Psychiatric Morbidity in Irritable Bowel Syndrome.

Psychiatric morbidity is frequent among outpatients with Irritable Bowel Syndrome (IBS) attending gastroenterology clinics. The lifetime prevalence of major depressive and anxiety disorders in IBS patients are up to 76% and 54% respectively. The point prevalence of Major depressive disorder and Anxiety disorders in IBS patients are ranged 9.6 to 54% and from 11.1 to 52.4% respectively. IBS is not usually life-threatening but it has a significant impact on quality of life. So, screening for psychiatric disorders in IBS patients attending Gastroenterology clinics is worthwhile. The objective of this study was to evaluate psychiatric morbidity among the patients with IBS. This cross sectional comparative study was conducted in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh during the period from January 2012 to June 2012. Inclusion criteria were patients of irritable bowel syndrome fulfilling the Rome-III criteria, age between 18 to 60 years irrespective of sex. Patients with any red flag sign, serious cognitive impairment such as dementia, schizophrenia, mania, delusional disorder, prior history of abdominal surgery and other chronic diseases were excluded. One hundred and ten patients with IBS were selected according to inclusion and exclusion criteria and categorized as IBS group. Another 110 age and sex matched subjects were selected as control group. The mean±SD age of the patients was 34.3±12.2 years which was almost identical to control group (p=0.820). Most of the patients (66.4%) were below the age of 40 years. There were 64 (58.2%) male and 46 (41.8%) female which was similar to control group (p=0.643). Psychiatric co-morbidity was most frequent in IBS patients (56.4%) as compared to control group (16.4%) p value <0.001. The most common psychiatric disorders were Anxiety disorders (22.7%), followed by major depressive disorder (19.1%) and somatization disorder (14.5%). The results of this study suggest that a significant number of patients with IBS suffer from psychiatric disorders than control, which are similar to the IBS group in age and gender.

Prevalence of Microalbuminuria and Overt Proteinuria in Diabetes Mellitus and their Association with Renal Function.

This cross sectional observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2009 to March 2010. Samples were collectedfrom rural area of Khalishaur union of Purbadhala upazilla in Netrakona District, 30km away from Mymensingh Town. The main objective of the study was to find out the prevalence of microalbuminuria as well as overt proteinuria in diabetes mellitus in a rural population and to observe their association with renal function. In this study 1048 adult participants of 18 to 65 years in a rural area of Netrakona were included purposively as study subjects. Among them 54% were male and 46% were female. Mean age of study subjects was 42.4±13.4 years. Prevalence of microalbuminuria among diabetic participants was 29.72% where as in non diabetic non hypertensive participants it was 6.62%. Diabetic persons 9.45% and 3.9% of non diabetic participants showed overt proteinuria by dipstick test. Prevalence of hypertension in diabetic and non diabetic participants was 45.94% and 16.52% respectively. The mean eCCr of the diabetic patients and non-microalbuminuric healthy persons was 78.4±25.4 ml/min/1.73m² and 94.67±24.8 ml/min/l.73m² respectively according to Cock Croft-Gault equation. The mean eCCr of diabetic participants with overt proteinuria was 57.44±28.33 ml/min/l.73m² but diabetic patients with microalbuminuria had better mean eCCr 80.62±21.17 ml/min/1.73m² which justifies the importance of detection of microalbuminuria for early intervention. By regression analysis it was found that degree of microalbuminuria had linear relation with renal function and random blood sugar level. Neither BMI nor duration of diabetes showed any correlation with urine microalbumin. There was no effect of sex on the prevalence of microalbuminuria in diabetes mellitus. Microalbuminuria is the first sign of renal involvement in diabetic patients which is a risk factor for overt nephropathy. Monitoring of this condition is important because early treatment of microalbuminuria can prevent or postpone overt nephropathy.

Acute Kidney Injury in Patients with Acute Viral Hepatitis: A Study in a Tertiary Care Hospital.

This cross sectional observational study was done in the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2013 to April 2014 to find out the proportion of acute kidney injury among patients with acute viral hepatitis and to identify risk factors associated with development of acute kidney injury (AKI). A total of 100 patients with acute viral hepatitis were included purposively as study subjects. Among them 61 were male and 39 were female. They were divided into AKI group (n=6) and non-AKI group (n=94) on the basis of development of AKI. There was no significant difference in mean age (39.0±13.1 years vs. 32.2±10.8 years, p=0.335) and sex (67% vs. 61% & 33.0% vs. 39.0%) p=0.769) between AKI group and non-AKI group. There were 27% acute viral hepatitis A, 21% acute viral hepatitis B and 52% acute viral hepatitis E but no case of acute viral hepatitis C was found in this study. Acute kidney injury (AKI) developed in 6 of 27 patients with acute viral hepatitis A. This study showed that 22.2% patients with acute viral hepatitis A developed acute kidney injury but patients with acute viral hepatitis B (HBV) and hepatitis E (HEV) did not develop acute kidney injury. Majority of the patients with acute kidney injury were smokers and hypertensive with elevated mean arterial pressure (p=0.0001) at presentation and had higher total bilirubin (p=0.0001), alanine aminotranseferase values (p=0.040), prolonged prothrombin time (INR) {p=0.0001}, lower albumin (p=0.0001), lower haematocrit level (p=0.0001), high CRP concentration (p=0.0001), leucocytosis (p=0.0001) and thrombocytopenia (p=0.0001) at presentation than patients without acute kidney injury. It is evident from the study that acute kidney injury is not a rare complication in patients with acute viral hepatitis.

Outcome of Pregnancy Related Acute Kidney Injury Observed in a Tertiary Care Hospital.

This prospective case control study was carried out in Mymensingh Medical College Hospital (MMCH) from April 2011 to March 2012. The main objective of the study was to determine the short term maternal outcome of pregnancy related Acute Kidney Injury and to identify aetiological factors and to observe clinical features of pregnancy related Acute Kidney Injury. Total 60 pregnant women with AKI were included in the study as sample and equal (60) number of pregnant women with normal renal function was taken as control. Mean ages (±SD) of study and control group were observed 31.6±6.9 years and 25.5±4.7 years respectively. It was observed that most patients were from rural area with low income group. Most women were multiparous and presented in third trimester and postpartum period. Majority of the study subjects did not receive antenatal care at any stage of pregnancy. Fifty (86.7%) of the study subjects were oligo-anuric, forty-nine (81.7%) were edematous and fifty one (85%) were anaemic. Twenty-five (41.7%) patients presented with abnormal vaginal bleeding. Sepsis (including septic abortion and puerperal sepsis) was responsible for of Pregnancy Related AKI (PR-AKI) in more than two fifths of cases. Haemorrhage (APH & PPH combined) was the next common cause of Pregnancy Related AKI (PR-AKI). Toxemia of Pregnancy was responsible in one fourth of cases. Dialysis (HD & IPD combined) was required for two fifths of the patients. Rest patients were treated conservatively with antibiotics, blood transfusion, maintenance of fluid and electrolytes balance etc. Maternal outcome of Pregnancy related acute kidney injury was considered for the period of patient's hospital staying. 56.6% patients recovered completely, 15.0% patients recovered partially, 6.7% did not recover at the time of hospital discharge; while 21.7% died. So it can be concluded that, pregnancy related acute kidney injury is a critical condition, associated with worse prognosis.

Evaluation of foot and mouth vaccination for yak (Bos grunniens) in Pakistan.

In northern Pakistan, many farming communities rely on domestic yak (Bos grunniens) as a principle source of income. A 2006 participatory disease surveillance report from this region indicated that foot-and-mouth disease (FMD) is the most prevalent annual disease of yak. Our objectives of this study were to determine exposure levels of yak to FMD virus; implement a vaccination program based on current, regional FMD virus serotypes and subtypes; and quantify immune responses following vaccination. Blood samples were used to determine pre-vaccination exposure of animals to FMD virus by antibody presence to non-structural proteins of FMD virus using a 3-ABC trapping indirect ELISA. Vaccine used consisted of FMD serotypes 'O' (PanAsia-2), 'A' (Iran-05), and 'Asia-1' (Shamir), but changed later during the study to match newly circulating viruses in the country ('O'-PanAsia-2; 'A'-Turk-06 and Asia-1-Sindh-08). Three hundred sixty-three blood samples were tested from selected villages to determine pre-vaccination FMD virus exposure in yak with an average of 37.7%. Immune responses from initial vaccination and booster dose 30 days later showed clear protective levels (as mean percent inhibition) of antibodies against structural proteins of serotypes 'O,' 'A,' and 'Asia-1.' These responses remained above threshold positive level even at day 210 following initial vaccination. Results of sero-surveillance and anecdotal information of repeated FMD outbreaks demonstrate the persistence of FMD virus of yak in northern Pakistan. Laboratory results and field observations clearly indicated that yak can be protected against FMD with a good quality vaccine with FMD serotype(s) matching current, regionally circulating FMD virus.

Serological Detection of Antibodies to Peste des Petits Ruminants Virus in Large Ruminants.

Peste des petits ruminants (PPR) is an economically important disease of small ruminants with a rapidly expanding geographical distribution. Peste des petits ruminants virus may manifest in a variety of ways with disease ranging from acute to subclinical. We investigated the exposure of large ruminants to PPRV in areas where the virus is endemic in the small ruminant population by assessing the serological status of groups of animals. This study focused on the Punjab province of Pakistan as an area where the virus is endemic and where mixed farming practices occur enabling close interactions between small and large ruminant populations. An overall PPR seropositivity was detected in 10.0% of cattle and 14.16% of buffaloes. Following an assessment of serological profiles in large ruminants within different age groups, a maximum seroprevalence was observed in cattle (17.5%) and buffaloes (22.5%) over 2 years of age indicating the potential utility of sampling large ruminant populations for PPR serosurveillance. The large ruminants sampled between one and two years of age had similar levels of seropositivity within populations with 11.2% and 16.2% of animals being seropositive, respectively. Current PPR vaccination strategies do not enable the differentiation between infected and vaccinated small ruminants, and as such, the serological surveillance of sheep and goats is of little value. When considering eradication programmes for PPRV, this factor is of great significance. However, where large and small ruminants are farmed together, serological surveillance of large ruminants may provide a snapshot of virus infection within populations where mild disease is present or where small ruminants are regularly vaccinated.

Juvenile onset ankylosing spondylitis with ankylosing tarsitis: a rare combination.

Ankylosing spondylitis is the most common whereas ankylosing tarsitis is the least common subgroup of juvenile onset spondyloarthritides. In our recent study a male presented with ankle joint pain and swelling with limited movements and characteristic radiological changes including; periarticular swelling, thickened heel pad, hyperostosis and reduced ankle, calcaneo-cuboid and talo-navicular joint space for ankylosing tarsitis. He also had persistent inflammatory low back pain with radiological sacroilitis satisfying the clinical features for ankylosing spondylitis. The patient was treated with different anti-inflammatory agents including intra-articular methyl-prednisolone with short-term relief. Associated back pain was improved with spine mobilizing exercise.

Observation of unintentionally incorporated nitrogen-related complexes in ZnO and GaN nanowires.

We report the observation of unintentionally incorporated nitrogen-related complexes in ZnO and GaN nanowires grown by the catalytic vapor-phase transport method. In particular, our experimental findings from Raman scattering spectroscopy and mass-selected time-of-flight particle emission measurements suggest the presence of interstitial nitrogen molecules that are formed during the nanowire growth. These results may be relevant for many nanowire systems, emphasizing the necessity of more studies on unintentional impurity incorporations in these nanomaterials.

Photoinduced formation of zinc nanoparticles by UV laser irradiation of ZnO.

Simple exposure of single-crystal ZnO to 193 nm excimer laser radiation at room temperature results in unexpected coloration. The gray to nearly black colored material, seen principally in the irradiated laser spot, is superficial. We present unambiguous evidence that this coloration is due to high densities of metallic Zn nanoparticles growing on the exposed surface of the crystal. Higher fluence laser exposure generates accumulated surface metal just outside of the irradiated spot. We suggest that the near surface bulk is photodecomposing; thermally driven diffusion leads to surface Zn metal aggregation.

Antimicrobial resistance in organisms causing diarrheal disease.

Antimicrobial resistance is becoming increasingly important in the treatment of enteric infections, particularly those due to Shigella, Vibrio cholerae, enterotoxigenic Escherichia coli (associated with traveler's diarrhea), and Salmonella typhi. The rate of antimicrobial resistance is highest in the developing world, where the use of antimicrobial drugs is relatively unrestricted. Of greatest immediate concern is the need for an effective, inexpensive antimicrobial that can be used safely as treatment for small children with dysentery due to Shigella, primarily Shigella dysenteriae type 1.

Randomised controlled comparison of single-dose ciprofloxacin and doxycycline for cholera caused by Vibrio cholerae 01 or 0139.

BACKGROUND: Effective antimicrobial therapy can reduce the duration and volume of cholera diarrhoea by half. However, such treatment is currently limited by Vibrio cholerae resistance to the drugs commonly prescribed for cholera, and by the difficulties involved in the administration of multi-drug doses under field conditions. Because of its favourable pharmacokinetics we thought it likely that single-dose ciprofloxacin would be effective in the treatment of cholera. METHODS: In this double-blind study treatment was either a single 1 g oral dose of ciprofloxacin plus doxycycline placebo, or a single 300 mg oral dose of doxycycline plus ciprofloxacine placebo. 130 moderately or severely dehydrated men infected with V cholerae 01 and 130 infected with V cholerae 0139 were randomly assigned treatment. Patients stayed in hospital for 5 days. We measured fluid intake and stool volume every 6 h, and a sample of stool for culture was obtained daily. The primary outcome measures were clinical success--the cessation of watery stool within 48 h; and bacteriological success--absence of V cholerae from cultures of stool after study day 2. FINDINGS: Among patients infected with V cholerae 01, treatment was clinically successful in 62 (94%) of 66 patients who received ciprofloxacin and in 47 (73%) of 64 who receive doxycycline (difference 21% [95% Cl 8-33]); the corresponding proportions with bacteriological success were 63 (95%) and 44 (69%) (27% [14-39]). Among patients infected with V cholerae 0139, treatment was clinically successful in 54 (92%) of 59 patients who received ciprofloxacin and in 65 (92%) of 71 who received doxycycline (< 1% [-9 to 9]), and bacteriologically successful in 58 (98%) and 56 (79%), respectively (19% [9-30]). Total volume of watery stool did not differ significantly between ciprofloxacin-group and doxycycline-group patients infected with either V cholerae 01 or 0139. All but one of the V cholerae 01 and all of the 0139 isolates were susceptible in vitro to doxycycline, whereas 48 (37%) of the V cholerae 01 isolates and none of the 0139 isolates were resistant to tetracycline. Treatment clinically failed in 14 (52%) of 27 doxycycline-treated patients infected with a tetracycline-resistant V cholerae 01 strain, compared with three (8%) of 37 patients infected with a tetracycline-susceptible strain (44% [23-65]). INTERPRETATION: Single-dose ciprofloxacin is effective in the treatment of cholera caused by V cholerae 01 or 0139 and is better than single-dose doxycycline in the eradication of V cholerae from stool. Single-dose ciprofloxacin may also be the preferred treatment in areas where tetracycline-resistant V cholerae are common. In V cholerae, in-vitro doxycycline susceptibilities are not a useful indicator of the in-vivo efficacy of the drug.

The effects of health services utilization on the recovery from dysentery.

A community-based programme for the treatment of dysentery in children under five years of age was implemented in Matlab, Bangladesh. Dysentery cases, identified at home, were referred to a sub-center for standard treatment with nalidixic acid. To assess the response to this intervention, a one year survey was carried out in 1990. The incidence of dysentery in this age group was 7 per cent. Isolation of Shigella species was 27 per cent (47/177) and was strongly associated with the frequency of stools (chi2 for trend, P = 0.001). S. flexneri accounted for 81 per cent of the isolates. Only 45 per cent of the cases were actually taken to the sub-center, 27 per cent went to traditional healers and 23 per cent used private allopathic services. Less than 40 per cent of the shigellosis cases received the suggested standard treatment. The overall recovery rate at 7 days, based arbitrarily on the number and type of stools, was 62 per cent and quite homogeneous among the types of services used. Neither the presence of Shigella isolates nor the type of treatment were associated with a higher recovery rate. We concluded that a systematic treatment of dysentery patients should be more selective on shigellosis.

Antimicrobial resistance of Shigella isolates in Bangladesh, 1983-1990: increasing frequency of strains multiply resistant to ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid.

The susceptibility to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ) was determined for 15,824 isolates of Shigella obtained from patients attending a treatment center in Dhaka, Bangladesh, from 1983 through 1990 and for 520 isolates obtained during community surveys from 1988 through 1990. Susceptibility to nalidixic acid was determined for isolates obtained after 1985. In 1983 13% of isolates were resistant to ampicillin, 23.5% to TMP-SMZ, and 0.8% to both drugs. By 1990 51.2% of isolates obtained at the Diarrhea Treatment Centre were resistant to ampicillin, 47.7% to TMP-SMZ, and 40.5% to both drugs (for comparison with figures for 1983, P less than .001). Resistance to nalidixic acid increased from 0.8% in 1986 to 20.2% in 1990 (P less than .001). In 1990 71.5% of Shigella dysenteriae type 1 isolates were resistant to ampicillin, 68.5% to TMP-SMZ, 67.7% to both drugs, and 57.9% to nalidixic acid. The resistance pattern of isolates obtained during community surveillance was similar to that of Treatment Centre isolates. In Bangladesh ampicillin and TMP-SMZ are no longer useful for treatment of infection with any species of Shigella, and nalidixic acid is no longer useful for treatment of infections due to S. dysenteriae type 1.