Antibacterial Effects of Methanol Henna (Lawsone inermis) Leaf Extracts against Two Food Borne Infection Causing Pathogens: Gram-Positive Staphylococcus aureus and Gram Negative Klebsiella pneumoniae.

Evaluation of the in vitro antibacterial activity of Methanol extracts isolated from Henna (Lawsonia inermis) leaf against two food born infection causing pathogens, gram-positive Staphylococcus aureus and gram-negative Klebsiella pneumoniae. This interventional study was carried out in the Department of Pharmacology and Therapeutics in collaboration with the Department of Microbiology, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. The antibacterial activity was tested at different concentrations of Methanol Henna leaf extracts by using disc diffusion and broth dilution method. The extract was prepared by using solvents Methanol and 0.1% dimethyl sulfoxide (DMSO). The test microorganisms were also tested for their activity against a standard antibiotic Ciprofloxacin by broth dilution method and the result was compared with that of Methanol extracts. Methanol Henna Extracts (MHE) were used initially in nine different concentrations (2.5, 5, 10, 20, 50, 100, 200, 500 and 1000mg/ml) and later in selected concentrations as needed to confirm the more precise margin of antimicrobial sensitivity of the extracts. Among different concentrations of the MHE, 100mg/ml and above concentrations showed inhibitory effect against afore said bacteria. The MIC for Staphylococcus aureus and Klebsiella pneumoniae were 100mg/ml in MHE. The MIC of Ciprofloxacin was 1µg/ml against Staphylococcus aureus and 1.5µg/ml for Klebsiella pneumoniae. The MIC of Ciprofloxacin was the lowest in comparison to MICs of MHE for the test organisms. This study showed that Methanol Henna extracts demonstrated antibacterial effects against pathogens. From this study, it is clearly observed that there is definite antibacterial effect of the methanolic extract of Henna leaves (Lawsonia inermis) against Staphylococcus aureus and Klebsiella pneumoniae.

Study on Serum Calcium Level in Patients with Chronic Kidney Disease.

Patients often present with chronic kidney disease (CKD) complicated with hypocalcaemia. Lower serum calcium is independently associated with chronic kidney disease. Aim of this study was to assess of serum calcium level in chronic kidney diseased patients in order to compare this parameter with healthy subjects. This analytical type of cross-sectional study was carried out in the Physiology department, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 subjects, age range 30-70 year were included in this study. Among 200 subjects, 100 healthy were taken as control group (Group I) and 100 chronic kidney diseased patients were taken as study group (Group II). Control group (Group I) subdivided into male healthy subject (Group IA) and female healthy subject (Group IB). Also study group (Group II) subdivided into male chronic kidney diseased patient (Group IIA) and female chronic kidney diseased patient (Group IIB). The results were calculated and analyzed by using SPSS version-21. Expression of data as mean±SE and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that mean±SE serum calcium of Group IA and Group IIA were 9.60±0.09mg/dl & 8.04±0.03mg/dl respectively. The mean±SE serum calcium of Group IB and Group IIB were 9.38±0.096mg/dl & 8.19±0.05mg/dl respectively. Serum calcium was significantly decreased in study groups in comparison with control groups (p<0.001). By this study we therefore recommended that routine estimation of this parameter is important for prevention of complication related to chronic kidney disease for leading a healthy life.

The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984-2017.

OBJECTIVE: To estimate the effect of estrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46-65 at first prescription. DESIGN: Matched cohort study. SETTING: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984-2017). POPULATION: 105 199 HRT users (cases) and 224 643 non-users (controls) matched on age and general practice. METHODS: Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy, hysterectomy, body mass index, smoking and deprivation status. MAIN OUTCOME MEASURES: All-cause mortality. RESULTS: A total of 21 751 women died over an average of 13.5 years follow-up per participant, of whom 6329 were users and 15 422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95% CI 0.88-0.94), and in estrogen-only users was 0.99 (0.93-1.07), compared with non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60 and 61-65 years at first treatment were 0.98 (0.92-1.04), 0.87 (0.82-0.92), 0.88 (0.82-0.93) and 0.92 (0.85-0.98) for combined HRT users compared with non-users, and 1.01 (0.84-1.21), 1.03 (0.89-1.18), 0.98 (0.86-1.12) and 0.93 (0.81-1.07) for estrogen-only users, respectively. CONCLUSIONS: Combined HRT was associated with a 9% lower risk of all-cause mortality and estrogen-only formulation was not associated with any significant changes. TWEETABLE ABSTRACT: Estrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

Correlation between Fasting Serum Glucose and Serum Zinc Level in Patients with Type-2 Diabetes Mellitus.

Type-2 diabetes mellitus accounts for 90-95% of all diabetes. There is a Correlation between Fasting Serum Glucose and Serum Zinc level in patients with Type-2 Diabetes Mellitus. This study was done to assess the relationship of Fasting Serum Glucose and Serum Zinc in type-2 diabetic patients in order to compare this parameter with healthy subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 140 subjects, age ranged from 35-65 years was included in this study. Among them, seventy (70) type-2 diabetic patients were taken as study group (Group II) and seventy (70) ages matched healthy subjects were taken as control group (Group I). Group I again subdivided into control group male (Group IA) and control group female (Group IB). Group II also subdivided into study group male (Group IIA) and study group female (Group IIB). Pearson correlation coefficient test is done to correlate the relationship between fasting serum glucose (FSG) and serum zinc. In this study we found that serum zinc level was decreased in study groups in comparison with control groups. Therefore, by this study we recommended that routine estimation of this parameter is important for prevention of complication related to diabetes for leading a healthy life.

Clinical and Neuro-radiological Profile of Symptomatic Cytomegalovirus Infection in Infants in a Tertiary Care Hospital.

Congenital CMV infection is the most common mother to child infection having spectrum of clinical presentation which can lead to severe neurological sequelae. Early assessment of disease severity from clinical and neuroimage profile is essential to initiate proper treatment and to predict the outcome is crucial. This cross sectional observational study was conducted at Dhaka Medical College Hospital a tertiary care centre of Bangladesh from January 2019 to June 2020 in the department of pediatrics. This study was carried on among 123 infants of aged 0-12 months with polymerase chain reaction proven congenital cytomegalovirus infection over a period of 18 months. Mean age of our study group is 7.01±2.02 months, with male predominance (85.00%); majority of our infants came from lower socioeconomic background of rural area. Only 5.70% took more than two antenatal visits, 70.00% had history of perinatal asphyxia where 54.50% developed neonatal seizure. Microcephaly was present among 69.10% children, epilepsy, movement disorder, central visual impairment, different level of hearing impairment (78.90%) and severe psychomotor retardation (83.80% - 87.80%) was the most consistent initial presentation of our study group. Neuroimage abnormality was present among 94.30% of infants where cortical atrophy (86.20%) and intracranial calcification (55.30%) was the most common findings, different type of congenital malformations was also observed among the study group. Multiple logistic regression analysis showed significant value for abnormal neuroimage findings as a predictor of severity of psychomotor retardation. Congenital cytomegalovirus infection is one of the leading cause of hearing impairment and psychomotor retardation, where neuroimage findings could guide to predict the severity of psychomotor retardation.

Study on Body Mass Index, Serum C-Reactive Protein and Their Association with Cardiovascular Risk Factors in Postmenopausal Women.

Menopause is the natural process of ageing when women pass from reproductive to non -reproductive phase with the cessation of cyclical ovarian functions. After menopause women are usually troubled by increasing weight and waist circumference caused by obesity and androidal fat redistribution. With the increase in life expectancy resulting in women living one half to one third of their lives after menopause, the high incidence of overweight and obesity in women have become important public health concerns. In postmenopausal women, elevated C-reactive protein (CRP) is one of the most significant predictors of cardiovascular disease and heart attack risk. In middle aged women, the risk of a coronary event rises dramatically after onset of menopause corresponding to decreased levels of circulating endogenous estrogens. Both body mass index (BMI) and serum CRP are significantly higher among postmenopausal women as compared with reproductive aged women. To assess the BMI and serum CRP level changes in healthy postmenopausal women in order to compare this parameter with healthy reproductive aged women. This comparative study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July, 2018 to June, 2019. Two hundred healthy women (100 female were postmenopausal as study group and 100 female were reproductive aged women as control group) aged between 25 to 65 years were enrolled in this study. BMI was calculated as weight in kilogram divided by the height in meter square. Serum CRP by CRP-Latex Test (Slide agglutination procedure). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean value ±SD of BMI and serum CRP level was higher in postmenopausal group in comparison to the reproductive women group. This study concludes, BMI and Serum C-Reactive protein level increased in postmenopausal women.

Evaluation of Change of Peak Expiratory Flow Rate (PEFR) in Male Chronic Obstructive Pulmonary Diseased (COPD) Patients.

Chronic obstructive pulmonary disease (COPD) is a major public health problem which causes high health care utilizations, poor health-related quality of life, and substantial cost burden and deaths in worldwide. This study was done to evaluate the changes of peak expiratory flow rate (PEFR) in COPD patients in comparison to healthy person. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 160 male subjects, age ranged from 30-70 years was included in this study. Among them, eighty (80) male COPD subjects were taken as study group (Group II) and eighty (80) age matched male healthy subjects were taken as control group (Group I). PEFR was assessed by peak flow meter. Data were expressed as mean ±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean ±SD of PEFR of Group I and Group II were 432.75±30.23 L/min & 203.5±20.81 L/min respectively. The mean ±SD of PEFR significantly lower in study group in comparison with control group. Patients with COPD with greater changes in PEFR causes more frequent hospitalization and increased mortality and morbidity due to COPD related complications. So, assessment of this parameter is important for early detection and prevention of complications related to COPD for leading a healthy life.

Relationship of BMI and Fasting Serum Glucose with Hypertension.

Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease. It is recognized as a major contributor to the disease burden globally. Aim of the study was to evaluate body mass index and fasting serum glucose level in male hypertensive patients in order to compare these parameters with male normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2018 to June 2019. Total 200 male subjects, age range was from 30-65 years were included in this study. Among them, 100 hypertensive subjects were taken as study group (Group II) and 100 ages matched normotensive male subjects were taken as control group (Group I). Quantitative data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that body mass index was significantly (p<0.001) increased in study group (29.52±2.46) in comparison with control group (22.91±1.04). Fasting serum glucose level was also significantly (p<0.001) increased in study group (6.35±0.47) in comparison with control group (4.52±0.50). Based on the study carried out it is concluded that there is definite relationship of body mass index and fasting serum glucose level with hypertension. Therefore, basic measurement of weight and height to determine the body mass index and fasting serum glucose level as routine assessment during hospital visitation with appropriate lifestyle modification would help in controlling hypertension as well as its devastating consequences.

Relationship of Serum Creatinine and Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease.

Chronic kidney disease (CKD) is a common condition in which there is a loss of kidney function over time. CKD is associated with increased risks of several co morbidities, not limited to but including cardiovascular disease and chronic renal failure. Hypercreatininemia is associated with low level of estimated glomerular filtration rate (eGFR) in chronic kidney diseased patients. Objective of the study was to assess the relationship of eGFR and serum creatinine in chronic kidney diseased patients in order to compare this parameter with healthy subjects. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 subjects, age range (30-70 year) were included in this study. Among them, 100 healthy subjects were taken as control group (Group I) and 100 chronic kidney diseased patients were taken as study group (Group II). Control group (Group I) again subdivided into male healthy subject (Group IA) and female healthy subject (Group IB). Study group (Group II) also subdivided into male chronic kidney diseased patient (Group IIA) and female chronic kidney diseased patient (Group IIB). The results were calculated and analyzed by using SPSS. Data were expressed as mean(±SE) and statistical significance of difference among the group was calculated by unpaired Student's t-test. In this study we found that eGFR was significantly decreased and serum creatinine was significantly increased in study groups in comparison with control groups. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complications related to chronic kidney disease.

Thyroid Function Status in Elderly Male.

With the advancement of age, the production, metabolism and action of thyroid hormone are also changed. The incidence of thyroid dysfunction is increased greatly with age. Aim of the study was to assess the age-related change in thyroid function status in elderly male in order to compare it with younger male. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2019 to December 2019. A total number of 140 male subjects were included in this study. Among them seventy (70) younger male were taken as control group (Group I) and seventy (70) elderly male were taken as study group (Group II). For assessment of thyroid function, serum free tri-iodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) levels were estimated by RIA method. Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's t-test. Pearson's correlation coefficient test was done to find the correlation of serum FT3, FT4 & TSH with age. In this study we found that mean serum free tri-iodothyronine (FT3) & free thyroxine (FT4) levels were significantly lower and serum thyroid stimulating hormone (TSH) level was significantly higher in elderly male persons in comparison to younger male. Again, serum FT3, FT4 was negatively correlated with age of the subjects whereas serum TSH level was positively correlated with age of the subjects. Based on the study carried out it is concluded that there is a progressive decrease in thyroid function with advancement of age.

Percent Saturation of Oxygen Status in Male Chronic Obstructive Pulmonary Diseased Patients.

At present Chronic obstructive pulmonary disease (COPD) is becoming one of the important global health problems. This study was done to evaluate the changes of percent saturation of oxygen in COPD patients in comparison to healthy person. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 160 male subjects, age ranged from 30-70 years was included in this study. Among them, eighty (80) male COPD subjects were taken as study group (Group II) and eighty (80) age matched male healthy subjects were taken as control group (Group I). Percent saturation of oxygen was estimated by pulse oximeter. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean±SD of percent saturation of oxygen of Group I and Group II were 98.30±0.74% & 90.65±3.27% respectively. The mean±SD of percent saturation of oxygen was significantly lower in study group in comparison with control group. Patients with COPD with greater changes in percent saturation of oxygen causes more frequent hospitalization and increased mortality and morbidity due to COPD related complications. So assessment of this parameter is important for prevention of complication related to COPD for leading a healthy life.

Evaluation of Serum Uric Acid and Serum Creatinine in Male Hypertensive Patients.

Hypertension is a major public health problem of adult population across the globe that significantly increases the risk of heart attack, stroke, kidney failure and blindness. It is one of the leading cause of premature death worldwide. Aim of the study was to evaluate serum uric acid and serum creatinine in male hypertensive patients in order to compare these parameters with male normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 male subjects, age ranged from 30-65 years was included in this study. Among them, hundred (100) hypertensive subjects were taken as study group (Group II) and hundred (100) ages matched normotensive male subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that serum uric acid and serum creatinine was significantly increased in study group in comparison with control group. Based on the study carried out it is concluded that there is definite relationship of serum uric acid and serum creatinine with hypertension. Therefore, serum uric acid and serum creatinine should be measured in all hypertensive subjects for prevention of devastating consequences of hypertension and thus can combat morbidity and mortality.

Evaluation of Serum Zinc Status and Glycated Hemoglobin in Patients with Type-2 Diabetes Mellitus.

Type-2 diabetes is the most common type of diabetes, accounting for about 90% of all diabetes. This study was done to assess the Serum Zinc status and Glycated Hemoglobin in type-2 diabetic patients in order to compare this parameter with healthy subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 140 subjects, age was ranged from 35-65 years were included in this study. Among them, seventy (70) type-2 diabetic patients were taken as study group (Group II) and seventy (70) age matched healthy subjects were taken as control group (Group I). Group I again subdivided into control group male (Group IA) and control group female (Group IB). Group II also subdivided into study group male (Group IIA) and study group female (Group IIB). Data were expressed as mean±SE and statistical significance of difference among the group was calculated by unpaired students' 't' test. Therefore, by this study we recommended that routine estimation of this parameter is important for prevention of complication related to diabetes for leading a healthy life.

Barriers to quality of work life among Bangladeshi nurses: a qualitative study.

AIM: To explore and provide understanding of the barriers to quality of work life among registered nurses in Bangladesh. BACKGROUND: Globally, there is growing interest in the working environments of nurses, especially at a time of nursing shortages and with the focus on safety and care quality in health systems. In a low socio-economic country like Bangladesh, nurses struggle in a grossly underfunded healthcare system to deliver care to the people but no studies have been conducted on their quality of work life. METHODS: This qualitative descriptive study was conducted at three Bangladeshi tertiary hospitals in May 2015-January 2016. Three focus group discussions were held with 30 registered nurses exploring their perceived barriers to quality of work life. Data were analysed with content analysis. FINDINGS: Seven barriers to their work-life arose: heavy workloads; lack of government accommodation and transportation; poor health status; lack of support from nursing supervisors; lack of promotion opportunities; incomplete hospital policies and procedures; and lack of night shift and risk allowances. DISCUSSION: Participants described many issues and barriers impacting on their work-life. They perceived little reward for their hard work, felt that their health suffered from their working conditions and described a low QWL. CONCLUSION AND POLICY IMPLICATIONS: Findings provide information for nursing and health policymakers and leaders to reduce barriers to improve work-life quality among nurses that can contribute better to quality of nursing care, and nursing retention and satisfaction. Work policies and practices, and funding and other resources need to be scrutinized to ensure better working conditions for Bangladeshi nurses. LIMITATIONS: Interviews were conducted with nurses only in tertiary hospitals in the Bangladeshi capital, and understanding of barriers to work-life quality of nurses in other health settings and regions needs to be explored.

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.

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.

Factors predicting quality of work life among nurses in tertiary-level hospitals, Bangladesh.

AIM: This study examined the level of quality of work life and predictability of years of education, monthly income, years of experience, job stress, organizational commitment and work environment on quality of work life among nurses in tertiary-level hospitals in the People's Republic of Bangladesh. BACKGROUND: There is an acute shortage of nurses worldwide including Bangladesh. Quality of work life is important for quality of patient care and nurse retention. Nurses in Bangladesh are fighting to provide quality care for emerging health problems for the achievement of sustainable development goals. METHODS: We collected data from 288 randomly selected registered nurses, from six tertiary-level hospitals. All nurses were requested to fill questionnaire consisted of Demographic Data Sheet, Quality of Nursing Work Life Survey, Expanded Nursing Stress Scale, Questionnaire of Organizational Commitment and Practice Environment Scale of the Nursing Work Index. Data were analysed by descriptive statistics and multiple regression. RESULTS: The quality of work life as perceived by nurses in Bangladesh was at moderate level. Monthly income was found as the best predictor followed by work environment, organizational commitment and job stress. DISCUSSION: A higher monthly income helps nurses to fulfil their personal needs; positive work environment helps to provide quality care to the patients. LIMITATION: Quality of work life and predictors measured by self-report only may not reflect the original picture of the quality of work life among nurses. CONCLUSION AND POLICY IMPLICATIONS: Findings provide information for nursing and health policymakers to develop policies to improve quality of work life among nurses that can contribute to quality of nursing care. This includes the working environment, commitment to the organization and measures to reduce job stress.

Challenges in HbA1C Level as a Diagnostic Tool of Diabetes and Pre-Diabetes in Middle-Aged Population: The Bangladesh Study.

Worldwide prevalence of diabetes is found to be the human health at an alarming rate. However, large numbers of patient remain undiagnosed. Oral glucose tolerance test (OGTT) still is regarded as gold standard in diagnosis of blood glucose abnormality. Although the less number of bodies are considering measurement of HbA1C as an alternate tool to identify risk group. This study was undertaken to evaluate the role of measurement of HbA1C in the diagnosis of diabetes and pre-diabetes in middle-aged Bangladeshi subjects and carried out in the department of Biochemistry, BIRDEM from July 2013 to June 2014. A total 177 subjects of age within the range of 30-45 years were selected for the purpose and classified into healthy control (n=62) pre-diabetes (n=69) and diabetes (n=46) groups based on the values of OGTT. Middle aged Bangladeshi subjects attending Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, the HbA1C values were 5.0-5.6% in control group, 5.6-6.2% in pre-diabetes and 8.1-9.7% in diabetes group (95% CI). The optimal cut-off value of HbA1C related to pre-diabetes diagnosed by OGTT was 5.6%, which showed the sensitivity 47.8%, specificity 74.2%, positive predictive value 67.3% and negative predictive value 58.5%. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1C measurements. So measurement of HbA1C may not be used as an alternate tool of OGTT to identify people of diabetes and pre-diabetes in certain situation.

A friendly approach to repair fourth degree perineal tears.

This observational study was done to make the Gynecologists familiar with the procedure of continuous repair of rectal mucosa and repair of the anal sphincter by other than figure of 8 sutures and to assess the effectiveness of the procedure. This study was carried out in two teaching hospitals and other two private hospitals in Dhaka city and out side. Total 20 patients were included in this study. All had fourth degree perineal tear and were repaired with the new approach. Follow up was carried out at 6th week, 12th week, and 24th weeks. Among 20 patients a large number of women were mother of one child and were of 21-25 years age group. At post operative period - wound infection was nil. Perineums were well established in all cases. On follow up at 24th week - pain in perineum and dyspareunia was nil in all cases, though this was present at early weeks in few cases. Faecal incontinence was absent in all patients by 24 weeks postoperatively. In follow up visits there was no complaint of faecal incontinence. In few cases pain was present in early post operative periods but dyspareunia was absent. So, continuous repair of anal mucosa and repair of anal sphincters other than figure of eight seems better regarding technical easiness, better compliance for the surgeon and less traumatic to the rectal mucosa and ultimately better results.

Supplementation of direct-fed microbials as an alternative to antibiotic on growth performance, immune response, cecal microbial population, and ileal morphology of broiler chickens.

An experiment was conducted to investigate the supplementation of direct-fed microbials (DFM) as an alternative to antibiotics on growth performance, immune response, cecal microbial population, and ileal morphology of broiler chickens. A total of 800 one-day-old male broiler chicks (Ross × Ross) were randomly allotted to 4 dietary treatments with 4 replicate pens per treatment (50 birds/replicate pen). The 4 dietary treatments fed for 35 d were a corn-soybean meal basal diet (control); control plus 0.1% virginiamycin, as an antibiotic growth promoter (AGP); control plus 0.1% direct-fed microbials that contained Lactobacillus reuteri (DFM 1); and control plus 0.1% direct-fed microbials that contained a mixture of L. reuteri, Bacillus subtilis, and Saccharomyces cerevisiae (DFM 2). Results showed that dietary AGP and DFM supplementation significantly increased (P < 0.05) the BW gain of broilers during 0 to 21 d. The feed intake was reduced, whereas the feed conversion was improved significantly when birds were fed DFM 2 at 0 to 7 d of age. The white blood cell and monocyte levels were significantly higher in the DFM 2 group compared with the control. In addition, feeding DFM significantly (P < 0.05) increased the plasma immunoglobulin levels where a higher level was observed in DFM 2 compared with those of the other treatments. Neither DFM nor AGP treatments affected the cecal Lactobacillus and Salmonella content; however, cecal Escherichia coli content significantly decreased in broiler chickens fed DFM and AGP. The ileal villus height, and width and total thickness of muscularis externa were significantly increased when birds were fed DFM compared with AGP and control. These results indicate that the dietary supplementation of DFM increases the growth performance of birds at an early age, stimulates the immune response, decreases the number of E. coli, and improves the ileal morphology of broiler chickens. Thus, DFM that contained a mixture of several beneficial microorganisms could be a viable alternative to antibiotics in the broiler diets.