Role of Intraoperative Coeliac Plexus Neurolysis on Postoperative Pain Management for Chronic Pancreatitis

Control of pain in patients with chronic pancreatitis is difficult because 30.0% to 50.0% of patients still experience persistence or recurrence of pain even after surgery. So a combined approach of surgery and coeliac plexus neurolysis was carried out in this study to see the relief of pain and reduce the requirement of analgesics in these patients. This prospective observational comparative study was carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2017 to October 2018. Forty one (41) study participants with the diagnosis of chronic pancreatitis were included consecutively in this study. The participants were divided into two groups. Group I (n=18) underwent pancreatic surgery with coeliac plexus neurolysis by infiltration of 20ml of 100% alcohol in the loose areolar tissue 10ml each into right and left para-aortic space at the level of coeliac trunk and Group II (n=23) underwent pancreatic surgery only. Participants' preoperative data were collected from patient record file. Number, frequency and intensity of pain and requirement of amount of analgesics for the last 3 months were recorded from patients' history. The intensity of pain was categorized by visual analog scale (VAS) preoperatively. The participants of both groups were followed up at 1, 2 and 3 months interval and asked for disappearance or reduction of pain, frequency of attack and requirement of analgesics. Again visual analog scale was used for categorization of pain. Pain free period was recorded after the end of follow up period. Pain reduction occurred after surgery in both groups. But when pain relief was compared on the basis of VAS (Visual Analogue Scale), it was significantly better in Group I after 1 month of surgery than Group II (p=0.05). But 2 and 3 months after surgery this difference became insignificant (p=0.246 and 0.264). No statistical difference was found in terms of analgesic usage, severe acute attack or hospital admission (p=0.511, 0.439 and 0.495) at the end of 3 months follow up. Participants in Group I had significantly longer pain free period than Group II (p=0.025). Regarding complications, postural hypotension developed in 5.6% (1) patients. Diarrhea developed in 11.1% (2) patients in Group I and wound infection developed in 2 patients in each groups respectively. No patients developed any major complications like anastomotic leakage, deep or organ or space infection. Intraoperative coeliac plexus neurolysis reduces pain immediately after surgery and provides longer pain free period in patients with chronic pancreatitis after surgery.

Management of Choledocholithiasis: Should We Remove the Bile Duct?

Retrieval of stone by endoscopic papillotomy, laparoscopic choledochotomy or open choledochotomy is the treatment of choice for choledocholithiasis. Published literature shows that the recurrence rate is 4% to 24% with existing method of treatment. We have treated 8 patients who admitted with recurrent choledocholithiasis in the department of Hepato-Biliary-Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh in the period of January 2016 to December 2019. None had intrahepatic duct abnormality or stones. All patients underwent either ERCP stenting, open choledocholithotomy or both 16 to 84 months back. Management policy is designed and outcome is observed on these patients. There were 3 males and 5 females; age ranges 18 to 60 years. The common bile duct (CBD) diameter of all patient ranges from 15 to 24mm. The shape of CBD is different from normal variant; S shaped, saculated, grossly dilated with terminal narrowing. Considering the anatomical abnormality and recurrence of disease we have removed the abnormal part of common bile duct along with stones and the operation was completed by Roux-en-Y hepaticojejunostomy. All patients were completely symptom free for 6 to 48 months after surgery. Removal of abnormal part of common bile duct with reconstruction in the form of Roux-en-Y hepatico-jejunostomy may be considered for treating choledocholithiasis with abnormal CBD (abnormally dilated, abnormally shaped, angulated or sacculated) however, long-term follow up is required for final comment.

Gender differences in central obesity: Implications for cardiometabolic health in South Asians

This study estimates the prevalence of central obesity in South Asian adults and examines gender differences in central obesity across cardiometabolic determinants. An urban community-based survey was conducted using multi-stage random sampling. Asia-Pacific criterion for waist circumference (WC) was used to measure central obesity. Amongst 1178 participants, females had a higher age-adjusted central obesity (48%), and more than two-fold increased odds of central obesity. Increased prevalence of central obesity and female preponderance are indicative for a gender-sensitive population-level intervention to tackle cardiometabolic risk. WC may be an effective population-level measurement tool for cardiometabolic risk assessment in South Asian adults.

Prevalence and RIsk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes

Objectives

To estimate the prevalence and to identify potential risk factors of silent myocardial ischemia in a cohort of patients with asymptomatic type 2 Diabetes (diabetes) for early detection of coronary risk by employing objective noninvasive clinical screening tools for Subclinical Atherosclerosis.

Methods

The study is a clinic-based observational study on 338 consecutive diabetes patients attending an urban health center from Eastern India. The response rate was 96.57% out of 350 eligible subjects, comprising 176 (52.1%) males and 162 (47.9%) females. Clinical, anthropometric, biochemical parameters were collected in all participants. Both tools, i.e., treadmill test (TMT) to identify subjects with silent myocardial ischemia, and carotid imaging to detect subclinical atherosclerosis by evaluating carotid intima-media thickness (CIMT), were assessed. Significant determinants were predicted by multivariable logistic regression.

Results

The study group was divided into a TMT negative (n = 260), and a TMT positive group (n = 78). These 78 TMT positive subjects (23.1%) were identified to have silent myocardial ischemia. The prevalence of silent myocardial ischemia was more common in males (28.4%) than in females (17.3%). The mean CIMT in our study group was 0.6741 ± 0.034 mm (males – 0.684 ± 0.034 mm and females – 0.663 ± 0.032 mm). Age ≥50 years, CIMT ≥0.70 mm, hypercholesterolemia, and hypertriglyceridemia were significant determinants for identifying asymptomatic diabetics at risk for silent myocardial ischemia.

Conclusion

Silent myocardial ischemia is highly prevalent at about one in four asymptomatic diabetic patients. An increased CIMT can be a surrogate marker of higher coronary risk amongst these asymptomatic diabetics.

Surgical Treatment of Hepatolithiasis: Our Experience in Bangabandhu Sheikh Mujib Medical University

Recurrent cholangitis and sepsis are common complications after surgical treatment for hepatolithiasis as total clearance is not always possible. This retrospective study is designed to see the effect of our treatment for hepatolithiasis on stone clearance and post operative complications. We have treated 60 patients with hepatolithiasis surgically from September 2010 to September 2016 in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Various operative procedures were applied on the basis of location of stone and status of biliary tree. Choledocoscopic examination was performed during surgery for checking and cleaning of intrahepatic duct. Regular follow up was given and outcome was assessed. The chronological changes of treatment methods for patients with hepatolithiasis were analyzed for appropriate treatments for particular type. There were 22 males and 38 females with age ranges from 15 to 60 years. The stone were located in left duct (56.6%), right duct (10%) and both duct (33.4%). The most commonly performed operation was extended choledocholithotomy and hepatolithotomy and it was performed in 28 patients (46.7%). Segmentectomy and lobectomy was performed in 17 patients (28.3%). Common bile duct (CBD) excision, hepatolithotomy and hepaticojejunostomy with or without segmentectomy, lobectomy and Houston access loop formation was performed in rest of the patients. Stones could be removed completely in all patients who underwent lobectomy or segmentectomy. In contrast stone clearance was possible only in 57.2% and 55.5% who underwent extended choledocholithotomy and hepatolithotomy, and excision of CBD, hepatolithiasis with hepaticojejunostomy for unilateral or bilateral hepatolithiasis respectively. Houston's access loop to stomach was made in 2 patients for future endoscopic removal of stone. There was no mortality in the present series but morbidity occurred in 18 patients; wound infection (n=15, 25%), bile leakage (n=1, 1.7%), and renal dysfunction (n=1, 1.7%), septicemia (n=1, 1.7%). Patients who underwent lobectomy or segmentectomy did not develop cholangitis or sepsis on 1 to 3 years follow up. In contrast who underwent extended choledocholithotomy and hepatolithotomy, 70.8% patients developed cholangitis and sepsis, and the patients who underwent excision of CBD, hepatolithotomy with hepaticojejunostomy 50% developed cholangitis and sepsis within 1 to 3 years of follow up, required re-operations or conservative treatment. The difference of developing postoperative cholangitis and sepsis is significant (p<0.05) between patient who underwent extended choledocolithotomy and hepatolithotomy, and who underwent excision of CBD, hepatolithotomy and Roux-en-Y hepaticojejunostomy. In conclusion, lobectomy or segmentectomy is the best option for hepatolithiasis if the stones are limited to a lobe or segment. Excision of CBD, hepatolithotomy with hepaticojejunostomy is better than extended choledocholithotomy and hepatolithotomy for bilateral hepatolithiasis. Huston's access loop formation associated with other procedures may be considered for bilateral hepatolithiasis for future minimal invasive stone retrieval procedure as residual stones and recurrent stone formation is common.

Avian influenza and Newcastle disease virusindead chickens in markets in Dhaka, Bangladesh in 2011-2012

A virological survey for avian influenza (AI) and Newcastle disease (ND) was conducted in two selected live bird markets (LBMs), namely Kaptan Bazar and Karwan Bazar in Dhaka city, Bangladesh from August 2011 to July 2012. A total of 513 dead chickens were collected. An immune-chromatographic rapid antigen test for Type A influenza virus and both conventional and real time RT-PCR were used for the detection and characterization of AI and ND viruses. All carcasses were first screened by the rapid antigen test kit and 93 were positive for Type A influenza virus. RT-PCR on a representative number of rapid antigen test positive samples (n = 24) confirmed the presence of Type A influenza virus and mostly H5 influenza virus (22 out of 24 tested samples). Influenza rapid test negative samples (n = 420) were subjected to routine necropsy. Heat stress, suffocation and physical injury were the most common cause of mortality (163 cases), followed by ND, suspected to be the cause of 85 deaths. On molecular investigation of these 85 samples, the presence of ND virus was confirmed in 59 and AI virus in 6; 15 were negative for both ND and AI viruses and 5 were unsuitable for investigation. Among the 59 ND confirmed cases 18 also contained AI virus. In summary, out of 513 carcasses 117 (22.81%) contained AI virus and 59 (11.50%) contained ND virus. Eighteen (3.51%) carcasses contained both AI and ND viruses. The findings suggest that both AI and ND should be considered as major threats to the poultry industry.Bangl. vet. 2016. Vol. 33, No. 1, 8-15

Pretransplant Serum Hyaluronic Acid Can Be a Biomarker as a Prognostic Predictor in Adult-to-Adult Living Donor Liver Transplantation

OBJECTIVE

The goal of this study was to evaluate whether pretransplant serum hyaluronic acid (HA) levels can predict outcomes after adult-to-adult living donor liver transplantation (LDLT).

METHODS

In study I, 21 patients who underwent LDLT (March 2002-February 2004) were divided into 2 groups: the H-I group (HA ≥500 ng/mL; n = 12) and the L-I group (HA <500 ng/mL; n = 9). The influence of pretransplantation HA levels on short-term surgical outcome was investigated. In study II, 77 LDLT patients (May 2004-December 2014) were also divided into 2 groups: the H-II group (HA ≥500 ng/mL; n = 40) and the L-II group (HA <500 ng/mL; n = 37). We compared long-term survival and investigated prognostic factors.

RESULTS

In study I, HA levels significantly decreased after LDLT, and those in the H-I group were significantly higher compared with the L-I group at 1, 3, 5, and 7 days after LDLT. There were significant differences in postoperative peak total bilirubin levels (H-I vs L-I, 17.2 vs 6.2 mg/dL; P = .013), peak ascitic fluid volume (1327 vs 697 mL/d; P = .005), and the hepatocyte growth factor levels at 3 days after LDLT (1879 vs 1092 pg/mL; P = .03). In study II, the 1- and 5-year survival rates were significantly lower in the H-II group than in the L-II group (H-II vs L-II, 65.0% and 48.5% vs 86.5% and 80.8%; P = .004). In multivariate analysis, significant prognostic factors were preoperative HA ≥500 ng/mL (P = .004) and graft to recipient body weight ratio <0.8 (P = .042).

CONCLUSIONS

Preoperative HA level can be a prognostic risk factor. Patients with high HA levels are vulnerable and should be carefully managed after LDLT.

Morbidity and Mortality after Pancreatoduodenectomy: A Five Year Experience in Bangabandhu Sheikh Mujib Medical University

Mortality and morbidity was assessed after adoption of a systematic care for patient with pancreatoduodenectomy starting from patient selection and preparation, operative technique, and postoperative care. In this prospective study seventy patients who underwent pancreatoduodenectomy for periampullary carcinoma with curative intent between January 2010 and December 2014 were carefully analyzed prospectively. Patients were selected those who had ampullary carcinoma, lower bile duct carcinoma and small size carcinoma head of pancreas without local invasion and distant metastasis, and the patient who did not have any major disabling comorbid diseases. All patients were assessed uniformly before surgery and deficiency were corrected up to normal level before operation. Pancreatoduodenectomy and standard lymphadenectomy was performed meticulously with minimum blood loss. The pancreatojejunal reconstruction was performed using duct-to-mucosa method mostly. A nasojejunal feeding tube was placed in most patients for starting postoperative early oral feeding. Broad spectrum antibiotics and the epidural analgesia were mostly prescribed for good control infection and pain. Proper nutrition was maintained in calculative way through central venous line and nasojejunal feeding tube in the early postoperative period. General care, early mobilization and chest physiotherapy were given routinely in each patient. Seventy-seven percent (n=54) patients did not have any postoperative complications and they were discharged from hospital within 12-14 postoperative days. The morbidity occurred in 16 patients (23%) and most common complication was wound infection (18%, n=9). The rest complications were pancreatojejunal anastomotic leakage - 2, hepaticojejunal anastomosis leakage - 1, melaena - 1, intra-abdominal abscess - 1, intra-abdominal hemorrhage - 1, and renal dysfunction - 1. The mortality rate was 5.7% (n=4), causes of death were massive myocardial infarction; 1, failure of reversal from anesthesia; 1, massive intraabdominal bleeding; 1 and CV catheter related severe sepsis; 1. Review of recent published literature revealed that mortality and morbidity our series is better than low volume center and almost similar with high volume center of pancreatoduodenectomy surgery. Our systematic management policy of careful patient selection, planned approach in the form of proper work up, meticulous conduction of the procedure, appropriate postoperative care provides an acceptable morbidity and mortality after pancreatoduodenectomy.

Expression and functional role of Bone Morphogenetic Proteins (BMPs) in cyclical corpus luteum in buffalo (Bubalus bubalis)

The role of growth factors in the modulation of ovarian function is an interesting area of research in reproductive biology. Recently, we have shown the expression and role of IGF, EGF, VEGF and FGF in the follicle and CL. Here, we report the presence of Bone Morphogenetic Proteins (BMPs) and their functional receptors in the corpus luteum (CL) of buffalo. The bubaline CL was classified into four stages according to the morphology and progesterone (P₄) concentration. The qPCR, immunoblot and immunohistochemistry studies revealed that BMP2 and BMP Receptors (BMPR1A, BMPR1B and BMPR2) were significantly upregulated during the mid stage whereas BMP4 and BMP7 were upregulated during the early stage of CL (P<0.05). Studies on primary luteal cell culture (LCC) using mid CL showed a significant time and concentration dependent effect of BMP4 and BMP7 (P<0.05). At 100ngml^-1, the BMPs maximally stimulated the transcripts of StAR, CYP11A1 and 3βHSD that paralleled with P₄ accretion in the media (P<0.05). Further, the BMP4 as well as BMP7 upregulated the transcripts of PCNA and downregulated CASPASE3 in the LCC at the same concentration (P<0.05). Though the combined effect of BMP4 and 7 was significantly higher (P<0.05) than that of individual one, it was not additive. In conclusion, the expression of BMPs and their receptors were dependent on the stages of CL in the buffalo. Treatment of LCC with BMPs in vitro confirmed the presence of functional receptors that stimulated the P₄ production and luteal cell survival. Moreover, the results support the concept that the upregulation of P₄ and its biosynthetic pathway enzymes such as CYP11A1, StAR and 3βHSD in the CL is likely due to the autocrine and /or paracrine effects of BMP4 and BMP7 under physiological milieu.

Evaluation of specific humoral immune response in pigs vaccinated with cell culture adapted classical swine fever vaccine

Aim:

To determine an efficient vaccination schedule on the basis of the humoral immune response of cell culture adapted live classical swine fever virus (CSFV) vaccinated pigs and maternally derived antibody (MDA) in piglets of vaccinated sows.

Materials and Methods:

A cell culture adapted live CSFV vaccine was subjected to different vaccination schedule in the present study. Serum samples were collected before vaccination (day 0) and 7, 14, 28, 42, 56, 180, 194, 208, 270, 284 and 298 days after vaccination and were analyzed by liquid phase blocking enzyme-linked immunosorbent assay. Moreover, MDA titre was detected in the serum of piglets at 21 and 42 days of age after farrowing of the vaccinated sows.

Results:

On 28 days after vaccination, serum samples of 83.33% vaccinated pigs showed the desirable level of antibody titer (log₁₀ 1.50 at 1:32 dilution), whereas 100% animals showed log₁₀ 1.50 at 1:32 dilution after 42 days of vaccination. Animals received a booster dose at 28 and 180 days post vaccination showed stable high-level antibody titre till the end of the study period. Further, piglets born from pigs vaccinated 1 month after conception showed the desirable level of MDA up to 42 days of age.

Conclusion:

CSF causes major losses in pig industry. Lapinised vaccines against CSFV are used routinely in endemic countries. In the present study, a cell culture adapted live attenuated vaccine has been evaluated. Based on the level of humoral immune response of vaccinated pigs and MDA titer in piglets born from immunized sows, it may be concluded that the more effective vaccination schedule for prevention of CSF is primary vaccination at 2 months of age followed by booster vaccination at 28 and 180 days post primary vaccination and at 1 month of gestation.

Predictive value of serum actin-free Gc-globulin for complications and outcome in acute liver failure

This prospective study was designed to evaluate whether early changes in actin-free Gc-globulin levels were associated with complications and outcomes and to identify factors associated with persistent low actin-free Gc-globulin levels in acute liver failure (ALF). Thirty-two consecutive ALF patients admitted from October 2011 to December 2012 were followed up until death or complete recovery. All had serum actin-free Gc-globulin estimation at admission and at day three or expiry. Logistic regression analysis was performed to identify independent predictors of mortality. A receiver operating characteristic curve analysis was also performed. Nonsurvivors had significantly lower median actin-free Gc-globulin levels than survivors (87.32 vs 180 mg/L; P < 0.001). A receiver operating characteristic curve analysis revealed an area under curve (AUC) of 0.771 and showed that serum actin-free Gc-globulin level of ≤124 mg/L would predict mortality with 92% sensitivity and 71.4% specificity. Patients with lower serum actin-free Gc-globulin levels and decreasing trend in serum actin-free Gc-globulin levels were found to have more mortality and developed more complications. Logistic regression analysis showed that serum actin-free Gc-globulin, total leucocyte count and serum creatinine at admission were independent predictors of mortality. Incorporating these variables, a score predicting mortality risk at admission was derived. The scoring system was compared to MELD score and King's College Criteria as individual predictor of mortality. Serum actin-free Gc-globulin level at presentation is predictive of outcome and can be used for risk stratification. Its persistent low-level predicts mortality and is correlated with various complications.

Re-emergence of circulatory foot-and-mouth disease virus serotypes Asia1 in Bangladesh and VP1 protein heterogeneity with vaccine strain IND 63/72

Foot-and-mouth disease virus (FMDV) serotypes O, A and Asia1 are responsible for significant number of disease outbreaks in Bangladesh; however serotype Asia1 has not been reported in circulation since 1996. The present investigation reports the detection of serotype FMDV Asia1 from local farms in 2012 and 2013 outbreaks. The farms were located in Jessore and Gazipur districts, and one of these farms was under vaccine control programme. Phylogenetic analysis of the complete VP1 gene revealed that FMDV Asia1 is under genetic lineage C having close similarity to the Asia1 sequences of Indian origin. The circulatory genotype Asia1 showed VP1 protein sequence heterogeneity of eight amino acid substitutions within the G-H loop with the vaccine strain [IND 63/72 (AY304994)] used in vaccination programme. ELISA assay revealed that, of seven, only one local field serum sample (cattle vaccinated 38 days earlier) was positive at a titre level of >2.4 (log10) but failed to protect the cattle from infection occurred by the virus. This investigation focused that the eight amino acid substitution in VP1 protein at G-H loop of the locally circulated FMDV serotype Asia1 strain may be a reason for current vaccination failure.

Chronic calcific pancreatitis and pancreatic cancer

An observational cross-sectional study of 50 cases of chronic calcific pancreatitis patients was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) and some other tertiary level hospitals of Dhaka city from August 2008 to July 2010. Patients required laparotomy for different modalities of surgical treatment to manage chronic calcific pancreatitis were included in the study. Biopsy was taken from panceatic duct containing stone during laparotomy to determine the histopathological changes. Among 50 cases female predominance was observed. Male, female ratio was 2:3. Majority (62%) patients were in 20 to 40 years age group. Female presented earlier than male (20-30 years and 30-40 years respectively). All patients complained recurrent attack of epigastric pain. Other presentations were diabetes (74%), malnutrition and weight loss (56%), steatorrhoea (24%) and jaundice (12%). Adenocarcinoma was found in 3(6%) patients (2 male and 1 female) and rests were chronic pancreatitis. Several studies showed the association between chronic calcific pancreatitis and pancreatic cancer. Further large scale study is required to find out the national incidence level.

Subclinical atherosclerosis and silent myocardial ischaemia in patients with type 2 diabetes: a protocol of a clinico-observational study

Introduction

Atherosclerotic cardiovascular disease is a significant modifiable complication in patients with diabetes and subclinical atherosclerosis is considered a surrogate marker of future vascular events. The clustering of cardiometabolic-risk factors in patients with diabetes and cardiovascular disease is increasingly being recognised. Recent evidence indicates that 20–50% of asymptomatic patients with diabetes may have silent coronary heart disease. However, the identification of subclinical atherosclerosis and silent myocardial ischaemia in patients with diabetes has been less well-explored, especially in low-resource population settings where cost-effective non-invasive clinical tools are available. The objective of this study is to identify patients with physician-diagnosed diabetes who are at risk of developing future cardiovascular events measured as subclinical atherosclerosis and silent myocardial ischaemia in an urban population of Eastern India.

Methods and analysis

This is a cross-sectional clinico-observational study. A convenience sampling of approximately 350 consecutive patients with type 2 diabetes based on predefined inclusion and exclusion criteria will be identified at an urban diabetes center. This estimated sample size is based on an expected prevalence of silent myocardial ischaemia of 25% (± 5%), we computed the required sample size using OpenEpi online software assuming an α level of 0.05 (95% CI) to be 289. On factoring 20% non-response the estimated sample size is 350. Previously validated questionnaire tools and well-defined clinical, anthropometric and biochemical measurements will be utilised for data collection. The two primary outcomes—subclinical atherosclerosis and silent myocardial ischaemia will be measured using carotid intima-media thickness and exercise tolerance testing, respectively. Descriptive and multivariate logistic regression statistical techniques will be employed to identify ‘at risk’ patients with diabetes, and adjusted for potential confounders.

Ethics and dissemination

Ethical approval was granted by the institutional review board of Kalinga Institute of Medical Sciences, Bhubaneshwar, India. Data will be presented at academic fora and published in peer-reviewed journals.

Delayed primary suture prevents wound infection in patients with obstructive jaundice and septic abdomen

This study was undertaken to assess the efficacy of delayed primary closure in prevention of postoperative wound infection in patients with obstructive jaundice and septic abdomen. Here analyzed 93 patients retrospectively who underwent surgery in hepato-biliary-pancreatic unit of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2011 to June 2011. Primary closure of the abdominal wound was applied in all patients. There was no mortality, but 21 patients had postoperative morbidity (wound infection in 17, intra-abdominal abscess in 1, melaena in 1, biliary leakage in 1, burst abdomen in 1). Seventy-two patients had uneventful postoperative recovery were included in Group 1. Patients who developed postoperative wound infection (n=17) were included in Group 2. Rest 4 patients who developed other complications were excluded from the study. Pre-, per and postoperative parameters were compared between two groups for identifying the risk factors for SSI. Delayed primary closure of the wound was applied prospectively in 21 patients (Group 3) on the basis of retrospective results and the outcome was assessed. Retrospective analysis revealed that the patient who developed wound infections (Group 2) after primary closure; significantly greater number of patients had obstructive jaundice or intra-abdominal septic condition preoperatively. Prospective results revealed that there was no wound infection in 21 patients with in obstructive jaundice or intra-abdominal sepsis in which delayed primary closure was applied. Hospital stay was significantly reduced in Group 3 in compare to Group 2. In subsequent follow up, it has been found that 2 patients developed incisional hernia in Group 2 patients but none in Group 3 patients. Delayed primary closure of the wound is a good option in patient with obstructive jaundice and intra-abdominal septic condition for preventing postoperative wound infection.

Effect of actin polymerization inhibitor during oocyte maturation on parthenogenetic embryo development and ploidy in Capra hircus

This study was designed to observe the effect of cytochalasin B (CCB) concentrations on ploidy and early development of parthenogenetic embryos in a caprine species. Caprine oocytes were matured in the presence of different concentrations of CCB (5, 10, 15, and 20 μg/ml) and activated by 7% ethanol followed by incubation with 2 mM DMAP. For embryos fertilized in vitro, oocytes were matured in maturation medium without CCB. The cleavage rate and further embryo development were significantly higher (P < 0.05) when oocytes were treated in this way. The percentage of embryos showed higher diploid values in 15 μg/ml CCB (83.66 ± 1.13), followed by 20 (72.22 ± 1.22), 10 (68.57 ± 1.17), and 5 μg/ml (62.00 ± 2.48). These results indicate that CCB with a concentration of 15 μg/ml in maturation medium can be used for the production of diploid parthenogenetic embryos in the caprine species.

Generation of transgenic mesenchymal stem cells expressing green fluorescent protein as reporter gene using no viral vector in caprine

Mesenchymal stromal cells (MSC) are multipotent cells that can be derived from many different organs and tissues. While there are many ways to label and track cells each with strengths and weakness, the green fluorescent protein (GFP) is a reporter gene commonly employed. In the present study, caprine MSC were collected from bone marrow and cells were characterised with MSC specific markers. Passage 10 (P10) MSC cells were transfected using plasmid vector containing GFP as reporter gene with different concentrations of DNA and lipofectamine. Six different concentrations of DNA and lipofectamine as 1 microg DNA: 2 microL lipofectamine, 1 microg DNA: 2.5 microL lipofectamine, 1.2 microg DNA: 2.2 microL lipofectamine, 1.2 microg DNA: 2.5 microL lipofectamine, 1.5 microg DNA: 2.5 microL lipofectamine, 1.5 microg DNA: 3 microL lipofectamine were used. After 24 h and 48 h of transfection, caprine MSC were observed under florescent microscope. Highest transfection rate indicating green flourecscent MSC were found when the cells were transfected with 1.2 microg DNA: 2.2 microL lipofectamine and 1.5 microg DNA: 2.5 microL lipofectamine than other combinations. These cells have been propagated beyond 4th passage maintaining GFP expression. The results indicated that stable GFP positive MSC cells can be generated using the above protocol. These cells are being used for transplantation studies.

Periampullary carcinoma: better prognosis with early pre-stenting referral to surgery

This study was undertaken to find out reasons of delayed referral for surgical treatment and to assess the effect of delayed referral on management and prognosis of patients with periampullary carcinoma. Patients with histopathologically proved periampullary carcinoma (n=41) during the period January 2010 to December 2010 who had been admitted into the department of surgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh (BSMMU) were included in this study. Information of the patient was retrieved from medical records. Patients and relatives were interviewed for reasons of delay in seeking surgical help. Patients were divided into two groups: Group I: those who admitted to surgical unit within one month (6 days to 1 month) of noticing jaundice (n=13), and Group II: those who admitted to surgical unit after one month (1.2 months to 18 months) of noticing jaundice (n=28). Parameters were compared between two groups. Patients in group II were poor liver function and nutritional status needed more supplementary therapy in perioperative period. The incidence of distant metastasis and ascites were more frequent in Group II than Group I patients. Definitive procedure (Whipple's operation) was possible in 53.8% patients in Group I whereas only 7.1% in Group II patients (p <0.05). The reasons for delay referral to surgery were due to patient's ignorance, superstition and fear of receiving operative treatment. Delay in diagnosis of periampullary carcinoma as a cause of jaundice and immediate relief of jaundice with ERCP and stenting is another important cause of delay in seeking definitive operative treatment. Awareness of public as well as general physicians is required for early referral of patients with periampullary carcinoma to surgery. Joint assessment of these patients by Gastroenterologist and Hepatobiliary surgeons before internal biliary drainage will improve prognosis.

Appropriate anthropometric indices to identify cardiometabolic risk in South Asians

BACKGROUND

South Asians show an elevated cardiometabolic risk compared to Caucasians. They are clinically metabolically obese but are considered normal weight based on current international cut-off levels of several anthropometric indices. This study has two main objectives: (i) to predict the most sensitive anthropometric measures for commonly studied cardiometabolic risk factors, and (ii) to determine optimal cut-off levels of each of the anthropometric indices in relation to these cardiometabolic risk factors in South Asians.

METHODS

The study was conducted on a random sample of 1178 adults of 20-80 years of age from an urban population of eastern India. Obesity, as evaluated by standard anthropometric indices of BMI (body mass index), WC (waist circumference), WHpR (waist-to-hip ratio) and WHtR (waist-to-height ratio), was individually correlated with cardiometabolic risk factors. Receiver operating characteristic (ROC) curve analyses were performed which includes: (i) the area under the receiver operating characteristic curve (AUROC) analysis to assess the predictive validity of each cardiometabolic risk factor; and (ii) Youden index to determine optimal cut-off levels of each of the anthropometric indices.

RESULTS

Overall, AUROC values for WHtR were the highest, but showed variations within the sexes for each of the cardiometabolic risk factors studied. Further, WHpR cut-offs were higher for men (0.93-0.95) than women (0.85-0.88). WC cut-offs were 84.5-89.5 cm in men and 77.5-82.0 cm in women. For both sexes the optimal WHtR cut-off value was 0.51-0.55. The optimal BMI cut-offs were 23.4-24.2 kg/m2 in men and 23.6-25.3 kg/m2 in women.

CONCLUSION

WHtR may be a better anthropometric marker of cardiometabolic risks in South Asian adults than BMI, WC or WHpR.

Effects of Growth Factors on Establishment and Propagation of Embryonic Stem Cells from Very Early Stage IVF Embryos and Their Characterization in Buffalo

BACKGROUND AND OBJECTIVES

Although ES cells have been derived from very early stage embryos in different species, but, so far ES cell line could be derived from early stage IVF embryos in buffalo. The present experiment was carried out to study the effects of different growth factors on attachment, formation of ES cell colonies, their extent of passaging and relative expression of pluripotency marker in these colonies in buffalo.

METHODS AND RESULTS

For this, 8~16 cell stages zona free IVF embryos were cultured with different culture condition viz. Control, Media-I: (Control+SCF), Media-II: (Control+SCF+bFGF) and Media-III: (Control+SCF+bFGF+IGF1). A total of 25 number of embryos were cultured in each medium. The efficiency (%) of blastomere attachment, % stem cell colony formation were recorded and number of passaging were evaluated in each culture condition. The results indicated that the efficiency of embryonic blastomere attachment, % stem cell colonies formation and propagation were significantly higher when medium was supplemented with growth factors viz. SCF, bFGF and IGF-1 (Media-III) than when supplemented with either SCF or SCF+bFGF. The expression of pluripotent genes viz Oct4, Nanog, FoxD3 and KLF4 were significantly higher (p<0.005) when medium was supplemented with three growth factors.

CONCLUSIONS

It can be concluded that when 8~16 cell stages zona free IVF embryos of buffalo was cultured on feeder,the %of blastomere attachment, % of ES cell colony formation and their further propagation were higher in ES cell medium supplemented with SCF+bFGF+IGF1 which may be due to high expression of pluripotent stem cell markers.

Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India

OBJECTIVES

To determine the prevalence of metabolic syndrome and to identify predictors for the same, specific to an underdeveloped urban locale of Eastern India.

MATERIALS AND METHODS

STUDY DESIGN

Population-based cross-sectional study, with multistage random sampling technique.

SETTING

Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India.

PARTICIPANTS

1178 adults of age 20-80 years randomly selected from 37 electoral wards of the urban city. Definition of Metabolic Syndrome: We followed a unified definition of the metabolic syndrome by joint interim statement of five major scientific organizations - the International Diabetes Federation, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association of the Study of Obesity. Individuals who meet at least three of five clinical criteria of abdominal obesity, hypertriglyceredimia, low HDL, hypertension, and hyperglycemia are diagnosed as having the condition; presence of none of these criteria is mandatory. Explicit cut points are defined for all criteria, except elevated waist circumference, which must rely on population and country-specific definitions.

MAIN OUTCOME MEASURE

Prevalence and significant predictors of metabolic syndrome.

STATISTICAL ANALYSIS

Both descriptive and multivariable logistic regression analyses.

RESULTS

Age-standardized prevalence rates of metabolic syndrome were 33.5% overall, 24.9 % in males and 42.3% in females. Older age, female gender, general obesity, inadequate fruit intake, hypercholesterolemia, and middle-to-high socioeconomic status significantly contributed to increased risk of metabolic syndrome.

CONCLUSION

Metabolic syndrome is a significant public health problem even in one of the poorest states of India that needs to be tackled with proven strategies.

Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: A clinico epidemiological evidence summary

Evidence is emerging that obesity-associated cardiovascular disorders (CVD) show variations across regions and ethnicities. However, it is unclear if there are distinctive patterns of abdominal obesity contributing to an increased CVD risk in South Asians. Also, potential underlying mechanistic pathways of such unique patterns are not comprehensively reported in South Asians. This review sets out to examine both. A comprehensive database search strategy was undertaken, namely, PubMed, Embase and Cochrane Library, applying specific search terms for potentially relevant published literature in English language. Grey literature, including scientific meeting abstracts, expert consultations, text books and government/non-government publications were also retrieved. South Asians have 3-5% higher body fat than whites, at any given body mass index. Additional distinctive features, such as South Asian phenotype, low adipokine production, lower lean body mass, ethno-specific socio-cultural and economic factors, were considered as potential contributors to an early age-onset of obesity-linked CVD risk in South Asians. Proven cost-effective anti-obesity strategies, including the development of ethno-specific clinical risk assessment tools, should be adopted early in the life-course to prevent premature CVD deaths and morbidity in South Asians.

Successful management of ventral abdominal hernia in goat: a case report

The study was conducted a four month old Jamunapari doe weighing 15kg that was brought to the SAQ teaching veterinary Hospital, CVASU, Chittagong with the history of unknown cause, loss of appetite and gradual swelling in the pelvic region since one month. Based on clinical examination the case was subjected as a ventral abdominal hernia and corrected by surgical intervention. The case was recovered unevenfully at 10th postoperative day. DOI: http://dx.doi.org/10.3329/ijns.v2i2.11387 International Journal of Natural Sciences (2012), 2(2):60-62

Prevalence and risk factors for diabetes and impaired glucose tolerance in Asian Indians: a community survey from urban eastern India

OBJECTIVES

To determine the prevalence of diabetes and impaired glucose tolerance (IGT) and to identify risk factors for the same specific to an underdeveloped urban locale of Eastern India.

METHODS

Study design. Population based cross-sectional study, with multistage random sampling technique. Setting. Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. Participants. 1178 adults of 20-80 years age randomly selected from 37 electoral wards of urban populace. Definition and diagnosis of diabetes mellitus and IGT. These were based on a Report of a World Health Organization/International Diabetes Federation Consultation of 2006. Main outcome measure. Prevalence and significant risk factors for Diabetes and IGT. Statistical analysis. Both descriptive and multivariable logistic regression analyses.

RESULTS

The crude rates of diabetes and IGT in the study population were 15.7% and 8.8%, respectively. Similarly age-standardized rates of diabetes and IGT were 11.1% and 6.7%, respectively. Both diabetes and IGT had shown a male preponderance.

CONCLUSION

Diabetes and IGT were very highly prevalent in this urban populace. Cardiometabolic risk factors like older age, central obesity, inadequate fruit intake, hypertension, hypertriglyceridemia and socio economic status were found to be significant predictors of diabetes in this study.