Capsular genotype and lipooligosaccharide locus class distribution in Campylobacter jejuni from young children with diarrhea and asymptomatic carriers in Bangladesh.

Campylobacter jejuni-related diarrheal diseases is one of the major health issues among young children (0-59 months old) in low-income countries. Monitoring of the capsular (capsule polysaccharide, CPS) types of virulent C. jejuni strains in regions where the disease is endemic is of great importance for the development of a customized capsule-based multivalent vaccine. Therefore, we aimed to determine the prevalence of CPS genotypes among C. jejuni strains isolated from young children with enteritis (n = 152) and asymptomatic carriers matched by age, sex, and residence defined as the control group (n = 215) in Bangladesh. CPS genotyping was performed using a newly established multiplex polymerase chain reaction (PCR) method and lipooligosaccharide (LOS) locus classes (A-E) were characterized using PCR as well. We identified 24 different CPS genotypes among the 367 isolates. Four prevalent capsular types, HS5/31 complex (n = 27, 18%), HS3 (n = 26, 17%), HS4A (n = 10, 7%), and HS8/17 (n = 10, 7%) covered almost 50% of the strains from enteritis patients and 43% of the isolates from controls. In combination, the CPS genotype and LOS class was not discriminative between cases and controls. Dominant capsular types previously identified in C. jejuni strains isolated from patients with Guillain-Barré syndrome in Bangladesh were rarely detected in strains isolated from the young children. A similar distribution was evident among enteritis- and control-related strains when comparison was done between CPS types and LOS classes. This is the first systematic study presenting the distribution of CPS genotypes of C. jejuni strains isolated in Bangladesh from children with diarrhea and controls, with capsular genotypes HS5/31 complex, HS3, HS4A, and HS8/17 being prevalent in both. In conclusion, systematic studies are required to develop a multivalent capsule-based vaccine for children in low-income countries.

Antibiotic Resistance: New Challenge in the Management of Bacterial Eye Infections.

Ophthalmologists are still facing difficulties in managing bacterial eye infections. The study was designed for the isolation and identification of bacteria from infected eyes and observation of the sensitivity and resistant pattern. This cross sectional study was performed among 160 patients of suspected bacterial eye infection at Dr. K. Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh from March, 2010 to June, 2014. After collection of the samples from suspected infected eyes, it was nourished into nutrient broth in shaking incubator for three hours and then cultured into nutrient agar media followed by Mannitol salt agar, MacConkey's agar and blood agar. Bacteria were categorized by colony characteristics and Gram staining. Antibiogram was performed by disc diffusion method on Mueller Hinton agar media. McFarland Equivalence Turbidity Standard was maintained. The efficacy of the drug was evaluated by measuring the diameter of the zone of inhibition surrounding the disc. Ten percent Staphylococcus species isolates was resistant to Gatifloxacin, Gentamicin, Tobramycin and Cloxacillin, 26.0% to Ciprofloxacin, 40.0% to Azythromycin and Moxifloxacin, 58.0% to Cefixime and 64.0% to Cephalexin. Methicillin resistant Staphylococcus aureus was 62.8%. About 24.0% Streptococcus species isolates was resistant to Gatifloxacin, 33.3% to Azythromycin, Ciprofloxacin, Gentamycin, Moxifloxacin and Tobramycin, 52.4% to Cefixime and 71.4% to Cephalexin. About 9.0% of Pseudomonas species was resistant to Gatifloxacin and Tobramycin, 14.7% to Ciprofloxacin, 26.5% to Cefixime, 29.4% to Gentamicin and Moxifloxacin, 44.1% to Azythromycin and 82.3% to Cephalexin and Cloxacillin. Rational use of antibiotics and proper attentions of concerned authorities are necessary to overcome the emergent ocular situation leaded by antibiotic resistant.

Randomized Controlled Trial of Slow Versus Rapid Enteral Feeding Advancements on the Clinical Outcomes in Very Low Birth Weight Neonates.

Starting and advancement of feeding in very low birth weight (VLBW) infants are big challenges for the neonatal practitioners. Wide variations in volume of feed advancement have observed in earlier trials both in slow and rapid advancement groups. Volume advancement in slow advancement groups have ranged from 10ml/kg/day to 23ml/kg/day and in rapid advancement groups have ranged from 15ml/kg/day to 45ml/kg/day in earlier different studies. This randomized controlled trial was conducted in neonatal intensive care unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2013 to July 2014 to evaluate the effects of slow versus rapid rates of feeding advancements on the clinical outcomes in very low birth weight infants. A total 95 infants were enrolled into two strata according to their birth weight. Infants of each stratum were randomly allocated to either slow or rapid advancement group during initiation of feeding. After gut priming over five days, feeding was advanced daily 10ml/kg in slow and 15ml/kg in rapid advancement group for 1000 - <1250gm weighing infants. For 1250 - <1500gm weighing infants, feeding was advanced daily 15ml/kg in slow and 20ml/kg in rapid advancement group. The primary outcome variable was time taken to achieve full enteral feed. Total 82 infants completed the trial. Demographically both groups were same. Infants in the rapid feeding advancement group achieved full enteral feedings before the slow advancement group, had significantly fewer days of parenteral nutrition and regained birth weight earlier. There were no statistical differences in episodes of feed interruption, number of infants with apnea, feed intolerance or diagnosis of sepsis. Rapid enteral feeding advancements were well tolerated by very low birth weight infants.

Comparison of Serum Bilirubin with Transcutaneous Bilirubinometry in Late Preterm and Term Newborn.

Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns. It can progress to develop kernicterus unless intervention is initiated. Severity and decision for management are usually based on serum bilirubin which needs blood sampling. Transcutaneous bilirubin measurement is a noninvasive technique and correlates closely with serum bilirubin. This Cross sectional study was done in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University from March 2013 to August 2014 to evaluate the transcutaneous bilirubin in comparison to serum bilirubin. Total 160 infants with ≥35 weeks were purposively included over a period of 16 months. Neonates with less than 35 weeks, previously exposed to phototherapy, serious illness which leads to impaired circulation, who have had exchange transfusion, having major congenital malformation were excluded. Transcutaneous bilirubin measurement was performed within 30 minutes of obtaining sample for total serum bilirubin measurements. Of the enrolled infants, mean birth weight was 2631±520 grams, postnatal age was 4.99±3.02 days ranging from 2 to 25 days and mean transcutaneous bilirubin and serum bilirubin value was 14.59±2.55 and 13.62±2.86mg/dl respectively. Mean difference of transcutaneous bilirubin and serum bilirubin was 0.97±1.01mg/dl. In the total enrolled infant, transcutaneous bilirubin and serum bilirubin values showed significant correlation (r = 0.93, r2 = 0.876, p<0.001) and this was not affected by sex, gestational age, postnatal age, and birth weight. The area under ROC curve for transcutaneous bilirubin was 87% (p value <0.001). If the cut off value of transcutaneous bilirubin was set at 15 mg/dl, then a sensitivity of 77%, specificity of 88% and accuracy of 82% were obtained. Use of transcutaneous bilirubin can reduce need for serum bilirubin in assaying neonatal jaundice; as it showed significantly high correlation with serum bilirubin. Predictive accuracy of transcutaneous bilirubin was found to be statistically significant in comparison to serum bilirubin.

Neonatal Transport - Experience of a Tertiary Care Hospital of Bangladesh.

Safe transportation is mostly an unnoticed neonatal health issue in Bangladesh and no documentation is available regarding the existing practices. So this study was intended to document transport status of the referred newborn to a tertiary care hospital. This observational study included 150 out born neonates over 12 months period transported from various places to NICU, Bangabandhu Sheikh Mujib Medical University (BSMMU) from May 2015 to April 2016. A structured data collection form was used to record information categorized into pre-transport, during transport and at admission. At admission detailed clinical assessment of the baby was done and recorded. Outcome was determined as discharge or death. Of 150 transported neonates, two-third were preterm 115(77%) & LBW 113(75%). Common indications for referral were prematurity and sepsis. Most of the patients were referred from private hospital 107(71%). Majority of newborns (86%) were referred from hospitals of Dhaka city while only 14% were referred from outside Dhaka. Referral notes were supplied in most of the cases 134(89%) but comprehensive information was obtainable only in 3 cases. Although main transport vehicle was ambulance 130(87%), medical personnel accompanied the sick baby only in 6(4%) of cases. The distance traveled was less than 10 kilometers (kms) in 95(63%) and more than 100 km in 10(7%) of enrolled neonates. Transport time was less than 1 hour in 72(48%), 1-6 hours in 66(44%) and more than 6 hours in 12(8%) of cases. Nearly two third of newborn were transported after office period, 107(72%). At admission 21(14%) babies had hypothermia, 8(7.62%) hypoglycemia, 16(11%), poor perfusion 28(19%), low saturation 27(18%). Hyperthermia & hyperglycemia were observed in 8(5%) & 7(5%) cases respectively. Of the total 150 babies referred, 17(11%) died. While comparing with discharged newborn, died newborn were more frequent sufferer of hypothermia (p value 0.007) and low saturation (p value 0.049) at admission. Premature, low birth weight and sick newborns are being transported despite lack of safe transport system.

Management of Infective Corneal Ulcer: Epidemiology Needs To Be Evaluated As Priority Basis.

Because of known and unknown etiology, management of ocular devastating situation like corneal ulcer is still a challenge for the Ophthalmologists. The cross sectional study was designed for detection of predisposing factor and identification of causal agent. To serve the above purpose, a cross sectional study was performed among 140 patients of the corneal ulcer at Dr K Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh. Detail history of patient was taken and recorded in a pretest questionnaire sheet. Two pieces of sample were collected from each corneal ulcer patient. One sample was examined in KOH wet mount for fungus. Other sample was nourished into nutrient broth and for further culture and identification. Bacterial corneal ulcer was higher among the patient of age group ≥46 years (61.9%) followed by 31-45 years (21.5%). P value is 0.261. Males were found predominant (58.5%). P value is 0.13. Agricultural related work was identified as most risky occupation in 83.1% of the total bacteria positive samples. P value is 0.01. Trauma was noted as most predominant influencing factor (56.9%). P value is <0.05. Bacteria were identified in 65(46.4%) and fungus in 40(28.6%) samples. Pseudomonas species were predominant (52.3%) followed by Staphylococcus species (26, 2%) and Streptococcus species (21.5%). No mixed infection was identified. For easier and earlier diagnosis of corneal ulcer, information about epidemiology is very essential. History should be taken meticulously followed by the laboratory procedures.

Pattern of Head Injuries (Cranio-cerebral) due to Homicide in Association with Other Injuries: A Retrospective Post-mortem Study Autopsied at Dhaka Medical College Morgue House.

Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%).

Prediction of Risk Factors of Frequent Relapse Idiopathic Nephrotic Syndrome.

This case control study was aimed to identify the predictive risk factors for frequent relapse idiopathic nephrotic syndrome (INS) and conducted in Sir Salimullah Medical College & Mitford Hospital, Dhaka and at Renal and Dialysis Unit of Dhaka Shishu Hospital and Bangladesh Institute of Child Health (BICH), Dhaka, from January 2006 to December 2006. We examined retrospectively the clinical course of fifty cases of frequent relapse nephrotic syndrome (FRNS) as cases and fifty cases of infrequent relapse nephrotic syndrome (IRNS) as control who met the predefined enrollment criteria, followed for at least one year after initial onset of disease. After enrollment following parameters were studied as predictors of frequent relapse: i) Socio-demographic variables: age, sex, socio-economic condition, number of living room ii) Disease related variables i.e. age of onset, duration of illness, frequency of relapse within the 1st year, regimen of initial steroid therapy, total cumulative dose of steroid for remission, day of remission after starting steroid, association with atopy and infection, concomitant upper respiratory illness iii) Biochemical and pathological variables (at the time of initial attack) i.e. Serum albumin, serum cholesterol, blood urea, 24 hours urinary protein, serum creatinine, complete blood count, urine RBC, urine pus cell, urine culture. The test statistics used to analyses the data were descriptive statistics, Chi-square probability test, Student's t-test and Binary logistic regression analysis for Odds ratio. Both univariate and multivariate logistic regression analysis revealed that age of onset (P<0.001, OR=0.9, 95% CI=0.85-0.95), poor socioeconomic status (P<0.034, OR=0.5.8, 95% CI=1.14-29.5) and low serum albumin level at the time of initial presentation (P<0.022, OR=0.8, 95% CI=0.65-0.97) were independent predictors of frequent relapse nephrotic syndrome. In conclusion, we demonstrated that age at onset, poor socioeconomic condition and low serum albumin level at the time of initial attack is independent risk factors for frequent relapse idiopathic nephrotic children. This information can be used as a predictor of FRNS.

Osteopenia of Prematurity: Are We at Risk?

The continuous advances in intensive care have led to increased survival of premature infants. As a consequence, the problem of less imminent, slowly progressing disorders such as osteopenia of prematurity has been emerging. Osteopenia of prematurity (OOP) also called metabolic bone disease of prematurity (MBD) or rickets of prematurity is characterized by a reduction in bone mineral content usually manifest between 6th to 12th weeks of corrected gestational age. It occurs in up to 55% of infants born with weight <1000gm and 23% of infants weighing <1500gm. Clinical features of osteopenia of prematurity are mostly non-specific often appears as a late symptoms. Several biochemical markers have frequently been used as screening tools and diagnostic markers, but timing of measurements and the levels at which treatment should be initiated vary widely. Dual energy X-ray absorptiometry (DEXA) and Quantitative ultrasnogram are important diagnostic tool. Standard X-ray, a widely accepted but cannot detect osteopenia unless 20% loss of bone mineralization. The treatment of osteopenia includes provision of adequate mineral supplementation. Monitoring of serum and urinary markers are mandatory. The focus on prevention has largely centered on providing adequate intake of phosphorus and calcium but more research is needed. Till date there are neither enough data regarding clinical risk factors, valid biochemical markers which can detect premature babies at risk of osteopenia nor supplementation as well as appropriate timely management protocol is practicing in Bangladesh.

Laparoscopic assisted appendicectomy in District Hospital, Joypurhat, Bangladesh.

"Laparoscopic assisted appendicectomy" refers to visualization of abdominal cavity, identification of appendix, drawing the appendix out through the port wound and appendicectomy. The objective of this study is to evaluate the outcome of the procedure of laparoscopic assisted appendicectomy. In this prospective study patients with appendicitis were randomly selected for laparoscopic assisted appendicectomy from August 2007 to February 2009 in the Department of Surgery, Modernized District Hospital, Joypurhat, Bangladesh. Out of 73 patients Laparoscopic assisted appendicectomy was performed successfully in 95.89% cases and conversion rate was 4.11%. Male to female ratio was almost 1:2 with mean±SD age 18.62±9.16 years. The wound infection rate was 8.2% and urinary retention 2.7%. Early postoperative feeding was started within 24 hours in 86.3% cases and mean duration of hospital stay was 2 days in 76.71% patients. More than 82% returned to their home and started social activities within 5 days. Duration of surgery was almost similar in emergency and interval appendicectomy group (19.35±10.13 vs. 23.66±9.43) minutes. Postoperative morbidity in emergency appendicectomy group showed significantly higher morbidity than interval appendicectomy group (p=0.003). This study indicates that the laparoscopic assisted appendicectomy is feasible for the majority of the patients with appendicitis in both emergency and interval settings. It reduces the operative time, shortens hospital stay and helps in early resumption of normal activities with good cosmetic outcome and patients' satisfaction.

Dieulafoy's lesion: an overview.

Dieulafoy's lesion accounts for 1-5.8% of cases of acute upper GI bleeding. The two largest retrospective series, both from North America, found Dieulafoy's lesion as the source of hemorrhage in 1.9% and 1.2% of all endoscopies performed for acute GI bleeding. In the prospective study of Chung et al., Dieulafoy's Lesion was found in 3.4% of all patients with acute GI bleeding referred to their unit. The Dieulafoy's Lesion accounted for up to 40% of all causes of nonvariceal upper GI bleeding not caused by gastric or duodenal ulceration or esophageal varices in the prospective study of Matsui et al. In the study of Schmulewitz and Bailli, colonic Dieulafoy's Lesion were only found in 0.09% of all colonoscopies performed for lower GI bleeding. The actual incidence of both upper and lower GI bleeding from Dieulafoy's Lesion is likely higher than estimated because the diagnosis remains difficult. Recent advances in endoscopy have led to an increased detection of Dieulafoy's lesions. Initial GI endoscopy is effective in diagnosing up to 70% of patients. Several endoscopies may be required with 6% of patients, requiring three or more to establish the diagnosis. Angiography and/or red cell scanning can be used when endoscopy fails to diagnose a doubtful case. There is no definite unique policy for the treatment of Dieulafoy's lesions. Therapeutic endoscopy remains the first line of treatment option for controlling the bleeding while angiography is considered as a valuable alternative. Surgical intervention is kept for failure cases where it should be guided by preoperative localization. The mortality rate has decreased dramatically from 80% to 8.6% in recent times due to advancement in both diagnostic and therapeutic tools.

Silhoutte of Deaths In Connection With Fatal Fall from Height Injuries.

As medicolegal consultant, we often encounter cases of fall from height related deaths which are invariably subjected to medicolegal autopsy and the numbers are gradually increasing day by day. During the study period of three years data were collected by using a pre-tested structured proforma, police inquest reports, hospital records and thorough medicolegal autopsy done at Chittagong Medical College Mortuary. This retrospective autopsy based study revealed 175 cases of fall from height casualties out of the total 2850 autopsies. We observed that the age group of 41-50 years i.e. 55 cases were mostly affected followed by 31-40 years i.e. in 40 cases. Males (144) were the main sufferers than the females (31). Maximum victims were construction workers 57 cases (32.57%) followed by 45 factory workers (25.71%). Construction sites were the main place of fall i.e. in 57 cases (32.57%) followed by working places 46 cases (26.28%). Most of the victims had head-neck injuries i.e. in 143 cases (81.71%) followed by thoracic injury 82 cases (46.85%). Multiple injuries i.e. in 92 cases (52.57%) were the main cause of death followed by head-neck injuries in 79 cases (45.14%). These casualties are definitely preventable by adopting safety measures and by educating the workers in the factories and construction sites.

Demographic Study of Epileptic Burn Patient in a Tertiary Level Hospital of Bangladesh.

Burns are very common and important injuries associated with epilepsy. Epileptics are afflicted with burns when they come in contact with fire or other burning agents while seizing, due to loss of consciousness. The aim of the study was to identify the causes of burn, pattern and characteristics of burn in patients with epilepsy, duration of hospital stay and pattern of treatment in these patients. This prospective observational study was conducted in the Department of Burn and Plastic Surgery, Mymensingh Medical College Hospital, Bangladesh from January 2022 to December 2023. Epileptics were found in 0.84% (n=19) of the total admission (2274) in Burn unit. Majority of the patients were females (84.2%) and the mean age was (31.42±1.32) years. Maximum patients were housewives (78.9%). Among 19 cases, 11 cases (57.89%) had history of irregularly taking antiepileptic drugs and 8 cases (42.11%) had no history of treatment for epilepsy. Two cases (10.53%) had history of previous burn injury. Flame burn was the major etiology (89.5%). Mean total burn surface area (TBSA) was (6.94±4.12%). Most patients had full thickness burns (63.2%). Regarding distribution of burn, maximum involvement was in upper limb i.e. 68.21% cases. Surgical treatment was needed in the majority of the patients (68.5%). Mean hospital stay of these patients was (5.36±2.26) weeks. Epilepsy patients whose seizures are inadequately controlled are at increased risks of injury, especially burn. For prevention of burn, epilepsy should be treated properly.

Coverage of defects over Posterior aspect of Ankle Joint and Heel with Lateral Calcaneal Artery Flap- Experience in Mymensingh Medical College Hospital.

Lateral calcaneal artery flap is randomly used by many Plastic Surgeons for covering any defect on the posterior aspect of heel. A prospective observational study was conducted in the Department of Burn and Plastic Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to June 2022, to see the outcome of the flap for coverage of defects over the posterior aspect of ankle joint and heel. A total number of 09 patients, selected by purposive sampling, were included in the study. The age of the patients ranged from 06 years to 70 years. The cause of the defects were post traumatic in 07 cases, electric burn in 01 case and pressure sore in 01 case. The defect sizes varied from 3×2 to 6×3cm. and flap size ranged from 4×2.5 to 7×4.5cm. The follow-up period ranged from 3 to 6 months. All the flaps survived completely without any complications; except in two cases. In one case, there was marginal epidermal necrolysis that healed secondarily without the need of any further surgical intervention. In the other case, there was gangrene of about 0.5 cm area at the flap tip, which was debrided and the resulting wound healed secondarily. The average operating time was 63 minutes. The results were satisfactory on the context of adequate coverage, and flap and donor site morbidity. So, the lateral calcaneal artery flap can be a good and safe option for the coverage of posterior ankle and heel defects.

Developments in Hand Surgery: Experience from a Tertiary Hospital of Northern Bangladesh.

Hand Surgery is a specialized branch of Plastic and Reconstructive surgery. There are many conditions that require hand surgery, for example, congenital deformity, electric or flame burn, mechanical or road traffic injury, and post burn or post traumatic deformity. A retrospective observational study was conducted in the department of Burn and Plastic surgery, Mymensingh Medical College Hospital, Bangladesh during a 2 years period extending from 9th September 2021 to 8th September 2023. The objective of this study was to see the hand surgery status in a tertiary hospital of Bangladesh during the post Covid pandemic period. During this period 236 hand surgery procedures were performed in 176 patients. The age of the patients ranged from 02 to 78 years (Mean 31.14±1.52). One hundred and four (59.0%) were male and 72(41.0%) were female. Thirty-four (19.32%) patients had co-morbidities e.g., Epilepsy, Diabetes Mellitus, Chronic Kidney Diseases and HBsAg +ve. Causes of surgery included, wound due to electric burn 49(27.84%), flame burn 36(20.45%), post traumatic 24(13.64%), post infective 11(06.25%), tumor excision 02(2.24%), Dupuytren's contracture 03(1.70%), congenital anomalies 06(3.41%), post burn scar contractures 41(23.29%), nerve injury 01(00.57%) and carpal tunnel syndrome 01 (00.57%). Procedures were performed: post burn scar contracture release 41(17.37%), syndactly release 06(2.54%), release of post traumatic contracture 06(2.54%), carpal tunnel release 01(00.42%), release of Dupuytren's contracture 03(01.27%), nerve repair 01(00.42%), debridement, amputation and Fillet flap 29(12.29%), split thickness skin graft 46 (19.49%), V-Y advancement flap 06(2.54%), transposition flap 18(07.63%), cross finger flap 16 (06.78%), reverse cross finger flap 02 (00.85%), first dorsal metacarpal artery (FDMA) flap 05 (02.12%), reverse FDMA flap 01 (00.42%), metacarpal artery perforator flap 08(3.39%), radial artery perforator flap 04(01.69%), posterior interosseous artery flap 05(2.12%), abdominal flap 11(04.46%) and flap division and insetting 27(11.44%). Outcome of surgery was satisfactory in 225(95.34%) and 11(04.46%) cases had complications (p value 0.453), which was not significant. So, it can be concluded that the outcome of various types of hand surgery procedures in tertiary hospital of northern Bangladesh during the post Covid period was satisfactory overall.

Hanging: Commonly Encountered by Forensic Experts at Autopsy.

Though human lives have become easier and faster due to rapid twist in urbanization, industrialization and digitalization suicidal tendency among common people are often seen. Hanging is the commonly chosen method to do so. The study was designed to find out the pattern of hanging cases and to discover the immensity of hanging as a method of committing suicide. This retrospective study was done for three years by retrospectively collected data at the department of Forensic Medicine and Toxicology of Chattogram Medical College. A total of 193 cases (6.73%) of hanging were observed among 2850 autopsies done from January 2015 to December 2017. The age group of 31-40 years was mostly affected i.e. in 54(27.97%) followed by 21-30 years 48(24.87%). Males 112(58.03%) out numbered the females 81(41.96%). Clothes 88(45.59%) were mostly used as ligature material followed by jute rope (33.67%) and nylon rope (20.72%). Maximum cases were atypical hanging 160(82.90%), while we observed 33 typical (17.09%) hangings. In 166 cases (86.01%) we observed no injuries to the neck while contusion of the neck in 27 cases (13.99%). This study revealed fracture of the thyroid cartilage in 5 cases (2.59%) and hyoid in 2 cases (1.03%). One hundred & eighty five (185) cases (95.85%) were of suicidal and only 8 cases (4.14%) were of accidental. As per observation of this study, hanging has been found to be a common means of committing suicide in Bangladesh.

A Comparative Study of Collagen Sheet versus 1% Silver Sulfadiazine Dressing in Superficial Partial Thickness Burns.

Burn injury causes a lot of suffering. The goal of burn management is to achieve rapid wound healing, pain relief, rehabilitation with minimum scars and optimal functional ability. Objective of this study was to compare the efficacy of collagen sheets and 1% silver sulfadiazine dressing (SSD) for superficial partial thickness burns. This prospective observational study was conducted among the patients of Department of Plastic surgery, Dhaka Medical College Hospital, and Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, from 1st April 2020 to 31st March 2021. Total 60 patients with superficial partial thickness burns by purposive sampling 30 patients of them were treated with collagen sheet dressing (Group A) and 30 patients with 1.0% silver sulfadiazine dressing (Group B). First case was selected by tossing a coin. Then every alternate patient was provided the same kind of dressing material (either collagen sheet or 1.0% silver sulfadiazine). Data were collected by semi structured data collection sheets. Pearson's chi-square test and student's 't' test were used for data analysis (p value was significant at <0.05). It was observed that a total of 18(60.0%) patients belonged to age <10 years in Group A and 17(56.7%) patients in Group B. The mean age was 14.9±14.2 years in Group A and 11.6±10.2 years in Group B. Good quality of healing was significantly higher in the collagen group compared to the SSD group (<0.05). The mean complete healing time in the collagen group was 10.47±2.21 days and in the 1.0% SSD group were 13.07±2.33 days. The mean healing time was significantly lower in the collagen group compared to the 1.0% SSD group (p<0.001). There was no significant difference in infection rate between the two groups (p>0.05). Considering the overall outcome, Collagen sheet dressing decreases pain, reduces the need for analgesics, aids in early healing as compared to the patients treated with 1% silver sulfadiazine.

Relationship between serum IgE and frequent relapse idiopathic nephrotic syndrome.

This prospective case control study was carried out in Renal and Dialysis Unit of Dhaka Shishu Hospital, Bangladesh from January 2004 to December 2004 to determine serum IgE level in frequent relapse Idiopathic nephrotic syndrome and to evaluate any role of IgE in the rate of relapse. Thirty cases of frequent relapse (FR) Idiopathic nephrotic syndrome (INS) were considered as cases and thirty cases of infrequent relapse nephrotic syndrome (IRNS) were considered as control. Serum IgE level was measured in all patients at the time of relapse and again four weeks after steroid treatment when patient was in remission. The test statistics used to analyses the data were descriptive statistics, Chi-square probability test, Student's "t"-Test, Mann Whitney test and Wilcoxon Signed Rank test. Majority of the patients' age in both the groups was between 2-6 years. The male female ratio in FR group was 2:1, while that in IR group was 3:2. Forty percent of the frequent relapsers and 30% of infrequent relapsers were found to possess the history of atopy. However, the difference between the two groups was not statistically significant (p>0.05). The mean serum albumin in FR was observed to be significantly lower (13.73±0.59 gm/L) than that in IR (15.73±0.67 gm/L) (p<0.05). Mean serum IgE at the time of relapse in FR (1791±95 IU/mL) was found to be more than 3 times higher than that in IR (560±50 IU/mL) (p<0.001). Serum IgE level at the time of remission has decreased to almost normal in IR group (204±21 IU/mL) but it was still found 5 times higher in FR group (1086±79 IU/mL) (p<0.001). Serum IgE level is high in both FR and IR groups of nephrotic syndrome at the time of relapse. It reverts back to normal in IRNS but persistently and significantly high in FR group in both relapse and remission. Level of the serum IgE can be used as a predictor of FRNS.

Forensic Profiling of Cut Throat Wounds.

This study was conducted to reveal the causative factors and injury pattern of cut throat wounds. This is a retrospective study of three years done at Chattogram Medical College Morgue House from January 2014 to December 2016. This study revealed 106 cases of cut throat wounds out of the total 7300 medico-legal autopsies of which most of the victims were male (74 cases) whereas females were 32. The most affected age group was 21-30 years (both male & female) i.e. 47 cases (44.33%). Homicides in 91 cases were the prime manner of death followed by suicide 13 and 2 accidental cases. Associated injuries were found in 70 cases out of the total 106 cases of cut throat wound. Haemorrhage was the main cause of death in 58 cases (54.71%) followed by air embolism (19 cases), other causes (15 cases) and asphyxia from aspirated blood in 14 cases. Fields were the mostly observed places of occurrence i.e. in 61 cases (57.54%) followed by outside house (18 cases), within the house (11 cases), public place (10 cases) and working place (6 cases). Criminal gang violence were the predominant motivational factors i.e. in 48 cases (45.28%) followed by robbery (26 cases), love or relationship (17 cases), domestic violence (9 cases) and financial hardship in 6 cases. Butcher's knives were the most commonly used weapon i.e. in 69 cases (65.09%) followed by kitchen knives (24 cases), ramda (8 cases) and axe in 5 cases.

Death Due To Electrocution- An Autopsy Based Study at Chattogram Medical College Morgue House.

As we less frequently encounter cases of death due to electrocution, less attention is given to them. These all have significant impact on morbidity and mortality of the common people of different ages. This autopsy based retrospective study (from January 2014 to December 2016) was carried out by the history of the case, inquest report and by doing thorough autopsy of each of the cases at Chattogram Medical College Mortuary, Bangladesh. Fifty (50) cases of electrocution accounted for 1.23% of the total 4020 autopsies. Male victims i.e. 43(86%) outnumbered the females 7(14%). The majorly affected age group was 21-30 (24 cases) followed by 31-40 years (13 cases) and 41-50 years (5 cases). The commonest place of occurrence was on the street side in 33 cases (66%) followed by home 17 (34%). High tension wire i.e. in 28 cases (56%) were the main causative agents followed by home appliances 16 (32%) and water pump 6 (12%). In relation to distribution of entry and exit wounds, we observed evidence of both entry and exit wounds in 32 cases (64%) followed by no entry or exit wounds in 11 (22%) and entry wounds only in 7 (14%). As per this study, entry wounds were present in the upper limbs in 34 cases (68%) followed by head-neck (7 cases) and lower limbs (3 cases). We also observed maximum exit wounds were in the lower limbs i.e. in 36 cases (72%) followed by upper limbs (5 cases) and chest-abdomen (2 cases). Considering manner of death, we observed all the cases of electrocution i.e. 50 cases (100%) were of accidental. Electrocution accounts for a smaller proportion of all unnatural deaths which could be prevented by adequate awareness and adopting safety measures.