Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study

Eosinophilic esophagitis (EoE) is a disease of modern era. It was first described 40 years back. Since then it has drawn an immense interest among the clinicians. It is diagnosed by the presence of eosinophils count ≥15/HPF on esophageal biopsied mucosa in patients with symptoms of esopohageal dysfunction. It is more prevalent among patients with gastroesophageal reflux disease. As its symptoms overlap with that of gastroesophageal reflux disease (GERD), it is frequently overlooked & misdiagnosed which increases patients' sufferings. No data is available in Bangladesh. The objective of the study was to find out the frequency of eosinophilic esophagitis among patients with gastroesophageal reflux symptoms. The study was conducted at the Outpatient department of the department of Gastroenterology of Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2018 to April 2019. One hundred and thirty three (133) consecutive patients with symptoms suggestive of gastroesophageal reflux disease based on validated questionnaire underwent upper GI endoscopy. Biopsies were taken from proximal and distal esophagus as well as any other endoscopically abnormal esophageal mucosal lesion. Among 133 patients with gastroesophageal reflux symptoms, 7 patients (5.3%) were found to be positive for eosinophilic esophagitis. Mean age at diagnosis was 37.28±13.38 years. It was more common in younger age group. Female patients (56%) were more than male patients (44%). Heart burn was the major symptom followed by acid regurgitation. Nocturnal cough showed statistically significant relationship with eosinophilic esophagitis. Although the frequency is low, it may be considered as a differential diagnosis among patients with GERD.

Risk Factors of UTI in Children with Nephrotic Syndrome

Urinary tract infection (UTI) is a common complication in nephrotic children and leads to most morbidity and mortality in developing countries like Bangladesh. This case control study was conducted in the Department of Pediatrics and Pediatric Nephrology ward of Dhaka Medical College Hospital, Dhaka from July 2016 to June 2018 to identify the risk factors of UTI in children with nephrotic syndrome. Total 90 patient of nephrotic children aged 2-12 years, who were fulfilling the inclusion and exclusion criteria were selected as Group I (case) and Group II (control) according to urine culture report. Group I was UTI positive and Group II was UTI negative. The mean age of Group I was 5.26±3.18 years and Group II was 6.03±2.85 years. There was male predominance in both groups. No significant difference has been found regarding age and sex (p>0.05). No significant difference was also observed regarding economic status and educational level of mother among both groups (p>0.05). Fever, dysuria, abdominal pain, anasarca, vomiting and pallor were found as common presentations in Group I. Children with dysuria and abdominal pain were significantly higher in Group I than Group II (p value <0.001). UTI was found more in relapsed cases than initial attack. E. coli was the most common etiologic agent (37.8%). Mean Hb (gm/dl), serum total protein, serum albumin and serum IgG level were found significantly lower and spot urine protein creatinine ratio was significantly higher in Group I, which implies that those biochemical factors were associated with development of UTI in nephrotic children. Younger age group (<6 years), Constipation and uncircumcised male were found as risk factors and has association with UTI in nephrotic children.

Comparative effects of ascobin and glutathione on copper homeostasis and oxidative stress metabolism in mitigation of copper toxicity in rice

Copper (Cu) pollution of agricultural land is a major threat to crop production. Exogenous chemical treatment is an easily accessible and rapid approach to remediate metal toxicity, including Cu toxicity in plants. We compared the effects of ascobin (ASC; ascorbic acid:citric acid at 2:1) and glutathione (GSH) in mitigation of Cu toxicity in rice. Plants subjected to Cu stress displayed growth inhibition and biomass reduction, which were connected to reduced levels of chlorophylls, RWC, total phenolic compounds, carotenoids and Mg²⁺ . Increased accumulation of ROS and malondialdehyde indicated oxidative stress in Cu-stressed plants. However, application of ASC or GSH minimized the inhibitory effects of Cu stress on rice plants by restricting Cu²⁺ uptake and improving mineral balance, chlorophyll content and RWC. Both ASC and GSH pretreatments reduced levels of ROS and malondialdehyde and improved activities of antioxidant enzymes, suggesting their roles in alleviating oxidative damage. A comparison on the effects of ASC and GSH under Cu stress revealed that ASC was more effective in restricting Cu²⁺ accumulation (69.5% by ASC and 57.1% by GSH), Ca²⁺ and Mg²⁺ homeostasis, protection of photosynthetic pigments and activation of antioxidant defence mechanisms [catalase (110.4%), ascorbate peroxidase (76.5%) and guaiacol peroxidase (39.0%) by ASC, and catalase (58.9%) and ascorbate peroxidase (59.9%) by GSH] in rice than GSH, eventually resulting in better protection of ASC-pretreated plants against Cu stress. In conclusion, although ASC and GSH differed in induction of stress protective mechanisms, both were effective in improving rice performance in response to Cu phytotoxicity.

Serum Iron Profile and Red Cell Indices in Children with Severe Acute Malnutrition in A Tertiary Level Hospital

This cross-sectional analytical study was conducted in the department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from March 2017 to August 2018 to assess the pattern of serum iron profile and red cell indices in children with severe acute malnutrition. Seventy children having severe acute malnutrition were compared with 70 age matched children those had normal growth. Age range of the studied children was 6 months to 59 completed months. Male was found predominant (54.3%) in both study group and comparison group. Mean serum iron, serum ferritin, serum total iron binding capacity and transferrin saturation in severely malnourished children were 45.3±19.3μg/dl, 26.5±20.0ng/ml, 246.3±47.5μg/dl and 16.4±2.0% respectively which were significantly lower than that of healthy children (p<0.05). Mean Hb level in children with severe acute malnutrition was found 8.3±1.6gm/dl which was also found significantly lower than that of normal children (p<0.05). Anaemia was found in all (100%) severely malnourished children compared to 25.7% of children in comparison group. Mean MCV, MCH and MCHC in children with severe acute malnutrition was found 71.7±13.5fl, 24.0±5.8pg and 31.4±4.0gm/dl respectively which were significantly lower than that of comparison group (p<0.05). Serum iron profile and red cell indices should be routinely done in severely malnourished children for early intervention and management of iron deficiency anaemia.

Association between Child Undernutrition and Maternal Undernutrition: A Study in a Tertiary Care Hospital

Undernutrition in children under five years remains a significant health problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although Bangladesh has made rapid progress over the last decade in the field of health and nutrition, there has been very slow progress in improving the state of child nutrition. Studies aiming at determination of interrelationship between child undernutrition and maternal undernutrition are to be scientifically established if appropriate intervention policy is to be introduced. This study was undertaken to see whether this assumption has a statistically proven basis that maternal undernutrition influences child undernutrition. The objective of this cross sectional analytical study was to evaluate the association between child undernutrition and their maternal undernutrition in child-mother pair in a tertiary care hospital and was conducted from July 2017 to April 2018 in the department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study subjects were 196 children between the ages of six months to five years who were admitted in BSMMU and their accompanying mothers. Children who had any known chronic diseases or clinically obvious syndrome were excluded. Before enrollment, parents of all the patients were informed about the study & its objectives. Anthropometric measurements of children and mothers were done by standard procedure. Demographic profile and relevant maternal information were collected by interviewing the mothers. Among the undernourished children, 17.3% were found underweight, 7.1% stunted, 16.3% wasted. Combined underweight & wasted were 34.7%, underweight & stunted 9.2%, stunted & wasted 5.1%, underweight, stunted and wasted 10.2%. Maternal undernutrition was more common (95.7%) in undernourished children group. Undernutrition was significantly higher in mothers of children with undernutrition (OR=40.75, p<0.001). Children having a better nutrition were born from mothers who were well nourished, educated, had good childcare knowledge and higher family income. This emphasized the need to provide the guideline for appropriate measure to be taken to reduce child undernutrition.

Raf promotes dimerization of the Ras G-domain with increased allosteric connections

Ras dimerization is critical for Raf activation. Here we show that the Ras binding domain of Raf (Raf-RBD) induces robust Ras dimerization at low surface densities on supported lipid bilayers and, to a lesser extent, in solution as observed by size exclusion chromatography and confirmed by SAXS. Community network analysis based on molecular dynamics simulations shows robust allosteric connections linking the two Raf-RBD D113 residues located in the Galectin scaffold protein binding site of each Raf-RBD molecule and 85 Å apart on opposite ends of the dimer complex. Our results suggest that Raf-RBD binding and Ras dimerization are concerted events that lead to a high-affinity signaling complex at the membrane that we propose is an essential unit in the macromolecular assembly of higher order Ras/Raf/Galectin complexes important for signaling through the Ras/Raf/MEK/ERK pathway.

Cyclic Thiosulfinates as a Novel Class of Disulfide Cleavable Cross-Linkers for Rapid Hydrogel Synthesis

We recently reported that cyclic thiosulfinates are cysteine selective cross-linkers that avoid the "dead-end" modifications that contribute to other cross-linkers' toxicity. In this study, we generalize the chemistry of cyclic thiosulfinates to that of thiol selective cross-linking and apply them to the synthesis of hydrogels. Thiol-functionalized four-arm poly(ethylene glycol) and hyaluronic acid monomers were cross-linked with 1,2-dithiane-1-oxide to form disulfide cross-linked hydrogels within seconds. The synthesized hydrogel could be reduced with physiological concentrations of glutathione, which modulated hydrogel mechanical properties and degradation kinetics. Bovine serum albumin protein was successfully encapsulated in hydrogel, and diffusion-mediated release was demonstrated in vitro. Hep G2 cells grew in the presence of preformed hydrogel and during hydrogel synthesis, demonstrating acceptable cytotoxicity. We encapsulated cells within a hydrogel and demonstrated cell growth and recovery up to 10 days, with and without cell adhesion peptides. In summary, we report cyclic thiosulfinates as a novel class of cross-linkers for the facile synthesis of biodegradable hydrogels.

Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh

Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

Antimicrobial Sensitivity Pattern in Neonatal Sepsis in Neonatal Intensive Care Unit of Mymensingh Medical College Hospital

This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.

Outcome of Open Reduction and Internal Fixation of Posterior Wall Fracture of Acetabulum

Acetabular fracture usually occurs as a result of high velocity injury and often affects the young and economically productive population. Previously, treatment of acetabular fracture was grossly inadequate and many patients were left with incapacitating pain, limitation of movement. Proper management should be given in our set-up to save lives and to minimize long term complications and related disabilities. This study was done to evaluate the outcome of open reduction and internal fixation of posterior wall fracture of acetabulum. This prospective observational study was carried out in Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2016 to June 2018. Total twenty five cases were selected. Radiological and functional outcome were evaluated six months after surgery according to Matta radiographic criteria and Merle d Aubigne and Postel criteria respectively. Effect of age, gender, hip dislocation, displacement of fracture fragment, associated injury, reduction quality, trauma to surgery time, complication of operation on the functional outcome was evaluated. Age range was 18-60 years. The mean age was 38±11 years. Male 23 and female 2, male and female ratio was 11.5:1. Mean follow up 8.5±1.7 months, range 6-12 months. According to Matta radiographic criteria, 6 months after surgery, 10 patients had excellent, 10 patients had good, 3 patients had fair and 2 patients had poor radiological outcome. According to Merle d Aubigne and Postel criteria, 6 months after surgery, 11 patients had excellent, 10 patients had good, 3 patients had fair and 1 patient had poor functional outcome. Overall functional outcome of the study population revealed that 21 patients (84%) belonged to satisfactory (Excellent + Good) and 4 patients (16%) belonged to unsatisfactory (Fair + Poor) outcome. AVN (avascular necrosis) of femoral head had been occurred in two patients, post-operative wound infection had been occurred in two patients and myositis ossificans around hip joint had been occurred in two patients. Twenty (20) patients were achieved anatomic (0, 1mm) reduction, 3 patients were achieved imperfect (2, 3mm) reduction and 2 patients were achieved poor (>3mm) reduction. This study concludes that open reduction and internal fixation of posterior wall fracture of acetabulum is a satisfactory method of treatment.

Isolation of Acinetobacter species from Clinical Specimens with Detection of Their Antimicrobial Susceptibility Pattern from a Tertiary Care Hospital, Bangladesh

Acinetobacter species are important opportunistic and nosocomial pathogens capable of causing both community and health care-associated infections. The aim of this study was to determine the prevalence of Acinetobacter species and determination of the antibiotic susceptibility patterns of Acinetobacter. A total of 341 specimens were collected over a period of one year from January 2017 to January 2018 from ICU and Surgery unit of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Antimicrobial susceptibility testing of all Acinetobacter isolates was done using Kirby Bauer's disc diffusion technique as per recommendations of Clinical Laboratory Standards Institute (CLSI). MIC of commonly used Imipenem and newly introduced Tigecycline by agar dilution method was done and was compared it with disc diffusion method. From total 341 specimens, 119(34.8%) pathogen were isolated. Among 119 isolates total 46(38.6%) Acinetobacter were isolated. Maximum number of Acinetobacter was isolated from respiratory samples- endotracheal secretions. Regarding antimicrobial resistance, 42(91.3%), 33(71.7%), 20(43.5%), 28(60.9%) and 1(2.2%) were resistant to Piperacillin-Tazobactam, Doxycycline, Imipenem, Colistin and Tigecycline. Regarding, MIC of Imipenem, 41.3% was resistant, 32.6% was intermediate and 26.1% was sensitive. Regarding MIC of Tigecycline none was resistant, 39.1% was intermediate and 60.9% was sensitive. Acinetobacter species is emerging as a predominant healthcare associated multidrug resistant pathogen. The findings of this study will help our clinicians to apply appropriate antibiotics for treatment of patients.

Replacement of Sodium Bicarbonate and Micronutrients in Kosaric Medium With Banana Leaf Ash Extract for Culture of Spirulina Platensis

Spirulina platensis is one of the most promising microalgae for culture due to its high nutritional values. The main constraint to its production is the high cost of culture media. Therefore, an experiment was conducted to evaluate the growth performance of S. platensis with the aim of replacing sodium bicarbonate (NaHCO3) and mineral nutrients in Kosaric medium (KM) with banana leaf ash extract. KM was used as control medium in treatment T1. In treatments T2 to T5, 50% of NaHCO3 in KM was replaced with banana leaf ash extract (BLAE). In addition, micronutrients in KM were reduced to 75%, 50% and 25% in treatments T3 to T5, respectively. The values of different physical and chemical parameters (temperature, pH, dissolved oxygen and light intensity) of the culture media were within the suitable range for S. platensis culture. Optical density in treatments T2 and T3 were similar to that was in treatment T1. Maximum cell dry weight (0.65 gL-1) was observed in treatment T1 and it was similar to the treatments T2 and T3 where 50% of NaHCO3 in KM was replaced with banana leaf ash extract with 100% and 75% micronutrients supply, respectively. The similar trend was found in chlorophyll a content. It was evident that 50% of NaHCO3 in KM can be replaced with BLAE for the culture of S. platensis, in addition micronutrients in KM can be reduced to 75%. Ann. Bangladesh Agric. (2019) 23(1) : 37-47

River toxicity assessment using molecular biosensors: Heavy metal contamination in the Turag-Balu-Buriganga river systems, Dhaka, Bangladesh

Pollution in rapidly urbanising cities and in delta systems is a serious problem that blights the lives and livelihoods of millions of people, damaging and restricting potable water supply and supplies to industry (Whitehead et al, 2015, 2018). Employing new technology based on luminescent molecular biosensors, the toxicity in the rivers around Dhaka in Bangladesh, namely the Turag, Tongi, Balu and Buriganga, has been assessed. Samples taken at 36 sites during medium and low flow conditions and during the Bishwa Ijtema Festival revealed high levels of cell toxicity, as well as high concentrations of metals, particularly aluminium, cadmium, chromium, iron, zinc, lithium, selenium and nickel. Chemical analysis also revealed low dissolved oxygen levels and anoxic conditions in the rivers at certain sites. The bacterial molecular biosensors were demonstrated to be fast, with results in 30 min, robust and a highly sensitive method for the assessment of water toxicity in the field. Furthermore, the biosensor toxicity analysis correlated with the metals data, and a multivariate regression relationship was developed relating toxicity to key metals, such a selenium, zinc and chromium. The resulting model has been validated against split samples and the Bishwa Ijtema Festival data. The combination of modelling and the molecular biosensor technology provides a new approach to detecting and managing pollution in urban river systems.

Prevalence and Risk Factors of Hypertension among Government Employees Serving in Rangpur City, Bangladesh

Hypertension (HTN) is an important cause of cardiovascular mortality and the prevalence of hypertension is increasing particularly in middle- and low-income countries including Bangladesh. No data are available for the prevalence of hypertension among the government employees in Bangladesh. In this cross-sectional study, conducted from 30 October to 31 December 2016, 1219 government employees aging ≥18 years working in Rangpur city were evaluated for the presence of HTN and its risk factors. Socio-demographic and anthropometric data, data on the presence of various known risk factors of hypertension were collected. Hypertension was defined with systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg or those getting treatment for hypertension. Statistical analysis was done by using SPSS version 23.0; odds of hypertension among subjects with risk factors were calculated and p ≤0.05 was considered to be statistically significant. The prevalence of hypertension was 38.3% among the study subjects. Significantly higher odds of having hypertension were observed in study subjects with the age groups of 35-49 (OR 2.12, 95% CI: 1.51-2.99, p<0.001) and ≥50 (OR: 4.96, 95% CI: 3.43-7.18, p<0.001) years than age group <35 years. Employees who were averagely satisfied and not satisfied for their jobs also had higher odds (OR: 1.38, 95% CI: 1.00-1.91, p=0.049 and OR: 1.48, 95% CI: 3.43-7.18, p=0.337) of having hypertension than fully satisfied ones. Having diabetes mellitus was found to increase the odds (OR 2.12, 95% CI: 1.51-2.99, p<0.001) of hypertension. Male gender, urban/suburban residence, not doing physical exercise, sedentary/light working habit, overweight/obesity also increased the odds of having hypertension though these were not statistically significant. There is a high burden of hypertension among the government employees in Rangpur city. Age, job satisfaction and diabetes were independent risk factors of hypertension.

Clinical Profile and Immediate Outcome of Children Admitted With Acute Glomerulonephritis in Pediatrics Department of A Tertiary Level Hospital

Acute post-streptococcal glomerulonephritis (APSGN) is the commonest cause of acute glomerulonephritis (AGN), which usually present with gross hematuria, mild edema, oliguria, hypertension and varying degree of renal insufficiency. It is more common among the population of school going age where poverty, overcrowding and poor hygienic conditions are prevailing. This cross sectional observational study was aimed to know the socio-demographic variables, clinical profile and immediate outcome of AGN in hospitalized children and was conducted in the Pediatric department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2014 to April 2015. A detailed history was taken from the parents in each case with a written questionnaire. A written consent was also taken from the guardian of the including patients and also permission was taken from the ethical committee of MMCH. Thorough clinical examination and available relevant investigations were done in all patients. Progresses of the patient were monitored by daily clinical examinations and also by investigations. Data were analyzed by statistical package for social science (SPSS) windows version 18. Results were verified by doing standard test for significance. Among total 60 cases male was 58.3% & female was 41.7%. The common age group of presentation was between 7-12 years (73%), peak age of incidence was 7-9 years. Most of them came from low socioeconomic status (83.3%), 63.3% from rural area with average 5-6 member's family size. Most of the parents were illiterate. History of (H/O) skin infection was present in 35(58.3%) patients, 15(25%) had H/O sore throat, 15% did not give any H/O infection before presentation. Average duration of gap between infection and appearance of clinical feature was 7-14 days in 73.40%and 15-21 days was in 45.7% in case of sore throat & skin infection respectively. Almost all (95%) patients presented with puffiness of face, others presented with scanty micturition, gross hematuria, respiratory distress, fever, convulsion and altered sensorium. Edema (75%), hypertension (88.3%), pallor (38%), tachypnea (25%), tachycardia (26.7%) were the important clinical findings. Microscopic hematuria was present among 96.66% patients; low complement level was found in 85% cases. There is significant association between low socioeconomic statuses with more hospital stay. Only one patient died due to heart failure and 98.3% patient had complete recovery. Results of this study conclude that most of the patients came from rural illiterate family with low socioeconomic background. Skin infection is the commonest cause of acute glomerulonephritis. Edema, scanty micturation, hematuria and hypertension are the common mode of presentation. Heart failure and hypertensive encephalopathy are the common complication of AGN. Immediate prognosis of AGN was excellent.

Outcome of Double Tension Band Wiring Method for the Treatment of Intercondylar Fractures of Humerus

Distal humeral fractures are relatively rare injuries that constitute approximately 2% of all fractures which occur due to high energy trauma in young males. Because they involve the articular surface and usually cause an instable elbow, surgical treatment is necessary for the recovery of elbow functions in the majority of cases. The principles of absolute stabilization and early mobilization in the elbow are of more importance than in any other joint. As the AO classification, nonunion and implant loosening is more common in type C fractures of the distal humerus involving the joint surface. Aim of this prospective study was to evaluate the outcome of "Double Tension Band wiring" method for the treatment of intercondylar fractures of humerus and was conducted in a tertiary hospital of Bangladesh from July 2017 to June 2019. Twenty five patients, all presenting with fresh fractures of the distal humerus, treated with double tension band wiring. These patients were prospectively evaluated over a period of at least 6 months. Fractures were classified according to Jupiter classification and AO classification of distal humeral fractures. Due to AO classification, total fractures were C1 fractures. Average age of the patients was 56.20 years (32-70 years). There were 20 males and 5 females. Out of 25 cases treated with this method, rigid fixation and union was achieved in all of them. The average tourniquet time was 69 minutes range was minimum 50 minutes and maximum 120 minutes. Radiological union was achieved at an average of 14.2 weeks (10-18 weeks). Average range of motion was 112.8 degrees (107-116). Excellent to good results were seen in almost 86% of cases as per the Mayo Elbow performance score at 6-month follow-up. Wound infection had been occurred in 2(8%) cases, ulnar nerve neuropathy had been occurred in 1 case, delayed union of olecranon process of ulna had been occurred in 1(4%) case, implant failure had been occurred in 2(8%) cases, heterotrophic ossification had been occurred in 2(8%) cases, varus valgus instability had been occurred in 1(4%) case, gun stock deformity had been occurred in 2(8%) cases. Double tension band wiring is a reliable, less demanding and cost effective method of fixation of intercondylar fractures of humerus.

Modelling heavy metals in the Buriganga River System, Dhaka, Bangladesh: Impacts of tannery pollution control

Heavy metal pollution from tanneries is a global problem in many rapidly developing economies. Effluent discharges into rivers cause serious problems for water quality, damaging ecology and threatening the livelihoods of people, especially in developing urban centres which often have a high concentration of factories. The industry intensive capital area of Bangladesh is impacted with high levels of metals pollution in rivers in the Greater Dhaka Watershed. Sampling and modelling studies have been undertaken to assess pollution in the Buriganga River System in Dhaka. The process based, dynamic model INCA (Integrated Catchments) model has been used to simulate metals along the Buriganga River System in Central Dhaka. Observed and simulated metals concentrations are high, and the model shows that the proposed transfer of the tannery industry upstream helps to reduce the pollution significantly downstream. However, moving the industry upstream may be counterproductive as it is discharged into the upper reaches of the river. This will create pollution upstream unless the newly constructed effluent treatment system can operate at a high level.

Co-circulation of dengue virus type 3-genotype I and type 2-Cosmopolitan genotype in 2018 outbreak in Dhaka, Bangladesh

Dengue virus (DENV) that caused an outbreak in Dhaka, Bangladesh during 2018 was analysed phylogenetically. DENV samples were classified into type 2-Cosmopolitan genotype (54%) and type 3-genotype I (46%), indicating co-circulation of two DENV types and resurgence of type 3 associated with genotype replacement.

Detection of Tubercular Pleural Effusion by Molecular Technique PCR

Tuberculosis is a common cause of death in developing countries like Bangladesh. About 30% of pulmonary tubercular infected patients developed tubercular pleural effusion. Tubercular pleural effusion was diagnosed by cytological, biochemical and bacteriological methods. But these methods showed low sensitivity. In some cases pleural biopsy showed also negative results. Now a days molecular technique like Polymerase chain reaction (PCR) is promising method for diagnosis of pleural TB. PCR was done in 100 pleural fluid collected from suspected tubercular pleural effusion cases admitted in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2011 to January 2013. Among the 100 samples 3% were culture positive and PCR positive was 6%. Sensitivity and Specificity of PCR considering culture as a gold standard method was 100% and 96.71% respectively in this cross sectional study. Among them Adenosine deaminase (ADA) level is >40IU/L in all PCR positive sample. Where PCR is available, measurement of ADA activity as well as PCR can be done simultaneously.

Evaluation of Corrosion and Tarnishing of Intra-oral Nickel Chromium and Gold-alloy Cast Crown

Although esthetic factors might limit by the presentation of materials used, all-metal complete cast crown should always be offered to patients requiring restoration of endodontically treated posterior tooth. The complete cast crown has the highest longevity of all fixed restorations. It could be used to rebuild a single tooth or a retainer for a fixed prosthesis. It involves all the axial walls as well as the occlusal surface of the tooth to be restored. All restorations are placed in the oral environment in contact with the gingival tissue. Thus clinicians must choose nontoxic or least toxic metal alloys, since any release of elements that might cause reactions. This study was designed to observe clinical responses of nickel chromium alloy and gold alloy cast crown and provide guidance to ascertain the best alloy for cast metal crown, which serves better functional restoration.

Cardiofacial Syndrome: A Rare Case Report

Cardiofacial syndrome is associated with facial abnormality with congenital heart disease. Here, we report a case of cardiofacial syndrome having anotia and facial nerve palsy on the right side in combination with infundibular pulmonary stenosis and patent ductus arteriosus which is a rare presentation of cardiofacial syndrome. A 6 years old girl presented to department of Cardiac surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of shortness of breath on exertion since 2 years of age. Her physical examination revealed right sided anotia and facial nerve palsy associated harsh ejection systolic murmur in upper left parasternal area. Echocardiography showed critical infundibular pulmonary stenosis with a small patent ductus arteriosus. She underwent ligation of patent ductus arteriosus and excision of infundibular muscular bands and discharged to home without any complication. Any child presented with facial abnormality should be checked for any cardiac abnormality for early intervention and better management of the patient.

Molecular characterization of Orientia tsutsugamushi causing scrub typhus among febrile patients in north-central Bangladesh

Scrub typhus is a mite-borne rickettsial disease caused by Orientia tsutsugamushi, which is endemic in Asia Pacific region. In this study, infection rate and molecular epidemiologic traits of O. tsutsugamushi was investigated in Mymensingh, located in north-central Bangladesh. Among the blood samples from 453 febrile patients who visited Mymensingh medical college hospital in 2018, the 47 kDa protein gene of O. tsutsugamushi was detected in 78 samples (17.2%) by nested PCR. Phylogenetic analysis of the O. tsutsugamushi 56 kDa protein gene (18 samples) revealed a predominance of Karp-related genotype (89%), while the remaining belonged to Gilliam genotype. Samples of the Karp-related genotype mostly clustered with those of China, Taiwan, Thailand and India, etc., in emergent subgroups clades 2 and 4, which were distinct from clade 1, including prototype Karp strains. Among the 18 samples, three variable domains (VD) of 56 kDa type-specific antigen had different types of sequence diversity; VDI contained two or three repeats of eight amino acid units, while VDII and VDIII had amino acid substitution, deletion or insertion. The present study documented a potentially high prevalence of genetically diverse O. tsutsugamushi in north-central Bangladesh.

Abstract 296: B7-33, a Functionally Selective Relaxin Receptor 1 Agonist, Exerts Protective Effects Against Myocardial ischemia-Reperfusion Injury in Mice

Background: B7-33 is a peptide derived from the B-chain of human relaxin, and is shown to elicit biased signaling at relaxin receptor 1 (RXFP1) in human cell lines. The influence of B7-33 on myocardial ischemia-reperfusion (IR) injury and associated cardiac adverse remodeling is unknown.

Methods and Results: Primary cardiomyocytes and cardiac fibroblasts were isolated from adult CD1 mice and subjected to simulated ischemia-reoxygenation (SIRO). Myocytes were placed in 1% O 2 chamber for 40 min, followed by 1 h of reoxygenation with control (myocyte media) or B7-33 (10, 50 or 100 nM)-infused media. Trypan blue staining showed a significant decrease in cell death with B7-33 concentrations of 50 nM and 100 nM ( Fig. A ).Treating myocytes with B7-33 for 15 min exhibited a dose-dependent increase in Erk1/2 phosphorylation, which reached statistical significance at 100 nM ( Fig. B ). Fibroblasts subjected to 4 h of hypoxia and 15 h of reoxygenation had increased viability (MTT assay) with B7-33 at all concentrations ( Fig. C ). In vivo , CD1 mice were subjected to IR injury via coronary artery ligation for 30 min, followed by 24 h of reperfusion. Vehicle (saline) or B7-33 (10 μg/kg) was injected i.p. at the onset of reperfusion. After 24 h, B7-33-treated mice demonstrated decreased infarct size (TTC stain) ( Fig. D ) and preserved fractional shortening (M-mode echo, Fig. E ) compared to vehicle-treated mice.

Conclusion: Reperfusion therapy with B7-33 reduces infarct size post-MI, preserves cardiac function and protects cardiomyocytes and fibroblasts against SIRO. We propose that B7-33 might be effective against acute MI and a possible alternative to recombinant relaxin for clinical utility.