Jejunal inflammatory fibroid polyp: a rare cause of intussusception

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

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

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

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

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

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

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

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

Disseminated melioidosis involving skin and joint: a case report

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

Apolipoprotein A-I and B levels in Bangladeshi patients with coronary artery disease

Coronary arteay disease (CAD) is an important cause of morbidity and mortality in developed as well as developing countries like Bangladesh. In this study, the status of serum apolipoprotein A-I (Apo A-1) and apolipoprotein B (Apo B) levels were assessed in Bangladeshi patients with coronary artery diseases. The study was carried out in the Department of Cardiology, University Cardiac Centre (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Total study population was 100, of which 50 were patients with CAD and 50 were individuals without CAD (control). The patients with CAD and controls were enrolled following the inclusion and exclusion criteria. About 5 ml blood was collected by venepuncture from each individual and apolipoprotein A-1 and B were determined by automated nephelometry. The mean age of total study population was 51.4 ± 10.8 years while the mean age of the patients and control was 51.3 ± 10.9 and 51.4 ± 10.9 years respectively. The Apo A-I level was significantly (p<0.01) different in CAD patients compared to control group (95.10 ± 20.50 mg/dl vs 113.47 ± 20.96 mg/dl). The ratio of Apo B and Apo A1 was also significantly higher (p<0.01) in CAD patients than that of controls (1.25 ± 0.40 vs 0.95 ± 0.26 while Apo B levels was not different among the two groups. The study revealed significant alteration of serum Apo A-I level and Apo B/Apo A-I ratio in patients with CAD compared to those without CAD. Further large-scale study is needed to evaluate the exact influence of apolipoproteins on coronary artery disease in Bengali ethnic population.Ibrahim Med. Coll. J. 2015; 9(1): 31-33

Evaluation of structured oral examination format used in the assessment of undergraduate medical course (MBBS) of the University of Dhaka

Objectives of this cross sectional descriptive study was to evaluate critically the current status of structured oral examination (SOE) format as practiced in the professional examination of undergraduate medical course (MBBS) and views of the faculties regarding the concept of SOE as an assessment tool. The study was conducted in 9 medical college examination centers of Dhaka University in July 2007. There were 36 examiners in 18 SOE board, 26 of them were interviewed with a semi-structured questionnaire and SOE boards were observed with a checklist. A total of 2455 questions used in SOE to assess 123 students, were recorded and analyzed using another checklist. These questions were used to assess learning hierarchy and content coverage using forensic medicine as a reference subject. Analysis of the questions revealed majority (97%) were of recall type, only 3% were interpretation and problem solving types. The questions for 119 (97%) examinee did not address 10%-50% content area. About 38% examiners responded that they had no clear idea regarding learning objectives and none had idea regarding test blueprint.The examiners marked the domain of learning measured by SOE in favor of cognitive skill (61%), communication skill (38.5%), motor skill (11.5%), behavior and attitude (19%). No examiner prepared model answer of SOE questions by consensus with other examiner. Though more than 80% examiner agreed with the statement that pre-selection of accepted model answer is an important element for success of SOE. But no examiners of any SOE boards practiced it. Similarly, none of the examiners of SOE board kept records of individual question and the answer of the examinees. No boards maintained equal time for a candidate during SOE by using timer or stop watch. Examiners of 8 boards (44%) did not use recommended rating scale to score individual response of examinee rather scored in traditional consolidated way at the end of the candidate’s examination. Majority (94%) boards scored the prompted answer and allowed another questions when a candidate failed to answer. During SOE conduction, 22% examiner were absent from the board for a prolonged period and 3% was engaged in marking the written scripts. About 56% of the examiners arrived late than schedule time. Behaviors of 14% examiner showed abusing to the candidates. The study revealed that the objectives of introducing SOE as assessment tool in undergraduate medical curriculum was not achieved and it was not appropriately implemented. The various elements of SOE were not followed in most of the sessions of examinations. However, the reasons for not implementing vis a vis following the attributes of SOE were not explored. The study was done only in forensic medicine but similar situations may exist in other subjects. It is recommended that further study may be instituted to determine the causes of not achieving the objective of SOE in undergraduate medical evaluation system. The examiners should be motivated and trained up adequately to implement the elements of SOE successfully as valid, reliable and objective assessment tool.Ibrahim Med. Coll. J. 2015; 9(1): 1-10

Molecular detection of atypical microorganisms in patients with ventilator associated pneumonia

Ventilator-associated pneumonia (VAP) is one of the major causes of morbidity and mortality among the critically ill patients of intensive care units (ICU). The present cross sectional study was conducted to isolate and identify bacterial causes of VAP among the patients admitted in intensive care unit (ICU) of Dhaka Medical College Hospital. The study was conducted between July, 2013 to June 2014. A total of 65 endotracheal aspirate (ETA) and blood samples were collected from patients with clinically suspected ventilator associated peumonia(VAP). Samples were collected from patients on mechanical ventilation for more than 48 hours. ETA and blood samples were cultured aerobically. Multiplex PCR was performed with ETA to detect Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia pneumoniae. Among the atypical bacteria, M. pneumoniae were detected in 5 (7.69%), L. pneumophila in 4 (6.15%) cases by multiplex PCR in ETA from VAP cases. No C. pneumoniae was detected. The study revealed that in VAP cases atypical bacteria should be considered as a possible bacterial agents.Ibrahim Med. Coll. J. 2015; 9(1): 22-25

Atypical central serous chorioretinopathy treated with intravitreal injection of bivacizumab – a case report

Central serous chorioretinopathy (CSCR) is common in adult male having sudden dimness of vision in one eye and typical pattern of leakage in fundus fluorescein angiography. Treatment of typical central serous chorioretinopathy is conservative and / or focal laser photocoagulation. But atypical central serous chorioretinopathy is uncommon having different patterns of clinical presentation and features in fundous fluorescein angiography. Treatment option of atypical central serous chorioretinopathy is not yet established. Here, we present a case of atypical central serous chorioretinopathy successfully treated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF, Bivacizumab).Ibrahim Med. Coll. J. 2015; 9(1): 34-36