Some bacteriologic aspects of the epidemiology of pulmonary and extrapulmonary tuberculosis

A study was carried out to investigate the drug resistance patterns of the prevalent tubercle bacilli in pulmonary and extrapulmonary tuberculosis in and about the city of Lahore, Pakistan. This report includes 168 strains of Mycobacterium tuberculosis isolated from the same number of pulmonary tuberculosis cases (100 untreated cases, defined as patients either having no history of anti-tuberculous therapy or having had chemotherapy for not more than 10 days; 68 treated, defined as having had chemotherapy for more than 10 days), and 162 strains from the same number of extrapulmonary tuberculosis cases (77 untreated, 38 treated and 47 doubtful). The proportion method of drug susceptibility assay was employed. According to the procedures used in this study and with 1% as the critical proportion for resistance, bacterial resistance was found to be very prevalent in pulmonary tuberculosis. Even among those cases in which no history of previous treatment was elicited, 46% were found to be excreting populations of tubercle bacilli having some degree of resistance to one or more of the primary drugs--isoniazid, streptomycin and para-aminosalicylic acid. In treated cases, 86.8% were found to have some resistance to one or more drugs. Overall, resistance to streptomycin was found to be commonest. Drug resistance was observed to be somewhat less common in extrapulmonary than in pulmonary tuberculosis, with streptomycin resistance predominating. Although both catalase-positive and catalase-negative isoniazid-resistant strains of M. tuberculosis were isolated from patients with pulmonary disease, no catalase-negative strains were isolated from patients with extrapulmonary disease, suggesting limited pathogenic potentialities of catalase-negative strains for man. Epidemiologic aspects of these observations are discussed.

[Vision in fish. An historical and analytical bibliography]

A collection of about 1100 references dealing with the history of the study of Vision of Fishes is compiled, from the earliest mentions to the present. These were chosen selectively on the basis of their relevence. The chronologically arranged bibliography places each of the references in one or more of the following categories: Structure, Behaviour, Development, Ecology, General and Physiology, Publications which started a new trend of technique and reviews are also indicated. Some extracts and quotations, particularly from the older literature, considered interesting are included. This compilation is intended to provide an overall view of the evolution of the subject and its multiplicity.

Temperature and vision

Published information concerning the influence of temperature in the physiological range (0-40 degrees) on various aspects of the visual process in invertebrates and vertebrates (poikilotherms and homeotherms) is reviewed. Bleaching and regeneration of scotopic and photopic pigments is influenced by temperature; so is the porphyropsin-rhodopsin ratio in fresh-water fishes. Effect on electrophysiological responses such as early receptor potential (ERP), electroretinogram (ERG) and its flicker fusion frequencies (FFF), S-potentials, glial membrane optic nerve and brain responses is presented. Histophysiological responses such as photomechanical or retinomotor responses are influenced by temperature. It also affects behavioural responses such as innate light reflexes, colour change, sensitivity, threshold acuity, FFF, spectral sensitivity and conditioned responses. General aspects such as oxygen consumption of the retina, acid formation and survival times are discussed with reference to their modification by temperature. Theoretical aspects such as the interaction between light and thermal energy in the absorption of a photon by a molecule, and available equations for comparing the effect of temperature on biological processes are also discussed. An attempt is made to draw a coherent picture and to discuss the significance of the thermal influence on vision to the animal. New avenues of research are also indicated. One hundred and eighty-eight (188) references are cited.

Hemoglobin A2 level. A proposed test for confirming the diagnosis of iron deficiency

The absolute hemoglobin A2 concentration in mg. per 100 ml. of blood was calculated from the hemoglobin level in Gm. per 100 ml. and hemoglobin A2 percentage for 38 patients with documented iron deficiency, 37 patients with proven beta-thalassemia minor, 26 patients with simple chronic anemia and 40 normal control laboratory workers. The mean hemoglobin A2 concentration (mg. per 100 ml.) in the control group was 459 plus or minus 60 (2 S.D.) and that in the beta-thalassemia group, 766 plus or minus 99. However, in the iron deficiency group it was 229 plus or minus 58, while in the simple chronic anemia group it was 315 plus or minus 39. The mean corpuscular volume (M.C.V.) in cu. mu was 90 plus or minus 8 (2 S.D.) in the normal controls, 68 plus or minus 10 in beta-thalassemia, 69 plus or minus 9 in iron deficiency, and 90 plus or minus 15 in secondary anemia. It is proposed that the absolute hemoglobin A2 level in mg. per 100 ml. of blood taken in conjunction with the M.C.V. is of value in establishing the diagnosis of iron deficiency.

Hemoglobinopathies in the Hamilton region. I. A 4-year survey

A regional laboratory for the diagnosis and investigation of hemoglobinopathies was established by the Hamilton District Program in Laboratory Medicine in October 1970. Specimens from patients suspected of having a hemoglobinopathy were referred to the regional laboratory from all the hospitals participating in the program. Between October 1970 and October 1974, 3547 specimens were screened for an abnormal hemoglobin and thalassemia; 758 cases of thalassemia, 165 cases of abnormal hemoglobin and 14 mixed cases were diagnosed. Before 1970, 110 cases of thalassemia and 12 cases of abnormal hemoglobin were on record in the Hamilton region. Regionalization of laboratory services provides a more effective means of screening for abnormalities in hemoglobin structure and synthesis and facilitates the opportunity for improving diagnostic procedures.

Hemoglobinopathies in the Hamilton region. II. Thalassemia traits and iron therapy

Between July 1973 and July 1974 all adult patients with hypochromic anemia and a mean corpuscular volume of 75 mum3 or less were screened for hemoglobinopathies. Of the 490 patients 105 had beta-thalassemia trait, 11 had alpha1-thalassemia trait, 4 had hemoglobin Lepore trait and 1 had hemoglobin H disease. Of 48 inpatients whose charts were reviewed 19 had been on oral iron therapy and 7 of them had been given iron intramuscularly. Of 27 outpatients interviewed 10 had been on intermittent iron therapy for 18 months or more; 4 had been given at least 1 g of intramuscular iron. Iron deficiency was not documented in any of these patients. Iron deficiency should be diagnosed by means other than the presence of a hypochromic picture in the peripheral blood before iron therapy is instituted, particularly in communities with a large population of Mediterranean or South-East Asian origin.

Retina of the South American lungfish, Lepidosiren paradoxa Fitzinger

The characteristic feature of the retina of Lepidosiren paradoxa is the hugeness (20–25 μm) and sparse-ness of the cells which compose it. The epithelial layer is well pigmented. The visual cells may be classified into rods and single cones which possess a large oil droplet and a smaller paraboloid. Neither the epithelial pigment nor the visual cells show retinomotor responses. Landolt's clubs arising from the bipolar cells and terminating amidst the epithelial cell processes are present and resemble those of another Dipnoan, Protopterus. The ratio of photoreceptor, bipolar, and ganglion cells is about 2:2:1, indicating a very low degree of summation. There is no noticeable difference among the dorsal, vental, temporal, and nasal regions of the retina. The similarity of this retina to that of other dipnoans and urodeles is briefly discussed. It appears as if the growth of the eye were arrested (neoteny) during the evolution of this genus because of the insignificant role of vision in its life.

Hemoglobin abnormalities in neoplastic hematological disorders

Fetal hemoglobin (F) and hemoglobin A(2) were estimated in 35 patients with malignant hematological disorders. In 9 out of 10 patients with morphological and cytochemical features of acute myeloblastic leukemia the hemoglobin F was greater than 2%. Of the other 25 patients investigated only one patient with polycythemia rubra vera had a hemoglobin F level of more than 2%. Estimation of fetal hemoglobin may be of value in the classification of acute leukemias and the increased level observed probably reflects disturbed hemoglobin synthesis in the acute myeloblastic type.

Electroretinographic determination of spectral sensitivity in albino and pigmented brook trout (Salvelinus fontinalis, Mitchill)

A technique for recording electroretinograms from the unpunctured eyes in situ of living, anesthetized fish is described. This technique permits the use of the same fish in a number of experiments over a period of weeks, months, or years. Using this technique the spectral sensitivity of dark-adapted (scotopic) and light-adapted (photopic) fish was measured at 13 bands of the visible spectrum. The scotopic curves of albino and pigmented trout thus obtained in the winter have their maxima around 525 nm which differ from that of the absorption spectrum of the scotopic pigment in situ and in vitro of older fish obtained in the summer. The photopic curve of the pigmented fish is a broad one with humps around 425 nm, 545 nm, and 595 nm. The albino's curve has a relatively narrow band with a peak around 630 nm and a shoulder at about 550 nm. The difference between the shapes of the two curves may be ascribed to the increase in the intensity of light of longer wavelengths within the eyeball of the albino, due to reflection from blood vessels and sclera caused by the absence of pigmentation.

Chemical composition of some medicinal plant products of indigenous origin

Chemical compositions of leaves of neem (Azadirachta indica), sajna (Moringa oleifera), arjun (Terminalia arjuna), tulsi (Ocimum sanctum), turmeric (Curcuma longa); rhizomes of ginger (Zingiber officinale) and turmeric; fruits of amla (Emblica officinalis), haritaki (Terminalia chebula), bohera (Terminalia belerica) and bulbs of garlic (Allium sativum) of indigenous origin were determined. Proximate and mineral components [Calcium (Ca), Phosphorus (P), Sodium (Na), Potassium (K), Magnesium (Mg), Copper (Cu), Zinc (Zn), Manganese (Mn)] were determined. Dry matter (DM) varied from 964g/kg in arjun leaves to 892g/kg in tulsi leaves. Sajna leaves were high in protein (240g/kg), whereas haritaki fruits were low (34g/kg). Highest amount of ether extract (EE) was found in turmeric rhizomes and the lowest in amla fruits. The crude fibre (CF) ranged from 134 g/kg in turmeric leaves to 7g/kg in garlic bulbs. Highest amounts of ash were found in tulsi leaves (136g/kg), whereas haritaki had 42g/kg. All the plant products had high Nitrogen Free Extract (NFE) and haritaki ranked the highest. Neem leaves contained the highest amount of Ca and Mg. Fruits had lower amounts of P than other products. K content ranged between 8510 ppm in turmeric leaves and 4190 ppm in arjun leaves. Tulsi leaves contain higher amounts of Na, whereas arjun leaves contained less. Tulsi leaves contain higher amount of Cu and Zn than other plant products. The Mn content ranged from 17 ppm in ginger to 780 ppm in garlic bulbs. Only sajna and neem leaves are considered as fair sources of protein. Such ingredients may be considered as good sources of Ca and Mg. DOI: 10.3329/bvet.v25i1.4616 Bangl. vet. 2008. Vol. 25, No. 1, 32-39

Early detection of cervical intraepithelial lesions by simple visual inspection after acetic acid among women in Rajshahi medical college hospital

Aim: To evaluate the performance of visual inspection of acetic acid (VIA) in the detection of precancerous and early cancerous lesions of cervix. Materials and methods: Total 5593 eligible women who randomly came to the Gyenae out patient department (OPD) of RMCH (Rajshahi Medical College Hospital) were examined by VIA. Detection of well defined, opaque, acetowhite lesions close to the squamocolumner junction or in transitional zone or dense acetowhitening of ulceroproliferative growth on the cervix constituted a positive VIA. Those who had abnormal results in screening test & those who had clinically suspicious lesions were sent for colposcopic evaluation (n= 442) & directed biopsy were taken from colposcopically suspected areas (n=214). The final diagnosis was based on histology. Results: Out of 5593 patients, 442 (7.20%) were VIA positive. 442 patients were colposcopically evaluated .Among them, 228 (51.58%) were normal and 202(45.70%) had different stages of cervical intraepithelial lesions (CIN) and 12 ( 2.71 % ) had carcinoma of cervix. Out of 214 patients biopsied, 23.36 % patients had a final diagnosis of CIN lesions, 5 (2.33%) had carcinoma in-situ & 17 cases (7.94%) had invasive carcinoma. Besides to find out the predictable factors of cervical lesions data have been collected from VIA positive patients regarding age of first coitus and first delivery, history of extra marital exposure and STI, use of contraceptive methods and family history of cancer. Age of first coitus between 12 to 15 years and 16 to 20 years were observed among 203 (46 %) and 40 % (177) women respectively. More than half of the patients (62%) were experienced with their first delivery within the age 15-20 years which was below 15 years of 12 % (53) patients. Fifty four percent patients used OCP and barrier methods used were only 10 %. Family history of cancer was observed among 09 % women. 58% patients were belonged to lower middle class and upper group were only 9% (table 1) Conclusion: In our study detection of different grades of intraepithelial lesions (CIN-I, CIN-II, CIN-III, invasive carcinoma) of cervix by VIA was comparable to that of colposcopy. So VIA is suitable for detection of precursor lesions of cervical cancer in low resource settings and also for diagnosis, follow up treatment and epidemiological studies of cervical cancer. Key words: Visual inspection; VIA; cervical carcinoma; colposcopy; screening; epidemiological studies. DOI: http://dx.doi.org/10.3329/bjms.v10i4.9494 BJMS 2011; 10 (4): 240-244

Microvascular Free Tissue Transfer at Chittagong Medical College Hospital - A Milestone

Introduction: A defect in any part of the body involving extensive soft tissue loss adversely affects the functional ability. With the advent of microvascular free tissue transfer in the reconstruction of large defects, the problem is going to be solved. However, studies are still going on about the different aspects of its success and failure. The present study is one such step to share our early experience.Methods: The study was carried out in the Department of Plastic Surgery, Chittagong Medical College Hospital from August 2009 to April 2010. We reviewed the operative experiences of free tissue transfer on 5 cases. Standard microvascular anastomotic techniques as well as peroperative & postoperative heparinization were maintained in all the cases. Follow up results were evaluated at varying periods following standard protocol.Results: Of the 5 cases reconstructed, 4(80%) had lesions in the maxillofacial region and 1(20%) in the ankle region. In terms of diseases they suffered, 3(60%) had squamous cell carcinoma and 2(40%) sustained mechanical injury. The outcome of treatment demonstrates that 3(60%) cases recovered uneventfully, one developed slight loss of sensation on the left thumb (20%) and another one failed to recover (20%).Conclusion: In this study successful microvascular free tissue transfer was possible in 80% cases. With the increase in experience we can expect increased success rate as well.DOI: http://dx.doi.org/10.3329/bdjps.v1i1.6485Bangladesh Journal of Plastic Surgery (2010) Vol. 1 (1) pp.3-8