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.

L-isoleucine-supplemented Oral Rehydration Solution in the Treatment of Acute Diarrhoea in Children: A Randomized Controlled Trial.

Antimicrobial peptides represent an important component of the innate immune defenses of living organisms, including humans. They are broad-spectrum surface-acting agents secreted by the epithelial cells of the body in response to infection. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides. The objectives of the study were to examine if addition of L-isoleucine to oral rehydration salts (ORS) solution would reduce stool output and/or duration of acute diarrhoea in children and induce antimicrobial peptides in intestine. This double-blind randomized controlled trial was conducted at the Dhaka Hospital of ICDDR,B. Fifty male children, aged 6-36 months, with acute diarrhoea and some dehydration, attending the hospital, were included in the study. Twenty-five children received L-isoleucine (2 g/L)-added ORS (study), and 25 received ORS without L-isoleucine (control). Stool weight, ORS intake, and duration of diarrhoea were the primary outcomes. There was a trend in reduction in mean±standard deviation (SD) daily stool output (g) of children in the L-isoleucine group from day 2 but it was significant on day 3 (388±261 vs 653±446; the difference between mean [95% confidence interval (CI) (-)265 (-509, -20); p=0.035]. Although the cumulative stool output from day 1 to day 3 reduced by 26% in the isoleucine group, it was not significant. Also, there was a trend in reduction in the mean±SD intake of ORS solution (mL) in the L-isoleucine group but it was significant only on day 1 (410±169 vs 564±301), the difference between mean (95% CI) (-)154 (-288, -18); p=0.04. The duration (hours) of diarrhoea was similar in both the groups. A gradual increase in stool concentrations of ß-defensin 2 and 3 was noted but they were not significantly different between the groups. L-isoleucine-supplemented ORS might be beneficial in reducing stool output and ORS intake in children with acute watery diarrhoea. A further study is warranted to substantiate the therapeutic effect of L-isoleucine.

Study of 89 Cases of Peripheral Vascular Disease by CT Angiography.

Objective: The purpose of this study was to observe the morphological pattern by CT angiography and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering from peripheral vascular disease using a multidetector scanner in the evaluation of patients with peripheral vascular disease. Subject and Method: Eighty nine patients with peripheral vascular disease who were referred for evaluation of peripheral vascular disease underwent CT angiography. We scanned patients from the level of the cerebral arteries to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection, multiplanous reformation and reconstructions. Findings were graded according to nine categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (>75% stenosis); 5, tortuosity; 6, aneurysm, 7, calcification, 8, Arteriovenous malformation (AVM), and 9, haematoma. Results: We found Most of the patients in our study were male (69 out of 89 patients). The mean age was 54.49 ±18.36 in male and 49.45 ±17.89 for female. Commonest risk factor in our study was hypertension 46.1%, followed by diabetes 30.3%, family history 27% smoking 23.6%, dyslipidaemia13.5%. Stenosis (5.61%) was the predominate lesion followed by haematoma (4.49%), Arterio –venous malformation (4.49%). Abdominal aorta was mostly affected in the studied population (58.43%) followed by Lower limb (37.08%), Carotid (22.47%), Renal (7.87%) and Upper limb arteries (4.49%). Conclusion: CT angiography is a noninvasive technique for the imaging of peripheral vascular disease. Since no data is available from a well designed study in PVD in our country, till then the data obtained from this study can be used in Bangladesh.

Detection of urinary leishmanial antigen by latex agglutination test (KAtex) in kala-azar patients.

Background: A new unique latex agglutination test (KAtex) that detects a stable, nonprotein, disease specific parasite antigen in the freshly voided urine of patients suffering from active kala-azar has been introduced by Kalon Biological Ltd. UK. This is absolutely non-invasive method of diagnosis for visceral leishmaniasis and suitable for implementation as a rapid diagnostic tool at the point of care. Objective: Diagnostic potential of KAtex was evaluated among clinically suspected kala-azar patients in an endemic zone of Bangladesh. Methodology: KAtex was done using freshly voided urine according to the manufacturer’s instructions for sixty (60) clinically suspected patients of kala-azar admitted in Rajshahi Medical College Hospital (RMCH), Bangladesh and forty (40) healthy controls during December 2005 to June 2006. Leishmania nested Polymerase Chain Reaction (Ln-PCR) using peripheral blood buffy coat was performed for all study population (100) and Ln-PCR positive cases were considered as confirmed cases of kalaazar. Results: Out of 60 clinically suspected kala-azar patients, 56 were Ln-PCR positive and 53 of 56 Ln-PCR positive cases were KAtex positive (sensitivity, 94.64%; Mantel- Haenszel Chi sq. 79.66, p= 0.0000, confidence interval [CI], >95 to 100%). None of the healthy controls was found positive by Ln-PCR but 2 of 40 were KAtex positive (specificity, 95%; confidence interval [CI], >95 to 100%). The positive and negative predictive values of KAtex were noted as 98.10% and 92.85% respectively. Conclusion: This limited prospective study suggests that KAtex is an absolutely non-invasive urinebased antigen detection test with high sensitivity and specificity and may be useful for screening active kala-azar patients, particularly suitable for field use.

Potassium Hydroxide (KOH) Wet Preparation for the Laboratory Diagnosis of Suppurative Corneal Ulcer.

Background: Suppurative keratitis is a common ophthalmic condition mostly caused by fungi. Apart from fungal culture, wet preparation using 10% Potassium hydroxide (KOH) for microscopic detection of fungal elements is a rapid and accurate method of laboratory diagnosis. Purpose: This prospective and cross sectional study was undertaken in order to evaluate the diagnostic sensitivity of wet preparation microscopy using KOH for detection of fungal agents from suppurative corneal ulcer patients. Methodology: Fifty six (56) consecutive clinically suspected patients of suppurative corneal ulcer attending Rajshahi Medical College Hospital (RMCH) during the period from July, 06 to June, 07 were included. Corneal swabs were taken aseptically for detection of bacteria in gram-stained smear and culture. Conventional mechanical corneal scrapings were collected under topical anesthesia and utilized for microscopic detection of fungal agents in KOH wet preparation and fungal cultures in the department of Microbiology of Rajshahi Medical College. Results: Culture yielded microbial growths in 47(83.93%) out of 56 samples of corneal ulcer that included 24 (42.86%) pure fungal growths, 14 (25.0%) pure bacterial growths and 09 (16.07%) mixed microbial growths (both bacteria and fungi). Direct microscopical examination using 10% KOH wet preparation detected 28 fungal agents out of total 33 fungal cases (combining both pure and mixed fungal growths in culture). Diagnostic sensitivity of wet preparation microscopy was found to be 84.85% by comparing its performance to fungal culture yields, which is the ‘gold standard’ for laboratory diagnosis. Conclusion: This limited study has revealed that wet preparation can be a tentative diagnosis of fungal keratitis and can be accurately relied upon for initiating prompt anti-fungal therapy and also recommended as a cost-effective method for laboratory diagnosis especially where culture facility is not available.

Feeding pattern of children under two years in some selected villages.

Objective: The present study was aimed to find out the feeding pattern of children less than two years of age in rural areas. Methodology: The study area consisting of three villages of Muradnagar Upazila under the district of Comilla. Families having children under-two years of age were included in the study. A total number of 54 families finally entered in the study. Respondents were interviewed using structured questionnaire regarding initiation of breast feeding of the new born, their breast feeding pattern and weaning of the children. Socio-demographic characteristics of the respondents were recorded. Data were presented as number and percentage. Results: Out of the 54 respondents 52 (96.3%) were mothers and 2 (3.7%) fathers. Of the total 50 (92.6%) respondents was housewife. Among 54 respondents 36 (66.7%) were in the age group of 18 to 25 years. Thirteen (24.1%) respondents were illiterate and among the rest 27 (50%) had primary level and 2 (3.7%) had bachelor level of education. Twenty six (48.1%) respondents said newborns were given breast milk first and rest 28 (51.9%) mentioned about giving of honey, cow’s milk and sweet water made of sugar or sugar product. Twelve (22.2%) mothers started breast feeding within 15 minutes after birth, 28 (51.9%) after 1 hour or more. Twenty one 21 (38.9%) had given exclusive breast feeding to the children for six months and 33 (61.1%) given additional stuff during that time. Thirty (55.6%) mothers started weaning before reaching 6 months of age, 13 (24.0%) between 6 months to 12 months and 1 (1.9%) started after 12 months. Commonly used weaning foods were rice, shuzi, khichuri, cow’s milk, infant formula, fish, egg, meat, honey, vegetables and fruits especially banana. Conclusion: The data suggest wide range of variability still exists in allowing colostrums to the newborn, breast feeding itself and also weaning practice.

Typhus Fever: An Overlooked Diagnosis.

A case of typhus fever is presented. On admission, the clinical diagnosis was typhoid fever. Forty-eight hours after admission, the presence of subconjunctival haemorrhage, malena, and jaundice raised the possibility of a different aetiology, the two most likely differentials being dengue and typhus. Finally, a co-infection of typhoid and typhus was discovered. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission being treated as a case of typhoid fever.

Study of 89 Cases of Peripheral Vascular Disease by CT Angiography in a Centre of Bangladesh.

Background: The peripheral arterial disease generally refers to a disorder that obstructs the blood supply to upper and lower extremities, most commonly caused by atherosclerosis. Objective: The purpose of this study was to observe the morphological pattern and risk factors for development of peripheral vascular disease in Bangladeshi patients suffering from peripheral vascular disease by CT angiography using a multidetector scanner. Method: Eighty nine patients with peripheral vascular disease who were referred for evaluation of peripheral vascular disease underwent CT angiography. We scanned patients from the level of the cerebral arteries to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection, multiplanous reformation and reconstructions. Findings were graded according to nine categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (>75% stenosis); 5, tortuosity; 6, aneurysm, 7, calcification, 8, Arteriovenous malformation (AVM), and 9, haematoma. Results: We found Most of the patients in our study were male (69 out of 89 patients). The mean age was 54.49 ±18.36 yrs in male and 49.45 ±17.89 yrs for female. Commonest risk factor in our study was hypertension 46.1%, followed by diabetes 30.3%, family history 27%, smoking 23.6%, dyslipidaemia13.5%. Stenosis (5.61%) was the predominate lesion followed by haematoma (4.49%) and arterio–venous malformation (4.49%). Abdominal aorta was mostly affected in the studied population (58.43%) followed by Lower limb (37.08%), Carotid (22.47%), Renal (7.87%) and Upper limb arteries (4.49%). Conclusion: CT angiography is a noninvasive technique for the imaging of peripheral vascular disease. Since no data is available from a well designed study in PVD in our country, till then the data obtained from this study can be used in Bangladesh.

A case of renal transplantation.

A 12-year-old boy was admitted in paediatric nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) with massive proteinuria, hypertension, respiratory distress and anaemia and diagnosed as nephrotic syndrome. Percutaneous needle biopsy was consistent with diffuse endocapillary proliferative glomerulonephritis and initially managed conservatively with injection methyl prednisolone, cyclophosphamide, lisinopril etc. without any improvement. Living-related renal transplantation was done successfully from paternal uncle. Two episodes of acute rejection occurred, one immediately after transplantation and another after one month. These were managed with IV methyl prednisolone for 3 days. At present, he is on oral prednisolone, cyclosporine, azathioprine and antihypertensives with normal haemoglobin and stable serum creatinine level (pre-transplant level 12.5mg/dl to post-transplant level 1.5mg/dl). He has been maintaining his normal life including schooling for last few months. It is concluded that a patient with uncommon presentation of nephrotic syndrome should be confirmed by renal biopsy and renal transplantation may be considered if conservative measures fail.

Introduction of routine zinc therapy for children with diarrhoea: evaluation of safety.

On 8 May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommended routine administration of zinc in the management of children, aged less than five years, with acute diarrhoea. In making the recommendation, WHO and UNICEF also suggested careful monitoring for adverse events associated with routine administration of zinc, particularly unusual or excess vomiting. The study assessed, in a phase IV trial, i.e. post-marketing surveillance of zinc, the occurrence of adverse events during the first hour after the administration of the first dose of zinc in children with acute or persistent diarrhoea. The study was conducted at the Dhaka Hospital of ICDDR,B and at an outpatient clinic operated by a local health NGO-Progoti Samaj Kallyan Protisthan (PSKP), Dhaka, Bangladesh. Eligible children, aged 3-59 months, were treated with 20 mg of zinc sulphate provided in a dispersible tablet formulation. The children were observed for 60 minutes following the initial treatment with zinc for adverse events, with particular attention given to vomiting or regurgitation. During the one-year observation period, 42,440 children (male 57% and female 43%) received zinc, and 20,246 (47.8%) of them were observed. Regurgitation and/or vomiting occurred in 4,392 (21.8%) of the children; 90.8% of these children had vomiting only once, 8.7% twice, and 0.5% more than twice. No children revisited the hospital for recurrent vomiting following their discharge. A significant proportion of infants and children may experience vomiting or regurgitation, usually once, following the administration of the first dose of zinc. This is a transient phenomenon that did not impact on continuation of treatment with zinc.

Evaluation of total hip replacement.

This prospective study was made to asses the results of total hip replacement done primarily at Dhaka Medical College Hospital by the surgical team from its orthopaedic department. Eight patients were selected randomly from April/2005 to December/2005. Six patients were male and two females. Age of the patients was ranging from 22 to 67 years with average of 37.4+/-5.12 (mean+/-SE) years. Majority of the patients (75%) were diagnosed as Aseptic necrosis of femoral head with secondary osteoarthritis. The femoral head was replaced by metallic component with C-stem and the acetabular cup made up of Ultra-High density Polyethylene. Both the components were cemented (methylmethacrylate) by hand-packing. The patients were followed-up for 7.75+/-6.1 months (mean+/-SE) ranging from 4 months to 1 year. The results were evaluated on the basis of Harris Hip Score(2). 75 % had good to excellent and 12.5% had fair results. One patient complicated with dislocation and ultimately had poor result. The quality of life in seven patients (87.5%) improved much for which they were grateful.

Role of fine needle aspiration cytology (FNAC) in the diagnosis of prostatic lesions with histologic correlation.

This study was carried-out to evaluate the diagnostic accuracy of fine needle aspiration cytology (FNAC) and the role of FNAC in the diagnosis of prostatic lesions. FNAC was performed on 64 patients presented with enlarged prostate. Cytological diagnosis by fine needle aspiration (FNA) of the prostate was compared with histological diagnosis in 60 patients. Of these, 42 cases were cytologically diagnosed as benign lesions, 18 cases as malignant. In remaining 4 cases, materials were inadequate for diagnosis in one case and biopsy materials were not available in 3 cases. On histological examination, 42 cases which were cytologically diagnosed as benign, 40 cases were found to be benign and 2 cases were malignant histologically leading to 2 false negative diagnoses. Of the 18 cases diagnosed cytologically as malignant (considering atypical hyperplasia and carcinoma as malignant), 15 cases were proved to be so by histological examination. So there were false positive diagnoses in 3 cases. No patient suffered from any complication following the aspiration biopsy. The sensitivity of this study for detection of prostatic carcinoma was 88 percent; specificity was 93 percent and diagnostic accuracy 91.7 percent. In this prospective study, FNAC of prostate was found to be associated with high diagnostic yields. These data support the value of transrectal FNAC as sensitive, easy to perform method for sampling of an enlarged prostate. The procedure may be used as an efficient primary screening tool in the diagnosis of prostatic lesions. Frequent use of this technique in our country should be encouraged.

Low osmolar oral rehydration salts solution in the treatment of acute watery diarrhoea in neonates and young infants: a randomized, controlled clinical trial.

To compare the efficacy and safety of low osmolar oral rehydration salts solution (ORS-75) (mmol/L: Na+ 75, osmolarity 245) with that of World Health Organization-recommended ORS (ORS-90) (mmol/L: Na+ 90, osmolarity 311 ) in the treatment of acute watery diarrhoea in neonates and very young infants, a randomized double-blind, controlled clinical trial was carried out at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh, during January 1998-December 1999. Infants, aged < or = 2 months, presenting with a history of watery diarrhoea of < or = 72 hours, with no or some dehydration and without any systemic illness, were randomly assigned to receive either ORS-75 or ORS-90 for the correction and subsequent prevention of dehydration. Infants were studied for a maximum of five days. Total stool output, stool frequency, and requirement for ORS were outcome measures. Serum electrolytes were measured at 24 hours after admission to monitor serum sodium imbalance. Seventy-three infants received ORS-75, and 71 received ORS-90. Both the groups were comparable in their baseline characteristics. Diarrhoea resolved within five days in 53% and 66% of infants receiving ORS-75 and ORS-90 respectively (p = 0.3). Total stool volume [median (inter-quartile range) 132 (65-280) vs 139 (70-259) g/kg, p = 0.9], during the study period, was not significantly different between the two groups. Total stool frequency [31 (16-51) vs 35 (16-53), p = 0.9] and total ORS intake [192 (96-374) vs 209 (134-317) mL/kg, p = 0.7] were similar between the groups. No infants developed late evidence of hypernatraemia, irrespective of treatment. The results of the study indicate that ORS-75 is as safe as standard ORS-90 in the treatment of acute watery diarrhoea in neonates and very young infants and is effective in correcting and preventing dehydration.

Holmium YAG laser treatment of superficial bladder carcinoma.

Holmium YAG laser is one of the new modalities of treatment of urinary bladder tumor. Thirty patients of superficial bladder carcinoma were selected from the Urology out patient department of Dhaka Medical College Hospital from January 2004 to July 2004. Among thirty cases, 18 were recurrent and 12 were primary superficial bladder carcinoma. Out of thirty patients, 24 were male and six were female. Patients were treated with Holmium YAG laser under spinal anesthesia. Before resection, cold cup biopsy were taken from the apex and after resection of the tumor, another cold cup biopsy were taken from the base of the tumor. Holmium YAG laser therapy was given with a 550 micron end firing quartz laser fiber through the working element of resectoscope. Small tumors (< 1 cm) were ablated and large tumors (1-4 cm) were resected. The initial laser setting was 0.5 to 0.8 J and 10 Hz. For resection of the tumor, a slightly higher energy of 1 to 1.2 J was used at 10 to 12 Hz. After resection, bleeding vessels were coagulated. The resected tumor was evacuated by Elik's evacuator. All cases were followed for 6 to 12 months by history, physical examination, urine analysis, sonogram and cystoscopy three monthly. Bleeding was minimum during the procedure and no transfusion was required. Complications like obturator jerk, clot retention or perforation were not developed. No recurrence was found during the 6 to 12 months follow up period. The procedure was found safe, effective, and acceptable. The study was conducted to evaluate the initial result of Holmium YAG laser for the treatment of superficial bladder carcinoma. We warrants further studies in this regard.

Holmium laser urethrotomy for urethral stricture.

A prospective cross-sectional study was carried-out in the department of urology, Dhaka Medical College Hospital (DMCH) to evaluate the outcome of Laser urethrotomy for the treatment of urethral stricture. For this purpose, 30 male patients aged 15 to 60 years with short segment anterior urethral stricture (>2cm) were treated by HO:YAG Laser. The energy used for this purpose was 0.8 to 1.5 joules by LISA 80 Watt Holmium Laser machine. All patients were catheterized for less than 24 hours and were followed up for 6 to 12 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram 3 monthly. The study revealed that out of 30 patients, 27(90%) showed good flow of urine (Qave>16.0 ml/sec) and adequate caliber urethra in retrograde urethrogram (RGU). Only 3(10%) patients showed narrow stream of urine (Qave<8.0 ml/sec) and recurrent stricture in RGU which were managed by optical internal urethrotomy (OIU) and clean intermittent self catheterization (CISC). The study showed satisfactory results in 90% cases with short term follow up. The study concludes that HO:YAG Laser urethrotomy for the treatment of short segment urethral stricture is highly effective. The study further reveals that the method is simple, safe and thus, it can be considered favorably as a new therapeutic option for the treatment of urethral stricture. However, long term follow up is necessary for making a final comment on this issue.

Tetracycline in the treatment of severe cholera due to Vibrio cholerae O139 Bengal.

Vibrio cholerae O139 synonym Bengal, recognized in 1993, is the second member in the list of about 200 serogroups of V. cholerae with epidemic and pandemic potential. Although replacement of fluids and electrolytes remains the cornerstone in the management of cholera, antimicrobial therapy can significantly shorten the duration of diarrhoea, and reduce stool volume and requirements ofrehydration fluids. The role of antimicrobial therapy on the natural course of the disease caused by this relatively new pathogen has not been systematically assessed. A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy of tetracycline in the treatment of adults with severe cholera due to V. cholerae O139 Bengal. Forty-three adult males with severe cholera were randomly allocated to receive either 500 mg of tetracycline (n=21) or placebo (n=22) for three consecutive days. Demographic and clinical characteristics of these patients on admission were comparable. Tetracycline therapy was associated with significantly reduced total median (inter-quartile range) stool volume [216.48 (90.18-325.22) mL/kg vs 334.25 (215.12-537.64) mL/kg; p=0.001], higher rates of clinical cure (81% vs 27%; p<0.001), and shorter median (inter-quartile range) duration of diarrhoea [32 (24-48) hours vs 80 (48-104) hours; p<0.001]. The mean +/- (SD) requirement of intravenous fluid was not significantly different between the two groups [146.42 +/- 42.12 mL/kg vs 150.44 +/- 27.21 mL/kg; p=0.70]. The median (inter-quartile range) duration of faecal excretion of V. cholerae O139 was significantly shorter in the tetracycline group than the placebo group [1(1-2) day vs 5 (3-6) days; p<0.001]. The results of the study indicate that tetracycline therapy is clinically useful in the treatment of severe cholera due to V. cholerae O139 Bengal.

Chronic carriers of hepatitis B virus in Bangladesh: a comparative analysis of HBV-DNA, HBeAg/anti-HBe, and liver function tests.

Serological markers of hepatitis B virus (HBV), liver function tests and quantitative estimation of HBV-DNA are important in the assessment of the state of infection and prognosis following treatment for hepatitis B. This study aimed to determine whether low-cost assays, eg hepatitis B e antigen (HBeAg) and liver function tests, could be used for the assessment of infectivity as an alternative to HBV-DNA estimation. We tested 125 hepatitis B carriers for HBeAg, antibody to HBeAg (anti-HBe), and serum HBV-DNA; we also carried out a range of standard liver function tests. Seventy-three subjects were positive and 52 were negative for HBeAg. Of the HBeAg positive cases, 3 were also positive for anti-HBe; of the HBeAg negative cases, 5 were also negative for anti-HBe. Of these 8 cases, 7 had no detectable HBV-DNA. Most of the HBeAg positive but anti-HBe negative subjects were positive for HBV-DNA (74.3%; 52/ 70) whereas most of the HBeAg negative and anti-HBe positive subjects (93.6%; 44/47) were also negative for HBV-DNA. Of 56 HBV-DNA positive individuals, alanine transaminase (ALT) was found to be raised in 69.6% (p=0.066) and aspartate transaminase (AST) was raised in 66.1% (p=0.011), while 67.9% had normal alkaline phosphatase (ALP) (p=0.054). HBeAg (p=0.018) and raised ALT (p=0.008) were found to be independent predictors for HBV-DNA positivity among HBV carriers. This study suggests that HBeAg positive and anti-HBe negative hepatitis B carriers with raised ALT and AST are likely to be positive for HBV-DNA; the combination of routine serology and biochemical tests may be considered as an alternative to HBV-DNA in evaluating the state of chronic HBV infection. However, HBV-DNA should be specifically assessed if discordance is observed between seromarkers and transaminases.

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.

Vibrio cholerae O139 Bengal: a descriptive study.

A prospective study was conducted to determine the clinical and laboratory characteristics and the clinical course of cholera due to Vibrio cholerae O139 Bengal. The study subjects included 22 adult males with stool culture-proven V. cholerae O139. On enrollment, mean +/- SD concentrations (mmol/L) of serum sodium, potassium, chloride, and bicarbonate were 134 +/- 3, 4 +/- 1, 102 +/- 4, and 13 +/- 4 respectively, and stool sodium, potassium, chloride, and bicarbonate concentrations were 120 +/- 24, 18 +/- 6, 93 +/- 16, and 37 +/- 9 respectively. Seventeen patients (7.8%) had faecal leukocytes ranging from 11 to 50 per high-power field. All V. cholerae O139 isolates (100%) were susceptible to tetracycline, erythromycin, and ciprofloxacin, 92% to furazolidine, and only 5% to trimethoprim-sulphamethaxazole. The median (interquartile) volume of liquid stool during the first 24 hours was 9 (5-12) litre. The median (interquartile) volume of liquid stool and the amounts of intravenous and oral rehydration fluids required during the entire study period were 16 (9-24) litre, 9 (6-18) litre, and 14 (9-20) litre respectively. The median (interquartile) duration of diarrhoea was 80 (48-104) hours. The median (interquartile) duration of excretion of V. cholerae O139 in stool was 5 (3-6) days. Clinical and laboratory features, and case management of cholera due to V. cholerae O139 are very similar to conventional cholera due to V. cholerae O1.