Introduction: Pneumothorax occurs more frequently in the neonatal period than in any other period of life & is associated with increased mortality and morbidity. Several risk factors for pneumothorax, including respiratory pathology, invasive and non-invasive respiratory support & predictors of mortality have been described. Objective: To evaluate the prevalence of pneumothorax, to identify underlying causes & to describe the clinical characteristics, management and outcome of neonates with pneumothorax, as well as to identify predictors of mortality in these neonates. Methods: A retrospective chart review of neonatal records included all neonates hospitalized in the NICU of 'Ad-din Women’s Medical College' Dhaka, between January 2016 & December 2017 with the diagnosis of pneumothorax. The collected data included: demographics & perinatal data, characteristics of pneumothorax, classification, treatment & clinical outcomes. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 16. Results: Our study included 83 neonates, of whom 48 were male (57.83%) & 60 (72.29%) born by lower uterine caesarean section (LUCS). Median gestational age(GA) was 36 (32-41) weeks & the median birth weight(BW) was 2,558 (1500-3800) grams. The prevalence of neonatal Pneumothorax in our centre was 2.60% & that of Spontaneous Pneumothorax was 1.53%. The analysis of perinatal data showed statistically significant differences in APGAR score at 5th minute (p = <0.00001) & in resuscitation at birth (p < 0.00001). Pneumothorax was significantly associated with RDS, pneumonia, Meconium aspiration syndrome (MAS) & Perinatal asphyxia (PNA), (p=0.235893) and all (n=6) death were observed in neonates who had coexisting diseases, (p=0.00226). Forty nine (59.04%) was SP (p = 0.002) & mainly observed in the right lung (77.11 %( (p=0.00011). To treat the pneumothoraces, 64 (77.11%) neonates only received oxygen therapy, 16 (19.28%) neonate needed MV along with chest tube (CT) drain, 02(2.41%) thoracentesis with needle aspiration, and 01 (1.20%) needle aspiration & chest tube (CT) drain (p <0.00001). Clinical data suggest that complications such as sepsis, severe hypotension, Necrotizing enterocolitis (NEC), DIC, Intraventricular haemorrhage (IVH) can negatively affect immediate outcomes (p=0.00025). The mortality rate was 7.23%. All the mortalities observed in neonates who got respiratory support with mechanical ventilation (MV) along with CT insertion (p=<0.00001). Hypotension, sepsis, DIC, IVH, MV and thoracentesis followed by a CT insertion were found to be predictors of mortality in neonates with pneumothorax. Conclusion: NP may develop during the neonatal period, especially in the presence of underlying clinical conditions, and neonates with pneumothorax managed with CT drain and respiratory support (MV), despite treatment have a high mortality rate. Bangladesh Crit Care J March 2019; 7(1): 12-19

The experiment was carried out to investigate the species composition of fish and prawn in Ruhul beel and Bamonji beel under Chalan beel of Pabna district of Bangladesh. Data were collected from selected sanctuary sites, focus group discussion, personal and group contract as well as Government and Non-Government organizations with prepared and pretested questionnaire. A total of 38 fish species belonging to 24 Genus, 17 families and 8 orders (7 fish, 1 prawn) were recorded during the study period at Ruhul beel and Bamonji beel. The largest order recorded for both beels according to species frequency were Cypriniformes and Perciformes which contributed 36.84% (14 species) and 35.14% (12 species) for Ruhul beel and Bamonji beel followed by Perciformes and Cypriniformes which contributed 34.21% (13 species) and 32.43% (12 species) for Ruhul beel and Bamonji beel, respectively. The third largest species was Siluriformes for both beels contributed 10.53% (4 species) and 10.81% (4 species) to Ruhul beel and Bamonji beel, respectively followed by Channiformes which contributed 7.89% (3 species) and 8.11% (3 species) to Ruhul beel and Bamonji beel, respectively. The prevalence of other 4 orders was Beloniformes, Cyprinidontiformes, Decapoda and Tetraodontiformes both were contributed 2.63% (only 1 species) to Ruhul beel and 2.70% (only one species) Bamonji beel.

Background: Neonatal infections are the commonest cause of neonatal mortality along with perinatal asphyxia and consequence of Prematurity and Low Birth Weight (LBW) in Bangladesh. Early Onset Neonatal Sepsis (EONS) is neonatal sepsis occurring within the first 72 hours of birth and it is much more fulminant and has a higher mortality than Late Onset Sepsis (LOS). Sepsis in neonate remains a significant cause of mortality and morbidity in developing countries. Changing bacterial flora and emergence of resistant strains adds to the problem. Thus, neonatal sepsis requires accurate and timely clinical and laboratory diagnosis and proper management for better outcome. The organisms responsible for Early Onset Sepsis (EOS) are different than Late Onset Sepsis (LOS). In this study an attempt has been made to know the positivity rate of EOS and profile of bacteria responsible for EOS and determine the antimicrobial sensitivity pattern that were investigated for rule out sepsis. Methods: This was a prospective observation single centre study over a period of nine months (January to September, 2017) conducted on neonates born at Ad-din Medical College Hospital (AMCH), Dhaka and subsequently admitted in Neonatal Intensive Care Unit (NICU) within 72 hours of birth that were investigated for rule out sepsis. Dual blood sample for cultures from separate area along with essential investigations were sent by collecting samples under aseptic precautions. Empirical antimicrobial therapy was started according to antimicrobial guidelines in the NICU. The blood cultures test were carried out by BD BACTEC automated blood culture system and susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Results: A total of 700 neonates were investigated to rule out sepsis and 5.43% neonates were found with culture proven sepsis in the study. The gram positive bacteria accounted for 71% and gram negative 29% of the total isolates. Out of total 38 isolates, Coagulase-Negative Staphylococci (CONS) (68.4%) was the commonest followed by Acinetobacter (18.4%) and E. coli (7.9%) was common culture isolates. Among the gram positive, CONS (96.3%) was commonest isolate and in gram negative Acinetobacter (63.6%) was the most prevalent bacteria followed by E.coli (27.3%). Gram positive isolate, especially CONS (68.4%) was the major culprit for the early onset sepsis. Among the commonly used antibiotics, the susceptibilities were remarkably low to Amikacin (16%) in comparison to Ampicillin (42%) Cefotaxime (45%) and moderately high to Gentamicin (58%) for both gram positive & gram negative isolates. All (100%) gram positive isolates were resistant to Amikacin. Majority of the gram positive showed low susceptibilities to Meropenem (22%) Ciprofloxacin (41%) Ampicillin (48%) & Oxacillin (48%) in comparison to Cefotaxime (52%) Levofloxacin (55%) Gentamicin (70%), Linezolid (70%) and Vancomycin (74%). 50% of Coagulase Negative Staphylococcus (CONS) were resistant to Methicillin/Oxacillin. The sensitivity pattern of majority of gram negative isolates showed high level of resistance to Piperacillin+Tazobacterm (9%) and Ampicillin (27%) Gentamicin (27%) Cefotaxime (27%) less sensitive to Ciprofloxacin (45%); moderately high to Levofloxacin (54%) & Amikacin (54%) and highly sensitive to Imipenem/Meropenem (73%) & Colistin (91%). Gentamicin (58%) and Levofloxacin (55%) were showed marginal superiority compared to Ampicillin (42%) and Cefotaxime (45%) for effective coverage of both. Conclusion: Present study indicated that gram positive species especially CONS continue to be the predominant causative organism followed by Acinetobacter and E. coli in gram negative species. The antibiotic susceptibility profile suggested that for a given cohort empiric (initial) choice of Ampicillin and Gentamicin in EOS. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 3-8

Fungi are a diverse group of microorganisms that play many roles in human livelihoods. However, the isolation of potential fungal species is the key factor to their utilization in different sectors, including the enzyme industry. Hence, in this study, we used two different fungal repositories—soil and weed leaves—to isolate filamentous fungi and evaluate their potential to produce the cellulase enzyme. The fungal strains were isolated using dichloran rose bengal agar (DRBA) and potato dextrose agar (PDA). For cellulase enzyme production, a rice straw submerged fermentation process was used. The enzyme production was carried out at the different incubation times of 3, 5, and 7 days of culture in submerged conditions with rice straw. Fungal identification studies by morphological and molecular methods showed that the soil colonies matched with Trichoderma reesei, and the weed leaf colonies matched with Aspergillus awamori. These species were coded as T. reesei UMK04 and A. awamori UMK02, respectively. This is the first report of A. awamori UMK02 isolation in Malaysian agriculture. The results of cellulase production using the two fungi incorporated with rice straw submerged fermentation showed that T. reesei produced a higher amount of cellulase at Day 5 (27.04 U/mg of dry weight) as compared with A. awamori (15.19 U/mg of dry weight), and the concentration was significantly different (p < 0.05). Our results imply that T. reesei can be utilized for cellulase production using rice straw.

Background: Perinatal asphyxia (PNA) remains a significant cause of death and disability despite the important advances in perinatal care in the past decades. Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. Estimates of the incidence of perinatal asphyxia vary, in resource-rich countries is about 1/1000 live births and in resource-poor countries is probably much more common, an incidence of 5–10/1000 live births and represents the second most common cause of neonatal death (24%) after preterm birth related complications (35%). About one quarter of all neonatal deaths globally are caused by PNA & an equal number of serious neurological consequences ranging from cerebral palsy & mental retardation to epilepsy. Objective: To determine how well neonatal arterial blood pH and base deficit predict immediate outcome (survival to discharge) following perinatal asphyxia. Methods: This was a prospective study conducted in the delivery room and adjacent neonatal area (NICU) of Ad-din Medical College Hospital (AMCH), over 6 months from 1st June and 30th November, 2017. Research assistants were trained to observe and record events related to labor and neonatal resuscitation. Patient information was obtained which included patient characteristics (gender, birth weight & gestational age) and APGAR scores at and beyond 5 minutes. Within one hour of delivery all admitted neonates were subjected to an arterial blood gas (ABG) analysis by GEM Premier 3000 blood gas analyzer and pH and base deficit were noted. All the neonates were classified according to GA, BW and Gender. After proper cleaning the collected data were analyzed thoroughly. Descriptive analyses were performed; differences in outcome by GA, BW, Gender, APGAR scores and ABG (pH and base deficit) status were determined using analysis of variance. Analyses were performed using the Statistical Package for Social Sciences (SPSS) version (Chi-Square test). Results: A total 50 neonates were studied in this period of which 72% survived & 28 % expired. Death was mostly observed in neonate who had very high level of base deficit (> 20mmol/L) & very low pH (pH <7.0) in 1st hour postnatal ABG. Survival rate was higher, 94.7% in >35 - <37 weeks GA group in comparison of >37 weeks (58%) of GA (p = 0.0050). The neonates with birth weight (BW ) >2000 - <2500 gm were observed 77.78% survival and 68.75% in neonates with BW >2500gm (p = 0.494). In this study most of the neonates were male (70%) & recovery rate was relatively better among baby boys (74.3%) than baby girls (66.67%) (p = 0.582). High APGAR score neonates had better rate of recovery than poor APGAR score neonates. The neonates with APGAR score 4-6 beyond 5 minutes were observed 88.33% survival & the neonates with APGAR score 0-3 beyond 5minutes were 55% survival (p= 0.028). High pH value neonates in 1st hour ABG were found higher rate of survival in comparison to low pH value neonates. It was 83.33% in pH 7.10- <7.20 neonates, 72.73% in pH 7.0- <7.10 neonates and 33.33% in pH <7.0 neonates respectively (p=0.0136). The neonates with high level of base deficit in 1st hour ABG showed lower rate of survival than low level of base deficit neonates. It was 12.5% in base deficit > 20mmol/L neonates, 33.33% in base deficit > 15 - 20mmol/L neonates & 87.18% in base deficit > 12 -15mmol/L neonates respectively (p=0.00003). Conclusion: From this study it is concluded that initial pH and base deficit of 1st hour ABG of neonates along with APGAR score at or beyond 5 minutes is a good predictor of risk & immediate outcome following perinatal asphyxia. A good percentage of neonates recover due to early diagnosis, meticulous nursing care and timely intervention. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.238-243