Effect of heat stress on blood parameter, carcass and meat quality of Black Bengal goat

The research was conducted to study the effect of heat stress on blood parameter, carcass characteristics and meat quality of the Black Bengal goat. Nine goats were randomly and equally divided into three groups having almost same age and weight. Three groups were divided as zero hour (T0), four hours (T4) and eight hours (T8) of heat exposure. The T0 group were not exposed to heat stress, the T4 and T8 group were exposed to heat by keeping them at outside for 4 (four) hours and 8 (eight) hours from 9.00 AM to 1.00 PM and from 9.00 AM to 5.00 PM, respectively. Temperature–humidity index (THI) was calculated as 26.88 indicating all the experimental animals were in extreme severe heat stress. The blood parameter such as RBC, PCV%, Hb%, WBC was significantly (p<0.01) higher in T8 group than those of T4 and T0 groups. There was also significant (p<0.05) effect of heat stress on pH of the meat from different groups of the Black Bengal goats. By-products e.g., blood, pluck, spleen and kidney, and cooking loss were significantly (p<0.01) increased with the increase of the heat, but no significant differences were observed for pre-slaughter parameters, carcass weight, drip loss, dressing percentage, and proximate composition of the goat meat for DM, CP and Ash, while the EE significantly (p<0.05) differed among the heat treated groups. Heat stress significantly affected the blood parameter, cooking loss, pH, by-product of goats rather than non heat stressed group. It indicates that heat stress limits the qualitative and quantitative production characteristics of goat meat. DOI: http://dx.doi.org/10.3329/bjas.v42i1.15783 Bang. J. Anim. Sci. 2013. 42 (1): 57-61

Comparative efficacy of subcutaneous versus oral methotrexate in active rheumatoid arthritis

This prospective study was conducted in rheumatology clinic under the department of medicine of Bangabandhu Sheikh Mujib Medical University from December 2004 to December 2005 to asses the efficacy, safety and compliance of subcutaneous methotrexate (MTX) in active rheumatoid arthritis (RA) patients. A total of 92 active rheumatoid arthritis patients according to American College of Rheumatology (ACR) criteria were recruited for the trial for six months. Among them 46 cases belonged to injectable MTX group and 46 cases belonged to oral MTX group. Mean±SD age of patients was 45.54±12.42 vs. 44.63±13.99 years in subcutaneous group and oral group respectively. In the subcutaneous group 41 were female and 5 male; in the oral group 34 were female and 12 male. Mean duration of the disease was 49.74 months in subcutaneous group and 49 months in oral group. RA test was positive in 35 cases in both groups whereas Rose Waaler test was positive in 19 patients in subcutaneous group and 14 patients in oral group. At 24 week, response rate of ACR 20 was significantly higher in subcutaneous MTX than oral MTX group (93% vs. 80%, p=0.02). Similarly ACR 50 response was significantly higher in subcutaneous MTX than in oral group (89% vs. 72%, p=0.03). ACR 70 response was not significantly higher in SCMTX group then oral group (11% vs. 9 %, p=0.72). Adverse effects were relatively less in subcutaneous MTX and most common side effects were nausea (37% vs. 63%), vomiting (11% vs. 30%), dyspepsia (29% vs. 48%), dizziness (4l% vs. 52%) and alopecia (72% vs. 85%). The results of the study demonstrated that subcutaneous MTX was significantly more effective than oral MTX at the same dosage in active Rheumatoid arthritis patients with no increase in side effects.

The management of cubitus varus using Ilizarov method

Cubitus varus is the most common complications of supracondylar fractures. Various combinations of osteotomy and fixation have been described to correct the deformity but each is associated with significant complications. In this study, we used distraction osteogenesis and Ilizarov frame fixation to treat 12 elbows with cubitus varus. The mean time to follow up was 24 months (10-38) and the mean time to frame removed was 14.5 weeks (10-22). The mean carrying angle was corrected from -19.8°(-10°-32°) to 6.2°(2°-12°). In patients with cubitus varus was from 35.5° (22°-45°). There were 11 excellent and one good result.

Prevalence and risk factors of chronic obstructive pulmonary disease (COPD) in Dhaka city population

This prospective, cross-sectional population based survey was carried out in the Respiratory wing, Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to see the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among Dhaka City Population in Bangladesh. The total sample size was 900 at the age of 35 years or above. Spirometry was performed according to ATS criteria. Data related to smoking history, respiratory symptoms, co-morbidities, physical examination findings, spirometry values and other investigation reports were noted in the questionnaire. The mean age was 45.26±10.08 (Mean±SD); of them, male 76.9% and female 23.1%. Among them, smoker was 481 with a smoking duration of 10 pack year 27.8% and non smoker were 419. Spirometric screening yielded diagnosis of COPD in 11.4% (103/900). Using operational severity criteria adopted from Global Initiative for Obstructive Lung Disease (GOLD) mild, moderate, severe and very severe COPD were found in 42.7%, 27.2%, 20.4% and 9.7% respectively. The hall mark symptom of COPD exertional dyspnea was seen in 10.4%, non-specific symptoms like cough and sputum were found in 40% and 19% respectively. Physical sign like vesicular breath sound with prolonged expiration and ronchi were found in 6.1% and 4.1% respectively. In this study, age (Mean±SD in years) (57.34±11.74), Sex (Male: Female = 4:1), low BMI (Mean±SD) (21.56±3.83), Smoker 56(20.2%) and low Socio-economic condition 54(13.6%) found to be risk factor of COPD. Regression analysis revealed that age (p<0.001), sex (p<0.001), smoking duration (p<0.001) and low socioeconomic condition (p<0.05) as independent risk factors for COPD.

Effects of Solid Waste and Industrial Effluents on Water Quality of Turag River at Konabari Industrial Area, Gazipur, Bangladesh

The study was conducted to investigate the effects of solid waste and industrial effluents on the water quality of Turag River. Both the upstream and downstream sampled water from the selected points were analyzed for color, odor, pH, electrical conductivity (EC), total dissolved solids (TDS), dissolved oxygen (DO), biological oxygen demand (BOD), copper (Cu), cadmium (Cd), iron (Fe), lead (Pb) and zinc (Zn) concentrations. Results of the study showed that the color of water was light to dark black and emitted noxious smell due to the industrial effluents. The upstream water was slightly alkaline with comparatively high DO content while low concentration of other parameters. The water after the solid waste and effluents received points as well as middle and downstream points was slightly alkaline with higher levels of other parameters when compared with upstream point. The minimum and maximum values of pH, EC, TDS, DO and BOD were 7.24-7.61, 425-2277 ?S/cm, 239-1349 ppm, 1.22-3.66 ppm and -2.44-0.86 ppm, respectively. The continuous dumping of waste materials resulted in a marked increase in the concentration of metals in the river water varied in the order of Fe > Zn > Pb > Cu > Cd. The study concluded that the downstream water in the river was almost polluted and unsuitable for human consumption and aquaculture purposes.DOI: http://dx.doi.org/10.3329/jesnr.v5i2.14817 J. Environ. Sci. & Natural Resources, 5(2): 213-218 2012

Effect of BARI Wheat Varieties on Seed Germination, Growth and Yield under Patuakhali District

A pot experiment was carried at Patuakhali Science and Technology University to study the performance of some BARI wheat varieties under the coastal area of Patuakhali. Four wheat varieties viz. BARI ghom-23, BARI ghom-24, BARI ghom-25 and BARI ghom-26 were planted in the field to evaluate their comparative performance in respect of germination percentage, growth, yield and yield attributing characters. Among the four varieties, BARI ghom-26 showed superior performance irrespective of all parameters studied except total dry matter content (TDM) and yield reduction percentage. Among the BARI varieties, BARI ghom-26 produced greater germination (61.00%) at 13 days judge against to other varieties. The taller plant (47.91 cm), higher LAI (1.84), maximum TDM (17.37 g plant-1) and effective tillers hill-1 (18.08) were also obtained with the similar variety. BARI ghom-26 was also most effective to produce the maximum grains spike-1 (38.52), higher weight of 1000-grains (49.38 g), higher grain (3.35 t ha-1) and straw (8.50 g plant-1) yield and greater HI (4.03%). So, the variety BARI ghom-26 produced the outstanding superiority among the varieties.DOI: http://dx.doi.org/10.3329/jesnr.v5i2.14816 J. Environ. Sci. & Natural Resources, 5(2): 209-212 2012

Aetiology and risk stratification of patients presenting with atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia in the World, occurring in approximately 0.4% of the general population. The purpose of the present study was to see the aetiology, presenting symptoms and risk stratification of hospital admitted patients with atrial fibrillation. It was conducted in the department of cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2008 to January 2009. A total of 100 patients with atrial fibrillation were enrolled in this study. Out of them, male were 40(40%) and female 60(60%); age range 22-79 years. Most common presenting symptoms were palpitation (80%) & dyspnoea (70%). Chronic rheumatic heart disease (CRHD) (63%) was found in most cases followed by IHD (13%), hypertension (11%). Among CRHD, mitral stenosis was 50%, and mixed mitral valve disease was 8%. Risk stratification of patients with AF for future thromboembolism revealed high risk factors were present in 60% cases, moderate in 25% cases, and weaker risk factors in 15% cases. According to CHADS2 score, most of the patients belonged to moderate risk group (47%) and 32% in low risk group. Chronic rheumatic heart disease is one of the major causes of atrial fibrillation in hospital admitted patients & risk stratification revealed that most of the patients were in risk for future stroke.

Impact of metabolic syndrome in acute myocardial infarction at hospital

The study was aimed to find out the impact of metabolic syndrome in patients with acute myocardial infarction during hospital stay. This prospective study was carried out in coronary care unit, Mymensingh Medical College Hospital from August 2009 to May 2010. Patients were followed up for minimum 3 days to maximum 6 days after admission. Variables of this study were age, sex, smoking, anterior AMI, inferior AMI, Non STEMI, hyperglycemia, low high density lipoprotein (HDL), raised blood pressure, high triglyceride (TG), waist circumference, recurrent non fatal MI, heart failure (Killip class), arrhythmia (VT, VF), ejection fraction (EF), family history of cardiovascular (CV) risk factors. Considering inclusion and exclusion criteria total 100 patients were included and divided into two groups, Group A - Acute Myocardial Infarction (AMI) with Metabolic Syndrome (MS) and Group B - Acute Myocardial Infarction (AMI) without Metabolic Syndrome (MS). Investigations included ECG, FBS, fasting lipid profile, cardiac enzyme (troponin I) and echocardiography (2D & M mode). The data were analyzed by computer software SPSS version 12. Chi-square test, t test, ANOVA test was used as test of significance. Among the study population (n=100), female were 12.0%. Mean age of study population was 53.3±10.6 years vs. 47.5±11.3 years. Distribution of metabolic syndrome components in study population, High TG (?150mg/dl) was more prevalent (81.1% vs. 25.8%). Heart failure (Killip class) was significantly more in metabolic syndrome patients than those without metabolic syndrome (46.0 % vs. 20%). LV ejection fraction also lowers in metabolic syndrome patients (46.76±8.34 vs. 50.45±7.50) with MI. Among the components of metabolic syndrome, hyperglycemia had strongest association for development of heart failure (OR 3.05; 95% CI 0.80-12.14).

Cough in systemic lupus erythematosus

This observational study was conducted in the lupus clinic of Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2007 to July 2007. Thirty-six consecutive SLE patients fulfilled American College of Rheumatology (ACR) diagnostic criteria and having cough for any duration was enrolled. Equal number of age and sex matched controls (The patient attending in the out patient department in the Medicine having cough without SLE) was taken after having informed consent. Severely disabled cases and cases unwilling to participate with a cough were excluded. Mean age of study population was 29.1±8.7 years and 29.8±9.9 years in controls. Duration of cough was less than 3 weeks in 17% of SLE patients and 8% of control group and was more than three weeks in 83% and 92% respectively. In SLE patient commonest causes of cough was bronchial asthma 47% and was 33% in controls. Post nasal drip syndrome was the next common causes and frequently due to sinusitis and allergic rhinitis. Its frequency was 14% and 16% in SLE and control groups respectively. Other causes were pneumonia (11%, 14%), Diffuse Parenchymal Disease lung (DPLD) (5.6% & 2.8%), and tuberculosis (5.6% & 8%) in SLE & control groups respectively. Gastro esophageal reflux disease (GERD) was 2.6% in SLE group but was not found in control group. Cough is common in SLE patients. Frequency distribution though similar to that of causes of cough in community but warns the possibility of serious underlying diseases in SLE cases and attentive evaluation.

Comparison of trabeculectomy with mitomycin-C versus medical treatment in moderate stage of steroid induced glaucoma

This prospective, comparative and interventional study was done to compare the effects of Trabeculectomy with Mitomycin-C and medical treatment with Timolol maleate 0.5% by controlling IOP (intra ocular pressure) and assessing the visual acuity (VA) and mean sensitivity (MS) of visual field in moderate stage of steroid induced glaucoma and conducted in the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2004 to June 2009. Sixty eyes of thirty patients with glaucoma due to use of topical steroids for >1 year. IOP range was 22-30 mm of Hg, visual field with (MD) mean deviation >6 to 12 dB and (MS) mean sensitivity >12-21dB, C:D ratio 0.7-0.8 and visual acuity 6/9 to 6/6 were included in this study. At first, topical steroid was stopped. Sample was collected in lottery method. Patients were divided into two groups. In Group I, 30 eyes were treated with Timolol maleate 0.5%. In Group II, 30 eyes were treated surgically by Trabeculectomy with Mitomycin-C. Follow-up were done on 1st POD, after 7 days, 1 month, 3 months and 6 months. Successful IOP control (<15mm of Hg) were achieved in 23 eyes (77%) in Group I and 30 eyes (100%) in Group II and were highly significant (p<0.001). Visual acuity and mean sensitivity also improved more in Group II than the Group I. It was also highly significant (p<0.001). So, Trabeculectomy with mitomycin-C is effective procedure in comparison to medical treatment for steroid induced glaucoma.

Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14331 Bangladesh Med Res Counc Bull 2012; 38(3): 84-89 (December)

Management of anticancer treatment in patients under chronic dialysis: results of the multicentric CANDY (CANcer and DialYsis) study

BACKGROUND

One million people worldwide benefit from chronic dialysis, with an increased rate in Western countries of 5% yearly. Owing to increased incidence of cancer in dialyzed patients, the management of these patients is challenging for oncologists/nephrologists.

PATIENTS AND METHODS

The CANcer and DialYsis (CANDY) retrospective multicenter study included patients under chronic dialysis who subsequently had a cancer (T0). Patients were followed up for 2 years after T0. Prescriptions of anticancer drugs were studied with regard to their renal dosage adjustment/dialysability.

RESULTS

A total of 178 patients from 12 institutions were included. The mean time between initiation of dialysis and T0 was 30.8 months. Fifty patients had received anticancer drug treatment. Among them, 72% and 82% received at least one drug needing dosage and one drug to be administered after dialysis sessions, respectively. Chemotherapy was omitted or prematurely stopped in many cases where systemic treatment was indicated or was often not adequately prescribed.

CONCLUSIONS

Survival in dialysis patients with incident cancer was poor. It is crucial to consider anticancer drug treatment in these patients as for non-dialysis patients and to use current available specific drug management recommendations in order to (i) adjust the dose and (ii) avoid premature elimination of the drug during dialysis sessions.

Presence of enterotoxigenic Escherichia coli in biofilms formed in water containers in poor households coincides with epidemic seasons in Dhaka

AIMS

The objective of this study was to investigate if biofilms may be potential reservoirs for the waterborne pathogen enterotoxigenic Escherichia coli (ETEC) in household water in Dhaka, Bangladesh.

METHODS AND RESULTS

Biofilms formed on submerged glass slides. Mature biofilms were found significantly more often on glass slides collected in the monsoon period between the two annual ETEC peaks in Bangladesh, that is, between May and August than the rest of the year (P < 0.03). Sixty-four per cent (49/77) of all biofilms analysed by quantitative real-time PCR were positive for ETEC. Significantly more ETEC-PCR positive biofilms were found during the epidemic peaks and during flooding periods than the rest of the year (P < 0.008). Planktonic ETEC was present in the household water during all seasons, but there was no correlation between presence or numbers of ETEC in water and the epidemic peaks.

CONCLUSIONS

We conclude that ETEC is continuously present in water and biofilms in household water reservoirs in Dhaka, which has a high prevalence of ETEC diarrhoea. The frequency of biofilms with ETEC was significantly associated (P < 0.008) with seasonal epidemic peaks of ETEC diarrhoea.

SIGNIFICANCE AND IMPACT OF THE STUDY

We show for the first time that enterotoxigenic Escherichia coli (ETEC), the causative agent of acute watery diarrhoea and travellers' diarrhoea is present in biofilms in household water tanks in Dhaka, Bangladesh.

A 60 years old lady with osteomalacia due to deficiency of vitamin D

DOI: http://dx.doi.org/10.3329/jdmc.v21i1.13248 J. Dhaka Med. Coll. 2012; 21(1): 116-119

Major Variation in Branches of the Abdominal Aorta in New Zealand White Rabbit (Orycotolagus Cuniculus)

The aim of the present study was to investigate the arrangement and major vascular variation of abdominal aorta in NZW rabbit. A total of 28 healthy adult rabbits (14 males and 14 females) with an average (1.3 ± 0.5kg) body weight were used in this study. Deep surgical anaesthesia was done by using combination of xylazine and ketamine at the doses of 10mg/kg and 40mg/kg body weight respectively, and was sacrificed by bleeding through the right ventricle of the heart. Cannulation of the thoracic aorta and stained latex (added with ammonium water and red carmine stain) injection were performed, followed by 10% neutral buffered formalin. Asymmetry of the even branches with their distribution and the way of departure of the arteries from the abdominal aorta were observed. However, double pair ovarian arteries were found in a single animal. The diameter of the caudal mesenteric artery showed significant (p?0.05) difference between male and female. In case of male and female, the variability of the origin (number and level of origin) of testicular, ovarian and profound iliac circumflex arteries was also observed. DOI: http://dx.doi.org/10.3329/ijns.v2i4.13218 International Journal of Natural Sciences (2012), 2(4) 91-98

Acute pancreatitis associated with acute viral hepatitis A (HAV) - a case report

In this case report, a young woman had acute viral hepatitis (HAV) and acute pancreatitis together. She was admitted to our hospital with fever, jaundice and abdominal pain. Hepatic and pancreatic enzymes were elevated. Her serum alanine aminotransferase (ALT) level was high. An initial abdominal ultrasound was per-formed at hospital and revealed features of acute viral hepatitis. Spiral computed imaging revealed imaging features of an acute stage of pancreatitis and gallbladder wall thickness. HAV infection was diagnosed by the detection of immunoglobulin M (IgM) against HAV in the serum. She was closely monitored and treated conservatively. On 10th day of hospital admission she was discharge after an uneventful recovery. In the current literature HAV infections have rarely been reported as a cause of acute pancreatitis.

Wegener's granulomatosis - a case report

Wegener's granulomatosis is an uncommon multi-systemic disease characterized by necrotizing granulomatous inflammation of the upper and lower respiratory tracts and general focal necrotizing vasculitis (commonly known as Wegener's triad). The diagnosis of Wegener's granulomatosis is suggested from the clinical and laboratory findings and from the presence of circulating anti-neutrophil cytoplasmic antibodies (ANCA) although the absence of ANCA does not exclude the diagnosis. We described a case of 27-year-old man with pansinusitis, mild azotemia and initial respiratory tract symptoms such as foul smelling nasal discharge and epistaxis. Later he developed fever, poly-arthritis, abdominal pain and haematuria. There were multiple painful oral ulcers and skin showed multiple palpable purpuric rash. C-ANCA was positive. He was treated with IV methyl prednisolone 1gm daily for 3 days followed by oral prednisolone 1mg/kg body weight and oral cyclophosphamide. His condition improved dramatically and on follow up after 3 months he was reasonably well. In this report, we wanted to emphasize that Wegener's granulomatosis, although rare, should be considered in the above clinical scenario and treatment should be initiated as soon as possible.

Phytofiltration of arsenic and cadmium from the water environment using Micranthemum umbrosum (J.F. Gmel) S.F Blake as a hyperaccumulator

Arsenic (As) and cadmium (Cd) pollution in water is an important global issue. Phytofiltration is an eco-friendly technology that helps clean up pollutants using ornamental plants, such as Micranthemum umbrosum (J.F. Gmel) S.F. Blake. After a seven-day hydroponic experiment, M. umbrosum removed 79.3-89.5% As and 60-73.1% Cd from 0 to 1.0 microg As mL(-1) and 0.3 to 30.0 microg Cd mL(-1) solutions, respectively. For As treatment, root to stem and stem to leaf translocation factors greater than 1.0 indicated that accumulation of As in leaves was large compared to that in stem and roots. However, the accumulation of Cd in roots was higher than that in the leaves and stem. In addition, M. umbrosum completely removed Cd within three days from 0.38 to around 0 microg mL(-1) Cd in the solution when the plant was exchanged daily. Bio-concentration factors (2350 for As and 3027 for Cd) for M. umbrosum were higher than for other As and Cd phytoremediators. The results show that M. umbrosum can be an effective accumulator of Cd and a hyper-accumulator of As, as it can lower As toxicity to a level close to the limit recommended by the World Health Organization (0.01 microg As mL(-1)).

Wilson's disease in children with blindness: an atypical presentation

Wilson's disease (WD) is an autosomal recessive disease affecting copper metabolism causing copper induced organ damage. Common organs involved are liver and central nervous system. But RBC, eye, kidneys and bone may also be affected. In WD main defect remains in copper transporter protein p type ATPase resulting from gene mutation in chromosome 13. Neurological manifestations in WD develop due to deposition of copper in different brain areas like basal ganglia, cerebral cortex, corticospinal and corticobulbar pathway. Different types of neurological manifestations develop in WD but visual impairment is very rare. A 14 years old boy of WD presented to us with blindness, tremor and slurred speech along with end stage liver disease. Blindness was thought to be due to optic neuropathy which reversed after drug treatment.

Metabolic syndrome is a risk factor for development of heart failure in acute myocardial infarction

There is a relationship between metabolic syndrome with heart failure. A case control study was designed to see the association of metabolic syndrome with heart failure. The study was conducted from August 2009 to May 2010. Hundred cases were selected as study population which was taken from Department of Cardiology Mymensingh Medical College, Mymensingh. Among them 50 were in Group A, 50 were in Group B. Group A was the patient with acute myocardial infarction (AMI) with metabolic syndrome. Group B was the patient with AMI without metabolic syndrome. It revealed that 23(46%) in Group A and 10 (20%) in Group B developed heart failure. Which is statistically significant (p<0.05). The study concluded that metabolic syndrome is significantly associated with heart failure.

Urinary microalbumin as a risk factor for ischaemic stroke

Microalbuminuria (MA), a microvascular irregularity of the blood - urine interface within kidney glomeruli, may reflect the renal sign of global endothelial dysfunction, and has been associated with an elevated risk of serious cardiovascular events including stroke. This case-control study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2008 to December 2009. This relationship appears graded with higher levels of microalbuminuria being independently associated with a greater magnitude of vascular risk over time. We studied 60 patients of ischemic stroke with in 4 weeks of onset of symptoms and performed a case control study for MA by spot urinalysis. The incidence of microalbuminuria was 31.7% of the patients compared with 8.3% of the controls. Of all the traditional risk factors for stroke - age, male gender, hypertension, diabetes, dyslipidemia, smoking showed a positive correlation with the presence of MA (p<0.05). The effect of microalbuminuria and subtypes of ischemic stroke was observed that small vessels stroke (lacunar infract) were more (70%) than large vessels stroke (30%) and effect of microalbuminuria 21.67% higher in small vessels stroke than large vessels stroke. The presence of microalbuminuria appears to independently predict proper clinical outcome following acute stroke.

Coronary angiographic profile in bangladeshi patients with metabolic syndrome and ischemic heart disease

The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. We evaluated interrelationships between angiographic CAD and the metabolic syndrome, in 478 patients who were referred for coronary angiography to evaluate suspected myocardial ischemia in the department of cardiology of BSMMU between June 2007 and May 2008. We applied the criteria for the metabolic syndrome proposed by ATP III guideline. Study populations were divided into two groups on the basis of presence or absence of metabolic syndrome. Age was similar in both groups. Body mass index (BMI) was higher (26.22 ± 1.94 vs. 22.07 ± 1.55) in metabolic syndrome group (p ≤ 0.0001). All parameters, waist circumference (103.16 ± 10.21 vs. 91.45 ± 7.61) cm, blood pressure both systolic (141.34 ± 21.49 vs. 127.94 ± 13.01) and diastolic (86.8 5 ± 8.42 vs. 79.28 ± 7.77) mm of Hg, serum triglyceride (248.32 ± 77.88 vs. 128.35 ± 19.00)mg/dl, fasting blood glucose (125.40 ± 22.86 vs. 95.65 ± 10.63)mg/dl were significantly higher in metabolic syndrome group (p value=0.0001), whereas HDL (33.10 ± 6.55 vs. 39.30 ± 6.17)mg/dl was lower (p value = 0.0001). More subjects in metabolic syndrome were having type B (55.60% vs. 31.00%) and type C (9.50% vs. 2.70%) lesion as compared to non-metabolic syndrome group. Involvement of left main artery was more (4.80% vs. 0.90%) in metabolic syndrome group. Metabolic syndrome has primary predictive ability for CAD. A metabolic profile should form part of the risk assessment in all patients with coronary disease, not just those who are obese.

Total proctocolectomy with ileal pouch-anal anastomosis by stapling technique

An ileal pouch-anal anastomosis (IPAA) has become the gold standard procedure for ulcerative colitis and familial adenomatous polyposis coli. Construction of an ileal pouch reservoir is now standard, usually in the form of J pouch. The aim of this study was to assess the outcome of ileal pouch-anal anastomosis by stapling technique after total proctocolectomy. This prospective observational study of six patients who underwent proctocolectomy followed by an ileal pouch-anal anastomosis by stapling technique. Whole colon and rectum was mobilized and resected; J pouch created by GIA device and pouch-anal anastomosis done by staplers. All patients were continent. Patients with familial adenomatous polyposis (FAP) and ulcerative colitis showed excellent outcome regarding their disease after proctocolectomy. The ileal pouch-anal anastomosis has become a feasible alternative to the conventional permanent ileostomy after total proctocolectomy. Satisfactory results have been reported, although the procedure is associated with considerable morbidity. Excision of all the affected mucosa is an essential part of the procedure. Our experience with the ileal pouch-anal anastomosis using stapling devices without mucosectomy.