Anti-quorum Sensing and Anti-biofilm Activity of Zinc Oxide Nanospikes.

This study evaluates the impact of two separate incubation periods (4 and 6 weeks) on the morphology of sol-gel-fabricated ZnO nanospikes (ZNs), that is, ZN1 and ZN2, respectively. We further analyzed the inhibitory effects of ZN1 and ZN2 on quorum sensing (QS) and biofilm formation in Pseudomonas aeruginosa (PAO1) and Chromobacterium violaceum (strains 12472 and CVO26). The size of the synthesized ZNs was in the range of 40-130 nm, and finer nanoparticles were synthesized after an incubation period of 6 weeks. Treatment with ZNs decreased the production of violacein in the pathogen without affecting the bacterial growth, which indicated that ZNs inhibited the QS signaling regulated by N-acyl homoserine lactone. ZN2 had a higher inhibitory action on the virulence factor productivity than ZN1. Furthermore, ZN2-treated cells displayed a substantial decrease in azocasein-degrading protease activity (80%), elastase activity (83%), and pyocyanin production (85%) relative to untreated P. aeruginosa PAO1 cells. Treatment with ZN2 decreased swarming motility and exopolysaccharide production by 89 and 85%, respectively. ZN2 was effective against both the las & pqs systems of P. aeruginosa and exhibited broad-spectrum activity. Additionally, ZN2 was more efficient in inhibiting the biofilm formation at the attachment stage than ZN1. These findings revealed that in P. aeruginosa, ZN2 demonstrated inhibitory effects on QS as well as on the development of biofilms. Thus, ZN2 can be potentially used to treat drug-resistant P. aeruginosa infections.

Assessment of Indications and Complications of Caesarean Section in A Private Medical College Hospital of Bangladesh.

Caesarean section (CS) is the most frequently performed major operation in obstetrics. Its frequency is gradually increasing because of extended indications. Now-a-days, caesarean section is also being performed at patient's request in absence of a medical indication. It is necessary to assess the risk and benefits to take a judicious decision to select cases for caesarean section. The cross sectional descriptive type of observational study was carried out among purposively selected 100 pregnant women admitted to the department of Obstetrics and Gynaecology of Community Based Medical College Hospital, Mymensingh, Bangladesh during the period of August 2011 to January 2012 to identify elective and emergency indications of caesarean section, to identify the common complications to identify the risk factors associated with complications and to establish a comparison between complications of elective and emergency caesarean section. The median age group of patients being operated was 20 to 25 years and operation were carried out on patients due to various indications. Principal indications were faetal distress (26%), PROM (15%), failed progress of labour and breech presentation were 8% each, other indications were eclampsia (4%), obstructed labour (5%), scar tenderness (4%), history of previous 2 caesarian section 5%. The rate of elective caesarean section was 21% while emergency operations were done in 79% of cases. Among the 100 patients 19% patients developed complications. Among the complications wound infection was most common (37%), then post partum haemorrhage and urinary tract infection 26% and 11% respectively. Other complications were abdominal distension, Puerperal sepsis, anaemic heart failure, wound dehiscence and Wound haematoma 5% each. We should try to keep the rate of caesarean section within optimum ranges (10%) as recommended by World Health Organization.

Seasonal Pattern of Pathogenic V. cholerae and V. paraheamolyticus in Surface Water of Dhaka, Bangladesh.

V. cholerae and V. parahaemolyticus are responsible for majority of the Vibrio-related infections world wide. In this observational study, we selected three important river and pondsites of Dhaka city, Bangladesh to observe the presence of pathogenic V. cholerae, and V. parahaemolyticus. Surface water samples were collected from July 2013 to April 2014. Identification of V. cholerae was confirmed by the presence of ompW gene by PCR. Vibrio cholerae was found in the unique dual peak (March to May and September to November) patternin Mirpur-1 Mazar pond and Abdullahpur bridge river site, like many other studies reported earlier in Dhaka with only one exception of finding V. cholerae in the month of July 2013 in Mirpur-1 Mazar pond. A single peak was found from September to November in Mirpur-1 river sites. The ctxB positive non- O1 V. cholerae has also been reported. The presence of ctxB gene was observed by MAMA PCR. The O1 and O139 serogroups were confirmed by O1rfb and O139 rfb genes in PCR. Both classical and El-Tor biotypes were observed in this one year round study. V. paraheamolyticus was confirmed by the presence of ToxRVP gene and all the strains were negative for tdh pathogenic gene by PCR. This study observed for the first time the seasonal pattern of V. parahaemolyticus in water bodies in Bangladesh showing a peak from February to April in all three sampling sites and another additional peak which span from August to September in Mirpur-1 Mazar pond, Dhaka, Bangladesh.

Stress Hyperglycemia and Stroke Outcome in Patients with Acute Stroke.

Stroke is leading cause of death world wide, after coronary artery disease and cancer. A high proportion of patients suffering from an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. An observational comparative study was carried out at the Department of Neurology and Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from July 2011 to June 2013 among purposively selected ninety-three patients with a view to assess the outcome of stress hyperglycemia on acute stroke. Data were collected through interview, physical examinations & laboratory investigations by using case record form. Statistical analysis was performed using SPSS (Statistical package for social science) version 17. The mean age of this study was 59.04±15.01 years in the hyperglycemic group and 62.06±13.81 years in the normoglycemic group. The male female ratio in the Hyperglycemic and normoglycemic group was 2.12:1 and 2.44:1 respectively. Smoker was 48.8% in the hyperglycemic group and 52% in the normoglycemic group. 70% of the Hyperglycemic group and 66% of the normoglycemic were found hypertensive. Mean±SD blood glucose level was found 11.86±0.58mmol/L in the Hyperglycemic group and 6.50±1.55mmol/L in the normoglycemic group. Mean HbAlc were 6.14±0.56 in hyperglycemic group and 5.29±0.54 in normoglycemic group. Stroke severity score were 21.79±11.85 in Hyperglycemic and 28.64±9.53 in normoglycemic group on admission. Functional outcome was measured on discharge & at the end of 4th weeks of every patient by Glasgo Outcome Scale (GOS). The study also suggests that stress hyperglycemia is an important risk factor of poor stroke outcome.

Prevalence of GERD in Type II Diabetes Mellitus Patients Admitted in A Tertiary Care Hospital of Bangladesh.

Gastroesophageal reflux disease (GERD) is defined as symptoms or complications associated with regurgitation from the stomach and/or the duodenum to the esophagus. Patients with type II diabetes mellitus (DM) were known to have higher prevalence of GERD in the Western countries, but data on the impact of GERD on DM patients in our country are scarce. The aim of this cross-sectional study was to evaluate the presence of GERD in type II DM patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2015 to September 2015. A total of 137 type II DM cases were purposively collected. Reflux Disease Questionnaire (RDQ) was used to check the presence of GERD. Patient's characteristics, laboratory data, face-to-face interview data were analyzed. Out of 137 type 2 DM patients 108 were suffering from GERD giving a prevalence rate of 78.8% which is quite high. Pathophysiological factors like age, sex, duration of DM, weight, waist circumference (WC) had no significant difference between GERD-DM and non-GERD-type II DM patients. Only hypertension and frequent eating fatty food were found to have significant differences between the two groups. From the study findings it could be said that the higher rate of GERD in patients with type II DM may be associated with lifestyle factor and some pathophysiological factors like hypertension. Psychiatric factors may also play role in contributing GERD. Further in-depth and large scale studies are necessary in our country in this regard.

High Wall Motion Score Index after Acute Myocardial Infarction is Associated with Worse In-Hospital Outcome.

Myocardial Infarction is a major cause of death and disability worldwide. The incidence of coronary heart disease is high and second most cause of death after cancer. This prospective study conducted on 100 patients admitted with first attack of acute myocardial infarction in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013 who were observed 3 to 8 days of hospital stay without doing further echocardiography and evaluated the relationship between echocardiographic wall motion score index (WMSI) assessed within 24 hours of admission and in-hospital outcomes. Mean age was 53.24±10.17 years in WMSI <2 and 55.58±12.68 years in WMSI ≥2 groups; difference was statistically non-significant (p>0.05). In both groups, males were predominant sufferer. Male-female ratio was 3.55:1 and the difference was statistically non-significant (p>0.05). As a risk factor, smoking was significantly higher in both groups but the difference was not statistically significant (p>0.05) between groups. Hypertension was 34(49.28%) cases in WMSI <2 and 13(41.93%) cases in WMSI ≥2 group; difference was not statistically significant (p>0.05). Diabetes mellitus was 13(18.84%) cases in WMSI <2 and 16(51.61%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Dyslipidemia was 28(40.58%) cases in WMSI <2 group and 23(74.19%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Site of involvement of MI in WMSI <2 group were 39(56.52%) cases AMI (Anterior) and 30(43.48%) cases AMI (Inferior). In WMSI ≥2 group, AMI (Anterior) were 29(93.55%) and AMI (Inferior) were 02(6.45%). It revealed that AMI (anterior) was significantly higher in WMSI ≥2 group and AMI (Inferior) was significantly higher in WMSI <2 group. Heart failure class (Killip class) increases with the increasing of WMSI. In Killip class-I, 4(5.80%) were WMSI <2 and 01(3.23%) was WMSI ≥2 (p>0.05). In Killip class-II, 8(11.59%) were WMSI <2 and 02(6.45%) were WMSI ≥2 (p>0.05). In Killip class-III, 4(5.80%) were WMSI <2 and 13(41.94%) were WMSI ≥2 (p<0.05). In Killip class-IV, 2(2.89%) were WMSI <2 and 05(16.13%) were WMSI ≥2 (p<0.05) that was statistically significant. Arrhythmia was 14(20.29%) cases in WMSI <2 group and 13(41.94%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Death was 2(2.90%) cases in WMSI <2 and 07(22.58%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Early mortality rate was greater in patients with both WMSI ≥2 and a higher Killip's class. The higher the WMSI determined within 24 hours of admission, the worse the in-hospital outcome. Echocardiography is an affordable and readily available technique, which may be used to identify and stratify the risk following acute MI.

Clinico-biochemical Profile of Women with Hyperemesis Gravidarum Admitted in a Tertiary Hospital.

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy with poor pregnancy outcome. Hormonal changes, psychological and immunological factors are attributed to the condition. Recently, prevalence of Helicobacter pylori among women with Hyperemesis gravidarum has been revealed. A descriptive, cross-sectional study was carried out at antenatal ward, Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Mymensingh among thirty-six purposively selected patients with Hyperemesis gravidarum to assess the clinic-biochemical profile. Data were collected through interview, physical examinations and laboratory investigations by using case record form. Statistical analyses were performed using SPSS version 20.0 for windows. Highest number 16(44.44%) of respondents were in age group 20 to 24 years with a mean of 23.81±4.55 years. Majority 29(80.56%) of the women had education less than 12 years, as many as 28(77.78%) women were housewives, and at least 14(38.89%) women had unplanned pregnancies. An overwhelming majority 29(80.56%) of women had their pregnancy duration between 8 to 12 weeks. At least 20(55.56%) of women were pregnant for first time, as many as 19(52.78%) women had duration of illness for 5 to 9 weeks, and all the women had remarkable weight loss. Cent per cent women were dehydrated, and appearance of 27(75.00%) women was ill-looking. Thyroid Stimulating Hormone (TSH), total leucocyte count and serum creatinine levels were normal for cent per cent women. As many as 15(41.67%) women had hypokalaemia, while 13(36.11%) had hyponatraemia and 3(8.33%) had hypochloraemia. Patient with Hyperemesis gravidarum often presents with ill-looking appearance, vomiting over 10 times a day, dehydration, remarkable loss of body weight and anaemia. Ketonuria, hyponatraemia, hypokalaemia and hypochloraemia are not associated with severity of illness.

Molecular characterization of extended spectrum ßlactamase producing bacteria isolated from urinary tract infected patients, Bangladesh.

The aims of the study were to examine the presence of extended spectrum ßlactamase (ESBL) producing pathogen in urinary tract infected (UTI) patients and their respected molecular characterization and classification. The isolates collected from UTI patients attending a private hospital during the period between January and June, 2012, were biochemically identified and subjected to double disc synergy method for the detection of ESBL. ESBL genes were detected by multiplex PCR and antibiotic sensitivity test was performed. Thirty two percent of all Gram negative isolates were found as ESBL producer. Among 65 ESBL positive isolates, 77% were Escherichia coli, 20% Klebsiella pneumoniae and 3% were Pseudomonas spp. Around 48% isolates were found carrying at least one of the four ESBL genes, blaCTX-M, blaTEM, blaSHV and blaOXA, and were found in 32%, 23%, 18.5% and 3% of the isolates respectively. In antibiotic sensitivity assay, higher resistance was found in E. coli than K. pneumonia against ciprofloxacin and nalidixic acid. Interestingly, two E. coli and three K. pneumonia strains were found resistant to only 3rd generation cephalosporines, but susceptible to all other antibiotics assessed. One E. coli strain was found resistant to ciprofloxacin but sensitive to nalidixic acid. Pseudomonas spp. was found resistant to most of the antibiotics. The susceptible rate to nitrofurantoin, amikacin, and gentamicin was also not satisfactory. Susceptibility (100%) to meropenem and imipenem render these as good alternatives to treat UTI. The majority of the isolates were positive for blaCTX-M and adverted to molecular class A. Two strains carrying blaOXA gene along with blaSHV/blaTEM/blaCTX-M, could not be included in any of the established ESBL classification.

Serum Zinc, Copper, Magnesium & Phosphorus Level in Children with Severe Acute Malnutrition (SAM).

Malnutrition is widely prevalent among hospitalized children in most developing countries including Bangladesh. Though malnutrition accounts for the high rate of under 5 mortality sometimes it is overlooked. Keeping in this in mind A comparative cross sectional study was done in Mymensingh Medical College Hospital from 1st October 2009 to 31st May 2011. Children aged 1-5 years with presence of one or more criteria WHM <70%, WHZ-score <-3SD, Bipedal edema & Mid upper arm circumference <110mm were taken as study group and children aged 1-5 years with normal growth allowable normal range of variation is between 3rd and 97th centile curve or median (50th centile) ±2SD of weight for age growth chart (CDC growth chart, USA, 2000) were taken as reference group. Persistent diarrhea, Patients taking medications containing zinc, copper, magnesium, phosphorus & calcium, PEM with shock were excluded from study group. Nutritional assessment was done according to WHO criteria of SAM. Serum Zinc, Copper Magnesium and Phosphorus level were determined by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer, model no. 969, Spain. Total 120 study populations were taken. Ninety Out of 120 were taken as a study group (SAM) & 30 were reference group. In reference group serum Zn, Cu, Mg, P value was 103.80±8.86µg/dl, 135.92±13.57µg/dl, 2.31±0.18mg/dl, 3.96±0.22mg/dl respectively. In study group serum Zn, Cu, Mg, P value was 60.33±11.08µg/dl, 80.60±15.46µg/dl, 1.47±0.22mg/dl, 2.00±0.52mg/dl respectively. All these results show that there is significant difference between study group & reference group. Considering the decreased level of these parameters, close biochemical monitoring and follow up should be emphasized for the children with SAM.

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.

Sol-gel synthesis of thorn-like ZnO nanoparticles endorsing mechanical stirring effect and their antimicrobial activities: Potential role as nano-antibiotics.

The effect of mechanical stirring on sol-gel synthesis of thorn-like ZnO nanoparticles (ZnO-NPs) and antimicrobial activities is successfully reported in this study. The in-house synthesized nanoparticles were characterized by XRD, SEM, TEM, FTIR, TGA, DSC and UV-visible spectroscopy. The X-Ray Diffraction analysis revealed the wurtzite crystal lattice for ZnO-NPs with no impurities present. The diametric measurements of the synthesized thorn-like ZnO-NPs (morphology assessed by SEM) were well accounted to be less than 50 nm with the help of TEM. Relative decrease in aspect ratio was observed on increasing the agitation speed. The UV-visible spectroscopy showed the absorption peaks of the ZnO-NPs existed in both UVA and UVB region. A hypsochromic shift in λmax was observed when stirring pace was increased from 500 rpm to 2000 rpm. The FTIR spectroscopy showed the absorption bands of the stretching modes of Zn-O between 500 cm(-1) to 525 cm(-1). The Thermal analysis studies revealed better stability for ZnO-NPs prepared at 2000 rpm (ZnO-2000 rpm). TGA revealed the weight loss between two main temperatures ranges viz. around (90 °C-120 °C) and (240 °C-280 °C). Finally, the effect of ZnO-NPs prepared at different stirring conditions on the growth of Gram-positive (Bacillus subtilis), Gram-negative (Escherichia coli) bacteria and a fungi (Candida albicans) were examined; which showed good antibacterial as well as antifungal properties. These findings introduce a simple, inexpensive process to synthesize ZnO-NPs using conventional methods without the use of sophisticated equipments and its application as a potent nano-antibiotic.

Flower-shaped ZnO nanoparticles synthesized by a novel approach at near-room temperatures with antibacterial and antifungal properties.

Due to enormous applications of metal oxide nanoparticles in research and health-related applications, metal oxide nanoparticles are increasingly being developed through cheaper and more user-friendly approaches. We have formulated a simple route to synthesize zinc oxide nanoparticles (ZNPs) by a sol-gel method at near-room temperatures 25°C, 35°C, 55°C, and 75°C. The results are analyzed by X-ray diffraction, scanning electron microscopy with energy-dispersive X-ray spectroscopy, and ultraviolet-visible absorption spectroscopy. The effect of different temperature conditions (25°C-75°C) on the particulate sizes (23.7-88.8 nm), pH levels (11.7-11.9), and morphologies (slender needle-broad arrow) of flower-shaped ZNP colonies is studied. A possible mechanism depicting the growth rates at different temperatures and of different facets, mainly towards the <0 0 0 I> and <0 I I 0> planes of the ZNPs has also been discussed. The values of λmax (293-298 nm) suggest that ZNPs prepared at 55°C are the most effective ultraviolet B absorbers, and that they can be used in sunscreens. Highly significant antimicrobial activity against medically important Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria and fungi (Candida albicans) by these ZNPs was also revealed. As S. aureus and C. albicans are responsible for many contagious dermal infections such as abscesses, furuncles, carbuncles, cellulitis, and candidiasis, we can postulate that our fabricated ZNPs may be useful as antimicrobial agents in antiseptic creams and lotions for the treatment of skin diseases.

Guillian-Barre syndrome.

Guillian-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis. All age groups can be affected, more common in elderly. Campylobacter jejuni, a major cause of bacterial gastroenteritis worldwide has become recognized as a most frequent antecedent pathogen for GBS. A prospective case-controlled study showed, positive C. Jejuni serology was found in an unprecedented high frequency of 57% as compared to 8% in family controls and 3% in control patients with other neurological diseases. In GBS there is molecular mimicry between epitops found in the cell walls of some micro-organisms and gangliosides in schwann cell membrane. Diagnosis is mainly clinical. The mainstay of treatment of GBS is supportive care and prevention of complications. Respiratory failure and autonomic dysfunction are the common causes of death from GBS. Plasma exchange and intravenous immunoglobulin therapy shorten the duration of ventilation and improve prognosis. Overall, prognosis of GBS is good. Eighty percent of patients recover completely within 3-6 months, 4% die, and the remainder suffers residual neurological disability. GBS may be prevented by development of a vaccine against C. Jejuni. Early and specific diagnosis is important to ensure a favourable outcome.

Seroprevalence of Hepatitis B, Hepatitis C, HIV Infections in Blood Donors of Khulna, Bangladesh.

To determine changes (Trends) in infection rates of Hepatitis B surface antigen (HBsAg), Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV) in blood donors of Khulna Population. Specimens of 34953 voluntary blood donors & party or relative donors in Transfusion Medicine Department of Khulna Medical College Hospital from 2007 to 2009 were screened for HBsAg, anti-HCV, anti-HIV 1 & 2 reactivity in a cross-sectional survey by rapid test method. Reactive samples were verified using a recognized confirmatory test which consisted of a second generation enzyme immune assay (HBsAg), anti-HCV antibodies by anti-HCV EIA & for HIV by western Blot, respectively. The seroprevalence of HBsAg, Anti-HCV, HIV antibody 1 & 2 was 1.4%, 0.09% & 0.03% respectively in all blood donors. Prevalence of confirmed positivity was 0.62% for HBsAg, 0.04 % for Anti-HCV, 0.02% for HIV Western Blot. Between 2007 to 2009 a decreasing trend was observed in HBsAg frequency, HCV frequency decreased in 2009 compared to 2007. One HIV positivity found in 2009. Although the frequency of transfusion transmitted infections is low, party or relative donors have some risk factors than voluntary blood donors. Through more scrutiny in donor selection, improved serological test & reevaluation of infections routes in donor, infection reduction can be achieved.

Aspects of infection in intensive care unit--prevention and control.

Nosocomial infections are the main source of infection in a hospitalized patient. Source of contaminant may be multiple. In a cardiac ICU the vulnerable open heart surgery patients are with multiple invasive lines and monitors. Pediatrics and neonates are more vulnerable because of their poor immunity and nutritional debility. Frequent indwelling line access makes a patient more prone to systemic infection with variable organisms. Our aim is to minimize the chances of hospital acquired infection as far as possible by the use of systemic approach to the patients as guided by the international standard hospital protocol.

Serum triglyceride level in IUGR babies and its comparison with preterm AGA and term normal babies.

Intrauterine growth and birth weight are probably the most important factors that affect in survival and future quality of life. Intrauterine growth retardation causes program changes in body systems specially lipid metabolism that creates various problems of which coronary heart disease is important. Higher serum triglyceride (TG) level in IUGR babies relates to increase incidence of coronary heart disease. This cross sectional study was conducted in Bhangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during July 2004 to June 2005. Serum TG levels were estimated among three groups: IUGR (n=30), preterm appropriate for gestational age (AGA) (n=30) and term normal (n=30) new born babies. Blood samples were collected from the study population in the neonatal unit and serum TG level were measured with all accuracy in a computerized automated biochemical analyzer in Biochemistry department of BSMMU. Statistical analysis were done by using student's 't' test. It was observed that serum TG level (54.4 +/- 11.2 mg/dl) in IUGR babies were significantly higher than that of term normal babies (38.7 +/- 5.8 mg/dl), p value < 0.05. This implicate future coronary heart disease in these babies as shown by others in long term prospective studies.

Pattern of change of weight following birth in the early neonatal period.

Birth weight of new born will vary according to gestational age, maternal, Placental and foetal intrauterine conditions. Postnatal weight change in the first few days of life (early neonatal period) may vary according to gestational age and birth weight. This may create problem in management of these babies. Birth weight and their pattern of change were followed on 105 newborns. Questionnaire and observation charts were the research Instruments and statistical analysis were done by using manual calculator. It was observed that full term newborns had better control on initial weight change following birth than preterm and low birth weight babies. Majority of term newborns loss their weight up to 5 days of life and regained their initial weight by 10 days. Maximum weight loss for longer duration occurred in preterm and very low birth weight babies who regained their initial weight by 10 - 14 days and some required more than 21 days.

Factors associated with delivery complications in rural Bangladesh.

OBJECTIVES: There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. METHODS: A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. RESULTS AND CONCLUSIONS: It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.

Obstetric deaths in Bangladesh, 1996-1997.

OBJECTIVES: The purpose of this study was to measure and to describe obstetric deaths in Bangladesh. METHODS: We reviewed hospital records and interviewed health workers in clinic sites and field workers who cared for pregnant women. RESULTS: We obtained case reports of 28998 deaths of women aged 10-50, of which 8562 (29.5%) were maternal deaths. Most (7086, 82.8%) of these deaths were due to obstetric causes. The most common causes of direct obstetric death were eclampsia (34.3%), hemorrhage (27.9%), and obstructed and/or prolonged labor (11.3%). National direct obstetric death rate was estimated to be 16.9 per 100,000 women. CONCLUSIONS: Efforts to reduce fertility in Bangladesh have led to an estimated 49% reduction in the maternal mortality rate per 1000 women during the past 18 years. Variations in maternal mortality suggest the need to develop local strategies to improve obstetric care.

The differentials and determinants of perinatal mortality in rural Bangladesh.

OBJECTIVE: In Bangladesh, the perinatal mortality is very high. This study examined the differentials and determinants of perinatal mortality in rural Bangladesh. METHODS: The study was based on the prospective data on maternal morbidity collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). This prospective study was conducted during the period November 1992 to December 1993. In this study, the factors associated with perinatal deaths were examined, employing differential and multivariate analyses. RESULTS: It was found that assisted delivery caused higher risks of stillbirth and death among live births during the first week of life. It was also observed that five or more pregnancies, prior to the index pregnancy, were positively associated with perinatal death. CONCLUSION: If the delivery is assisted or there are complications in delivery, then it is likely that the incidence of perinatal mortality will increase sharply. If the newborn baby was given colostrum, then perinatal mortality decreased to a great extent.