Bacteriological Spectrum of Different Infections and their Antibiogram at NICVD, Dhaka.

Background: One of the major causes of death in the current era is the infectious diseases. Aerobic bacteria are one of the most commonly isolated organisms from hospitalised patients. Objectives: The aim of the present study was to observe the infections caused by aerobic bacteria and their antibiotics susceptibility pattern. Methods: This retrospective study was carried out in the National Institute of Cardiovascular Diseases (NICVD) from January 2012 to December 2012 for a period of one year. Patients who were admitted in medical wards and medical ICU suffering from different infections were undertaken for this study. Proper thoroughly clinical examination, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy or in between as required. Aerobic bacterial culture and sensitivity tests were done according to clinical laboratory standard institute (CLSI) standard. Result: A total of 660 samples were studied of which male (70.0%) were predominant than female (30.0%). The highest number of patients was in the age group of 30-60 years (54.0%) followed by 15-30 years (21.5%) and less than 15 years (13.0%). The mean age with standard deviation was 38.61±19.236 years. The most common isolated bacteria was Escherichia coli (40.1%) followed by Pseudomonas species (30.4%), coagulase negative Staphylococcus (19.0%) and coagulase positive Staphylococcus (5.9%); however, beta-haemolytic Streptococcus (4.2%) was detected. Urine culture has yielded Pseudomonas species (13.3%), E. coli (71.1%) and CNS (15.0%). From pus Pseudomonas species (37.3%) was isolated mostly which was 62 cases followed by E. coli (31.3%), CNS (19.3%) and CPS (7.2%). Pseudomonas species was resistant to penicillin, amoxycillin and vancomycin and ~50% resistant to cotrimoxazole, cefuroxim, ceftriaxone, piperacillin, azythromycin, cephalexin, netelmycin and pfloxacillin. Conclusion: In the conclusion, majority bacteria are resistant to commonly used antibiotics.

Prevalence of Rheumatic Fever and Rheumatic Heart Disease in School Children of Bharateswari Homes of Bangladesh.

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to affect millions of people around the world, including Bangladesh. Children and adolescents are especially susceptible to this disease. Classical risk factors, i.e. poverty, overcrowding, ignorance and insufficient health care services are responsible for the high incidence and prevalence of these diseases. To assess the prevalence of RF and RHD among children, a school survey was conducted in Bharateswari Homes, in the district of Tangail, Bangladesh. Methods: A total of 947 students were examined. Revised Jones’ criteria (1992), and clinical examination were used for the diagnosis of RF and RHD. Results: Four cases of RF/RHD were found giving the prevalence of 4.22/1000. This is lower than the prevalence reported in eighties, but is consistent with those found in nineties. Conclusion: Among the school children, there is a declining trend in the prevalence of RF/RHD.

Antibiotic Sensitivity Pattern of Bacterial Isolates from Different Clinical Specimens: Experience at NICVD, Dhaka.

Background: Infectious diseases are among the leading causes of death and sometimes curable. Bacteria are the most common etiology in hospitalized patients. The objective of this study was to evaluate the incidence of bacterial infections and their pattern of susceptibility to antibiotics in moderate and severe infections in patients admitted at NICVD hospital. Methodology: The study was performed in the apical teaching hospital of Bangladesh situated at Dhaka in the first half of 2012. Patients admitted in medical wards and medical ICU, suffering from moderate and severe infections were studied. Clinical evaluation, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy or in between as required. Aerobic bacterial culture and sensitivity tests were done. Result: A total of 274 cases were studied of which male (67.5%) were predominant than female (32.5%). The highest number of patients were in the age group of 30-60 years (53.6%) followed by 10- 30 years (24.5%) and more than 60 years (12.8%). The mean age with standard deviation was 39.15±19.07 years (range 1-90 years). Most common isolated bacteria was the Pseudomonas species (14.2%) followed by Escherichia coli (13.5%), Staphylococcus saprophyticus (6.9%) and Staphylococcus aureus (2.2%). From these specimens Pseudomonas species (31.5%) was isolated mostly from pus. E. coli was found most commonly in pus (16.3%) and urine (14.1%). Staph saprophyticus (13.0%) and Staphylococcus aureus (4.3%) were both found most commonly in pus. Pseudomonas species was 100% resistant to Penicillin, Amoxycillin and Vancomycin. It was found that Pseudomonas species was still more than 90% sensitive only to Imipenem. Escherichia coli was more than 80% sensitive to only Imipenem and Amikacin. Staphylococcus aureus was sensitive to only Imipenem and Cephalexin. Conclusion: In this study Pseudomonas species and Escherichia coli are the most common isolated bacteria in this Institution. Most of the antibiotics are resistant to these two bacteria.

Comparison of haematological values among different groups of low birth weight babies and normal birth weight babies.

This prospective cross sectional study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. This study was undertaken to compare the haematological value (reference range) among Small for gestational age-low birth weight (SGA-LBW), Appropriate for gestational age-low birth weight (AGA-LBW) and Normal birth weight (NBW) babies. Total 90 (ninety) newborn babies were enrolled in this study. They were ultimately divided into three groups as a) Group I (SGA-LBW), b) Group II (AGA-LBW), c) Group III (NBW). Study period was one year (December 2003 to December 2004), Relevant informations were collected from the guardian of the babies before inclusion in the study. In group I, 19(63.3%) were preterm and 11(36.7%) were term. In group II, 30(100%) were preterm and in group III, 30(100%) were term. Mean Hb, and HCT levels were highest in group I (SGA-LBW) and the value was 17.14+/-1.41 gm/dl (Hb) and 0.51+/-0.04 (HCT) respectively. Mean Hb and HCT value were lowest in group II (AGA-LBW) and the value was 14.57+/-1.78 gm/dl (Hb) and 0.43+/-0.05 (HCT) respectively. In between value was found in group III (NBW) and the value was 16.14+/-1.09 gm/dl (Hb) and 0.48+/-0.04 (HCT) respectively. Differences were statistically significant. On the contrary, MCV Values were highest in group II (AGA-LBW) and the value was 103.23+/-4.99 (fl). Lowest MCV value was in group III (NBW) and the value was 98.13+/-3.93 (fl). In between result of MCV value was found in group I (SGA-LBW) and the value was 99.27+/-10.73 (fl). Differences were also statistically significant. MCH and MCHC level was also highest in group I (SGA-LBW). Difference was also statistically significant. No significant differences of TC of WBC and platelet counts were not found among different groups. Hb and HCT level had significant positive correlation with gestational age. Other parameters had no Positive correlation with gestational age.

Anomalous Origin of Left Coronary Artery from Pulmonary Trunk in an Adult Patient –A Rare Occurrence.

Anomalous origin of coronary arteries is a rare cause of cardiac disease. One of the very rare coronary anomalies is origin of left main coronary artery from pulmonary trunk. Most of these patients die in the first year of life and only 10-15% survive in adulthood. We are reporting a rare case of anomalous origin of left coronary artery from pulmonary artery who survives into sixth decade of life.

Ventricular Septal Defect as a Complication of Blunt Chest Trauma: A Rare Occurrence and First Case-Report in Bangladesh.

Traumatic ventricular septal defect (VSD) is a very uncommon condition, especially in association with blunt chest trauma. A healthy young adult was diagnosed as a case of VSD one week after a road-traffic accident. History and other medical records suggest it was an acquired post-traumatic VSD. Thus, all patients of blunt chest trauma deserve close cardiac evaluation.

Knowledge of AIDS and condom as a preventive measure against AIDS among married males and factors influencing it in Bangladesh.

BACKGROUND: The acquired immunodeficiency syndrome (AIDS) is now a global scourge of mankind. Nevertheless, Bangladesh is categorized as a low HIV prevalence country, from an epidemiological point of view, the HIV epidemic in Bangladesh is evolving rapidly. The majority of the studies on HIV/AIDS and condom use were carried out among the risk segment of people in the country. This study aimed to investigate the knowledge of AIDS and use of condoms among general population for prevention of HIV/AIDS in Bangladesh. METHODS: Both quantitative and qualitative study designs were adopted in this study. Cross-sectional data were collected from rural and urban areas. Married males aged 20 years and above constituted the study population. Data on 524 male respondents were analyzed using SPSS software version 11.5. For qualitative data, selective in-depth interview was done using unstructured guidelines. RESULTS: Analysis indicated that 26 of the respondents had no knowledge about AIDS. More than one-fifth 23 had poor, 26 had well and 25 had excellent knowledge on AIDS. Only 29 reportedly mentioned that condom might be a preventive measure against AIDS. Multivariate logistic regression analysis revealed that urban residents with access to electronic and printed media, better socioeconomic condition and service holders appeared to be significantly associated with knowledge of condom as a preventive measure for AIDS p<0.05. However, in the social context, the respondents had different views about use of condom as a preventive measure against AIDS. CONCLUSION: Useful and fruitful media campaigns to educate the people regarding the health consequences of STDs including HIV/AIDS and integrated approach is strongly suggested for disseminating knowledge and awareness to control the spread of HIV/AIDS among people in Bangladesh.

Serum triglyceride level in IUGR babies and its comparison with preterm AGA and term normal babies.

Intrauterine growth and birth weight are probably the most important factors that affect in survival and future quality of life. Intrauterine growth retardation causes program changes in body systems specially lipid metabolism that creates various problems of which coronary heart disease is important. Higher serum triglyceride (TG) level in IUGR babies relates to increase incidence of coronary heart disease. This cross sectional study was conducted in Bhangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during July 2004 to June 2005. Serum TG levels were estimated among three groups: IUGR (n=30), preterm appropriate for gestational age (AGA) (n=30) and term normal (n=30) new born babies. Blood samples were collected from the study population in the neonatal unit and serum TG level were measured with all accuracy in a computerized automated biochemical analyzer in Biochemistry department of BSMMU. Statistical analysis were done by using student's 't' test. It was observed that serum TG level (54.4 +/- 11.2 mg/dl) in IUGR babies were significantly higher than that of term normal babies (38.7 +/- 5.8 mg/dl), p value < 0.05. This implicate future coronary heart disease in these babies as shown by others in long term prospective studies.

Hospital readmission and its corelates in a selected armed forces hospital.

This descriptive study used admission level data of 1040 patients to find out the readmission rate and its possible contributing factors within 30 days of discharge in a selected Armed Forces Hospital (Combined Military Hospital, Dhaka). The patients were grouped according to their admission status like group-I (readmission within 30 days of previous discharge), group-II (readmission after 30 days of previous discharge) and group-III (newly admitted patients). The readmission rate at the study period was 9.5% in group-I and 10.2% in group-II. The overall readmission rate was 19.7%. Disease pattern revealed that patients with surgical ailments (25.3%) comprised the greatest number of readmissions followed by cardiovascular diseases (19.2%) and neoplasm (10.1%). Bivariate analyses between two groups (group-I and group-II) were carried-out on different conditions of readmitted patients. No significant relationship was found between different conditions of the readmitted patients with previous stay in the hospital except adequacy of treatment. It was found that the proportion of readmission was higher in group-I among the patients who perceived that their treatment was not adequate during previous stay. This study was aimed for assessment of quality of care in order to find out the relationship between quality of care and readmission status. No statistically significant difference was found among the three groups of patients in overall quality of care (p>0.05). It is widely believed that hospital readmission has a relationship with the substandard care in previous stay. But findings of this study were not consistent with the findings of other study. Therefore, it can be concluded that readmission in an armed forces hospital is probably related with the different characteristics of the study population, disposal procedure of disease condition and the attitude of the physicians towards admission process. Further investigation and strategies, combined with reduction of avoidable admission and better screening are required to prevent this adverse outcome.

Pattern of change of weight following birth in the early neonatal period.

Birth weight of new born will vary according to gestational age, maternal, Placental and foetal intrauterine conditions. Postnatal weight change in the first few days of life (early neonatal period) may vary according to gestational age and birth weight. This may create problem in management of these babies. Birth weight and their pattern of change were followed on 105 newborns. Questionnaire and observation charts were the research Instruments and statistical analysis were done by using manual calculator. It was observed that full term newborns had better control on initial weight change following birth than preterm and low birth weight babies. Majority of term newborns loss their weight up to 5 days of life and regained their initial weight by 10 days. Maximum weight loss for longer duration occurred in preterm and very low birth weight babies who regained their initial weight by 10 - 14 days and some required more than 21 days.

Mycosis fungoides - a case of cutaneous lymphoma.

A 65 years old male, retired chemical factory worker presented with generalized erythematous plaques of various sizes for 2 years. Sun exposure of the skin lesion was painful and pruritic. Lymph nodes were palpable in the neck, axilla and inguinal region after the appearance of skin lesions. He did not give any history of prolonged pyrexic illness, night sweating and significant weight loss. On peripheral flood film examination, lymphocytosis and eosinophilia with few atypical lymphocytes suggestive of Sezary cells were noted. Histopathological examination of skin tissue confirmed the diagnosis of mycosis fungoides.

Use of Wigglesworth classification for the assessment of perinatal mortality in Bangladesh--a preliminary study.

The Wigglesworth pathophysiological classification was used to analyse perinatal deaths occurring in 5 health centres in Bangladesh. The aims were to assess the feasibility of this classification, to determine the causes of perinatal deaths and thereby to identify the areas in need of intervention. A total of 8058 births were recorded at 5 centres during the period of 11 months from mid-January to mid-December 2001. There were 1069 deaths in the perinatal period. Stillbirths were slightly more frequent (53.5%) than early neonatal deaths (46.5%). Among the stillbirths, fresh stillbirths predominated over normally formed macerated ones at all centers except BIRDEM, where the majority (52.5%) was macerated. The majority (71.6%) of perinatal deaths were in the groups comprising asphyxial conditions (46.8%), conditions associated with immaturity (13.3%), and normally formed macerated stillbirths (NFMSB, 11.5%). In the group, 'other specific conditions' which was responsible for 9.3% of perinatal deaths, all but one case was attributed to sepsis. When the cases were subdivided by birth groups, asphyxia predominated in all but the <1000g group, in whom immaturity was responsible. Conditions associated with immaturity were second highest in number. The majority of the perinatal deaths (83.4%) was in babies less than 2500g. The study has shown that the Wigglesworth classification can be used in different types of health facilities in Bangladesh by doctors, nurses and midwives. The areas which need intervention are antepartum care, obstetric and newborn care practices, and environmental factors responsible for the high prevalence of prematurity and low birth weight.

Experience of cranial ultrasonography in admitted symptomatic neonates.

In infants who have experienced perinatal injury or who have neurological symptoms, it is often difficult on the basis of history and clinical examination to come to a proper diagnosis. Cranial ultrasonography of the symptomatic neonates can often diagnose the underlying pathology. Cranial ultrasonography of 28 admitted neonates with neurological symptoms was done at Community Based Medical College Hospital (CBMCH), Mymensingh. In 11 cases (39%) there were positive findings in ultrasonography. Of them, 7 (25%) were Hypoxic ischaemic encephalopathy (HIE) and 4 (14%) had dilated ventricles. No abnormal ultrasonography findings were noted in the remaining neonates. Before closure of the fontanelles, Ultrasonography can help as a cheaper, easier and acceptable method to diagnose some neurologic problems in children.

Quality of health care from patient perspectives.

The quality of health care is the consequence of strong link between service providers and user of the services. Perceived quality is one of the principal determinant of utilisation and non-utilisation of health services, a major issue in developing countries. Considering this, the present study was aimed to assess the quality of care in in-patient and outpatient departments of rural and urban government hospitals in Bangladesh. A total of 2420 patients were interviewed. The patients were selected by using systematic random sampling technique. Results revealed that age, waiting time, time spent for patient examination, place of treatment, income, years of schooling and male sex appeared to be independent predictors of patient satisfaction (p<0.001). Age, waiting time and years of schooling were negatively related with level of satisfaction indicating younger patients, less waiting time and patients with less education were more satisfied, whereas time spent for examination, income were positively related with patient's satisfaction. Patients attending at the urban hospitals and male sex were also significantly associated with patient's satisfaction. The study recommends that both short and long-term policy action should be adopted for quality assurance of the existing health care facilities in Bangladesh.

Risk factors for acute respiratory infections among the slum infants of Dhaka city.

A cross-sectional study was conducted in five slums of Dhaka city. The study population was all adult women of reproductive age having an infant aged less than one year with a view to assessing the prevalence of Acute Respiratory Infections (ARIs) among the slum infants and also to identify the factors responsible for it. A total of 1,008 mothers were interviewed. Among them, 927 had children aged 0-12 months. Mothers with live infants (927) were asked if their children had any disease during the two weeks prior to the interview. Respiratory infection was the highest among the prevalent diseases (ARI 72%, diarrhoeal diseases 28%, measles 4% and others 4%). So, an emphasis was given in this regard. Out of 228 ARI cases, percentage of mild (78%) and severe ARI (11%) were present in children aged less than 6 months, whereas moderate ARI (23%) was higher in 6 months and above age groups. The variation was statistically significant between the two age groups (p<0.05). But there was no significant difference in ARI by sex (p>0.05). In logistic analysis, maternal age below 20 years, working mothers, low housing and socio-economic index, no household possession, no access to piped water and infant's age above 6 months appeared to be significant predictors of ARIs. The risk of acquiring ARI was 3.33 times higher in low socio-economic index, 3 times in no access to piped water, 2.39 times in low housing index, 1.9 times in mother's age below 20 years, 1.85 times in infant's age above 6 months, 1.69 times in working mothers. On the other hand, household possessions had protective effects on ARIs. The study provides important information for policy makers regarding the prevention of ARI among the children of the slum dwellers.

Serum zinc and copper levels in the maternal blood and cord blood of neonates.

Estimation of serum zinc and copper in the maternal blood and cord blood of neonates was carried out to correlate the trace metals in the neonates and their mothers in relation to gestational age and birth weight. Sixty-five healthy neonates, both term and preterm and their mothers were selected. This cross sectional study was done at Azimpur Maternity Centre, Dhaka Medical College Hospital and Chemistry Division, Atomic Energy Centre, Dhaka, Bangladesh from July 1997 to June 1998. The estimation of trace metals was carried out by Atomic Absorption Spectrophotometry (AAS). The mean serum zinc levels in the maternal blood and cord blood were 0.47 +/- 0.24 microgram/ml and 0.85 +/- 0.33 microgram/ml respectively and the mean copper levels in the maternal blood and cord blood were 1.37 +/- 0.62 micrograms/ml and 0.31 +/- 0.32 microgram/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels. There was no significant correlation between gestational age and serum zinc levels in the cord or maternal blood. But significant inverse correlation was found between gestational age and serum levels of copper in the maternal and cord blood.

Iodine deficiency disorders in Bangladesh.

An extensive iodine deficiency disorders survey was conducted in Bangladesh in 1993 to assess the latest iodine nutriture status of the country. The clinical variables of the survey were goitre and cretinism, and the biochemical variable was urinary iodine. The "EPI-30 cluster" sampling methodology was followed for selecting the survey sites. In each survey site, the study population consisted of boys and girls, aged 5-11 years, and men and women, aged 15-44 years, in about equal populations. The total number of survey sites was 78 and the total number of respondents was 30,072. The total number of urine samples was 4512 (15% sub-sample). The current total goitre rate (grade 1 + grade 2) in Bangladesh is 47.1% (hilly, 44.4%; flood-prone, 50.7%; and plains, 45.6%). The prevalence of cretinism in the country is 0.5% (hilly, 0.8%; flood-prone, 0.5%; and plains, 0.3%). Nearly 69% of Bangladeshi population have biochemical iodine deficiency (urinary iodine excretion [UIE] < 10 mg/dl) (hilly, 84.4; flood-prone, 67.1%; and plains 60.4%). Women and children are more affected that men, in terms of both goitre prevalence and UIE. The widespread severe iodine deficiency in all ecological zones indicates that the country as a whole is an iodine-deficient region. Important recommendations of global interest are made from the experience of the survey.

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.