[Show abstract][Hide abstract]ABSTRACT: Background
In visceral leishmaniasis (VL), retinal changes have previously been noted but not described in detail and their clinical and pathological significance are unknown. A prospective observational study was undertaken in Mymensingh, Bangladesh aiming to describe in detail visible changes in the retina in unselected patients with VL.
Patients underwent assessment of visual function, indirect and direct ophthalmoscopy and portable retinal photography. The photographs were assessed by masked observers including assessment for vessel tortuosity using a semi-automated system.
30 patients with VL were enrolled, of whom 6 (20%) had abnormalities. These included 5 with focal retinal whitening, 2 with cotton wool spots, 2 with haemorrhages, as well as increased vessel tortuosity. Visual function was preserved.
These changes suggest a previously unrecognized retinal vasculopathy. An inflammatory aetiology is plausible such as a subclinical retinal vasculitis, possibly with altered local microvascular autoregulation, and warrants further investigation.
[Show abstract][Hide abstract]ABSTRACT: A cross sectional analysis of chest radiograph was performed in 100 patients with tuberculosis to observe the recent trends of radiographic presentation. The study was done from April to December, 2009, in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh.The chest x-ray findings were analyzed and zonal involvement and pattern of opacities were catagorized and compared. Majority of patients (45%) showed involvement of the upper zone. Dominating lesion was consolidation (25%). Most of the patients were between 15-40 Years. Forty-four percent patients were sputum positive for acid fast bacilli and cavitation was dominant lesion among them. Chest x-ray of patients with post-primary tuberculosis shows involvement predominantly in the upper zone of lung. The most common opacity was consolidation. This correlates with different student. done over different population.
No preview · Article · Oct 2013 · Mymensingh Medical Journal
[Show abstract][Hide abstract]ABSTRACT: A cross sectional analysis of chest radiograph was performed in 100 patients with tuberculosis to observe the recent trends of radiographic presentation. The study was done from April to December, 2009, in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. The chest x-ray findings were analyzed and zonal involvement and pattern of opacities were categorized and compared. Majority of patients (45%) showed involvement of the upper zone. Dominating lesion was consolidation (25%). Most of the patients were between 15-40 years. Forty-four percent patients were sputum positive for Acid Fast Bacilli and cavitation was the dominant lesion among them. Chest x-ray of patients with post primary tuberculosis shows involvement predominantly in the upper zone of lung. The most common opacity was consolidation. This correlates with different studies done over different population.
Full-text · Article · Oct 2013 · Mymensingh Medical Journal
[Show abstract][Hide abstract]ABSTRACT: CONSENT AND COMMUNITY ENGAGE-ment (CE) in health research are two aspects of a single concern-that research is carried out in a respectful manner where social value is maximized. There are important overlaps and interdependencies between consent and CE; for example, CE can provide insights into how best to tailor consent to context and can be an important component of consent processes. Engaging communities can also have intrinsic and instrumental value beyond consent; for example, as a means of showing respect and identifying appropriate ways of working respectfully. In this paper we critically examine how CE and consent processes are characterized, conducted, and evaluated in diverse health research contexts, and propose a preliminary research agenda to support future learning in these critical areas.
Full-text · Article · Oct 2013 · Journal of Empirical Research on Human Research Ethics
[Show abstract][Hide abstract]ABSTRACT: The study was intended in determining the levels of some physico-chemical parameters, ioaccumulation of heavy metals in fish, shrimp and snail muscle sampled from the River Karnafuli. Samples were collected from two different points of the Karnafuli River (UPS-upstream the pollution source and PS- Pollution source) during July 2012-January 2013. The samples were collected for two different seasons: the summer and the winter. The samples like one fish species-Goby (Apocryptes bato), one shrimp species- Karnafuli shrimp (Palaemon karnafuliensis) and one snail species- Girdled horn snail (Cerithidea cingulata) were analyzed for the detection of concentration of six heavy meta like copper (Cu), hromium (Cr), lead (Pb), iron (Fe), aluminium (Al) and nickel (Ni). The concentrations of heavy metals in each sample were determined via Atomic Absorption Spectrophotometry. Among the physico-chemical parameters studied the dissolved oxygen concentration was considerably low at pollution source area in winter. Out of the six most hazardous substances Cu, Cr, Pb and Ni were identified in low amount in fish and shrimp but high in snail. These metals were within the safe limit adapted by fish and shrimp. The bioaccumulation of heavy metal concentrations in snail was higher than the other samples like fish and shrimp during both summer and winter. The present study indicates that the water quality of Karnafuli River is deteriorating and the organisms are getting polluted due to discharge of untreated industrial wastes.
[Show abstract][Hide abstract]ABSTRACT: Post-Kala-Azar Dermal Leishmaniasis (PKDL) remains a major public health threat in Bangladesh. A cross-sectional study was carried out in Surya Kanta Kala azar Research Centre (SKKRC), Mymensingh, from January 2012 to July 2013 to evaluate the health seeking behaviour and the length of delay of PKDL management. The consecutive 200 diagnosed PKDL cases that got treatment in SKKRC hospital were subjected to evaluation. Most (98%) of the patients were not aware and had no knowledge about PKDL, though 87.5% had a history of history of Kala-azar treatment. Many patients reported first to village doctor (15.5%), the pharmacy shop (10%), or traditional health provider (7.5%) upon recognition of symptom. The time between the initial symptom recognition and first medical consultation (patient delay) ranged from 10 days to 4745 days (13 years) with a median of 373 days (mean: 696; IQR: 138 to 900 days). The time between first medical consultations to definite treatment (system delay) ranged from 0 days to 1971 days (5.4 years), with a median delay of 14 days (mean: 46.48; IQR: 7 to 44 days) that was reported in this study. Age, education, occupation, and residential status had significant association with patient delay (
). Educational status, occupation, number of treatment providers, and first health care provider had a significant association with system delay (
). Success in PKDL diagnosis and treatment requires specific behavior from patients and health care providers which facilitate those practices.
Full-text · Article · Jun 2013 · International Journal of Antimicrobial Agents
[Show abstract][Hide abstract]ABSTRACT: Adenosine De Aminase (ADA) is increased in tuberculous ascitic fluid due to the stimulation of T-cells by mycobacterial antigens. The treatment for abdominal tuberculosis including ascites as a presentation is a matter of controversy around the world. The study is aim at to see the outcome of antitubercular chemotherapy in selected tubercular ascites patients. This hospital based prospective study was done in 24 cases of adult (>13 years) tubercular ascites admitted in a tertiary hospital Dhaka, over one year. Increased ADA level (>37iu/L) in ascitic fluid evaluated after the colorimetric method of Galanti and Giusti and other supportive investigations were done for diagnosing tuberculosis. Patients were under treatment of ATT cat-1 for six months as per national guide line. Outcome was seen as predefined criteria as treatment completed, cured, improved and not improved. Total number of patient is 24. Of which range of age is 13-70 years and mean±SD (33.2±14.77) with male female ratio is 0.85:1. Ninety six percent patients presented with abdominal pain, 23(96%) with fever, 22 (91%) with anorexia. Abdominal tenderness in 22(91%), ascites on 24(100%), hepatomegaly on 2(8%). Hundred percent patients were evaluated after completion of treatment. Twenty three (96%) patients improved and 1(4%) not improved. There is effectiveness of standard chemotherapy suggested by national guideline. Outcome of the patients were highly satisfactory with short regimen of antitubercular chemotherapy.
No preview · Article · Apr 2013 · Mymensingh Medical Journal
[Show abstract][Hide abstract]ABSTRACT: Infection with Burkholderia pseudomallei has been described, albeit rarely, patients in Bangladesh. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, which is present in soil and surface water in the endemic region. A 35-year-young male farmer presented with prolonged fever and significant weight loss. Patient gradually deteriorated despite getting different antibiotics including intravenous ceftriaxone and metronidazole. Panels of investigations were done which revealed no diagnostic confirmation except uncontrolled diabetes and multiple abscesses in different organs. Melioidosis was suspected and serum samples were positive for Burkholderia pseudomallei antibody. The case illustrates the importance of non-specific nature of the clinical presentation and high index of suspicion of uncommon diseases like melioidosis where the disease has not been considered as an endemic.
No preview · Article · Apr 2013 · Mymensingh Medical Journal
[Show abstract][Hide abstract]ABSTRACT: We conducted a study of the knowledge, attitudes and practices regarding dog bites among residents of a rural community in Bangladesh from September 2006 to February 2007 using face to face interviews with 1,973 adults from five villages. The mean age of the respondents was 34+/-16 years. Sixty-eight percent of subjects were female, 7.3% of respondents reported a history of dog bite in a family member; 10% had been bitten twice. Sixty-five percent of subjects were aware of rabies and 99.1% knew a dog bite was the cause of rabies. Seventy-one percent of subjects were aware of a rabies vaccine, 77.5% of respondents stated rabies can cause death. Ninty percent of dog bite victims received treatment by traditional healers, 25% were treated with a rabies vaccine and 2.1% of victims died. Greater awareness is needed in rural Bangladesh regarding prevention of rabies.
Full-text · Article · Mar 2013 · The Southeast Asian journal of tropical medicine and public health
[Show abstract][Hide abstract]ABSTRACT: Background:
Acute organophosphorus (OP) poisoning is relatively common and a major cause of death from poisoning in developing countries. Magnesium has been shown to be of benefit in animal models.
We conducted a phase II study of bolus doses of (MgSO4) in 50 patients with acute organophosphate poisoning. Patients eligible for inclusion had ingested OP and had cholinergic symptoms consistent with moderate or severe poisoning. All patients received standard care of atropinization titrated to control muscarinic symptoms and pralidoxime. The trial was run in 4 sequential groups of patients. Participants in each group received a different total dose of MgSO4 (20%) administered as intermittent bolus doses infused over 10-15 min or placebo. There was one control patient for every 4 patients who received MgSO4. Group A (16 patients) received a total of 4 gm MgSO4 as a single bolus, group B (8 patients) received 8 gm (in two 4 gm doses q4H), group C (8 patients) received 12 gm (in three 4 gm doses q4H) group D (8 patients) received 16 gm (in four 4 gm doses q4H) and control (10 patients) received placebo). Patients were closely monitored for any adverse reaction like significant clinical neuromuscular disturbance and respiratory depression.
No adverse reactions to magnesium were observed. The 24 hour urinary magnesium concentration were statistically different between 16 gm (234.74 ± 74.18 mg/dl) and control (118.06 ± 30.76 mg/dl) (p = 0.019), while it was much lower than the 80% of the intravenous magnesium load. Six patients died in control group compared to 3 in 4 gm, 2 in 8 gm and 1 in 12 gm group. There was no mortality in 16 gm group.
Magnesium was well tolerated in this study. Larger studies are required to examine for efficacy.
Full-text · Article · Jan 2013 · Clinical Toxicology
[Show abstract][Hide abstract]ABSTRACT: There was an outbreak of new emergence viral encephalitis caused by Nipah virus among humans in some areas of Bangladesh during 2001 - till to date. The disease affected mainly the young, had increased suspicion to spread from bat to man through eating of the same fruits. The risk of human-to-human transmission is thought to be low though many of the affected individuals belonged to the same family. The disease presented mainly as acute encephalitis with usually a short incubation period of less than two weeks, with the main symptoms of fever, headache, and giddiness followed by coma. Distinctive clinical signs include areflexia, hypotonia, hypertension, tachycardia and segmental myoclonus. Serology was helpful in confirming the diagnosis. Magnetic resonance imaging (MRI) showed distinctive changes of multiple, discrete or confluent small high signal lesions, best seen with fluid-attenuated inversion recovery (FLAIR) sequences. Mortality was as high as 32-92% and death was probably due to severe brainstem involvement. Relapse encephalitis was seen in those who recovered from acute encephalitis, and late-onset encephalitis was seen in those with initial non-encephalitic or asymptomatic diseases. Both these manifested as focal encephalitis arising from recurrent infection.
No preview · Article · Oct 2012 · Mymensingh Medical Journal
[Show abstract][Hide abstract]ABSTRACT: Severe organophosphate compound (OPC) poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine the best therapy. A study was therefore undertaken to determine the optimal dosing regimen for atropine in the treatment of OPC poisoning. An open-label randomized clinical trial was conducted in Chittagong Medical College Hospital, Chittagong, Bangladesh, on 156 hospitalized individuals with OPC poisoning from June to September 2006. The aim was to compare the efficacy and safety of conventional bolus doses with individualized incremental doses of atropine for atropinization followed by continuous atropine infusion for management of OPC poisoning. Inclusion criteria were patients with a clear history of OPC poisoning with clear clinical signs of toxicity, i.e. features of cholinergic crisis. The patients were observed for at least 96 h. Immediate outcome and complications were recorded. Out of 156 patients, 81 patients received conventional bolus dose atropine (group A) and 75 patients received rapidly incremental doses of atropine followed by infusion (group B). The mortality in group 'A' was 22.5% (18/80) and in group 'B' 8% (6/75) (p < 0.05). The mean duration of atropinization in group 'A' was 151.74 min compared to 23.90 min for group 'B' (p < 0.001). More patients in group A experienced atropine toxicity than in group 'B' (28.4% versus 12.0%, p < 0.05); intermediate syndrome was more common in group 'A' than in group 'B' (13.6% versus 4%, p < 0.05), and respiratory support was required more often for patients in group 'A' than in group 'B' (24.7% versus 8%, p < 0.05). Rapid incremental dose atropinization followed by atropine infusion reduces mortality and morbidity from OPC poisoning and shortens the length of hospital stay and recovery. Incremental atropine and infusion should become the treatment of choice for OPC poisoning. Given the paucity of existing evidence, further clinical studies should be performed to determine the optimal dosing regimen of atropine that most rapidly and safely achieves atropinization in these patients.
Full-text · Article · Feb 2012 · Journal of medical toxicology: official journal of the American College of Medical Toxicology
[Show abstract][Hide abstract]ABSTRACT: The present study aims to assess the different types of costs for treatment of snake bite patients, to quantify household economic impact and to understand the coping mechanisms required to cover the costs for snake bite patients in Bangladesh. The patients admitted to four tertiary level hospitals in Bangladesh were interviewed using structured questionnaires including health-care-related expenditures and the way in which the expenditures were covered. Of the snakes which bit the patients, 54.2% were non-venomous, 45.8% were venomous and 42.2% of the patients were given polyvalent antivenom. The total expenditure related to snake bite varies from US$4 (US$1 = Taka 72) to US$2294 with a mean of US$124 and the mean income loss was US$93. Expenditure for venomous snake bite was US$231, which is about seven times higher than non-venomous snake bite (US$34). The treatment imposes a major economic burden on affected families, especially in venomous snake bite cases.
[Show abstract][Hide abstract]ABSTRACT: Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.
Full-text · Article · Feb 2011 · Transactions of the Royal Society of Tropical Medicine and Hygiene