Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021.

OBJECTIVE: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN: Descriptive multi-country secondary data analysis. SETTING: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION: Liveborn infants. METHODS: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.

Adherence Pattern of Lipid Lowering Drugs in a Tertiary Care Hospital.

Dyslipidemia is one of the major risk factors of cardiovascular diseases. Worldwide, dyslipidemia is estimated to cause about 2.6 million deaths annually. Low drug adherence has been found to be a significant problem leading to poor health outcome. Medication non-adherence in chronic conditions is a recognized, but understudied public health problem. The present study was conducted to observe pattern of adherence to lipid lowering drugs, to find out the causes of non-adherence to medication and see the medication adherence in relation to various factor. The study was performed among 125 cardiovascular disease patients (both indoor and outdoor) of Cardiology department in Mymensingh Medical College Hospital (MMCH) who received lipid lowering drugs at least 6 months.Among them 21.6% patients were highly adherent, 34.4% patient showed medium adherent and 44% patients were low adherence to their treatment plan. Most important cause of non-adherence was financial problem (52.04%). Among them 46-55 years age group were highly adherent, male were more adherent to medication than female. Rich patient were highly adherent. Patient with above higher secondary level of education were highly adherent than others. Patients lived in urban area were more adherent than rural patients. Immediate efforts are required to tackle this situation. Multiple kinds of processes are required to improve the drug adherence such as to provide proper health education focusing on preventive aspect as well as financial support for the care. Such acts might prevent future complication thereby reducing costs of health care and eventually turns out to be reducing morbidity and mortality in the long run.

An Evaluation of Faculty Wise Teaching Performance in a Public Medical College of Bangladesh.

Teaching is a complex and demanding activity that involves Mastery of content, classroom control and techniques of organization and command of teaching skills. Teachers' continuous engagement in learning, skill acquisition and refinement to practice is essential for meeting student learning needs. Medical education is principally centered on the transmission of medical knowledge and assisting medical students to acquire the necessary skills and attitudes associated with medical practice. Evaluation of teaching is important in the teaching-learning process. The medical profession demands to be increasingly concerned with evaluation of teachers' performance as a part of its accountability. This study was designed to evaluate teaching performance in the department of Pharmacology, Forensic Medicine, Microbiology, Community Medicine and Pathology in Mymensingh Medical College and this descriptive cross sectional study was conducted among 94 students of 5th year MBBS students (session 2011-2012) of Mymensingh Medical College, Bangladesh from January 2016 to June 2016. A semi-structured self-administered questionnaire was used for collection of data. All the respondents provided opinion regarding scholarship of teachers, methods of presentation, communication and interaction, learning, coverage of contents and approachability by a 5 points rating scale. Attained score was variable in the context of different statements and different faculties. Students were also asked to provide suggestions for improvement of teachers' performance in each subject. Remarkable number of the students demanded for deployment of subject-specific teachers in adequate number. A significant number of students called for more practical classes in Pathology, Microbiology and Pharmacology. They also desired for the improvement of teaching quality and student friendly attitude from the teachers. A significant number of students opined that teaching materials and other logistics in the class rooms and even the class rooms were inadequate and need improvement in this regards. Regular conduction of classes by adequate number of teachers having post-graduate degree in the relevant faculty with adequate skill in teaching, student-friendly attitude of the teachers, adequate physical facilities and teaching materials help in improvement of teaching quality.

Current Trends of Using Antimicrobials at Obstetrics and Gynaecology Department in a Tertiary Care Hospital.

This cross-sectional descriptive study was done to analyse the current trends of using antimicrobials in various surgical procedures at Obstetrics and Gynaecology department in Mymensingh Medical College Hospital, Mymensingh from July 2014 to June 2015. Among 300 postoperative obstetrics and gynaecological surgery cases, samples were selected as non-random purposive selection method where pattern of using antimicrobials were analysed by SPSS method 20.1 versions. The incidence of antimicrobial resistance is on continued rise with a threat to return to the pre-antibiotic era. This has led to emergence of such bacterial infections which are essentially untreatable by the current armamentarium of available treatment options. Now-a-days variation of choosing antibiotic are quietly accepted in Obstetrics and Gynaecology department as prophylaxis purpose to control life threatening conditions such as postoperative wound infection, septicaemia, urinary tract infection etc. The data analysis revealed that among 300 obstetrical and gynaecological surgeries, Nitroimidazoles (93.33%), Cephalosporins (91%) and Aminoglycosides (59%) group were most commonly used antimicrobials in both obstetrics and gynaecological surgeries. Metronidazole (93.33%), Ceftriaxone (68.66%), Gentamicin (60.33%), Cefuroxime (48%), Flucloxacillin (42%), Cefixime (27%) were the most commonly used antimicrobials at obstetrics and gynaecology department. Combination of Ceftriaxone, Metronidazole and Gentamicin (37.66%), Ceftriaxone and Metronidazole (25.33%), Cefuroxime, Metronidazole and Gentamicin (16%), Ciprofloxacin, Metronidazole and Gentamicin (5.33%) were most commonly used antimicrobials postoperatively. Total mean duration of antimicrobial therapy was 10.45 days. Antibiotics are useful in prevention of infection. But indiscriminately use of antibiotics without any guideline may lead to antimicrobial resistance. So, antimicrobial surveillance committee should be formed by hospital authority to know the local using pattern of antibiotics.

Current Trend of Using Anti-Hypertensives in Pregnancy and Postpartum Period in a Tertiary Level Hospital.

Hypertensive disorders are one of the most common disorders in pregnancy. They are amongst the major cause of maternal and perinatal morbidity and mortality. Incidence is increasing in developing countries like Bangladesh. This cross sectional descriptive study has done to observe the utilization of antihypertensive drugs in hypertensive disorders of pregnancy and conducted from January 2016 to December 2016 in the department of Pharmacology in collaboration with department of Gynecology and Obstetrics in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Non random purposive sampling technique was used. Total of 300 patients participated in the study, 281 anti partum and 19 postpartum. Age distribution showed 42% patients were in 21-25 years age group. Majority of the participants (91%) were housewife and majority (79%) came from poor socioeconomic status with below SSC education (68%). About 82% patients lived in rural area. Trimester and gravida wise distribution showed most of the participants were 3rd trimester (61%) and primigravida (57%) and only 6% patients belong to postpartum period. In this study preeclampsia was highest (63.8%) among all other types of hypertensive diseases in pregnancy. Majority of the patient were preferred for dual therapy (53%), mono therapy was used in 29% of cases. Most frequently given drug in pregnancy associated hypertension was methyldopa that is 88.33% (single 22.3%, combination 66%). Second most commonly used drug was nifidipine consisting of 47.6% but used in combination in all cases. Average number of anti hypertensive drugs prescribed per prescription was 1.87 and majorities (92%) were from essential drug list but used as trade name. Preeclampsia and eclampsia were more common among the hypertensive disorders in tertiary level hospital cases. Methyldopa was found to be the commonest prescribed antihypertensive in monotherapy and in combination.

Current Trends of Using Antimicrobials and Their Sensitivity Pattern in Infectious Cases at Department of Orthopedics in a Tertiary Care Hospital.

This cross-sectional descriptive study was carried out to analyse the current trends of using antimicrobials at orthopaedics department in different surgical procedures and observe the antimicrobial sensitivity pattern of infective organisms in postoperative wound infection cases at the department of Orthopaedics, Mymensingh Medical College Hospital with collaboration of department of Pharmacology and Therapeutics in Mymensingh Medical College, Mymensingh from January 2016 to December 2016. Among 253 orthopaedics surgical cases Penicillins, Cephalosporins, and Aminoglycoside group were commonly prescribed antimicrobials that had been use postoperatively in most of the Orthopaedics cases. Rate of occurring postoperative wound infection was 18.58%. Pseudomonas aeruginosa (36.17%) was the predominant microorganisms in our study followed by Klebsiellae (12.77%), Proteus (10.64%), Escherichia coli and (6.38%) Enterococcus (4.25%). Pseudomonas aeruginosa exhibited sensitivities to Gentamicin (35.29%), Amikacin (35.29%). Good sensitivities patterns for Klebsiellae in our study were shown to Imipenam (100%), Gentamicin (20%). Sensitivity patterns for Proteus in our study were shown to Imipenam (80%), Gentamicin (20%). Enterococcus in our study showed good sensitivities against Imipenam (100%), Linezolid (100%). Cephalosporin generation showed more resistance.

Pattern of Anti-hypertensives Usage in Hypertension with or without Comorbidities in a Tertiary Care Hospital.

Hypertension is a chronic illness associated with high morbidity & mortality. A large number of antihypertensive drugs alone or in various combinations are available and physicians need to choose the most appropriate drug for a particular patient. The standard treatment guidelines and drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to evaluate the use of antihypertensive in hypertension with or without ischemic heart disease and diabetes mellitus at Department of Cardiology in Mymensingh Medical College Hospital, Mymensingh from July 2015 to October 2015. It was an observational type of descriptive cross sectional study. The study was performed among 400 hypertensive patients in Cardiology department in MMCH who received antihypertensive drug. Out of 400 hypertensive patients 67% were male and 33% were female. Maximum patients (54%) found in 40 - <60 years age group and ≤60 years age group (37.5%). Mean age of the patients was 55.02±12.47 years. Mean systolic BP was 146.74±28.28 and diastolic BP was 90.60±14.27mmHg. In overall prescription combination therapy (63.25%) was prescribed more frequently than mono-therapy (36.75%). In monotherapy ramipril was the most commonly prescribed (27.89%) antihypertensive drug and ARB was the most commonly prescribed group (37.41%). In our study 5 groups of antihypertensive were found (ARB, ACEI, BB, Diuretics, and CCB). In combination therapy 2-drugs combination were found most frequently (37.50%) and ACEI + Diuretics (23.72%) was the most common combination followed by ARB + Diuretics (12.25%), ACEI + BB (11.86%). Average number of antihypertensive drug per prescription was 1.9.

Effect of dietary utilisation of sugarcane press mud on production performance of Muzaffarnagari lambs.

Sugarcane press mud (SPM) is one of the potential agro-industrial by-products available in India and research exploring its utilisation in small ruminant nutrition is scanty. In this direction, the present study evaluated the feasibility of dietary incorporation of SPM at different levels in a feeding trial lasting 180 days. A total of 21 Muzaffarnagari ram lambs were randomly distributed into three groups of seven each based on comparable body weight (11.70 ± 0.29 kg) and age (3-5 months) following a completely randomised design. The three dietary treatments were (1) SP0 (control), concentrate mixture without SPM; (2) SP10, concentrate mixture comprising 10% SPM and (3) SP20, concentrate mixture comprising 20% SPM on air-dry basis. The experimental lambs were offered weighed quantity of designated isonitrogenous (crude protein = 20.6%) and isoenergetic (metabolisable energy = 12.1 MJ/kg) concentrate mixture (coarse mash) and along with ad libitum wheat straw (threshed to 1-2-cm length) and a 9-day metabolism trial was conducted. Results revealed no significant (P > 0.05) differences in intake and digestibility of nutrients, nitrogen balance, nutritive value of diets, average daily gain, as well as feed conversion ratio among three groups. The serum concentration of triiodothyronine and tetraiodothyronine did not differ due to treatments. Likewise, wool yield and its quality, measured in terms of fibre diameter, medullation percentage and staple length were also comparable irrespective of dietary variation. Furthermore, the cost of concentrate mixture (Rs/day) was lower (P ≤ 0.05) in SP20 followed by SP10 as compared to group SP0. These findings suggested that SPM could be safely fed up to 20% level in the concentrate mixture for lambs substituting expensive traditional feed ingredients without negatively inflicting the performance of growing lambs.

In Vitro Determination of Minimum Inhibitory Concentration of Aqueous Garlic Extract and Imipenem against Staphylococcus aureus and Escherichia coli.

An interventional study was performed to determine and compare the MICs of aqueous garlic extract (AGE) and Imipenem against standard strains of Staphylococcus aureus ATCC 25923 & Eschericha coli ATCC 25922. The study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2014 to January 2015. The MIC of AGE and antibiotic Imipenem were determined with the help of broth dilution method. The MIC of AGE was determined as 400µg/ml and 700µg/ml against Staphylococcus aureus, and Escherichia coli respectively and the MIC of Imipenem was 1µg/ml against Staphylococus aureus and 1.5µg/ml against Escherichia coli. The MICs of Imipenem was much lower in comparison to MICs of AGE for the test organisms. The subculture study showed the same results with that of the primary isolates. From the study it was clearly observed that AGE have anti bacterial effect but is not potent like antibiotic Imipenem. In this regard active ingredient present in garlic needs to be separated & purified for further study.

Prevalence and Symptom Correlation of Lactose Intolerance in the North East Part of Bangladesh.

This study was designed to see the prevalence of lactose intolerance and symptom correlation following oral lactose challenge in healthy volunteers in the north east part of Bangladesh. Symptoms of abdominal pain, nausea, borborygmi, flatulence, diarrhea and others were noted for 24 hours and blood glucose was estimated at 0 hour and 30 minutes after 50 gm oral lactose load to healthy volunteers. Failure to rise blood glucose level ≥1.1 mmol/l at 30 minutes after lactose intake from fasting level was taken as lactose malabsorption (LM) i.e., lactose intolerance. Sensitivity and specificity of different symptoms were then found out. A total of 171 volunteers (male 123, female 48) with a mean age 34.08 years participated in this study. Lactose intolerance was found among 82.5% (n=141, M=100, F=41) subjects. Symptoms mostly experience by the lactose malabsorbers were diarrhea 93(66.0%), borborygmi 80(56.7%), abdominal pain 31(22.0%) and flatulence 32(22.7%). LM prevalence was found to increase with increasing number of symptoms up to 3 symptoms. A week positive correlation (r=0.205, P=0.007) was found between the number of symptoms and proportion of subjects having positive lactose tolerance test. Lactose intolerance among healthy adults of North East part of our country is as common as in other Asian countries including China and Malaysia. But LM is higher than that of Europeans and south Indians. Diarrhea and borborygmi were mostly associated with LM.

Current Trends of Using Antimicrobial Drugs in the ICU at a Tertiary Level Teaching Hospital in Mymensingh.

The aim of the present study was to investigate the current trends of using antimicrobial drugs in the ICU at a tertiary level teaching hospital in Mymensingh. The study of prescribing patterns seeks to monitor, evaluate and suggest modifications in clinicians prescribing habits so as to make medical care rational. It was an observational type of descriptive study, conducted in the Mymensingh medical college hospital, Mymensingh, during the study period of June 2016 to September 2016.The study was approved by the institutional ethical committee. Most patients in the ICU belonged to the older age group >60 years. Male patients were more than the female patients in ICU. Average duration of stay in ICU was 4.35 days. Admissions in ICU were common due to respiratory system related diseases and the present study showed that 31.68% of the reported cases belong to the respiratory system. Average number of drugs per prescription was 6.46. Average number of anti-microbial drugs per prescription was 1.38. Cephalosporin group and individually ceftriaxone was the most frequently prescribed antimicrobial group and agent respectively in the ICU. Most commonly used antimicrobial combination was Cephalosporin and Metronidazole (43.33%) followed by Carbapenem (Meropenem) and Metronidazole (13.33%). Most antimicrobial agents were prescribed without bacteriological culture and sensivity testing evidence. There is a need for motivating the physicians to prescribe antimicrobial agents with supportive bacteriological evidences.

Anti-Bacterial effect of Aqueous Garlic Extract (AGE) determined by Disc Diffusion Method against Escherichia coli.

The study was performed to determine the antibacterial effect of aqueous extract of garlic (Allium sativum) against standard strain of Escherichia coli ATCC 25922. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. Antibacterial effect of AGE was determined by disc diffusion method. Sensitivity of AGE determined in disc diffusion and the zone of inhibition (ZOI) was 4 mm, 10 mm and 20 mm at 25 µg/10 µl, 50 µg/10 µl and 100 µg/10 µl concentrations respectively. From the findings it is clearly determined the extract has definite antibacterial effect upon Escherichia coli. Further studies are required to detect and isolate the active ingredients present in the Garlic extract as well as detail steps of mechanism responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account.

Effectiveness of Topical Corticosteroid, Topical Calcineurin Inhibitors and Combination of Them in the Treatment of Vitiligo.

Vitiligo is an acquired pigmentary skin disorder which is disfiguring and difficult to treat. Cure and response rates for vitiligo are significantly lower. This study was conducted to evaluate the effectiveness of topical corticosteroid, topical calcineurin inhibitors (tacrolimus) and combination of them in the treatment of vitilligo in two tertiary care Hospital, in the Department of Dermatology and Venereology OPD (out patient department) in Mymensingh Medical College Hospital and Jahurul Islam Medical College Hospital, Bajitpur, Kishoregonj from January 2015 to December 2015. Newly diagnosed 112 vitiligo patients, aged more than 1 year to 70 years were assigned for therapy and to observe the response. This study indicates that, in case of vitiligo treatment topical tacrolimus was the most effective drug. Topical tacrolimus, topical corticosteroid and combination of them are to be effective in the treatment of vitiligo with reduction in the number of vitiliginous spots by increased repigmentation. But topical tacrolimus was the most effective drug, as it caused highest percentage of repigmentation of vitiliginous spot.

In vitro assessment of antibacterial effect of garlic (allium sativum) extracts on pseudomonas aeruginosa.

The study was aimed to determine the antibacterial effect of crude and aqueous extract of garlic (Allium stivum) against standard strain of Pseudomonas aeruginosa ATCC 27853. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. The minimum inhibitory concentration (MIC) of aqueous garlic extract (AGE) and antibiotic Imipenem were also determined with the help of broth dilution method. Inhibitory effect of crude garlic extract (CGE) was determined by inoculation of bacteria in CGE incorporated nutrient agar (NA) media and for AGE antibacterial effect was determined by disc diffusion method. All experiments except disc diffusion procedure were reconfirmed by subculture in pure NA media. In case of CGE the growth inhibition of test organism was observed in 30% CGE incorporated NA media. On the other hand sensitivity of AGE also determined in disc diffusion and the zone of inhibition (ZOI) was 7 mm, 12 mm and 20 mm at 25 µg/10 µl, 50 µg/10 µl and 100 µg/10 µl concentrations respectively. The MICs of AGE and Imipenem were 600 µg/ml and 1µg/ml. The MIC of imipenen was far less in comparison with the MIC of AGE. From the findings it is clearly determined that both the extracts have definite antibacterial effect upon Pseudomonas aeruginosa. Further studies are required to detect and isolate the active ingredients present in the Garlic extract responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account. Only then the Garlic extracts fulfilled the criteria for its therapeutic use. Still then external application advised for burn and superficial skin infections and may be used in food poisoning, and respiratory tract infection along with conventional antibiotics which are used in those conditions.

A regulatory approach on serum bilirubin level in subjects with impaired glucose tolerance.

The present study was undertaken to find the role of dietary intervention and physical exercise on serum bilirubin level in IGT subjects. Thirty three newly detected otherwise healthy subjects with IGT, aged 35-63 years, were randomly selected to participate in a 12 weeks diet and exercise program. Nine participants were within 35-40 years while majority fifteen participants aged 41-50 years and rest six participants were above 50 (51-63) years. A male preponderance was observed among the study participants where 53.3% of the total participants were male (n=16) and 46.7% were female (n=14). Mean bilirubin (mg/dl) level was recorded 0.68 ± 0.29 at base line and with follow-up, the value was 0.66 ± 0.26 mg/dl. For men (n=16), serum bilirubin were 0.77 ± 0.39 and 0.75 ± 0.36 mg/dl at base line and follow-up while for women (n=14), the values were 0.67 ± 0.33 and 0.59 ± 0.28 mg respectively. The 35-40 years group (n=9) showed bilirubin from 0.66 ± 0.23 at base line to 0.73 ± 0.19 mg/dl at follow-up while 41-50 years group (n=15) had 0.70 ± 0.34 and 0.58 ± 0.26 mg/dl and for 51-63 years group (n=6), the values were 0.65 ± 0.29 and 0.73 ± 0.33 mg/dl respectively. Participants with BMI 20-25 had bilirubin 0.62 ± 0.29 mg/dl at base line and 0.71 ± 0.21 mg/dl at follow-up while with BMI >25 (n=20) had 0.71 ± 0.30 and 0.63 ± 0.2 8 mg/dl respectively. No significant changes in serum bilirubin were observed among the groups and therefore, the dietary intervention and physical exercise during the period did not have a significant role in this respect.

Antibacterial Effect of Curcuma longa (Turmeric) Against Staphylococcus aureus and Escherichia coli.

This observational study was conducted during the period from July 2010 to June 2011 in the Department of Pharmacology in the collaboration of Department of Microbiology, Mymensingh Medical College, Mymensingh to determine the profile of antibacterial effect of Crude Turmeric paste aqueous turmeric extract, and standard antibiotic Amikacin against Staphylococcus aureus and Escherichia coli. Three separate experiments were done e.g. (Expt- I) Inhibitory effect of Crude Turmeric paste incorporated into nutrient agar (NA) media, (Expt- II) Minimum inhibitory concentration of (a) Aqueous Turmeric extract and (b) Amikacin by broth dilution technique and (Expt-III) their subculture study in nutrient agar (NA) media for confirmation of respective results of previous experiments. Inhibitory effects were observed against the growth of Staph Aureus and Esch coli at 10% and 30% respectively of Crude Turmeric paste incorporated into NA media. The broth dilution technique was followed to determine the MIC of Aqueous Turmeric extract and Amikacin. The MIC of Aqueous Turmeric extract was 800 µg/ml against Staph aureus and that against Esch coli was 2000 µg/ml and the MIC of Amikacin was 10 µg/ml for both the bacteria. The MIC of Amikacin was the lowest in comparison to MIC of Aqueous Turmeric extract for complete inhibition of growth of Staph aureus and Esch coli. The subculture study showed similar results with that of previous experiments in terms of inhibitory effects of Crude Turmeric paste and MIC of Aqueous Turmeric extract and Amikacin against all of the organisms studied.

Initial Experience with Endoscopic Ultrasound.

Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4 ± 20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n = 165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n = 6), Gall stones (n = 12), Biliary ascarrisis (n = 22), Choledocholithiasis (n = 42), Acute Pancreatitis (n = 9), Chronic Pancreatitis (n = 15), Pancreatic pseudocysts(n = 4) (B) Malignant Pathologies : GB Carcinoma (n = 4), Cholangiocarcinoma (n = 29), Ca- pancreas (n = 9), Periampullary carcinoma (n = 12). Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n = 9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n = 2) for restaging or recurrence after chemoradiation and 21% (n = 4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, seven were for staging of gastric carcinoma, four were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and two for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.

Relationship between estimated foetal weight and renal volume in intra uterine growth retarded foetus in Bangladeshi women.

Low birth weight (LBW) baby predisposes to long term renal disease, adult hypertension and related cardiovascular disease. This could be due to reduced nephron number in early life. From different studies, it is becoming increasingly clear that nephron number, indirectly reflected in renal volume may be related with normal or retarded foetal growth. This prospective study was undertaken in the department of Obstetric and Gynae in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. One hundred pregnant women were included in this study and divided into two groups (IUGR and normally growing foetuses). Forty one foetuses weighted less than 2.5kg and fifty nine foetuses weighed 2.5kg or more. Kidney dimensions and estimated feotal weight were measured by USG by the same ultrasonologist. There were no significant difference between two groups regarding age, height, weight, and parity. The subjects with intrauterine growth retardation had smaller head circumference, abdominal circumferences, biparietal diameters, femur length, estimated foetal weight and lower amniotic fluid indices than did the subjects with non-intrauterine growth retardation (IUGR). All biometric data shows significant deference except head circumference (HC). Intrauterine growth retardation (IUGR) foetus had significantly lower kidney volume than normally growing foetuses.

Intermittent prophylaxis of recurrent febrile seizures with clobazam versus diazepam.

Febrile seizures are the most common type of seizure among children that can be prevented by using prophylactic drugs like Clobazam and Diazepam. The present prospective study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh over a period of 1 year from July 2012 to June 2013 to compare the effectiveness of intermittent Clobazam versus Diazepam therapy in preventing the recurrence of febrile seizures and assessed adverse effects of each drug. A total of 65 patients (32 children administered Clobazam and rest 33 children received Diazepam) of simple and complex febrile seizures aged 6 months to 5 years of both sexes were the study population. Data were collected by interview of the patients, clinical examination and laboratory investigations using the research instrument. Data were analyzed by using Chi-square (χ2) Test, Student's 't' Test and Fisher's Exact Test. For all analytical tests, the level of significance was set at 0.05 and p<0.05 was considered significant. The proportion of patients was higher between age 12-36 months and male was predominant in the both Clobazam and Diazepam groups. Over 31% of patients in Clobazam group who experienced episode of fever within 3 months, 40.6% within 6 months and 9.4% within 9 months compared to 36.4% in Diazepam group within 3 months, 45.5% within 6 months & 12.1% within 9 months after discharge from the hospital. Three (9.4%) patients in Clobazam group and 7(21.3%) in Diazepam group who experienced febrile convulsion during the follow up period. From the data adverse effects within 3 and 6 months experienced by the patient's drowsiness, sedation and ataxia were higher in Diazepam group than those in Clobazam group. However, within 9 months lethargy and irritability were somewhat higher in Clobazam group than those in Diazepam group. The mean duration of hospitalization was significantly higher in Diazepam group compared to Clobazam group (6.0±1.0 vs. 4.6±0.08 days, P<0.001). Seven (21.2%) out of 33 children with febrile seizures in Diazepam group had a history of recurrent seizures, whereas 3(9.4%) of 32 children in the Clobazam group. The risks of recurrent febrile seizure in the Diazepam group was 2.6 times greater compared to those in the Clobazam group (P=0.186). The result indicates that Clobazam is safe, efficacious, requires less frequent dosing and has less adverse effects such as drowsiness, sedation, ataxia and irritability as compared to Diazepam. So, Clobazam may be an alternative to Diazepam given intermittently for prevention of recurrent febrile seizures.

Efficient and accurate optimal linear phase FIR filter design using opposition-based harmony search algorithm.

In this paper, opposition-based harmony search has been applied for the optimal design of linear phase FIR filters. RGA, PSO, and DE have also been adopted for the sake of comparison. The original harmony search algorithm is chosen as the parent one, and opposition-based approach is applied. During the initialization, randomly generated population of solutions is chosen, opposite solutions are also considered, and the fitter one is selected as a priori guess. In harmony memory, each such solution passes through memory consideration rule, pitch adjustment rule, and then opposition-based reinitialization generation jumping, which gives the optimum result corresponding to the least error fitness in multidimensional search space of FIR filter design. Incorporation of different control parameters in the basic HS algorithm results in the balancing of exploration and exploitation of search space. Low pass, high pass, band pass, and band stop FIR filters are designed with the proposed OHS and other aforementioned algorithms individually for comparative optimization performance. A comparison of simulation results reveals the optimization efficacy of the OHS over the other optimization techniques for the solution of the multimodal, nondifferentiable, nonlinear, and constrained FIR filter design problems.