Antenatal and postnatal factors associated with neonatal death in the Indian subcontinent: a multilevel analysis.

OBJECTIVES: This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality. STUDY DESIGN: Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used. METHODS: Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths. RESULTS: Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days. CONCLUSIONS: The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.

Frequency, Distribution of Congenital Anomaly and Associated Maternal Risk Factors.

This study was done to find out the maternal risk factors associated with congenital anomaly. This cross-sectional observational study was carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh from January 2011 to December 2011. During this study period 78 patients had pregnancy with congenital anomaly and delivered in the Department of Obstetrics and Gynaecology. Women with ultrasound report of congenitally abnormal fetus irrespective of gestational age were included. Clinical evaluation of neonates was done by experienced neonatologist. The frequency of congenital anomaly was 3.46%. Most of the women belong to age <35 years (97.43%). Congenital anomalies more commonly were seen in the primiparas (64.10%). Most frequent associated risk factor was the history of abortions (35.89%). Maternal infections during antenatal period were also high (15.58%). There were 58 males (74.35%) and 20 females (25.64%). There was positive history of delivery of congenital abnormal babies in 6 cases (7.6%). Mothers of eight cases (10.25%) had history of drug ingestion during pregnancy. Four cases (5.12%) of mothers had hypothyroidism and 6 cases of mothers (7.69%) had diabetes mellitus respectively.

Cardiovascular risk assessment among rural population: findings from a cohort study in a peripheral region of Bangladesh.

OBJECTIVES: The incidences of non-communicable diseases including cardiovascular diseases (CVDs) is increasing in Bangladesh. The reasons for this increasing trend need to be explored. The aim of this study is to assess the risk of CVDs among a peripheral rural Bangladeshi population and to explore the sociodemographic, anthropometric and clinical variables associated with increased risk. STUDY DESIGN: Cohort study. METHODS: From a cohort of 190,471 individuals of all ages, originally included in a diabetic eye disease program initiated in 2008-2009, a purposive sub-cohort of 66,710 individuals, aged 31-74 years was recruited. During 2011-2012 these participants were assessed for CVDs using the WHO's risk assessment tool designed for primary care settings in low resource societies. Participant characteristics associated with higher risk were explored using univariable and multivariable regression analysis. RESULTS: Out of all (95.5% participation rate) participants 1170 (1.84%) were found to be at high risk for CVD. The prevalence of hypertension (HTN), pre-HTN, obesity, underweight and self-reported DM were 8.9%, 15.2%, 9.6%, 7.8% and 0.5% respectively, among the study population. In multivariable regression analysis female sex, older age, temporary housing structure (i.e., tin shed), extremes of BMI (both underweight and obese) and central obesity were associated with higher risk for CVDs. CONCLUSIONS: The prevalence of CVD risk factors and high CVD risk individuals in this cohort was found to be lower than previous studies. It may be the effects of urbanization are yet to reach this relatively traditional rural population. This study adds to the literature on use of the WHO risk assessment tool.

Characteristics and Management of Children with Continuous Spikes and Waves during Slow Sleep.

This study was done to describe the clinical spectrum, EEG characteristics and treatment modalities in children with continuous spike and slow wave in sleep (CSWS). Ten patients with CSWS had been treated between 2012 and 2013. Mean age of the patients was 6.9 years; male female ratio was 3:2. The main etiologic group in this study was epilepsy (10), cerebral palsy (3) and brain lesion (arachnoid cyst). All the patients had prior seizure. Presenting features were abnormal behavior (4), agitation (4), aggression (4), eye blinking (2) and involuntary movement (2). Three patients had speech regression and 1 had motor regression. Regarding EEG finding, 7 out 10 cases had SWI>85% whereas, rest of them had SWI 50 to 80%. Most of the patients were resistant to two or more oral AED. The AED found to be efficacious were Midazolam drip, pulse methyl prednisolone and valproate. Eighty percent (80%) patient responded to midazolam drip. Methyl prednisolone caused 50% improvement in one patient but failed in 2 cases. In contrast to the previous studies where high dose valproic acid, levetiracetam, Injection ACTH was more efficacious, this study demonstrates significant positive result with midazolam drip.

Prevalence of Abnormal Semen Parameters among the Infertile Couples Seeking Infertility Treatment.

Infertility, affecting 60 to 80 million couples globally, is clinically defined as the inability to conceive after 12 months of unprotected sexual contact. Male factors contribute significantly, comprising 40.0% to 50.0% of infertility cases. While the prevalence ranges from 5.0% to 30.0% in developing countries, the exact global prevalence remains unknown. The study, conducted at CMH and Ibn Sina Hospital, Jashore from October 2020 to September 2023, utilized a cross-sectional approach; examining 4173 samples aged 21 to 41. Exclusion criteria considered known female reproductive abnormalities or medications impacting male fertility. Standardized procedures, in-depth questionnaires and SPSS software version 15.0 were employed, adhering to World Health Organization Guidelines. In a study of 4173 seeking infertility treatment, 63.0% had abnormal semen parameters, with 45.0% aged 31-40 years. Addiction patterns: 76.0% used tobacco, 14.0% reported alcohol and tobacco. Occupations: 43.0% government workers, 41.0% private workers. Marriage duration: 44.0% married 5-10 years, infertility duration: 64.0% less than 6 years. Semen analysis showed 40% with sperm count above 65 million, 46.0% with 60.0-90.0% motile sperm, and 78.0% with sperm morphology below 15.0%. The most prevalent abnormality is asthenozoospermia 59%, with oligozoospermia and azoospermia observed in 31% and 3% of cases, respectively. This study highlights the global complexity of male infertility, emphasizing genetic factors in infertile couples. Addressing sample bias and the lack of national epidemiological data underscores the ongoing need for comprehensive research to advance global infertility diagnosis and treatment.

The Impact of use of Modified WHO Partograph on Labour Progress and Delivery: Outcome among Spontaneous and Induced Labour in Nulliparous Women at Term.

Labour is a normal physiological process considered by a progressive rise in frequency, intensity, and duration of uterine contractions resulting in effacement and dilatation of the cervix with descent of the fetus over the birth canal. Spontaneous or Induced labour has a significant role in the eventual mode of delivery and neonatal outcome. This study aims to compare mean duration of labour and maternofoetal outcome of spontaneous versus induced labour among nulliparous women. This was a prospective observational study conducted in the Department of Obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2016 to September 2017. The study was conducted in nulliparous women coming at term (38-41) weeks in active phase of labour (with cervical dilatation at least 4cm) either spontaneous or induced, both group of labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery, and the maternofoetal outcome. A total of 160 women were enrolled in this study into two groups. There was no difference in mean age group, but BMI and gestational age were noted significant (p=0.001) More women had spontaneous normal vaginal delivery among those with spontaneous labour (86.25% vs. 78.75%). The mean duration of the second stage of labour was significantly more in induced (17.65 minutes) than in spontaneous labour (14.78 minutes) with a significant P-value (p=0.001). The mean Apgar score between the groups showed almost same. No statistically significant difference was found (p>0.05). This study prevailed that, requirement of oxytocin for augmentation of labour and mean duration of labour was less in spontaneous group and most of the patient delivered vaginally but in induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. We observed that induced labour can be a safe procedure among nulliparous women if labour is monitored by modified WHO partograph.

Development and evaluation of an in-house ELISA to detect hepatitis B virus surface antigen in resource-limited settings.

Hepatitis B virus (HBV) infection is of global public health concern. Among various serological tests used for the diagnosis and screening of HBV infection, the enzyme-linked immunosorbent assay (ELISA) to detect hepatitis B surface antigen (HbsAg) is most widely used. The present study was designed to develop and standardize a cost effective in-house ELISA for the detection of HbsAg and compare its performance with two established commercial kits. The concentrations of coating antibody, conjugates and sera were fixed by checkerboard titration. Using known HBsAg positive and negative sera, four different concentrations (1, 0.5, 0.25 and 0.125 microg/well) of coating anti-HBs were applied. Similarly, serial dilutions of patients' sera (1 in 2, 1 in 3, 1 in 5 and 1 in 9) and conjugates (1 in 2, 1 in 3, 1 in 5, 1 in 9 and 1 in 17) were evaluated by checkerboard titration. The optimal concentration of coating antibody was determined at 0.25 microg/well and 1 in 9 dilution for both conjugates and sera. The performance comparison of our in-house ELISA showed excellent correlation with two commercial kits (Pearson 0.957, P = 0.001 for monoclonal antibody coated kit and Pearson 0.929, P = 0.000 for polyclonal antibody coated kit) when OD values were compared. All commercial kit proven positive samples was positive while all negative samples were negative with the in-house ELISA resulting in 100% sensitivity and specificity. The results of our study demonstrated that our in-house ELISA for detection of HBsAg was equally as sensitive and specific as two well-known commercial kits. Thus, this system may be a useful tool for diagnostic and screening purposes, as well as outbreak investigations.

Treatment Seeking Practices and Etiology of Infertile Couples in Bangladesh.

Infertility is a major reproductive health problem, at least in part, a cultural problem also. In developing countries like Bangladesh, infertility is a devastating experience for a couple, particularly in women. For this reason many women suffer from many social and medical consequences. Most of the infertile patients of Bangladesh have no access to adequate comprehensive treatment. Also due to lack of proper knowledge, some couples use varied traditional methods and religious practices. This study was done to assess the treatment seeking behavior of infertile couple and also to find out the gross causes of infertility of patients attending at Motherhood Fertility center, Dhaka, Bangladesh. This prospective study was done over 3 years from June 2016 to June 2019. Two thousand two hundred and fifty (2250) patients attending a secondary infertility center at Dhaka were included in this study. Out of 2250 infertile patients 56.00% were rural and 44.00% urban. Of 737 (58.49%) rural and 658 (66.46%) urban infertile patients had consulted with General practitioner and Gynae specialist before coming to secondary and tertiary care center. Out of 1260 rural, 463(36.75%) and 990 urban, 291 (29.39%) had visited the infertility center as the first choice for treatment. Still about 8.8% infertile couple visited quacks and traditional healers for solving infertility. The overall primary and secondary infertility were 67.69% and 32.31% respectively. In 12.57% couples, male factor was the obvious cause (azoospermia and abnormal semen parameters). In 27.43%, female factors and in 28.0% couples both male and female had obvious reasons responsible for infertility. Thirty two percent (32.00%) cases were unexplained infertility. Out of female factors 43.00% anovulation, 29.00% tubal factors, 11.00% endometriosis, 5.00% Uterine factors, 2.00% POF (premature ovarian failure) and 10.00% others (Thyroid disorder, DM, Hyper-prolactinemia, Luteal phase defect). Infertility is an important health problem in Bangladesh. Etiology of infertility varies from regional, social and cultural conditions so that it requires proper diagnosis and then treats this problem accordingly. It is necessary to build up proper referral system and also proper training should be needed to service provider and traditional healers. Reproductive technology should be widely available in our society where motherhood is one of the most desired stages of a women's life.

Contrast induced nephropathy in patients with pre-existing renal impairment undergoing coronary angiogram and percutaneous transluminal coronary angioplasty.

Contrast induced nephropathy is the third leading cause of acute renal failure in hospitalized patients. However, its incidence and risk factors in Bangladeshi population undergoing coronary angiogram and percutaneous coronary intervention is not clear. This study was to assess the incidence of contrast induced nephropathy in patients, with or without pre existing renal impairment, undergoing coronary angiogram and percutaneous transluminal coronary angioplasty in Bangladeshi population. Two hundred patients undergoing coronary angiogram and percutaneous were included in the study .Patients having history of contrast allergy and patients on renal dialysis were excluded from the study. Serum creatinine level was estimated before the undergoing procedure. Creatinine clearance rate was calculated by applying Cockcroft Gault formula to the preprocedure serum creatinine level. Patients were assigned to one of the two groups, that is with or without chronic renal insufficiency. Serum creatinine levels were again estimated at the end of 24 hours of contrast exposure. The rise of serum creatinine by ≥0.5mg/dl or ≥25% occurring within 24 hours of contrast administration was defined as contrast induced nephropathy. The incidences of Contrast induced nephropathy (CIN) in these groups were compared. We tried to analyze whether there is relation between the incidence of CIN with contrast volume, chronic renal insufficiency, diabetes mellitus, and coronary procedures undergone. We enrolled 120 pre existing chronic renal insufficiency patients and 80 patients without pre existing chronic renal insufficiency. In this study 21.7% of pre existing chronic renal insufficiency group and 6.3% of no pre existing chronic renal insufficiency group developed contrast induced nephropathy (p=0.003). Contrast induced nephropathy is an iatrogenic disorder and pre existing renal impairment is one of the risk factors for developing contrast induced nephropathy.

Association of cardiac ischemic score and coronary collateral circulation.

Coronary collateral circulation maintains myocardial perfusion in coronary atherosclerotic disease. The indicators of cardiac ischemia, (Angina pectoris on exertion, during emotion, previous myocardial infarction and prior coronary intervention) are associated with presence of coronary collateral circulation. In this prospective observational cross sectional study, 128 patients with history of angina pectoris on exertion and or during emotion and or myocardial infarction and or previous coronary intervention were enrolled. The cardiac ischemic score (range 1-4) was calculated by adding 1 point for each of the above four clinical factors, which can be easily assessed. Presence of coronary collaterals in coronary angiogram was defined as Rentrop grade ≥1. Patients were divided into two groups. Group A patients having Rentrop grade 0 and Group B patients are with collateral circulation, having Rentrop grade 1-3. Patients having cardiac ischemic score (range 1-4) are compared in these groups. Maximum (83.3%) patients of Group B with coronary collateral circulation had cardiac ischemic score 2-4, but majority (86.4%) of Group A patients without collaterals showed the score only 1. Thus the cardiac ischemic score is strongly associated with the presence of coronary collaterals.

Correlation between CT scan Findings of the Head and Motor Disturbances in Children with Cerebral Palsy.

Cerebral palsy (CP) is the commonest movement disorder in childhood. Clinical spectrum of CP is variable and CT scan of brain is an important mode of diagnosis and prognosis in recourse limited set up. This study was done to categorize the CT scan findings and correlate them with the type of motor disturbances of CP patients. This was a cross sectional study done in 100 children diagnosed as CP carried out in Pediatric Neurology unit, BSMMU from July 2009 to July 2010. The patients were randomly selected and CT scan was done in all the patients. Detailed history and clinical examination was done to find out the baseline characteristics, risk factors and topographic type of CP patients. Among 100 patients 92% had abnormal CT scan finding. Most common abnormality was cerebral atrophy. Maximum number of abnormal CT scan was found in quadriplegic CP (92%). Highest number of children was in 13-24 months (29%) and a slight male predominance was found. Commonest risk factor was perinatal asphyxia (75%). The brain lesions are often associated with a clinical phenotype where specific needs may be anticipated and addressed. This is important for the planning of intervention in the child with CP.

Correlation between severity of coronary artery stenosis and perfusion defect assessed by SPECT myocardial perfusion imaging.

Numerous non-invasive techniques are developed to assess the severity of coronary artery disease (CAD). Coronary angiography (CAG) is an established method for the diagnosis and to quantify the severity of coronary artery stenosis. Single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) using Technetium-99m (Tc-99m) tetrofosmin is also a useful established technique for the assessment of severity of CAD. This prospective observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess the severity of coronary artery stenosis using Tc-99m Single Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI) in comparison with CAG. Eighty two (82) consecutive patients with mean age 53.51(SD+/-7.08) years and Candian Cardiovascular Society (CCS) class I and II severity of chest pain, male: female ratio (4.8:1) was studied. Tc-99m SPECT-MPI was performed by one-day exercise stress and rest protocol. A total of two hundred and forty six coronary artery territories examined in this study. By CAG normal coronary arteries were found in seventy six, moderate stenosis in twenty four and severe stenosis in one hundred and forty-six coronary artery territories whereas SPECT-MPI found normal perfusion in twenty seven, mild perfusion abnormality in seventeen, moderate perfusion abnormality in thirty two and severe perfusion abnormality in one hundred and sixty five coronary artery territories. Sensitivity and specificity of SPECT-MPI using Tc-99m tetrofosmin in detecting coronary artery stenosis were 87.09% and 80.95% respectively. The positive predictive value, negative predictive value and accuracy of the test were 91.01%, 73.91% and 85.18% respectively. From this study it can be concluded that Tc-99m SPECT-MPI was a safe, effective and excellent non-invasive tool for the detection of severity of coronary artery lesion and can be used to predict severity of CAD.

Demography and Symptom Profile of Tetanus: A Cross-sectional Observation in an Infectious Disease Hospital of Bangladesh.

Tetanus is a potentially preventable neurological infectious disorder with paucity of literature in Bangladesh. We aimed to see the demography and symptom profile of tetanus cases managed at the Infectious disease Hospital Sylhet. This hospital based cross-sectional descriptive study was conducted within the time period of January to December 2012 among 50 consecutive admitted patients in the Infectious Disease Hospital, Sylhet, Bangladesh who were diagnosed as a case of tetanus and fulfilling the inclusion criteria and exclusion criteria. Neonatal tetanus was considered as exclusion criteria and clinical diagnosis of tetanus was considered as the tetanus. Data were collected purposively with pretested predesigned questionnaire. Data were processed manually and analyzed with the help of SPSS Version 16.0. The mean±SD age was 33.00±16.8 years, ranging from 10 to 70 years. Among the 50 respondents, 72.0% were male, 50% from lower class, 34% were students and 30.0% had their educational status of primary level, 60.0% from rural social background. Trismus was found in 98.0% of the cases, rigidity in 96.0% cases, body ache in 94.0% cases, dysphagia in 92.0% cases, neck pain in 78.0% cases, dysarthria in 92.0% cases, reflex spasm in 66.0% cases, opisthotonus in 46.0% cases and urinary retention in 26.0% cases. In this study rural male people with lower socioeconomic status individuals were mostly affected with trismus, rigidity, body ache and dysphagia symptoms.

Seizures in Down Syndrome: An Update.

The prevalence of seizures in individuals with Down Syndrome (DS) is higher than in the general population. Rates of epilepsy in DS range from 1-13%. Forty percent of individuals develop seizures before 1 year of age and another 40% develop in their thirties or later. Boys have an earlier age of onset. The prevalence of epilepsy increases with age. Types of seizures are: 47% partial seizures, 32% infantile spasms and 21% generalized tonic-clonic seizures. Sex distribution for epilepsy in children with DS varies. Males have a younger age at onset. Trisomy 21 is common among epileptic children with DS but mosaicism or translocation has also been documented. The mechanisms underlying the increased seizure susceptibility in DS have not yet been completely explained. Seizures in infancy may be due to inherent structural brain abnormalities, like fewer inhibitory neurons, abnormal cortical lamination, persistent fetal dendritic morphology, underdeveloped synaptic profiles. Concentrations of carbonic anhydrase II are increased in the brains of young children with DS. It potentially increases seizure susceptibility. The pharmacological treatment of epilepsy in DS is same as that of other patients diagnosed with epilepsy. Individuals with DS have an unusually high number of side-effects from phenytoin. The diagnosis, classification and treatment of epilepsy in DS follow the guidelines applied to the general population. Review of literatures from 1960 to 2017 and electronically identified articles on epilepsy in Down syndrome in children in English are searched from internet and pub med to describe features of seizures in children with DS.

Intra Uterine Contraceptive Device: Socio-Demographic Characteristics of Acceptors Acceptability and Effectiveness in a Tertiary Institution.

To assess the acceptability and efficacy immediate Postpartum Intrauterine Contraceptive Device (PPIUCD) among parturient at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh; this prospective interventional analytical study was conducted from January 2013 to June 2013. Contraceptive counseling was given to 370 eligible parturient after delivery during their postpartum hospitalization. A pre-tested structured data collection sheet was administered to all participants. Women who accepted the PPIUCD during their postpartum care were inserted with the device before discharge (within 48 hours). These women were followed up at 6 weeks for complications. The acceptance rate of PPIUCD and the percentage of actual insertions were recorded. The reasons for both acceptances and decline were also recorded. Of the 370 women counseled, a total of 132(35.67%) were inserted with PPIUCD. Parturient who had a short duration from their last child birth (2-3) were significantly associated with greater acceptance of the PPIUCD. Preference of other methods of contraception mainly short acting methods and the need to discuss with their partners were the most common reasons for declining use of PPIUCD. More than half (51.51%) of the women whom PPIUCD was inserted did so due to its long term effect. Immediate PPIUCD was demonstrably safe due to its low rates of complications. The common complications at six weeks interval were expulsion (5.8%) and lost strings (2.5%) and pelvic infection (1.66%). Acceptance of PPIUCD was relatively high probably because of its 'newness' in the community. For these women, the best opportunity to receive information about contraception is during child birth when they are in contact with healthcare providers. It is also important to emphasize and educate women on long term methods of contraception as majority of the women preferred short term methods despite their future pregnancy desires of more than three years. Couple counseling should also be promoted. The government needs to develop strategies to increase public awareness of the PPIUCD through different media sources.

A Randomized Controlled Trial of Phenobarbital and Levetiracetam in Childhood Epilepsy.

Levetiracetam has been introduced for the control of seizures besides phenobarbital as monotherapy in children with epilepsy. This study was aimed to compare the effectiveness of these two drugs for the control of seizures in epilepsy. This randomized controlled trial was done to assess the efficacy and tolerability of levetiracetam compared to phenobarbital in childhood epilepsy and was conducted in Institute of Pediatric Neurodisorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh among children between 1 month to 15 years who were diagnosed as cases of epilepsy (idiopathic focal, generalized, focal with secondary generalization) according to ILAE to assess the effect of Levetiracetam (n=50) and Phenobarbital (n=68) from May 2015 to July 2016. The children were followed up for 12 months at 3 months interval to compare the seizure remission and side effects of Levetiracetam and Phenobarbital. The children in levetiracetam group was about 10 months older along with older age of onset of seizure (p=0.02) than those of phenobarbital group (p=0.03 and 0.02 respectively). GTCS was the most common type of seizure in both groups. During 3 months of intervention 55.8% patients of levetiracetam group achieved 50-75% seizure remission compared to 44.2% in phenobarbital group, at 6 months period 75-100% seizure remission observed among 57.4% patients of levetiracetam group compared to 42.6% of phenobarbital group (p=0.06), which continued to increase at 9 months in levetiracetam (n=33, 55.9%) compared to phenobarbital (n=26, 44.1%) and this value is statistically significant (p=0.05). No further improvement observed at 12 months follow up. Behavioral problem was reported among 4 patients of phenobarbital group without any evidence of cognitive deterioration, only 3 patients of levetiracetam experienced irritability, but no children of both group discontinued treatment due to side effects. Levetiracetam mono-therapy is more effective in controlling seizures in focal, generalized and focal with secondary generalization epilepsy compared to phenobarbital with minimum side effects.

Double Heterozygous For Haemoglobin S and Haemoglobin E.

Here we present a Bangladeshi family where out of four family members two (mother and son) inherited both haemoglobin (HbS) S and haemoglobin (HbE) E gene confirming the diagnosis of double heterozygous state for HbS and HbE, presented in the Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh on the month of July 2016. Among other two members, one (daughter) inherited HbS and other (father) HbE. Double heterozygous state for HbS and HbE is a rare condition in this subcontinent especially in Bangladesh. HbS is rare but HbE is prevalent in Bangladesh. Co-inheritance of both HbS and HbE is therefore uncommon in this country in comparison to HbE/ß - thalassaemia. Though the double heterozygous state for HbS and HbE is rare and the patients are usually asymptomatic but their documentation is important for genetic counseling and to determine the reproductive risk of the family.

Non-convulsive Status Epilepticus in Children: Clinical Profile, EEG Characteristics and Treatment.

Non-convulsive status epilepticus (NCSE) is a term used to denote a range of conditions in which electrographic seizure activity is prolonged and results in non-convulsive clinical symptoms. This study was done to describe the clinical spectrum, EEG findings and to evaluate the efficacy of different therapeutic agents in children with NCSE in 33 patients from January 2011 to December 2015 period. All patients had EEG before and after treatment. Age range was 6 months to 14 year, 25 were male. Regarding development status, 48% had developmental delay, 21% had normal development, 9% had regression and 21% had both developmental delay and regression. Twenty nine cases were previously diagnosed as epilepsy. EEG diagnosis was as follows: Generalized NCSE 23(69%), focal 9(27%), unknown 1(3%). Eighteen patients were treated with Midazolam drip out of which 1 patient had complete remission in EEG, 6 had >80% remission, 5 had >50% remission and 5 patients had minimal or no response. Thirteen patients were treated with methyl prednisolone bolus out of which 2 patients had complete remission, 4 patients had >80% remission while 4 patients had >50% remission and 3 patients showed no response. NCSE may present with various clinical feature without any convulsion. Midazolam, methyl prednisolone and oral drugs are equally effective for treatment of NCSE. However, further randomized controlled study is needed to chalk out management of NCSE.

Distribution of Heavy Metals in Surface Sediments of the Bay of Bengal Coast.

The concentrations of major (Si, Al, Ca, Fe, and K) and minor (Cd, Mn, Ni, Pb, U, Zn, Co, Cr, As, Cu, Rb, Sr, and Zr,) elements in the surficial sediments were studied in an attempt to establish their concentration in the Bengal coast. It was revealed that the majority of the trace elements have been introduced into the Bengal marine from the riverine inflows that are also affected by the impact of industrial, ship breaking yard, gas production plant, and urban wastes. The concentration of heavy metals was measured using Atomic Absorption Spectroscopy and Energy Dispersive X-ray fluorescence instruments. The highest concentrations for several trace elements were thus recorded which generally decrease with distance from the coast. It was observed that the heavy metal concentrations in the sediments generally met the criteria of international marine sediment quality. However, both the contamination factor and pollution load index values suggested the elevation of some metals' concentrations in the region. Constant monitoring of the Bengal coast water quality needs to be recorded with a view to minimizing the risk of health of the population and the detrimental impacts on the aquatic ecosystem.

Left ventricular diastolic dysfunction in patients with bronchial asthma with long-term oral beta2-adrenoceptor agonists.

BACKGROUND: Long-term administration of oral beta(2)-adrenergic receptor agonists (beta(2)-AG) in patients with bronchial asthma (BA) causes disastrous events such as sudden death and heart attack. However, long-term effects of beta(2)-AG on cardiac function have not been previously quantified. METHODS: Seventy-four patients with BA with regular long-term use of oral beta(2)-AG (group A) and 69 patients with BA without beta(2)- AG (group B) were examined in medical records of outpatient clinics from 1985 to 1999. In the prospective study, echocardiography was performed in 48 consecutive patients from January to April 1999. There were 26 patients with regular oral use of beta(2)-AG (group a) and 22 patients without beta(2)-AG (group b). Twenty-one age-matched normal volunteers without heart or pulmonary diseases were used as control subjects (group c). Oral beta(2)-AG was withdrawn from remedies in 11 patients of group a, and echocardiographic studies were repeated 2 weeks after its cessation. RESULTS: Events related to heart failure were more frequently seen in group A than in group B (14% vs 1%, P <.01). The echocardiographic study showed that indexes of left ventricular diastolic but not systolic function were significantly deteriorated in group a, along with a markedly reduced level of plasma norepinephrine concentration (P <.05 vs groups b and c). When heart rate was adjusted to 90 beats/min during isoproterenol infusion, left ventricular diastolic function remained deteriorated in group a (P <.05 vs groups b and c). In 11 patients of group a, the cessation of beta(2)-AG for 2 weeks resulted in an improvement of left ventricular diastolic function and in an increase of plasma norepinephrine level (P <.01). CONCLUSIONS: Long-term use of oral beta(2)-AG impaired left ventricular diastolic function in patients with BA, and the cessation of beta(2)-AG reversed diastolic pump performance to the normal level.