Anthropometric Study of Face on Bangladeshi Adult Garo Male

The present cross sectional descriptive type of study provides a standard for Bangladeshi Garo male regarding physiognomical face height, morphological face height and maximum facial breadth in Mymensingh Sadar, Haluaghat, Madhuopor Upazilas from July 2015 to June 2016. An attempt has been made out to find out correlation of stature with the parameters and to measure different face index. The current study also generates different face types on the basis of morphological face index. The study was done on 121 Garo male between 25-45 years of age in Bangladesh. The measurements were taken by digital Vernier caliper and spreading caliper. The stature was measured in anatomical position with stadiometer. Data were tabulated and statistically analyzed using Microsoft excel and SPSS software. A significant positive correlation of stature was observed with physiognomical and morphological face height. But maximum facial breadth shows a non significant correlation with stature. The results of present study may be useful for physical anthropologist, Forensic Medicine experts, plastic and reconstructive surgeons.

Transient receptor potential melastatin 8 ion channel in macrophages modulates colitis through a balance-shift in TNF-alpha and interleukin-10 production

The transient receptor potential (TRP) ion channel family is well characterized in sensory neurons; however, little is known about its role in the immune system. Here we show that the cold-sensing TRPM8 has an unexpected role in innate immunity. TRPM8 expression and function in macrophages were demonstrated in vitro using molecular techniques and calcium imaging. In addition, adoptive macrophage transfer and systemic interleukin (IL)-10 overexpression were performed in experimental colitis. TRPM8 activation induced calcium-transients in murine peritoneal macrophages (PM) and bone marrow-derived macrophages of wild-type (WT) but not TRPM8-deficient mice. TRPM8-deficient PM exhibited defective phagocytosis and increased motility compared with those in WT, whereas the opposite effects of TRPM8 activation were induced in WT PM. TRPM8 activation or blockage/genetic deletion induced a anti- or pro-inflammatory macrophage cytokine profile, respectively. WT mice treated with repeated menthol (TRPM8 agonist) enemas were consistently protected from experimental colitis, whereas TRPM8-deficient mice showed increased colitis susceptibility. Adoptive transfer of TRPM8-deficient macrophages aggravated colitis, whereas systemic IL-10 overexpression rescued this phenotype. TRPM8 activation in peptidergic sensory neurons did not affect neuropeptide release from the inflamed colon. TRPM8 in macrophages determines pro- or anti-inflammatory actions by regulating tumor necrosis factor-α and interleukin-10 production. These findings suggest novel TRPM8-based options for immunomodulatory intervention.

Anthropometric Study of Carrying Angle on Bangladeshi Garo People

The present study was designed to construct an anthropometric data of 20-40 years aged 104 Bangladeshi Garo people (60 male and 44 female) regarding carrying angle and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Participants were selected through purposive sampling for this cross sectional, observational, descriptive and analytic type study which was carried out in different areas of Mymensingh district (Haluaghat, Mymensingh Sadar), Bangladesh from July 2015 to June 2016. The carrying angles of both side were measured by goniometer. Data were tabulated and statistically analyzed using Microsoft excel and SPSS software. Carrying angle was found to be higher in males but angle of inclination was higher in females. Comparison of differences of means between male and female was statistically significant. The results of present study would be useful for Anthropologist and Forensic Medicine experts.

Cerebrospinal fluid lipocalin 2 in patients with clinically isolated syndromes and early multiple sclerosis

Background:

Lipocalin 2 (LCN2) may be involved in the immunopathogenesis of multiple sclerosis (MS) and might further impact on iron homoeostasis. Brain iron accumulates in MS; however, the association to iron-related proteins is still unsolved.

Objective:

To investigate cerebrospinal fluid (CSF) and serum LCN2, transferrin (Trf) and ferritin in early MS in relation to disease evolution and longitudinal brain iron accumulation.

Methods:

We analysed CSF and serum LCN2 by enzyme-linked immunosorbent assay (ELISA) and Trf and ferritin by nephelometry in 55 patients (45 clinically isolated syndrome (CIS), 10 MS, median clinical follow-up 4.8 years) and 63 controls. In patients, we assessed sub-cortical grey matter iron by 3T magnetic resonance imaging (MRI) R2* relaxometry (median imaging follow-up 2.2 years).

Results:

Compared to controls serum ( p < 0.01), CSF ( p < 0.001) LCN2 and CSF Trf ( p < 0.001) levels were reduced in the patients. CSF LCN2 correlated with CSF Trf ( r = 0.5, p < 0.001). In clinically stable patients, CSF LCN2 levels correlated with basal ganglia iron accumulation ( r = 0.5, p < 0.05). In CIS, higher CSF LCN2 levels were associated with conversion to clinically definite MS ( p < 0.05).

Conclusion:

We demonstrate altered LCN2 regulation in early MS and provide first evidence for this to be possibly linked to both clinical MS activity and iron accumulation in the basal ganglia.

Increased frequencies of serum antibodies to neurofilament light in patients with primary chronic progressive multiple sclerosis

We investigated whether serum and cerebrospinal fluid (CSF) antibodies to the light subunit of the NF protein (NF-L), a main component of the axonal cytoskeleton, may serve as biological markers for axonal pathology and/or disease progression in multiple sclerosis (MS). IgG to NF-L was measured in sera and CSF of MS patients, patients with inflammatory demyelinating diseases of the PNS, with acute inflammatory neurological diseases (including bacterial and viral meningitis), with neurodegenerative diseases, with acute noninflammatory neurological diseases (including stroke, headache and backache) and healthy controls by enzyme-linked immunosorbent assay. We found that serum anti-NF-L IgG antibodies were significantly elevated in MS patients with primary progressive disease course and we provide evidence for an intrathecal production of these antibodies. Our findings support the use of serum antibodies to NF-L as a marker for axonal destruction.

Differing immunogenic potentials of interferon beta preparations in multiple sclerosis patients

Interferon beta (IFNβ) is a first-line therapy for multiple sclerosis (MS). However, some patients experience a decline in efficacy with continued therapy due to the development of anti-IFNβ neutralizing antibodies (NAb). We investigated the frequency of NAb cross-sectionally in 846 MS patients who were receiving IFNβ-1b, IFNβ-1a im, or IFNβ-1a sc. The frequency of NAb in patients receiving IFNβ-1a im was lower (5%) than in patients treated with any other form of IFNβ (22-35%) (P < 0.0001). Binding antibodies (BAb) were measured in 808 patients. The frequency differed significantly between treatment groups, ranging from 45% (IFNβ-1a im) to 88% (IFNβ-1b). The proportion of NAb-positive patients within the BAb-positive group differed significantly among treatment groups, ranging between 12% (IFNβ-1a im) and 51% (IFNβ-1a sc). The median NAb titer from all IFNβ-1a-treated patients was higher than from IFNβ-1b-treated patients (446 versus 171 NU/mL, P = 0.04). Among NAb-positive patients, the frequency of NAb titers > 100 NU/mL was 71% for IFNβ-1a compared with 58% for IFNβ-1b (P = 0.04). Except for conflicting data regarding IFNβ-1a sc, the results are generally consistent with the literature and together with the differing proportion of NAb-positive patients within the BAb-positive group, provide further insight into the immunogeni-city of the IFNβ preparations.

Interferon-beta: the neutralizing antibody (NAb) titre predicts reversion to NAb negativity

Background: It has been reported that in some patients with MS who develop neutralizing antibodies (NAbs) against interferon beta (IFNb), antibody levels can initially increase and then decrease thereafter even when treatment is continued. Objective: To determine whether NAb titre correlates with time to reversion to NAb negativity in patients with multiple sclerosis (MS). Methods: Twenty-eight patients with MS who were NAb-positive during treatment with one of the currently available IFNbs were included in this retrospective study. NAb titres were determined by the myxovirus resistance protein A induction assay. Patients were considered NAb-positive if they had at least two consecutive samples with titres of]/20 neutralizing units (NU). Reversion to NAb-negative status was defined as two consecutive negative samples (NAb titre of B/20 NU) after NAb positivity. Results: When measured two years after treatment initiation, a NAb titre of B/75 NU had a 91.7% sensitivity and a 87.5% specificity for reversion to NAb negativity in the following two years (after a total of four years of treatment). In addition, somewhat surprisingly, patients whose serum converted to NAb-negative generally developed peak NAb titres earlier than patients who remained NAb-positive (mean time of first detection was 21 versus 38 months, respectively). Conclusion: The NAb titre might support treatment decisions in patients with MS whose test results are positive for NAbs.

Variations of Weight of Prostate Gland in Different Age Groups of Bangladeshi Cadaver

Now a days, benign prostatic hyperplasia and carcinoma of the prostate are the most common disorders in men. A cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh to find out the difference in weight of the prostate gland of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate gland collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College by non random purposive sampling technique. The specimens were collected from Bangladeshi cadaver of age ranging from 10 to 80 years. All the specimens were grouped into three categories - Group A (upto 18 years), Group B (19 to 45 years) and Group C (above 45 years) according to age. Dissection was performed according to standard autopsy techniques. The weight of the prostate gland were measured and recorded. The mean weight of the prostate gland was 10.13gm in Group A, 17.27gm in Group B and 22.50gm in Group C. Variance analysis shows that mean differences of weight of the prostate were highly significant among all age groups. The weight of prostate gland was found to increase with increased age. For statistical analysis, differences between age groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the weight of prostate gland of Bangladeshi people.

Histomorphological Study on Number of Acini of the Prostate Gland of Bangladeshi Cadaver

The prostate is made up of 30 to 50 compound tubuloalveolar glands that are embedded in a framework of fibromuscular tissue and arranged in three concentric groups (mucosal, submucosal and main prostatic gland). The prostate consists of peripheral, central and transitional zone accounting for approximately 70%, 20% and 5% of the glandular substances. Benign prostatic hyperplasia affects the transitional zone and carcinoma of the prostate affects the peripheral zone. The glandular tissue consists of numerous acini with frequent internal papillae. Follicular epithelium is variable but predominantly columnar and either single-layered or pseudostratified. This cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh to find out the difference in number of acini of the prostate gland of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate gland collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College by non random purposive sampling technique. The specimens were collected from Bangladeshi cadaver of age ranging from 10 to 80 years. All the specimens were grouped into three categories: Group A (up to 18 years), Group B (19 to 45 years) and Group C (above 45 years) according to age. Dissection was performed following standard autopsy techniques. In the present study, total 60 slides were made for histological study from both central and peripheral zone of the prostate which were examined under low power objectives. The number of the acini of the prostate gland were counted and recorded. The mean number of the acini of the prostate gland was 16.45, 43.54 and 42.45 in Group A, B and C respectively in central zone and 30.08, 51.35 and 44.16 in Group A, B and C respectively in peripheral zone of the prostate. Variance analysis shows that mean differences were highly significant between Group A & B and Group C & A and non significant between Group B & C in central zone of the prostate. Mean differences were non significant among all three groups in peripheral zone of the prostate. The number of the acini of prostate gland was increased up to certain age limit but decreased in extreme age. In statistical analysis, differences between age groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the number of the acini of the prostate gland of Bangladeshi people at different age group.

Detecting labor using graph theory on connectivity matrices of uterine EMG

Premature labor is one of the most serious health problems in the developed world. One of the main reasons for this is that no good way exists to distinguish true labor from normal pregnancy contractions. The aim of this paper is to investigate if the application of graph theory techniques to multi-electrode uterine EMG signals can improve the discrimination between pregnancy contractions and labor. To test our methods we first applied them to synthetic graphs where we detected some differences in the parameters results and changes in the graph model from pregnancy-like graphs to labor-like graphs. Then, we applied the same methods to real signals. We obtained the best differentiation between pregnancy and labor through the same parameters. Major improvements in differentiating between pregnancy and labor were obtained using a low pass windowing preprocessing step. Results show that real graphs generally became more organized when moving from pregnancy, where the graph showed random characteristics, to labor where the graph became a more small-world like graph.

VATER/VACTERL Association and Caudal Regression with Xq25-q27.3 Microdeletion: A Case Report

We report a term female neonate with vertebral anomalies, anal and urethral atresia, esophageal atresia with tracheoesophageal fistula (TEF), renal agenesis, pulmonary hypoplasia, genital and sacral appendages, and a single umbilical artery. Genetic studies revealed a 20.91 Mb interstitial deletion of the long arm of X chromosome: Xq25-q27.3. This is a new case of VATER/VACTERL association with Xq25 microdeletion.

Variations of Thickness of Splenic Capsule of Different Age and Sex in Bangladeshi Cadaver

The spleen is the most frequently injured organ in the abdomen. Splenic rupture is usually precipitated by a crushing injury or severe blow. If ruptured the spleen will bleed profusely because its capsule is thin and its parenchyma is soft and pulpy. Such "spontaneous ruptures" never occur in truly normal spleen but rather than from some minor physical insult to a spleen that has been rendered fragile by an underlying condition. The most common predisposing conditions are infectious mononucleosis, malaria, typhoid fever and lymphoid neoplasms. These diverse entities can all cause rapid splenic enlargement, producing a thin, tense splenic capsule that is susceptible to rupture. Understanding of splenic capsular structure may help explain mechanical properties of the normal and diseased spleen. Histological changes are evident in advancing age along with functional capability of the human spleen. This cross sectional descriptive study was done to measure the thickness of splenic capsule to establish the difference between sexes of different age groups in Bangladeshi cadaver. The study was carried out in the department of Anatomy, Mymensingh Medical College, Mymensingh from June 2013 to July 2014. A total 30 human spleen were collected by purposive sampling technique from October 2013 to April 2014, among them 14 were male and 16 were female. The specimens were collected from Bangladeshi cadavers of age ranging from 6 months to 60 years, from autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College. For convenience of differentiating the thickness of splenic capsule in relation to age and sex, the collected specimens were divided into three groups like Group A (upto 20 years), Group B (21 to 40 years) & Group C (41 to 60 years). Each group was again divided into male & female groups. In this study 10 slides from each age group were chosen for measuring the thickness of splenic capsule and examined under low power objective. In present study the mean capsular thickness of spleen was 107.71±8.70, 125.71±31.29 and 136.39±6.49 μm in Group A, B and C respectively. The mean difference of capsular thickness of spleen between Group A & B, Group B & C was statistically non-significant but the difference between C & A was highly significant (p<0.001). From this study it was also observed that the mean±SD thickness of splenic capsule was higher in male than that of female among the age groups but there was no significant difference between sexes. In statistical analysis, differences between age groups and sexes were calculated by using one way ANOVA test and unpaired 't' test respectively.

Suspected involvement of EPTFE membrane in sterile intrathoracic abscess and pericardial empyema in a multi-allergic LVAD recipient: a case report

Device-related infections in recipients of left ventricular assist devices (LVAD) have been recognized as a major source of morbidity and mortality. They require a high level of diagnostic effort as part of the overall burden resulting from infectious complications in LVAD recipients. We present a multi-allergic patient who was treated for persistent sterile intrathoracic abscess formation and pericardial empyema following minimally invasive LVAD implantation including use of a sheet of e-polytetrafluoroethylene (ePTFE) membrane to restore pericardial integrity. Sterile abscess formation and pericardial empyema recurred after surgical removal until the ePTFE membrane was removed, suggesting that in disposed patients, ePTFE may be related to sterile abscess formation or sterile empyema.

Combined analysis of global and compartmental brain volume changes in early multiple sclerosis in clinical practice

Background:

The extent and clinical significance of brain volume changes in different phases of multiple sclerosis (MS) is still under discussion.

Objective:

To determine the rate of global and compartmental brain volume changes in patients with a clinically-isolated syndrome (CIS) compared to patients with definite MS, by long-term follow-up and as a predictor of conversion to MS in a routine clinical setting.

Methods:

We investigated 120 patients (63 CIS and 57 MS) at baseline and after a mean follow-up period of 43 months, including detailed clinical examination and 3-Tesla magnetic resonance imaging (MRI). Our imaging analyses comprised the normalized brain volume (NBV), cortical grey matter (cGMV) and white matter (WMV) volumes using SIENA/X, the percentage of brain volume change (PBVC) using SIENA and the change in the volume of the thalami (TV) and basal ganglia (BGV). We also determined the amount and change of T2-lesion load (T2-LL).

Results:

At baseline, all the brain volume metrics, except cGMV, were significantly lower; and the T2-LL was significantly higher, in patients with MS rather than CIS. During the follow-up, only the PBVC was higher in MS ( p = 0.008) and this difference was driven by converters from CIS to MS. Quartiles of PBVC did not allow us to predict conversion to MS, but were associated with the degree of disability.

Conclusions:

PBVC is the most sensitive marker of progressing atrophy and a higher PBVC was generally associated with more active disease; however, it did not serve to predict the course of MS on an individual basis, in this study.

Coronary sinus lead extraction in CRT patients with CIED-related infection: risks, implications and outcomes

AIM

The aim of the study was to examine risks, implications and outcomes of coronary sinus (CS) lead extraction in patients with infections of cardiac resynchronization therapy (CRT) systems.

METHODS

The study included 40 (65.5 ± 11.1 years; 80% male) transvenous CS lead extraction procedures performed between 2000-2011. Nine (22.5%) patients suffered from infection and included one sepsis (11.1%), two (22.2%) of lead and valve endocarditis, and four (44.4%) cases of pocket infection. CS lead extraction in the infection subgroup was performed between 14 days and more than five years after the last CIED-related surgical procedure.

RESULTS

Totally 42 CS and 35 non-CS leads were extracted. Leads extracted in the infection subgroup were significantly longer in situ (49.7 ± 30.7 months) compared to the non-infection subgroup (19.2 ± 28.6 months). Extraction in infected patients required more aggressive methods and longer exposure to radiation than non-infected. Procedural success without major complications was achieved in all patients. Minor post-procedural complications occurred in four (44.4%) of the infected and one (3.2%) of the non-infected patients and were surgical-related in three cases. Overall hospitalization times were significantly longer for the infection than for the non-infection subgroup (21.4 ± 15 versus 9.6 ± 6.9 days).

CONCLUSION

Our results support the concept of complete CIED-system removal in CIED-associated infection, regardless of whether or not infection appears to be limited to the generator pocket site, despite risk of heart failure, patient frailty and a high level of comorbidity. An interdisciplinary approach encompassing appropriate diagnostic, procedural and safety standards allows CS lead extraction in this high-risk subpopulation to be performed with excellent outcomes and low complication rates.

Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study

Background and objective:

We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort.

Methods:

Thirty-three centres provided serum samples from 1047 CIS cases with at least two years’ follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS.

Results:

At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71–2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52–2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04–3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98–0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres.

Conclusions:

We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation.

Revisited phonon assignment and electro-mechanical properties of chromium disilicide

We report a complete study of the lattice dynamics, dielectric, elastic and piezoelectric properties of hexagonal semiconducting chromium disilicide (CrSi₂).

Length of papillary muscles in both ventricles of different age group on Bangladeshi cadaver

Papillary muscle rupture and dysfunction can lead to complications of prolapsed atrioventricular valve and valvular regurgitation. Morphology, measurements and attachments of papillary muscles in both tricuspid and bicuspid valve gains utmost importance in cardiac surgeries and variations in the papillary muscle morphology is one of causes for myocardial infarction in recent time. Therefore, it is important to know both the normal anatomy and variations of papillary muscles. The study was carried out in the department of Anatomy, Mymensingh Medical College, Mymensingh from July 2013 to June 2014. A total 80 human hearts were collected by purposive sampling method, among them 49 were male and 31 were female. The specimens were collected from Bangladeshi cadavers of age ranging from 6 months to 60 years, from autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College. All the specimens were grouped into three categories Group A (upto 20 years), Group B (21 to 40 years) and Group C (41 to 60 years) according to age. Dissection was performed according to standard autopsy techniques. Length of each papillary muscle was measured in both ventricles in different age groups. In present study the mean length of the anterior papillary muscles of right ventricle was higher than both the posterior and septal papillary muscles among the age groups. The mean±SD length of the anterior papillary muscle was 1.07±0.48, 1.50±0.37 and 1.60±0.25cm in Group A, B and C respectively. The mean±SD length of the posterior papillary muscle was 1.02±0.35, 1.31±0.40 and 1.37±0.34cm in Group A, B & C respectively. The mean±SD length of the septal papillary muscle in right ventricle was 0.51±0.42, 0.65±0.31 and 0.81±0.35cm in Group A, B & C respectively. It was also observed that the mean length of anterior, posterior and septal papillary muscle was increased with age. In present study the mean length of the anterior papillary muscles in left ventricle was higher than that of the posterior papillary muscle among the age groups. The mean±SD length of the anterior papillary muscle was 1.53±0.34, 2.05±0.39 and 2.01±0.25cm in Group A, B and C respectively. The mean±SD length of the posterior papillary muscle was 1.33±0.34, 1.95±0.89 and 1.81±0.76cm in Group A, B and C respectively and it was also observed that the mean length of both anterior and posterior papillary muscle was increased with age. In statistical analysis, differences between age groups were calculated by using one way ANOVA test.

Morphometric study of dentate nucleus of cerebellum in Bangladeshi cadaver

This cross sectional descriptive study was done by using nonprobability sampling technique and performed by examining 63 (sixty three) cerebellum. Out of them 40 postmortem human cerebellum collected from Bangladeshi cadavers of both sexes (male 25 and female 15) age ranging from 5 to 60 years and 23 cerebellums from caesarian section of intrauterine death cases of both sexes (male 14 and female 9) age ranging from 34 to 41 weeks of gestation. Specimens were collected from dead bodies autopsied on different dates from April' 2009 to September' 2009 at the autopsy laboratory of department of Forensic Medicine and prenatal cases from Gynaecology and Obstetrics Department of Mymensingh Medical College, Mymensingh. The collected specimens were grouped into three age groups like Group A (28 to 42 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years) and, two sex groups (male and female) and two sides (right and left). A transverse section was made at the level of horizontal fissure, and length and breadth of dentate nucleus were measured by divider and scale. The mean (±SD) length and breadth of dentate nucleus was 8.619±2.995mm and 14.770±3.604mm respectively and it was observed that length and breadth of dentate nucleus increased with age upto certain level then slightly decreased in the late age Group C. In this study, differences of the mean length of dentate nucleus on both right and left sides were statistically moderately significant between age Groups A&B. The differences of mean breadth of dentate nucleus on both right and left side were statistically highly significant between age Groups A&B and moderately significant between age Groups A&C on right side and only significant on left side. The differences between male & female were statistically insignificant in length and breadth of dentate nucleus.

The evolving role of saline infusion sonography (SIS) in infertility

Saline infusion sonography (SIS) has become a valuable diagnostic modality in gynaecology over the last three decades. SIS is now commonly employed for detailed evaluation of the uterine cavity as part of pre-treatment assessment in infertile women. The objective of this paper is review the scientific literature on SIS in infertility. Medline, Ovid and Cochrane databases were searched for relevant articles. The indications, technical aspects and the potential advantages of SIS are discussed. The efficacy and sensitivity of SIS are compared to hysteroscopy in the evaluation of uterine polyps, fibroids, intrauterine adhesions and uterine anomalies. Increasing evidence suggests the use of SIS prior to an in-vitro fertilization (IVF) cycle as it has increased sensitivity in the detection of intrauterine pathology. SIS is cost-effective and results in better patient satisfaction scores than hysteroscopy.

Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries

INTRODUCTION

Traumatic brain injury is a leading cause of disability in bicycle riders. Preventive measures including bicycle helmet laws have been highlighted; however, its protective role has always been debated. The aim of this study was to determine the utility of bicycle helmets in prevention of intra-cranial hemorrhage. We hypothesized that bicycle helmets are protective and prevent the development of intra-cranial hemorrhage.

METHODS

We performed a 4-year (2009-2012) retrospective cohort analysis of all the patients who presented with traumatic brain injury due to bicycle injuries to our level 1 trauma center. We compared helmeted and non-helmeted bicycle riders for differences in the patterns of injury, need for intensive care unit admissions and mortality.

RESULTS

A total of 864 patients were reviewed of which, 709 patients (helmeted = 300, non-helmeted = 409) were included. Non-helmeted bicycle riders were more likely to be young (p < 0.001) males (p = 0.01). There was no difference in the median ISS between the two groups (p = 0.3). Non-helmeted riders were more likely to have a skull fracture (p = 0.01) and a scalp laceration (p = 0.01) compared to the helmeted riders. There was no difference in intra-cranial hemorrhage between the two groups (p = 0.1). Wearing a bicycle helmet was not independently associated (p = 0.1) with development of intra-cranial hemorrhage.

CONCLUSION

Bicycle helmets may have a protective effect against external head injury but its protective role for intra-cranial hemorrhage is questionable. Further studies assessing the protective role of helmets for intra-cranial hemorrhage are warranted.

The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.

Variations of thickness of trigonal muscle layer in different age and sex

This cross sectional descriptive study was to measure the thickness of muscular layer in trigone of the urinary bladder and to establish the difference between sexes of different age groups in Bangladeshi cadaver. A total 60 human urinary bladders were collected by purposive sampling from May 2013 to October 2013. Among them from male 43 and from female 17 were collected from Bangladeshi cadavers of age ranging from 01 to 60 years, from autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College, Mymensingh. The thickness of muscular layer in trigone of the urinary bladder was measured and significant differences of the value between age and sex groups were observed. The mean±SD thickness of muscular layer of trigone of the urinary bladder was 318.59±93.15μm in age Group A (01 to 20 years), 633.25±79.79μm in age Group B (21 to 40 years), and 352.50±116.15μm in age Group C (41 to 60 years). The mean difference of muscular layer of the trigone of the urinary bladder between age Groups A&B, B&C was statistically highly significant, where p=0.001. In statistical analysis, differences between age groups were calculated by using one way ANOVA test. The present study revealed that the value of thickness of muscular layer in trigone of the urinary bladder was increased with the increase of age and it was declined to a low level in the late age. The mean value of muscular layer of the trigone of the urinary bladder was higher in male than that of in female of Group A, B & C.

Kernel based support vector machine for the early detection of syncope during head-up tilt test

This study aims to analyze the autonomic nervous system response during head-up tilt test (HUTT), by exploring the changes in dynamic properties of heart rate variability in subjects with and without syncopes, to predict the outcome of HUTT. Baroreflex response, as well as linear and non-linear parameters of RR-interval time series, have been extracted from the ECG of 66 subjects: 35 with and 31 without syncope during HUTT. The results show that, when considering the first 15 min of tilting position, the total power spectrum, the standard deviation, the long-term fractal scale of RR-interval and ΔRR-interval of time series increase, while the sample entropy decreases in the positive group compared to the negative one. These indices may be good predictors of positive response in patients with reflex syncope. Additionally, an analysis of the first 15 min of tilting position using kernel support vector machines leads to a correct classification of 85% of patients, within negative and positive response groups (specificity = 80.6% and sensitivity = 88.5%). In medical applications, it is important to avoid false negative diagnosis of syncopes during HUTT. Taking this into account, an overall accuracy of 72.1% can be obtained in the same window allowing the reduction of the examination time in the clinical domain.