Management of external hernias: analysis of 1020 [corrected] cases.

A prospective study was done to find out the incidence of different external hernias, identify the predisposing factors and type of repair performed. Over a period of 8 years, 1020 patients were admitted with different varieties of external hernias in Chittagong Medical College Hospital. Among them 743 patients had inguinal hernia, 130 had incisional hernia, 58% had indirect inguinal hernia, 29% had direct inguinal hernia, Bilateral inguinal hernia was present in 13% cases. 272 (32.08%) presented with complications like, irreducibility, obstruction, strangulation, 576 (67.92%) was admitted from out-patient department for elective operation. 97.04% of patients with inguinal hernia were male, 2.96% of patients were female. But among incisional hernia 77.70% are female and 22.30% are male patients. The highest incidence of both inguinal hernia and incisional hernia were found in 4th decade of life. Predisposing factors could be identified in 42.06% cases. 90.76% patients approached doctors for advice after 6 months of noticing hernia only 36.37% could mention the cause of delay. Out of 1020 patients (812) 72.18% patients underwent different operations. 2.5% patients were inoperable due to associated disease like Ca-liver, IHD, renal transplant, CLD, uncontrolled DM. Others refused or absconded, being afraid of operation. Effort for post operative follow up was not very satisfactory as only a small number could be followed for a limited period.

Current status of leprosy and leprosy control in Bangladesh: an ongoing collaboration.

Elimination of leprosy as a public health problem, defined by a registered prevalence of less than one case per 10,000 population, was achieved by Bangladesh in 1998, and steady reduction in prevalence is ongoing. It is less certain whether a sustained reduction in case detection is occurring, with little overall change in some longstanding programme areas, though the overall annual new case detection rate has fallen by over one-third between 1996 and 2004, from 9.8 to 6.1 per 100,000. Concerns about 'hidden' cases have been raised in Bangladesh as elsewhere, though the National Leprosy Elimination Campaign of 1999 detected relatively fewer new cases than in other countries, and mainly in low endemic areas. Investigation into the correct diagnosis of leprosy and recording and reporting practices has not suggested high levels of over-diagnosis or 'over-registration'. Both before and since achievement of the elimination target at national level, the collaboration of Non-Governmental Organizations with the national Leprosy Elimination Program has been considerable. NGOs now support ongoing leprosy control efforts in rural and urban populations, moderate to high endemic for leprosy, amounting to 50% of the entire population, and NGO staff look after 75% of all new cases in Bangladesh. This close collaboration has highlighted the potential for large-scale partnership in disease control, and has expanded to extensive partnership in tuberculosis control, which will hopefully enhance cost-effectiveness and quality of both programmes. Further challenges remain in the area of urban leprosy control, where leprosy case finding represents 30% of the whole country, but public health infrastructure and community organization is weakest. Sustaining of leprosy services in the long term is a significant concern, and new modes of collaboration, with a more technical, supportive role for NGOs in some areas is being piloted.

Experience from Bangladesh: implementing emergency obstetric care as part of the reproductive health agenda.

This paper describes the activities of the Ministry of Health and Family Welfare of the Government of Bangladesh and UNFPA to introduce emergency obstetric care (EmOC) services into the reproductive health care agenda. Working through the existing system of Maternal and Child Welfare Centers (MCWC), the quality and availability of comprehensive Reproductive Health and Emergency Obstetric Care services was improved. Investments in training, infrastructure, management information systems, quality assurance mechanisms and linkages between health care facilities in Bangladesh, have produced positive results in terms of increased utilization of these services. The Ministry of Health first implemented services in one division of the country and later scaled up to include all of the MCWCs nationally. While there are still obstacles to preventing obstetric deaths in Bangladesh, this experience shows that improvements in the quality and expansion of the range of services in existing health systems is an important step toward increasing the use of reproductive health care services by the women who need them most.

Report of the national leprosy elimination campaign (NLEC) of Bangladesh, 1999.

A national leprosy elimination campaign (NLEC) was implemented country-wide in all the 64 districts of Bangladesh for 6 days from 7 to 12 February 1999. The campaign was jointly funded by the Government of Bangladesh (GOB)/World Bank (US$250,000) and the remaining US$381,000 was provided by other international non-governmental organizations (NGOs). A total of 44,400 health workers and community volunteers were directly involved in the campaign. In all, 60,878 suspected leprosy cases were identified during the campaign, of whom 31,433 were examined and 2435 were confirmed as leprosy cases. The remaining suspects are expected to be examined within the next 2 months. Details of the new cases detected are given in Table 8. The impact of NLEC has been significant, the number of cases detected during NLEC being 20% of the annual case detection in 1998. About 52% of the total population were directly contacted through a rapid house-to-house survey and over 90% of the population was targeted through extensive use of electronic/print media and various information, education and communication (IEC) activities.

A baseline survey on use of drugs at the primary health care level in Bangladesh.

The drug use pattern and the quality of care were assessed in 80 public sector facilities throughout rural Bangladesh. A total of 40 thana health complexes and 40 union subcentres, the lowest level in primary health care facilities, were selected at random. A total of 2880 prescriptions, consultations, and drug-dispensing practices were studied, and the availability and use of essential drugs and of the essential drugs list were recorded. The average consulting time (54 seconds), the proportion of adequate examinations (37%), and prescription of drugs according to standard treatment guidelines (41%) were unsatisfactory. The mean number of drugs prescribed per patient was 1.44; 25% were treated with antibiotics, and 17% with metronidazole, irrespective of the diagnoses. The availability of drugs (54%) and the presence of an essential drugs list (16%) in the health facilities were low. However, 78% of the drugs were prescribed by their generic names, 85% complied with the essential drugs list, and 81% were dispensed according to prescription. The average dispensing time (23 seconds) and the proportion of patients who correctly understood the dosage (55%) were poor.

PIP: A nationwide survey was undertaken in Bangladesh to determine current treatment practices for the 6 most common diseases seen in outpatient clinics. Assessment was made of patient care in terms of history-taking, physical examination, and time devoted to each patient; of the drug dispensing process in terms of time taken and whether drugs were properly dispensed; of patient's knowledge of how to take the drugs; of the availability of 12 essential drugs on the survey date; and of the availability of an essential drugs list. The 6 diseases were watery diarrhea, dysentery with blood, helminthiasis, pneumonia, acute respiratory tract infections, and scabies. The health units analyzed were 10 Thana Health complexes (THCs) and 10 union subcenters (USCs) from each of the 4 administrative divisions in the country. Retrospective data were examined for September 1991 to August 1992. Prospective data were collected through observations and exit interviews with patients. It was found that the average consultation time in the THCs (60 seconds) was significantly greater than that in the USCs (48 seconds). Significantly more patients were sufficiently examined in the THCs than in the USCs, but the quality of care was found to be inadequate in each type of facility. Standard treatment guidelines were followed for only 41% of the patients, with no statistically difference between type of facility. The mean number of drugs prescribed per patient was 1.44. 25% of the patients were treated with antibiotics, and 17% with metronidazole, regardless of the diagnoses. The availability of drugs (54%) was low, and only 16% of the facilities had an essential drugs list. However, 78% of the drugs were prescribed by generic name, 85% complied with the essential drugs list, and 81% were dispensed according to prescription. The average dispensing time (23 seconds) and the proportion of patients who understood the dosage (55%) were poor. This survey was the largest to examine compliance with the World Health Organization/International Network for the Rational Use of Drugs guidelines on drug use. These findings are likely representative of the use of drugs in the public health system in rural Bangladesh. Similar surveys should be undertaken to cover the private health sector, to monitor inpatient prescribing and care, and to investigate the drug use pattern in the medical colleges and teaching hospitals.

Polarization-encoded optical shadow-casting arithmetic-logic-unit design: separate and simultaneous output generation.

A memory-efficient dual cell and a multioutput parallel arithmetic logic unit are designed by using a polarization-encoded optical shadow-casting scheme. The design algorithms for identifying the source patterns, input encoding, and output mask are also presented.

Effect of dexamethasone on the estrous cycle length in Black Bengal goats (Capra hircus ).

In an experiment to examine the relationships between adrenals and reproductive cycle, 10 mg dexamethasone (a synthetic glucocorticoid) were injected intramuscularly twice daily for 10 d to four Black Bengal goats, beginning on Day 11 of the synchronized estrous cycle. The extended length of the sexual cycle was monitored by the clinical signs of anestrus. Laparotomy was performed to examine the status of the ovary of an 8, 9, 10 and 8 d extended cycle, respectively. The length of the next cycle was normal. Endogenous cortisol values were suppressed for 11, 13, 20 and 24 d, respectively. It is thought that dexamethasone caused prolonged luteal function either by the suppression of prostaglandin F(2)alpha synthesis or by the suppression of pituitary stimulation of follicular growth.