Showing papers by "Chittagong Medical College Hospital published in 2016"
01 Dec 2016
TL;DR: This study proposes a new and robust machine learning model based on a convolutional neural network (CNN) to automatically classify single cells in thin blood smears on standard microscope slides as either infected or uninfected.
Abstract: Malaria is a major global health threat. The standard way of diagnosing malaria is by visually examining blood smears for parasite-infected red blood cells under the microscope by qualified technicians. This method is inefficient and the diagnosis depends on the experience and the knowledge of the person doing the examination. Automatic image recognition technologies based on machine learning have been applied to malaria blood smears for diagnosis before. However, the practical performance has not been sufficient so far. This study proposes a new and robust machine learning model based on a convolutional neural network (CNN) to automatically classify single cells in thin blood smears on standard microscope slides as either infected or uninfected. In a ten-fold cross-validation based on 27,578 single cell images, the average accuracy of our new 16-layer CNN model is 97.37%. A transfer learning model only achieves 91.99% on the same images. The CNN model shows superiority over the transfer learning model in all performance indicators such as sensitivity (96.99% vs 89.00%), specificity (97.75% vs 94.98%), precision (97.73% vs 95.12%), F1 score (97.36% vs 90.24%), and Matthews correlation coefficient (94.75% vs 85.25%).
199 citations
TL;DR: TGF‐β1‐induced Shh may regulate EMT and tumorigenicity in bladder cancer and targeting the Shh pathway could be clinically beneficial in the ability to reverse the EMT phenotype of tumor cells and potentially inhibit bladder cancer progression and metastasis.
Abstract: Activation of the sonic hedgehog (Shh) signaling pathway controls tumorigenesis in a variety of cancers. Here, we show a role for Shh signaling in the promotion of epithelial-to-mesenchymal transition (EMT), tumorigenicity, and stemness in the bladder cancer. EMT induction was assessed by the decreased expression of E-cadherin and ZO-1 and increased expression of N-cadherin. The induced EMT was associated with increased cell motility, invasiveness, and clonogenicity. These progression relevant behaviors were attenuated by treatment with Hh inhibitors cyclopamine and GDC-0449, and after knockdown by Shh-siRNA, and led to reversal of the EMT phenotype. The results with HTB-9 were confirmed using a second bladder cancer cell line, BFTC905 (DM). In a xenograft mouse model TGF-β1 treated HTB-9 cells exhibited enhanced tumor growth. Although normal bladder epithelial cells could also undergo EMT and upregulate Shh with TGF-β1 they did not exhibit tumorigenicity. The TGF-β1 treated HTB-9 xenografts showed strong evidence for a switch to a more stem cell like phenotype, with functional activation of CD133, Sox2, Nanog, and Oct4. The bladder cancer specific stem cell markers CK5 and CK14 were upregulated in the TGF-β1 treated xenograft tumor samples, while CD44 remained unchanged in both treated and untreated tumors. Immunohistochemical analysis of 22 primary human bladder tumors indicated that Shh expression was positively correlated with tumor grade and stage. Elevated expression of Ki-67, Shh, Gli2, and N-cadherin were observed in the high grade and stage human bladder tumor samples, and conversely, the downregulation of these genes were observed in the low grade and stage tumor samples. Collectively, this study indicates that TGF-β1-induced Shh may regulate EMT and tumorigenicity in bladder cancer. Our studies reveal that the TGF-β1 induction of EMT and Shh is cell type context dependent. Thus, targeting the Shh pathway could be clinically beneficial in the ability to reverse the EMT phenotype of tumor cells and potentially inhibit bladder cancer progression and metastasis.
111 citations
TL;DR: Analysis of clinicopathological characteristics and prognosis of BC patients from Bangladesh support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC.
Abstract: Dysregulation of Hedgehog (Hh) signaling pathway has been documented in mammary gland development and breast cancer (BC) progression. Despite the remarkable progress in therapeutic interventions, BC related mortality in Bangladesh increased in the last decade. Triple negative breast cancer (TNBC) still presents a critical therapeutic challenge. Thus effective targeted therapy is urgently needed. In this study, we report the clinicopathological characteristics and prognosis of BC patients from Bangladesh. Routine immunohistochemical analysis and high throughput RNA-Seq data from the TCGA library were used to analyze the expression pattern and association of high and low level of Shh expression in a collection of BC patients with a long-term follow-up. High levels of Shh were observed in a subset of BC tumors with poor prognostic pathological features. Higher level of Shh expression correlated with a significantly poorer overall survival of patients compared with patients whose tumors expressed a low level of Shh. These data support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC. We propose that BC patients exhibiting a higher level of Shh expression, representing a subset of BC patients, would be amenable to Shh targeted therapy.
50 citations
TL;DR: Current trends and issues on adolescent pregnancy are reviewed to update the practitioners and more recent data on adolescent sexuality, child bearing as well as suggestions for addressing the challenges of teenage pregnancy are provided.
Abstract: Adolescent pregnancy, which is detrimental to the health of mother and child, is a common public health problem worldwide. It is one of the key issues concerning reproductive health of women not only in developing countries but also in developed countries. There is growing awareness that early child bearing has multiple consequences in terms of maternal health, child health and over all well-being of the society. The purpose of the article is to review current trends and issues on adolescent pregnancy to update the practitioners. The readers are provided with more recent data on adolescent sexuality, child bearing as well as suggestions for addressing the challenges of teenage pregnancy. Chatt Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 53-56
33 citations
TL;DR: Sequestration of parasitized red blood cells and reduced RCD both contribute to decreased microcirculatory flow in severe disease.
Abstract: Despite the recent gains in malaria control, falciparum malaria still causes an estimated 198 million cases globally and kills 0.58 million patients each year [1]. Once severe disease develops, the case-fatality rate is around 8% in children and 15% in adults despite optimal antimalarial treatment with artesunate [2]. A better understanding of the underlying pathophysiology is critical for developing adjunctive treatments to lower morality.
Lactic acidosis is a common complication of severe malaria, which has a strong predictive value for death in both pediatric and adult patients [3, 4]. Lactate accounts for approximately one fourth of the strong acids [5] present in severe malaria. The high lactate to pyruvate ratios in severe malaria indicate that anaerobic glycolysis most likely results from microcirculatory hypoperfusion [6]. Impairment of tissue microcirculatory flow is caused by the sequestration of cytoadherent red blood cells (RBCs) containing mature forms of the malaria parasite [7–9]. Rosetting, autoagglutination, and endothelial cell dysfunction may further compromise microcirculatory flow [10, 11]. Reduced uninfected RBC deformability (RCD) is thought to be an additional contributing factor [10, 12]. Other causes include circulatory shock and severe anemia, compromising oxygen delivery.
The relative contributions of these factors to lactic acidosis have not been well established. In this prospective study of adults hospitalized with falciparum malaria, we measured the plasma P. falciparum histidine-rich protein 2 (HRP2) concentration as a proxy measure for the total and sequestered parasite biomass [13], RCD, and other established contributors to lactic acidosis and assessed their relative associations with plasma lactate concentrations.
22 citations
TL;DR: Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever, and lower respiratory tract and CNS infections were also common.
Abstract: Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.
19 citations
TL;DR: It is concluded that multidimensional poverty is associated with greater pre-hospital delays and expenditure in this setting and closer links between health and development agendas could address these consequences of poverty and streamline access to adequate healthcare.
Abstract: Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0 °C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in decision-making and travel to a lack of money (P<0.001), and more likely to face catastrophic expenditure of more than 25% of monthly household income (P<0.001). We conclude that multidimensional poverty is associated with greater pre-hospital delays and expenditure in this setting. Closer links between health and development agendas could address these consequences of poverty and streamline access to adequate healthcare.
18 citations
17 Nov 2016
TL;DR: Analysis of the prevalence of H. pylori infection among dyspeptic patients in Chittagong, the second most populous city of Bangladesh, using 16S rRNA-based H.pylori-specific Polymerase Chain Reaction and Campylobacter-like organism test found that 67% of the population under study was positive for H. Pylori infections.
Abstract: The pathogenic bacterium Helicobacter pylori is a causative agent of gastric diseases in Bangladesh as well as throughout the world. This study aimed at analyzing the prevalence of H. pylori infection among dyspeptic patients in Chittagong, the second most populous city of Bangladesh, using 16S rRNA-based H. pylori-specific Polymerase Chain Reaction and Campylobacter-like organism test. We found that 67% of the population under study was positive for H. pylori infection. Gastric ulcer and duodenal ulcer disease showed statistically significant association with H. pylori infection; however, no association of H. pylori infection was observed in terms of age and gender. This study would play a crucial role in managing H. pylori-induced gastric diseases by understanding the current trend of H. pylori infection in the Chittagong region of Bangladesh.
10 citations
TL;DR: Corchorus olitorius can be used as a potential food supplement to the affected people of arsenic prone zone to ensure the food security and significant increase in arsenic accumulation in different parts of rice with the increase of arsenic concentrations in irrigation water was found.
Abstract: In the present study, we investigated the arsenic accumulation in different parts of rice irrigated with arsenic contaminated water. Besides, we also evaluated the protective effects of Corchorus olitorius leaves against arsenic contaminated rice induced toxicities in animal model. A pot experiment was conducted with arsenic amended irrigation water (0.0, 25.0, 50.0 and 75.0 mg/L As) to investigate the arsenic accumulation in different parts of rice. In order to evaluate the protective effects of Corchorus olitorius leaves, twenty Wistar albino rats were divided into four different groups. The control group (Group-I) was supplied with normal laboratory pellets while groups II, III, and IV received normal laboratory pellets supplemented with arsenic contaminated rice, C. olitorius leaf powder (4 %), arsenic contaminated rice plus C. olitorius leaf powder (4 %) respectively. Different haematological parameters and serum indices were analyzed to evaluate the protective effects of Corchorus olitorius leaves against arsenic intoxication. To gather more supportive evidences of Corchorus olitorius potentiality against arsenic intoxication, histopathological analysis of liver, kidney, spleen and heart tissues was also performed. From the pot experiment, we have found a significant (p ≤ 0.05) increase of arsenic accumulation in different parts of rice with the increase of arsenic concentrations in irrigation water and the trend of accumulation was found as root > straw > husk > grain. Another part of the experiment revealed that supplementation of C. olitorius leaves with arsenic contaminated rice significantly (p < 0.05) restored the altered haematological parameters and other serum indices towards the normal values. Arsenic deposition pattern on different organs and histological studies on the ultrastructural changes of liver, kidneys, spleen and heart also supported the protective roles of Corchorus olitorius leaves against arsenic contaminated rice induced toxicities. Arsenic accumulation in different parts of rice increased dose-dependently. Hence, for irrigation purpose arsenic contaminated water cannot be used. Furthermore, arsenic contaminated rice induced several toxicities in animal model, most of which could be minimized with the food supplementation of Corchorus olitorius leaves. Therefore, Corchorus olitorius can be used as a potential food supplement to the affected people of arsenic prone zone to ensure the food security.
8 citations
TL;DR: Doppler study of umbilical artery allows a noninvasive assessment of uteroplacental insufficiency and is an accurate method for diagnosis and management of fetal growth retardation.
Abstract: Objectives: To study pregnancy outcomes in growth restricted fetuses with normal umbilical artery velocimetry, low end-diastolic umbilical flow, and absent or reversed diastolic flow. Methods: Fifty pregnant women with growth restricted fetuses were evaluated by umbilical artery velocimetry between 28 and 39 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n=17; 34%), the low end diastolic flow group (n=23; 46%), the group with absent diastolic flow (n=8; 16%) and the group with reversed diastolic flow (n=2; 4%). Results: The average birth weight, diagnosis to delivery interval and gestational age at delivery were comparatively lower in case of abnormal umbilical Doppler velocimetry group. Again there was higher incidence of LSCS for fetal distress, Apgar score <7 at 1 minute, admission to neonatal intensive care unit and perinatal death with those of the abnormal umbilical Doppler velocimetry. Conclusion: Doppler study of umbilical artery allows a noninvasive assessment of uteroplacental insufficiency and is an accurate method for diagnosis and management of fetal growth retardation. J Bangladesh Coll Phys Surg 2015; 33(1): 12-17
8 citations
TL;DR: The study concluded that use of Widal test may be justified in second week of illness as a suggestive test for clinical diagnosis or in patients who have clinical typhoid fever but are culture negative.
Abstract: Typhoid Fever occurs worldwide primarily in developing nations where sanitary conditions are poor. The absence of specific symptoms and signs makes the clinical diagnosis difficult. Definitive diagnosis requires the isolation of S. typhi from blood or other body fluid. But in developing countries culture facilities often not available & diagnosis rely upon clinical features and the detection of antibodies by the Widal test. Numerous studies however have cast serious doubts on the value of the test. The aim of the study was to reassess the utility of a single Widal test in the diagnosis of typhoid fever. The descriptive study was carried out on 100 adult patients with suspected cases of typhoid fever, in the Department of Medicine, Chittagong Medical College Hospital for a period of one year from January to December 2009. Blood samples were collected to perform culture and Widal test. TO titre ≥1:160 were considered as significant. AO or BO≥1:160 was also considered as significant. The results showed 24 among 100 clinically suspected typhoid fever cases yielded growth of S. typhi. Widal test was found significant in 20(83.33%) out of 24 cultured confirmed cases. Results revealed significant difference in Widal test results between culture positive and negative cases, X 2 value 5.601, P value 0.018(<0.05).The study concluded that use of Widal test may be justified in second week of illness as a suggestive test for clinical diagnosis or in patients who have clinical typhoid fever but are culture negative. Medicine Today 2015 Vol.27(2): 28-32
TL;DR: Biomass fuel smoke exposure is a risk factor for development of COPD in rural women in Bangladesh and lung function was significantly reduced among women who were using biomass than those using natural gas/LPG.
Abstract: Background: Chronic Obstructive Pulmonary Disease (COPD) is of public health importance Indoor biomass (wood, cowdung etc) smoke exposure from cooking is associated with respiratory conditions and may predispose to COPD The objective of this study was to evaluate the risk of biomass smoke exposure and COPD Methods: A cross sectional study was conducted at a rural setting of Bangladesh Rural women over 40 years and exposed to biomass fuel, liquid petroleum gas or natural gas smoke were evaluated using a questionnaire and their lung function was assessed using a portable spirometry Results: The overall prevalence of COPD in the rural women was 204% It was significantly higher in women using biomass fuel for cooking than in those using natural gas/LPG (p<0001) Biomass smoke exposure was found significantly associated with COPD (OR= 3385, CI=160-713, p<005) Lung function was significantly reduced (p<005) among women who were using biomass than those using natural gas/LPG Conclusion: Biomass fuel smoke exposure is a risk factor for development of COPD Chatt Shi Hosp Med Coll J; Vol15 (1); Jan 2016; Page 8-11
TL;DR: Investigation of the antibiotic resistance of urinary pathogens isolated at Chittagong Medical College Hospital during January to June, 2007 found members of the Enterobacteriaceae were 80%-100% sensitive to Imipenem while they were found variably sensitive to other commonly used antibiotics.
Abstract: Urinary tract infection (UTI) is the most common nosocomial infection among hospitalized patients. Area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and resistance pattern of the causative agents may help clinicians to choose correct treatment regimen. So, the present study was aimed to investigate the antibiotic resistance of urinary pathogens isolated at Chittagong Medical College Hospital (CMCH) during January to June, 2007. Out of 360 clinical samples of urine collected, 175 (48.61%) showed significant bacterial growth. The most common pathogens isolated were Escherichia coli (66, 37.71%), Klebsiella species (60, 34.29%), Proteus species (17, 9.71%) and Pseudomonas species (16, 9.14%). Members of the Enterobacteriaceae were 80%-100% sensitive to Imipenem while they were found variably sensitive to other commonly used antibiotics. Pseudomonas species were 100% sensitive to Imipenem, 75% to Amikacin, and 50% to Ceftazidime. Staphylococcus aureus was found 100% sensitive to Vancomycin, 80% to Gentamicin and Amikacin each, and 55% to Oxacillin. Enterococcus species were 80% sensitive to Imipenem, 60% to Ciprofloxacin, 50% to Vancomycin and Amikacin each. The clinicians should use Imipenem selectively in cases of un-responsiveness to commonly used antibiotics. Bangladesh J Med Microbiol 2008; 02 (02): 17-21
TL;DR: The patients with breast cancer would experience high symptoms during a 7-day period after receiving chemotherapy of the previous cycle and nurses need to perform full measurement of multiple symptoms when care for breast cancer patients after the administration of chemotherapy.
Abstract: Background : The present study was aimed to the relationships between symptom severity and distress and quality of life (QoL) of patients receiving chemotherapy for breast cancer. Objectives and methodology : A total number of 132 patients, attending both In-patient and Out-patient department and fulfilling the recruitment criteria were included in the study. A self-report questionnaire was used to collect data from the eligible participants by the primary investigator. The data were analyzed by using descriptive and inferential statistical tools. Results : On average, the participants of the study experienced seventeen symptoms with moderate level. The level of QoL of the participants was at moderate level (M=2.02, SD=0.39). Among all the subscales, the physical well-being had the lowest score and social well-being had highest score. Symptom experience and quality of life showed significant negative correlation. Conclusion : The patients with breast cancer would experience high symptoms during a 7-day period after receiving chemotherapy of the previous cycle. Nurses need to perform full measurement of multiple symptoms when care for breast cancer patients after the administration of chemotherapy. Bangladesh Journal of Medical Science Vol.15(2) 2016 p.201-206
TL;DR: The skin and related structures undergo changes during pregnancy and peurperium which are mainly of cosmetic importance and some of them are associated with an increase in both fetal and/or maternal morbidity and mortality.
Abstract: The skin and related structures undergo changes during pregnancy and peurperium. They can be separated into three categories - hormone related pregnancy specific and preexisting. the physiologic changes are mainly of cosmetic importance. The pregnancy specific skin diseases have associated symptoms. Most skin conditions resolve post partum and only require symptomatic treatment. Some of them are associated with an increase in both fetal and/or maternal morbidity and mortality. Bangladesh Med J. 2015 May; 44 (2): 112-116
TL;DR: It is essential to report ESBL production along with routine sensitivity reporting, which will help the clinician in prescribing the proper antibiotics, as well as provide a base line data in treating them & prevent unnecessary use of antibiotics.
Abstract: Background: Extended Spectrum b -Lactameses Producing Organisms (ESBLs) are increasing in number and causing more severe infections because of their continuous mutation and multidrug resistance property with limited therapeutic option. Aims and Objectives: Present study was undertaken to detect the prevalence of the ESBLs producing bacteria in wound infection, so as to provide a base line data in treating them & prevent unnecessary use of antibiotics Methods: Isolated gram-negative bacteria initially screened by Minimum Inhibitory Concentration (MIC) ESBLs breakpoints. Then suspected ESBLs producers were confirmed by Phenotypic confirmatory test. Results: 105 (One hundred five) (91.30%) bacterial strains were isolated from 115 samples of wound swab & pus from different patients were studied of which 84(80.00%) were Gram-negative and 21(20.00%) were Gram-positive. Among the isolated Gram-negative bacteria 79(94.05%) were found suspected ESBLs producers of which 54(68.35%) were found as confirmed ESBL producers. The prevalence of ESBLs producing organisms in the present study were found to be 64.29% and Klebsiella spp as most prevalent ESBLs producers. Conclusion: It is essential to report ESBL production along with routine sensitivity reporting, which will help the clinician in prescribing the proper antibiotics. Chatt Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 26-30
TL;DR: A 23 yrs old young man visited us with the complaints of a pulsatile mass in right groin and a thrill over the medial side of the right thigh which radiate to the hypogastric region for last 3 months following a stab injury on the lateral aspect of right upper thigh.
Abstract: A 23 yrs old young man visited us with the complaints of a pulsatile mass in right groin and a thrill over the medial side of the right thigh which radiate to the hypogastric region for last 3 months following a stab injury on the lateral aspect of right upper thigh. He was diagnosed to have a pseudoaneurysm in common femoral artery and an arteriovenous fistula between common femoral artery and common femoral vein in same region by vascular duplex scanning and CT angiogram. We excised the aneurysm and repaired the arteriovenous fistula tract under epidural anesthesia. Finally we repaired the severed right Common femoral artery and common femoral vein. Postoperative course was uneventful. Cardiovasc. j. 2016; 8(2): 149-154
TL;DR: The aetiological association between the tuberculosis and colon cancer is a matter of debate, however, the treating surgeon should be aware of this association, to avoid confusion and delay in the management.
Abstract: Tuberculosis affecting the colon is an uncommon extra-pulmonary form of the disease, and its association with malignancy is highly unusual. A 66-year man presented with lower gastrointestinal bleeding altered bowel habit and significant weight loss. On examination, he had ulcer infiltrative growth in the descending colon, with friable mucosa, bleeds easily on touch. With the diagnosis of carcinoma of the descending colon, he underwent left hemicolectomy. The histopathological examination revealed carcinoma colon with coexisting tuberculosis. The aetiological association between the tuberculosis and colon cancer is a matter of debate. However, the treating surgeon should be aware of this association, to avoid confusion and delay in the management. Bangladesh Journal of Medical Science Vol.15(1) 2016 p.131-134
TL;DR: It is revealed that future prescribers recognize the necessity of targeted teaching on antimicrobial to prepare them to prescribe antimicrobials rationally.
Abstract: The study was aimed to evaluate the knowledge, perception and prepared-ness of the 4th year students of three medical colleges of Bangladesh during January 2016. The questionnaire was designed to evaluate knowledge, perception and preparedness about antimicrobial stewardship and resistance. Out of two hundred and seventy six students provided with questionnaire, one seventy one (82%) had responded completely. The term ‘antimicrobial stewardship’ was familiar to only 6% students. Thirty nine percent respon-dents correctly responded on antibacterial spectrum. Seventy two percent students mentioned that teaching on antimicrobial should begin from 3 rd year and 89% felt necessity of spending more time on antimicrobials. This study revealed that future prescribers recognize the necessity of targeted teaching on antimicrobial to prepare them to prescribe antimicrobials rationally.
TL;DR: Initial cardiac arrest rhythm as VF and pulseless VT, a shorter time to defibrillation and location whether the event in monitored area were factors associated with a higher survival are found.
Abstract: Background: In-hospital cardiac arrests are associated with poor survival despite basic and advanced life support measures. Objective of this study was to find out the profile and outcome of in-hospital cardiac arrest patients admitted to coronary care unit (CCU) of Chittagong Medical College Hospital. Methods: This prospective observational study was done on 243 consecutive patients developing cardiac arrest in CCU of Chittagong Medical College Hospital during a period of 1 year. Baseline demographics, clinical data, such as mode of arrest, timing of the event, duration of resuscitation were recorded. Basic and advanced life support measures were given according to AHA guidelines. The main outcomes were death and survival to hospital discharge with or without severe neurological disability. Results: There were 168 male and 75 female. Male:female ratio was 2.4:1.Mean age of the study population was 56.5±14.6 (range 23-76 yrs). Out of 243 arrest cases 108 (44.4%) had ventricular fibrillation(VF), 75(30.8%) had pulseless ventricular tachycardia(VT), 51 (20.8%) had pulseless electrical activity(PEA) and 9 patients (3.7%) had asystole. Mean±SD of time to defibrillation was 1.8±4.3min (range 0-30 min). Ninety eight (40.2%) patients had a return to spontaneous circulation, 71 (29.2%) survived up to 24 hours and only 46 (18.9%) patients survived to hospital discharge. Out of the 183 patients with VF and pulseless VT, 42 (22.9%) survived to hospital discharge. Survival following asystole and PEA were only 6.6% in each. Conclusion: Only 18.9% of cardiac arrest victims survived to hospital discharge. Initial cardiac arrest rhythm as VF and pulseless VT, a shorter time to defibrillation and location whether the event in monitored area were factors associated with a higher survival. Cardiovasc. j. 2016; 8(2): 123-127
TL;DR: Evaluated efficacy of TAP block in postoperative analgesia for Total Abdominal Hysterectomy with subarachnoid block (SAB) in comparison of morphine consumption and VAS score provided considerably effective postoperative pain management in first 24 hours after major abdominal surgery like TAH.
Abstract: Background: In perioperative care, a reliable pain management is a vital appeal. Over recent years, Transversus Abdominis Plane (TAP) block is introduced as an important component of multimodal analgesia. Objective: To evaluate efficacy of TAP block in postoperative analgesia for Total Abdominal Hysterectomy (TAH) with subarachnoid block (SAB) in comparison of morphine consumption and VAS score. Methods: 60 patients were randomly allocated into 2 groups (TAP group-A & control group-B). Standard SAB was applied to all patients for elective TAH. Immediate after operation classical TAP block was performed through both Lumber Triangle Of Petit (LTOP) of group A patients. Both groups were placed in Post Anesthesia Care Unit (PACU), arranged a common standard postoperative analgesic regimen for all, observed periodically and documented it accordingly in pre-designed data sheet. Results: TAP block prolonged the mean time of 1 st required I/V morphine (TAP vs control, mean±SD 271.23±40.34 vs 195.33±22.16 min., p=0.001 HS ). Morphine requirement was also reduced (17.4±5.4 vs 26.2±4.4 mg, p=0.001 HS ). Pain VAS scores at rest and movement were also reduced at all time period (p≤ 0.01 to 0.001). There was no complication attributed to the TAP block. Conclusion: TAP block provided considerably effective postoperative analgesia in first 24 hours after major abdominal surgery like TAH. Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 3-11
TL;DR: It is demonstrated that canalith repositioning procedure (CRP) was effective in the treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery & low drug dependence.
Abstract: Benign paroxysmal positional vertigo (BPPV) is paroxysms of vertigo occurring with certain head movements, typically looking up or turning over in bed comprising about 20% of Dizziness cases. This study was carried out to evaluate the Efficacy of canalith repositioning procedure(CRP) in BPPV. A randomized clinical trial including 80 patients with BPPV was performed Medicine & Neurology Outpatient Department, Chittagong Medical College Hospital. The patients were randomly divided into two groups. Group A treated by anti-vertigo drug and CRP, Group B treated by anti-vertigo drug alone. All patients were followed up in hospital at one week after & 4 weeks. The rates of effectiveness of CRP treatment and the control treatment for were 86.8% and 59.4%, respectively. There was a significant difference (27.4%) in the outcomes of the CRP & control groups (P <.05). Mean total drug use for the group A was 10 ± 1, whereas it was 30 ± 1.5 for group B, mean difference = 20 (P < .001, highly Significant). At 4 Weeks, subjective improvement and symptom free occurred in 94.7% patients in group A and 73% patients in group B (difference21.7%). Complications in the CRP group were observed in 10.6% of the patients. This study demonstrated that canalith repositioning procedure (CRP) was effective in the treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery & low drug dependence. Complications of CRP were limited to 10.6% of patients. Medicine Today 2015 Vol.27(2): 23-27
TL;DR: The good long-term outcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives and using right atrial wall as a buffle is rare and done first time in Bangladesh.
Abstract: The Fontan procedure is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic right ventricle. A 23 years old adult male from Noakhali admitted with the diagnosis of transposition of great arteries (D-TGA) with large perimembranous ventricular septal defect (PM VSD) with severe pulmonary stenosis (PS) and single ventricle morphology in National Institute of Cardiovascular Disease (NICVD), Dhaka .He underwent Intracardiac lateral tunnel Fontan by using right atrial wall. Patient recovered uneventfully in his early postoperative period. The lateral tunnel Fontan procedure results in excellent long-term outcome even when used in patients with diverse anatomic diagnoses. The incidence of atrial tachyarrhythmia is low and mainly depends on the underlying cardiac morphology and preoperative arrhythmia. The good long-term outcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives. But using right atrial wall as a buffle is rare and done first time in Bangladesh. Cardiovasc. j. 2016; 9(1): 68-72
TL;DR: Therapy needs to be individualized to achieve optimal care of each child with steroid sensitive NS, as most children with steroidsensitive NS have multiple relapses and a significant percentage also develop steroid dependent NS.
Abstract: Nephrotic Syndrome (NS) is a common renal disease seen in children. Children who go into complete remission following treatment with corticosteroids are classified as having steroid sensitive NS. In developed countries over 80% of children with idiopathic NS have steroid sensitive disease. The exact pathogenesis of this condition remains elusive. Podocyte injury and proteinuria are the two main issues in the pathogenesis. Recent studies suggest release of cytokines by T-cells as well as a strong contribution of Bcell immunity. Genetic studies have reported human leucocyte antigen (HLA) class II antigens DR and DQ associations linked to steroid sensitive NS. Most children with steroid sensitive NS have multiple relapses and a significant percentage also develop steroid dependent NS. Diuretic- resistant edema also a clinical problem to manage these patients. These children receive multiple courses of steroids and are at high risk of developing steroid toxicity. Patient with frequent relapses who develop steroid dependency thus require alternative treatment. Steroid resistant NS considers when failure to response within 8 weeks of steroid therapy. Steroids sparing agents used include levamisole, cyclophosphamide, mycophenolate mofetil (MMF), calcineurin inhibitors (cyclosporine and tacrolimus), rituximab and vincristine; these agents have greatly reduced the adverse effects seen with long-term use of steroids; so therapy needs to be individualized to achieve optimal care of each child. J Bangladesh Coll Phys Surg 2016; 34(1): 26-32
TL;DR: A total of 50 biopsy proved squamous cell carcinoma of the glottis larynx were treated with radical Radiotherapy, total dose of which was 66Gy in 33 fractions over 7 weeks, conventionally fractionated with 200 cGy per fraction, one fraction per day and 5 fractions per week, using the machine 6 MV LINAC.
Abstract: This study was carried out from May 2012 to April 2013, on short term effects of Radical Radiotherapy for patients with Stages I-III squamous cell carcinoma of the glottic larynx at National Institute of Cancer Research and hospital, Mohakhali, Dhaka. A total of 50 biopsy proved squamous cell carcinoma of the glottis larynx were treated with radical Radiotherapy, total dose of which was 66Gy in 33 fractions over 7 weeks, conventionally fractionated with 200 cGy per fraction, one fraction per day and 5 fractions per week, using the machine 6 MV LINAC. The main outcome variables of the study were toxicities and clinical outcome of the patients. The peak age incidence was found in the age group of 51-60 years (56%). Among 50 patients, there were 82% males and 18% females and male to female ratio was 4.6:1. There were 86% found smokers and rests of the 14% patients were non smoker. Treatment related haematological and non-haematological acute and delayed toxicities were studied. Mucosities 28% (grade-II), skin reaction 78% (grade-II), anaemia 52% (grade-II), dysphagia 70% were the most common acute toxicities where as xerostomia 16% was the delayed side effect. With this treatment protocol, 86% patients responded completely. Faridpur Med. Coll. J. Jul 2015;10(2): 63-67
TL;DR: There is little information on the prevalence of STIs in Bangladesh, but Chittagong is the commercial capital and port city of Bangladesh and has the highest risk of infection.
Abstract: The WHO estimates that there are around 340 million curable sexually transmitted infections (STIs) worldwide each year, with the highest prevalence being in South and Southeast Asia.1 STIs disproportionally affect the developing world due to social and cultural prejudices and practices and the non-availability of and lack of access to health services. There is little information on the prevalence of STIs in Bangladesh.2 Chittagong is the commercial capital and port city of Bangladesh and has the highest risk …
01 Jan 2016
TL;DR: Although bacterial STIs are common findings in this study, viral STIs show also in increasing trend, unlike HIV, many STIs can be treated and cured relatively easily and cheaply if diagnosed early enough.
Abstract: Background: The burden of sexually transmitted infections (STIs) is huge and is disproportionately affecting developing nations. Epidemiologically sound data on the prevalence of sexually transmitted infections are dearth in Bangladesh. Objectives: To study the prevalence and pattern of STIs as seen in a tertiary care hospital of Bangladesh. Materials and methods: A descriptive retrospective cross-sectional study is carried out in Chittagong Medical College Hospital from the registered records of patients attending during the period between 2003 and 2011. Results: A total number of 30,151 patients are analyzed. Among the patients there is 21,746 (72%) of male and 8,405 (28%) of female. The mean age is 30.94 ± 0.001 SEM. Common sexually transmitted infections are non-gonococcal urethritis (NGU) (31.37%), gonorrhea (27.81%), syphilis (18.06%), genital scabies (6.56%), chancroid (5.3%), genital herpes (4.8%) and genital wart (3.62%). NGU is the most common discharging STI, while syphilis is the most common ulcerative STI. Genital herpes is the most common viral STI. Human immunodeficiency virus (HIV) (0.10%) infections are rare. Lymphogranuloma venereum and Granuloma inguinale are not found among the attendees. Conclusion: Although bacterial STIs are common findings in our study, viral STIs show also in increasing trend. Unlike HIV, many STIs can be treated and cured relatively easily and cheaply if diagnosed early enough. We hope that reporting this unique presentation of STIs in Bangladesh will be of educational value to increase awareness and offer possible options of planning and management for STIs.
TL;DR: The burden of poisoning in Bangladesh is not exactly known but the information from the Health Bulleting 2014 mentioned poisoning within 10 causes for hospital admission and is one of the leading causes of death along with injury.
Abstract: The burden of poisoning in Bangladesh is not exactly known but the information from the Health Bulleting 2014 mentioned poisoning within 10 causes for hospital admission and is one of the leading causes of death along with injury1. Most of the cases of poisoning are managed in the public health care system in Bangladesh. Cases of acute poisoning despite a medical emergency are admitted in general wards of medicine and paediatrics units of medical colleges and district hospitals or in upazilla health complexes. Considering poisoning as an important but relatively less well addressed field,a‘training manual for management of poisoning’ was prepared in 2007.Updated twice since then by the Directorate General of Health Services, Government of the People’s Republic of Bangladesh for the improved management, is a laudable job done2. There is still a large gap in practice at the filed level.To cite couple of examples, large bore orogastric tube for stomach wash is still widely practiced though hardly there is any indication of using it; titration dose of atropine for initial atropinizationis not uniformly used for managing organphosphorus compound poisoning, though there are evidences supporting it3,4.
12 Dec 2016
TL;DR: Hypertensive AMI patients had a significantly higher incidence of AF, lower incidence of cardiogenic shock and an overall better inhospital outcome compared with the normotensives, probably owing to a better preserved left ventricular function, prior use of cardioprotective drugs and yet undefined mechanism.
Abstract: Background :In-hospital complications and mortality in hypertensives developing acute myocardial infarction(AMI) may be different from those of normotensive counterpart.The aim of the current study was to analyze in-hospital complication and outcome of AMI in hypertensive patients and compare it with age and sex matched normotensive AMI patients. Methods : In-hospital complications of 112 hypertensive patients with AMI admitted over a period of 1 year (April 2014 to March 2015) were compared with the control group. Location and types of AMI were determined by ECG. Patients were considered to be hypertensive if they were taking antihypertensive treatment or were found to have a systolic blood pressure (SBP) e”140 mmHg and/or a diastolic blood pressure (DBP) e”90 mmHg on repeated measurements. Both groups were studied prospectively. The results were analyzed by SPSS software. Results :Out of total 112 patients 69 were male and 43 were female in each group. Male: female ratio was 1.6:1. Mean age of the study population was 67.3±10.2 yrs (range 41 to 83 yrs). Mean blood pressure values were 145.7±11.5/88.3±8.9 mmHg in the hypertensive and 127.3±9.7/75.8±5.6 mmHg in normotensive group respectively. A significantly higher prevalence of diabetes, dyslipidemia, chronic kidney disease, stroke and peripheral vascular disease were found in the hypertensive compared with the normotensive subjects. Hypertensive AMI patients had higher left ventricular ejection fraction compared with the normotensives(0.51±0.13 vs 0.47±0.15). A higher frequency of paroxysmal atrial fibrillation(AF) (10.7% vs 7.1%, P<0.05) and a lower frequency of atrioventricular block (5.4 % vs 8.0%), ventricular fibrillation (2.7% vs 4.5%), cardiogenic shock (4.5% vs 9.8%, P<0.01) and a lower inhospital mortality(6.2% vs 10.7%, P<0.01) were found among the hypertensives compared with the normotensives. Conclusion : Hypertensive AMI patients had a significantly higher incidence of AF, lower incidence of cardiogenic shock and an overall better inhospital outcome compared with the normotensives, probably owing to a better preserved left ventricular function, prior use of cardioprotective drugs and yet undefined mechanism. Bangladesh Heart Journal 2016; 31(1) : 10-17
TL;DR: This small trial gave a good impression about medical treatment in selective cases of ectopic pregnancy and the efficacy should be assessed in a randomized clinical trial with a different set of population Bangladesh.
Abstract: Objectives: The aim of this study was to explore the safety and efficacy of medical management of ectopic pregnancy. Materials and methods: This prospective observational study was conducted between February 2011 to August 2013 in Chittagong Medical College Hospital (CMCH) and in different private clinics of Chittagong city. Twenty-seven patients of ectopic pregnancy conceived by fertility treatment were recruited for medical treatment after proper evaluation. Ectopic pregnancy was diagnosed by serum ?-hCG and progesterone level but missing intrauterine pregnancy by transabdominal sonography (TAS). Serum ?-hCG was repeated after 48 hours to observe doubling of the level. If level was not doubled or increment was not at least 66% and serum progesterone level was less than 15ng/ml then it was considered as ectopic pregnancy. Patients were treated with Injection methotrexate 50 mg intramuscularly either by single dose or two doses. After 4 days of 1 st injection ?-hCG was repeated and if level decreased > 15% then patients were assessed weekly till ?-hCG fell to <5lU/L. If drop was <15% after 4 days a second dose of methotrexate was given. Results: Overall success rate was 66.66% . Surgical intervention was needed in 22.22% patients. All patients were treated after hospitalization in CMCH and different private clinics of Chittagong. They got injection methotrexate, antibiotic, antispasmodic and analgesics for abdominal pain. Single dose cured 55.55% patients and 11.11% patients needed second dose, another 11.11% patients were misdiagnosed later on they were diagnosed as intrauterine pregnancy and medical termination was done. Within one year of treatment 33.33% patients conceived again. There was no side effect or complications of the treatment. Conclusion: This small trial gave a good impression about medical treatment in selective cases. The efficacy should be assessed in a randomized clinical trial with a different set of population Bangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 32-36