M Shahidullah

Maxillofacial surgeons often deal with many cases of delayed wound healing, some are related to known risk factors and some are unknown. This study was aimed to assess the histological features of wound healing on day 0 and day 7 in postoperative cases of maxillofacial region in patients with or without risk factors. Microscopic examination of tissue specimen is a reliable and reasonably safe method to evaluate the histological differences. Six known risk factors for delayed wound healing were studied, which are commonly associated with maxillofacial pathology. Both clinical and histological examinations were performed for the evaluation of 32 postoperative cases. Out of 32 patients, 17 patients with risk factor were in study group and 15 apparently healthy persons without risk factor were in control group. Postoperative clinical evaluation of wound was done at 3rd, 5th, 7th, 9th, and 11th day and histological examination of tissue specimen was done on day 0 and day 7. Based on six histological parameters, microscopic examination of tissue specimen was done by both routine Haematoxylin and Eosin stain and Masson's Trichrome stain. In day 7, healing wound of study group having risk factors showed profound amount of granulation tissue, early collagen fibres, plenty inflammatory infiltrate, vertical orientation of reticular pattern of collagen and minimum amount of mature collagen in majority of patients which indicates delayed healing. On the other hand, in control group majority showed horizontally oriented mature collagen fibres in fascicle. Statistically, significant association was found between study and control subjects in terms of pattern of collagen tissue, amount of early and mature collagen tissue at the 7th day of follow up. Clinical evaluation also had strong association with histological state of healing. Key words: Wound healing, Postoperative, Maxillofacial region. doi: 10.3329/bjpath.v24i1.2874 Bangladesh J Pathol 24 (1) : 3-8

This cross sectional observational study was done in the division of neonatology, department of pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) in the year 2007. The study population was 50 newborns in total who needed evaluation of sepsis on clinical suspicion. The main objective of this study was to assess serum procalcitonin (PCT) as a better diagnostic marker than C-Reactive Protein (CRP) in neonatal sepsis. The total study populations were classified into 4 groups like highly probable, probable, and possible and no sepsis group according to the clinical and blood parameters. PCT and CRP were assessed and compared by statistical analysis. For the estimation of PCT and CRP, venous blood was drawn and centrifuged and stored at - 20 degrees C in the refrigerator. Later on PCT was measured by rapid semi quantitative immunochromatographic test. Level of CRP was determined by semi quantitative method (latex). All data were analyzed by SPSS version 10 windows. For statistical analysis appropriate tests were done. In all observations sepsis was found to be more common in male newborns and in those who were delivered by caesarean section. In low birth weight and preterm newborns sepsis was more prevalent. Premature rupture of membrane (PROM) was found to be the commonest maternal clinical condition as a risk factor of sepsis. There was positive correlation between serum PCT and CRP and values of serum PCT as well as CRP differed significantly in the different categories of sepsis indicating relation to the severity of sepsis. PCT is a useful, sensitive and independent biomarker of neonatal sepsis. CRP measurement along with PCT measurement may increase the specificity. Though PCT measurement is comparatively expensive but an easy bed side promt convenient procedure for sick neonates in addition to CRP for rapid evaluation of neonatal sepsis rather than waiting for the report of blood culture.

The present study was undertaken to find out and compare the usefulness of C-reactive protein (CRP) and hematological value with the blood culture in the diagnosis of neonatal sepsis. This prospective and cross sectional study was carried out in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of July 2003 to January 2005. One hundred cases of suspected septicemia and fifty of controls were enrolled in this study. Blood was collected for the estimation of CRP, hematological parameters (total leukocyte count, differential count, platelet count) and blood culture from the newborns having suspected sepsis and CRP and hematological parameters from the control. CRP was raised in 72% of cases and 4% of control. Total leukocyte count (TLC) was elevated in a total of 10% cases and only in 4% controls. Leucopenia occurred in 6% cases. In 50% cases of culture proven sepsis there was thrombocytopenia. Sensitivity and specificity of CRP were 78.6%and 62.5% respectively in suspected neonatal sepsis & 92.86% and 36.11% respectively in culture proven sepsis. This study concluded that CRP is most sensitive method (93%) in culture proven sepsis and (79%) in suspected sepsis and its positive predictive value in suspected sepsis amounts to 88%. In this study among the suspected sepsis TLC and its differential count didn't show any positive results significantly but thrombocytopenia was present in 50% cases of culture positive sepsis. Therefore, CRP can be taken as alternate method for the diagnosis of neonatal sepsis specially in developing countries like Bangladesh.

The antiviral drug acyclovir or its analogue, valacyclovir, has been applied in various trials on Bell's palsy with inconsistent results. We compared the therapeutic effect of famciclovir plus prednisolone with prednisolone alone, in patients with Bell's palsy. In a randomized, prospective trial, 68 patients were randomized to treatment with famciclovir and prednisolone (34 patients) or prednisolone alone (34 patients). All patients underwent supportive therapy. Severity of Bell's palsy was evaluated using the House-Brackmann scale (HBS). Follow-up was done after 1 week, 1 month and 3 months, with complete recovery defined as House-Brackmann grade I. The analysis revealed that recovery rates at month 1 and 3 were significantly higher in combination group than that of prednisolone only group (94.1% vs. 61.8% and 97.1% vs. 74.5% respectively). Again recovery from mild to moderate (HBS-II, III, IV) Bell's palsy occurred completely at month 3 and that of severe (HBS-V, VI) Bell's palsy was two-third of the patients. Again in severe Bell's palsy combination treatment increased the chance of complete recovery more than 10-fold than that of steroid only. The study results suggest that better outcome for Bell's palsy patients occurred if they were treated with prednisolone and famciclovir combination instead of prednisolone alone. In fact a considerable number of patients were benefited from additional antiviral therapy with famciclovir.

Infection in neonates is difficult to identify solely on the basis of physical findings, because signs are not specific. C reactive protein (CRP) is an acute phase reactant which has been used in diagnosis of bacterial infection in neonates. IL-6 is a proinflammatory cytokine produced by monocytes and macrophages activated by bacterial infection. IL-6 can be detected in blood earlier than CRP during the course of bacterial infection. The objective of this study was to compare the usefulness of the level of interleukin-6 with CRP as early markers of neonatal sepsis. This was a queasy experimental study carried out in neonatal unit, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of September 2005 to February 2006. Forty five cases of suspected septicemia were enrolled in the study and thirty healthy newborns were taken for comparison. On the 1st day of symptoms and 1st day of admission, complete blood count, blood for culture and sensitivity and interleukin-6 (IL-6) estimation were done. After 48-72 hours CRP was estimated. In suspected septic babies with high leukocyte count, IL-6 level was found to be raised with high sensitivity (85.71%), negative predictive value (95%). IL-6 was found to have high sensitivity (76.9%), specificity (73.68%), positive predictive value (80%) and negative predictive value (70%) in CRP positive suspected sepsis cases. So, the conclusion was that IL-6 is a very early marker of neonatal infection. IL-6 was mostly positive within 24 hours of onset of sepsis in comparison with other tests. So IL-6 is more useful than other markers for early detection of neonatal sepsis.