Endoluminal Ultrasonography versus Computed Tomography for Locoregional Staging of Carcinoma Stomach.

Curative surgery remains the mainstay treatment of carcinoma stomach till to date. Preoperative accurate diagnosis of the depth of tumour invasion (T) and nodal involvement (N) in stomach cancer is important in determining the choice of an optimal therapeutic approach. Endoluminal ultrasonography (EUS) is considered as most reliable tools for assessing locoregional staging as it can overcome bones and air barrier on the other hand computed tomography (CT) has increased its' efficacy greatly after introduction of extreme multi-detector and phase-contrast CT. The objective of this study was to compare the accuracy of T and N staging with EUS and CT by comparing with postoperative histopathology in stomach carcinoma. This cross-sectional observational study was conducted in the department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2019 to July 2020. Forty five (45) patients who underwent curative stomach resection surgery due to carcinoma of stomach were enrolled in this study. All patients were investigated by EUS and CT preoperatively to assess locoregional staging. Then patients underwent stomach resection surgery and specimen sent for histopathology. EUS had sensitivity 80.0% to predict T staging but specificity 60.0% and the overall accuracy was 68.89%. CT result showed sensitivity 59.38% to predict T staging but specificity 46.15%, and the overall accuracy was 55.56%. EUS had 65.63% sensitivity to predict nodal involvement but specificity 61.54% and the overall accuracy was 64.44%. CT had 83.33% sensitivity to predict nodal involvement but specificity 55.56% and the overall accuracy was 77.78%. EUS is more accurate than CT in T staging but CT is more accurate than EUS in the N staging of carcinoma stomach. So EUS and CT both should be used as a diagnostic tool for preoperative locoregional staging of carcinoma stomach.

Comparison of Pain Control and Analgesic Consumption With or Without Infiltration of Bupivacaine at Port Sites after Laparoscopic Cholecystectomy.

Pain management is an essential component of all surgical procedures. Analgesics are used for this purpose but there are some complications in using them. Local anesthetics like bupivacaine can be used to reduce postoperative pain as well as analgesics consumption. The objective of this study is to observe the result of infiltration of bupivacaine at port sites and to compare the postoperative pain relief with that of opioids and NSAID administration following laparoscopic cholecystectomy for chronic calculus cholecystitis. This is a cross sectional study was conducted over one year in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2018 to August 2019. Here total 40 patients were enrolled by purposive sampling. They were divided in two groups. One group received bupivacaine while other did not. A numerical pain scale was used as tool. Data will be recorded by peer reviewed interview and observation based semi structured data collection sheet. Data analysis was done by SPSS version 23.0. P-value was significant at (p<0.05) and determined by chi square test. Written informed consent was taken from the patient. The mean Numerical Rating Scale (NRS) score of pain at 6 hour was 2.55±0.6 in Group I and 6.8±1.15 in Group II. The mean NRS score of pain at 12 hour was 4.1±1.21 in Group I and 7.95±0.6 in Group II. The mean time of 1st analgesic administration was 13.85±1.57 hours in Group I and 2.75±0.72 hours in Group II. The mean repeat dose of analgesic was in 22±2.29 hours in Group I and 9.5±1.15 hours in Group II. In Group I one third patients (30.0%) single dose analgesic required in 1st 12 hours while in Group II almost 90.0% patients needed analgesics in 1st 12 hours. In Group I, total doses of analgesics required were 2 in 75.0% patients while in Group II at least 3 doses of analgesics were needed. In Group I only one patient needed analgesic in first 6 hours (5.0%) while in Group II, all the patients (100.0%) needed analgesics. The difference was statistically significant (p<0.05) between two groups. The patients receiving bupivacaine at port sites will experience less pain at postoperative period and will need less analgesic medications.

Development and external validation of machine learning algorithms for postnatal gestational age estimation using clinical data and metabolomic markers.

BACKGROUND: Accurate estimates of gestational age (GA) at birth are important for preterm birth surveillance but can be challenging to obtain in low income countries. Our objective was to develop machine learning models to accurately estimate GA shortly after birth using clinical and metabolomic data. METHODS: We derived three GA estimation models using ELASTIC NET multivariable linear regression using metabolomic markers from heel-prick blood samples and clinical data from a retrospective cohort of newborns from Ontario, Canada. We conducted internal model validation in an independent cohort of Ontario newborns, and external validation in heel prick and cord blood sample data collected from newborns from prospective birth cohorts in Lusaka, Zambia and Matlab, Bangladesh. Model performance was measured by comparing model-derived estimates of GA to reference estimates from early pregnancy ultrasound. RESULTS: Samples were collected from 311 newborns from Zambia and 1176 from Bangladesh. The best-performing model accurately estimated GA within about 6 days of ultrasound estimates in both cohorts when applied to heel prick data (MAE 0.79 weeks (95% CI 0.69, 0.90) for Zambia; 0.81 weeks (0.75, 0.86) for Bangladesh), and within about 7 days when applied to cord blood data (1.02 weeks (0.90, 1.15) for Zambia; 0.95 weeks (0.90, 0.99) for Bangladesh). CONCLUSIONS: Algorithms developed in Canada provided accurate estimates of GA when applied to external cohorts from Zambia and Bangladesh. Model performance was superior in heel prick data as compared to cord blood data.

Synthesis, in vitro bioassays, and computational study of heteroaryl nitazoxanide analogs.

Antiprotozoal drug nitazoxanide (NTZ) has shown diverse pharmacological properties and has appeared in several clinical trials. Herein we present the synthesis, characterization, in vitro biological investigation, and in silico study of four hetero aryl amide analogs of NTZ. Among the synthesized molecules, compound 2 and compound 4 exhibited promising antibacterial activity against Escherichia coli (E. coli), superior to that displayed by the parent drug nitazoxanide as revealed from the in vitro antibacterial assay. Compound 2 displayed zone of inhibition of 20 mm, twice as large as the parent drug NTZ (10 mm) in their least concentration (12.5 µg/ml). Compound 1 also showed antibacterial effect similar to that of nitazoxanide. The analogs were also tested for in vitro cytotoxic activity by employing cell counting kit-8 (CCK-8) assay technique in HeLa cell line, and compound 2 was identified as a potential anticancer agent having IC50 value of 172 µg which proves it to be more potent than nitazoxanide (IC50  = 428 µg). Furthermore, the compounds were subjected to molecular docking study against various bacterial and cancer signaling proteins. The in vitro test results corroborated with the in silico docking study as compound 2 and compound 4 had comparatively stronger binding affinity against the proteins and showed a higher docking score than nitazoxanide toward human mitogen-activated protein kinase (MAPK9) and fatty acid biosynthesis enzyme (FabH) of E. coli. Moreover, the docking study demonstrated dihydrofolate reductase (DHFR) and thymidylate synthase (TS) as probable new targets for nitazoxanide and its synthetic analogs. Overall, the study suggests that nitazoxanide and its analogs can be a potential lead compound in the drug development.

Electrosurgery Dissection versus Sharp Dissection: Effect on Early Postoperative Wound Complications in Modified Radical Mastectomy.

Modified radical mastectomy (MRM) is still the most commonly performed operation for breast cancer, despite the trends toward breast-conserving treatment. Since 1970s, electrosurgery (also known as electrocautery, diathermy) has been a widespread surgical tool to raise flaps and excise the breast specimen in order to perform a bloodless mastectomy. Use of diathermy has been well blamed for wound complications. To prevent undue delay in the adjuvant treatment, it is important to minimize the surgical complications. This quasi experimental study was conducted in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to evaluate the effects of electrosurgery and sharp dissection on early postoperative wound complications in MRM. 46 patients were included in the study (23 in each group). Data analysis done in SPSS version 23.0 and 'p' value <0.05 considered significant at 95% confidence interval. In Electrosurgery Dissection (ED) group mean duration of drainage was 7.8±1.2 days and in Sharp Dissection (SD) group 6.4±1.0 days (p value 0.000). Mean total drainage in ED group found 1082±287ml and in SD group 693±194ml (p value 0.000). Seroma formation found 7(30.4%) in ED group and 3(13.0%) in SD group (p value 0.004). Wound dehiscence found 5(21.7%) in ED group and 2(8.7%) in SD group (p value 0.013). Flap necrosis rate was 4(17.4%) and 1(4.4%) in ED and SD group respectively (p=0.003). Demographic and clinical variables were similar or differences were not statistically significant in two groups. No difference found in operating time and wound infection rate in two groups. The result of the study showed that, electrocautery dissection caused early postoperative wound complications more than the sharp dissection.

Role of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Lesions.

To evaluate the diagnostic utility of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic lesions, EUS-FNA was carried out on a total of 28 cases at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2015 to August 2016. Clinical impression was compared with the final cytological diagnosis and the percentage of non diagnostic smears was calculated. The lesions were categorized according to cytological report. Out of 28 cases, 3(10.71%) cases were normal, 6 cases (21.43%) were reported as inconclusive while a definite diagnosis was given in 19 cases (67.85%). The mean patient age was 47.82 years. There were 16(57.1%) males and 12(42.9%) females. The most common site biopsied was pancreatic head in 21cases (75%) followed by tail in 5 cases (17.9%) & body in 2(7.1%) cases. The average number of passes made was two. Endoscopic Ultrasound Guided Fine-Needle Aspiration in the diagnosis of pancreatic lesion is a useful procedure.

SERS-Active 3D Interconnected Nanocarbon Web toward Nonplasmonic in Vitro Sensing of HeLa Cells and Fibroblasts.

A noninvasive intracellular component analysis technique is important in cancer treatment and the initial identification of cancer. Carbon nanomaterials/nanostructures, such as carbon nanotubes and graphene, have little to no surface enhanced Raman scattering (SERS) ability. Because of these structures' low Raman responses, they are conjugated with gold or silver to attain the SERS-active ability to detect normal fibroblasts and HeLa cancer cells. To the best of our knowledge, the effectiveness of the individual use of carbon nanomaterials as a nonplasmonic SERS-active platform for in vitro cancer/normal cell detection has not been investigated to date. Here, for the first time, we introduce a unique nonplasmonic SERS-based biosensing platform that uses a biocompatible self-assembled three-dimensional interconnected nanocarbon web (INW) for in vitro detection and differentiation of HeLa cells and fibroblasts. The sub-10-nm morphology of the INW facilitates the endocytic uptake of INW clusters to the cells, and its SERS functionality introduces live cell Raman sensing. The INW platform has achieved an enhancement factor (EF) of 3.66 × 104 and 9.10 × 103 with crystal violet and Rhodamine 6G dyes, respectively, significant in comparison to the EF of graphene surfaces (2-17). The results of the time-based Raman spectroscopy of live HeLa cells and fibroblasts revealed chemical fingerprints of intracellular components, such as DNA/RNA, proteins, and lipids. The components' spectroscopic differences facilitate and elucidate the specification of each cell. The highest Raman enhancement achieved was fourfold for fibroblasts (protein) and sixfold for HeLa cells (DNA). Furthermore, the SERS spectra along with scanning electron microscopy and fluorescence microscopy analysis of the immobilized cells after 24 and 48 h shed light on the health of fibroblasts and HeLa cells. A photon energy-induced ionization achieved with a femtosecond laser fabricated a biocompatible INW platform with the designated unique attributes. This simple, label-free, in vitro diagnosis approach for HeLa cells and fibroblasts has strong potential for cancer research.

Fibroblast-Cytophilic and HeLa-Cytotoxic Dual Function Carbon Nanoribbon Network Platform.

Carbon nanomaterials have emerged as a promising material in cancer diagnosis and therapy. Carbon nanomaterials/nanostructures (C-C molecular structure) act as a carrier/skeleton and require further surface modification through functionalization with chemicals or biomolecules to attain cell response. We report the synthesis of a novel carbon nanoribbon network (CNRN) platform that possesses a combination of C-C and C-O bond architecture. The bioactive CNRN showed enhanced ability for cell adhesion. Most importantly, it induced opposite cell responses from healthy cells and cancerous cells, cytophilic to fibroblasts but cytotoxic to HeLa cells. Ultrafast laser ionization under ambient conditions transforms nonbioresponsive C-C bond of graphite to C-C and C-O bonds, forming a self-assembled CNRN platform. The morphology, nanochemistry, and functionality on modulating fibroblast and HeLa adhesion and proliferation of the fabricated CNRN platforms were investigated. The results of in vitro studies suggested that the CNRN platforms not only attracted but also actively accelerated the adhesion and proliferation of both fibroblasts and HeLa cells. The proliferation rate of fibroblasts and HeLa cells is 91 and 98 times greater compared with that of a native graphite substrate, respectively. The morphology of the cells over a period of 24 to 48 h revealed that the CNRN platform induced an apoptosis-like cytotoxic function on HeLa cells, whereas fibroblasts experienced a cytophilic effect and formed a tissuelike structure. The degree of cytotoxic or cytophilic effect can be further enhanced by adjusting parameters such as the ratio of C-C bonds to C-O bonds, the nanoribbon width, and the nanovoid porosity of the CNRN platforms, which could be tuned by careful control of laser ionization. In a nutshell, for the first time, pristine carbon nanostructures free from biochemical functionalization demonstrate dual function, cytophilic to fibroblast cells and cytotoxic to HeLa cells.

Correction: Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases.

[This corrects the article DOI: 10.1371/journal.pone.0167702.].

Biofunctionalized 3-D Carbon Nano-Network Platform for Enhanced Fibroblast Cell Adhesion.

Carbon nanomaterials have been investigated for various biomedical applications. In most cases, however, these nanomaterials must be functionalized biologically or chemically due to their biological inertness or possible cytotoxicity. Here, we report the development of a new carbon nanomaterial with a bioactive phase that significantly promotes cell adhesion. We synthesize the bioactive phase by introducing self-assembled nanotopography and altered nano-chemistry to graphite substrates using ultrafast laser. To the best of our knowledge, this is the first time that such a cytophilic bio-carbon is developed in a single step without requiring subsequent biological/chemical treatments. By controlling the nano-network concentration and chemistry, we develop platforms with different degrees of cell cytophilicity. We study quantitatively and qualitatively the cell response to nano-network platforms with NIH-3T3 fibroblasts. The findings from the in vitro study indicate that the platforms possess excellent biocompatibility and promote cell adhesion considerably. The study of the cell morphology shows a healthy attachment of cells with a well-spread shape, overextended actin filaments, and morphological symmetry, which is indicative of a high cellular interaction with the nano-network. The developed nanomaterial possesses great biocompatibility and considerably stimulates cell adhesion and subsequent cell proliferation, thus offering a promising path toward engineering various biomedical devices.

Coblation® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up.

OBJECTIVES: Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with few published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation® intracapsular tonsillectomy, for both obstructive and infective indications. DESIGN: Prospective case series, March 2013-January 2016, all with completed follow-up. SETTING: Tertiary paediatric otolaryngological practice. PARTICIPANTS: A total of 500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT). MAIN OUTCOME MEASURES: Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and postoperatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure. RESULTS: With a mean follow-up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 postoperatively, P<.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%); otherwise, no complications, delayed discharges or readmissions occurred; 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery. CONCLUSIONS: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases.

A comprehensive germplasm evaluation study of wheat accessions conserved in the Indian National Genebank was conducted to identify sources of rust and spot blotch resistance. Genebank accessions comprising three species of wheat-Triticum aestivum, T. durum and T. dicoccum were screened sequentially at multiple disease hotspots, during the 2011-14 crop seasons, carrying only resistant accessions to the next step of evaluation. Wheat accessions which were found to be resistant in the field were then assayed for seedling resistance and profiled using molecular markers. In the primary evaluation, 19,460 accessions were screened at Wellington (Tamil Nadu), a hotspot for wheat rusts. We identified 4925 accessions to be resistant and these were further evaluated at Gurdaspur (Punjab), a hotspot for stripe rust and at Cooch Behar (West Bengal), a hotspot for spot blotch. The second round evaluation identified 498 accessions potentially resistant to multiple rusts and 868 accessions potentially resistant to spot blotch. Evaluation of rust resistant accessions for seedling resistance against seven virulent pathotypes of three rusts under artificial epiphytotic conditions identified 137 accessions potentially resistant to multiple rusts. Molecular analysis to identify different combinations of genetic loci imparting resistance to leaf rust, stem rust, stripe rust and spot blotch using linked molecular markers, identified 45 wheat accessions containing known resistance genes against all three rusts as well as a QTL for spot blotch resistance. The resistant germplasm accessions, particularly against stripe rust, identified in this study can be excellent potential candidates to be employed for breeding resistance into the background of high yielding wheat cultivars through conventional or molecular breeding approaches, and are expected to contribute toward food security at national and global levels.

Bilateral Tubercular Mastitis - Case Reports.

Breast tuberculosis is a rare form of tuberculosis. Moreover the disease is often overlooked and misdiagnosed as carcinoma or pyogenic abscess. Reports on breast tuberculosis have been few; reported incidence of breast tuberculosis amongst the total number of mammary conditions varies between 0.1 and 4 percent. Bilateral involvement is still more uncommon (3%). Here we report 3 cases of adult female ranging from 27 to 35 years who presented with 1 to 4 months history of firm lumps in both breasts and no axillary lymphadenopathy. Fine needle aspiration cytology (FNAC) of breast lump in all 3 cases were done but in 1 case showed evidence of tubercular mastitis and other 2 cases findings were inconclusive. Subsequent Excisional Biopsy of those 2 cases showed features of tuberculosis. All 3 were prescribed with four drug anti-tubercular treatments continued for 12 months in 2 cases and 9 months in other case depending upon their response. The lumps disappeared and ulcer healed after anti-tubercular treatment.

Pylorus Preserving Pancreaticoduodenectomy vs. Standard Whipple's Procedure in Case of Carcinoma head of the Pancreas and Periampullary Carcinoma.

Pancreatic carcinoma is a life threatening condition. Surgical resection is the only hope of cure. Advances in surgical technique have reduced the mortality rate. Nevertheless, operative complications related with morbidity still remains high. Two operation techniques in the treatment of periampullary and pancreatic head cancer: the Standard Whipple operation (SW) and Pylorus Preserving Pancreaticoduodenectomy (PPPD) are performed predominantly. This study was performed to compare the results of Pylorus Preserving Pancreaticoduodenectomy (PPPD) with that of the Standard Whipple's (SW) procedure. This prospective study was carried out in the Department of General Surgery, BSMMU in two years duration. All admitted patient's with periampullary carcinoma and carcinoma of the head of the pancreas were included and randomized for a SW or a PPPD resection. Data regarding patients demographics, preoperative assessment, intraoperative and postoperative findings were collected and analyzed. Less blood loss (2.67±0.65 units in Group I and 2.88±0.64 units in Group II), fewer need of blood transfusions and shorter hospital stay in the PPPD group were observed. Gastrointestinal leakage was similar in both groups of patients (1:1). One pancreatic fistula (8.3% in Group I) was observed in PPPD group and one intra-abdominal abscess developed in Standard Whipple's procedure (00.0% in Group I and 12.5% in Group II). Bile leakage was higher in standard Whipple procedure (8.3% in Group I and 37.5% in Group II). Morbidity was more or less similar in both groups (58.0% in Group I and 50.0% in Group II) but one patient (12.5% in Group II) died in standard Whipple's resection. PPPD procedure is more effective treatment for periampullary carcinoma and cancer of the pancreatic head region than the standard Whipple's operation.

Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures.

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.

Biochemical alterations and liver toxicity analysis with pioglitazone in healthy subjects.

Pioglitazone, a member of the thiazolidinediones, is a potent, highly selective agonist for peroxisome proliferator-activated receptor gamma and is an excellent insulin sensitizer used in treating type 2 diabetes mellitus. The present study investigated the effect of pioglitazone on glucose, total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol, total proteins, albumin (ALB), alanine transaminase (ALT), and aspartate transaminase (AST) levels in 20 healthy Bengali male volunteers in a randomized, placebo-controlled study. Blood samples were collected before and 0.5-24.0 hours after a single oral dose of a 30 mg pioglitazone tablet. Plasma pioglitazone level was determined using a validated method of reverse-phase binary high-performance liquid chromatography. Blood lipid profile and levels of glucose, ALT, and AST were estimated using enzyme assay kits, plasma protein level was estimated by the biuret method, and plasma ALB level was determined colorimetrically. No significant change in blood glucose, total proteins, total cholesterol, triglyceride, HDL, and LDL levels was observed over the 24-hour assessment period, indicating no plasma biochemical alterations. There were no significant differences between baseline and 24-hour values of ALB, ALT, and AST levels, indicating a lack of liver toxicity. Our results indicate that a single dose of 30 mg of pioglitazone has no hypoglycemic or hypolipidemic effect or liver toxicity within 24 hours of treatment among healthy Bengali males.

A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh.

BACKGROUND: Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh. METHODS: The study employed both quantitative and qualitative research methods. The methods used were--a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined. RESULTS: As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications. CONCLUSIONS: As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.

Emergence of Multidrug Resistant Extended-Spectrum ß-Lactamase Producing Eshcherichia coli Associated With Urinary Tract Infections in Bangladesh.

The incidence of infections due to extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli has been increased dramatically in recent years. Treatment is difficult because of frequent multidrug resistance. To identify the sensitivity of commonly used antibiotics, 36 ESBL producing E. coli strains were isolated from young adult female patients in a govt. medical college hospital in Bangladesh. The samples were studied for antimicrobial sensitivity against nine (9) commonly used antibiotics namely ampicillin (amp), trimethoprim-sulfomethoxazole (tms), tetracycline (tet), ciprofloxacin (cip), mecillinum (mel), ceftriaxone (cef), nalidixic acid (nal), Azithromycin (azm) and Chloramphenicol (chl) and the MIC values were determined by agar dilution method. Overall, 72% of the strains were multidrug resistant (MDR) i.e. resistant to two or more drugs. Among 36 strains, 14 isolates were initially found to be resistant against third generation cephalosporin, ceftriaxone. Those were subjected to the test for production of ESBL (Extended Spectrum ß-Lactamase) and 7 showed positive results.

Short-chain fatty acids and commensal microbiota in the faeces of severely malnourished children with cholera rehydrated with three different carbohydrates.

BACKGROUND: Short-chain fatty acids (SCFAs) liberated by fermentation of complex carbohydrates might stimulate water and salt absorption, and provide energy. The aim of the study was to assess the number and proportion of faecal bacteria and the concentration of SCFAs of severely malnourished children with cholera receiving oral rehydration solution (ORS) containing glucose, amylase-resistant starch (ARS) or rice. METHODS: Serial faecal samples were collected from 30 malnourished children with cholera until rehydration and partial nutritional recovery. SCFAs were identified and quantitated by high-performance liquid chromatography. In situ hybridization combined with flow cytometry was used to analyse the microbiota in the faeces. RESULTS: Before treatment the concentration of total SCFA in faecal sample of cholera children was found to be 4.7±0.6 mmol/kg and it increased steadily until 95.0±8.7 mmol/kg at day 28. Among different ORS groups, concentration was significantly higher in the Rice-ORS group at day 1 (P<0.011) and at day 2 (P<0.025). During recovery faecal output was significantly reduced and the number of bacteria also increased faster in the Rice-ORS group than in the glucose-ORS group at day 1 and day 2 (P<0.01), and a modest increase in bacterial number was observed in the glucose-ORS plus ARS group (day 1, P=0.07; day 2, P=0.09). CONCLUSION: Clinical recovery was associated with an increase in bacterial and SCFA concentrations with all three carbohydrates in ORS. However, the increases were significantly higher in children receiving Rice-ORS.

Evaluation of simple hematological screen for early diagnosis of neonatal sepsis.

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to evaluate the role of simple hematological test for early diagnosis of neonatal sepsis. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following laboratory investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. Immature and total neutrophil ratio (I/T ratio) detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Absolute neutrophil count (ANC) had low sensitivity (13%) but Micro-ESR, CRP, I/T ratio, platelet count had moderately high sensitivity and specificity. These simple hematological screen are useful marker for early diagnosis of neonatal sepsis.