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Caesarean section (CS) is the most frequently performed major operation in obstetrics. Its frequency is gradually increasing because of extended indications. Now-a-days, caesarean section is also being performed at patient's request in absence of a medical indication. It is necessary to assess the risk and benefits to take a judicious decision to select cases for caesarean section. The cross sectional descriptive type of observational study was carried out among purposively selected 100 pregnant women admitted to the department of Obstetrics and Gynaecology of Community Based Medical College Hospital, Mymensingh, Bangladesh during the period of August 2011 to January 2012 to identify elective and emergency indications of caesarean section, to identify the common complications to identify the risk factors associated with complications and to establish a comparison between complications of elective and emergency caesarean section. The median age group of patients being operated was 20 to 25 years and operation were carried out on patients due to various indications. Principal indications were faetal distress (26%), PROM (15%), failed progress of labour and breech presentation were 8% each, other indications were eclampsia (4%), obstructed labour (5%), scar tenderness (4%), history of previous 2 caesarian section 5%. The rate of elective caesarean section was 21% while emergency operations were done in 79% of cases. Among the 100 patients 19% patients developed complications. Among the complications wound infection was most common (37%), then post partum haemorrhage and urinary tract infection 26% and 11% respectively. Other complications were abdominal distension, Puerperal sepsis, anaemic heart failure, wound dehiscence and Wound haematoma 5% each. We should try to keep the rate of caesarean section within optimum ranges (10%) as recommended by World Health Organization.

Cervical cancer is a major world health problem and the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. So detection of HPV DNA by PCR may help in early detection and management of cervical cancer. This cross sectional observational study was done to detect L1 antigen gene of HPV from cervical swab by nested PCR. Following universal safety precautions a total of 141 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of MMCH from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh HPV DNA was tested among 141 VIA positive women aged between 20-70 years by nested PCR method. DNA was extracted by phenol-chloroform extraction method. Two pairs of consensus primers MY09-MY11 and GP5-GP6 were used in a nested PCR assay. Histopathological examination was done on 66 samples in the Department of Pathology, MMC, Mymensingh, Bangladesh. A total of 36.9% (52/141) cases were positive for HPV DNA by nested PCR. On Histopathological diagnosis PCR was positive in 42.9% chronic cervicitis, 21.2% CIN cases and 90.9% cervical carcinoma cases. Based on the findings of the study, it may be concluded that the HPV DNA testing has opened the door for an alternative surveillance mechanism to routine cytological screening. Detection of HPV may play an important role in diagnosis and clinical prognosis of precancerous lesions. So PCR may be done for all VIA positive cases for screening of cervical cancer.

Cervical cancer is a major world health problem for women. It is the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. Oncoprotein E6 and E7 play an important role in the development of cervical cancer which can be detected by OncoE6 cervical test. This Cross sectional observational study was performed to detect E6 Oncoprotein from cervical swab by OncoE6 cervical test. Following universal safety precautions a total of 47 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh medical college. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. The swab specimen was treated with lysis solution and conditioning solution. Then the specimen solution was clarified by centrifugation. After that the sample solution was transferred into Detector mAb vial, wash solution vial and finally into developing solution vial. The test unit was then placed on a reading guide. Positive result was indicated by the appearance of purple colored test line. Out of 47 specimens 21(44.68%) were OncoE6 positive by OncoE6 cervical test. Among 21 positive cases 19(90.48%) were HPV-16 and 2 were (9.52%) HPV-18. Histopathologically out of 22 cervical carcinoma cases 20(90.90%) were positive by this test. Based on the findings of the present study, it may be concluded that screening with HPV E6 may minimize the overtreatment as well as the colposcopy referral. So it can be used as primary screening to aid colposcopy and to identify real disease. HPV based screening may help to control cervical cancer in Bangladesh. As HPV is a sexually transmitted infection; so, male screening method should be established.

Hypertensive disorders are one of the most common disorders in pregnancy. They are amongst the major cause of maternal and perinatal morbidity and mortality. Incidence is increasing in developing countries like Bangladesh. This cross sectional descriptive study has done to observe the utilization of antihypertensive drugs in hypertensive disorders of pregnancy and conducted from January 2016 to December 2016 in the department of Pharmacology in collaboration with department of Gynecology and Obstetrics in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Non random purposive sampling technique was used. Total of 300 patients participated in the study, 281 anti partum and 19 postpartum. Age distribution showed 42% patients were in 21-25 years age group. Majority of the participants (91%) were housewife and majority (79%) came from poor socioeconomic status with below SSC education (68%). About 82% patients lived in rural area. Trimester and gravida wise distribution showed most of the participants were 3rd trimester (61%) and primigravida (57%) and only 6% patients belong to postpartum period. In this study preeclampsia was highest (63.8%) among all other types of hypertensive diseases in pregnancy. Majority of the patient were preferred for dual therapy (53%), mono therapy was used in 29% of cases. Most frequently given drug in pregnancy associated hypertension was methyldopa that is 88.33% (single 22.3%, combination 66%). Second most commonly used drug was nifidipine consisting of 47.6% but used in combination in all cases. Average number of anti hypertensive drugs prescribed per prescription was 1.87 and majorities (92%) were from essential drug list but used as trade name. Preeclampsia and eclampsia were more common among the hypertensive disorders in tertiary level hospital cases. Methyldopa was found to be the commonest prescribed antihypertensive in monotherapy and in combination.

Dyslipidemia is one of the major risk factors of cardiovascular diseases. Worldwide, dyslipidemia is estimated to cause about 2.6 million deaths annually. Low drug adherence has been found to be a significant problem leading to poor health outcome. Medication non-adherence in chronic conditions is a recognized, but understudied public health problem. The present study was conducted to observe pattern of adherence to lipid lowering drugs, to find out the causes of non-adherence to medication and see the medication adherence in relation to various factor. The study was performed among 125 cardiovascular disease patients (both indoor and outdoor) of Cardiology department in Mymensingh Medical College Hospital (MMCH) who received lipid lowering drugs at least 6 months.Among them 21.6% patients were highly adherent, 34.4% patient showed medium adherent and 44% patients were low adherence to their treatment plan. Most important cause of non-adherence was financial problem (52.04%). Among them 46-55 years age group were highly adherent, male were more adherent to medication than female. Rich patient were highly adherent. Patient with above higher secondary level of education were highly adherent than others. Patients lived in urban area were more adherent than rural patients. Immediate efforts are required to tackle this situation. Multiple kinds of processes are required to improve the drug adherence such as to provide proper health education focusing on preventive aspect as well as financial support for the care. Such acts might prevent future complication thereby reducing costs of health care and eventually turns out to be reducing morbidity and mortality in the long run.

Typhoid fever is a major health problem in developing countries in spite of the use of antibiotics and the development of newer antibacterial drugs. Blood cultureserological tests (specially Widal test) which are invariably done in Bangladesh for typhoid fever diagnosis give unacceptable levels of false negativefalse positive results respectively. This cross sectional study was done at Bangabandhu Sheikh Mujib Medical University from March 2013 to February 2014. In this study, a polymerase chain reaction-based technique (which has 100% specificity for Salmonella Typhi) was compared with blood culture and widal test among 80 clinically suspected cases of typhoid fever. PCR showed maximum positivity rate (70%) followed by widal test (43.75%) and blood culture (16.25%). PCR showed positive results for 17(48.6%) of 35 typhoid patients with negative results with blood culture and widal test. The results of the study revealed that PCR is rapid and reliable diagnostic technique for detection of S. Typhi in clinically suspected typhoid fever cases, as compared to most commonly done methods such as conventional blood culture, widal test applied.

The present study was designed to know the landing and distribution pathways of fish and types and nature of stakeholders involved in fish distribution chain in Bangladesh. A total of 237 fish landing centers and 5440 markets were detected. The number of landing center and market were highest in Chittagong and Dhaka division respectively. Stakeholders in fish distribution, viz., arotdars, paikers and retailers were found to be 6219, 39506 and 122922, respectively. A 84.71% of the landing centers were found to be operated year round while 15.29% were seasonal. The major fish production zones and major gateways of the country where inland capture and culture and marine capture fish landed were identified. In any locality 62.83% of the landed fish were transported within 100 km area and 5.73% of fish were transported beyond 500 km. The quantity of fish harvested from river, beel, Kaptai lake floodplain, pond, baor, coastal area/sea and shrimp/prawn farm were 5.25, 4.41, 0.13, 35.03, 38.22, 0.23, 10.93 and 5.80%, respectively. The common constraints identified were lack of adequate infrastructure facilities in the landing center and market, unhygienic environment, influence of middlemen, money lending at high rate etc. For the betterment of fish landing and distribution, appropriate authority should pay proper attention so that both quality and fair price are ensured.

A cross sectional descriptive study was performed on 70 post mortem human trachea (44 of male and 35 of female) to find out the difference in length of the trachea of Bangladeshi people in relation to age and sex. The specimens were collected from the morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique. All specimens were grouped into three categories, Group A (upto 20 years), Group B (21-40 years) and Group C (41-60 years) according to age. Dissection was performed according to standard autopsy techniques. The length of the trachea was measured with the help of a metallic tape and data was analyzed by using one way ANOVA test. A general trend of increasing tracheal length was observed as age advanced. The mean±SD length of the trachea was 7.88±1.01cm in Group A, 8.81±0.81cm in Group B and 8.94±1.04cm in Group C. The mean length of the trachea in male were 8.1±0.81cm, 8.95±0.69cm and 8.92±1.1cm in Group A, Group B and in Group C respectively and in female the length were 7.57±1.24cm, 8.61±0.96cm and 9±1cm in Group A, Group B and Group C respectively. Variance analysis shows significant difference in mean length of the trachea between the age Group AB and Group AC but no significant difference was shown between Group BC. No significant difference of length of trachea between male and female was observed. The study would help to increase the information pool on the length of the trachea of Bangladeshi people.

Iron deficiency anaemia is a major public health problem in pregnancy. About 58% of pregnant women in developed countries are anaemic mainly due to iron deficiency resulting a serious negative consequences on children, mothers and eventually on the nation. This quasi-experimental multi centered study (Before after study) was done to evaluate the efficacy and tolerability of Iron Polymaltose Complex (IPC) in the treatment of iron deficiency anaemia and it was performed at the OPD of Bangladesh Medical College and two other clinics of Dhaka city from August 2011 to September 2013. A total of 80 (eighty) subjects were selected by purposive sampling as per inclusion and exclusion criteria. They were treated by Iron Polymaltose-IPC [47mg elemental iron + Folic Acid 0.5mg + Zinc 22.5mg - Once daily orally for 12 weeks]. At the beginning and after 12 weeks of intervention by Iron Polymaltose Complex (IPC) Hb%, Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Serum iron, and Serum ferritin were measured. Data were analyzed by SPSS version 13.0. Paired and unpaired 't' test was used to analyze differences within groups and between groups. Chi-square test was done to analyze primary efficacy parameters and adverse drug reactions (ADR). Most of the respondents were within the age group of 18-23 and 30-35 years (32.6% each). Significant differences were found by treatment with IPC for 12 weeks in Hb%, PCV, MCV, MCH, Serum iron, and Serum ferritin level. In iron deficiency anaemia during pregnancy IPC may be used as a safe and cost-effective therapeutic management.

Bartter syndrome (BS) is a hereditary disease, with an autosomal recessive or autosomal dominant mode of transmission. It is characterized by salt wasting hypochloraemic, hypokalaemic metabolic alkalosis and hyperreninaemia with normal blood pressure. The primary defect is in the thick ascending limb of loop of Henle (TAL). Herein, we report a case that had typical features of BS like severe dehydration, severe hypokalaemia, metabolic alkalosis and failure to thrive but had normal aldosterone level which is very uncommon.

Summary Two Bangladeshi isolates of Newcastle disease virus (NDV), one from a chicken and one from a pigeon, were characterized in this study. Pathogenicity of the isolates was evaluated on the basis of intracerebral pathogenicity index (ICPI). Both the isolates were found to be of velogenic pathotype having ICPI of 1.83 and 1.51 for the chicken and pigeon isolate, respectively. Genotype of the isolates was determined by phylogenetic analysis based on partial F gene sequences. A 766-bp genome fragment spanning partial M and F gene was amplified by RT-PCR and sequenced. The first 354 bp of the coding region of F gene and corresponding deduced amino acid sequences (residues 1–118) of these two NDV isolates were aligned with that of other NDV strains retrieved from GenBank. A phylogenetic tree constructed from the alignment showed that the chicken isolate (BD-C162) belonged to the newly described genotype XIII and the pigeon isolate (BD-P01) to genotype VI. Both the chicken and pigeon isolates possessed a virulent-like fusion protein cleavage site 112RRQKRF117.

Infants born for small for date (SFD) fetuses have an increased risk of perinatal mortality and morbidity. Different methods have been applied to identify these fetuses including history, clinical examination and ultrasonography. Ultrasonography has a better predictive value and majority of such fetuses can be identified. Measurements of the fetal biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) charts are widely used in dating pregnancies and follow-up of pregnant women in assessing fetal growth, identification of small for date (SFD) and growth retarded fetuses. This prospective study was performed to construct fetal chart for BPD, AC and FL at different gestational weeks from the Bangladeshi pregnant women. Seven hundred and ten women had ultrasonic measurements of fetal BPD, AC and FL between 12 to 42 weeks of pregnancy. Centiles, mean and the standard deviation (SD) were calculated for BPD, AC and FL. Mean maternal age was 24.73 +/- 4.48 (Mean +/- SD) and 310 (43.7%) were primigravidae. There was a gradual increase of the BPD (outer-inner), AC and FL measurements of 5th, 10th, 50th and 90th Centiles upto 38th weeks of gestation with a gradual increase of SD showing increasing dispersion of data. In cases of BPD and AC, After 38th weeks of gestation the Centiles showed a slower growth rate towards 42 weeks of pregnancy. This slower growth rate from 38 weeks of pregnancy was not noted in case of femur length. Fetal charts with the raw data for each measurement with superimposed fitted lines derived from polynomial (quadratic) regression were constructed. Quadratic model showed good fit to the data during construction of fetal charts. The new fetal measurement charts of BPD, AC and FL are unique for the Bangladeshi population and have not been found similar in the later weeks of pregnancy to those published for other Caucasian populations. These charts will help the clinicians and sonographers in dating pregnancy, identifying SFD and growth retarded fetuses.

This cross sectional study was conducted in the department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University, Dhaka during July 1997 to June 1998. Two hundred and twenty (220) Bangladeshi premenopausal and post-menopausal women aged from 35 to 55 years were studied to compare the effect of age, parity, socioeconomic status and nutritional status on bone mineral density (BMD) of distal and ultra distal ends of radius and ulna. A bone densitometer (Single photon X-ray absorptiometry, DTX100, USA) was used to measure the BMD. BMD was calculated by taking the mean of the two sites and is expressed in g/cm2. Bone mineral density in post-menopausal women (0.48 +/- 0.1 g/cm2) was significantly lower than pre-menopausal women (0.61 +/- 0.06 g/cm2, p0.001). Parity and number of family members were significantly greater in post-menopausal women compared to pre-menopausal women (6.5 +/- 2.9 vs. 4.2 +/- 2.3 and 8.1 +/- 2.5 vs. 6.2 +/- 2.3 respectively, p0.001). Height was significantly lower in post-menopausal women (148.6 +/- 6.9 vs. 151.8 +/- 5.7 cm, p0.001). After adjustment of various biological factors in multiple linear regression, body mass index (BMI) showed negative relationship with age (slope -0.0068, p0.001) and positive relationship with weight (slope 0.0011, p0.05). Peak BMD was observed upto the age of 40 years and thereafter declined and sharply after menopause. The study concluded that bone mineral density is greater in pre-menopausal women than post-menopausal women and remains high up to 35-40 years of age, and declines to older age. BMD positively correlates with weight of women. Premenopausal women have higher height than postmenopausal women though height does not have correlation with BMD in this study.

This study was performed to identify the seroprevalence of rubella IgG among the antenatal population attending a tertiary level hospital in Bangladesh. Sera from 609 pregnant women were tested for rubella IgG antibody using enzyme linked immunosorbent assay (ELISA) technique. Of the 609 pregnant women, 85.9% were seropositive and 14.1% were seronegative. The prevalence of the antibody was 80% between 15 and 20 years of age. This figure gradually increased with age until it peaked at 90.2% in the age group of 31-36 years. Then the seropositivity decreased to 81.3% in the age group of36 years. No statistically significant difference of seroprevalence was found among housewives vs service-holders. This small preliminary study indicates that, like many other countries rubella is endemic in Bangladesh. The results of this study indicate the need for more detailed epidemiological studies to be used as the basis for a national immunization programme.