We describe 70 cases of monocled cobra (Naja kaouthia) bite admitted to Chittagong Medical College Hospital, Bangladesh. The biting snakes were identified by examining the dead snake and/or detecting N. kaouthia venom antigens in patients' serum. Bites were most common in the early morning and evening during the monsoon (May–July). Ligatures were routinely applied to the bitten limb before admission. Thirty-seven patients consulted traditional healers, most of whom made incisions around the bite site. Fifty-eight patients experienced severe neurotoxicity and most suffered swelling and pain of the bitten limb. The use of an Indian polyvalent antivenom in patients exhibiting severe neurotoxicity resulted in clinical improvement but most patients experienced moderate-to-severe adverse reactions. Antivenom did not influence local blistering and necrosis appearing in 19 patients; 12 required debridement. Edrophonium significantly improved the ability of patients to open the eyes, endurance of upward gaze, and peak expiratory flow rate suggesting that a longer-acting anticholinesterase drug (neostigmine) could be recommended for first aid. The study suggested that regionally appropriate antivenom should be raised against the venoms of the major envenoming species of Bangladesh and highlighted the need to improve the training of staff of local medical centers and to invest in the basic health infrastructure in rural communities.

We performed an open, randomized chemotherapy trial comparing the recommended first-, second- and third-line drug regimens, as well as mefloquine, for uncomplicated falciparum malaria in Bangladesh in 1996-97. The regimens were chloroquine for 3 days (CQ, Group I), quinine sulphate for 3 days followed by single-dose sulfadoxine-pyrimethamine (Q3 + SP, Group II), quinine for 7 days (Q7, Group III), and mefloquine 20 mg/kg single dose (MEF, Group IV). Subjects were symptomatic patients, aged > or = 12 years, with parasite density 500-250,000/mm3 and no history of taking antimalarials during the previous week. Drug administration was supervised and subjects were followed clinically and with blood slides in the hospital for 8 days, then as outpatients on days 14, 21 and 28. A total of 413 subjects (149, 145, 49 and 70 in Groups I-IV, respectively) completed the study. Early treatment failures (persistent or worsening clinical manifestations by day 3 confirmed with parasitological examinations) occurred only in the chloroquine group. RII and RIII parasitological failures occurred in 56%, 12%, 8% and 14% in Group I-IV, respectively. There were significantly more clinical and parasitological failures with chloroquine than with Q3 + SP, which we now recommend as a better (but far from ideal) choice for first-line therapy. The alternative compounds show parasitogical evidence of Plasmodium falciparum resistance. Further studies are needed to determine the optimum treatment for malaria in Bangladesh.

There are few studies on the relationship between socio-economic factors and rheumatic fever (RF) in the populations where the burden of both socio-economic deprivation and RF is still very high. The aim of this study is to assess the association between some socio-economic factors and RF by examining data available from a RF hospital in Bangladesh. We have reviewed the medical records of patients presenting with manifestations suggestive of RF during a 1-year period. From the patients who showed group A beta-haemolytic streptococcal upper respiratory infection (ABHS infection), 44 RF cases defined by the Jones criteria and 86 control subjects, who did not satisfy the criteria, were identified for analysis. The median age was 12 years and 60% were female. RF was significantly associated with low income (odds ratio [OR] 2.37; P = 0.04); poor living conditions: substandard (kacha) house (OR 2.93, P = 0.02); and poor nutritional status: low height for age (OR 2.68, P = 0.02). Multiple logistic regression analysis revealed an increased OR for kacha house (OR 3.18, P = 0.02) but the same estimate for low height for age (OR 2.68; P = 0.04). Our analysis shows that, among the patients presenting to the RF hospital with proven ABHS infection, acute RF is associated with socio-economic deprivation.

Five varieties of napiergrasses (Pennisetum purpureum) were fractionated botanically into leaf blade, leaf sheath, stem and head. Chemical composition of each of whole napiergrass and their botanical fractions were determined. Correlation, linear and multiple regressions between botanical fractions and nutritive value of varieties of napiergrass were also estimated. All botanical fractions differed due to the effect of variety. Napier Pusha contained the highest proportion of leaf blade and internode, but the lowest proportion of leaf sheath. Napier Hybrid contained the lowest proportion of leaf blade, but highest proportion of node. Consequently, napier Pusha contained the highest (p<0.01) crude protein (CP, 9.0%), but Napier Hybrid had the lowest CP (7.0%). Chemical composition of whole plant differed significantly (p<0.01; except NFE, p>0.05) due to the variety. Not only the whole plant, chemical composition of most botanical fractions of whole plant differed (p<0.05 to 0.01) due to the variety. The intrarelationships between leaf blade and leaf sheath was negative (r=-0.43). Leaf sheath was also negatively correlated to CP, but positively correlated to ash of whole Napier or their botanical fractions. Leaf blade, on the other hand, increases CP but decreases ash content of whole plant or their fractions. These results, therefore, suggest that napiergrass varieties differ widely in terms of botanical fractions and nutritive value, which may have important implications on intake and productivity of animals. Furthermore, napiergrass varieties should be selected for leaf blade only for a better response.

Seed extracts of medicinal plants Leea macrophylla were investigated for phytochemical as well as antibacterial screening. Phytochemical studies of the plant extracts revealed the presence of phenolic, saponin, glycosides, carbohydrate and protein types of compounds. The antibacterial effects of the plant extracts were also tested against several human multidrug resistant pathogens, including one gram positive and three gram negative bacterial species and one fungal species using the disc-diffusion assay. All the plant extracts showed potent anti-microbial effects against gram positive micro-organism (inhibition zone 7-19 mm) whereas none of the extracts produced any potent anti-microbial effects against gram negative bacteria. Furthermore, it has been shown that the extracts exhibit antifungal activities against candida albicans except the extract n-hexane.

Impact of 6-monthly massive dosings of preschool-age children with oral vitamin A (VAC: 200,000 IU of oil soluble retinyl palmitate with 40 IU vitamin E) was evaluated in Bangladesh. In 100 sites, 11,889 households were visited and eyes of 22,335 children aged 3-71 mo were examined. About half the rural target population and less than 20% urban slum population were being reached. Risk of night blindness was halved for children reportedly given VAC, although 2.5% of the reportedly protected population were still night blind. There was no significant reduction in prevalence of Bitot's spot. Risk of corneal ulcers or keratomalacia (X3A/B) was 2.7 times higher in children not given VAC. Based on reported coverage, efficacy of protection against potentially blinding corneal lesions was 63%. For maximum impact on eye lesions, massive dosing with vitamin A at ideally less than 6-monthly intervals needs to be combined with other nutrition and health interventions.

Introduction: Cystic echinococcosis (CE) is reported from nearly all geographic areas of Bangladesh, but little information is available on its epidemiologic and clinical features. The aim of this study was to describe the clinical manifestations of hepatic and abdominal CE cases presenting to tertiary referral hospitals in Dhaka, Bangladesh. Methodology: A retrospective study was conducted via chart reviews of hepatic and abdominal CE patients under care at tertiary referral hospitals in Dhaka, Bangladesh, between 2002 and 2011. Age, sex, education level, occupation, urban versus rural residence, drinking water source, history of dog ownership, cyst type and location, and clinical manifestations were recorded for all patients. Results: Of the 130 patients enrolled, 92 (70.8%) were female and 38 (29.2%) were male. The majority of patients were from rural (76.2%) rather than urban (23.8%) areas. All cases were from the northern part of the country, with no cases reported from the south or southeast. Most patients were between 21 and 40 years of age. A total of 119 patients (91.5%) had cysts only in the liver, with the remaining 8.5% having cysts in both the liver and lungs or in the abdominal cavity. Seventy-six (58.5%) of the hepatic cysts were stage CE1, indicating recent infection. Conclusions: Active transmission of Echinococcus granulosus appears to be occurring in Bangladesh, as indicated by the high number of CE1 hepatic cysts seen at tertiary care hospitals. Community ultrasound screening studies are warranted to better define the distribution of cases and risk factors for parasite transmission.

A cross-sectional study was carried out on 96 commercial layer farms of six upazilas of Khulna district to know the seroprevalence of Mycoplasma gallisepticum (MG) infection during the period from August 2009 to July 2010. A total of 1268 sera samples were collected from randomly selected layer birds of different age groups and tested by serum plate agglutination (SPA) test by using commercial MG antigen (Nobilis ® MG, Intervet International) to detect the presence of antibodies against MG. The overall prevalence of MG infection was recorded as 67.4%. Age-wise analysis revealed that there was significant relationship (p<0.001) between MG infection and age of birds. The highest prevalence of MG infection was 71.2% in 21-56 weeks age group followed by 66.8% in 8-20 weeks age group. There was significant (p<0.001) variation in the seroprevalence in terms of areas of study (upazilas). Significant (p<0.001) effect of seasons in the seroprevalence of MG infection in layer birds was observed in the present study. The prevalence of MG infection was the highest (75.6%) in winter season followed by summer (66.3%) and rainy (60.8%) seasons. The seroprevalence of MG infection was higher in most of the large flocks and lower in small flocks with some exceptions. It is evident from the present study that above 50% layer birds are infected with MG organism. Therefore, it may be suggested that the layer farms should be routinely checked to monitor MG infection and the reactor birds should be culled since MG organism has the potential to transmit vertically.