QT interval prolongation in people treated with bedaquiline for drug-resistant tuberculosis

Background: Bedaquiline (BDQ) is indeed recommended for treating multidrug-resistant tuberculosis (MDR-TB). However, it's essential to monitor patients receiving bedaquiline therapy closely because it has been associated with prolongation of the QTc interval. This study aimed to assess the association of bedaquiline to QT interval prolongation in DR-TB patients. Methods: This was an observational longitudinal study conducted in the Department of Respiratory Medicine in Chest Disease Hospital, Rajshahi, from August 2020 to February 2023. A total of 44 MDR-TB patients were included in the study. Data analyses were done by using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of 44 patients the majority 30(68.2%) patients belonged to age >40 years with a mean age of 49.3±15.6 years, and all patients were male. All MDR patients were detected by sputum Gene-Xpert, 44 (100%), and sputum for AFB culture was done in all patients, 44 (100%). QT level and QT changes were statistically significant for baseline and 24 weeks. Only one patient died in 2 weeks of follow-up (Table 3). Changes of QT >60 ms was found in 6 (13.6%) and ?60 ms was 38 (86.4%). Age, sex, marital status, residence, educational status, occupational status, monthly income, chief complaints, co-morbidities, and using drug-causing QT prolongation were not statistically significant (p>0.05). Conclusions: Prolonged QT interval is in DR-TB patients who receive treatment using the bedaquiline regimen. We observed that with a moderate prolongation of QTc, there were no arrhythmias recorded and 1 death occurred due to acute MI.

Climate Change Impact on Agriculture and Related Sustainable Land Management Practices in Bangladesh – A Review

Sustainable land management (SLM) is an effective climate adaptation technique in the present world. Bangladesh is listed in long-term Climate Risk Index 2019 due to its unicorn geographic features (e.g. low-lying riparian lands, big rivers, dense population and coastal settings). The livelihoods of Bangladesh are directly or indirectly linked to agricultural practices and or agribusiness. Many studies revealed that climate change-induced natural calamities (e.g. rainfall and temperature variability, sea level rise, flood, cyclone, drought, groundwater depletion, salt intrusion) unfavorably effect on agricultural production and livelihood activities and these are making critical food insecurity situation. Thus, identification and implementation of SLM practices to maintain food security of the bursting population are a prerequisite in Bangladesh. In this study, we have compiled the prospective SLM practices based on land management objective, land user requirements, crop and land suitability by reviewing peer-reviewed articles and grey literature. The potential SLM identified includes land resource conservation, erosion control, tillage technology, soil fertility management, vegetation management, efficient groundwater use, salinity-drought adaptations, land zoning and site-specific climate-smart agriculture. Among these SLM practices, the cultivation of suitable crop based on land quality and resource availability requires knowledge of decision support components involving the stakeholders for meaningful implementation of SLM. We proposed conceptual decision support components (e.g. land user, land quality, crop suitability, site-specific management, capital and governance) that would be the basis for the development and implementation of SLM towards land users and or farmers. The motivation of farmers through efficient extension activity and agri-governance for optimized land management can lead to minimizing the climate-induced vulnerability in agriculture. We concluded that the identified SLM practices, if implemented by adequate decision supports, SLM will help to achieve agricultural production as required by the sustainable Millennium Development Goals in Bangladesh.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh

@#Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

Application of near- and mid-infrared spectroscopy combined with chemometrics for discrimination and authentication of herbal products: A review

Herbal medicines along with its preparations have been commonly used as preventive and promotive agents around theworld, especially in developing countries. Motivated by economic profits, the high-priced value of herbal medicinesmay be substituted or adulterated with less expensive ones; therefore, the authentication methods must be developedto overcome the adulteration practices. Due to their properties as fingerprint analytical techniques, near-infrared (NIR)and mid-infrared (MIR) spectroscopies offered fast and reliable techniques for authentication of herbal medicine.The data generated during authentication of herbal medicines were complex and difficult to be interpreted; therefore,the statistical approach called chemometrics has been used to treat data. The objective of the present review was tohighlight the updates on the application of NIR and MIR spectroscopies and chemometrics techniques (discrimination,classification, and quantification) for discrimination and authentication of herbal medicine.

Application of near- and mid-infrared spectroscopy combined with chemometrics for discrimination and authentication of herbal products: A review

Herbal medicines along with its preparations have been commonly used as preventive and promotive agents around theworld, especially in developing countries. Motivated by economic profits, the high-priced value of herbal medicinesmay be substituted or adulterated with less expensive ones; therefore, the authentication methods must be developedto overcome the adulteration practices. Due to their properties as fingerprint analytical techniques, near-infrared (NIR)and mid-infrared (MIR) spectroscopies offered fast and reliable techniques for authentication of herbal medicine.The data generated during authentication of herbal medicines were complex and difficult to be interpreted; therefore,the statistical approach called chemometrics has been used to treat data. The objective of the present review was tohighlight the updates on the application of NIR and MIR spectroscopies and chemometrics techniques (discrimination,classification, and quantification) for discrimination and authentication of herbal medicine

Management of Patient with Sturge-Weber Syndrome: a Case Report.

Sturge-Weber syndrome sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder. This is case report of 7 years old mentally disabled boy, with long-standing seizures, with a portwine nevi on the right side of the face along the distribution of trigeminal nerve. Interictal encephalogram showed bilateral slow activity, pronounced in the right hemisphere, with epileptogenic activity in the right fronto-parietal region. Computerized tomography and magnetic resonance imaging showed intracranial calcifications and atrophy of the right hemisphere of brain. Professional counseling and support in addition to drug treatment provide help to patients and their family to overcome their problems and improve the treatment outcome.

Respiratory Health Problems Among the Ceramic Workers in Dhaka,.

Ceramic factory workers are potentially at risk to develop occupational respiratory diseases due to chronic inhalation of dust particles generated in the ceramic factory. A cross-sectional descriptive study was carried out to assess the respiratory and other health problems among the workers of Mirpur Ceramic Works Limited, Dhaka, Bangladesh during the period of April to June, 2011. Among 200 participants, 132 (66%) were males and 68 (34%) were females. Less than one-third of the workers were habituated to use personal protective equipments (PPE), while more than two-third were not habituated. Nearly half (45.5%) of the workers were suffering from at least one respiratory problem and of them 86.8% (P = 0.001) had problems after joining the factory. Of the respiratory sufferers 27% had chronic bronchitis, 20% bronchial asthma, 1% pulmonary tuberculosis, and 0.5% had silicosis. A significant numbers (60.5%) of workers were suffering from other health problems along with or without respiratory problems, in terms of musculoskeletal pain, back pain, headache, dermatitis, anaemia and fever. The prevalence of respiratory problems was significantly higher among non-users of PPE than PPE users (P = 0.006), and it was found to be higher with the increased of job duration. The study showed the notable higher prevalence of respiratory problems among the workers exposed to ceramic dust, although the other potential environmental confounding factors could not be ruled out in the analysis. Obligatory use of PPE by all workers and health education to increase awareness among the workers might have role to reduce the prevalence.

Comparative Study on Cryosurgery with Carbamazepine and Alcohol injection in Trigeminal Neuralgia.

Objectives: To assess the efficacy of Cryosurgery for the treatment of Trigeminal neuralgia and to compare this procedure with Carbamazepine and alcohol block. Materials and method-A prospective study with 75 cases of Trigeminal neuralgia was carried out in the Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University from January 2006 to December 2007. Out of 75 cases 25 treated with Carbamazepine only, starting dose 100 mg b.d. with incremental dose up to 800 mg, 25 received alcohol block with maintenance dose of Carbamazepine 200 mg b.d. over the study period and 25 received Cryosurgery with initial maintenance dose of Carbamazepine 100 mg b.d. then tappered on 1st follow up visits and withdrawn on the 2nd follow up visits. Visual linear analogue scale (VAS) was used to measure pain intensity in different groups. Results: Out of different treatment modalities on follow up onwards pain control was better in Cryosurgery than Carbamazepine and alcohol block. Conclusion: This study reveals that the efficacy of Cryosurgery is better than Carbamazepine and alcohol block to eliminate the pain intensity in Trigeminal neuralgia.

Urinary Bladder Tuberculosis – A Case Report.

Genito-urinary tuberculosis is an infrequent but not uncommon condition in countries with high incidence of tuberculosis like Bangladesh. A female patient of 25 years was admitted into Faridpur Medical college Hospital with acute retention of urine with history of haematuria, dysuria, fever and difficulty in urination for about three years. USG revealed few masses in the urinary bladder, later proved by histopathological examination as granulomatous lesion consistent with tuberculosis. Anti-TB treatment was given and the masses were removed surgically. With this treatment recovery of the patient is satisfactory and symptoms are disappearing. The aim of this study to make internist more efficient to diagnose the disease by strong clinical suspicion and relevant laboratory investigation, otherwise such uncommon disease and its complications may endanger life of such patient.

Outbreak Of Nipah Encephalitis In Greater Faridpur District.

Nipah viral encephalitis is one of the fatal re-emerging infections especially in southeast Asia. After its outbreak in Malaysia and Singapore; repeated outbreaks occurred at western part of Bangladesh especially in Faridpur region. Besides, sporadic attacks appear to occur in the country throughout the year. Here two Nipah outbreaks in greater Faridpur district in 2003 and 2004 are described along with brief review on transmission of the virus. Where the history of illness among patients are very much in favour of man to man transmission. Moreover the death of an intern doctor from Nipah encephalitis who was involved in managing such patients in Faridpur Medical College Hospital strongly suggests man to man transmission of this virus. So, aim of this review article to make the health personnel and general people be aware about man to man transmission of virus, so that they can adapt personal protection equipment (PPE) for their protection against this deadly disease.

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.

Surgical Angioplasty for Left Main Coronary Artery Disease - A Case Report.

Conventional treatment of left main coronary artery (LMCA) disease includes coronary artery bypass graft (CABG) and more recently, in selective indications, percutaneous coronary intervention (PCI). Direct surgical patch angioplasty of the LMCA using fresh autologous pericardium, saphenous vein, or mammary artery patch can be proposed as an alternative treatment. We have successfully operated one patient with surgical angioplasty for isolated ostial left main coronary stenosis at National Heart Journal.

Risk factors of bronchial asthma in two contrasting settings–metropolitan and coastal areas of Bangladesh: A case control study.

Background. Seven million people are suffering from bronchial asthma in Bangladesh. But scanty data is available to explain the risk factors for asthma in Bangladesh. Methods. This population-based, age, sex, and economic status matched case-control study was conducted to identify the risk factors responsible for the development of bronchial asthma in two contrasting settings, the metropolitan capital city and coastal area of Bangladesh. A structured pre-tested questionnaire was filled up by face-to-face interviews with the patients or parents of patients with bronchial asthma and the normal controls after a respiratory physician confirmed the diagnosis on the basis of history, physical examination and spirometry. Results. Presence of allergic problems was recognised as risk factors for the development of bronchial asthma. Concomitant existence of atopic diseases, like allergic rhinitis, eczema and allergic conjunctivitis were found to be significant risk factors in both the settings. History of early childhood lung infections, like pneumonia, bronchiolitis and intake of antibiotics and paracetamol in last 12 months were also observed to be the risk factors in both the areas. Though most of the so-called allergic foods were statistically found to be a protective factor in both the settings [odds ratio (OR) 0.48, 95% confidence intervals (CI) 0.37-0.63 in city area and OR 0.80, 95% CI 0.66-0.96 in coastal area], this was considered to be an artifact. Conclusions. Several common risk factors for the development of bronchial asthma were identified in both city and coastal areas of Bangladesh. Bronchial asthma prevention campaign in Bangladesh may focus on sensitising the people on these risk factors.

Role of Micro-ESR and I/T Ratio in the Early Diagnosis of Neonatal Sepsis.

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to determine the role of micro-ESR and immature and total neutrophil (I/T) ratio in early diagnosis of neonatal septicaemia. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. I/T ratio detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Micro-ESR more than age of the patient in days + 3mm in 1st hour were considered significant for sepsis. I/T ratio more than 0.2 was considered positive for sepsis. Sensitivity and specificity of micro-ESR was 63.3% and 60% respectively. Sensitivity and specificity of I/T ratio was 70% and 56% respectively. Combination of micro-ESR and I/T ratio showed high sensitivity (80%) and specificity (70%).

Comparison between DOT EIA IgM and Widal Test as early Diagnosis of Typhoid Fever.

A recently developed DOT enzyme immunoassay known as "Typhidot" for detecting IgM antibody against 50 KDa OMP antigen of Salmonella typhi, was evaluated on 100 clinically suspected typhoid fever cases and 40 age-sex matched controls, in the Department of Microbiology, Mymensingh Medical College during, the period from June 2006 to July 2007. Blood culture, Widal test, and DOT EIA for IgM test were performed in all patients. Among 100 clinically suspected typhoid fever cases, 35 were subsequently confirmed on the basis of positive blood culture for S. typhi and/or significant rising titre of Widal test. The DOT EIA IgM test could produce results within 1 hour. The result of the DOT EIA IgM test showed a good diagnostic value for typhoid fever. The sensitivity, specificity, positive and negative predictive value of the test was found as 91.42%, 90.00%, 88.88% and 92.30% respectively. On the other hand corresponding values for Widal test were of 42.85%, 85.00%, 71.42% and 62.96% respectively. Thus, The DOT EIA IgM seems to be a practical alternative to Widal test for early diagnosis of typhoid fever.

Anti H.pylori IgM in Symptomatic and Asymptomatic Population.

To evaluate the usefulness of specific IgM in the diagnosis of Helicobacter pylori infection, a cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2006 to June 2007. A total of 45 patients having upper gastrointestinal symptoms underwent endoscopy and were subsequently diagnosed as patients with gastritis, peptic ulcer (PU) and non-ulcer dyspepsia (NUD) and another 45 asymptomatic individuals aged 18-65 years, were included in the study. The serum samples of participants were tested for presence of anti-H pylori IgM by using ELISA method. The ELISA for anti H. pylori IgM provided sensitivity and specificity of 73.33%, 93.33% respectively.

PCR for mecA Gene of Methicillin Resistant Staphylococcus Aureus.

The study was under taken to detect mecA gene of methicillin resistant Staphylococcus aureus (MRSA) by PCR. It was carried out in the department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh between the periods from July 2006 to June 2007. A total of 40 S. aureus strains were used in this study. Isolates of S. aureus were identified by standard microbiology technique and their antimicrobial susceptibility test was done by disk diffusion method according to NCCLS. Minimum inhibitory concentration (MIC) of oxacillin was determined for all isolates by standard agar plate dilution method. All strains were tested for mecA gene by PCR. Out of 40 S. aureus strains 15(37.5%) were detected as MRSA by disk diffusion and agar dilution method but 10(25%) yielded mecA gene by PCR. Detection rate of MRSA by disk diffusion and agar dilution test showed significant difference to that by PCR (p<0.001).

Effect of zinc on growth of preterm babies.

Zinc is being recognized increasingly as an important element in human growth, development and immunological function. It is probably the most intensely studied microelement in newborn nutrition. Zinc deficiency is common in young infants in the developing world and is associated with reduced immunocompetence and increased rates of serious disease. Preterm neonates are especially vulnerable because of preterm delivery and low birth weight. The preterm baby has very limited stored energy and needs an adequate supply of nutrient. Preterm infant have high zinc dietary requirements as 60% fetal zinc is acquired during third trimester of pregnancy. Low concentration of zinc was found in pre-term low birth weight babies in different studies. Studies showed that before supplementation serum zinc level in perterm low birth weight babies were 62+/-12.4mugm/dl, 65mugm/dl, 54+/-14.4mugm/dl and after supplementation serum zinc level were 105.8+/-16.6mugm/dl, 86.4+/-24.7mugm/dl respectively. At the same time mean weight & length of supplementation and without supplementation group were 6084 gm vs. 5280gm, 2779+/-638.7gm vs. 2474.6+/-441.8gm and length 23.7cm vs. 21.4cm, 46.49+/-2.6cm vs. 44.1+/-2.8cm respectively. So supplementation of zinc in preterm babies causes improved growth and development. Various reports showed beneficial effect of long supplement in early growth of pre-term babies. However long term follow up studies are needed to evaluate the beneficial effect of zinc supplementation on growth of preterm babies.

Evaluation of alternative diagnostic techniques for diagnosis of cerebral malaria in a tertiary referral hospital in Bangladesh.

Five alternative techniques for diagnosis of malaria were evaluated in 124 clinically diagnosed cerebral malaria cases admitted in a tertiary hospital in Bangladesh. Clinical diagnosis of cerebral malaria was done by WHO criteria. The tests were conventional routine malaria microscopy; prolonged microscopy; dipstick antigen capture assay (Para Sight TM-F test); pigments in peripheral leucocytes and routine microscopy repeated at 12 hours interval. First four tests were done at 0 hours of hospital admission and repeat routine microscopy was added at 12 hours interval. Diagnostic capability of the test was 64%, 65%, 69%, 27% and 63% respectively. None of the tests except pigments in peripheral leucocytes was superior at initial evaluation. Only the dipstick test added 5% more diagnostic possibility compared with routine microscopy as standard. Stratification of diagnostic capability in different ways improved diagnosis 15% and 11% in smear negative cases by dipstick and prolonged microscopy respectively. It was increased by 50% (5/10 patients) with dipstick test in the smear negative patients with history of anti-malarials prior to hospital admission.