Blood level of lead in women with unexplained infertility.

Toxic effect of lead on human reproductive system is a recent concern. Various studies suggest that lead has adverse effect on the reproductive system of both sexes. The present cross-sectional case-control study was done to investigate the blood lead level in women with unexplained infertility. The study was conducted in the Department of Obstetrics and Gynecology and Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2008 - June 2009. A total of 50 women with unexplained infertility (case) ranging from 18-40 years were consecutively included in the study. An equal number of apparently healthy fertile women (control) were included as control. None of the cases and controls was diabetic. Of the infertile women over half (54%) of the patients had primary infertility and 46% secondary infertility. The mean blood level of lead was significantly higher in case group than that in control group (130.0±45.2 vs. 78.3±36.4µg/L, (p<0.001). Correlation between blood lead level and FSH revealed that the two variables had a significantly linear relationship (r=0.213, p=0.033). The correlation coefficient shows that 21% of the variations in FSH can be explained by blood level of lead. Infertile women with absence of the apparent causes of infertility including absence of their male-partner infertility may have unusually high level of lead which could be attributed to infertility.

Cutaneous sporotricosis.

Sporotrichosis, a deep fungal infection caused by Sporothrix schenckii, is a rare disease. Infection acquired by traumatic implantation of fungus to the skin. Our patient a 40 years old woman presented with multiple erythematous, ulcerated, crusted nodules of different size and shape situated over the right little finger to upper arm along the course of the lymphatic in a linear fashion. Microscopic examination and culture of the discharge from the skin lesion was done. Sporothrix schenckii was detected on microscopic examination (Yeast form) and on culture (Mycelial form). The patient was treated with Itraconazole at a dose of 100 mg twice in a day for 6 months. She was clinically cured of the disease by 6 months and then the treatment was stopped. We do not commonly encounter sporotrichosis in our practice. We are therefore, prompted to report the case.

Patch test for the detection of contact allergens.

Patch Test was done in 340 suspected allergic contact dermatitis patients having different ages of both sexes during the period of January 2000 to December 2003 in the department of Dermatology and Venerology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Of these 340 cases 145 (42.65%) were male and 195 (57.35%) were female. Among these 340 cases, 250 (73.53%) cases were tested with international standard series allergen (ISS) and 90 (26.47%) cases with cosmetic series allergen (CSS), of which patch test was positive in 125 (50%) cases and 65 (72.22%) cases respectively. The 125 positive cases with ISS consisted of 56% male and 44% female. In 65 CSS positive cases 90.77% were female and 9.23% were male. Highest incidence of positive patch test was found in 61.54% cases in the age group of 30-39 years in ISS and 71.43% cases in the age group of 20-29 yrs in CSS. In ISS--Potassium Dichromate (19.2%), Fragrance mix (17.6%), Nickel Sulphate (15.2%) and PPD (11.2%) were found to be the common allergen and in CSS--Octyl Gallate (27.69%), Getrimide (18.92%), Balsum of Peru (15.38%), Thiomersal (12.31%) were found to be the common allergens.

Seroprevalence of dengu infections amongst the children.

Serosurvillance of 650 children of clinically suspected dengue infection based on simple laboratory tests were evaluated to find out the early indicator for diagnosis of dengue infection. The study was conducted among the patients attending the Sir Salimullah Medical College (SSMC) and Mitford Hospital and Popular Diagnostic Center, Dhaka, during July 2002 to September 2002. Of these 650 suspected dengue cases, 294 were in the age group 1-5 years, 206 were in age group 6-10 years and 150 cases in age group 11-15 years, of which Seropositivity was found in 78 (26.53%), 60 (24.12%) and 65 (43.33%) cases respectively. Primary dengue IgM was positive in 123 (60.59%) cases and secondary dengue (IgG & IgM combined or IgG alone) was positive in 80 (39.41%) cases. Leucopenia was found in 90 (75%) cases and Thrombocytopenia was found in 95 (79.16%) cases in primary dengue cases. Similarly in secondary dengue cases TWBC and PLT was decreased in 60 (72.29%) and 65 (78.15%) cases respectively. Haemoconcentration was found in 40 (36.67%) cases of primary dengue and 13 (18%) cases in secondary dengue. Month wise distribution of dengue seropositivity shows that 10 (8.53%) cases was found in July, 175 (50.10%) cases in August and 78 (10.00%) cases in September. This study reveals that seropositivity is highest (43.33%), in the age group 11-15 years and incidence of dengue increased in the month of August. Leucopenia (WBC

The potential for social mobilisation in Bangladesh: the organisation and functioning of two health insurance schemes.

Health insurance schemes are usually assessed according to technical indicators. This approach, however, neglects the dynamic perspective of insurance schemes as an element of people's mobilisation for participation in organising and managing health care delivery and financing. The first part of this paper describes the technical performance and the level of community involvement in management of the two largest health insurance schemes in Bangladesh, both in the rural areas and in the non-government sector. Part two discusses these achievements in light of the schemes' potential role as a mechanism for people's management of health care. A review of documents and key-informant interviews were conducted. Key findings include that (1) subscribers currently are not actively participating in scheme management. However, existing family groups, involved in credit programmes may serve as entry-points for interaction. This is sustained by the 'natural link' between health insurance as a means of spreading the risks of treatment costs and credit programmes as a means of decreasing the relative impact of illness on household income. (2) The schemes' role could be further enhanced, by improving their technical performance and applying health care systems elements with the input of all partners involved. These issues are avoidance of service duplication with other providers; better protection of the poorer households; inclusion of hospital care in the coverage package; simplification of scheme administration by introduction of episode-based co-payments instead of the current itemised ones and concentrating the schemes at the level of community-based services, which may be self-financed and also self-managed by the community, given available sensitisation, training and interaction. A shift to episode-based co-payments would also introduce solidarity among patients and among individuals at higher risk, such as pregnant women and under-fives. Finally, action-research is needed to document the process of increased community involvement.

Injectable contraception (medroxyprogesterone acetate) in rural Bangladesh.

1601 women used the injectable contraceptive agent medroxyprogesterone acetate for up to 3 years. The programme was conducted by a rural health centre with detailed follow-up. While the continuation-rate, 56% after 1 year, compared favourably with that of other contraceptive methods in Bangladesh, at least half the women experienced troublesome menstrual side-effects and there were indications that milk yield was adversely affected in 147 out of the 1020 women who received the first injection while lactating.