Chittagong Medical College Hospital Research Articles

Comparative Study of Some Haematological Parameters in Ckd Patients on Haemodialysis

Many patients with chronic kidney disease eventually become anaemic. Generally, haemodialysis patients tend to have more severe anaemia than those receiving peritoneal dialysis, probably because of greater blood loss and haemolysis in haemodialysis patients and better removal of uncharacterized ‘middle molecules’ inhibitory to erythropoiesis in peritoneal dialysis patients. Haemodialysis generally improves the fluid environment of the erythrocytes by partial correction of the electrolyte disequilibrium, the acid-base status and the removal of a number of uremic substances that may possibly disturb both the biochemical and physical properties of the cells. However, transit of the cells through the extracorporeal circuit may have some detrimental effects on the cells, including exposure to a rapidly changing plasma osmolality, mechanical damage as a result of blood pump occlusion, bio-incompatibility of dialyser membranes and blood lines, as well as friction due to haemodialyser design. Effects of the extracorporeal circuit include direct haemolysis as well as morphological changes that could lead to in vivo post-dialysis haemolysis. This study is aimed at to compare the consequent changes in some of the haematological parameters related to RBC, viz. Hb and total count of RBC and PCV in patients receiving Maintenance haemodialysis (MHD) in their pre and post-dialysis blood samples and to show that there is no detrimental effects of haemodialysis procedure on these haematological parameters. It is a Hospital based, cross-sectional comparative study. The study population consisted of 40 patients of diagnosed case of chronic kidney disease patients on haemodialysis in the Department of Nephrology, Chittagong Medical College Hospital, Chittagong. The haematological changes before and after the ending of haemodialysis procedure were studied by complete blood count study by automated analyzer. Data were analyzed by statistical methods (Paired sample t-test). In our study the pre-dialysis and post-dialysis sample showed the mean(±SD) haemoglobin level was 7.76(±1.65) gm/dl and 8.34(±2.00) gm/dl respectively. Also this study shows highly significant difference between mean of pre-dialysis and post-dialysis haemoglobin level (p=0.004). In this study the pre-dialysis and post-dialysis sample showed the mean(±SD) RBC count was 2.71(±0.68) million/μl and 2.93(±0.78) million/μl respectively. This shows highly significant difference between mean of pre-dialysis and post-dialysis RBC count (p=0.000). This study also shows the Haematocrit / PCV (%) in pre-dialysis and post-dialysis sample of the patients. In pre-dialysis and postdialysis sample the mean(±SD) Haematocrit / PCV(%) was 26.46 (±7.34)% and 27.39 (±8.07)% respectively. This shows no significant difference between mean of pre-dialysis and post-dialysis Haematocrit / PCV(%) level (p=0.157). The results of this study revealed that significant changes in haematological parameters, specially, regarding Hb level, total count of RBC and no significant changes in PCV occur in patients receiving MHD during HD process in their postdialysis blood samples. And all these findings are consistent with each other. Study shows that there is no detrimental effects of haemodialysis procedure on these haematological parameters.
 JCMCTA 2016 ; 27 (2) : 72 - 76

Neonatal Surgery in Chittagong Medical College Hospital

Abstract not available
 JCMCTA 2016 ; 27 (2) : 1 - 3

Serum Magnesium Level in Eclamptic Patients In a Tertiary Care Hospital

Magnesium deficiency during pregnancy has been reported to be associated with eclampsia. This descriptive cross sectional study carried out in Obstetrics and Gynecology Department of Chittagong Medical College Hospital from September 2013 to August 2014. The objective of the study was to estimate the serum magnesium level in eclamptic patients. Serum magnesium level of 80 eclamptic patients and 80 healthy pregnant women (Age and gestational age matched) were measured and compared to evaluate the association between hypomagnesaemia and eclampsia. All the necessary information and clinical data were recorded in predesigned questionnaires and analyzed using SPSS. t-Test and Chi-square test were used for comparison of quantitative and qualitative data respectively. For analytical test the level of significance was 0.05 (‘p’ value <0.05 was considered significant). Serum magnesium level was found below normal (<1.9mg/dl) in 93.75% eclamptic patients whereas in case of healthy pregnant women 73.75% had serum magnesium level within normal range (1.9-2.5mg/dl). The mean serum magnesium level (1.05±0.29mg/dl) was significantly (p<0.05) lower than the mean serum magnesium level of healthy pregnant women (2.19±0.35mg/dl). Significant difference of serum magnesium level between eclamptic patients and healthy pregnant women recommends that there may have some relationship between hypomagnesemia and development of eclampsia.
 JCMCTA 2016 ; 27 (2) : 18 - 23

Demographic Profile of Spinal Cord Injury (SCI): A Hospital-based Prospective study in Bangladesh

Purpose: To provide an overview of demographic characteristics of spinal cord injury (SCI) in Bangladesh. Methods: The study was conducted between 1st January and 31st December 2012 at 5 hospitals: Centre for the Rehabilitation of the Paralysed (CRP) in Savar, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Bangabandhu Sheikh Mujib Medical University (BSMMU), Rangpur Medical College Hospital, and Chittagong Medical College Hospital. 600 SCI cases from these tertiary hospitals were enrolled, and data was collected from those who met the study criteria, using a structured questionnaire developed on the basis of SCI core data set. Data was processed and analysed by SPSS version 16. Results: The male/female ratio was 4.5:1. Mean age at injury was 34.53 years (16–83 years). The cause of SCI was falls for 34.8% and RTA for 25.5% of the clients. 83.5% of SCI was traumatic and 16.5% was non-traumatic in origin. Only 9.5% of the clients were directly admitted to tertiary hospitals while 90.5% had intermediate admission before that. One-third (33.2%) of the clients used ambulance for intra-hospital transfer. 70.5% of the injury resulted in paraplegia and 29.5% in tetraplegia. Thoraco-lumbar junction (T11-L2) was the region most commonly involved, accounting for 38.7% of all cases. Overall 58.7% SCI cases were found with complete injury (ASIA-A) and 41.3% with incomplete injury during admission. 20.8% of the clients were admitted with pressure ulcer. The study found 27.2% of cases were operated on. The in-hospital mortality rate was 3.3%. Limitation: The pre-hospital fatalities were not included in the study. During data collection, extent of SCI was found in only 507 cases instead of all 600 enrolled. Conclusions: This study could contribute to the establishment of an effective prevention programme and comprehensive SCI management in Bangladesh.

Bites by the Monocled Cobra, Naja kaouthia, in Chittagong Division, Bangladesh: Epidemiology, Clinical Features of Envenoming and Management of 70 Identified Cases.

We describe 70 cases of monocled cobra (Naja kaouthia) bite admitted to Chittagong Medical College Hospital, Bangladesh. The biting snakes were identified by examining the dead snake and/or detecting N. kaouthia venom antigens in patients' serum. Bites were most common in the early morning and evening during the monsoon (May–July). Ligatures were routinely applied to the bitten limb before admission. Thirty-seven patients consulted traditional healers, most of whom made incisions around the bite site. Fifty-eight patients experienced severe neurotoxicity and most suffered swelling and pain of the bitten limb. The use of an Indian polyvalent antivenom in patients exhibiting severe neurotoxicity resulted in clinical improvement but most patients experienced moderate-to-severe adverse reactions. Antivenom did not influence local blistering and necrosis appearing in 19 patients; 12 required debridement. Edrophonium significantly improved the ability of patients to open the eyes, endurance of upward gaze, and peak expiratory flow rate suggesting that a longer-acting anticholinesterase drug (neostigmine) could be recommended for first aid. The study suggested that regionally appropriate antivenom should be raised against the venoms of the major envenoming species of Bangladesh and highlighted the need to improve the training of staff of local medical centers and to invest in the basic health infrastructure in rural communities.

Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial

Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.

Leprosy reactions in postelimination stage: the Bangladesh experience.

Leprosy reactions are immunologically mediated conditions and a major cause of disability before, during and after multidrug therapy (MDT). Little data have been published on the epidemiology of leprosy reactions in Bangladesh. To describe the pattern and prevalence of leprosy reactions in the postelimination stage. A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients in the period between 2004 and 2013. Of the 670 patients with leprosy, 488 (73.38%) were males and 182 (27.37%) were females. The prevalence of reaction was in 300 (44.78%) patients with a male:female ratio of 3.55 : 1. The age-specific cumulative reaction cases at >40 years were 115 (38.33%) among all age groups. The prevalence of reaction was found to be in 166 (55.33%) patients for the reversal reaction, 49 (16.57%) for the erythema nodosum leprosum (ENL) and 85 (28.33%) for the neuritis. Borderline tuberculoid was most common (106, 35.33%)in the reversal reaction group, while lepromatous leprosy was most common (37, 12.33%) in ENL group. More than half of the patients (169, 56.33%) had reactions at the time of presentations, while 85 (28.33%) and 46 (15.33%) patients developed reaction during and after MDT, respectively. The reversal reaction group presented with ≥six skin lesions in 96 (57.83%) patients and ≥two nerve function impairments (NFIs) in 107 (64.46%) patients. The ENL was present chiefly as papulo-nodular lesions in 45 (91.84%) patients followed by pustule-necrotic lesions in four (8.16%), neuritis in 33 (67.35%), fever in 24 (48.98%), lymphadenitis in six (12.24%), arthritis in five (10.20%) and iritis in two (4.08%). Bacterial index ≥3 had been demonstrated in 34 (60.71%) patients in ENL group. The incidence of leprosy reaction seemed to be more than three times common in borderline tuberculoid (52.33%) group than in lepromatous leprosy (14%) group. Reactions with NFI and disability still occur among multibacillary patients during and after MDT. Early detection and management of leprosy reaction are very important in preventing disability and deformity, and patients should be educated to undergo regular follow-up examinations. Developing reinforced new therapies to curb leprosy reactions is crucial for improving leprosy healthcare services.

Medical Management of Ectopic Pregnancy: An Observational Study

Objectives: The aim of this study was to explore the safety and efficacy of medical management of ectopic pregnancy.Materials and methods: This prospective observational study was conducted between February 2011 to August 2013 in Chittagong Medical College Hospital (CMCH) and in different private clinics of Chittagong city. Twenty-seven patients of ectopic pregnancy conceived by fertility treatment were recruited for medical treatment after proper evaluation. Ectopic pregnancy was diagnosed by serum ?-hCG and progesterone level but missing intrauterine pregnancy by transabdominal sonography (TAS). Serum ?-hCG was repeated after 48 hours to observe doubling of the level. If level was not doubled or increment was not at least 66% and serum progesterone level was less than 15ng/ml then it was considered as ectopic pregnancy. Patients were treated with Injection methotrexate 50 mg intramuscularly either by single dose or two doses. After 4 days of 1st injection ?-hCG was repeated and if level decreased &gt; 15% then patients were assessed weekly till ?-hCG fell to &lt;5lU/L. If drop was &lt;15% after 4 days a second dose of methotrexate was given.Results: Overall success rate was 66.66% . Surgical intervention was needed in 22.22% patients. All patients were treated after hospitalization in CMCH and different private clinics of Chittagong. They got injection methotrexate, antibiotic, antispasmodic and analgesics for abdominal pain. Single dose cured 55.55% patients and 11.11% patients needed second dose, another 11.11% patients were misdiagnosed –later on they were diagnosed as intrauterine pregnancy and medical termination was done. Within one year of treatment 33.33% patients conceived again. There was no side effect or complications of the treatment.Conclusion: This small trial gave a good impression about medical treatment in selective cases. The efficacy should be assessed in a randomized clinical trial with a different set of populationBangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 32-36

Efficacy of the Canalith Repositioning Procedure in Benign Paroxysmal

Benign paroxysmal positional vertigo (BPPV) is paroxysms of vertigo occurring with certain head movements, typically looking up or turning over in bed comprising about 20% of Dizziness cases. This study was carried out to evaluate the Efficacy of canalith repositioning procedure(CRP) in BPPV. A randomized clinical trial including 80 patients with BPPV was performed Medicine &amp; Neurology Outpatient Department, Chittagong Medical College Hospital. The patients were randomly divided into two groups. Group A treated by anti-vertigo drug and CRP, Group B treated by anti-vertigo drug alone. All patients were followed up in hospital at one week after &amp; 4 weeks. The rates of effectiveness of CRP treatment and the control treatment for were 86.8% and 59.4%, respectively. There was a significant difference (27.4%) in the outcomes of the CRP &amp; control groups (P &lt;.05). Mean total drug use for the group A was 10 ± 1, whereas it was 30 ± 1.5 for group B, mean difference = 20 (P &lt; .001, highly Significant). At 4 Weeks, subjective improvement and symptom free occurred in 94.7% patients in group A and 73% patients in group B (difference21.7%). Complications in the CRP group were observed in 10.6% of the patients. This study demonstrated that canalith repositioning procedure (CRP) was effective in the treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery &amp; low drug dependence. Complications of CRP were limited to 10.6% of patients.Medicine Today 2015 Vol.27(2): 23-27

Value of Widal Test in the Diagnosis of Typhoid Fever

Typhoid Fever occurs worldwide primarily in developing nations where sanitary conditions are poor. The absence of specific symptoms and signs makes the clinical diagnosis difficult. Definitive diagnosis requires the isolation of S. typhi from blood or other body fluid. But in developing countries culture facilities often not available &amp; diagnosis rely upon clinical features and the detection of antibodies by the Widal test. Numerous studies however have cast serious doubts on the value of the test. The aim of the study was to reassess the utility of a single Widal test in the diagnosis of typhoid fever. The descriptive study was carried out on 100 adult patients with suspected cases of typhoid fever, in the Department of Medicine, Chittagong Medical College Hospital for a period of one year from January to December 2009. Blood samples were collected to perform culture and Widal test. TO titre ?1:160 were considered as significant. AO or BO?1:160 was also considered as significant. The results showed 24 among 100 clinically suspected typhoid fever cases yielded growth of S. typhi. Widal test was found significant in 20(83.33%) out of 24 cultured confirmed cases. Results revealed significant difference in Widal test results between culture positive and negative cases, X2 value 5.601, P value 0.018(&lt;0.05).The study concluded that use of Widal test may be justified in second week of illness as a suggestive test for clinical diagnosis or in patients who have clinical typhoid fever but are culture negative.Medicine Today 2015 Vol.27(2): 28-32

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh.

BackgroundFever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.MethodsAdults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.ResultsWe enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.ConclusionEnteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.

Detection of Bacterial Vaginosis and Comparison Of Clinical &amp; Microbiological Methods Among Women Attending Chittagong Medical College Hospital

Bacterial vaginosis is a special public health concern in the world because of high burden of reproductive and pregnancy related morbidity. This present study was undertaken to detect the bacterial vaginosis in reproductive women by different clinical and microbiological methods on patients attending at the out patient department of Gynaecology and Obstetrics of Chittagong Medical College Hospital. A total of 170 sexually active female in the age group of 15-45 years, with abnormal vaginal discharge were selected for the study. In this study bacterial vaginosis was detected by Amsel clinical criteria (Clinical method) Gram stain Nugent criteria (Gold Standard) culture and by newly developed BV assay test and compared these methods. Out of 170 study cases, 43(25.30%) cases were diagnosed as bacterial vaginosis by Amsel criteria, 45(26.47%) cases were positive by Nugent criteria, 46(27.06%) cases were positive by BV assay test and 38(22.35%) cases were culture positive for Gardnerella vaginalis. Sensitivity of the clinical criteria (Amsel) BV assay test, and culture were 95.5%, 97.8% and 84.4% respectively in response to Gold standard Nugent criteria. All these findings make the BV assay test more accurate and reliable screening procedure for the diagnosis of bacterial vaginosis which help our physicians and patients.&#x0D; JCMCTA 2016 ; 27 (1) : 40 - 45

Conventional Therapy vs Nitazoxanide Plus Omeprazole for the Eradication Of Helicobacter Pylori : A Randomized Control Trial

Helicobacter pylori has an important association with Peptic Ulcer Disease (PUD). Numerous trials have proved that eradication of Helicobacter pylori results in healing of PUD and a very low recurrence rate. Attempts at eradication in Bangladesh with different regimens showed poor results. In Bangladesh there is no study with regimen containing Nitazoxanide and Omeprazole that showed to be very effective in several trails in different countries. This study was conducted in the Medicine department, Chittagong Medical College Hospital, from December 2008 to November 2009 to evaluate the efficacy of Nitazoxanide and Omeprazole in the eradication of Helicobacter pylori in PUD patients of Bangladesh. 130 endoscopically proven PUD patients were enrolled in this study when rapid urease test gave positive result &amp; randomized into two halves for comparison of treatment regimens. After six weeks endoscopy was done. Ulcer healing, rapid urease test negativity and absence of Helicobacter pylori in histology was considered as cure. Conventional group treated with Clarithromycin, Amoxicillin, Lansoprazole for 14 days showed cure rate of 80%, whereas nitazoxanide group showed 76% cure, the difference is not statistically significant. This study shows that two regimens are effective and comparable though newer regimen failed to show superiority over conventional treatment. JCMCTA 2016 ; 27 (1) : 33 - 39

Ruptured Uterus: Still an Ugly Truth of Maternal Mortality in a Tertiary Care Centre, Bangladesh

This prospective observational study was carried out in the Department of Obstetrics &amp; Gynecology, Chittagong Medical College Hospital from May 2002 to April 2003. The objective of the study was to evaluate various aspects of ruptured uterus regarding etiology, identification of risk factors, types of surgery carried out, maternal mortalities &amp; morbidities and fetal outcome. During the period, out of total 9643 hospital deliveries, 70 cases of ruptured uterus were admitted. This gives an incidence of ruptured uterus 1 in 137 deliveries. Most of the women ranged between 20-29 years of age, while almost all of them were multi parous with mean parity of 5.5. There were only 2 cases in primi gravida , 81% patient was not on any antenatal care. Most of them (81%) were illiterate and from low socioeconomic (87%) group of the community. The common etiological risk factors were Cephalo pelvic disproportion (67%) Shoulder presentation (21%) Abuse of oxytocic drugs (10%) Previous caesarean scar (16%) and Malhandling by dai (42%). Most of the patients gave the history of prolonged labor for more than 24 hours. Shock and sepsis were the prominent presenting features. In most cases, the rupture site was on the lower segment (51%) and in 78% cases, the tear was complete. Out of 68 patients, 33(48%) underwent subtotal hysterectomy, 19(31%) had repair and 14(20.5%) patient undergone total hysterectomy. (2.8%) patients expired after arrival at the hospital before any surgical intervention could be done. Out of 70 patients, 7 patients died giving the mortality rate10%. The fetal mortality rate was 87%.Uterine rupture still remains one of the major causes of maternal and newborn morbidity and mortality in Bangladesh. Promotion of skilled attendance at birth, use of family planning among those at high risk, avoiding injudicious use of oxytocics during labor, correct use of Partograph and preventing unnecessary c-sections are essential in reducing the occurrence of uterine rupture.&#x0D; JCMCTA 2016 ; 27 (1) : 17 - 22

Delayed Presentation of Patients with Acute Myocardial Infarction in Chittagong Medical College Hospital

Background: Delay between onset of symptoms and hospital presentation is a critical factor in determining the management strategy and subsequent outcome. Objective of the study was to identify predictors of late presentation in patients with acute myocardial infarction (AMI) and target interventions for those at high risk of late presentation.Methods: In our cross sectional study we prospectively analyzed a cohort of 1032 AMI patients for 1 year (August, 2014 to July, 2015). Demographic factors, clinical characteristics, perception of health and access to health care were compared between early (within 12 hours of symptom onset) and late presenters (&gt;12 hours of symptom onset). Bivariate comparison and multivariate logistic regression were done to identify independent predictors of late presentation .Odds ratio and 95% confidence intervals were calculated directly from the estimated regression coefficient.Results: Of the total 1032 patients 385 (37.3%) were early presenters and 647 (62.7%) were late presenters. Mean time interval between onset of symptom and presentation to hospital were 6.85±8.06 hrs (range 1.5 to 12 hrs) in early and 37.88±25.13 hrs (range 13 to 120 hrs) in late presenters. Bivariate comparison found that in the late presentation group was higher age group patients and employed citizens, had ? one angina episode over past 4 weeks, was unable to use emergency medical transport, had no nearby ECG facilities and misinterpreted chest pain as peptic ulcer disease (PUD). Multivariate analysis showed older age ?65 yrs, traveling long distance ?50 miles from home residence, reporting one or more angina episode over past 4 weeks, attending PHC/clinic and misinterpreting chest pain as PUD were associated with late presentation.Conclusion: A significant majority of patients with AMI were late presenters. Misinterpreting chest pain as PUD was responsible for the delay in the majority. Reporting ?1 angina episodes over past 4 weeks was also independently associated with late presentation. Lack of emergency medical transport and traveling long distance were also significantly associated with the late presenters. Patient education, appropriate utilization of existing resources and use of tele-electrocardiography that allows transmission of ECG signal to a medical control officer may decrease late presentation and improve outcome.Cardiovasc. j. 2016; 9(1): 3-8

Pattern of Bacteria Causing Urinary Tract Infections and Their Antibiotic Susceptibility Profile at Chittagong Medical College Hospital

Urinary tract infection (UTI) is the most common nosocomial infection among hospitalized patients. Area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and resistance pattern of the causative agents may help clinicians to choose correct treatment regimen. So, the present study was aimed to investigate the antibiotic resistance of urinary pathogens isolated at Chittagong Medical College Hospital (CMCH) during January to June, 2007. Out of 360 clinical samples of urine collected, 175 (48.61%) showed significant bacterial growth. The most common pathogens isolated were Escherichia coli (66, 37.71%), Klebsiella species (60, 34.29%), Proteus species (17, 9.71%) and Pseudomonas species (16, 9.14%). Members of the Enterobacteriaceae were 80%-100% sensitive to Imipenem while they were found variably sensitive to other commonly used antibiotics. Pseudomonas species were 100% sensitive to Imipenem, 75% to Amikacin, and 50% to Ceftazidime. Staphylococcus aureus was found 100% sensitive to Vancomycin, 80% to Gentamicin and Amikacin each, and 55% to Oxacillin. Enterococcus species were 80% sensitive to Imipenem, 60% to Ciprofloxacin, 50% to Vancomycin and Amikacin each. The clinicians should use Imipenem selectively in cases of un-responsiveness to commonly used antibiotics.Bangladesh J Med Microbiol 2008; 02 (02): 17-21

Diastrophic Dysplasia : A Case Report

Abstract not availableBangladesh J Child Health 2015; VOL 39 (1) :46-49

Profile and Outcome of In-hospital Cardiac Arrest in Coronary Care Unit of a Tertiary Care Hospital

Background: In-hospital cardiac arrests are associated with poor survival despite basic and advanced life support measures. Objective of this study was to find out the profile and outcome of in-hospital cardiac arrest patients admitted to coronary care unit (CCU) of Chittagong Medical College Hospital.Methods: This prospective observational study was done on 243 consecutive patients developing cardiac arrest in CCU of Chittagong Medical College Hospital during a period of 1 year. Baseline demographics, clinical data, such as mode of arrest, timing of the event, duration of resuscitation were recorded. Basic and advanced life support measures were given according to AHA guidelines. The main outcomes were death and survival to hospital discharge with or without severe neurological disability.Results: There were 168 male and 75 female. Male:female ratio was 2.4:1.Mean age of the study population was 56.5±14.6 (range 23-76 yrs). Out of 243 arrest cases 108 (44.4%) had ventricular fibrillation(VF), 75(30.8%) had pulseless ventricular tachycardia(VT), 51 (20.8%) had pulseless electrical activity(PEA) and 9 patients (3.7%) had asystole. Mean±SD of time to defibrillation was 1.8±4.3min (range 0-30 min). Ninety eight (40.2%) patients had a return to spontaneous circulation, 71 (29.2%) survived up to 24 hours and only 46 (18.9%) patients survived to hospital discharge. Out of the 183 patients with VF and pulseless VT, 42 (22.9%) survived to hospital discharge. Survival following asystole and PEA were only 6.6% in each.Conclusion: Only 18.9% of cardiac arrest victims survived to hospital discharge. Initial cardiac arrest rhythm as VF and pulseless VT, a shorter time to defibrillation and location whether the event in monitored area were factors associated with a higher survival.Cardiovasc. j. 2016; 8(2): 123-127

Prevalence of Extended Spectrum 3-Lactamases (Esbl) Producers Among Gram-Negative Bacilli In Chittagong Medical College Hospital, Chittagong

The emergence and spread of antibiotic resistance in microorganisms have rendered the management of infectious diseases difficult. Extended-Spectrum 3-Lactamases (ESBLs) producing organisms are increasing in number and causing more severe infections because of their continuous mutation and multidrug resistance property which make its treatment difficult. The present study was undertaken to detect the prevalence of the ESBLs producing bacteria in patients attending Chittagong Medical College Hospital, so as to provide a guideline in treating them &amp; prevent unnecessary use of antibiotics. All the isolates were identified by standard procedure &amp; isolated gram-negative bacteria initially screened by Minimum Inhibitory Concentration (MIC) ESBLs breakpoints. Then confirmed by Phenotypic Confirmatory Test (PCT). In the present study, 176(74.89%) bacterial strains were isolated from 235 samples of wound swab, pus and urine. Among the isolates, 150(85.23%) were gram-negative and 26(14.77%) were gram-positive bacteria. Isolated gram-negative bacteria were screened for suspected ESBLs producers where 142(94.67%) were found suspected ESBLs producers, of which 89(62.68%) confirmed as JCMCTA 2015 ; 26 (2) : 23 - 28

Effect of Topical Tacrolimus on Vitiligo in Children

Background: Considering safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. Hence, new immunomodulatory agents such as calcineurinantagonists, frequently referred to as topical immunomodulators (TIMs) have recently been introduced as new promising tools to treat acquired hypopigmentary disorders. Tacrolimus is safe in treating children due to lack of skin atrophy and less data are available on effect of topical tacrolimus on vitiligo.Objective: To see the effect of topical tacrolimus on vitiligo in children.Materials and Methods: This prospective study was done in outpatient department of Dermatology and Venereology, Chittagong Medical College Hospital (CMCH), Bangladesh. Clinically diagnosed vitiligo patients of up to 12 years age visiting Skin &amp; VD OPD, CMCH during study period were the study population (total 30). The study was carried out from November 2007 to April 2008.Results: A total of 30 patients, 13 (43.33%) males and 17 (56.66%) females with focal, segmental or generalized vitiligo were studied. Seventy percent of study subjects were from 7–12 years of age. Topical tacrolimus 0.03% ointment was administered twice daily for 12 weeks to each patient. Repigmentation was complete (&gt;75%) in 43.33% cases (13/30), was moderate (50–75%) in 33.33% (10/30), mild (&lt;50%) in 13.33% (4/30). Clinical adverse effects were noted in 6.67% (2/30) of cases where pruritus was in 3.33% (1/30) and burning in 3.33% (1/30). None of the reactions was severe, all were mild and well-tolerated and most occurred within the first month of initiation of treatment and resolved with continued use of drug and completely cured after the treatment completed. Nobody had to discontinue the therapy for side effects.Conclusion: In conclusion, tacrolimus ointment may be a rapidly efficacious and safe option for the treatment of vitiligo in children. The ease of topical self-administration with minimal side effects makes this novel immunomodulatory agent a promising addition to the therapeutic armamentarium for vitiligo in children.J Enam Med Col 2016; 6(1): 33-37