Ibrahim Medical College Journal

Disseminated melioidosis involving skin and joint: a case report

Samira Rahat Afroze — 2016-07-21

Melioidosis is an infectious disease that can cause serious morbidity and may result in death if not treated early. Its causative organism, Burkholderia pseudomallei is present in soil and water. Here, we report a case of disseminated melioidosis involving skin and joint in a farmer residing in an area where the organism has been found in the soil.

Ibrahim Med. Coll. J. 2015; 9(2): 55-57

Jejunal inflammatory fibroid polyp: a rare cause of intussusception

Md Rajibul Haque Talukder — 2016-07-21

Inflammatory fibroid polyp is a benign and non-neoplastic condition of the gastro-intestinal tract, commonly affecting the gastric antrum, though it can affect any part of the gastro-intestinal tract. It is a submucosal, sessile, polypoid mass composed of myofbroblast like mesenchymal cells, numerous small blood vessels and marked inflammatory cell infiltrate mainly eosinophils. It commonly presents with intestinal obstruction or intussusception. We present here a case of recurrent episodes of small intestinal sub-acute obstruction due to intermittent intussusception associated with inflammatory ûbroid polyp of jejunum.

Ibrahim Med. Coll. J. 2015; 9(2): 58-60

Non-fatal drowning in under-five rural children of Bangladesh

Syed Hassan Abdullah — 2016-07-21

Drowning has been identified as a major cause of death in children in both developed and developing countries. Non-fatal drowning is several times higher than the fatal drowning. To describe the socio-demographic and environmental attributes of non-fatal drowning in rural children this community based descriptive study was conducted on 122 children having non-fatal drowning events within one year of study period. This study was undertaken in Raigonj sub-district of Sirajgonj district in Bangladesh. Mothers of those children were interviewed using a structured questionnaire. Out of all participants 56.6% children were 2-4 years of age and male-female ratio was almost equal. Of the total respondent mothers 55% were illiterate and 41.8% were below the age of 25 years. Seasonal variation was observed in non-fatal drowning. Rainy season (50.8%) appeared as the most risky period followed by summer (29.5%). Higher incidence occurred (53.3%) between 10 am to 2 pm of the day. Although most of the drowning occurred outside the home, 9% drowning occurred in water container (like drum, tub) within the home. Pond (50.5%) was found as the most common place among open water source. During the occurrence, 23% child was not accompanied by parents or any caregivers. At the time of drowning, 47.5% mothers were engaged with usual household work and were not present at the place of occurrence whereas 13% mothers were present around the place of occurance. Before drowning, 45.1% victim was either playing, bathing or swimming in the water. Only 10.7% needed resuscitation, 25% were taken to health centre and reached the health centre within an hour, about a fifth (22.6%) of them were admitted. Restriction in dangerous water activities, strengthening supervision of children might decrease the incidence of drowning while quick and effective medical response might prevent its fatal consequences.

Ibrahim Med. Coll. J. 2015; 9(2): 37-41

Use of antibiotics in selected tertiary and primary level health care centers of Bangladesh

Abdullah Akhtar Ahmed — 2016-07-21

A cross sectional study was conducted in inpatient department of seven primary level hospitals care centers (PLHCs) and six tertiary level hospitals (TLHs) of the country. Total 2058 hospitalized patients were interviewed over a six month period from October 2012. Most of the patients (85.9% in TLH and 100% in PLH) were prescribed with antibiotics at the time of admission. Only 6.4% patients of TLHs treated with antibiotic had culture proven infection and rest of the patient of TLH and all the patients of PLH were treated with antibiotic empirically. Top prescribed antibiotic was ceftriaxone (39.64% in TLH, 59.64% in PLH). Parenteral route of antibiotic administration was preferred for both at TLHs and PLHCs (63.3% and 76.9%). The results of the present study indicated that antibiotics were widely and inappropriately used without following standard guidelines or based on any rationality. This is an alarming situation, and needs to be addressed by the relevant authority to save the people from growing antibiotic resistance.

Ibrahim Med. Coll. J. 2015; 9(2): 42-44

Detection of OXA-181/OXA-48 carbapenemase producing Enterobacteriaceae in Bangladesh

Rehana Khatun — 2016-07-21

Carbapenem resistant Enterobacteriaceae (CRE) is becoming a major public health concern globally. Detection of carbapenem hydrolyzing enzyme carbapenemase in Enterobacteriaceae is important to institute appropriate therapy and to initiate preventive measures. This study was designed to determine the presence of carbapenemase producers among the CRE isolated from patients at Dhaka Medical College Hospital, Bangladesh. Twenty-nine CRE strains detected by disk diffusion technique were included in the study. Minimum inhibitory concentration of imipenem and tigecycline was determined by agar dilution method. Carbapenemase production was phenotypically detected by Modified Hodge test while MBL producers were detected by combined disk and double disk synergy tests. Genes encoding blaNDM-1, blaOXA-181, blaOXA-48, blaKPC, blaCTX-M-15, blaOXA-1-group were identified by polymerase chain reaction (PCR). Out of 29 CRE, nineteen (65.6%) were positive for carbapenemase by any of the three phenotypic tests namely MHT, CD or DD tests. Those 19 isolates were also positive either for blaNDM-1 or blaOXA-181/blaOXA-48 by PCR. Of the 19 PCR positive isolates, the rate of positivity for blaNDM- 1, blaOXA-181/blaOXA-48 and blaNDM-1+ blaOXA-181/blaOXA-48 was 73.7% (14/19), 57.9% (11/19) and 31.6% (6/19) respectively. Both blaOXA-181 and blaOXA-48 co-existed. All the carbapenemase producing organisms harboured blaCTX-M-15 except one C. freundii strain. The rate of resistance to different classes of antibiotics ranged from 63.2% to 100% except colistin and tigecycline. Organisms positive for OXA-181/OXA-48 had a low level of resistance to carbapenem (MIC 1 - 4 ì g/ml) while with NDM-1 had high level resistance to imipenem (MICs 16 - ? 32 ì g/ ml). Out of 19 carbapenemase positive isolates, 12 (63.16%) were extensively drug-resistant (XDR) and were only sensitive to tigecycline and colistin. The result of this study showed the presence of blaOXA-181/ blaOXA-48, blaNDM-1 positive strains in Bangladesh and colistin and tigecycline were the most effective drugs against carbapenemase producing Enterobacteriaceae (CPE). Epidemiological monitoring of carbapenemase producing organisms in Bangladesh is important to prevent their dissemination.

Ibrahim Med. Coll. J. 2015; 9(2): 45-51

Effects of aqueous and ethanolic extracts of Aegle marmelos (BAEL) leaves on chronic inflammation in rats

Sharmin Rahman — 2016-07-21

Aegle Marmelos Linn (Rutaceae) is used as ethno medicine against various human ailments. Several curde extracts from various parts (Leaves, flower, stem, root etc) of the plant A. marmelos Linn have shown variable anti-inflammatory effects in acute and chronic inflammation in animal models. The anti-inflammatory effects of A marmelos linn may be of special advantage compared to conventional anti-inflammatory drugs. The present study has therefore been undertaken with the objective to evaluate the anti inflammatory effect of aqueous and ethanolic extracts of A. marmelos leaves, compared to a standard anti-inflammatory drug (indomethacin) in chronic inflammatory conditions. The anti-inflammatory effect was studied in rats using cotton pellet implantation, where granuloma formation was used as an index of chronic inflammation. Aqueous and ethanolic extracts of A. marmelos leaves were given orally for 7 days daily at doses of 100 mg/kg body weight. The percent inhibition of granuloma formation following treatment with aqueous and ethanolic extracts of A. marmelos leaves, and indomethacin compared to control were 16.5%, 25.72%, and 39.37% respectively. The differences were statistically significant (p<0.05 in case of aqueous and ethanolic extracts and p<0.001 in case of indomethacin). The results suggest that in case of chronic inflammation, both aqueous and ethanolic extracts of A. marmelos have significant anti- inflammatory effect. The ethanolic extracts compared to aqueous extract produced greater anti- inflammatory effects.

Ibrahim Med. Coll. J. 2015; 9(2): 52-54