Risk Factors Analysis of Gastro- Intestinal Infections among the Patients in Tertiary Care Hospital in Dhaka, Bangladesh

Background: Viral hepatitis is one of the major public healthconcerns around the world. Every year millions of people diefrom viral hepatitis-related cirrhosis and liver cancer. Howeverthe fact is the majority of the infected populations are unawareof their condition.Objective: The objective of the study was to find out theproportion of the risk factors associated with gastrointestinalinfections among the inpatients attending in tertiary carehospital in Dhaka city.Materials & Methods: A cross-sectional study was carried outamong the hospital admitted patients at gastroenterologydepartment from January to April, 2019.A total of 193patientswere purposively selected who were above 18 years anddiagnosed case of hepatitis, diarrhoeal diseases, enteric fever,H. pylori infection.Results: The outcome of the study was that, majority82(42.5%) of the patients age was between 21-40 years.Maximum participants were male (65.3%). Study found thatamong 193 patients, 45 (23.3%) were diagnosed as hepatitisB, 31 (16.1%) were H. pylori infection, 29 (15.0%) diarrhoea,hepatitis C 19 (9.8%), hepatitis E 23 (11.9%) and hepatitis A 21(10.9%). It also found that mean duration of Gastro-Intestinal(GI) infection was 2.59 (± 3.22) years. Water borne diseaseslike hepatitis A, E, diarrhoea, typhoid and H. pylori infectionmostly presents due to 44 (34.4%) patients drunk water fromsupply water (Dhaka WASA), 73.4% eaten street juice and79.7% had eaten street food before diagnosed diseases.Commonest risk factors were hepatitis B and C. 37 (56.9%)patients had received blood previously, 11 (17.2%) had theirprevious history of operation, 42 (64.6%) had visited dentist fordental issues, 29 (44.6%) patients attended endoscopy orcolonoscopy test, 28 (43.1%) patients informed that they hadfaced minor skin injury when shaving in salon and 6 (9.2%)patients mentioned taken dialysis. According to the findings,20.3% patients having liver diseases, 5.7% heart diseases,4.1% respiratory diseases, 7.3% renal diseases, 26.4%diabetic, 22.8% hypertensive, 15.0% anemia and 26.9%smoker Street juice [OR: 95% CI, 4.9%] and Street food [OR:95% CI, 6.1%] risk of hepatitis A infection. The proportion ofrisk factors of hepatitis B infection revealed that the patientswho received blood previously [OR: 95% CI, 3.14%] has therisk of hepatitis, second hand razor use [OR: 95% CI, 7.76%],Dialysis [OR: 95% CI, 2.47%].Conclusion: Street foods & juice, unpurified water was thecommonest factors of hepatitis A &E, typhoid and diarrhea. Onthe other side, unscreened blood, dental procedure, skin injuryin saloon, dialysis and endoscopy/colonoscopy test were thecommonest risk of hepatitis B& C virus. H. pylori infection

Left Ventricular Diastolic Dysfunction in Congestive Heart Failure Due to Systematic Hypertension

This was a prospective observational study was carried out in Shaheed Shaikh Abu-Naser Specialized Hospital, Khulna, Bangladesh during the period from January 2017 to December 2018. Our aim was to evaluate left ventricular diastolic dysfunction in congestive heart failure resulting from systemic hypertension. Methods: Fifty patients with systemic hypertension who had recently experienced CHF with normal ejection fraction (≥50%) and no clinical history of ischaemic cardiomyopathy were studied. The patients were divided into two groups according to the degree of echocardiographic hypertrophy: group-I (26 patients) with a ventricular mass/volume ratio >1.8 and group-II (24 patients) with a ratio <1.8. Results: Group I patients had a higher ejection fraction (67.62±3.14 vs 55.33 ±4.13, P<0.001), smaller ventricular diameter (28.88+2.46 vs 34.38±4.37, P<0.001), higher LV mass (154.42±6.80 vs 123.38±5.58, P<0.001), lower ETT positivity (15%vs75%, P<0.001). Clinically, group I had more frequent audible fourth heart sound (57% vs 20%, P< 0.001), low incidence of audible third heart sound (15% vs 70%, P<0.001), ECG evident LVH mass (96% vs 16%, P<0.001), cardiomegaly (23% vs 70%, P<0.001). Conclusion: There were no significant differences between groups for NYHA class, age, sex, heart rates and systolic blood pressure but significantly associated with Diastolic BP, ECG (LVH) and Cardiomegly.

Effect of organic amendment on stem canker and black scurf disease of potato (Solanum tuberosum) / Efeito da alteração orgânica sobre o cancro da haste e doença dos tuberculos pretos da batata (Solanum tuberosum)

An experiment was conducted at Tuber Crops Research Centre, BARI, Bogra during 2008-2009 to evaluate the organic amendment for controlling the stem canker and black scurf of potato. The different kinds of organic amendments were: T1 =Poultry refuse (PR) at 4 t ha-1, T2 =PR at 5 t ha-1, T3 =PR at 6 t ha-1, T4 =Mustard oil cake (MOC) at 300kg ha-1, T5 =MOC at 500kg ha-1, T6 =Neem oil cake (NOC) at 300kg ha-1, T7 =NOC at 500kg ha-1, T8 =Sawdust burning and T9 = Control. The experiment was laid out in a randomized complete block design (RCBD) with four replications. The organic amendment significantly influenced the disease incidence, yield attributes and yield of potato. The lowest disease incidence (17.5%) and per cent disease index (9.99) were found in T3 (poultry waste at 6 t ha-1). The minimum russet, deformed and Sclerotia infected tubers were also recorded in poultry waste at 6 t ha-1. The highest healthy tubers and tuber yield were found in the same treatment. Therefore, poultry manure 6 t ha-1 along with recommended dose of chemical fertilizer can be recommended to produce healthy tubers and maximum tuber yield of potato.

O experimento foi conduzido no (Centro de Pesquisa em Tubérculos ) Tuber Crops Research Centre, Bari, Bogra durante 2008-2009 para avaliar a alteração orgânica e controlar o cancro da haste e Black Scurf da batata. Os diferentes tipos de alterações orgânicas foram: T1 = Poultry recusar (PR) a 4 t ha-1, T2 = PR a 5 t ha-1, T3 = PR em 6 t ha-1, T4 = bolo de óleo de mostarda (MOC) em 300 kg ha-1, T5 = MOC em 500 kg ha-1, T6 = bolo de óleo de Neem (NOC) em 300 kg ha-1, T7 = NOC em 500 kg ha-1, T8 = queima de serragem e T9 = Controle. O delineamento experimental foi em blocos casualizados (RCBD) com quatro repetições. A alteração orgânica influenciou significativamente a incidência da doença, os atributos de rendimento e produtividade da batata. A menor incidência da doença (17,5%) por cento do índice de doença (9,99) foram encontrados em T3 (resíduos de aves a 6 t ha-1). O russet mínimo, deformado e Sclerotia tubérculos infectados também foram registrados em resíduos de aves a 6 t ha-1. O rendimento mais elevado tubérculos saudáveis e tubérculos foram encontrados no mesmo tratamento. Portanto, aviário 6 t ha-1, juntamente com a dose recomendada de fertilizante químico pode ser recomendado para a produção de tubérculos saudáveis e rendimento máximo dos tubérculos de batata.

Teachers Perception on Tobacco Free School in Bangladesh.

Introduction: Comprehensive tobacco-free school policy benefits everyone by reducing exposure to second-hand smoking and creating a system that reinforces tobacco-free norm and attitudes, which in turn affect tobacco use having an impact on the health of the community. Objective: This study aims to assess the perception of teachers on tobacco free school environments and factors supporting it. Methods: A two-stage cluster sampling technique was used for the selection of schools with selection probability proportional to enrolment size followed by stratified random sampling of government and private schools. Data were collected from 559 secondary school teachers using a structured questionnaire. Results: Estimation indicated that 48.3% (95% CI: 44.5%, 52.6%) of the teachers were less supportive and 51.7% (95% CI: 47.4%, 55.5%) were more supportive for smoking free school. Logistic regression analysis revealed that non tobacco user teachers were more likely to be supportive (OR=1. 891, 95% CI: 1.197, 2.986) for tobacco free school. However, no statistically significant association was found between perceived supportive tobacco free school and age, sex, level of education, type of school and family size (p>0.05). Exposure to second hand smoking and curriculum content of tobacco issues were not significantly related with tobacco free school. Conclusion: Comprehensive school based programme with participation of school personnel and community can effectively implement tobacco free school programmes.

Status of Female Adolescents Living at Rajshahi Slum in Bangladesh.

Objective: To avoid the social consequences of unplanned pregnancy, transmission of STIs and HIV/AIDS, adolescents need to be awaked of their reproductive health. That is why; the study is aimed to know the present status of adolescents in terms of socio-demographic and menstrual management status living in slum areas of Rajshahi City Corporation (RCC), Bangladesh. Materials and methods: The data for this study were collected purposively in 2012 from 200 girls aged 10-19 who were slum living at RCC using a pre-designed questionnaire. The purpose and importance of this study were explained to the respondents before participating in this study. Results and discussion: The result showed that 64% of the respondents were in the group of 18-19 years. Around 9.5% of the adolescents had never gone to school. The maintenance of hygiene during menstruation is a vital aspect of adolescent reproductive health. But the result showed that about 94% of the respondents answered that they do not know the underlying reasons for what menstruation occurred. Only 5% of the respondents maintained some form of hygiene measurements (pad or clean cloth) during the onset of their menstruation. The result also indicated that 24.5% of the respondents felt physical illnesses during their menstruation. Conclusion: The authority should commit to ensuring that the needs, challenges, aspirations, vulnerabilities and rights of adolescents, especially for girls, are fully considered in this new development agenda. Keeping this in mind, adolescent friendly health services should be ensured by arranging special hours or special days for them, orienting and providing training to healthcare providers on how to counsel adolescents.

Mycoplasma infection in Malaysian children: laboratory investigation and antimicrobial therapy.

Background: Mycoplasma pneumonia (M. pneumoniae) is an important causative agent of childhood infection with variable clinical presentations. The objective of the study was to evaluate the laboratory investigation and antimicrobial therapy of M. pneumoniae infection in children admitted to paediatric ward. Materials & Methods: A total of 111 children, of which 59 (53.2%) boys and 52 (46.8%) girls, with median age of 2 years (inter quartile range 1-6 years) with suspected M. pneumoniae infection were tested for IgM by enzyme-linked immunosorbent assay (ELISA). The children were classified as seropositive and seronegative. Results: Of the 111 children, 45 (40.5%) had serological evidence of M. pneumoniae infection and the remaining 66 (59.5%) were seronegative. There was significant association (p < 0.001) between age and serology response. Seropositive children were more likely to be older (median age 5.0 [interquartile range 2- 7] years, p < 0.001). Children with M. pneumoniae infection were less likely to have cough (p = 0.023) in which 55 (65.5%) patients having cough were seronegative. There was no significant association between laboratory findings of full blood count and serology. Conclusion: In addition to clinical and laboratory features, other factors like age group and absence of cough might be helpful in predicting M. pneumoniae infection.

Dual use of tobacco among Bangladeshi men.

INTRODUCTION: Dual use of tobacco (using smoking and smokeless forms) in Bangladesh is uncommon in women but common in men. Dual users are at additional risk of cancers and heart diseases compared with a single form of tobacco use. Knowledge about their socioeconomic background is necessary for planning appropriate interventions. We report here socioeconomic background of the dual users of tobacco from a nationally representative survey. METHODS: The study adopted a probability proportionate to size sampling technic of divisional population stratified into urban and rural areas to recruit men aged 25 years or older from their households. A total of 4312 men were recruited. Variables included questions on 20 household assets, tobacco use and other behavioral risk factors, and measurement of body weight and height. RESULTS: The average age of dual users was 46.7 years old compared to 43.4 and 52.3 years for smokers and smokeless tobacco users. Prevalence of “smoking only,” “smokeless only” and “dual use” of tobacco was 40.6%, 15.2%, and 14.2%, respectively. Among all tobacco users, dual users constituted 20%. These dual users had lower educational achievement, rural residence, lower intake of fruit, and higher intake of alcohol. They were more undernourished as indicated by a thin body mass index compared to nonusers and smokers. Dual users were of socioeconomically deprived as measured by wealth quartiles constructed out of household assets. CONCLUSION: Dual use of tobacco is common in Bangladesh, and it is intimately linked with socioeconomic deprivation. Poverty reduction strategy and campaigns should address tobacco control not only tobacco in general, but its dual use in particular.

Determination of alpha-amylase activity of Streptomyces spp isolated from Bangladeshi soils.

Streptomyces, the largest genus of actinobacteria, is a group of bacteria which is most commonly isolated from soil. In this study, total 24 indigenous Streptomyces spp. were isolated from soil samples collected from different parts of Bangladesh Of them, two species designated as S-31 and S-109 were studied to determine their alpha-amylase activity. The α-amylase activity of S-31 and S-109 was 2.26 unit/ml and 2.67 unit/ml .Based on this study, it can be concluded that both species of Streptomyces were good candidate for amylase production.

Laparoscopic Versus Open Appendicectomy: A Comparison of Primary Outcome.

Currently, laparoscopic appendectomy is widely practiced for the management of acute appendicitis. It is not clear whether open or laparoscopic appendectomy is more appropriate. Our aim was to compare the safety and the advantages of laparoscopic versus open appendectomy in a prospective study. 102 patients were participated in this study. The group 1 patients were subjected to laparoscopic appendectomy [LA], whereas the group 2 patients were subjected to open appendectomy [OA]. 46 patients included in LA group and 54 patients in OA group. The mean operative time for LA and OA was 84.4 (45-220) minutes and 59 (30-180) minutes respectively. Although LA was associated with a shorter hospital stay [LA-3.5 days versus OA-5 days] but duration of operation is prolong in LA than OA and the postoperative wound infection is significantly higher in OA than LA. LA is safe and superior to OA in respect to an early discharge, lesser postoperative pain; decreased post operative wound infection, early return to work and a better cosmetic scar.

Scedosporium apiospermum fungaemia: the ramification of broad spectrum antimicrobial treatments.

Scedosporium apiospermum is a cosmopolitan mycotic agent with unique characteristics. This is a case of a 65-year-old immunocompetent patient who presented with shortness of breath and fever. Consolidation was observed in both lung fields on chest X-ray. A diagnosis of aspiration pneumonia was made. Extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae was identified from his tracheal aspirate and imipenem was administered. Initial blood cultures were negative but after 10 days on imipenem, Candida glabrata was isolated. Amphotericin B was added to the treatment regimen, but after a week on this antifungal, Scedosporium apiospermum was cultured from the blood. The patient succumbed to illness before a change in the antifungal regimen. The case highlights the unwelcome consequence of using a broad spectrum antibiotic and later a broad spectrum antifungal agent.

Articulation of speech of patients treated with radicular attachment assisted obturator following maxillectomy.

Background: Obturators are used to separate the oro-nasal opening. These improve speech and other oral functions as well as provide psychological support to the patients. Adding radicular attachments in an obturator makes more effective. Objective: To evaluate and compare the effectiveness of obturator with radicular attachment and conventional obturator in articulation of speech. Materials and Methods: Fifty patients, age ranged from 18 to 72 years, with maxillectomy defect were selected as the sample of the study. Among them 25 patients were treated with obturator with radicular attachment and another 25 patients were treated with conventional obturator. After insertion of obturator, data were collected on the basis of articulation of speech. Results: Patients treated with obturator with radicular attachment showed significantly better (P value <0.001) articulation of speech. Conclusion: Obturator with radicular attachment is more effective than conventional obturator.

Knowledge, Awareness and Perception about HIV/AIDS among Primary School Teachers in Bangladesh.

Objective: Information is very important to have accurate understanding of people about the modes of HIV/AIDS transmission and its prevention strategies. Teachers at all levels are always expected to play a foremost role in the provision of information to promote awareness leading to behavioral change among students. Therefore, this article is aimed to evaluate the knowledge, awareness and perception about the deadly disease HIV/AIDS among primary school teachers in Bangladesh. Materials and methods: To do so, about 120 teachers from 28 primary schools, out of 68, in Rajshahi City Corporation (RCC) areas were interviewed purposively for this study using a self-administered questionnaire. Results and discussion: The results showed that the teachers serving at primary schools level were not too sure of their own knowledge about the issue. They had much misperception about the knowledge of facts, modes of transmission to reduce contamination and the modes of transmission from one person to another of HIV/AIDS. Conclusion: Government should provide adequate funding to organize and sponsor teachers to attend in training workshops, seminars and conferences related to HIV/AIDS and that the pandemic should be discussed with other for the purpose of awareness.

Management of Inferior Vena Cava Injury in a Non Specialized Tertiary Hospital-a Case Report.

Abdominal vascular injury are among the most challenging and lethal injuries in the traumatized patients. Inferior vena cava (IVC) is the most frequently injured vein during the blunt or penetrating trauma. Ligation of IVC, venorrhaphy, venoplasty, end to end anastomosis, endovascular stenting or graft interposition should be considered in selected cases. However most of the procedures require special setting and surgical team. Relatively simple procedure e.g. venorrhaphy produces narrowing of lumen in many cases. Ligation of IVC may result in thrombosis and embolism thus increases morbidity of patients. Here, in the present case the authors report a patient with IVC injury repaired by venoplasty (cavaplasty) with great saphenous vein patch in a non specialized tertiary hospital and it can be performed by a team led by general surgeon.

Off Pump CABG along with Resection of Giant Thymoma : A Case Report.

Coronary artery disease is the most common form of heart disease and the single most important cause of premature death world-wide. Thymomas are anterior mediastinal neoplasms, characterized by epithelial cells and lymphocytes. Although they are often encapsulated and well differentiated tumors, they can show local invasion, pleural invasion or extrathoracic metastasis. In this article, we report the case of a rare patient who underwent thymectomy along with off-pump coronary artery bypass graft surgery.

Link between Periodontal Disease and Coronary Artery Disease: Bangladesh Perspective.

Coronary artery disease (CAD) is an increasingly important medical and public healthproblem, and is the leading cause of mortality in Bangladesh. Besides conventional risk factors and ethnicity, a number of emerging risk factors may explain the undue prevalence of CAD in this population. Periodontal disease (PD) is one of them, with prevalence of approximately 50%. As with many other diseases, PD is associated with CAD, and the association is independent of conventional risk factors. Low socioeconomic condition, illiteracy and ignorance, metabolic syndrome, nutritional deficiencies including hypovitaminosis D presumably contribute to the prevalence of PD in Bangladesh. In fact, PD and CAD share some cardiometabolic risk factors including diabetes mellitus, obesity and metabolic syndrome. Future research will hopefully explore different aspects of both public health problems, namely, PD and CAD in the country. The information gathered thereby, will help formulate policy to promote good oral health and tackle the deadly epidemic of CAD more efficiently.

Mitral valve Replacement in a 4 yrs old Child: First Time in Bangladesh.

Congenital mitral valve incompetence is a rare and complex congenital heart disease in children. We report, a case of a 4-year-old child admitted to hospital with fever, dyspnea on exertion or feeding and repeated respiratory infection for last 3 years. The transthoracic echocardiogram revealed grossly dilated left atrium and left ventricle and severe mitral regurgitation due to cleft in anterior mitral leaflet. Per-operatively mitral valve annulus was found very much dilated; leaflet thinned out and rudimentary posterior mitral leaflet. Morphology of mitral valve was totally distorted, leaflets were diminutive and beyond repairable. Mitral valve replacement was done with 25 mm Edward Life Science porcine tissue heart valve with total preservation of subvalvular structure and the patient showed dramatic symptomatic improvement and later follow up revealed good LV function with alleviation of symptoms. This is a rare and unusual case of congenital mitral valve disease with better prognosis after surgical replacement with tissue valve.

Longterm effects of compression method in the surgical treatment of bleeding haemorrhoids.

Objective: Present study was undertaken to find out the long term effect of application of compression probe after haemorrhoidectomy in the treatment of bleeding haemorrhoids. Materials and methods: They study was carried out in the Department of Clinical Surgery, Russian People's Friendship University, Moscow, Russia, from January 1992 to December 2001, on 80 patients, equally divided into two groups, case (haemorrhoidectomy plus application of compression probe) and control (haemorrhoidectomy only). Results: Long term follow up showed higher good outcome in case group (82.1%) compared to control (53.8%) (P<0.05), satisfactory and unsatisfactory outcome was higher in control group (17.9% and 28.2%) compared to case group (12.8% and 5.1%). Conclusion: Application of compression problem after haemorrhoidectomy in patients with bleeding haemorrhoids gives better long term results.

Evaluation of Adenosine Deaminase (ADA) Activity for Diagnosis of Tubercular Pleural Effusion.

To find out a sensitive and specific marker for early diagnosis of tubercular pleural effusion, this cross sectional study was carried out in the of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka. One hundred and three pleural effusion cases were enrolled in the study. Out of the 103 cases, 62 were tubercular pleural effusion cases and 49 were nontubercular cases. Among the nontubercular cases, 30 cases were due to malignancy, 8 were due to pneumonia and rest 3 cases were due to nephrotic syndrome, congestive cardiac failure and rheumatoid arthritis. Considering 40 U/L as a cut off value for ADA level, the test result was positive in 58 out of 62 patients of tuberculosis indicating sensitivity of the test as 94%; however, among 41 non-tuberculous patients, 5 presented ADA activity level more than 40U/L, which lowers the specificity of the test to 88%. ADA levels were significantly higher in tuberculous than in nontuberculous cases (p value <0.001). It may be concluded that ADA levels are significantly high in patients with tuberculous pleural effusion compared to that in non-tubercular group. Sensitivity (94%) and specificity (88%) of the test in tuberculous pleural effusions are very high, when cut off value set at 40U/L. The result indicated that the analysis of ADA levels in pleural effusion constitute a very useful marker for the diagnosis of tubercular pleural effusion (TPE) which, in addition, can be made quickly in a noninvasive way.

Plasma total homocysteine is not associated with peripheral neuropathy in a groups Bangladeshi type 2 diabetic subjects.

Aims: The present study was undertaken to explore the relationship of plasma homocysteine in the pathogenesis of neuropathy in diabetic patients. Subjects and Methods: Forty two type 2 diabetic patients [22 with neuropathy (DN group) and 20 without neuropathy (DNN group)], age range between 35-70 years had relatively controlled glycemia and duration of diabetes 7-15 years, were studied. Motor and sensory nerve conduction velocities and action potential amplitudes of peripheral nerves were determined by following standard protocol. HbA1c was estimated by modified HPLC (BIO-RAD Variant, USA). Serum C-peptide was measured by enzyme linked immunosorbentassay (ELISA), plasma total homocysteine by Fluorescent Polarization Immunoassay (FPIA). Results: Age, BMI and blood pressure of the study subjects were. Duration of diabetes between DN and DNN groups was comparable. DN group had significantly higher fasting glucose levels (9.8±3.8, mmol/l) compared to the DNN group (6.9±1.8, p=0.004). This trend was also reflected in the HbA1c level: 8.7± 2.1 vs 7.2±1.6 in DN group and DNN group respectively (p=0.009). The two diabetic groups had relatively higher absolute C-peptide level compared to the controls (p=ns). DN and DNN groups had significantly higher plasma homocysteine level compared to the Controls. But between the two diabetic groups no significant difference was observed. Ulnar and peroneal motor nerve conduction velocities and compound muscle action potentials in the diabetic neuropathy group significantly lower compared to diabetic counterpart and the controls. Ulnar and sural sensory nerve conduction velocities and action potentials were significantly lower in the diabetic neuropathy group compared to the diabetic counterpart and the controls. Plasma homocysteine did not show any correlation with nerve conduction velocities and action potential amplitudes. Conclusions: The data concluded that (i) Diabetic neuropathy may not be related to hyperhomocysteinemia in type 2 diabetic patients of Bangladeshi origin; (ii) Hyperglycemia, even at milder level, is related to neuronal dysfunction in these subjects; and (ii) Hyperinsulinemia don't seem to be prerequisite for neuropathy in these subjects.