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Background: HbA1c is now accepted as a standard measure for diagnosing type 2 diabetes mellitus. Maternal high HbA1c levels have been associated with increased risk of adverse neonatal outcomes. Objective: To find out the relationship between maternal HbA1c and neonatal outcomes. Materials & Methods: This prospective observational study was conducted from February 2018 to January 2019 in the Department of Neonatology and Department of Gynecology & Obstetrics, BSMMU, Dhaka. Diabetic mothers with known HbA1c Value and their infants who were born in this study period in BSMMU were enrolled. Neonates were divided into two groups. One group that had maternal HbA1c 6%. Neonatal weights, routine capillary blood glucose were recorded. Results: Among the total 94 mothers, HbA1c level were

Background: Despite improvement in overall survival, neonatal period is not free of complications. Ventilator associated Pneumonia (VAP) is a serious complication and account for 6.8 - 32.2 % of healthcare associated infections among neonates. Objective: The objective of the study was to document the effectiveness of an educational programme for neonatal intensive care (NICU) service provider in preventing occurrence of ventilator associated pneumonia in NICU. Methods: It was a prospective cohort study compared with historical control taken from the hospital records. All neonates admitted to the NICU during 12 months period from May 2019 to April 2020 were enrolled. Prospective enrollment of ventilated baby after educational interventions was subjected to the VAP educational care bundle. Eligible neonates who spent more than 48 h on MV were followed up and monitored closely for the development of VAP. Detail history, thorough clinical examination, relevant investigation including chest radiography were carried out on all enrolled infants. Results: A total of 54 neonates ventilated newborn, 41 met the inclusion criteria and were enrolled in the current study; 22 cases in pre-intervention phase and 19 cases in the post- intervention phase. Among enrolled mechanically ventilated newborn, 18 patients (18/41, 44%) developed at least single episode of VAP during the ventilated period. Baseline characteristics were comparable in both the groups. The primary indication of mechanical ventilation was sepsis related complications during both the phases (9/22, 41% and 8/19, 42.1%). Next to sepsis, perinatal asphyxia (5/22, 22.7%) was the indication of MV in pre-intervention period whereas respiratory distress syndrome (7/19, 36.8%) was the second leading causes of MV during post-intervention period. Significant reduction in VAP incidence rate was observed after implementation of VAP interventions, as 13/22, 59 % episodes of VAP were diagnosed in pre-intervention period compared to 5/19, 26.3% were diagnosed during implementation period. (p = 0.035). Non-significant reduction in mean duration of MV days was observed in the post-intervention period when compared to pre-intervention counterpart (7.23±4.48 days versus 5.16±2.77 days, p = 0.089). There was no significant reduction in NICU length of stay (13.05±8.16 versus 11.58±7.75 days in pre and post intervention period respectively, p = 0.56). The difference in overall mortality rates between the two phases were 15/22, 68.18% and 10/19, 52.63% respectively and found to be non- significant. Gram negative bacteria were the most commonly isolated micro-organisms, Acinetobacter was the leading causative pathogen. Conclusion: It demonstrates that an educational program including bundle of infection control practice can reduce the occurrence of VAP during ventilation period. These educational programs for NICU care providers can be expanded to other NICU s of the country to prevent ventilator associated pneumonia. Bangladesh Med Res Counc Bull 2021; 47(2): 143-150

This cross sectional descriptive study was conducted to observe the quality of Pharmacology professional MCQ papers of different Universities of Bangladesh. For this purpose, total 80 MCQ papers of five universities dated from January 2007 to July 2015 were reviewed against a checklist to find out the coverage of recall, understanding and problem solving type questions, content coverage and construction of each question. The mean of recall, understanding and problem based type questions of all the universities were 92.1, 7.8 and 0.1 respectively and all of them statistically significantly differed from curriculum standard. All of the MCQ papers contained more than 75% recall type questions and 27.5% MCQ papers had only recall questions, Only 1(1.2%) MCQ papers contained 100 % topics (all the 11 groups). Eighteen (22.5%) contained 10 groups and 26.3% contained 9 groups out of 11. Forty percent MCQ papers contained less than 80% topics. Most of the stems of the MCQ were in the form of incomplete sentence (53.5%), 28.4% were in the form of complete statement and 16.8% were in the form of single word. Only 0.4% stem were in the form of clinical scenario. Fifty (62.5%) MCQ papers had defective stems and 68.75% had defective options. Total 14 (17.5%) MCQ papers were without any flaw but the rest 88.5% MCQ papers were with flaws either defective stem or faulty options or both. Findings of this study may be used to redefine the distribution of different type of questions in SAQ papers and to improve the quality of question papers by ensuring their coverage. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 49-57

Written examination is an important method for juddering the learning of medical students. Short Answer Questions (SAQ) and multiple choice questions (MCQ) are introduced in MBBS curriculum to assess student cognitive domain. This cross sectional descriptive study was conducted to get the teachers’ opinion about Pharmacology professional written short answer question papers of different Universities of Bangladesh. For this purpose, opinion of total 56 purposively selected teachers of the Department of Pharmacology & Therapeutics of 20 Medical Colleges were collected through self-administered semi-structured questionnaire. Most of the teachers (66% & 61%) were in favour of existing distribution of different types of question in curriculum (recall-60%, understanding -30% and problem based-10%) for short answer question paper (SAQ). Majority of the teachers (66% & 54%) were satisfied with the present coverage of recall and understanding type questions respectively but only 41% teachers were satisfied with the coverage of problem based type questions. Seventy-seven percent teachers were satisfied with content coverage in SAQ papers. Eighty-seven percent teachers were satisfied with present marking scheme on SAQ paper. Findings of this study may be used to redefine the distribution of different types question in SAQ papers and to improve the quality of question papers by ensuring their coverage. Bangladesh Journal of Medical Education Vol.12(1) 2021: 40-49

Background: A competence based and community oriented with reflection of integrated and community based curriculum was introduced in 2002. Objectives: To assess the achievement of objectives of MBBS curriculum-2002 by the Intern Doctors and Clinical Medical Teachers view in Bangladesh. Materials and Methods: This descriptive cross sectional study surveyed on the performance of Intern Doctors about 60- attributes of clinical and generic skills. Results: The overall result revealed that the Interns' could achieve these skills just below the level of an expected standard. The low performance was observed in certain clinical, procedural and management skills like examination of eye, ear, per rectum examination, auscultation of heart and lung, lumber puncture, fluid aspiration, basic CPR, skin sensitivity test, ante natal check-up and conduction of normal labour, systematic interpretation of basic ECG etc. Though few Interns perceived to have attained mastery in some clinical skills but on the other hand 5-10% of other fellows did not even try the skill during the tenure. Conclusion: All learning must occur in an appropriate clinical context and there should be a system of skill assessment for the Interns. Bangladesh Journal of Medical Education Vol.10(1) 2019: 30-33

Introduction: The development of anti-RBC antibodies (alloantibodies and/or autoantibodies) can significantly complicate transfusion therapy, particularly in patients needed repeated transfusion. Objectives: To find out the prevalence of alloantibodies and autoantibodies in repeatedly transfused patients so that serious hazards due to immune reaction may be avoided. Materials and Methods: This descriptive cross-sectional study was carried out in Department of Immunology, BIRDEM and Armed Forces Institute of Pathology (AFIP) during the period of July 2015 to June 2016. Total 370 patients who had received at least five units of transfusions were enrolled in this study but known patients of auto immune haemolytic anaemia, patients in whom antibody was previously detected and pregnant women were excluded from the study. Blood grouping and Direct Anti-globulin Test (DAT) were performed with cell suspension using a poly-specific Coombs reagent. In cases of a positive DAT, further investigation using specific monoclonal reagents to detect IgG or a complement (C3d) was carried out. Serum was used to detect red cell alloantibodies using standard blood bank methods. Antibody identification was performed in antibody screening positive samples using red cell Identicells. Results: Maximum 132 (35.7%) patients were in the age group 1-10 years. The male-female ratio was 1.2:1. Among 370 total patients 290 were HHA and 80 were non-HHA. Antibody was detected in only 17(4.59%) patients. Among the Hereditary Haemolytic Anaemia (HHA) patients it was 11 (3.79%) but among the non-HHA patients it was 6(7.5%). Out of 8 auto-antibodies, 5 were anti IgG followed by 3 were anti C3d. Out of 14 alloantibodies, 4(28.6%) were anti E, 3(21.4%) were anti K and in 3(21.4%) cases specificity of alloantibody was not detected. Conclusion: Prevalence of anti-RBC antibodies was not so uncommon in multiple transfused patients. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 73-77

Introduction: Transfusion of blood and its components such as Packed Red Cell (PRC), Platelet Rich Plasma (PRP) and Fresh Frozen Plasma (FFP) play an important role as a supportive therapy in patients admitted to a hospital. Objective: To conduct an audit of blood transfusion requests regarding demographic data of the recipients, the component therapy, blood groups of the issued units, cross-match transfusion ratio, expiry of the transfusion units, pattern of blood components usage and transfusion reaction for which blood was returned back to blood bank. Materials and Methods: This retrospective crosssectional study was conducted at the transfusion wing of a referral laboratory over a period of three months from January 2013 to March 2013 upon 3015 episodes of transfusion units of whole blood and different blood components. Results: Out of total 3015 episodes of transfusion unit in 1926 recipients, 930 were male and 996 female. About 41.0% requests of transfusion units received from the department of Obstetrics and Gynaecology (OBG) followed by the department of Surgery of about 28.7%. The most commonly used transfusion units was whole blood (55.3%) followed by platelet rich plasma (27.2%). Most of the recipients (62.3%) received single transfusion units and 37.7% recipients of ≥2 units. Out of 3769 cross-match, 3015 transfusion units were issued. In 12 (0.4%) cases, there were minor febrile and allergic reactions. During the study period, shelf life of six transfusion units had expired. Conclusion: This study suggests that either systems audit or medical practice audit of blood and blood component orders can help to reduce the inappropriate or indiscriminate transfusions and may be an important educational tool for the ordering physicians as well as for residents in training Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 3-6

Background: Geographic variations with regard to incidence and histological subtypes are known to occur in Non-Hodgkin lymphoma (NHL). This study was aimed to see the incidence and subtypes of NHL in a group of Bangladeshi population.Methods: This cross sectional study was carried out in Armed Forces Institute of Pathology (AFIP) Bangladesh, from 1st April 2017 to 31st March 2018. All nodal and extranodal tissues which were morphologically diagnosed as NHL were included in the study and immunohistochemistry was done for sub-classification according to WHO classification 2016. Bone marrow trephine biopsy samples were excluded.Results: Total cases: 106, mean age: 48.5 years ± 18.5 (range 2Y 9 M –82 years), male-female ratio: 2.2:1. Total subject of B cell Lymphoma (BNHL): 83 (78.3%) and T cell lymphoma (TNHL): 23 (21.7%). Among BNHL, total subjects of diffuse large B cell lymphoma (DLBCL) 50 (60%), follicular lymphoma 9 (11%), marginal zone lymphoma 8 (10%), small cell lymphoma and mantle cell lymphoma 5 (6%) each, Burkitt lymphoma 4 (5%) and B cell lymphoblastic lymphoma 2 (1.89%) in number. Among TNHL peripheral T-cell lymphoma NOS 11 (48%), anaplastic large cell lymphoma (ALCL) 5 (22%), T cell lymphoblastic lymphoma 4 (17%), and angio-immunoblastic T cell lymphoma 3 (13%) in number. Among 5 ALCL, 4 ALK positive and 1 ALK negative. Number of primary extra-nodal NHL were 29 (27%) with most common involved organ system being GIT and most common histological subtype being DLBCL.Conclusion: Quite similar pattern of age range with mean age, male to female ratio, subtypes and extra nodal NHL distribution prevailing in our subcontinent is found in our population with subtle increased incidence of TNHL indicating the necessity of further large epidemiological study.Birdem Med J 2018; 8(3): 215-222

Background: Multiple Myeloma (MM) is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells, secreting abnormal immunoglobulin causing monoclonal gammopathy which can be detected by the presence of M protein in serum and urine electrophoresis.Aim: Present study is aimed to detect and quantify monoclonal gamma globulins by SPEP and IFE in suspected case of MM and other plasma cell dyscrasias and also to find out the discrepant findings between SPEP and IFE.Methods: A retrospective observational study was carried out on clinically highly suspected cases of Multiple Myeloma (MM) presenting with backache, asthenia and generalized weakness at Armed forces Institute of Pathology(AFIP), Dhaka cantonment from January 2015 to July 2016. A total of 140 blood samples were collected and subjected to serum protein electrophoresis (SPEP) and Immunofixation electrophoresis (IFE). IFE identifies the type of heavy (IgG, IgM or IgA) and light chain (either kappa or lambda in suspected cases of MMResults: Out of 140 cases, SPEP identified monoclonal band in 62 cases and either non-specific findings or polyclonal band in 78 cases. At the same time immunofixation electrophoresis (IFE) which was done on all samples detected another 14 cases of M-band in addition to earlier 62 cases of monoclonal gammopathy by SPEP. Among 140 cases, SPEP detected M-band in 62 cases, whereas IFE identified monoclonal band in 76 cases. So in the remaining 14 cases (10%) small sharp spikes of monoclonal band was found only by IFE whereas SPEP failed to detect those 14 cases.Conclusion: SPEP is an easy to perform laboratory test which can be used for detection and quantification of monoclonal gammopathy but there is some limitation in detecting monoclonal band by SPEP. IFE is more sensitive to detect the monoclonal band than SPEP. So both SPEP and IFE should be done simultaneously for precise diagnosis of MM and related disorders.J Bangladesh Coll Phys Surg 2018; 36(3): 95-100

Background: Fine needle aspiration cytology (FNAC) is now a days the initial investigation in most cases of superficial lymphadenopathy. In clinical practice both clinicians and cytopathologists are not commonly suspecting of Toxoplasma lymphadenitis (TL), though it may constitute a significant proportion of unexplained lymphadenitis. Careful cognizance of cytological findings can give valuable clue to the diagnosis of toxoplasmosis which can be confirmed by serological evidence.Methods: This cross-sectional study was conducted in Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Bangladesh from 01 July 2017 to 31 March 2018. FNAC smears of the patients with lymphadenopathy who reported for FNAC were examined and suspicion of toxoplasmosis was made on coexistence of abundance of ‘tingible body macrophages’ (TBM) and follicular center cells (FCC), small collections of epithelioid histiocytes and absence of necrosis and/or more than occasional giant cells. Serum enzyme linked immunosorbent sorbent assay (ELISA) for Toxoplasma IgM and IgG antibody was then performed in all cases that deemed suspicious for toxoplasmosis for confirmation of the diagnosis.Results: Total 925 patients were examined by FNAC of lymph node. Among them 574 were categorized as reactive hyperplasia (RH). Thirty two patients (5.74%) of RH were suspected as TL and included in the study. Serum ELISA confirmed toxoplasmosis in 22 (68.75%, twelve male and ten female) of these 32 cases. One among the positive cases revealed bradyzoites of Toxoplasma in the smear. The age of the patients diagnosed finally as TL spanned between 5 to 47 years (mean 28.59±11.51 years) though most frequent age group was 26 Yr to 35 Yr (7 cases- 31.8%).Conclusion: A high index of suspicion of TL can be made on careful study of smears of FNAC of enlarged lymph node, diagnosis of which can then be confirmed by ELISA.Birdem Med J 2018; 8(2): 103-107

Sensitivity pattern of isolates from patients’ specimens associated with infection, admitted to the critical care centers with empiric or prophylactic antibiotic use were assessed. Till identification of the organism and resultant sensitivity awaited; and compared with sensitive antibiotic to the isolates which could be used for management. This analytical cross sectional study carried out during the period of April 2016 to July 2016 in the Critical Care Centre (CCC) of Combined Military Hospital, Dhaka Cantonment. Urine and other specimens including wound swab, pus, sputum, tracheal aspirate, catheter tip, nasal swab, high vaginal swab, broncheoalveolar lavage, blood, urethral discharge were collected from the patients following aseptic precautions. Isolate identification was done using standard procedures at the Armed Forces Institute of Pathology (AFIP). Sensitivity was tested using antibiotic disc diffusion technique. A total of one thousand six hundred and seventy patients were dealt with in the study, and positive yield obtained in 190 (11.38%) cases. Of those, 116 were urine specimens which constituted 69 (57.76%) female and 47(42.24%) male patients. A total of 1088 discs of antibiotics were used on an average 9 discs per isolate. Six hundred and forty nine (59.65%) showed resistance to the antibiotic used against them, while four hundred and thirty nine (40.35%) showed sensitive response. The study population was of 2-80 years age group. Other specimens included 74 isolates, fifty (67.57%) were males and twenty four (32.43%) were females. A total of eight hundred and twenty seven (11.18 discs per isolate) antibiotic doses were used 479 (57.92%), showed resistant and 348 (42.08%) sensitive result. Enteric gram negative bacilli (GNB) were the majority of isolates in both types of specimens. The study indicated that, newer antimicrobials have a substantial impact in decreasing human morbidity and mortality rates. It encourages to expand surveillance of antibiotic resistance determinants and to exercise caution in dispensing antibiotics to maximize their continued efficacy. Excess or injudicious use is causing increase in cost as well as inducing drug resistance among the common bacterial isolates. A work on the clinical presentation with trends of antimicrobials used in the CCC setup right now in tertiary care hospital would be of supplemental value for the study.

Background: Blood transfusion is a significant life-saving intervention in the present era of patient management system. As the blood and blood products are a potential source of infection and the necessity of transfusion is increasing day by day, transfusion transmissible infections (TTIs) have become a major threat to ensure safe transfusion. Objectives: The aim of this study was to assess the prevalence of some common and serious TTIs among blood donors as well as evaluate the pattern of seroprevalence in accordance with few other characteristics. Methods: It was a cross sectional study which was conducted at the Department of Transfusion Medicine of Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment from January 2015 to June 2017. Donors were selected very carefully according to criteria of National Guidelines of Bangladesh Government and by using a detailed questionnaire. They were screened properly for HBV, HCV, HIV, Malaria and Syphilis. All positive cases were confirmed again by using more sensitive and specific tests. We analyzed the data as percentage and comparison. Results: A total of 32,625 donors were screened. Among them 28,775 were male and 3850 female. Total 135 were found reactive in the screening assays and among them no one was reactive in more than one assays. The prevalence of HBV and HCV in our study population was 0.38% and 0.03% respectively. It was found that percentage of HBV and HCV seropositivity was more among civilian donors. There was no positive case of Malaria, Syphilis and HIV. The number of seropositive cases were found to be decreased gradually in consecutive years. The study also revealed that both HBsAg and Anti-HCV positive cases were more prevalent amongyoung donors. Conclusion: Our study revealed that a significant number of donors were positive for TTIs who might be a potential source of transfusion related infections. It justifies the necessity of stringent screening of blood donors to prevent the transfusion transmissible infections. Bangladesh J Med Microbiol 2018; 12 (1): 20-23

This cross sectional descriptive study was conducted to observe the quality of Pharmacology professional written question papers of Bangladesh University of Professionals (BUP), University of Chittagong (CU), University of Dhaka (DU), Rajshahi University (RU) and Shahjalal University of Science & Technology (SUST). For this purpose total 82 SAQ papers of five universities dated from January 2007 to July 2015 were reviewed. Question papers were reviewed to find out the coverage of recall, understanding and problem solving type questions, content coverage and presence of marking scheme in SAQ papers. Mean percentage of recall, understanding and problem questions were 54.3%, 44% and 01.7% respectively in SAQ papers. Mean of the recall questions of SUST statistically significantly differed from curriculum standard 60%. Other universities had no significant differences with the standard. Mean of the understanding questions of all the universities statistically significantly differed from curriculum standard 30% except BUP. There was statistically significant difference between mean of the problem solving questions of all the universities and curriculum standard 10% . Most of the SAQ papers (62%) were without problem based questions. No question paper was found having different types question as per curriculum standard. Total 15(18.3%) SAQ papers contained 100 % topics (all the 11 groups). Thirty nine (47.6) contained 10 groups and 22% contained 9 groups out of 11. Twelve percent SAQ papers contained less 80% topics Total 29 (35.4%) SAQ papers of all the universities showed marking scheme on the questions papers, rest 64.6% were devoid of it. Maximum 87.5% SAQ papers of RU had marking scheme. Findings of this study may be used to redefine the distribution of different types question in SAQ papers and to improve the quality of question papers by ensuring their coverage.Bangladesh Journal of Medical Education Vol.8(2) 2017: 12-17

Background: Establishment of full enteral feed is a major challenge in the care of preterm low birth weight (LBW) neonates. Probiotics are live microbial supplements that colonize preterm bowel with favourable flora, improve tolerance to feed and promotes growth of these premies.Objective: To determine the effect of probiotic supplementation on feed tolerance, postnatal weight gain, duration of hospital stay in preterm low birth weight babies.Methods : This prospective clinical trial was conducted in the Neonatal Intensive Care Unit (NICU), Bangabandhu Sheikh Mujib Medical University, (BSMMU) from February, 2012 to November, 2012. A total of 65 preterm, low birth weight ( LBW) newborns were included in this study. A multistrain probiotic suspension was given once daily to the infants in probiotic group along with expressed breast milk (EBM) through the nasogastric tube/ dropper from the first day of feed which was continued till attainment of full feed. Those in controls received only expressed breast milk. Weight, feed volume increment, features of intolerance were followed up daily. Relevant investigations were done whenever indicated.Results: The mean time to reach full enteral feed in probiotic and control group was 13.71±3.4 vs 16.53±6.13; p

Van Wyk- Grumbach syndrome (VWGS) is characterized by juvenile hypothyroidism, delayed bone age, and precocious puberty with a complete reversal to the pre-pubertal state following thyroid hormone replacement therapy. In this study, a 7 years and 1 month old girl presented with precocity having premature menarche, short stature, constipation, delayed bone age and enlarged bilateral multicystic ovaries. She presented with acute abdomen due to torsion of left ovary and had to undergo left sided oophorectomy and right ovarian cystectomy. High serum TSH, low FT4 with high FSH but low LH within pre-pubertal range suggestive of ‘severe hypothyroidism with FSH dominant precocious pseudopuberty’ confirmed the diagnosis of VWGS.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 85-88

In the past decade, the use of flow cytometry in the clinical haematology laboratory has grown substantially due to the development of smaller, user-friendly, less-expensive instruments and a continuous increase in the number of clinical applications. Multiple characteristics of single cells can be analyzed rapidly by flow cytometry. Both qualitative and quantitative information are obtained by flow cytometry whereas previously only in research institutions and esteemed academic centres flow cytometers were found. With advances in technology now it is possible for secondary level hospitals to use this methodology. This paper reviews the selected applications of flow cytometry in the clinical haematology laboratory in Bangladesh. This review serves to awaken the interest of stakeholders involved in the diagnosis and management of haematological malignancies (HM) in the efficacy of flow cytometry in the immunophenotypic characterization of leukaemias and lymphomas. Relevant literature including those provided by different international consensus groups on the phenotypic characterization of HM was reviewed. Additionally, recent reports on the immunophenotypic analysis of HM published in haematology, oncology, pathology, immunology and cell biology journals were also analyzed. Flow cytometric immunophenotyping of HM is highly demanding. It is highly useful in profiling the leukaemias and lymphomas and allows proper ramification along the latest WHO classification guidelines, thereby paving the way for targeted therapy and clinical trial-driven management, significantly outweighs the cost, which can be fully recovered if properly managed. In a low-resource setting like Bangladesh, limited immunohistochemistry serves to bridge the gap in technological advancement.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 74-80

Introduction: In Asia the stone belt has been reported to stretch across our neighbouring countries Pakistan, India, Myanmar etc signifies a higher incidence of renal stone disease in Bangladesh. Objective: To determine the pattern of chemical composition of renal stones by semi-quantitative technique in patients presented to Armed Forces Institute of Pathology (AFIP) and to evaluate the predominant constituent present in them. Materials and Methods: This descriptive study was conducted at Armed Forces Institute of Pathology (AFIP), Chemical pathology department from October 2013 to October 2014. Renal stones of 37 Urolithiasis patients were analyzed chemically, using DiaSys analysis kit, employing titrimetric method for estimation of calcium and colorimetric method for Oxalate, Ammonium, Phosphate, Magnesium, Uric Acid and Cystine. Concentration of each individual component then was expressed in percentage and used to interpret renal stone composition using the calculation scale. Results: Males were more prone to renal stone disease, having male to female ratio 5.2:1. Urinary stones occur in all age groups, in this study age ranged from 4 to 72 years with mean age 38.8±16.0 years and mostly affected was the working age group 21 to 50 years (70.2%). Mixed components (i.e. mixed stone) rather than a single component was the commonest type constituting 83.8% of all renal stones. The commonest mixed stone found was Calcium Oxalate with Apatite (41.9 %). Pure Calcium Oxalate was the 2nd most common (10.8%) variant followed by Struvite stones (5.4%). Cystine and Brushite were the least common renal stones in this study. Conclusion: Calcium Oxalate was the most predominant chemical component in renal stones (94.6%). More research is needed to assess the frequency, types, and correlation of renal stones with environmental, dietary and genetic factors in Bangladesh. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 21-25

Introduction: In the last one decade first generation tyrosine kinase inhibitor (TKI), imatinib mesylate was the choice of treatment in Chronic Myeloid Leukemia (CML) but recently, a considerable number of patients have developed resistance to first as well as second generation TKIs. Objective: To present two cases which were first and second generation TKIs resistant and to review multidrug resistant CML. Materials and Methods: Relevant articles and literatures were retrieved from different journals and web pages to find out the mechanism of development of drug resistance in chronic myeloid leukaemia. Discussion: Two cases of drug resistant CML were found in Combined Military Hospital (CMH), Dhaka cantonment. Extensive review of the literature showed that two mechanisms, namely Breakpoint Cluster Region-Abelson (BCR-ABL) dependent and independent mechanisms, are mainly responsible for multi drug resistant (MDR) CML. In Bangladesh, it is difficult to identify the exact mechanism of development of drug resistance in CML. In a few cases, sample from CML patients are sent overseas to detect any new mutation in TKI binding domain of BCR – ABL fusion gene but it is not possible to find out other mechanisms responsible for drug resistance in CML. Conclusion: To overcome the drug resistance in CML, it is important to use the conventional drugs used in the treatment of CML meticulously and regularly as irregular use and discontinuation of treatment will permit the development of drug resistance. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 135-140

This article has no abstract. The first 100 words appear below: A 30 year old male patient hailing from Jatrabari, Dhaka, the capital city of Bangladesh reported to the Department of Hematology, Armed forces Institute of Pathology, Dhaka Cantonment for the follow-up checkup of hemophilia A by assessing the factor VIII level. The patient had been suffering from mild rise of temperature, cough and weight loss for the last three months. So, he wanted to consult with a hematologist of the department. The concerned hematologist took detailed history of the patient and performed physical examination. History of the patient revealed cough, fever and mild weight loss for the last three months.

Aggregates grown in mild shear flow are released, one at a time, into homogeneous isotropic turbulence where their breakup is recorded by three-dimensional particle tracking velocimetry (3D-PTV). T ...

Aggregates grown in mild shear flow are released, one at a time, into homogeneous isotropic turbulence, where their motion and intermittent breakup is recorded by three-dimensional particle tracking velocimetry (3D-PTV). The aggregates have an open structure with a fractal dimension of ∼2.2, and their size is 1.4 ± 0.4 mm, which is large, compared to the Kolmogorov length scale (• = 0.15 mm). 3D-PTV of flow tracers allows for the simultaneous measurement of aggregate trajectories and the full velocity gradient tensor along their pathlines, which enables us to access the Lagrangian stress history of individual breakup events. From this data, we found no consistent pattern that relates breakup to the local flow properties at the point of breakup. Also, the correlation between the aggregate size and both shear stress and normal stress at the location of breakage is found to be weaker, when compared with the correlation between size and drag stress. The analysis suggests that the aggregates are mostly broken due to the accumulation of the drag stress over a time lag on the order of the Kolmogorov time scale. This finding is explained by the fact that the aggregates are large, which gives their motion inertia and increases the time for stress propagation inside the aggregate. Furthermore, it is found that the scaling of the largest fragment and the accumulated stress at breakup follows an earlier established power law, i.e., dfrag ∼ ∼-0.6 obtained from laminar nozzle experiments. This indicates that, despite the large size and the different type of hydrodynamic stress, the microscopic mechanism causing breakup is consistent over a wide range of aggregate size and stress magnitude.

This article has no abstract. The first 100 words appear below:A 48 year old male attended the cardiac outpatient department with the complaints of chest pain on exertion. Two years back, he developed chest pain on exertion. The pain was retrosternal, dull in nature, non-radiating, aggravated on exertion and relieved by rest. There was no relation with food intake and not relieved by taking H2 blocker. The patient was a known case of hypertension for the last 10 years. He was on antihypertensive medication and his blood pressure was controlled with therapy. There was no history of respiratory distress and cough. With these complaints, he at first attended to a nearby Government medical college hospital in Barisal (South central division of Bangladesh).

This present study was carried out to compare the post-transfusion platelet increment between the apheresis platelet concentrate (n=74) and pooled platelets (n=54). Pre- and post-transfusion platelet count of the recipient were carried out by automated hematology analyzer. In apheresis platelet concentrate group, the mean 24 hours post-transfusion platelet increment was 47 x 109/L which was statistically significant (p9/L which was also statistically significant (p

Aggregates prepared under fully destabilized conditions by the action of Brownian motion were exposed to an extensional flow generated at the entrance of a sudden contraction. Two noninvasive techniques were used to monitor their breakup process [i.e. light scattering and three-dimensional (3D) particle tracking velocimetry (3D-PTV)]. While the first one can be used to measure the size and the morphology of formed fragments after the breakage event, the latter is capable of resolving trajectories of individual aggregates up to the breakage point as well as the trajectories of formed fragments. Furthermore, measured velocity gradients were used to determine the local hydrodynamic conditions at the breakage point. All this information was combined to experimentally determine for the first time the breakage rate of individual aggregates, given in the form of a size reduction rate K(R), as a function of the applied strain rate, as well as the properties of the formed fragments (i.e., the number of formed fragments and the size ratio between the largest fragment and the original aggregate). It was found that K(R) scales with the applied strain rate according to a power law with the slope being dependent on the initial fractal dimension only, while the obtained data indicates a linear dependency of K(R) with the initial aggregate size. Furthermore, the probability distribution function (PDF) of the number of formed fragments and the PDF of the size ratio between the largest fragment and the original aggregate indicate that breakage will result with high probability (75%) in the formation of two to three fragments with a rather asymmetric ratio of sizes of about 0.8. The obtained results are well in agreement with the results from the numerical simulations published in the literature.

This paper presents an experimental investigation of the freezing process of fresh and saline water droplets impacted upon a supercooled surface. Freshwater solidification is a common and highly investigated phenomenon due to its application in the aircraft industry and power transmission lines. The freezing behavior of salt water, mostly encountered in marine vessels and offshore structures, is very complicated compared to fresh water due to the salt content. A comparative effort to analyze the difference and similarity between these two diverse forms are rare due to its application in contrasting industries. The present study correlates the differing ice accretion behaviors of salt and fresh water. The experiments involve the measurement of thermal distribution and physical spreading of fresh and saline water droplets as they strike and solidify on a super-cooled surface. The results show that presence of salt content in water affects the cooling time, splash area and cooling pattern for droplets. The new experimental data provides new insights on the fundamentals of sea water icing and is key to predicting marine icing in offshore arctic and sub-arctic environments.

This paper presents an experimental investigation on the extent of water splash resulting from the collision of a flat water jet onto a vertical surface. The water sheet spread on the plate and its splash, as a result of water breakup, are the most significant phenomena that affect water delivery to marine and offshore structures. In an arctic environment, wave impact and splash can significantly affect ice accretion on a marine structure. To predict ice accretion, water sheet breakup behavior onto a surface needs to be studied closely. The motivation of this experimental study is to further examine water sheet splash. The tests performed in the lab scale setup comprise of high-speed image capture from a water jet-vertical surface collision at various attack angles, which cause mild to severe breakup situations. The results show that variation in jet velocity significantly affects the height, width and splash area of a water sheet. The results also show that attack angle is another significant factor for water trajectory and therefore water shedding beyond the vertical surface. The interdependence in between water trajectory and water shedding provides a new correlation of water transport after water sheet breakup.

Background: Postoperative nausea and vomiting (PONV) is a serious concern in patients undergoing laparoscopic cholecystectomy (LC), with an incidence of 46 to 72%. The purpose of this study was to compare the antiemetic efficacy of intravenous (iv) ondansetron 8 mg, ramosetron 0.3 mg, and palonosetron 0.075 mg for prophylaxis of PONV in high-risk patients undergoing LC. Materials and Methods: In this prospective, randomized, double-blinded study, 87 female patients, 18 to 70 years of age (ASA I and II) and undergoing elective LC under general anesthesia were randomly allocated into three equal groups, the ondansetron group (8 mg iv; n=29), the ramosetron group (0.3 mg iv; n=29), and the palonosetron group (0.075 mg iv; n=29), and the treatments were given just after completion of surgery before extubation. The incidence of complete response (patients who had no PONV and needed no other rescue antiemetic medication), nausea, vomiting, retching, and need for rescue antiemetics over 24 hours after surgery were evaluated. Results: The number of complete responders were 19 (65.5%) for ramosetron, 11 (37.9%) for palonosetron, and 10 (34.5%) for ondansetron, representing a significant difference overall (P=0.034) as well as between ramosetron and ondansetron (P=0.035). Comparison between ramosetron and palonosetron also showed a clear trend favoring the former (P=0.065). Conclusion: Ramosetron 0.3 mg iv was more effective than palonosetron 0.075 mg and ondansetron 8 mg in the early postoperative period, but there was no significant difference in the overall incidence of nausea suffered.

In this paper, arrays of Savonius hydrokinetic turbines are investigated for operation in sub-optimal tidal conditions. The placement and rotation sequence of turbines in the array are investigated to optimize the overall power output. Transient numerical simulations are developed to represent the vortex shedding and capturing by subsequent turbines to investigate the potential to improve the array's performance by strategic placement and rotational sequence of the turbines. The results show that turbine with asymmetrical/counter positioning provide better performance than symmetrical blades.

Many patients requiring plasmapheresis (PE) have renal failure and also need hemodialysis. If done separately almost 6-7 h is required. Hence, we decided to perform the procedures simultaneously in those patients requiring both PE and hemodialysis. The plasmafilter was inserted into the extracorporeal circuit after the hemodialyzer. A total of 8 such sessions of tandem PE and hemodialysis were performed in 2 patients. This is called tandem PE/hemodialysis. The total procedure was completed in the same time as is required for routine hemodialysis. The total amount of priming fluid is also less when PE and hemodialysis are performed separately. Thus, it is economically beneficial to the hospital and also convenient to the patient. Apart from transient episodes of hypotension, which were corrected by saline infusion, no other complications were noted.

We have compared the B cell responses evoked in Bangladeshi, adults (n=11, median age 25 years) and children (n=21, median age 4.5 years), 7 days after intake of each of two doses of an oral, inactivated enterotoxigenic Escherichia coli (ETEC) vaccine composed of formalin-killed ETEC strains expressing the colonization factors, CFA/I, CFA/II and CFA/IV together with 1 mg of recombinant cholera toxin B-subunit (rCTB). The vaccine was well tolerated and only gave rise to negligible side effects. Peak antibody-secreting cell (ASC) response of the IgA isotype were seen 7 days after the first dose of the vaccine. The ASC responses to the different colonization factors (CFs) increased from a 29- to 46-fold (responder frequency 90-100%) in the adults and 13- to 24-fold (responder frequency 67-90%) in the children. The IgA-ASC response to rCTB also peaked after the first dose in the adults (426-fold, responder frequency 100%) and the children (46-fold, responder frequency 95%). Increased IgA antibody levels against CFA/I as well as IgA and IgG antibody levels to rCTB were seen in plasma after immunisation. About 86% of the children and 80% of the adults responded with faecal antibodies to rCTB, whereas about 67% of both groups responded to CFA/I. These results show that a single dose of the ETEC vaccine may elicit significant mucosal immune responses in both children and adults residing in an ETEC-endemic country such as Bangladesh.