to their older counterparts. Among others, women’s education appeared as the most significant single determinant of child marriage as well as decline in child marriage. Findings revealed that, after being adjusted for sociodemographic factors, child marriage compared to adult marriage appeared to be significantly associated with lower age at first birth (OR=0.81, 95% CI=76-0.86), higher fertility (IRR=1.45, 95% WCI=1.35-1.55), increased risk of child mortality (IRR=1.64, 95% WCI=1.44- 1.87), decreased risk of contraceptive-use before any childbirths (OR=0.56, 95% CI=0.50-0.63), higher risk of giving three or more childbirth (OR=3.94, 95% CI=3.38-4.58), elevated risk of unplanned pregnancies (OR=1.21, 95% CI=1.02-1.45), increased risk of pregnancy termination (OR=1.16, 95% CI=1.00-1.34), and higher risk of the use of any current contraceptive method (OR=1.20, 95% CI=1.06-1.35). Increased enforcement of existing policies is crucial for the prevention of child marriage. Special programmes should be undertaken to keep girls in school for longer period to raise the age of females at first marriage in Bangladesh and thereby reduce the adverse reproductive outcomes.

Effect of plant growth promoting substances from rhizo- and cyano -bacteria on sugar beet growth, yield and yield quality in saline soil

The production of plant growth promotors [indole acetic acid, gibberellic acid and abscissic acid] by rhizobacteria and cyanobacteria has been taken as a main criterion in the selection of the microbial strains used in this study. A field experiment was conducted at Sahl El Hussinia Station, El Sharkia Governorate, during the winter season of 2008/2009 to investigate the effect of rhizobacteria and cyanobacteria either individually or in combination on growth, yield and yield quality of sugar beet under salinity stress. Soil biological activity in terms of dehydrogenase activity was significantly affected by the biological treatments. The dehydrogenase recorded its highest value when the combined inoculum of rhizobacteria and cyanobacteria was applied. Inoculation with rhizobacteria and/or cyanobacteria in saline soil alleviated the salinity effects on the sugar beet and enhanced photosynthesis [leaves chlorophyll content], proline and phenoic accumulation in roots, along with, increasing the concentrations of N, P and K and decreasing Na[+] concentrations in roots. This physiological positive response of the plant growth promoting rhizobacteria and/or cyanobacteria resulted in significant increases in sugar beet root yield and yield quality [TSS, sucrose and purity%]. Best results were obtained by the combined mixture of bacteria and cyanobacteria followed by the individual treatments of either. This investigation pointed out that plant growth promoting substances secreted by rhizobacteria [PGPR] and cyanobacteria could be used as a good tool to alleviate salinity stress and promote sugar beet productivity and yield quality as it provides an ceo-friendly biological approach under saline soil conditions

Influence of beneficial microbes and proline treatments on sugar beet under nitrogen limitation in saline-sodic soil

A field experiment on sugar beet [Beta vulgaris L.] yield and yield quality under saline-sodic soil conditions was conducted at Sahl El Hussinia Res. Station, El Sharkia Governorate, Egypt, during the winter season of 2008/2009. The influence of cyanobacteria and N[2]-fixing bacteria were compared either individually or in combination to supplementation with proline amino acid under two levels of mineral nitrogen fertilization [50 and 75% of nitrogen recommended dose]. Soil enzymatic activities [dehydrogenase and nitrogenase], total bacterial counts, total cyanobacteria counts and total nitrogen fixing bacteria counts were enhanced by the biofertilizers compared to proline treatment and controls, particularly when the combined inoculum of cyanobacteria and N[2]-fixing bacteria was applied in the presence of 75% N. In addition, inoculation with cyanobacteria and N[2]-fixing bacteria, either individually or in combination with 75%N, led to a slight decrease of pH and EC values of saline soil, while there was an increase in the availability of NPK as compared with control plots. Proline and biofertilizers showed a significant positive impact on some physiological properties of plants drown at 75% nitrogen level, such as chlorophyll in leaves, proline and phenolic compounds in roots. The highest responses for these traits were in proline-treated plots followed by the combined inoculation of cyanobacteria and N[2] fixing bacteria, while, there was no significant difference in root yield productivity between proline treatment and the combined inoculum of cyanobacteria and N[2] fixing bacteria with 75% nitrogen fertilizer. The combined inoculation positively increased N, P and K uptake and decreased the uptake of Na in roots. Also, the combined inoculum of cyanobacteria and N[2] fixing bacteria with 75% nitrogen led to a significant increase in shoot and root dry weight as well as root yield quality [sucrose and purity]. Results suggest that the beneficial effect of the cyanobacteria and N[2] fixing bacteria on sugar beet growth, yield and yield quality was attributed to the biologically active substances produced by these microbial strains besides the nitrogen fixation of the diazotrophs which compensate the reduction of the costly and the environmentally polluted mineral nitrogen fertilizers in the new reclaimed saline-sodic soil

Impact of adding antioxidant vitamins [A or E] with antihelmintic treatment on naturally gastrointestinal nematode infected ewes

The present study was aimed to examine the oxidative stress/antioxidant status in naturally infected ewes with gastrointestinal nematodes [GIN] after use of antioxidant vitamins such as vitamin A or E with antihelmintic treatment [ivermectin] .A total of 12 Barki ewes were chosen naturally infected with GIN, aged between [1.5 - 2.5] years, weighted between [35 -38 kg]. All ewes were treated with 2ml/50kg BW ivermectin. They were divided into three groups [n=4]. The first group was non-vitamin treated [the control group], the second group, was orally treated with vitamin A [0.5X10[5] IU/ewe/day] for four weeks, the third group was orally treated with vitamin E [75mg/ewe/day] also for four weeks. Fecal samples were collected from rectum of each ewe before the beginning of the trial and weekly after treatments. Degree of infestation was performed by fecal egg counting [FEC] and identified by fecal culture technique. Blood samples were collected from each ewe for biochemical analysis of serum lipid peroxide-Malondialdehyd [MDA], Nitricoxide [NO], total-antioxidant capacity [TAG] and glutathione-S-transferase [GST]. Ewes were weighed every two weeks till the end of the study. Four weeks post-treatment, MDA significantly [p <0.05] decreased in their levels in both vitamin treated groups in comparison to the control one, meanwhile NO showed no alterations in their levels in both treated groups in comparison to the control one all over the expermental period. Four weeks post treatment, there was significant [p <0.05] increase in the mean value of TAC in vitamin E treated group comparing with the other groups. While there were significant increase in GST level after the second and the fourth weeks in vitamin E treated group. It was concluded that vitamin E should be used at least 2 weeks with other antihelmintic protocols in order to obtain a more effective and earlier cure against GI parasites in infected sheep for improving their health and reproductive performance

Biochemical, pathological and genetical studies for HER-2/neu oncogene in cancer breast patients

Breast carcinoma ranks as first malignancy affecting females, contributing 33% of all female cancers. The C-erbB-2 is a class of oncogenes prevalent in breast cancer that play a role in cancer development. This research was performed to assess HER-2/neu oncogene amplification by semi-quantitative PCR technology, and HER-2/neu expression using immunohistochemical [IHC] staining. Electron microscopy made a contribution to the final diagnosis in the only case of invasive duct carcinoma. HER-2/neu gene amplification positive by PCR was detected in 40% of invasive duct breast cancer and showed a significant correlation between HER-2/neu gene amplification by PCR and HER-2/neu gene expression by IHC. Breast tumor specimens from 20 patients invasive duct carcinoma were studied; 10 without radiotherapy treatment and 10 after radiotherapy treatment. The study revealed a significant increase in chromosomal breaks and chromosomal rearrangements in breast cancer patients. There are also increases in chromosomal aberrations in patients received radiotherapy compared with patients not received radiotherapy. Cytogenetic study could be used as a prognostic factor in some breast cancer cases