Prevalence of Bacterial Vaginosis among the PID Patients in Bangladesh.

A cross sectional study was conducted on patients attending at the outpatient department of Gynaecology and Obstetrics of Dhaka Medical College Hospital, Dhaka during the period of July, 2007 to December, 2007. Two hundred sexually active female in the age group of 15-45 years, with vaginal discharge and itching, were selected for the study. Among them 143 having only vaginal discharge and itching without PID (Pelvic inflammatory disease) and 57 patients having vaginal discharge and itching with PID. A detailed history and a thorough clinical examination of all the cases were done. After making the clinical diagnosis of BV (Bacterial vaginosis) by Amsels criteria, diagnosis also carried out with Acridine orange staining, Gram stain Nugent criteria. Out of 200 women, 48 (24%) cases were diagnosed as having bacterial vaginosis by applying Amsel's clinical criteria. The rate of detection of bacterial vaginosis was 23% by Gram stain Nugent criteria and 24.5% by acridine orange staining. In this study BV was diagnosed in 31(54.39) cases among the PID patients and 17(11.89) among the women having only vaginal discharge and itching. This study shows the increased association of BV in PID patients of Bangladesh.

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%).

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.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh.

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

Predominance of the DEN-3 genotype during the recent dengue outbreak in Bangladesh.

A recent outbreak of dengue in Bangladesh was marked by many fatal complications. As clinical virulence varies among the genotypes of dengue virus, a study was conducted to investigate the molecular genotypes of dengue in Bangladesh. Reverse transcription polymerase chain reaction was used to determine viral genotypes using oligonucleotide generic primers that produce a 511 bp product. The resulting product was typed by nested PCR with strain-specific primers, yielding 482 (DEN-1), 119 (DEN-2), 290 (DEN-3) and 392 (DEN-4), visualized on UV transilluminator after electrophoresis on 2% agarose gel stained with ethidium bromide. Of 45 clinically diagnosed dengue patients (mean age 28 years; male/female 30/15), 19 (42.2%) had detectable viral RNA in their blood. However, during the first 5 days of fever in 30 patients, the frequency was 60% (18/30), implying that the sooner serum is drawn after the fever, the greater the chances of detecting viral RNA. DEN-3 was detected in all except 2 patients who were infected with DEN-2. DEN-2 (two cases) and DEN-4 (one case) were present as co-infections with DEN-3. All of the patients presented with fever, anorexia and vomiting; many had headache and general body ache; a few had a rash. About a quarter had suffered episodes of bleeding, while ascites, pleural effusion and CNS symptoms were found in a few patients Patients positive for viral RNA were also positive for anti-dengue IgM (p=0.007) in subsequent sampling. The study suggests the predominance of DEN-3 infection with occasional co-infection with other types, during the recent outbreak of dengue in Bangladesh.

Prevalence of infectious diseases and drug abuse among Bangladeshi workers.

Individuals seeking jobs abroad need health fitness certificates before entering into those countries. Medical screening of 43,213 Bangladeshi job seekers (M/F: 42,290/923) was carried out in our reference center during the period August, 1994 to May, 1996. Albeit male predominance, they represented middle and lower middle socio-economic class of the population from all over the country. All were young adults (age: 27.05+/-3.56 years; mean+/-SD) applying for job visas to different Asian countries. Physical examination and laboratory investigations including markers for several infectious diseases and drugs of abuse were carried out as required by countries recruiting the workers. Serological tests revealed that 1,884 (4.4%) of individuals were positive for hepatitis B surface antigen (HBsAg), 737 (1.7%) for Treponema pallidum hemagglutination (TPHA) and only 83 (0.2%) for antibody to human immunodeficiency virus (anti-HIV). However, we could not confirm any case of infection with HIV. Chest X-ray suggestive of pulmonary tuberculosis was found in 162 (0.4%) and on blood film, malarial parasites could be observed only in 4 cases. Their urine analysis revealed the presence of opiates or cannabinoids in 471 (1.1%) individuals. HBsAg-positive cases (p = 0.003) and abuse of opiates (p = 0.024) or cannabinoids (p = 0.002) were significantly higher among males. TPHA reactivity and chest X-ray suggestive of tuberculosis were found to be higher among opiates (p = 0.002 and 0.027) and cannabinoids (p = 0.000 for both) abused as well as with increasing age (p = 0.000). These results may represent a cross-sectional view of the prevalence of different infectious diseases and abuse of drugs among the young adult population of Bangladesh.

Intestinal transport of water, sodium & glucose from an electrolyte solution with & without bicarbonate.

In this study we have evaluated the role of bicarbonate on water and sodium transport in normal and secreting ilea of rabbits as controversy exists regarding the inclusion of bicarbonate in oral rehydration solution (ORS). In anaesthetized rabbits 10 cm closed ileal loops were constructed and filled with 5 ml of an electrolyte solution with and without bicarbonate, which contained polyethylene glycol (PEG; mol wt 4,000) as a non-absorbable marker. The fluid was withdrawn after an hour and analyzed for PEG, sodium and glucose. Similar studies were carried out in loops one hour after exposure to 1 microgram/ml of purified cholera toxin. Body temperature was maintained at 37 degrees C during the experiment by using a lamp. The mean +/- SE of water and sodium absorption, with bicarbonate versus without bicarbonate, was -1.4 +/- 0.1 vs -1.1 +/- 0.3 ml/h/10 cm, and -340.8 +/- 23.0 vs -308.4 +/- 35.6 mM/h/10 cm, respectively from secreting rabbit ilea. A similar effect was observed in normal ilea. It is concluded that bicarbonate containing electrolyte solution has no additional promoting effect on water and sodium absorption in normal or secreting ilea of rabbits.

Serum levels of gentamicin at peak and trough in neonates and infants.

The peak and the trough levels of serum gentamicin were determined in 50 cases of neonates and infants by microbiological assay method. The peak levels in the neonates and the infants were 5.98 +/- 0.48 and 4.63 +/- 0.31 mcg/ml respectively. The trough levels in the corresponding group were 1.06 +/- 0.19 and 0.94 +/- 0.23 mcg/ml. The mean values of the peak and trough levels of the antibiotic were 5.57 and 1.02 mcg/ml respectively. It was observed that there was a significant lower peak concentration in the infants than in the neonates. A significantly higher peak concentration of gentamicin was observed in babies aged under 7 days than in those above 7 days. The route of administration (between I/M and I/V) did not seem to have any effect on the peak and trough levels of the antibiotics.

Efficacy of aqueous extract of garlic & allicin in experimental shigellosis in rabbits.

The aqueous extract of garlic (Allium sativum) and allicin both showed significant in vitro antibacterial activity against isolates of multiple drug-resistant Shigella dysenteriae 1, Sh. flexneri Y, Sh. sonnei and enterotoxigenic Escherichia coli. The minimum inhibitory concentrations of the aqueous extract and allicin against Sh. flexneri Y were 5 and 0.4 microliters/ml, respectively. The two agents also showed promising in vivo antibacterial activity against Sh. flexneri Y when tested in the rabbit model of experimental shigellosis, fully curing the infected rabbits within 3 days. On the contrary, 4 of the 5 rabbits in the control group died within 48 h. The rectal swab of rabbits of the experimental groups became free of the challenge bacteria on the second day of treatment. The antibacterial activity against the challenge strain was observed in the sera of the treated rabbits with 30-60 min of administration of the agents. The LD50 values of the aqueous extract and allicin in mice were 173.78 ml/kg and 204.17 microliters/kg of body weight, respectively. At the therapeutic dose, the two agents did not show any adverse effects on the standard biochemical profile of blood.

Management of long standing post burn deformities of hand.

A study of 50 cases of long standing post burn deformities of hand in respect to their type of deformities, their operative correction, reconstruction and subsequent recovery had been carried out during the period from January 1979 to May 1986. Contractures were mainly due to shortage of skin and soft tissue; joint deformities developed secondary to that. Purpose of this study was to provide the patient with a good functioning hand. Of them 19 cases required skin grafting and 31 cases required different types of skin flap like groin flap in 13, abdominal flap in 12 and transposition flap in 3,Z-plasty in 2 and buttock flap in one case for resurfacing the raw area which was created following release of contracture of skin and soft tissue. Six patients required capsulotomy and collateral ligament excision, 2 required excision arthroplasty and one patient required excision of lower end of ulna along with a flap cover. Deformities corrected at an earlier date showed better functional recovery than those which were treated at a much later date. In this series, 3 children required secondary correction of their contracted flap due to their growing age, 3 adult patients developed contracture to the grafted skin for not using splint or having any physiotherapy, 2 patients had little extension deformities even after correction flap cover of hyperextension deformity, 2 patients with excision arthroplasty had weak grip and 3 patients were not followed up. Rest had good results. Extensive physiotherapy, proper splinting and regular follow-up at least for 3 to 5 years after operation are the secrets of better functional recovery.

Dasherkandi project studies--health of the under fifteen.

Morbidity pattern of the under fifteen of a rural community was analysed and related to socio-economic factors. This was a part of Dasherkandi project studies carried out in a village near Dhaka city. 48.26% of the population was under the age of fifteen. Infants under the age of one year had low sickness rate which rose steeply between 1 and 4 years of life and then gradually declined after the age of 5 years. Commonest morbidity was worm infestation which was followed by flu and upper respiratory tract infection. The non-agriculturist and the low income group had the highest level of sickness. It is suggested that children in rural areas suffer mainly from diseases which are related to poor nutrition and hygiene resulting from unsatisfactory socio-economic condition. All the childhood mortality occurred under the age of one year and was found to be due to tetanus in this study.

Dasherkandi project studies. Demography, morbidity and mortality in a rural community of Bangladesh.

The entire population of Dasherkandi, a village near Dacca city was surveyed. Out of 1181 people 44.2% suffered from organic or psychiatric disorders. 37.7% suffered from physical disorders, 3.6% suffered from psychiatric disorders and another 2.9% suffered from both psychiatric and physical disorders. The common physical disorders were worm infestations, hypertension, peptic ulcer, dental problems and upper respiratory tract infection including flu. Females suffered from psychiatric diseases more than males. The psychiatric morbidity found in the survey differed significantly from those found in other similar surveys. Depressive states were the commonest psychiatric disorder and women suffered four times as frequently as men. Anxiety neurosis was the next common psychiatric problem. Both crude mortality and infant mortality rates (5.75 and 93.20 per thousand respectively) were lower than those of other similar studies. The commonest cause of infant mortality during first one month of life was tetanus in this series. Inspite of the fact that diagnosis was based entirely on clinical findings the morbidity rate was high. It was observed that a high percentage of the people who suffered from psychiatric disorders were due to problems which can be easily tackled under field conditions.

Symptomatology of depressive disorders in Bangladesh.

Presenting symptomatology of 191 cases with depressive disorders has been presented and discussed. The selective nature of the sample has been pointed out. Predominant symptoms were both psychological and physical. Sleep disturbance, burning pain, anorexia and other gastro-intestinal symptoms occurred frequently. Palpitation and diminished libido were also common. Guilt feelings and ideas of worthlessness were frequent but retardation was not common. Suicidal feelings were expressed by large number of patients but actual suicidal attempts were low. Anxious personality was more prone to develop reactive depression. Physical symptoms were generally more complained by females but diminished libido was more often complained by males. Both physical and psychological symptons were present in the endogenous and the reactive groups. Overlaping nature of the symptoms has also point out.

Some aspects of psychiatric morbidity in the out-patient population of a general hospital.

A preliminary report on certain aspects of psychiatric morbidity in persons attending the medical out-patients department of the Institute of Post-graduate Medicine, Dacca, have been presented. Out of 652 cases who have been interviewed, 31% had purely psychogenic conditions, 45% were suffering from purely organic diseases and 14.8% complained of symptoms of both organic and psychogenic features. No apparent underlying aetiology have been detected in 8.6% of cases. Of the psychogenic group, neurotic disorders comprised the largest number in the sample; anxiety state and sexual neurosis in males were the commonest neurotic disorders. When the mixed groups are included, 44% of males and 49.8% of females had symptoms which were either purely psychogenic in nature or had conspicuous psychogenic component. Reason for such a high percentage of psychogenic component has been discussed. Most of the patients attending the out-patient department were within the age of 21 to 40 years. Attendance in the number of older age persons were less in the psychogenic group than with organic conditions. Further, in females a significant difference was observed between psychogenic and organic group patients above and below the age of 40 years. Patients younger than 40 years were more in purely psychogenic group compared to organic conditions. Most of the patients have been found to be married both in psychogenic and organic group. However, there was significant difference in attendance rate of single males in the psychogenic group were somewhat over-represented in the sample in comparison to purely organic group. There was no relation of marital states in cases of females.