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

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

Anti H.pylori IgM in Symptomatic and Asymptomatic Population.

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

PCR for mecA Gene of Methicillin Resistant Staphylococcus Aureus.

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

Comparison of efficacy between Tamsulosin and Finasteride on symptomatic Benign Prostatic Hyperplasia.

This prospective study was done to compare the efficacy of Tamsulosin and Finasteride for the medical treatment of symptomatic Benign Prostatic Hyperplasia (BPH) at the surgery and urology outpatient department of Mymensingh Medical College Hospital during the period from January 2003 to December 2004. Closely matched 70 patients in the age range of 50-80 years presented with lower urinary tract symptoms and clinically diagnosed as BPH were selected in the present study. Among them, 36 patients (Group I) and 34 patients (Group II) were treated with Tamsulosin (0.4 mg once daily) and Finasteride (5 mg once daily) for a duration of 06 months respectively. The efficacy of two drugs was compared on the basis of IPSS and Qmax. The base-line parameters of both groups were statistically insignificant. A significant improvement of IPSS and Qmax was found after 06 months of treatment in both groups (P<0.001). A significant improvement of IPSS Qmax was found in both groups (p<0.001) during follow-up at 1st, 2nd, 4th and 6th month. It was also observed that Tamsulosin improved the IPSS and Qmax more quickly than Finasteride.

Diagnosis of human rotavirus in stool specimens: comparison of different methods.

A total of 345 stool specimens of hospitalized children below 5 years of age with acute gastroenteritis were tested for the presence of rotavirus by Polyacrylamide gel electrophoresis (PAGE), a monoclonal antibody based enzyme immunoassay (EIA) and a latex agglutination test (LAT). Detection rate for PAGE and EIA were 24.9% (345/86) and 20.9% (345/70) respectively. Using PAGE as the standard, the sensitivity and specificity of EIA were 75.6% and 98.1% respectively. The sensitivity of LAT was 70.9% with 100% specificity (LAT was done in only PAGE positive specimens). LAT appeared as the simplest and economic for both bed side and field use.

Serum copper in rural women taking combined oral contraceptive.

This prospective case-control study included 78 women between 15 to 45 years of age from rural area to see changes in serum copper level as a consequence of oral contraceptive use. Among the subjects, 34 women were included as controls because of not taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. Women in the control group were motivated to consume oral pill (Sukhi) for 3 consecutive cycles. At the 3(rd) month, 25 such women became available and henceforth included as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for a duration of 4 months onwards. Considering different duration of oral contraceptive (OC) use, subjects were grouped as follows: Group I (n=34)--> controls, Group II (n=25)--> 3 months, Group III (n=17)--> 4 months - 2 years and Group IV (n=27)--> >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Copper (mgm/dl) by Atomic Absorption Spectrometry using UNICAM-AA Spectrometer. Mean+/-SD of Serum Copper significantly increased in all 3 contraceptive groups in comparison to controls (p<0.001). Further study including larger population from rural area was recommended to see correlation among serum copper and other trace elements with side effects of hormonal contraceptives. This preliminary study tried to explore the possibility of establishing biochemical monitoring of serum trace elements in OC users.

Extracranial complications of chronic suppurative otitis media.

The aim of this study was to find out the pattern of extracranial complications of CSOM cases who attended to the department of ENTD, Mymensingh Medical College Hospital during the period from July'1999 to June' 2001. Different types of extracranial complications of CSOM were presented here. A total of 100 cases, diagnosed clinically and radiologically were included in the study of which 66 were male and 34 were female giving a male to female ratio of 1.94 : 1 (p < 0.05). Majority cases (53) were in the age group of 11- 20 years followed by the age group of below 10 years where there were 30 cases. Majority (64) cases came from low socio-economic class. The number of different types of extracranial complications of CSOM were as follows: mastoid abscess 57, discharging sinuses 28, purulent labyrinthitis 07, Bezold's abscess 04, fascial nerve paralysis 03 and zygomatic abscess 01. In all cases of CSOM Cholesteatoma were detected. In 14 cases, Cholesteatoma were associated with granulation tissue/polyp. Modified radical mastoidectomy were performed in all cases. On analyzing the findings of the present study it was observed that mastoid abscess were the predominant extracranial complications of CSOM, affecting mostly the male population of 11 - 20 years age group coming from low socio-economic class.

Comparison between ELISA and ICT- MycoDot in adult pulmonary tuberculosis.

The present study was conducted to see the diagnostic efficacy of serum anti-TB IgG antibody detection in adult pulmonary tuberculosis (TB) by ELISA and Immunochromatography test (ICT) method using commercially available diagnostic kit (Pathozyme TB complex and MycoDot test respectively). This case-control study included 48 cases of adult pulmonary TB within the age range of 15-65 years. Among them, 22 (45.9%) were AFB positive confirmed cases, 12 (25.0%) were AFB negative clinically diagnosed cases before treatment and 14 (29.1%) were clinically diagnosed cases on treatment. Age and sex matched 33 controls were also included, of which 19 (57.6%) were healthy and 14 (42.4%) were sick with non-specific pulmonary infection. Overall sensitivity and specificity of ELISA were 60.42% & 96.97% (p<0.001) and those of MycoDot as 72.92% & 93.94% (p<0.001). Rate of both ELISA and MycoDot positive were higher among clinically diagnosed cases on treatment with respective values as 71.42% and 85.71%. Respective values among AFB positive confirmed TB cases were 68.18% and 72.72%. As, both ELISA and MycoDot yielded be used as a confirmatory test for TB.

Evaluation of hormone replacement therapy.

Hormone Replacement Therapy (HRT), once considered as the gold standard of treatment of menopausal symptoms and osteoporosis, introduced about seventy years ago still continuing with lot of controversies. Menopause, a transitional period of women's life, is not an illness when oestrogen level falls leading to its consequences. Results of earlier observational studies showed beneficial effects of HRT including cardiovascular protection. But all recent randomized controlled trials have failed to prove these positive effects, rather increases the cardiovascular risk and breast cancer. Women's Health Initiative(WHI), one of the recent randomized controlled trials was stopped prematurely in 2002 due to unfavorable risk-benefit ratio. HRT is not the only way of treating the menopausal symptoms and other consequences of estrogen deficiency. There are suitable alternatives without bearing the risk of HRT. Vasomotor symptoms with hot flushes and sweating experienced by about 75 percent of menopausal women can be treated with alternatives like phyto-estrogens, selective estrogen receptor modulators (SERMs), clonidine, selective serotonin reuptake inhibitors, acupuncture, exercise, behavioral therapy etc. HRT is no longer considered as the first line of treatment of postmenopausal osteoporosis. It can be treated with alternatives like regular weight bearing exercise, balanced calcium rich diet, maintaining weight, avoidance of bone robbers, (like excess alcohol, caffeine, smoking), use of SERMs etc. Use of HRT should be individualized and rationalized considering its risks and benefits.

Comparison between ELISA and ICT-MycoDot in childhood tuberculosis.

Diagnosis of childhood tuberculosis (TB) is a difficult job. Keeping this fact in mind, the present study was designed to detect serum anti-TB IgG antibody in childhood TB cases by Enzyme Linked Immunosorbent Assay (ELISA) and Immunochromatography test (ICT) method using commercially available diagnostic kit (Pathozyme TB complex and MycoDot test respectively). This case-control study, were done on 52 cases of childhood TB within the age range of 4(+)-14 years. Among them, 15 (28.8%) were AFB positive confirmed cases, 25 (48.1%) were AFB negative clinically diagnosed cases before treatment and 12 (23.1%) were clinically diagnosed cases on treatment. Age and sex matched 36 controls were also included of which 21 (58.3%) were healthy children and 15 (41.7%) were sick children with non-specific pulmonary infection. Overall sensitivity and specificity of ELISA were 34.62% and 97.20% (p<0.001) and those of MycoDot as 48.08% and 96.92% (p<0.001). Rate of both ELISA and MycoDot positive were higher among. clinically diagnosed cases on treatment with respective values as 71.42% and 85.71%. Respective values among AFB positive confirmed TB cases were 40% and 72.72%. Different aspects of immune response in TB were discussed. Since, both method yielded negative results in confirmed TB cases, so none of the methods should be considered as a confirmatory test method for TB.

Serum zinc status of rural women taking combined OC.

This prospective case-control study was undertaken on 78 women between 15 to 45 years of age from rural area to see alteration of serum zinc due to oral contraceptive (OC) use. Of the subjects, 34 women was taken as controls having no history of taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. All of the women in the control group were advised to start consuming oral pill (Sukhi) for 3 consecutive cycles and at the 3(rd) month, 25 women were taken as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for 4 months onwards. Subjects were classified as follows on the basis of duration of oral contraceptive use: Group I (n=34) -- controls, Group II (n=25) -- 3 months, Group III (n=17) -- 4 months -- 2 years and Group IV (n=27) -- >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Zinc (microg/dl) by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer. MeanSD of Serum Zinc significantly reduced in all 3 contraceptive groups in comparison to controls (p<0.001). It was recommended to carry out further study including larger population from rural area to elucidate alteration in serum zinc and other trace elements to correlate with side effects caused by hormonal contraceptive so that attempt could be made to mitigate those.

Pattern of aerobic bacteria with their drug susceptibility of surgical inpatients.

The pattern of aerobic bacteria with their antibiotic susceptibility isolated from infected patients in one of the surgical units at Mymensingh Medical College Hospital during the period from September to November' 2000 were reported in the present study. Out of 74 clinical samples, 52 were wound swabs, 18 were pus and 4 were urine. Bacterial growth was yielded in 43 samples and the distribution of isolates was as follows: Pseudomonas spp 16, Esch.coli 13, Staphylococcus aureus 08, Klebsiella spp. 03 and others 03. Majority (61.5 %) of culture positive results were found in wound swabs. Antibiotic susceptibility pattern showed considerable variation within Gram negative bacterial isolates. All the Esch.coli and Klebsiella isolates were resistant to amoxicillin. Ceftriaxone (65.6% and 100% respectively) and ciprofloxacin (71.4% and 100%) still appeared to be highly sensitive for both species. Over 93% strains of Pseudomonas were sensitive to Ceftazidime and aztreonam. Whereas, over 43% of same strains were resistant to ciprofloxacin. Over 87% strains of Staph.aureus were resistant to penicillin but sensitive to erythromycin. Whereas, 100% of those strains were sensitive to cloxacillin. Over 50% of all isolates were sensitive to gentamicin but resistant to cefalexin and cotrimoxazole. It was suggested to be careful regarding selection of antibiotic regime in surgical cases to minimize incoming higher magnitude of drug resistance among bacteria in near future.

Pattern of bacteria and their antimicrobial susceptibility isolated from inanimate objects and hospital personnel.

Different inanimate samples collected from surgery wards and general operation theatre (GOT) as well as animate samples from surgery personnel were subjected to aerobic culture with the aim of identifying source of infections in surgical cases. The pattern of aerobic bacteria with antibiotic susceptibility isolated from those samples were reported in the present study. Out of 91 such samples, 53 and 26 were from different locations in general wards and OT respectively and 12 were comprising of hand swabs, throat swabs and nasal swabs from surgery personnel. Pathogenic bacteria were isolated from 34 samples having Pseudomonas spp. (18/34) in the top of the list followed by Esch. coli (14). Among the Esch.coli isolates resistance to cotrimoxazole, amoxicillin and doxycycline were 78.7%, 71.4% and 57.1% respectively, whereas sensitivity to aztreonam, ceftazidime, gentamicin and ciprofloxacin were 100%, 85.8%, 78.7% and 71.4% respectively. Ceftriaxone yielded intermediate sensitive results in 21.4% strains. Isolates of Pseudomonas spp. also showed very high sensitive results to aztreonam, ceftazidime and ceftriaxone (94.7%, 94.7% and 84.2% respectively). Ciprofloxacin and gentamicin were sensitive in 68.4% and 57.9% respectively. Susceptibility pattern showed well correlation with clinical response in infected cases.

A preliminary report on culture of Leishmania donovani in Mymensingh Medical College and evaluation of new immuno-chromatography test (ICT).

A total of 51 inpatients having prolonged low grade irregular fever with anaemia, hepatosplenomegaly, emaciation and other allied features were evaluated by findings of haematologic, seroimmunologic, microscopic examination for LD body and culture for L. donovani. The study was done during the period from September' 1999 to January' 2000. Bone marrow or splenic aspirates were examined for LD bodies and those samples were cultured in modified NNN media following a standard method. Out of 51 samples, 36 (70.5%) were positive for LD bodies in stained smears and 38 (74.5%) were positive in culture. The mean time of culture positivity was 5 +/- 2 days. Specific antileishmanial antibody were detected by Immunochromatography Test (ICT) in all 38 confirmed cases, whereas Aldehyde test (AT) were negative in 3 such cases. ICT was positive in 1 and AT in 7 cases where no parasite could be detected. So, sensitivity of ICT was 100% with a specificity of 92.3% and sensitivity of AT was 92.1% with a specificity of 46.1%.

Increasing trend of ciprofloxacin resistance amongst common bacterial isolates at Mymensingh Medical College and Hospital.

Ciprofloxacin resistance among common bacterial pathogen comprising Esch.coli, Staph.aureus and Pseudomonas spp. isolated from different clinical samples of Mymensingh Medical College Hospital during the periods of September, 1999 to March, 2001 and September, 2001 to August, 2002 were recorded. Values of two periods were compared and increased rate of ciprofloxacin resistance were noted in every bacterial species, e.g. 32.0% in Esch.coli, 8.7% in Staph.aureus and 5.1% in Pseudomonas spp. It was suggested to be aware and careful regarding use of ciprofloxacin in clinical practice so as to limit emergence of bacterial strains resistance towards the drug.