Needle Biopsy of Pleura in the Aetiological Diagnosis of Pleural Effusion.

Exudative pleural effusion appears as manifestation of underlying specific disease process and pleural biopsy is usually enough to find out the underlying causative disease. The aim of the study was to find out the efficacy of needle biopsy of pleura in the aetiological diagnosis of pleural effusion. This cross-sectional study was conducted for a period of one year from January 2008 to December 2008 in the Department of Medicine, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh enrolling 50 subjects with exudative pleural effusion. The cases with transudative pleural effusion were not included. Needle biopsy was done in all the cases. Histopathological reports of pleural biopsy specimen were correlated with other data and analyzed to detect the causes of effusion. Major incidence of malignant effusion occurred between 41 to 70 years of age. No malignant effusion was found before 30 years of age. Incidence of tuberculous and malignant pleural effusion was much more common in males than in females. Sensitivity and specificity of combined pleural biopsy and pleural fluid analysis in the diagnosis of pleural effusion was 97.06% and 100.% for tuberculosis and 81.82% and 100.0% for malignancy. The present study reveals that pleural biopsy was very effective method in the diagnosis of cause of pleural effusion.

Antimicrobial Resistance Pattern and Genetic Characteristics of ESBL and Carbapenemase-producing Escherichia coli at a Tertiary Care Hospital in Bangladesh.

Uropathogenic Escherichia coli is frequently resistant to different antibiotic leading to a critical condition of the patients. The purpose of the present study was to see antibiotic resistance pattern and genetic characteristics of ESBL and Carbapenemase-producing Escherichia coli. This cross sectional study was conducted in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from October 2014 to December 2015. Patients presented with clinically diagnosed urinary tract infection at any age with both sexes who attended in the OPD of Mymensingh Medical College Hospital and the Doctors Diagnostic Centre in Mymensingh, Bangladesh was selected as study population. Non duplicate clinical isolates from urine were collected in full aseptic precaution for culture of bacteria. Escherichia coli were confirmed by PCR Stargetingadk. Antimicrobial susceptibility was measured by broth microdilution test. Minimum inhibitory concentrations against 18 antimicrobial agents were measured. Beta-lactamase genes were detected by multiplex PCR. For all the isolates showing resistance to imipenem and/or meropenem, presence of carbapenemase genes was confirmed by multiplex/uniplex PCR using primers. A total of 233 non-duplicate clinical isolates of Escherichia coli were collected from patients of which dominant phylogenetic group was B2 which was 78(33.5%) isolates of which 71 isolates were B2a and 7 isolates were B2b. Furthermore, Group A was in 29.6% isolates and Group D was in 26.6% isolates. E. coli showed significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials. Meropenem-resistance was detected in 8.2% of E. coli. The detection rate of blaTEM was 41.6% in E. coli. Carbapenemase genes were detected in 9(3.9%) isolates of E. coli and identified as genes encoding NDM-1, -5, and 7 and OXA-181. All the blaNDM-positive E. coli isolates carried also blaCTX-M-15, except for a group B1 isolate. E. coli is significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials and possesses different ESBL and carbapenemase genes.

Diagnostic Accuracy of Refractory Shadowing from Uterine Leiomyomas: Sonographic-Pathologic Correlation.

This cross sectional study was carried out in the Department of Radiology & Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh from July 2010 to June 2011 with a view to evaluate the diagnostic accuracy of refractory shadowing on transabdominal pelvic sonography for leiomyomas and in differentiating them from other pelvic masses. Histopathological examination of the surgically resected masses was taken as the standard diagnostic tool. A total number of 50 patients of pelvic masses were studied. It was observed that a pattern of sharp, discrete, shadow was typical of leiomyoma, which reduces diagnostic ambiguity. The mean age of the patients was 38 years. Mean size of the masses was 4.25±3.25cm. Taking histopathological examination as the Gold standard, accuracy of refractory shadowing on transabdominal sonography in diagnosis of leiomyoma was 65.1%. Specificity and sensitivity were 90.3% and 54.2% respectively. Positive predictive value was 92.9% and negative predictive value was 45.9%. Statistical analysis revealed strong association of refractory shadowing with diagnosis of leiomyomas (p<0.01).

Clinical Characteristics and Haematological Parameters Associated With Visceral Leishmaniasis in Bangladeshi Individuals.

Visceral leishmaniasis (VL) also known as kala-azar (KA) is the most severe form of leishmaniasis and can be fatal in the absence of treatment. KA is highly endemic in Mymensingh region of Bangladesh. Although estimating the true incidence of VL may be difficult. The objective of the study was to evaluate clinico-haematological parameters in different groups of leishmaniasis cases. It was a cross-sectional descriptive type of study and was conducted in a research centre of Mymensingh, Bangladesh from February 2016 to January 2017. A total of 90 cases who were rk-39 strip test positive from five divisions of Bangladesh admitted to Research Centre were included for clinical and haematological parameters. All the cases were categorized into five different groups depending on the clinical case definition and Real Time PCR (RT-PCR) was performed using buffy coat preparation. The age of the study subjects ranged from 3 to 80 years. Mymensingh was the highest affected division (60%) and primary kala azar (PKA) cases were more than half of the study subjects. Fever was the most common feature (100%) in PKA, relapse kala azar (R-KA) and treatment failure kala azar (TF-KA) followed by splenomegaly (70.2%) in PKA, loss of appetite (62.9%) in R-KA, and skin pigmentation was observed (100%) in PKDL cases. Anaemia was present in 62.7%, leucopenia in 57.6% and thrombocytopenia in 61.7% PKA cases. Pancytopenia was observed in a total of 33 cases from all groups. There were no significant changes in serum bilirubin, SGPT and serum creatinine level. RT-PCR was performed in all cases and found positive in 30 (63.8%) PKA, 16 (59.3%) R-KA, 2 (100%) TF-KA and 2 (50%) R-KA associated with PKDL cases. Overall, VL cases were positive in 62.5% (50/80) and no PKDL cases were detected by buffy-coat RT-PCR. In endemic areas, the magnitude of the problem and limited resources of a developing country like ours, clinical characteristics and hematological parameters may also play important role for diagnosis of the clinical cases.

Evaluation of PCR with culture for the diagnosis of pulmonary tuberculosis.

Tuberculosis (TB) is a major public health problem in most developing countries. The present study was carried out among 100 clinically suspected pulmonary TB patients. One hundred sputum specimens were collected one from each of the suspects attending DOT'S corner of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The aim of the study was to evaluate the sensitivity and specificity of a polymerase chain reaction (PCR) based method detecting IS6110 sequence present in all Mycobacterium tuberculosis strains using sputum samples in comparison to culture on Lowenstein-Jensen mediums. The PCR was done using primers mtb1 & mtb2 which commonly target an insertion sequence of the organism (IS6110). Out of 100 samples, 18 (18%) showed PCR positive, whereas culture in Lowenstein-Jensen media were positive in 19(19%). In PCR 1 was false negative but none was false positive. In present study, sensitivity and specificity of PCR found 94.74% and 100% respectively. Analyzing the findings of the present study, it can be concluded that the PCR technique is a rapid and alternative method of culture on Lowenstein-Jensen medium for the diagnosis of pulmonary tuberculosis. In the present study, only presence or absence of M. tuberculosis was determined.

Comparison between ICT and PCR for diagnosis of Chlamydia trachomatis.

Chlamydia trachomatis is an obligate intracellular gram-negative bacterium which is the most prevalent cause of bacterial sexually transmitted infections (STI). The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Immunochromatographic test (ICT) and Polymerase chain reaction (PCR). A total of 70 females were included in this study. Out of 70 cases 56 were symptomatic and 14 asymptomatic. Endocervical swabs were collected from each of the cases and examined by Immunochromatographic test (ICT) for antigen detection and Polymerase chain reaction (PCR) for detection of endogenous plasmid-based nucleic acid. A total 29(41.4%) of the cases were found positive for C. trachomatis either by ICT or PCR. Of the 56 symptomatic cases, 19(33.9%) were found ICT positive and 17(30.4%) were PCR positive. Among 14 asymptomatic females, 2(14.3%) were ICT positive and none were PCR positive. Though PCR is highly sensitive but a total of twelve cases were found ICT positive but PCR negative. It may be due to presence of plasmid deficient strain of C trachomatis which could be amplified by ompA based (Chromosomal gene) multiplex PCR.

Molecular diagnosis of genital Chlamydia trachomatis infection by polymerase chain reaction.

The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Polymerase chain reaction (PCR). A total of 70 females were investigated including 56 symptomatic and 14 asymptomatic cases. Endocervical swabs were collected and dipped in 500µl Tris buffer. Polymerase chain reaction (PCR) amplification was done for detection of endogenous plasmid-based nucleic acid. A total 17 out of 56 of the symptomatic cases (30.4%) were positive for C. trachomatis and none were found positive among the 14 asymptomatic cases. These findings suggest high prevalence of C. trachomatis infection among this group of population.

[Antibioticograms of microorganisms isolated from foci of local infections in infants]. / Antibiotikogrammy mikroorganizmov, vydelennykh iz ochagov lokal'nykh infektsii u novorozhdennykh detei.

Microbiological tests were performed in regard to 474 newborns within 1985-1995. It was shown that gram-positive microflora (Staphylococcus epidermidis and Staphylococcus aureus) predominated in the etiological structure of omphalitis and conjunctivitis. Among gram-negative isolates in the cases with omphalitis there predominated Klebsiella pneumonia. The antibioticograms were of great practical value for the adequate therapy.