Clinical Profile and Outcome of Organophosphorus Poisoning in a Tertiary Hospital.

Organophosphorus compound (OPC) poisoning is common in Bangladesh. The toxicity of the agent and paucity of appropriate medical services has resulted in high mortality rates. To find out the clinical profile and outcome of OPC poisoning patients is the main aim of my study. This descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from September 2016 to November 2018. In this study, mean age of the study subjects was 25.90±11.24 years. Males (70.8%) were predominant than female (29.2%). In this study, most of the poisoning was done by ingestion (98.3%) and only two (1.7%) by inhalation. Regarding features, most muscarinic effect was constricted pupil and bronchospasm (65.0%). Common nicotinic effect was fasciculation (25.0%) and central effect was headache (61.67%). Mean amount of OPC ingestion was 26.30±17.24 ml in this study. Regarding circumstances of poisoning, familial disharmony (38.3%) and quarrel with other family members (37.5%) were the major reason followed by failure of personal affairs (15.0%) and other reasons (9.2%). Regarding complications, aspiration pneumonia was found in 6.7% cases, cardiac arrhythmia was in 6.7% cases and intermediate syndrome was in 1.7% cases. Most of the study subjects (95.0%) recovered fully. Most of the patients were from rural area. Suicidal was the common motive and familial disharmony and quarrel with other family members are the common circumstances of poisoning. Mortality rate was 5.0%.

Serum Electrolyte Status of Patients with Acute Stroke Admitted in a Tertiary Care Hospital.

Stroke, usually a focal rather than global neurological deficit resulting from vascular origin with sudden onset, may be with cerebral infarction or intracerebral haemorrhage. It results in brain oedema following vascular injury and electrolyte imbalance. A descriptive cross sectional study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during March 2016 to May 2018 to assess the electrolyte levels among 220 purposively selected patients with stroke confirmed by CT scan. Data were collected by the principal investigator himself by using interview schedule and case record form after attaining consent. Blood samples were collected from the patients to carry out biochemical and haematological tests and to assess serum electrolyte levels. Data were cross-checked for completeness, consistency and relevancy, and were analyzed by computer software SPSS 20.0. Age was significantly higher in haemorrhagic stroke (64.88±13.00 years) than ischaemic stroke (60.92±13.96 years). Male (55.91%) were predominant than female (44.09%). One hundred nineteen (54.09%) patients had ischaemic stroke and 101(45.91%) patients had haemorrhagic stroke. The serum concentration of Na+, K+, Cl- and HCO3- were measured during acute period of stroke. Imbalance in serum Sodium, Chloride, Potassium and Bicarbonate level were observed in 37.27%, 29.55%, 23.18% and 6.36% patients respectively. Hyponatremia, hypokalemia, hypochloremia and acidosis were most common electrolyte imbalance in both ischaemic and haemorrhagic strokes. In ischaemic stroke hyponatremia was 35.29%, hypernatremia was 3.36%, hypokalemia 19.33%, hyperkalemia 0.84%, hypochloraemia 30.25%, hyperchloraemia 3.36%, acidosis was in 6.72% and alkalosdis in 1.68% patients while in haemorrhagic stroke hyponatremia 33.66%, hypernatremia 1.98%, hypokalaemia 22.77% hyperkalemia 3.96%, hypochloremia 19.80%, hyperchloraemia 4.95%, acidosis 2.97% and alkalosis was in 0.99% of patients. Mortality was more in hyponatremic, hypokalemic and in hypochloremic patients.

A Study on Clinical Presentation and Histological Diagnosis of Lymphadenopathy Patients Admitted In Department of Medicine in A Tertiary Hospital.

Lymphadenopathy is a common problem encountered in day to day clinical practices in Bangladesh. It is an abnormal increase in size and/or altered consistency of lymph nodes. The condition generally is not a disease itself but a symptom of one of many possible underlying problems. So it is very much essential to achieve a correct diagnosis of patients presenting with lymphadenopathy. This cross sectional study carried out at the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh over a period of 6 months from January 2014 to June 2014. This study was carried out to evaluate the clinical presentations and to see the ultimate diagnosis by appropriate investigations of lymphadenopathy patients. It is a male predominance study. Metastatic carcinoma (Met. Ca) belonged to relatively higher age group, tuberculosis (TB) and acute leukaemias belonged to younger age group and lymphoma belonged to middle age group. Among 50 cases metastatic carcinoma comprises total 14(28%), lymphoma 13(26%), tuberculosis (TB) 12(24%), acute leukaemia 7(14%), non-specific (Non Sp.) 4(8%) cases. Among lymphoma non Hodgkin's lymphoma (NHL) was 10 (20%) then Hodgkin's disease (HD) was 3(6%) and among acute leukaemia acute lymphoblastic leukaemia (ALL) was 5(10%) and acute myeloblastic leukaemia (AML) was 2(4%) cases. Most of the patients belong to younger age groups, 32% cases were from 18-30 years. Most of the patients had generalized lymphadenopathy. Biopsy of lymph node was done in 60% cases. Fine needle aspiration cytology (FNAC) was done in 24% cases. Bone marrow study (BMD) was done in 14% cases include all cases of leukemia. Among 50 patients correct clinical diagnosis were found 100% cases of ALL and non-specific infection, 80% cases of metastatic carcinoma, 66.66% cases of AML and NHL, 62.5% cases of TB, 50% cases of HD. AML and ALL were diagnosed by bone marrow study. Over all 70% of clinical diagnosis were found correct in this study. In conclusion malignancy, lymphoma and tuberculosis were the most common cause of lymphadenopathy patients. Most of the cases were diagnosed by taking appropriate history and examination but FNAC, biopsy and bone marrow study were need for final diagnosis.

Detection of Quinolone Resistance Pattern and Presence of qnr Genes in Human Salmonella Isolates at Mymensingh, Bangladesh.

Among the quinolones, fluoroquinolones are broad spectrum antimicrobial agents used for treating many clinical infections including Salmonellosis. Although high level of resistance to fluoroquinolones remains low in Salmonella but reduced susceptibility is increasing worldwide. Plasmid-mediated quinolone resistance (PMQR) of qnr type (qnrA, B and S) has been identified now a day in several enterobacterial species including Salmonella spp. This cross-sectional study was held at department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from March 2019 to February 2020. This study was conducted to determine the current quinolone resistance pattern and to detect the presence of qnrA, qnrB and qnrS genes among Salmonella isolates. Antimicrobial susceptibility test of 36 Salmonella isolates were done by disc diffusion method. MIC of ciprofloxacin was detected by agar dilution method. Then amplification with specific primers of qnrA, qnrB and qnrS genes were performed for all Salmonella isolates. The present study observed 80.5% resistance to nalidixic acid, 33.3% to ciprofloxacin and 19.4% to ofloxacin by disc diffusion method. qnr A gene was detected in 2(5.5%) isolates, where as qnrS was detected in 5 (13.8%) isolates. None of the isolates was positive for qnrB gene. All the qnrA positive isolates showed resistance to Ciprofloxacin (MIC=128µg/ml) and Ofloxacin. In conclusion, presence of qnr genes in the study isolates is alarming, because, rapid dissemination might occur due to conjugative plasmid mediated horizontal transfer.

Early and Rapid Detection of Typhoid Fever by Nested PCR in Blood.

Typhoid fever caused by Salmonella typhi is one of the major health problems in developing countries including Bangladesh. Still now blood culture is gold standard method for diagnosing typhoid fever, but this method is laborious, requires several days and detection rate is low. Failure of early laboratory diagnosis often leads to increased morbidity and mortality. This study was intended to apply a nested PCR in blood for early diagnosis of typhoid fever. In this cross sectional study blood samples were collected from 200 suspected typhoid fever patients attending Mymensingh Medical College Hospital, Bangladesh. Nested Polymerase Chain Reaction (n PCR) of flagellin gene was done in all the blood samples. At the same time all blood samples were subjected to culture by lytic centrifugation method. Culture positive isolates were identified as S. typhi by biochemical tests. Among the 200 blood samples, 57 (28.5%) were positive for S. typhi on nested PCR where as blood culture was positive for S. typhi in 16 (8%) samples. Among the 57 PCR positive samples, only 15 (26.3%) samples were culture positive for S. typhi and rest 42 (73.7%) were culture negative. So, in culture negative cases PCR can be used as a rapid diagnostic test for diagnosing typhoid fever. Considering time requirement, PCR takes one day, whereas blood culture takes 3 or more days to confirm diagnosis.

Detection of Antimicrobial Resistance Pattern and ESBL Production among Clinical Isolates of Salmonella Species in Mymensingh, Bangladesh.

The occurrence of antimicrobial resistance in Salmonella enterica serovars (both typhoidal and non-typhoidal Salmonellae) is a major public health problem especially in developing countries, which have been associated with treatment failures. Therefore, the study was undertaken to determine the current antimicrobial resistance pattern and extended spectrum ß-lactamase (ESBL) production among clinical isolates of Salmonella spp. during 2019-2020 in Mymensingh, Bangladesh. In this cross sectional study, 36 Salmonella enterica isolates were obtained from blood and stool culture of suspected 200 enteric fever and 100 gastroenteritis patients attending at Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Isolated Salmonella species were identified by biochemical tests and Polymerase Chain Reaction (PCR). Disk diffusion test was performed by modified Kirby Bauer method. Minimum Inhibitory Concentration (MIC) of ceftriaxone was detected by agar dilution method. Double disk synergy test was used as a screening test for ESBL production. PCR was done for detection of blaTEM, blaSHV and blaCTX-MU genes. The isolates showed 25% resistance to Ceftriaxone and 58.3% to Azithromycin. The highest sensitivity rates were 88.9% to Meropenem and 83.3% to Amikacin. Whereas 6(16.7%) isolates were Multi Drug Resistant (MDR). Eight (8) isolates were confirmed as ESBL producer by DDST. The marked increase in MIC was observed between 8->512µg/ml to ceftriaxone. blaTEM, blaSHV and blaCTX-MU genes were detected in 3, 5 and 8 isolates respectively. In conclusion, the current study observed, higher level of resistance to ceftriaxone and azithromycin. At the same times 22.2% isolates showed ESBL production, which is a cause for concern as it may lead to treatment failure. On the other hand the study also showed the re-emergence of chloramphenicol and Sulfamethoxazole-Trimethoprim sensitivity.

Aetiology of Myelopathy in a Tertiary Hospital of Bangladesh.

Disease of the spinal cord is called myelopathy which are frequently devastating. They produce motor weakness in the form of quadriplegia or paraplegia, sensory impairment, with a definite anatomical level, and loss of sphincteric function far beyond the site of damage. Many spinal cord diseases are reversible if known and treated at an early stage. Purpose of this study is to evaluate clinical presentation and aetiology of myelopathic patients on the basis of history, clinical examination and investigations. Patients getting admission in indoor of Medicine, Neuromedicine and Neurosurgery units of Rajshahi Medical College Hospital, Rajshahi, Bangladesh from March 2013 to August 2013, having complains of spastic paraplegia and quadriplegia or flaccid type of paralysis with sensory level or bowel bladder disturbance. This cross-sectional descriptive study was done with total 44 myelopathic patients were evaluated. Out of 44 patients, 75% were male and 25% were female (ratio 3:1), mean age 35±13.9 years (range 13-65 years). Among them 54.5% patients had paraparesis and 45.5% patients had quadriparesis. Sensory disturbance had 70.45%, 68.18% had urinary sphincter disturbance and 22.72% had bladder sphincter disturbance. Among the aetiology of myelopathy the commonest cause was cervical spondylotic myelopathy 31.8%, second cause was acute transverse myelitis 20.5% and third cause was Pott's disease 18.2%. It was observed that majority (75%) of them had compressive type and 25% patients had non-compressive type of involvement. Myelopathy was three times more common in male than female. Cervical spondylotic myelopathy & transverse myelopathy was the main aetiology of compressive and non compressive myelopathy respectively.

Sonographically Detected Non Alcoholic Fatty Liver Disease in Apparently Healthy Adults and Associated Factors.

This hospital-based study was done to see the prevalence of sonologically detected non alcoholic fatty liver disease and associated factors in the apparently healthy adults. Apparently healthy and non alcoholic companions of the patients visiting the Centre of Nuclear Medicine and Ultrasound, Sylhet were subjected to abdominal ultrasonography to see the presence of fatty liver. Demographic features and other relevant data were collected in a semi structured questionnaire to find out the associated factors for non alcoholic fatty liver disease (NAFLD). Total 1019 persons with mean age of 37.23 years were included in the study. Among them 703 (69%) were female and 316 (31%) were male. Out of them 189 (18.5%) persons had sonologically detectable nonalcoholic fatty liver disease. NAFLD was more prevalent in male than female (25.6% vs. 15.4%, p=0.000). In univariate analysis NAFLD were more in male (25.6%) 41-50 years age group (29.3%, p=0.000), over weight (32.3%)/obese subjects (51.4%), businessmen (24.0%), service holders (28.7%), high income group, diabetics (27.0% vs. 18.0%, p=0.000) and hypertensive subjects (43.3% vs. 15.24%, p=0.000). In multivariate analysis, BMI over 23kg/m² (OR 6.683, p=0.000), age >30 years (OR 1.787, p=0.006) and higher income (OR 1.788, 95% CI 0.970-3.293) were independent factors associated with NAFLD. Sonologically detected nonalcoholic fatty liver disease (18.5%) is common in our apparently healthy adults. BMI over 23kg/m² was the most important predictor for NAFLD.