Common bleeding complications of dengue hemorrhagic fever are epistaxis, gum bleeding, gastrointestinal bleeding, menorrhagia, hematuria.1 Major hemorrhage like intracranial hemorrhage have been documented but rare. We present here a case of a 24 year old man with complaints of high grade intermittent fever for 5 days, upper abdominal discomfort for 3 days and swelling of right upper limb for same duration. Laboratory investigations revealed a positive dengue serology, thrombocytopenia and elevated transaminases. USG of the hand revealed a hematoma involving the right upper arm. The patient was managed conservatively with elevation and immobilization of the upper limb and recovered gradually. J MEDICINE 2024; 25: 100-101

Objective To identify the associations of in-hospital cardiovascular events and mortality with pre-existing comorbidities and cardiovascular disease (CVD) risk factors among COVID-19 patients in Bangladesh without vaccine availability.Design A secondary analysis of a prospective multicountry study.Setting Three COVID-19-designated hospitals in Bangladesh.Participants Adult patients aged ≥18 years with PCR-positive COVID-19 admitted between 10 October 2020 and 31 July 2021 at participating hospitals.Outcome measures In-hospital cardiovascular events and mortality.Main exposures Pre-existing comorbidities and cardiovascular risk factors.Results In 897 COVID-19 patients, 18.7% developed cardiovascular events and 12.6% died. After adjusting for clinical information and treatment, patients with two comorbidities (excluding CVD risk factors) were significantly associated with cardiovascular events (adjusted (adj.) OR 2.47, 95% CI 1.24 to 4.90). Patients with a higher heart rate at admission (adj. OR 1.03, 95% CI 1.01 to 1.04) and those who were receiving intravenous fluids (adj. OR 2.13, 95% CI 1.23 to 3.70) or antibiotics (adj. OR 4.54, 95% CI 1.47 to 14.01) had significantly higher odds of cardiovascular events. The odds of cardiovascular events were lower in those receiving antiviral medications (adj. OR 0.31, 95% CI 0.18 to 0.53). There were no interactions between comorbidities and other covariates in the models. Comorbidities and cardiovascular risk factors were not significantly associated with 30-day mortality in the Cox regression models after adjusting with clinical information and treatment. The mortality within 30 days of admission was significantly higher in patients receiving corticosteroids (adj. HR 2.82, 95% CI 1.48 to 5.38) and lower in those receiving antiviral treatment (adj. HR 0.53, 95% CI 0.34 to 0.81). Those having cardiovascular events significantly increased mortality hazard.Conclusions Clinical factors and treatment affected in-hospital cardiovascular events, which subsequently increased the risk of mortality within 30 days for COVID-19 patients. COVID-19 patients regardless of CVD risk factors and comorbidities require close monitoring for cardiovascular events.

Background The safety of health care workers (HCWs) in Bangladesh and the factors associated with getting COVID-19 have been infrequently studied. The aim of this study was to address this gap by assessing the capacity development and safety measures of HCWs in Bangladesh who have been exposed to COVID-19 and by identifying the factors associated with respondents' self-reported participation in capacity development trainings and their safety practices. Methods This cross-sectional study was based on an online survey of 811 HCWs working at 39 dedicated COVID-19 hospitals in Bangladesh. A pretested structured questionnaire consisting of questions related to respondents' characteristics, capacity development trainings and safety measures was administered. Binary logistic regressions were run to assess the association between explanatory and dependent variables. Results Among the respondents, 58.1% had been engaged for at least 2 months in COVID-19 care, with 56.5% of them attending capacity development training on the use of personal protective equipment (PPE), 44.1% attending training on hand hygiene, and 35% attending training on respiratory hygiene and cough etiquette. Only 18.1% reported having read COVID-19-related guidelines. Approximately 50% of the respondents claimed that there was an inadequate supply of PPE for hospitals and HCWs. Almost 60% of the respondents feared a high possibility of becoming COVID-19-positive. Compared to physicians, support staff [odds ratio (OR) 4.37, 95% confidence interval (CI) 2.25-8.51] and medical technologists (OR 8.77, 95% CI 3.14-24.47) were more exhausted from working in COVID-19 care. Respondents with longer duty rosters were more exhausted, and those who were still receiving infection prevention and control (IPC) trainings were less exhausted (OR 0.54, 95% CI 0.34-0.86). Those who read COVID-19 guidelines perceived a lower risk of being infected by COVID-19 (OR 0.44, 95% CI 0.29-0.67). Compared to the respondents who strongly agreed that hospitals had a sufficient supply of PPE, others who disagreed (OR 2.68, 95% CI 1.31-5.51) and strongly disagreed (OR 5.05, 95% CI 2.15-11.89) had a higher apprehension of infection by COVID-19. Conclusion The findings indicated a need for necessary support, including continuous training, a reasonable duty roster, timely diagnosis of patients, and an adequate supply of quality PPE.

Abstract Objectives General: To assess the safety, efficacy and dose response of convalescent plasma (CP) transfusion in severe COVID-19 patients Specific: a. To identify the appropriate effective dose of CP therapy in severe patients b. To identify the efficacy of the therapy with their end point based on clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality c. To assess the clinical improvement after CP transfusion in severe COVID-19 patients d. To assess the laboratory improvement after CP transfusion in severe COVID-19 patients Trial Design This is a multicentre, multi-arm phase II Randomised Controlled Trial. Participants Age and sex matched COVID-19 positive (by RT-PCR) severe cases will be enrolled in this trial. Severe case is defined by the World Health Organization (W.H.O) clinical case definition. The inclusion criteria are 1. Respiratory rate > 30 breaths/min; PLUS 2. Severe respiratory distress; or SpO2 ≤ 88% on room air or PaO2/FiO2≤ 300 mm of Hg, PLUS 3. Radiological (X-ray or CT scan) evidence of bilateral lung infiltrate, AND OR 4. Systolic BP < 90 mm of Hg or diastolic BP <60 mm of Hg. AND/OR 5. Criteria 1 to 4 AND or patient in ventilator support Patients’ below18 years, pregnant and lactating women, previous history of allergic reaction to plasma, patients who have already received plasma from a different source will be excluded. Patients will be enrolled at Bangabandhu Sheikh Mujib Medical University (BSMMU) hospital, Dhaka medical college hospital (DMCH) and Mugda medical college hospital (MuMCH). Apheretic plasma will be collected at the transfusion medicine department of SHNIBPS hospital, ELISA antibody titre will be done at BSMMU and CMBT and neutralizing antibody titre will be checked in collaboration with the University of Oxford. Patients who have recovered from COVID-19 will be recruited as donors of CP. The recovery criteria are normality of body temperature for more than 3 days, resolution of respiratory symptoms, two consecutively negative results of sputum SARS-CoV-2 by RT-PCR assay (at least 24 hours apart) 22 to 35 days of post onset period, and neutralizing antibody titre ≥ 1:160. Intervention and comparator This RCT consists of three arms, a. standard care, b. standard care and 200 ml CP and c. standard care and 400 ml CP. Patients will receive plasma as a single transfusion. Intervention arms will be compared to the standard care arm. Main outcomes The primary outcome will be time to clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality. The secondary outcome would be improvement of laboratory parameters after therapy (neutrophil, lymphocyte ratio, CRP, serum ferritin, SGPT, SGOT, serum creatinine and radiology), length of hospital stay, length of ICU stay, reduction in proportion of deaths, requirement of ventilator and duration of oxygen and ventilator support. Randomisation Randomization will be done by someone not associated with the care or assessment of the patients by means of a computer generated random number table using an allocation ratio of 1:1:1. Blinding (masking) This is an open level study; neither the physician nor the patients will be blinded. However, the primary and secondary outcome (oxygen saturations, PaO2/FiO2, BP, day specific laboratory tests) will be recorded using an objective automated method; the study staff will not be able to influence the recording of these data. Number to be randomised (sample size) No similar study has been performed previously. Therefore no data are available that could be used to generate a sample size calculation. This phase II study is required to provide some initial data on efficacy and safety that will allow design of a larger study. The trial will recruit 60 participants (20 in each arm). Trial Status Protocol version 1.4 dated May 5, 2020 and amended version 1.5, dated June 16, 2020. First case was recruited on May 27, 2020. By August 10, 2020, the trial had recruited one-third (21 out of 60) of the participants. The recruitment is expected to finish by October 31, 2020. Trial registration Clinicaltrials.gov ID: NCT04403477 . Registered 26 May, 2020 Full Protocol The full protocol is attached as an additional file, accessible from the Trial’s website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

Background: Burr hole drainage for chronic subdural haematoma is a common neurosurgical treatment. Traditionally which were done under local anaesthesia with sedation. The primary aim of this prospective study was to assess the effects of Total intravenous anaesthesia with Propofol forBurr hole drainage of chronic subdural haematoma. Method: Sixty adults patients age group ranging from 20-80 years without gender discrimination scheduled for Burr hole drainage of chronic subdural haematoma were enrolled in this study. The patients were randomized into two groups. Group A received Inj. propofol I/V @ 1mg/kg over 10 min followed by 25-50 ìg/kg/ min infusion. Group B received Inj. Midazolam0.05mg/kg I/V followed by normal saline infusion at 0.2 ml/ kg/hr infusion. Perioperative GCS Score, Heart Rate (HR), mean arterial pressure (MAP), SpO2, Ramsay sedation score (RSS), complications, rescue drugs requirements are recorded and compared at specific time. Results: The MAP and HR was monitored throughout the perioperative period in both groups and they were more in Group B than Group A in most time intervals and was statistically significant. The Ramsay sedation score (RSS) was significantly lower in Group B patients when compared with Group A.Perioperative requirements of rescue drugs and complications like nausea, vomiting (11.7%) and shivering (13.3%) consecutively were more in group B than in group A and it was statistically significant. Conclusion: This study suggests that Total intravenous anaesthesia with propofol is safe & effective technique alone for Burr hole drainage of CSDH than local anaesthesia with sedation. It also facilitates patient comfort and surgical competence during surgery, perioperative haemodynamicstability,less perioperative complications, thus reduced hospital stay. Bang. J Neurosurgery 2019; 8(2): 100-104

OBJECTIVES: To use biochemical parameters and FibroScan as noninvasive tool in determination of various stages of liver fibrosis in chronic hepatitis C virus (HCV) patients. METHODS: Total 759 participants (609 chronic HCV patients and 150 normal healthy controls) were recruited from Lady Reading Hospital and Al-Hayat Medical Center, Dabgri garden, Peshawar, Pakistan and analyzed for biochemical markers from February 2015 to January 2017. On the basis of liver stiffness, 609 HCV patients were categorized in 05 groups as per FibroScan findings that include patients with no fibrosis, mild fibrosis, moderate fibrosis, severe fibrosis and cirrhosis. Only those HCV patients who showed presence of HCV RNA (PCR assay) in serum were included in this study. HCV patients who were co-infected with Hepatitis B virus and HIV were excluded from this study. RESULTS: Advance staged disease patients with severe liver fibrosis and cirrhosis showed elevated level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), AST/ALT, total bilirubin and lower level of albumin and haptoglobinas compared to controls and were found statistically significant (P<0.01). Patients group with cirrhosis showed elevated level of AST, GGT, ALP, AST/ALT and total bilirubin when compared to patients group with no liver complications and were statistically significant (P<0.01). Albumin and haptoglobin were significantly lower (P<0.05) in cirrhotic patients compared to those without liver complications. CONCLUSION: Combination of FibroScan and routinely available biochemical parameters are helpful in identifying liver fibrosis and cirrhosis in chronic HCV patients.

Background: Chikungunya virus was introduced into the Dhaka city of Bangladesh and triggered a massive outbreak which affected millions of lives and forced upon significant damages in socioeconomic factors. Objectives: This community based descriptive study was conducted in selected area of Dhaka city to see the clinical profiles of chikungunya patients in Dhaka city. Methodology: This prospective observational study was carried out in the Department of Medicine OPD at Shaheed Suhrawardy Medical College & Hospital (ShSMC), Dhaka, Bangladesh. This cross-sectional study was conducted during the peak of chikungunya outbreak (1st March to 31st August, 2018) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Results: The study included 1133 patients (Male 51.9%and Female 48.1%). The main symptoms were Fever (66%), higher in patients with Joint pain (82%), Rash (21.3%) and others (10.1%).Sensitivity of the patients by acute chikungunya 14.3% and other 85.7%. Patients had post chikungunya complications 14.3% and no complications 85.7%. Chikungunya patients increasing month are March 0.5%, April 0.5%, May 3.4%, June 25.8%, July 50.8%, August 19.1%. In Dhaka cities the affected area were Mirpur 41.7%, Mohammadpur 28.9%, Agargaon 8.8%, Tejgoan 5.9%, Shamoly 5.7%, Adabar 4.4%, Savar 2.0%, Rayerbazar 0.9%, Dhanmondi 0.8%, Mohakhali 0.8%. Conclusions: The result found that gender and age are significantly associated with Chikungunya infection. This study will also help to provide support and services to public health science which will eventually contribute the country for the diagnosis, prevention and control of Chikungunya and similar viral diseases. Overall, it necessitates the importance of utilizing appropriate and reliable diagnostic methods, proper surveillance system and effective control measures that must be implemented to manage the disease outbreak situations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 148-151

Background: A large number of kala-azar cases from a particular village in Debigonj upazila of Panchaghar, a remote district of Bangladesh, led us to carry out the study of the situation. Materials & methods: This cross-sectional study was done among clinically screened people at the health camp in two days in Dararhat in Debigonj upazila of Panchaghar. Results: Around 700 people were screened at the health camp and 51 (7.2%) were suspected to have either Kala-azar or related disorders where 42 (82%) were rk-39 test positive. The disease was more prevalent among adult (59.6%) and children (23.8%) under the age of 10 years. However, there was no clear linear relationship between the prevalence of the disease and age group. Kala-azar occurred in both male and female, and its prevalence did not correlate significantly with income. A history of fever (73.8%) and splenomegaly (45.2%) was noted in most of the kala-azar cases. A significant number of PKDL (26.2%) cases were also found in that area. Conclusions: Since there are a significant proportion of PKDL cases, eradication will be very tough unless the health authority take adequate measure to identify and treat them properly. J MEDICINE JUL 2019; 20 (1) : 25-28

Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder predominantly affecting the women of childbearing age. It often manifests with various constitutional symptoms as well as combination of organ systems involvement and outcome varies in different population with available treatment. The present study is to see the patterns of organ involvement and their outcomes at first 6 months with standard treatment. Methods This was a retrospective study done in lupus clinic of Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh during 2010 to 2016. Patients were included based on ACR lupus diagnostic criteria and had received standard treatment. Outcomes were assessed regularly by clinical features, urinalysis and serum creatinine done in the appropriate cases. Composite endpoint was calculated by using SELENA SLEDAI in all the cases. Results Among 120 patients, 111 (92.5%) were female, age ranging from 14 to 57 years with a mean of 26.5±10.68 (SD) year. Median follow up was 1.7 years. The most common manifestations were fever (70%), joint pain (72.5%), oral ulceration (49%), alopecia (40%), malar rash (28.3%), photosensitivity (25.8%) and Raynauds phenomenon (19%). Commonly involved major organ-systems were renal (40%), neuropsychiatric (19%), respiratory (14%), cardiac (6.6%) and hematological (6.6%). In lupus nephritis, proteinuria was present in 100% of cases. The other parameters of renal involvements were RBC >5/HPF and RBC or cellular cast in 37.5%. Serum creatinine was raised in 23 patients (19.17%) with a mean of 1.68±0.96 mg/dl. Renal biopsy was done in 40 (83.3%) cases. The histology showed class-II in 03 (7.5%), Class-III in 03 (7.5%), class-IV in 20 (50%) and class-V in 08 (20%) cases. With standard treatment, major reduction of mean serum creatinine, 24 hours UTP and SLEDAI were observed in most of the cases at least after 6 months. Total flare occurred in 31 (25.8%) among them renal flare was in 10 (8.33%) and non-renal flare in 21 (17.5%). Four SLE patients died during the course of treatment. Conclusions Renal and central nervous systems are the most commonly involved major organ systems. The overall outcome is favorable with standard treatment. Funding Source(s): None

Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world's thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries.

Cutaneous leishmaniasis is rare in Bangladesh although very few case reports are seen since last few years. But Visceral Leishmaniasis (kala azar) and PKDL are common in this region. In country like ours where tuberculosis and leprosy are more prevalent Cutaneous Leishmaniasis is very likely to be mistreated as Cutaneous tuberculosis especially lupus vulgaris or leprosy. Cases of Cutaneous Leishmaniasis (CL) are usually imported to Bangladesh from other endemic countries. A patient from an endemic area of Cutaneous Leishmaniasis, a non-healing nodulo-ulcerative lesion on exposed part of the body, dermal infiltration with lymphocytes, histiocytes and plasma cells and demonstration of intracellular parasites in lesional skin establish the diagnosis of Cutaneous Leishmaniasis. We present a case of Cutaneous Leishmaniasis in a Bangladeshi adult working in Saudi Arabia for more than 15 years. He presented with multiple ulcerative lesions on nasal bridge, right ear lobule and dorsum of right ring finger. The patient’s clinical history, morphology of the lesions and laboratory analysis were consistent with Cutaneous Leishmaniasis, a rare entity for Bangladesh.Bangladesh J Medicine Jul 2014; 25 (2) : 78-80

Introduction Chikungunya is an arthropod-borne virus endemic to Africa, Southeast Asia and India that causes acute febrile polyarthralgia and arthritis. In this short case series, we discuss six Bangladeshi patients with chikungunya fever. Though Bangladesh is in endemic zone, it is not common here, hence it demands attention for proper diagnosis and management. Case presentation The six cases of chikungunya we report occurred in native Bangladeshi women with ages ranging from 20 to 50 years and all having a middle class family background. Three women had severe incapacitating arthralgia as well as a maculo-papular rash and a high fever. The other three had a high grade fever and arthralgia only, but no rash. They were tested for chikungunya immunoglobulin M antibody and found to be positive in all cases. They were treated symptomatically with non-steroidal anti-inflammatory drugs and found responsive in most cases. Conclusion From this case series, it is evident that chikungunya is not that uncommon in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. An awareness and clinical knowledge are necessary to diagnose chikungunya infection properly.

A 55-year-old woman was presented with fever, splenomegaly, generalized lymphadenopathy and weight loss. The patient came from Sreepur, an endemic region of Kala-azar in Bangladesh. About 2 years back, the patient presented with fever and splenomegaly and on investigation, ICT for Kala-azar was found positive. Thus the patient was diagnosed as a case of visceral Leishmaniasis and was treated with Miltefosin in full dosage form. The condition was improved with the treatment. After about a year of treatment the patient again developed fever and splenomegaly? this time was also generalized lymphadenopathy. Lymph node biopsy showed non-Hodgkin’s lymphoma and bone marrow study showed the presence of LD-bodies. FNAC from cervical and epitrochlear lymph nodes showed the presence of LD bodies without the presence of any malignant cells, so she was diagnosed as a case of treatment failure of visceral Leishmaniasis with lymphatic involvement. DOI: http://dx.doi.org/10.3329/jsf.v10i2.17961 J Sci Found, 2012;10(2):80-84

This paper describes the socio-economic and environmental impacts of battery driven Auto Rickshaw at Rajshahi city in Bangladesh. Unemployment problem is one of the major problems in Bangladesh. The number of unemployed people in Bangladesh is 7 lacks. Auto Rickshaw reduces this unemployment problem near about 2%.In this thesis work various questions were asked to the Auto Rickshaw driver in the different point in the Rajshahi city. Then those data were calculated to know their socio economic condition. The average number of passenger per Auto Rickshaw was determined at various places of Rajshahi city (Talaimari mor, Hadir mor, Alupotti, Shaheb bazar zero point, Shodor Hospital mor, Fire brigade mor, CNB mor, Lakshipur mor, Bondo gate, Bornali, Panir tank, Rail gate, Rail Station, Bhodrar mor, Adorsha School mor). Air pollution is a great threat for human health. One of the major causes of the air pollution is the emission from various vehicles, which are running by the burning of the fossil fuel in different internal combustion(IC) engines. All the data’s about emission from various power plants were collected from internet. Then the amounts of emission (CO2, NOX and PM) from different power plant were calculated in terms of kg/km. The energy required by the Auto Rickshaw per km was also calculated. Then the histogram of emission from different vehicles in terms of kg/km was drawn. By analyzing the data and chart, it was found that, battery driven Auto Rickshaw increases income, social status, comfort and decreases unemployment problems.

This paper describes the socio-economic and environmental impacts of battery driven Auto Rickshaw at Rajshahi city in Bangladesh. Unemployment problem is one of the major problems in Bangladesh. The number of unemployed people in Bangladesh is 7 lacks. Auto Rickshaw reduces this unemployment problem near about 2%.In this thesis work various questions were asked to the Auto Rickshaw driver in the different point in the Rajshahi city. Then those data were calculated to know their socio economic condition. The average number of passenger per Auto Rickshaw was determined at various places of Rajshahi city (Talaimari mor, Hadir mor, Alupotti, Shaheb bazar zero point, Shodor Hospital mor, Fire brigade mor, CNB mor, Lakshipur mor, Bondo gate, Bornali, Panir tank, Rail gate, Rail Station, Bhodrar mor, Adorsha School mor). Air pollution is a great threat for human health. One of the major causes of the air pollution is the emission from various vehicles, which are running by the burning of the fossil fuel in different internal combustion(IC) engines. All the data’s about emission from various power plants were collected from internet. Then the amounts of emission (CO2, NOX and PM) from different power plant were calculated in terms of kg/km. The energy required by the Auto Rickshaw per km was also calculated. Then the histogram of emission from different vehicles in terms of kg/km was drawn. By analyzing the data and chart, it was found that, battery driven Auto Rickshaw increases income, social status, comfort and decreases unemployment problems.

Naphthalene, a widely used industrial and household chemical, has rarely been an agent of poisoning worldwide. Severe haemolysis from naphthalene poisoning is rare and can be a challenge to clinicians. We report a 22-year-old female, who accidentally ingested naphthalene mixed coconut oil and got admitted with recurrent vomiting, headache and passage of dark urine. Severe intravascular haemolysis with hypotension and neutrophilic leukocytosis was detected. She was treated with red blood cell transfusions, intravenous saline infusion and ascorbic acid.

Background. The parasitic causes of diarrhea have historically been identified by use of microscopy; however, the use of this technique does not allow one to distinguish between subspecies or genotypes of parasites. Our objective was to determine, by use of modern diagnostic methods, the proportion of diarrhea cases in Bangladesh attributable to Cryptosporidium hominis, Cryptosporidium parvum, Entamoeba histolytica, and Giardia lamblia assemblages A and B.Methods. A prospective case-control study was performed involving 3646 case patients (both children and adults) who presented with diarrhea to the Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, and 2575 control subjects with asymptomatic infection. Parasitic infection was detected by use of a stool parasite antigen test, and the parasite load and the species and/or genotypes were determined by use of polymerase chain reaction (PCR).Results. Cryptosporidium species and E. histolytica were more prevalent in patients with acute diarrhea than in healthy control subjects, for all ages (2.1% vs. 1.4%; P = .039) and, specifically, for those 0-12 months of age (2.2% vs. 0.4%; P = .009). G. lamblia assemblage A was also more prevalent in case patients with diarrhea than in healthy control subjects (20% vs. 5%; P <.001). For case patients with diarrhea, the parasite load in feces, as measured by quantitative real-time PCR cycle threshold, was not higher that that for control subjects with asymptomatic infection. Case patients with diarrhea and cryptosporidiosis were less likely to have abdominal pain, compared with control subjects (15% vs. 37%; P <.001); case patients with amebiasis more likely to have visible blood in stool, compared with control subjects (8% vs. 1.6%; P <.001); and case patients with giardiasis more likely to be dehydrated, compared with control subjects (81% vs. 71%; P = .001).Conclusion. E. histolytica, C. hominis, C. parvum, and G. lamblia assemblage A infections are important causes of diarrheal illness in Bangladesh.

OBJECTIVE:To determine disease characteristics, check the treatment status and compare outcome with other series.DESIGN AND SETTING:A retrospective study in a single unit of the Department of Surgery of Khulna Medical College Hospital, south west Bangladesh.PATIENTS AND METHODS:After diagnosis by clinical and radiological examination, 491 patients were treated during the period July 1992 to November 2002. Two options of treatment were carried out: simple closure and peritoneal lavage in 364 cases, and 127 patients managed by non-surgical methods.MAIN OUTCOME MEASURES:mortality and morbidities.RESULTS:Male:female ratio was 445:46, average age 43 years. Mortality in the surgical group was 6.8% and in the non-surgical group 0.02%.CONCLUSION:Perforated peptic ulcer is prevalent even after the wide use of H2 receptor antagonists. Strict case selection for surgical and non-surgical treatment has reduced mortality. These results support the case for non-operative treatment and for conservative surgery.

DOI = 10.3329/jom.v8i2.1415Â J MEDICINE 2007; 8 : 81-82