Endovascular Aneurysm Repair for Infrarenal Abdominal Aortic Aneurysm: New Horizon in Endovascular Surgery in Bangladesh.

Abdominal aortic aneurysm remains mostly asymptomatic. It is usually detected incidentally with imaging studies. Here we present a 55 years old hypertensive, non smoker, non diabetic, male patient who was diagnosed as a case of infrarenal abdominal aortic aneurysm. He was treated by endovascular means using endograft without laparatomy. Endografts were deployed through bilateral femoral artery cut down technique under general anesthesia. Completion angiogram following this endovascular aneurysm repair (EVAR) technique revealed good technical success with no endoleak. This hybrid procedure was performed in a cathlab having surgical instruments in hand. Three years after the procedure, patient is doing well.

Tuberculosis of the central nervous system.

Tuberculosis can involve any organ system of the body. Although rare tuberculosis of nervous system (NS) is not uncommon in our country. In the nervous system tubercle bacilli can cause tuberculous meningitis, abscess , tuberculoma in brain & spinal cord. Untreated Central Nervous System (CNS) tuberculosis is devastating. Early diagnosis & prompt treatment of NS is essential to avoid morbidity & mortality. Tubercle bacilli causes chronic caseating granulomatous lesion. Tubercular meningitis presents with fever, headache, neck stiffness & cranial nerve palsy. Tuberculoma may present with headache, seizure and focal deficit. In the spinal cord tuberculoma or tubercular abscess may result in para paresis or quadri-paresis. For diagnosis of nervous system tuberculosis CSF analysis and neuroimaging are important. CSF cell count, Gram staining, Culture and Polymerase Chain Reaction (PCR) are helpful for diagnosis. Imaging helps in the diagnosis of tuberculoma and tubercular abscess. Computed tomography (CT) guided Fine Needle Aspiration for Cytology (FNAC) helps to establish the histopathological diagnosis. Use of combination antitubercular drugs for long period (12-18 months) is necessary to treat nervous system tuberculosis.

Chromium III exposure inhibits brain Na+K+ATPase activity of Clarias batrachus L. involving lipid peroxidation and deficient mitochondrial electron transport chain activity.

The present study elucidated the role of lipid peroxidation and diminished mitochondrial electron transport chain activity in partial dysfunction of brain Na+K+ATPase of Clarias batrachus exposed to chromium III ions. The fish were exposed to 10% and 20% of the derived 96 h LC50 value, 5.69 mg/L and 11.38 mg/L, respectively, and sampled on 20, 40 and 60 days. Exposure to chromium III on fish brain demonstrated an increased lipid peroxidation, production of protein carbonyl and reactive oxygen species and loss of protein thiol groups in synaptosomal fraction with decreased activity of Na+K+ATPase, partial inactivation of mitochondrial electron transport chain activity and energy depletion.

Age and Gender-dependent Correlates as Risk Factors of Recurrent Headache among Bangladeshi Secondary School Children.

Magnitude of recurrent headache (RHA) is not well explored among school-children (schoolers) particularly in developing countries like Bangladesh, though recent literature reveals that RHA connotes serious public health implication(s) particularly in schoolers in resource constraint countries. To study age and gender-dependent correlates of RHA among secondary-level schoolers and to determine if these remains its risk-factors. Cross-sectional population based respondent-dependent study employing direct interviews using pre-tested open and closed-ended questionnaire following ICHD-II (2004) diagnostic criteria. Overall, 17% RHA was observed among 1499 schoolers surveyed initially, being more in pubertal/adolescents (13-15 years) than pre-pubertal (11-12 years) ones. Of screened-out 255 RHA positive cases, migraine (MHA) was observed in 55.3% while tension-type-headache (TTH) in 19.6% schoolers. RHA demonstrated a steady-inclining trend with schooler's age. Gender difference was obvious in MHA (p<0.001) but not in TTH (p<0.31). Pubertal schoolers (OR=8.75) and boys (OR=1.8) remained at greater risk for migraine but less risky for TTH. Mass-awareness program is imperative to prevent RHA among schoolers towards progressing it into chronicity, psycho-socially handicapped and economically burdened. Further in-depth studies warrant prudent data to examine its long-term risks/underlying factors involving more diverse population (school-children) from different geographical areas and cultural contexts.

Role of Oral Clonidine Premedication on Intra-operative Haemodynamics and PONV in Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy is a gold standard surgical procedure for gallbladder operation. It causes altered haemodynamic responses due to pneumoperitoneum and surgical procedure also causes high incidence of postoperative nausea &vomiting. Clonidine has been shown to reduce intraoperative haemodynamic instability. This randomized prospective single blind clinical study was designed to evaluate the efficacy of oral clonidine premedication for attenuation of haemodynamic responses associated with pneumoperitoneum & also reduce the incidence of postoperative nausea & vomiting and carried out in the department of Anaesthesia Analgesia and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to June 2010. Sixty adult patients of ASA physical status I & II scheduled for elective laparoscopic cholecystecomy were recruited for a prospective randomized single blind study. They were selected randomized into two equal groups, thirty in each group. Group A received no premedication & Group B (Clonidine) received clonidine (100µgm) orally 60 minutes before induction of anaesthesia. Pulse rate, mean arterial pressure were recorded prior to induction, 2 minutes after endotracheal intubation, before pneumoperitoneum, 10 minutes & 20 minutes after pneumoperitoneum, 10 minutes after release of carbon dioxide & 10 minutes after extubation. Patients in Group B (Clonidine) maintained greater haemodynamic stability intraoperatively compare to Group A after intubation, during pneumoperitoneum and also extubation. Pulse rate & mean arterial pressure significantly varies in Group A compare with Group B (Clonidine) at different times of intraoperative period (p<0.05). Postoperative nausea & vomiting was significantly less in Group B (Clonidine). Premedication with oral clonidine attenuates the haemodynamic responses produced by pneumoperitoneum during laparoscopic cholecystectomy and also significantly nausea and vomiting, results better patient satisfaction and cost effective.

Epidemiological and clinical profiles of acute invasive diarrhoea with special reference to mucoid episodes: a rural community-based longitudinal study.

A study was carried out in 3 villages near Calcutta, India, having a population of 5464, between August 1992 and December 1994. A cohort of rural children below 4 years of age was prospectively observed to determine the clinico-epidemiological aspects of mucoid diarrhoea and examine propensity to invasiveness. Overall, the incidence of diarrhoea was 1.7 episodes/child/year, and that of mucoid and bloody dysentery was 0.8 and 0.2 episodes/child/year, respectively. Children aged 6-11 months had a higher incidence of mucoid diarrhoea (1.3 episodes/child/year) and the peak season occurred in June and July. Multivariate analysis using logistic regression showed that mucoid diarrhoea and bloody dysentery were closely similar in both clinical and laboratory findings, including raised faecal leucocyte count (> 10/high power microscope field [hpf]). However, abdominal pain occurred more frequently in bloody dysentery than in mucoid diarrhoea. Faecal leucocyte count (> 10/hpf) can therefore be used as an indicator for invasiveness of mucoid diarrhoea at the community level.

Epidemiology of Vibrio cholerae O139 with special reference to intrafamilial transmission in Calcutta.

A total of 27 families of hospitalised patients (index case families) suffering from acute watery diarrhoea caused by Vibrio cholerae O139, and 14 neighbourhood families were bacteriologically screened for 4 consecutive days to determine the extent of V. cholerae O139 infection amongst healthy contacts and other suspected vehicles of transmission at the intrafamilial level. V. cholerae O139 was isolated from faeces of 14.6% of healthy contacts in index case families as compared to none in neighbourhood families (P = 0.002). The organism could be recovered from 3.7% of handwashings of contacts of index cases and also from stored drinking water (8.0%), open well water (28.6%), flies (3.8%) and pond water (25.0%) used by the index case families and none from neighbourhood families. The large number of asymptomatic infected persons indicate an epidemiological similarity to that of eltor cholera. The organisms may be carried on hands and may act as a potential source of infection to other inmates through contamination of stored drinking water, open wells etc. The results will be useful in formulating strategies for intervention of transmission of V. cholerae O139 at the community level.

Spectrophotometric determination of iminodiacetic acid in presence of primary amino-acids.

Iminodiacetic acid down to 10(-5)M is determined spectrophotometrically in the presence of primary amino-acids by complex-formation with iron(III) at pH 3.0-3.5. The method is simple, fairly accurate, rapid and free from interference from most common metal ions.

An operational study on implementation of oral rehydration therapy in a rural community of West Bengal, India.

An operational study of a 3-tier strategy for implementation of oral rehydration therapy (ORT) was conducted in a block of West Bengal with 216,825 population through the existing health services facilities. All the grassroot level, health workers including their supervisors at various levels were trained regarding the management of patients of diarrhoea with mild to moderate degree of dehydration, by ORT. Another block in the same district with similar demographic features where this intervention was not provided served as control. After 22 months of observation, it was evident that despite adequate training, the performance of Community Health Guides (CHGs) and Anganwadi Workers (AWWs) was not encouraging because of the low utilization of both home available fluids (32.0%) and oral rehydration solution (18.0%) in the study area. Similarly, diarrhoea associated mortality could not be reduced significantly. Lack of motivation and failure to maintain sustained level of skill by the CHGs and AWWs constitute the major bottlenecks for the successful implementation of the programme at the community level.

PIP: Between April 1985-January 1987, researchers conducted a 3 stage operational study of oral rehydration therapy (ORT) implementation in 2 rural blocks of Hooghly district in West Bengal, India. ORT implementation only occurred in 1 block. The stages included training of community health guides (CHGs) and Anganwadi workers (AWWs); monitoring, supervision, and logistic support; and health and practices surveys. Home available fluids (HAF) usage rate increased from 31-53% in the study block, but fell to only 32% by January 1987. In fact, the initial and final HAF usage rates for the study block were comparable to those of the control block (31% vs. 28.4% and 32% vs. 30%, respectively). Moreover the corresponding figures for oral rehydration solution (ORS) use stood at 13% vs. 8% and 18% vs. 18%). Despite several CHG and AWW training sessions on informing mothers to use ORT in adequate amounts as early as possible during a diarrheal episode, only 12.4% of mothers ever educated by a CHG/AWW knew to do so. In fact, none of the mothers administered ORT early or in adequate amounts. Furthermore diarrhea related mortality remained essentially the same in the study area throughout the study (2-2.8) and indeed the lowest rate (1.7) was in the control area in April 1986. Even though mothers in the study block were significantly more likely to know about oral rehydration solution (ORS) and the availability of free treatment for diarrhea in the village (57% vs. 26% and 34% vs. 13% respectively; p.05), no difference in use of HAF and ORS during diarrhea occurred (26.8% vs. 20% and 11% vs. 12% respectively). The researchers concluded that the major obstacles for improvement of HAF and ORS use were lack of motivation and the CHGs and AWWs inability to maintain a sustained skill level.

Intestinal parasitism: a childhood problem in rural Bengal.

A study was undertaken to assess the parasitic infection rate in a rural community of West Bengal amongst children below four years of age suffering from gastrointestinal complaints. A total of 221 faecal samples were examined during November 1992 to April 1994. G. lamblia (17.2%) and E. histolytica (8.1%) were the predominant protozoas, whereas E. vermicularis (12.2%) and A. lumbricoides (8.1%) were found to be common amongst helminthic infection. A significantly lower infection rate was observed in children below one year (24.4 per cent) as compared to older age groups (66.4 per cent).

Adults with chronic cough in urban Bangladesh: healthcare utilization and management of cases by private practitioners.

Tuberculosis (TB) case detection under the Directly Observed Treatment - Short-course (DOTS) strategy largely relies upon care seeking of chronic coughers and the actions taken by their healthcare providers. This study aimed to describe the healthcare utilization of people 15 years of age with a chronic cough in urban areas of Bangladesh and to understand their management by private practitioners. A community-based, household survey included 60,382 persons ≥ 15 years of age from two administrative areas of Dhaka City. A total of 1138 (2%) were identified to have had a cough for 3 weeks or more. This survey was linked to interviews of licensed and unlicensed practitioners in Dhaka and the Chittagong City Corporation of Bangladesh. Among identified coughers, 1046 (92%) were interviewed, of whom 648 (62%) reported having sought care from any provider. Among care seekers, 16% directly attended a DOTS facility. The remaining 84% sought care from the private sector, where less than 1% reported referral to a DOTS facility. Bivariate and multivariate assessments showed that care seeking from a licensed private practitioner or a DOTS centre was significantly associated with severity of the disease and previous diagnosis of TB.

Toxicity of methanol to fish, crustacean, oligochaete worm, and aquatic ecosystem.

Static renewal bioassays were conducted in the laboratory and in outdoor artificial enclosures to evaluate toxic effects of methanol to one teleost fish and two aquatic invertebrates and to limnological variables of aquatic ecosystem. Ninety-six-hour acute toxicity tests revealed cladoceran crustacea Moina micrura as the most sensitive to methanol (LC50, 4.82 g/L), followed by freshwater teleost Oreochromis mossambicus (LC50, 15.32 g/L) and oligochaete worm Branchiura sowerbyi (LC50, 54.89 g/L). The fish, when exposed to lethal concentrations of methanol, showed difficulties in respiration and swimming. The oligochaete body wrinkled and fragmented under lethal exposure of methanol. Effects of five sublethal concentrations of methanol (0, 23.75, 47.49, 736.10, and 1527.60 mg/L) on the feeding rate of the fish and on its growth and reproduction were evaluated by separate bioassays. Ninety-six-hour bioassays in the laboratory showed significant reduction in the appetite of fish when exposed to 736.10 mg/L or higher concentrations of methanol. Chronic toxicity bioassays (90 days) in outdoor enclosures showed a reduction in growth, maturity index and fecundity of fish at 47.49 mg/L or higher concentrations of methanol. Primary productivity, phytoplankton population, and alkalinity of water were also reduced at these concentrations. Chronic exposure to 1527.60 mg/L methanol resulted in damages of the epithelium of primary and secondary gill lamellae of the fish. The results revealed 23.75 mg/L as the no-observed-effect concentration (NOEC) of methanol to freshwater aquatic ecosystem.

Effect of handwashing on the incidence of diarrhoea in a Calcutta slum.

PIP: Diarrheal diseases pose a major threat to the health of people living in developing countries, particularly where there is poverty and a poor environment. The effect of handwashing in reducing the incidence of diarrhea in day-care centers has been reported recently. The present study is a prospective community based study conducted to evaluate the effect of handwashing on the incidence of diarrheal disease in Calcutta slums. Handwashing was implemented in 1 slum and the other nearby slum, without handwashing program, served as control. The incidence of watery diarrhea during the 13 month period, between the study and control groups was not significantly different. However, the incidence of dysentery in individuals above 5 years of age in the control group was significantly higher as compared to those in the study group (p 0.05). The results of this study indicate that handwashing with soap may reduce the incidence of dysenteric cases in the community by interruption of transmission of the pathogens from 1 person to the other.^ieng

Studies on interventions to prevent eltor cholera transmission in urban slums.

Transmission of eltor cholera infection in endemic communities continues without diminishing because of the absence of effective intervention measures. Two methods-chlorination of stored water and the use of a narrow-necked earthenware vessel (called a 'sorai') for storing the water-were found to be effective in reducing the transmission of infection among the family contacts of cholera patients. The cholera carrier rates in the chlorination and 'sorai' intervention groups were 7.3% and 4.4%, respectively, compared with 17.3% in the control group. The 'sorai' is cheap and was well accepted by the local communities; its narrow neck prevented the introduction of the hand and contamination of the stored water.

Epidemiology of campylobacteriosis in a cohort of rural population near Calcutta.

Over a 2-year period, 25 families comprising of 181 individuals of all ages were longitudinally observed for the excretion of Campylobacter species. Faecal samples were taken from all persons with diarrhoea. Specimens were also taken from apparently healthy individuals and from domestic animals living within the confines of the study families at monthly intervals. The overall diarrhoea attack rate was 19 episodes per 100 person-years with peak incidence in the 1- to 4-year-old age group (76/100 person-years). Eight (11.5%) of the total episodes were campylobacter-associated and the overall rate of campylobacter positive diarrhoeal episodes were 2.2 per 100 person-years. Of the 1002 stool samples from healthy individuals 32 (3.2/100 samples) were positive for campylobacter. The organism was most frequently isolated from children under 1 year of age both during diarrhoeal episodes (11.5 per 100 person-years) and non-diarrhoeal (11.1 per 100 samples). Multiple infections in a family were rare. In 19.4% of the occasions one or more animals were campylobacter positive. However, only in 7.7% of these occasions was a human infection recorded within 1 month after the animal was found to be positive. The study showed that the epidemiology of campylobacteriosis in this community was distinct compared to that observed in developed countries.