Dermatology Life Quality Index in Patients with Dermatophytosis in a Tertiary Care Centre of Bangladesh.

In our country a huge number of populations are suffering from dermatophytosis. During the last few years, the number of patients affected by dermatophytosis has been increasing. Dermatophytosis tends to be prolonged, recurrent and persistent course which can affect quality of life (QoL). The aim of this study was to seek out the effect of dermatophytosis on the quality of life of the patients of dermatophytosis and to analyze its relationship with various demographic and clinical factors. This was a cross-sectional study in which 306 patients aged ≥16 years with dermatophytosis were included and evaluated for impact of dermatophytosis on quality of life using dermatology life quality index (DLQI) questionnaire. Independent sample t-test and one way ANOVA were used to find out statistical associations between various variables and mean DLQI scores, wherever applicable. The mean DLQI score in this study was 13.07±8.51. Majority (39.5%) subjects had a 'very large' effect on the QoL. Mean DLQI was significantly higher in young subjects, patients with longer duration of disease, more body surface area involved, involvement of more than one sites (generalized involvement) and topical steroid containing preparation users (p<0.05). This study revealed that the quality of life is adversely affected by dermatophytosis. Hence, Steps must be taken for proper counseling and management, along with early detection and elimination of topical steroid use in dermatophytosis.

Pattern of Neonatal Danger Signs and its Related Factors in a Tertiary Level Hospital.

Considering very limited information in the pattern of neonatal danger signs with associated risk factors in our perspective, the aim of the study was to understand the country-context pattern of neonatal danger signs and its related factors in a tertiary level hospital. This cross-sectional study was conducted among 259 mothers and their neonates in Dhaka Medical College Hospital, Dhaka, Bangladesh from 01 January 2015 to 31 December 2015. Data were collected by face to face interview from mother by pre-tested semi structure questionnaire which was adopted from WHO-UNICEF list of newborn danger signs. Measurement of weight was taken from hospital record. Observation of danger signs were done by following check list. Data analysis was done by SPSS 20.0. Of all, majority (41.6%) was in the age group of 20-24 years & was educated up to secondary level (42.47%). More than half of the participants (54.1%) had family income >10,000 BDT. Sixty percentage of mother took ANC visit <3 times during their pregnancy period. About 42.1% had ≥1 co-morbidities. Hospital was the predominate place of birth with 48.3% caesarean delivery. At least one neonatal danger sign was present in 20.1% while 39.4% had at least 2 danger signs. Rest of the child had ≥2 danger signs at a time. The distribution of danger signs were not feeding since birth or stop feeding 206(79.5%), severe chest in drawing 145(56.1%) respiratory rates 60 or more 126(48.6%), convulsion 72(27.8%), yellow soles 68(26.3%). Factors like 'fail to identify with an expert health assistant', trial of delivery at home, delivery at home, older neonatal age (8-28 days), presence of injury at birth, and cutting of umbilical cord by blade during delivery were associated with higher number of danger signs (p<0.05 in all cases). About 80% neonate in our setting had ≥1 sign and had association with fail to identify with an expert health assistant', trial of delivery at home, delivery at home, older neonatal age, presence of injury at birth, and cutting of umbilical cord by blade during delivery.

Genetic diversity of Nipah virus in Bangladesh.

BACKGROUND: Nipah virus (NiV) infection, often fatal in humans, is primarily transmitted in Bangladesh through the consumption of date palm sap contaminated by Pteropus bats. Person-to-person transmission is also common and increases the concern of large outbreaks. This study aimed to characterize the molecular epidemiology, phylogenetic relationship, and the evolution of the nucleocapsid gene (N gene) of NiV. METHODS: We conducted molecular detection, genetic characterization, and Bayesian time-scale evolution analyses of NiV using pooled Pteropid bat roost urine samples from an outbreak area in 2012 and archived RNA samples from NiV case patients identified during 2012-2018 in Bangladesh. RESULTS: NiV-RNA was detected in 19% (38/456) of bat roost urine samples and among them; nine N gene sequences were recovered. We also retrieved sequences from 53% (21 out of 39) of archived RNA samples from patients. Phylogenetic analysis revealed that all Bangladeshi strains belonged to NiV-BD genotype and had an evolutionary rate of 4.64 × 10-4 substitutions/site/year. The analyses suggested that the strains of NiV-BD genotype diverged during 1995 and formed two sublineages. CONCLUSION: This analysis provides further evidence that the NiV strains of the Malaysian and Bangladesh genotypes diverged recently and continue to evolve. More extensive surveillance of NiV in bats and human will be helpful to explore strain diversity and virulence potential to infect humans through direct or person-to-person virus transmission.

Straight-to-test colonoscopy for 2-week-wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high-volume unit.

AIM: We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. METHOD: We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA). RESULTS: Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P < 0.0001). STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P < 0.0001) and tissue diagnosis from the referral date (17 days vs 24.5 days; P < 0.0001). Thirty-seven (6.8%) CRCs were detected. Proportionately fewer patients in the STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months. CONCLUSION: STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly.

Removal of Unusually Large Torpedo Sialolith from Wharton's Duct under Local Analgesia: A Case Report.

Submandibular salivary gland system is commonly affected with sialolith (calculus) and victim suffers painful acute symptoms. Sialoliths usually are of 1-15mm in size. Although rarely giant sialoliths are seen, a giant torpedo sialolith of about 41mm × 9mm within the submandibular salivary duct is reported which was removed intraorally under local analgesia. Post-operatively, within six weeks salivation through duct was evidenced showing the process of re-establishment of salivary function.

Remote surveillance after colorectal cancer surgery: an effective alternative to standard clinic-based follow-up.

AIM: Most colorectal cancer recurrences are asymptomatic and are detected through routine postoperative clinic surveillance programmes with associated investigations. However, attendance at these clinics has a financial cost and may be associated with an increase in patient anxiety and dissatisfaction. The results of a remote follow-up system developed for selected patients are reported. METHOD: A remote surveillance programme has been in place in our institution for over 9 years. Patients having elective and emergency treatment for colorectal cancer were enrolled. The timeliness of the investigation, detection of local recurrence and distant metastases and overall 5-year survival rates were determined. A cost review and patient satisfaction survey were performed. RESULTS: The programme was suitable for over 900 patients who had received surgery for colorectal cancer between 2004 and 2012, representing some 50% of the total number of patients treated in this period. Of these, 811 (90%) had investigations carried out on time. Five-year survival rates were comparable with national data. Cost-minimization analysis demonstrated a financial saving of 63% and a 75% reduction in clinic appointments. High levels of overall patient satisfaction (97%) were noted with the programme. CONCLUSION: A remote surveillance system after colorectal cancer surgery is a safe and cost-effective alternative to traditional clinic-based follow up and has high patient satisfaction.

Role of D-dimer in determining coagulability status in pre-eclamptic and normotensive pregnant women.

A cross sectional study was carried out from January 2007 to December 2008 in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka in collaboration with Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Pregnant women with pre-eclampsia attending at Out-patient Department (OPD) and admitted in In-patient Department of Obstetrics and Gynaecology Dhaka Medical College Hospital, Dhaka were selected as cases. Healthy and uncomplicated pregnant women admitted in the same hospital were taken as controls. The study showed that 26-30 years and 21-25 years age category was higher in the case and control groups and the mean age was significantly higher in case group compared to control group (p=0.025). The study showed that 44% of case group had a significantly high level of plasma D-dimer (>0.5µg/ml) as opposed to control group (8%) (p<0.001). Estimation of odds ratio demonstrates that pre-eclamptic women (case) had 9 times (95% of CI = 2.8 - 28.9) more risk of having plasma D-dimer >0.5µg/ml than that of normal pregnant women (control). The mean systolic and diastolic blood pressures in patients with plasma D-dimer >0.5µg/ml were considerably higher than those who had plasma D-dimer ≤0.5µg/ml (p<0.001). The study showed that majority (81.8%) of pre-eclamptic women with plasma D-dimer >0.5µg/ml had systolic blood pressure ≥ 160 mm Hg compared to 46.4% of those who had plasma D-dimer ≤0.5µg/ml (p=0.010). And ninety percent of pre-eclamptic women with plasma D-dimer >0.5µg/ml had exhibited severe proteinuria as opposed to 53.6% of those who had plasma D-dimer ≤0.5µg/ml (p=0.017). The study concludes that plasma D-dimer level can easily be used in screening for the hypercoagulable state in pre-eclamptic patients which have preventive and therapeutic implications.

Cryopreservation of quince (Cydonia oblonga Mill.).

BACKGROUND: Quince (Cydonia oblonga Mill.) has great potential for utilisation in pharmaceutical and food industries. OBJECTIVE: The study was to develop an efficient cryopreservation approach for quince. METHODS: Factors on the survival and regrowth such as cold acclimation, explant type and recovery media composition were assessed. The effectiveness of the resultant protocols for a number of quince cultivars was determined. RESULTS AND CONCLUSION: Quince shoot tips and nodal sections are successfully cryopreserved. Sustained regrowth of quince Angers A was observed after encapsulation-osmoprotection/dehydration, encapsulation-dehydration and PVS2 vitrification. The highest regrowth rate (80%) was obtained from explants excised from cold hardened shoots and cryopreserved using encapsulation-osmoprotection/dehydration and vitrification protocols. The optimised vitrification protocol in combination with shoot cold hardening and a MS recovery medium without activated charcoal and auxin resulted in satisfactory regrowth of shoots from six quince cultivars. The morphology of acclimatised plants derived from cryopreserved shoots was comparable with non-cryopreserved plants.

Microbiological analysis of tube-well water in a rural area of Bangladesh.

Five tube-wells in Matlab, Bangladesh, were selected for analysis of selected biophysicochemical parameters. The results showed that all tube-well water samples contained zooplankton and bacteria. Results for some of the parameters were outside the accepted limits recommended by the World Health Organization for drinking water. It is concluded that water from tube-wells should be treated if used as drinking water.