Comparative Study of Clinical and Sonographic Estimation of Foetal Weight at Term.

A cross sectional comparative study was conducted at Dhaka National Medical College, Dhaka from January to June 2012, to observe the accuracy of clinical and ultrasonographic estimation of foetal weight at term in our environment. Seventy five pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Accuracy was determined by percentage error, absolute percentage error and proportion of estimates within 10% of actual birth weight (birth weight fetus of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birth weight of 2989.60 ± 408.76 (range 2310-4000 gm). Overall, the clinical method overestimated birth-weight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was more than that of the sonographic method, and the number of estimates within 10% of actual birth weight for the clinical method (41.3%) was less than for the sonographic method (57.3%); the difference was not statistically significant. In the low birth-weight (<2,500 gm) group, the mean absolute percentage error of sonographic estimates were significantly smaller. Significantly more sonographic estimates (75%) were within 10% of actual birth-weight than those of the clinical method (0%). No statistically significant difference was observed in all the measures of accuracy for the normal birth-weight range of 2,500-<4,000 gm and in the macrosomic group (≥ 4,000 gm). Clinical estimation of birth-weight is as accurate as routine ultrasonographic estimation, except in low-birth-weight babies.

Planned conception in a hyper immunized rhesus-d negative mother by elective plasmapheresis.

Here we report a case of planned pregnancy in a Hyper immunized Rh D negative Banker lady who was interested to have a healthy baby in her fourth Gestation as previous conceptions were ended by intra uterine death (IUDs) due to Rhesus Hemolytic diseases of new born (HDN) which is a condition where the lifespan of the infant's red cells is shortened by the action of specific antibodies derived from the mother by placental transfer. The disease begins in intrauterine life and is therefore correctly described as hemolytic disease of the fetus (HDF) and new born, but the simple term HDN has been used for a long time and can be taken to include hemolytic disease of the fetus (HDF). This hemolytic process takes place in utero and results in marked compensatory overproduction of young nucleated red cells in fetal erythropoietic sites. For this reason the disease also called erythroblastosis foetalis. Elective plasmapheresis done at the Transfusion Medicine Department of BSMMU, Dhaka on her, 800 ml. plasma were extracted in 4 different sessions during her antenatal period. One healthy male baby was delivered by LUCS at 32 weeks of pregnancy; the Baby has to receive 170 ml. O negative fresh Whole Blood as Exchange Transfusion to correct mild hyper bilirubinimia and anemia. Manual plasmapheresis may thus be practiced to all Hyper-immunized carrying mothers to prevent intra uterine death (IUD) in Rhesus D negative carrying mothers.

Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh.

BACKGROUND: Outbreaks of scabies in institutions and the socio-economic consequences have not been reported from overpopulated countries such as Bangladesh. STUDY DESIGN: A community-based study among children from six residential Islamic education institutes (madrashas) in Dhaka. Multistage random sampling was used. OBJECTIVES: To study the socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children. METHODOLOGY: Direct interviews were used to collect the data and clinical check up was performed in all children. RESULTS: In total, 492 children received clinical check-ups; 92.5% were boys (mean age: 11.2+/-2.4 years). 63.4% of fathers and 98.5% of mothers were either illiterate or had only received primary education, 55.1% of fathers were in low-paid labouring jobs, and 99% of mothers were housewives. Of the 98% of children who had scabies, 71% had been re-infected (96% during the winter). Randomly assigned anti-scabies drugs revealed an average cure rate of 85.5%. Seventy-four percent of children were living in poorly ventilated buildings with overcrowded sleeping arrangements. They had poor personal hygiene: 21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on a communal line or shelf. Sanitation was also poor: 39% bathed infrequently, although 97% carried out mandatory ablution. Most children (61%) washed their clothes (including undergarments) two or three times a fortnight, 35% did so every 2-3 days, and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P<0.001) and bed linen (P<0.001), overcrowded sleeping arrangements (P<0.001) and infrequent bathing (P<0.001) with soap (P<0.001). This was further related to household income (P<0.001 for both). CONCLUSION: The study findings have potentially dangerous implications for public health. Immediate attention should be given to developing a sustainable long-term intervention programme to combat scabies hyperendemicity, and to save thousands of children from impending complications.

Clinical profile and predisposing factors of cerebral palsy.

This was an analysis of one hundred ten children with cerebral palsy (CP) attending at the Child Development & Neurology Care Center of Dhaka Medical College Hospital during January 2002 to December 2003. These children were observed to study their clinical profile, etiological factors and associated problems. The mean age of these children was 2.9 +/- 2.9 years, mostly being males (n=79, 71.8%). Most of the families of these children belonged to poorer socioeconomic strata. Spastic diplegia constituted the predominant group (34.5 per cent), followed by spastic quadriplegia (25.5 per cent). Dyskinetic CP was present in 15.5 percent of the cases. Hypotonic CP constituted a significant proportion of cases. Delayed Motor Function was observed in all 110 cases, delayed speech was complained in 67.3% cases and impaired hearing was identified in 26.8% CP children. Mothers of 43.6% CP cases reported that they had prolonged labour during delivery and almost one third (29.1%) had suffered from pre-eclampsia or eclampsia. Majority (53.6%) of the CP cases were reported to have had perinatal asphyxia. Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities. By proper perinatal care, CP can be prevented.

Long term outcome of birth asphyxiated infants.

Fifty eight neonates who survived birth asphyxia were prospectively studied in the department of Paediatrics, Dhaka Medical College Hospital, to see the incidence of long term neurodevelopmental sequelae among them and also to identify possible risk factors. All of them had been admitted in the Neonatal Unit of this hospital and were born between July 1997 & December 1999. After discharge from the hospital, the study infants were followed up at the Child Neurology Clinic of this hospital. They were seen at 6 weeks. at 3 months & then every 3 months upto 2 years of age for evaluation of growth and development (age corrected for prematurity for preterm babies) 69% of them were boys and 31% were girls. 74% of the babies were inborn in the same hospital & the rest were out born. Prolonged labour (24%) and PET (18.96%) were the most common obstetric factors & respiratory distress (38%) and neonatal convulsion (35%) were the important neonatal complications. Of the 58 enlisted study cases, 30 (51.7%) responded to complete 2 years follow up and the rest were lost. Normal growth and developments were observed in 12 (40%) cases, 7 (23.33%) had mild handicap, 6 (20%) moderate & 5 (16.6%) were left with severe neurodevelopmental handicaps at 2 years of age. 61% of the handicapped children had suffered from neonatal seizure for varying periods. It may be concluded that the response to follow up unsatisfactory, the number of severe handicap was alarmingly high and post asphyxiated seizure was associated with poor outcome. So prevention of perinatal asphyxia should be targeted. Further long term follow up study is required.

Extent of utilization and factors influencing antenatal care in rural Rajshahi.

PIP: This cross-sectional study determined the extent of utilization of antenatal care (ANC) and identified factors influencing utilization. The study was conducted in 9 rural hospitals in Rajshahi district, Bangladesh, among 810 recently delivered women. Data were collected using a structured interview schedule and were analyzed using simple descriptive analysis, Chi-square test, and logistic regression. Of the 810 respondents, 30.05% had antenatal checkups and 81.3% received tetanus toxoid before delivery. 69.5% of the women did not have any antenatal check-ups for reasons such as absence of complications and the feeling that it was not mandatory to have such check-ups. Important factors influencing utilization of ANC were freedom of decision-making, perception about the need for ANC, and income. There is a need for improving utilization of ANC, especially through perception improvement about ANC and freedom of decision-making.^ieng

Role of male factors in infertility and analysis of semen.

PIP: This study attempted to determine the male factors among infertile couples who attended consultation centers of obstetricians/gynecologists and endocrinologists in Dhaka, Bangladesh. Data were collected from 260 male partners of the infertile couples using a structured questionnaire. Semen specimens were collected from each respondent after a sexual abstinence of 3 days. Physical (quantity, density, morphology and motility), chemical (pH), microscopic (sperm counts and pus cells), and serological [Venereal Disease Research Laboratory (VDRL)] examinations were conducted for each specimen. Data were analyzed and interpreted using univariate and multivariate descriptive analyses. The mean standard deviation of age was 30.35 +or- 2.8 years and the majority (65.4%) was between the ages of 30 and 35 years. Duration of infertility following marriage was 6-10 years for most of the subjects (63.1%). The commonest (63.1%) method of semen specimen collection was masturbation. Volume of ejaculate varied between 2 and 3 ml in the majority of the subjects (81.2%). Microscopic examination showed that 166 (63.9%) of the subjects were normospermic, 54 (20.8%) were azospermic, and 20 (7.6%), 13 (5%), and 7 (2.5%), respectively, were severely, moderately, and mildly oligozoospermic. Only 8 (3.9%) showed necrospermia (dead spermatozoa). Only 34 (13%) subjects reported a past history of relevant illnesses. VDRL tests were negative in all the cases. A strong relationship of the presence of plenty pus cells was found with abnormal sperm motility (P 0.00001). Further study is recommended to assess the actual male infertility factors in the population.^ieng

Histomorphological study of indomethacin induced gastrointestinal lesions in rat.

This study was undertaken in Long Evans rat to investigate the effect of a single therapeutic as well as toxic dose of indomethacin on the gastrointestinal mucosa. The effect was studied morphologically six hours after oral administration of the drug. The affected tissue was then examined histologically. The histomorphological evaluation revealed that the drug has induced acute hemorrhagic erosive gastritis in the fasted animals (6 mg/Kg body weight) where as in normally fed (10 mg/kg body weight) rats the small intestinal mucosal inflammation and erosions were predominant.