Bacteriology of Chronic Supporative Otitis Media (CSOM) at a Tertiary Care Hospital, Mymensingh.

Chronic suppurative otitis media (CSOM) is a notorious infection in developing countries causing serious local damage and threatening complications. It was a cross sectional observational study to isolate and identify aerobic bacteria and to analyze the susceptibility pattern of the aerobic bacterial isolates. It was carried out from March 2017 to July 2018 in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Samples were collected from Outpatient of ENT department, MMCH. Out of a total 300 patients with CSOM were enrolled in this study and 209 were culture positive. Among them gram negative organisms were 129(61.72%) and gram positive organisms were 70(33.49%). The most frequently isolated organism in this study was Pseudomonas aeruginosa 72(34.44%), gram positive organisms S. aureus 63(30.14%), E. coli 21(10.04%), other Pseudomonas spp (other than P. aeruginosa) 15(7.17%), mixed bacterial infectios 10(4.78%), Proteus spp 9(4.30%), CoNS 7(3.34%), Klebsiela lspp 7(3.34%), Acinetobactor spp 5(2.39%). P. aeruginosa isolates had least resistant to imipenem and colistin, S. aureus were showed high sensitivity to Vancomycin and Linezolid and E. coli were sensitive to imipenem and amikacin, ciprofloxacin and amikacin respectively. Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Piperacillin-Tazobactum, Ciprofioxacin, Gentamicin and Amikacin were found to be the most suitable drug for Pseudomonas aeruginosa, S. aureus and E. coli. The resistance against ceftriaxone and aztreonam was found to be very high.

A methodology for mapping current and future heat stress risk in pigs.

Heat stress is a global issue constraining pig productivity, and it is likely to intensify under future climate change. Technological advances in earth observation have made tools available that enable identification and mapping livestock species that are at risk of exposure to heat stress due to climate change. Here, we present a methodology to map the current and likely future heat stress risk in pigs using R software by combining the effects of temperature and relative humidity. We applied the method to growing-finishing pigs in Uganda. We mapped monthly heat stress risk and quantified the number of pigs exposed to heat stress using 18 global circulation models and projected impacts in the 2050s. Results show that more than 800 000 pigs in Uganda will be affected by heat stress in the future. The results can feed into evidence-based policy, planning and targeted resource allocation in the livestock sector.

New Therapeutic Approach to Treat Allergic Rhinitis & Bronchial Asthma, Considering These Two as One United Airway Disease.

The relationship between allergic rhinitis and asthma is now established, and most of the clinical, epidemiological and biological data recommend integrated management. This review discusses rhinosinusitis as a co-morbid condition, a precipitating or triggering condition, and an epiphenomenon as an integrated part of the disease. A better understanding and a more pragmatic method of diagnosis and management is needed using cost-effective long-term strategies. Allergic Rhinitis, though a non-life threatening disease, its pathogenesis reveals that Bronchial Asthma also develops by the same aetiopathogenesis. The United airway disease hypothesis proposes that the upper & lower airway diseases are both manifestations of a single inflammatory process and studies have already proved it. Allergic Rhinitis when once develops if not treated vigorously, can later turn up to Asthma. As chronic inflammation is the central process which is actually continuously changing pathologically the lower respiratory tract & helping to develop Bronchial Asthma. The conventional therapies for Allergic Rhinitis such as antihistamines & decongestants are only symptom relievers, to stop the ongoing pathogenesis of Bronchial Asthma to develop it, the chronic inflammatory process should have to be stopped. This can be done by corticosteroid nasal sprays. Also Asthma with Rhinitis is better controlled by them. Even Bronchial Asthma treatment should be started with inhaler corticosteroid therapy rather than getting it after intermittent use of only bronchodilators (salbutamol) only.

Potency dependent activity of homeopathic nanomedicine- classical and quantum electrodynamical approach

The effect of homeopathic medicine on biological and physical system is directly related to its potency [1]. However, from physico-chemical point of view it is difficult to explain this effect at such high dilution, as then the existence of even trace amount of particle is questionable. It has been reported that during the process of potentization, a large amount of mechanical energy gets transferred to the medium due to succussion [2]. This energy in all probability reduces the size of the drug aggregates. The drug then penetrates easily through the membrane barrier, and thereby gives rise to enhanced activity of the medicine. It has been experimentally proved by us and supported by others that indeed a reduction of size of the aggregates takes place with increase in potency [3]. Using five different homeopathic medicines, their sizes at three different potencies have been estimated and a general mathematical expression relating the size of the particle (Y) and the corresponding potency (X) has been derived as follows Y = a X -n. (AU)

Association between Metabolic Syndrome and Acute Myocardial Infarction (AMI).

To evaluate the biochemical parameters of metabolic syndrome in case of acute myocardial infarction (AMI) patients this case control study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013. To assess of serum total cholesterol, triacylglycerol, HDL-cholesterol, LDL-cholesterol, to estimate of serum glucose and to establish the association of age, sex, BMI, waist circumference, waist hip ratio and blood pressure of myocardial infarction patients. A total of 120 subjects were included in the study. Among them 60 were subjects of AMI cases and another 60 subjects of non AMI patients as controls. Serum total cholesterol, serum triacylglycerol, serum LDL-Cholesterol & serum HDL-Cholesterol were estimated in each sample. All values were expressed as Mean±SD. Statistical significance of difference between case and control were evaluated by using student's unpaired 't' test. All statistical analysis was done by using SPSS windows package. Past history of diabetes Mellitus and hypertension were more common in cases compared to those in control (p<0.001) which was statistically highly significant. There was no significant difference in the history of smoking between case and control. Statistical mean values of serum triacylglycerol, serum FBS, serum total cholesterol were highly significant in AMI patients in comparison to control (p<0.001). Statistical mean value of HDL-C was significantly decreased in AMI patients in contrast to control (p<0.001). In this study systolic blood pressure and diastolic blood pressure were significantly increased in AMI patients in comparison to control (p<0.05). Waist circumference was highly significant in AMI patients in comparison to control (p<0.001). Analyzing the findings of the present study there were significant alteration in lipid profile, blood pressure, fasting blood sugar & WC. These findings reaffirm the clinical importance of the metabolic syndrome as a significant risk factor for AMI. So it may be recommended that estimation of these parameters may help pivotal for better management of AMI.

Cutaneous Tuberculosis: An Update.

Among extra pulmonary tuberculosis cutaneous tuberculosis occurs rarely, despite a high and increasing prevalence of tuberculosis worldwide particularly in developing countries. Cutaneous tuberculosis can be acquired exogenously or endogenously and present as a diverse of differing clinical morphologies. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. Moreover, microbiological confirmation is poor, despite scientific advances, such as the more frequent use of polymerase chain reaction. Furthermore, treatment of cutaneous tuberculosis is also challenging in many cases.

Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

Bickerstaff's Brainstem Encephalitis - A Case Report.

A 11 years male child was presented with fever, headache, vertigo, repeated seizure for 8 days. He had also complains of hemiperesis of right side and impaired vision. On examination patient was drowsy and somnolent. Paralysis of circular muscles of eye ball, exaggerated deep reflexes, extensor planter reflexes and right sided ataxia were present. All routine investigations revealed normal findings except CSF showed slight pleocytosis. MRI of brain revealed hyper intensity of midbrain in left side. The diagnosis of Bickerstaff's brainstem encephalitis (BBE) was strongly suggested from the medical history, clinical examination, biochemical and radiological (MRI) findings of brain. The purpose of our report is to highlight this very rare disease to all.

Peak expiratory flow rate of normal school going children in Mymensingh municipality.

This cross sectional study was conducted to measure the PEFR values of normal school going children of Mymensingh, Bangladesh. Peak expiatory flow rate (PEFR) is a lung function test which is easily measurable and reproducible but the base line values of PEFR have not been studied in large scale among Bangladeshi children. In Mymensingh municipality out of 79 schools 4 schools were selected purposively. A total of 984 (499 boys and 485 girls, nearly equal in ratio) normal children (6-15 years), were selected randomly by using lottery technic in classroom. To obtain peak expiratory flow rate (PEFR) mini Wright peak flow meter was used. The highest of three readings was taken as the correct value. Anthropometric parameters including body weight and height were recorded by bathroom scale and stadiometer respectively and body surface area was calculated. According to age interval (10 months) in boys and girls the mean difference of PEFR values showed that among age categories of 6, 7 & 8 years had no significant (p were <0.18, <0.73 and <0.70 accordingly) and all other age categories the mean difference of PEFR between boys and girls had significant (p<0.01). The correlation coefficient (r values) and the level of significance between different anthropometric parameters and PEFR in case of boys and girls were significant (p<0.001). Correlation of height (boys r=0.961 & girls r=0.954) with PEFR was the highest in comparison to other anthropometric parameters (age, sex and body weight). Boys had significantly higher values of PEFR than the girls at any height.

Sexual and urinary outcome after surgical treatment for low rectal cancer.

Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. This study was designed to observe the sexual and urinary dysfunction in both sexes of the patients suffering from cancer of the lower third of the rectum managed by surgical intervention with preservation of sphincter. A comparative study was carried out on 54 patients with low rectal cancer who underwent ultra-low anterior resection in the department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January, 2009 to December, 2010. Patients were divided into two groups depending on the tumor distance from anal verge. Thirty one (57%) patients were in Group A (Experimental) where tumor distance was 5cm from anal verge and upper 1cm of anal sphincter was sacrificed during surgical intervention. Twenty three (43%) patients were in Group B (Control) where tumor distance was 6cm from anal verge and whole length (4cm) of anal sphincter was preserved during surgical intervention. The mean±SD age of the patients was 45.96±14.41 years. During surgery, ultra low anterior resection was performed to remove the tumor in all patients and for anastomosis double stapling technique was performed in 52(96%) patients and hand sewn technique was performed in 2(4%) patients irrespective of tumor distance from anal verge. Covering ileostomy was fashioned in all but one patient. During post-operative follow up Sexual activity in both groups of male patients (Potency, P=0.17; ejaculation; satisfaction and loss of libido, P=0.15) and in female patients (Satisfaction and loss of libido, P=0.15) was not significantly hampered following surgery. Urinary function was assessed by incontinence, increased frequency (P=0.54) and retention (n=0) which were not impaired significantly following surgery. Sexual and urinary function was not significantly impaired in both sexes after low rectal cancer surgery. Sphincter saving surgery can be performed in a very low rectal cancer with preservation of anal sphincter.

Evaluation of transurethral ethanol ablation of prostate for symptomatic benign prostatic hyperplasia.

Evaluating short-term (03 months) efficacy and safety of transurethral intraprostatic injection of absolute ethanol to treat benign prostatic hyperplasia (BPH). This intervention study was conducted to evaluate 30 patients with benign prostatic hyperplasia treated by transurethral injection of dehydrated ethanol. Mean age was 69.96 years. Endoscopic injection of 6-13.5 ml ethanol was carried out at 4-8 sites in the prostate. International Prostate Symptom Score (IPSS), maximum flow rate, prostate volume, postvoid residual and side effects or complications were measured postoperatively. Mean IPSS (SD) improved significantly from 18.43 ± 2.38 preoperatively to 6.80 ± 1.34 at 03 months of follow-up, mean peak urinary flow rate increased from 7.33 ± 1.19 ml/s to 16.31 ± 1.69 ml/s after 3 months, mean residual urine volume had decreased from 54.16 ± 30.93 ml to 17.01 ± 9.59 ml after 3 months (p<0.05). The prostate volume decreased from 44.66 ± 9.52 gm preoperatively to 32.46 ± 7.78 gm after 3 months (statistically significant at 5% level). There were no intra-operative complications but post-operative haematuria occurred in two patients, urinary retention occurred in two patients after removal of the catheter. Urinary tract infection developed in one patient. Transurethral ethanol ablation of prostate appears to be safe and cost effective. No occurrence of retrograde ejaculation was detected. The short-term effects of ethanol injection at prostate were satisfactory and acceptable as a minimally invasive therapeutic modality in selected patients.

Comparative study of total prostate specific antigen and free to total prostate specific antigen ratio in the diagnosis of prostate cancer.

This descriptive study was done to compare total Prostate Specific Antigen (tPSA) and the Free to Total Prostate Specific Antigen [(F/T) PSA] ratio measurements for prostate cancer detection. This study included a total of 43 patients with suspected prostate cancer observed over a period of 12 months. Out of 43 consecutive male patients (mean age 69±9.39 years, range 48-100 years), 32 had benign disease (74%) and 11 had prostate carcinoma patients (26%), who had histologically proven prostate cancer. The mean total PSA was 67.9 ng/ml and 12.4 ng/ml in patients with carcinoma prostate and nodular hyperplasia of prostate (NHP) respectively (p<0.05). The mean free PSA in carcinoma patients was 7.4±9.8 ng/ml and in NHP patients it was 2.3±4.1 ng/ml. The difference in mean free PSA concentration was significant (p<0.05). The free to total PSA ratio in two groups was significantly different (p<0.01) from each other. In carcinoma patients, mean F/T PSA ratio was 0.144±0.152 as compared 0.328±0.076 in patients with benign disease. The sensitivity and specificity of the test was calculated at different F/T PSA ratio cutoff. At 0.1 cut off value, sensitivity of the test was 64% and specificity was 84%. The positive predictive value (PPV) was 58% and negative predictive value (NPV) was 87%. From cutoff value of 0.12 to 0.16, sensitivity was increased from 64% to 91% but specificity was reduced from 84% to 59%. The PPV did not show much change and NPV was increased from 89% to 95%. Increasing the cut off value thereafter showed no change in sensitivity but specificity was further reduced to 41%. Therefore in this patient, F/T PSA ratio cut off of 0.15 was found to be the appropriate cutoff value. In 43 men who were biopsied, 11(26%) prostatic carcinoma were identified. Only one patient (9.1%) had F/T PSA ratio above 0.15 and diagnosed by biopsied. Out of 32 patients who were negative for malignancy, 13 patients had F/T PSA ratio more than 0.15 and 19 patients had F/T PSA ratio less than 0.15. The validity of tPSA and F/T PSA ratio in the diagnosis of prostate cancer was identified by calculating their sensitivity, specificity, PPV and NPV. In case of F/T PSA ratio the sensitivity was 91% and in conventional tPSA the sensitivity was 82%. Specificity was low in both the cases. But in tPSA the specificity was only 13% compare to 59% in F/T PSA. Positive predictive value (PPV) for tPSA was 25% and in F/T PSA it was 44%. Negative predictive value (NPV) for t PSA was 67% and for F/T PSA was 95% which was very high. The effectiveness of F/T PSA ratio at 0.15 cut off value with corresponding tPSA>10ng/ml shows sensitivity 83% in prostate cancer and 50% in NHP patient.

Awareness about organ donation among school girls.

Prevalence of organ failure is high through out the world. Organ transplantation, the definitive treatment option of organ failure keeps very low due to scarcity of organ. Most of the people are not aware about organ donation. Adolescent girls will be the mother of future nation and they can motivate family members for organ donation. This study was carried out to see attitudes towards organ donation and determine the negative factors of organ donation prevailing among school girls. One hundred sixty eight girls from class VIII to class X of a higher secondary school were participated. A structured questionnaire was filled up by the girls. The data were processed from questionnaire and analyzed. Among study population, most of them (64%) had no idea about on going organ donation and transplantation. The positive attitude of the girls towards organ donation was low when they are live (16%) and their attitudes also kept low even after their death (14%). The girls who did not agree to donate organ were further asked to mention the reasons. The reasons of negative attitude were religious belief, fear of illness and social and familial reservation. The result of this study suggests that among girls, awareness and attitudes about organ donation is poor. There were several reasons identified for low consent rates. Multidisciplinary actions should be taken to improve the awareness of the people about organ donation and motivate them for donation.

Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain.

Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive.

Uroflowmetry before and after transurethral resection of prostate for bladder outlet obstruction.

This prospective study evaluates the effectiveness of uroflowmetry to follow up the patients of benign prostatic hyperplasia treated by transurethral resection of prostate. Total sixty eight patients of 50 to 70 years age group attending for the treatment of BPH with bladder outlet obstruction in the department of Urology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka were recruited for the study. All the TURP's were performed by experienced urologist. Patients were advised to come after 3 months and 6 months for follow up visits. In each visit, the patients were evaluated through history, physical examination and relevant investigations including IPSS and uroflowmetry. Significant improvement was observed in term of Qmax, voided volume, and voiding time in all patients after TURP. Mean (+/-SD) IPSS change in pre to post TURP was 16.2(+/-0.76) (p<0.05). The objective parameters of uroflowmetry correlated well with the subjective parameters represented by IPSS in this study.

Terahertz wave propagation in one-dimensional periodic dielectrics.

We demonstrate the temporal evolution of terahertz (THz) wave propagation in one-dimensional periodic dielectrics. Distributed Bragg reflectors and a resonant cavity are investigated: The structures involve air gaps interleaved between polymer films. Transmitted and reflected broadband THz waves are measured by means of THz time-domain spectroscopy. The experimental results agree well with transfer matrix calculations.

National health care 'by-passing' in Bangladesh: a comparative study.

Using data from a survey of urban residents of Dhaka, Bangladesh, the phenomenon of by-passing national health care resources in favor of foreign ones has been analyzed. The results clearly suggest that the incidence of national health care by-passing is relatively widespread, particularly among the wealthy residents of Dhaka. The findings of this study show that the health care system in Bangladesh is costly, some specialized care is not available, and the quality of services obtained in foreign countries is perceived as better than what is available nationally. While complete prevention of national health care by-passing is not possible, improvement in health care services available within Bangladesh will help in decreasing the incidence of by-passing.

Maternal mortality in Africa: 1980-87.

African women of reproductive age have the highest death risk from maternal causes of any women in the world. The lifetime chance of maternal death is 1 in 21 in Africa as compared to 1 in 54 in Asia, which ranks second. Using published data, this paper examines the level and correlates of maternal mortality ratio (MMR) in Africa. The data indicates that MMR greatly differs among the countries of Africa. High MMR is found in most countries of sub-Saharan Africa, while countries of Northern Africa are characterized by relatively low maternal death. Reasons for high MMR in sub-Saharan Africa are explored in detail. Analysis using multiple regression suggests that the MMR in Africa is strongly influenced by population size, crude birth rate (CBR), crude death rate (CDR), calorie supply as a percentage of requirements, access to safe water, and percentage of urban population. Some cultural and behavioral factors, such as female circumcision and infibulation, are also associated with a high MMR. Future programs aimed at reducing the maternal mortality in African countries may benefit from the findings of this study.

Ocular trauma among major trauma victims in a regional trauma center.

The authors conducted a retrospective review of the medical records of patients entering an adult level I regional trauma unit to ascertain descriptive epidemiologic information about ocular trauma occurring in the midst of major trauma. Over a 6-year period 6313 patients entered our trauma unit with major trauma. Of these, 856 (13.5%) patients had concomitant ocular trauma. Six hundred twenty-eight (73.4%) patients were male and 228 (22.6%) were female. The average age was 37 years with 743 (86.6%) victims aged between 15 and 55 years, 111 (13.0%) over the age of 55 years. Blacks constituted 48.8% of the sample with whites and other races accounting for 45.4% and 5.5%, respectively. Among the specific causes of ocular injury in our survey, motor vehicle crashes accounted for over 52% of the injuries. Assault-related ocular trauma was responsible for approximately 8% of these injuries. Nearly one third of patients had blood alcohol levels exceeding 100 mg/dL. The mean Revised Trauma Score and Injury Severity Score (based upon AIS-1985 severity coding) of the sample were 6.6 and 19.8, respectively.