Dhaka To Chittagong Flight Bimanual Palpation

Dhaka to chittagong flight bimanual palpation

Dengue Bulletin - World Health Organization. Recommend Documents.

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Wang HT, Ku A reversal of Table 2b lists international arrivals in each sub-region. Table 3 lists dengue cases by country We now invite contributions for Volume 28 The deadline for the receipt of contributions is 30 June Dengue Newsletter. Bulletin - World Health Organization. Dengue Bulletin. These are the highest figures We now invite contributions for Volume 36 The deadline for the receipt of.

Dhaka to chittagong flight bimanual palpation

Dasawisma activity reports are classified into. It calls for targeted attention to the needs and rights of the most vulnerable and excluded,4 to ensure.

Much more than documents.

Rajasthan, Uttar Pradesh and Uttarakhand. A blood film may also show atypical.

Dhaka to chittagong flight bimanual palpation

Cover Dengue Bulletin. A comparison of an in-house IgM and IgG assay with a commercial Bulletin of the World Health Organization. Bulletin of the World Health Organization and decrease perinatal mortality.

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For singleton pregnancies, the adjusted risk ratio aRR for a stillbirth among women Competing interests: None declared. Modern ships, especially those with container The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

The views expressed in this publication are those of the author and do not necessarily reflect the decisions or stated policy of the World Health Organization; however they focus on issues that have been recognized by the Organization and Member States as being of high priority.

The wide geographic spread of both the vectors and the viruses over the last 30 years have led to the development of hyperendemicity in several urban areas in the tropics.


Before the s, only nine countries had epidemic DHF. Today, the number has increased several fold.

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During , the World Health Organization estimated about 50 million infections with over , cases of DHF with at least 12, deaths, mainly among children. A reversal of these trends is the major challenge facing the health communities globally. Endemic countries are striving hard to improve surveillance, particularly pro-active surveillance which entails collection of blood samples to detect the virus genome and to help predict DHF outbreaks.

Cost-effective and sustainable interventions, rapid diagnostics and improved case management to reduce both morbidity and mortality are being pursued vigorously by these countries. Volume 26, includes contributions from four WHO Regions, viz.

The popularity of the Bulletin can be gauged by the fact that we have closed contributions for Volume 27 which is due for publication by the end of We are now inviting contributions for Volume The deadline for the receipt of contributions is 31 January Contributors are requested to follow the instructions carefully while preparing the manuscript.

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The total number of patients were males Thirty-five The dengue virus subtypes alone or in combination were: DEN 2. There was no DEN-1 case.

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Seasonal occurrence of positive cases was: pre-monsoon Most cases were from thickly populated old quarters of Chittagong city, but 2 cases also were found from far off rural areas of Chittagong. Test results from both labs were in full agreement and no clinical correlation was possible. Contrary to our common notion, dengue is present in Bangladesh with high male preponderance, higher frequency related to monsoon, predominant secondary and mixed types and all serotypes of virus except DEN The present situation is possibly an alarming harbinger of a catastrophe warranting appropriate measures in all relevant spheres.

Dhaka to chittagong flight bimanual palpation

Introduction Dengue fever DF is a lesser known infectious disease among the public and the medical profession in Bangladesh. The classical form of dengue has been known for more than a century in tropical southEast Asia and the Western Pacific region.

Dhaka to chittagong flight bimanual palpation

These countries geographically surround Bangladesh. On the other hand, Bangladesh is a country where most infectious diseases are prevailing.

Of these, vector-borne diseases such as malaria, filariasis and kala-azar are endemic. Dengue is a similar vector-borne disease transmitted by Aedes aegypti. All favourable environmental conditions conducive for maintaining such mosquitoes are present here.

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This followed an outbreak in Kolkata India in Some other sporadic studies undertaken with the help of WHO detected evidence of dengue in Dhaka city in the Seventies and Eighties.

But no formal documentation was done and, up to , it was thought that four major cities of Bangladesh were free of dengue haemorrhagic fever 5. But over the last decade the scenario has changed. Dengue and DHF have evolved as serious emerging infectious diseases causing high morbidity and significant mortality in almost all countries in south-east Asia. Thus, there is reason to believe that dengue has a significant presence in the country, which is escaping clinical attention because of the nonavailability of appropriate lab facilities and the clinical features of dengue being nonspecific.

Paired serum samples from each index case were taken.

Dhaka to chittagong flight bimanual palpation

The second sample was taken after seven days of the first sample. Case inclusion criteria: years of age, febrile illness for 72 hours, no focal clinical signs within next 48 hours, chest Xray CXRPA , complete blood count CBC , urine routine examination URE negative for any other infectious diseases, and negative blood slide examination for malaria parasite.


Case exclusion criteria: Clinical review and routine tests revealing any confirmatory evidence of other infectious diseases, refusal to give consent and or samples plus lost from follow-up. Data collection and analysis: A specified data collection form was used for each case. The data was analysed with EPI6 software following the standard format.

Results A total of cases were screened, out of which cases with a mean age of 7.

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Out of these, 35 Age: mean 7. Roughly, the collection covered a part of the monsoon, postmonsoon and pre-monsoon periods. The positive cases showed higher frequencies during the pre- and post-monsoon periods.

But the highest yield was found during the autumn and winter periods Figure 1. But most cases were from the thickly populated old quarters of the city Table 2 and Figure 2 Table 2: Area-wise frequency distribution of positive cases Zone Cases Comments Kotwali 17 The presence of more secondary responses pointed to the fact that the transmission was continuing.

Moreover, the evidence of more than one viral serotypes should be taken as a warning that outbreaks of DHF might occur in the future 7. The interpretation of the study was based on the WHO criteria for HI test, so there might be some lacunae of cross-reaction by other falviviridae infection as evident through some equivocal test results.

However, the overall interpretation was that a low-grade infection and transmission was present. This should warn the health authorities and policy-makers that dengue outbreaks might occur in the future.

From the experiences of other dengue-endemic countries an inference can be drawn that a similar situation might occur in Bangladesh as well 8. The clinical correlation was not possible as clinicians were not acquainted with the presentation and management of dengue cases. Thus in this study, some subtle changes were perhaps ignored which one would take into account after becoming conversant with the condition.

Dhaka to chittagong flight bimanual palpation

During this period a serious dengue outbreak was occurring in neighbouring India 9 and in Thailand There might have been a linkage with the outbreak in India as there is intense population exchange between that country and Bangladesh, not to speak of only the city of the study. The outbreak in Chittagong possibly was of low grade and therefore without any severe syndrome to draw attention by visible characteristic features.

But covert changes may, in future, lead to cases with severe characteristic features. Most cases were from the old quarters of the city which have a high population density.

This reaffirms the role of the predisposing factors for the breeding and sustenance of the vector. These factors are not only present but are constantly increasing. The real concern, however, is the reporting of cases from rural areas; though it is not unusual for dengue to spread to rural areas.

In fact, confirmatory specific lab test is neither essential nor is needed for guiding the clinical management of dengue. But these tests are important for the epidemiological and control programmes. Ideally, sentinel surveillance should be continued where these tests become necessary. From this study it can be concluded that dengue infection is present in Bangladesh, and that its outbreaks may occur any time, and DHF may also take the usual toll of life.

Therefore, national programmes should address the issue appropriately in all its aspects such as diagnosis and clinical management, continued surveillance, capacity-building for lab confirmation and viral isolation.

Moreover, linkages and collaboration should be developed with countries and centres conversant with this public health problem by appropriate utilization of WHO portals and channels. References 1. Am J Trop Med, , 7: Some aspects of epidemiology of Thai haemorrhagic fever