Detection of OXA-181/OXA-48 carbapenemase producing Enterobacteriaceae in Bangladesh

Carbapenem resistant Enterobacteriaceae (CRE) is becoming a major public health concern globally. Detection of carbapenem hydrolyzing enzyme carbapenemase in Enterobacteriaceae is important to institute appropriate therapy and to initiate preventive measures. This study was designed to determine the presence of carbapenemase producers among the CRE isolated from patients at Dhaka Medical College Hospital, Bangladesh. Twenty-nine CRE strains detected by disk diffusion technique were included in the study. Minimum inhibitory concentration of imipenem and tigecycline was determined by agar dilution method. Carbapenemase production was phenotypically detected by Modified Hodge test while MBL producers were detected by combined disk and double disk synergy tests. Genes encoding blaNDM-1, blaOXA-181, blaOXA-48, blaKPC, blaCTX-M-15, blaOXA-1-group were identified by polymerase chain reaction (PCR). Out of 29 CRE, nineteen (65.6%) were positive for carbapenemase by any of the three phenotypic tests namely MHT, CD or DD tests. Those 19 isolates were also positive either for blaNDM-1 or blaOXA-181/blaOXA-48 by PCR. Of the 19 PCR positive isolates, the rate of positivity for blaNDM-1, blaOXA-181/blaOXA-48 and blaNDM-1+ blaOXA-181/blaOXA-48 was 73.7% (14/19), 57.9% (11/19) and 31.6% (6/19) respectively. Both blaOXA-181 and blaOXA-48 co-existed. All the carbapenemase producing organisms harboured blaCTX-M-15 except one C. freundii strain. The rate of resistance to different classes of antibiotics ranged from 63.2% to 100% except colistin and tigecycline. Organisms positive for OXA-181/OXA-48 had a low level of resistance to carbapenem (MIC 1 - 4 μg/ml) while with NDM-1 had high level resistance to imipenem (MICs 16 - ³ 32 μg/ml). Out of 19 carbapenemase positive isolates, 12 (63.16%) were extensively drug-resistant (XDR) and were only sensitive to tigecycline and colistin. The result of this study showed the presence of blaOXA-181/ blaOXA-48, blaNDM-1 positive strains in Bangladesh and colistin and tigecycline were the most effective drugs against carbapenemase producing Enterobacteriaceae (CPE). Epidemiological monitoring of carbapenemase producing organisms in Bangladesh is important to prevent their dissemination. Ibrahim Med. Coll. J. 2015; 9(2): 48-5

Molecular detection of atypical microorganisms in patients with ventilator associated pneumonia

Ventilator-associated pneumonia (VAP) is one of the major causes of morbidity and mortality among the critically ill patients of intensive care units (ICU). The present cross sectional study was conducted to isolate and identify bacterial causes of VAP among the patients admitted in intensive care unit (ICU) of Dhaka Medical College Hospital. The study was conducted between July, 2013 to June 2014. A total of 65 endotracheal aspirate (ETA) and blood samples were collected from patients with clinically suspected ventilator associated peumonia(VAP). Samples were collected from patients on mechanical ventilation for more than 48 hours. ETA and blood samples were cultured aerobically. Multiplex PCR was performed with ETA to detect Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia pneumoniae. Among the atypical bacteria, M. pneumoniae were detected in 5 (7.69%), L. pneumophila in 4 (6.15%) cases by multiplex PCR in ETA from VAP cases. No C. pneumoniae was detected. The study revealed that in VAP cases atypical bacteria should be considered as a possible bacterial agents. Ibrahim Med. Coll. J. 2015; 9(1): 22-2

Assessment of Traffic Induced Noise Pollution Indices and its Impact on Students' Health at Bangladesh Agricultural University

The Bangladesh Agricultural University (BAU) is a prime campus of agricultural study on 488 hectares of scenic land on the western array of the old Brahmaputra River. This study aimed to measure the prevailing levels of traffic induced noise pollution at the core academic points and to assess the impacts of noise pollution on students' health at BAU. The recorded Lave ranges from 55–85 dB. The Lave ranges from 79–85 dB throughout the whole day at FoA and FoAH. The Lave at these two core academic points are almost the double than the permissible limit of 45 dB. The Lmax pressure (96 dB) at Jobber moor during the noon is the maximum inside the whole BAU campus. The movement of traffic vehicles is responsible as the main sources of these noise. The noise level indices and their degree of fluctuation as given by Leq, Lnp, and NC are higher in roadside locations namely at FoA, FoAH, FoAERS. In terms of noise pollution, three of the sampled areas namely FoA, FoAH, and KR market show ‘moderate risk' (Lave: 81 dB) during the morning whilst, the FoAH possessed the ‘high risk' with the Lave of 85 dB. The results show that the FoA, FoAH, KR market, Jobber moor, and administration building can be labelled as the highest zone of noise level intensity. Due to excessive noise, university students are facing disorders like irritation, headache, nervousness, insomnia, anxiety, hearing problem, and hypertension. Controlling noise pollution is an absolute necessity for BAU to ensure noise-less academic culture whilst the dwellers of BAU is in the risk of serious noise-related health hazards. The results would be very useful for BAU authority to monitor and formulate a structural noise management policy, and to control excessive noise at our beloved BAU. [J Bangladesh Agril Univ 2023; 21(2.000): 233-243

Development of a context specific accreditation assessment tool for affirming quality midwifery education in Bangladesh

OBJECTIVE: using the International Confederation of Midwives (ICM) Global Standards for Midwifery Education as a conceptual framework, the aim of this study was to explore and describe important 'must haves' for inclusion in a context-specific accreditation assessment tool in Bangladesh. DESIGN: A questionnaire study was conducted using a Likert rating scale and 111 closed-response single items on adherence to accreditation-related statements, ending with an open-ended question. The ICM Global Standards guided data collection, deductive content analysis and description of the quantitative results. SETTING: twenty-five public institutes/colleges (out of 38 in Bangladesh), covering seven out of eight geographical divisions in the country. PARTICIPANTS: one hundred and twenty-three nursing educators teaching the 3-year diploma midwifery education programme. FINDINGS: this study provides insight into the development of a context-specific accreditation assessment tool for Bangladesh. Important components to be included in this accreditation tool are presented under the following categories and domains: 'organization and administration', 'midwifery faculty', 'student body', 'curriculum content', 'resources, facilities and services' and 'assessment strategies'. The identified components were a prerequisite to ensure that midwifery students achieve the intended learning outcomes of the midwifery curriculum, and hence contribute to a strong midwifery workforce. The components further ensure well-prepared teachers and a standardized curriculum supported at policy level to enable effective deployment of professional midwives in the existing health system. KEY CONCLUSIONS: as part of developing an accreditation assessment tool, it is imperative to build ownership and capacity when translating the ICM Global Standards for Midwifery Education into the national context. IMPLICATIONS FOR PRACTICE: this initiative can be used as lessons learned from Bangladesh to develop a context-specific accreditation assessment tool in line with national priorities, supporting the development of national policies