Status of Serum Zinc in Multidrug Resistant Tuberculosis

Zinc plays a vital role in the immune status. Its deficiency affects host defense by reducing the number of circulating T cells and phagocytosis activity of other cells which ultimately impair cell mediated immunity. The cell-mediated immunity plays a major role in the causation of pulmonary tuberculosis. The present study was carried out to estimate serum zinc level in newly detected multidrug resistant tuberculosis (MDR-TB) in adult population. In this study total fifty (50) MDR-TB patients were enrolled conveniently from the in-patients departments of National Institute of Diseases of the Chest Hospital (NIDCH), Bangladesh. Serum zinc was estimated by atomic absorption spectrophotometry method from early morning fasting blood sample. Serum zinc level was assessed according to normal cut-off value 70-120 μgm/dl and 76% studied population were found lower than this value. The mean±SD serum zinc level was observed 60.40±8.91 μgm/dl. No associations were found between serum zinc level with age (p=0.11) and with sex (p=0.085) of the study population respectively. The low level of serum zinc in MDR-TB patients suggested impaired immune status of our study population.

Incomplete Pentalogy of Cantrell--A Case Report

Cantrell's Pentalogy is a rare congenital malformation consists of supraumbilical abdominal wall defect, defect in the lower part of sternum, agenesis of anterior portion of diaphragm, an absence of the diaphragmatic part of the pericardium and intracardiac malformation. This case report presents a female neonate, who was born at 40 weeks of gestation weighing 2400 gm and was admitted 4 hours after delivery with the complaints of something coming out from chest. On physical examination her vital signs were within normal limit, she had a systolic murmur on heart at lower left sternal area and there was a vascular structure present on the upper part of abdomen which was pulsatile and pulsation was synchronized with cardiac pulsation. On investigation chest X-ray lateral view showed absence of lower part of sternum, echocardiography findings were different in different institutes. Echocardiography findings at Mymensingh medical college hospital (MMCH) were large VSD (Ventriculo septal defect), ASD (Atrial septal defect) and rotated heart. On colour Doppler ultrasonogram at MMCH showed there were VSD, ASD, and a small epigastric swelling which was vascular and appears to be attached to the apex of the heart. On the other hand echocardiography findings of LAB AID hospital in Dhaka were Dextrocardia, complete AV (atrio ventricular) canal defect, almost common atrium, almost single ventricle, common AV valve, double outlet right ventricle (DORV), Cortriatriatum, mild A-V valve regurgitation and severe pulmonary hypertension (PAH). Echocardiography was also done at national heart foundation hospital in Dhaka. Findings were situs solitus, mesocardia to dextrocardia, DORV, large VSD, mild mitral inflow, mild TR (triuspid regurgitation), good LV (left ventricle) and RV (right ventricle) systolic function. Cardiologists at Dhaka in Bangladesh were suggested for surgery. Then the patient was consulted at Naryan Institute of Cardiac Science, Chennai in India. Here echocardiography findings were dextroversion/dextrocardia, DILV (Double inlet left ventricle), large inlet VSD with bidirectional shunt, mild TR, severe PAH with good ventricular function. Cardiologists in India were given comment about this patient. This patient was highly risky for surgery. They advised medical treatment and requested to review after one year. By taking medical treatment patient condition is well except failure to thrive and cyanosis develops during feeding and crying according to the statement of guardian of the patient. This case has 3 criterias among the five criteria of Cantrell's Pentalogy. So, it is incomplete Pentalogy of Cantrell.

Awareness among Parents of β-Thalassemia Major Patients Regarding Prenatal Diagnosis and Premarital Screening in Day Care Centre of Transfusion Medicine Department

Thalassemia is one of the most common genetic diseases in the world. It is a major health problem, brings much morbidity, early mortality and a great deal of misery for a family both financially and emotionally. The patients suffering from beta thalassemia major do not survive for more than 5 years without blood transfusion. Blood transfusion is usually administered every two to five weeks to maintain the pre-transfusion hemoglobin level of 9-10 gm/dL. This study carried out in the department of Transfusion Medicine of Mymensingh Medical College Hospital from January 2014 to June 2014. A total of 200 parents were interviewed. There was a slight preponderance of females which accounted for 57.5% of the parents. Ninety seven (45.5%) had an income less than Rs. 5000 per month. Nearly 50% were illiterate with only 24.5% with a higher education. Consanguinity was positive in 72.5% of the parents with extended family history of thalassemia positive in 40.8%. Only 29.5% were immunized against Hepatitis B. Around 27.5% did not know whether they should be immunized. Fifty five percent of parents knew children should receive Dysferol. Twelve percent were aware of consanguinity to be a risk factor for thalassaemia with only 5% having undergone antenatal diagnosis. Parental knowledge about thalassemia and its preventive measures is inadequate; this requires intervention in the form of public health education programs concentrating on high risk/targeted population.

Anti-Bacterial effect of Aqueous Garlic Extract (AGE) determined by Disc Diffusion Method against Escherichia coli

The study was performed to determine the antibacterial effect of aqueous extract of garlic (Allium sativum) against standard strain of Escherichia coli ATCC 25922. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. Antibacterial effect of AGE was determined by disc diffusion method. Sensitivity of AGE determined in disc diffusion and the zone of inhibition (ZOI) was 4 mm, 10 mm and 20 mm at 25 μg/10 μl, 50 μg/10 μl and 100 μg/10 μl concentrations respectively. From the findings it is clearly determined the extract has definite antibacterial effect upon Escherichia coli. Further studies are required to detect and isolate the active ingredients present in the Garlic extract as well as detail steps of mechanism responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account.

Biomass Fuel Smoke and Tuberculosis: A Case-Control Study

This case control study was done to ascertain the association between exposures to biomass cooking fuel smoke and pulmonary tuberculosis. Cases were all newly diagnosed pulmonary tuberculosis patients, randomly collected from the Hospital (DOTS centers) Registry from January 2012 to June 2012 from two Upazillas of Sirajganj district, Bangladesh. A home visitation program was done subsequently. Healthy controls were recruited from the neighbourhood of each case through a predefined procedure. Total 276 new pulmonary tuberculosis cases and 276 neighbourhood controls were enrolled. A semi-structured questionnaire containing demographic information, smoking habits, cooking place, kitchen condition, use of biomass fuel for cooking was used for interview. Crude (unadjusted) odd ratios and their corresponding 95% confidence limits for independent variables were determined by binary logistic regression. All significant variables were entered into a multivariate conditional logistic regression model and a final fitted model was determined by backward elimination methods. In univariate analysis, member of a nuclear family {Unadjusted odd ratio (Unadj. OR) 1.570, 95% CI 1.008-2.44)}, having non-formal education (Unadj. OR 2.739, 95% CI 1.219, 6.153) or primary (Unadj. OR 3.407, 95% CI 1.492, 7.782) to secondary level (Unadj. OR 2.392, 95% CI 1.032, 5.544) education, using cow dung (Unadj. OR 3.961, 95% CI 1.267, 12.376) and biomass fuel i.e. plant origin (Unadj. OR 3.382, 95% CI 1.087, 10.518) for cooking, past smoker (Unadj. OR 2.504, 95% CI 1.061, 5.910), using open oven (Unadj. OR 3.109, 95% CI 0.995, 9.716), having small kitchen area (Unadj. OR 0.99, 95% CI 0.989, 0.999) all were significantly associated with tuberculosis. When all significant variables were entered into a multivariate conditional logistic regression model nuclear family {Adjusted odd ratio (Adj OR) 1.808, 95% CI 1.127, 2.9)}, primary level education (Adj OR 2.86, 95% CI 1.23, 6.647) and non formal education (Adj OR 2.312, 95% CI 1.013, 5.276), biomass fuel (plant origin, Adj OR 3.497, 95% CI 1.059, 11.55), and cow dung (Adj OR 4.368, 95% CI 1.319, 14.464)) used in cooking and irregular smoker (who stop smoking at least 6 month back) (Adj OR 2.806, 95% CI 1.141, 6.901) were significantly associated with tuberculosis cases. From this study significant association have been found between exposure to combustion of biomass cooking fuel and tuberculosis.

Specific gyrA gene mutations predict poor treatment outcome in MDR-TB

OBJECTIVES

Mutations in the gyrase genes cause fluoroquinolone resistance in Mycobacterium tuberculosis. However, the predictive value of these markers for clinical outcomes in patients with MDR-TB is unknown to date. The objective of this study was to determine molecular markers and breakpoints predicting second-line treatment outcomes in M. tuberculosis patients treated with fourth-generation fluoroquinolones.

METHODS

We analysed treatment outcome data in relation to the gyrA and gyrB sequences and MICs of ofloxacin, gatifloxacin and moxifloxacin for pretreatment M. tuberculosis isolates from 181 MDR-TB patients in Bangladesh whose isolates were susceptible to injectable drugs.

RESULTS

The gyrA 90Val, 94Gly and 94Ala mutations were most frequent, with the highest resistance levels for 94Gly mutants. Increased pretreatment resistance levels (>2 mg/L), related to specific mutations, were associated with lower cure percentages, with no cure in patients whose isolates were resistant to gatifloxacin at 4 mg/L. Any gyrA 94 mutation, except 94Ala, predicted a significantly lower proportion of cure compared with all other gyrA mutations taken together (all non-94 mutants + 94Ala) [OR = 4.3 (95% CI 1.4-13.0)]. The difference in treatment outcome was not explained by resistance to the other drugs.

CONCLUSIONS

Our study suggests that gyrA mutations at position 94, other than Ala, predict high-level resistance to gatifloxacin and moxifloxacin, as well as poor treatment outcome, in MDR-TB patients in whom an injectable agent is still effective.

Association of bacteria in diabetic and non-diabetic foot infection - An investigation in patients from Bangladesh

The microbial community on a host relies on its immune status and pathophysiological condition. Diabetes mellitus is a metabolic disorder associated with a 25% increased risk of developing foot infection. The pathophysiological differences between diabetic foot infection (DFI) and non-DFI patients may alter the microbial composition in infections. The present study aims to comparatively analyze the microbes colonized in DFI and non-DFI patients in Bangladesh. Pus specimens were collected from 67 DFI and 12 non-DFI patients to investigate the bacteria associated with foot infection. For this investigation, an array of microbiological, molecular biological and immunological approaches were performed. Common bacteria detected in both DFI/non-DFI samples were Pseudomonas spp. (22/29%), Bacillus spp. (12/3%), Enterobacter spp. (22/7%), Staphylococcus spp. (13/13%) and Acinetobacter spp. (10/10%). Enterococcus spp. (9%) and Klebsiella spp. (8%) occurred only in DFI patients, whereas Citrobacter spp. (29%) was only detected in non-DFI samples. The rate of occurrence of three organisms, namely, Enterococcus spp. |Z|=2.2125, Klebsiella spp. |Z|=1.732, Bacillus spp. |Z|=1.9034, were also statistically significant. Most of the isolates from DFI patients were commonly resistant to the cephalosporin (Ceftazidime, Ceftriazone, Cefurozime) and monobactam (Aztreonam) groups of antibiotics. DFI patients had comparatively higher C-reactive protein (CRP) levels than non-DFI patients, and a positive correlation was observed between multi-antibiotic resistance and CRP levels (one of the markers of chronic subclinical inflammation). The present investigation implicated a complex association of the bacterial population in DFI compared with non-DFI with different antimicrobial resistance properties, which was linked with CRP levels.

An in silico model to demonstrate the effects of Maspin on cancer cell dynamics

Most cancer treatments efficacy depends on tumor metastasis suppression, where tumor suppressor genes play an important role. Maspin (Mammary Serine Protease Inhibitor), an non-inhibitory serpin has been reported as a potential tumor suppressor to influence cell migration, adhesion, proliferation and apoptosis in in vitro and in vivo experiments in last two decades. Lack of computational investigations hinders its ability to go through clinical trials. Previously, we reported first computational model for maspin effects on tumor growth using artificial neural network and cellular automata paradigm with in vitro data support. This paper extends the previous in silico model by encompassing how maspin influences cell migration and the cell-extracellular matrix interaction in subcellular level. A feedforward neural network was used to define each cell behavior (proliferation, quiescence, apoptosis) which followed a cell-cycle algorithm to show the microenvironment impacts over tumor growth. Furthermore, the model concentrates how the in silico experiments results can further confirm the fact that maspin reduces cell migration using specific in vitro data verification method. The data collected from in vitro and in silico experiments formulates an unsupervised learning problem which can be solved by using different clustering algorithms. A density based clustering technique was developed to measure the similarity between two datasets based on the number of links between instances. Our proposed clustering algorithm first finds the nearest neighbors of each instance, and then redefines the similarity between pairs of instances in terms of how many nearest neighbors share the two instances. The number of links between two instances is defined as the number of common neighbors they have. The results showed significant resemblances with in vitro experimental data. The results also offer a new insight into the dynamics of maspin and establish as a metastasis suppressor gene for further molecular research.

Gender Variation in the Risk Factors with Ischemic Stroke: Bangladesh Perspective

It is suggested in different studies that gender has a great impact on the distribution of risk factors of stroke. This study aims at determining the gender differences in risk factors of acute ischemic stroke among male and female patients. Data extracted for this study were taken from a case control study which was carried out in the departments of Neurology and Medicine of Dhaka Medical College Hospital (DMCH) and Shaheed Suhrawardy Medical College Hospital (ShSMCH) Dhaka from July 2009 to June 2011. We collected data of 125 patients with ischemic stroke and 129 healthy controls from the primary source. All secondary data were divided on the basis of gender. Among all male respondents 70 stroke patients were considered as case and 72 healthy respondents were considered as control and in female group 55 were stroke patients (case) and 57 were healthy control. Risk factors of stroke for male and female were evaluated separately. After multivariate analysis ever smoking (both present and ex smoker) (adj. OR 3.799, 95% CI 1.416, 10.19), diabetes mellitus (adj. OR 5.687, 95% CI 1.99, 16.26), hypertension (adj. OR 18.53, 95% CI 6.43, 53.4) and total cholesterol (adj. OR 1.017, 95% CI 1.01, 1.03) were found significant predictors for stroke in male whereas diabetes mellitus (adj. OR 6.989, 95% CI 1.54, 31.64), hypertension (adj. OR 17.85, 95% CI 5.1, 62.38), serum low density lipoprotein (LDL) (adj. OR 1.04, 95% CI 1.013, 1.07) and serum triglyceride (TG) (adj. OR 1.012, 95% CI 1.004, 1.02) were found significant in female. Besides taking the controlling measure for hypertension and diabetes mellitus, life style modification is an important factor to prevent stroke in both sexes.

Pattern of Dermatophytes in Patients Attend in Mymensingh Medical College Hospital

Dermatophytosis is a common fungal disease which involves the keratinized tissue. This is an attempt to observe the spectrum of dermatophytes among the clinically suspected cases of dermatophytosis attending the outpatient department of Dermatology and Venereology, Mymensingh Medical College Hospital, Mymensingh during the period of July 2013 to December 2014. Two hundred thirty (230) clinically suspected cases of dermatophytosis were subjected in this study. Sixty three cases (27.39%) were positive for fungus in direct microscopy while 53(23.04%) were culture positive. Among the clinical types tinea unguium was the most common followed by tinea corporis. Dermatophytosis was more common in the age group of 21-30 years. The male to female ratio was 1.53:1. Trichophyton rubrum 44(83.04%) was found common etiological dermatophyte species followed by Trichophyton mentagrophytes 5(9.43%) and Epidermophyton floccosum 4(7.55%).

Rotavirus is Predominent Enteropathogen in Acute Childhood Diarrhea in Mymensingh

The study was carried out from July 2011 to June 2012 in the Department of Microbiology, Mymensingh Medical College. A total of 200 clinically diagnosed diarrheal paediatrics patients were included in this study. Stool specimens were examined by standard laboratory methods for identification of enteropathogens. Diarrheagenic Escherichia coli strains were detected by Multiplex PCR following standard methods and Rotavirus genome was detected by Polyacrylamide Gel Electrophoresis (PAGE). Rotavirus was the most common enteropathogen detected in 69(34.5%) cases, followed by Diarrheagenic Escherichia coli (DEC) and Campylobacter species in 34(17.0%) and 23(11.5%) cases respectively. Rotavirus detection rate was high in upto 1 year age group which was 51(25.5%).

Two guard cell mitogen-activated protein kinases, MPK9 and MPK12, function in methyl jasmonate-induced stomatal closure in Arabidopsis thaliana

Methyl jasmonate (MeJA) and abscisic acid (ABA) signalling cascades share several signalling components in guard cells. We previously showed that two guard cell-preferential mitogen-activated protein kinases (MAPKs), MPK9 and MPK12, positively regulate ABA signalling in Arabidopsis thaliana. In this study, we examined whether these two MAP kinases function in MeJA signalling using genetic mutants for MPK9 and MPK12 combined with a pharmacological approach. MeJA induced stomatal closure in mpk9-1 and mpk12-1 single mutants as well as wild-type plants, but not in mpk9-1 mpk12-1 double mutants. Consistently, the MAPKK inhibitor PD98059 inhibited the MeJA-induced stomatal closure in wild-type plants. MeJA elicited reactive oxygen species (ROS) production and cytosolic alkalisation in guard cells of the mpk9-1, mpk12-1 and mpk9-1 mpk12-1 mutants, as well in wild-type plants. Furthermore, MeJA triggered elevation of cytosolic Ca(2+) concentration ([Ca(2+)]cyt ) in the mpk9-1 mpk12-1 double mutant as well as wild-type plants. Activation of S-type anion channels by MeJA was impaired in mpk9-1 mpk12-1. Together, these results indicate that MPK9 and MPK12 function upstream of S-type anion channel activation and downstream of ROS production, cytosolic alkalisation and [Ca(2+)]cyt elevation in guard cell MeJA signalling, suggesting that MPK9 and MPK12 are key regulators mediating both ABA and MeJA signalling in guard cells.

Analysis of genetic variability, heritability and genetic advance for yield and yield associated traits in some promising advanced lines of rice

A field experiment was conducted using twenty three rice genotypes including three check varieties during the period from June to December, 2013, at the Agronomy Field Laboratory, Department of Agronomy, Bangladesh Agricultural University, Mymensingh to study genetic variability, heritability and genetic advance (GA) for yield and yield associated traits in rice. The experiment was laid down in a randomized complete block design with three replications. Plant height, number of filled grains per panicle, days to 50% flowering, thousand grain weight, grain width and grain yield showed relatively high genotypic co-efficient of variation (GCV) and phenotypic co-efficient of variation (PCV) estimates. The PCV were higher than GCV for all eight traits indicating that they all interacted with the environment to some extent. High heritability was obtained for grain width (88.54%), followed by days to 50% flowering (87.61%), thousand grain weight (81.96%), grain length (81.94%), days to maturity (81.81%) and number of filled grains per panicle (78.19%) which indicates high heritable portion of variation. High to medium estimates of heritability and genetic advance were obtained for number of filled grains per panicle (18.97), days to 50% flowering (11.89), days to maturity (12.16) indicating the roles of additive gene action and a good scope of selection using their phenotypic performance. Considering, all of these characters, filled gains per panicle and days to 50% flowering and maturity were important yield related traits and could be used for selection in rice breeding programs.Progressive Agriculture 26:26-31, 2015

Silkworm as an animal infection model for the screening of environmental, clinical and veterinary pathogens

Silkworm, Bombyx mori, has passive immunity and can be infected by pathogenic bacteria. Therefore, it can be used as a robust bacterial infection model for screening of pathogenic isolates from various sources. In this work, 11 environmental, clinical and veterinary isolates were screened for pathogenicity using silkworm larvae by injecting bacterial suspension through their dorsal surface and observing response. Experimental conditions were established by using Bacillus thuringiensis SW_R_F_1, Escherichia coli 0157:H7, E. coli DH5a and 0.6% saline. Nine out of 11 isolates were detected pathogenic after screening. The biochemical and genomic analysis of the nine test isolates confirmed their pathogenicity. The LD₅₀ of Pseudomonas aeruginosa 47D and Salmonella Typhimurium 77 were 4.63x107 at 12 hours was 8.02x10⁷ cells/lOOμI/gram at 24 hours respectively. These results indicated that silkworm exhibits differential pathological response for pathogenic and nonpathogenic bacteria, and can be used as an alternative to animal model for screening diverse isolates.

Attitude and Practices of Mothers on Breastfeeding Attended at a Tertiary Hospital in Bangladesh

This descriptive cross sectional study was conducted in Pediatric Out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) from November 2013 to April 2014 to assess the knowledge and practices of the mothers about breastfeeding. Four hundred mothers having children 6 months to 2 years of age attended at OPD of MMCH for any cause were included in the study by systematic random sampling. A structured, pre-tested, interview schedule was used to collect data from mothers. All mothers were continuing to breastfeed their children. Two hundred and seventy-two (68.00%) infants received breast feeding within 1 hour after birth, while 128(32.00%) infants received breast feeding after 1 hour of birth. Of 128, in 48(37.50%) cases, mother's illness was the reason for delay in initiation of breast feeding, whereas in 70(54.69%) cases, it was due to reduced milk production on mother's statement. Pre-lacteal feeding was given in 96(24.00%) children. Among them honey was given in 24(25.00%) cases, cow's milk was given in 14(14.58%) cases, sugar water was given in 18(18.75%) cases and formula milk was given in 40(41.67%) cases. One hundred and twenty-eight (32.00%) mothers started to give their child food other than breast milk before 3 months of age and 148(37.00) mothers started to give their child food other than breast milk before 6 months of age. The reason for starting to give their child food other than breast milk before 6 months of age was mother's assumption of milk insufficiency in 166(60.14%) cases and baby's cry for hunger in 110(39.86%) cases. Formula milk was given in 120(30.00%) infants before 6 months of age. Among them 96(80.00%) mothers prepared it with larger amount of water. Plain water was given in 240(60.00%) children before the age of 6 months. One hundred and twenty-four (31.00%) children were exclusively breastfeed for first 6 months of age. Breastfeeding is almost universal in Bangladesh but the exclusive breastfeeding rate is alarmingly very low. Great emphasis is needed to educate mothers about benefits of colostrum, exclusive breastfeeding, and the harmful effects of pre-lacteal feeding.

Successful '9-month Bangladesh regimen' for multidrug-resistant tuberculosis among over 500 consecutive patients

SETTING

Tuberculosis (TB) program, Damien Foundation Projects, Bangladesh.

OBJECTIVE

To summarize the outcome and its determinants of the first treatment for multidrug-resistant TB using a standardized regimen consisting of a minimum 9 months.

DESIGN

This was a prospective, observational study of a gatifloxacin (GFX) based directly observed regimen, mainly with initial hospitalization. The 4-month intensive phase was extended until sputum smear conversion. Patients were monitored using culture for up to 2 years after treatment completion.

RESULTS

Of the 515 patients who met the study inclusion criteria and were successively enrolled from 2005 to 2011, 84.4% had a bacteriologically favorable outcome. Due to extensive disease with delayed sputum conversion, only half of the patients completed treatment within 9 months; however, 95% were able to complete treatment within 12 months. Eleven patients failed or relapsed, and 93.1% of the 435 patients who were successfully treated completed at least 12 months post-treatment follow-up. The strongest risk factor for a bacteriologically unfavorable outcome was high-level fluoroquinolone (FQ) resistance, particularly when compounded by initial pyrazinamide (PZA) resistance. Low-level FQ resistance had no unfavorable effect on treatment outcome. Amplification of drug resistance occurred only once, in a patient strain that was initially only susceptible to kanamycin and clofazimine.

CONCLUSION

The excellent outcome of the Bangladesh regimen was largely maintained. Bacteriological treatment failures and relapses were rare, except among patients with high-level GFX resistance, notably in the presence of PZA resistance.

A study on-effect of hematoma and perihematomal edema volume on GCS at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage

Objective: To know effect of hematoma and perihematomal edema volume on Glasgow Coma Scale (GCS) at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage.Methods: this cross sectional study was conducted in Neurosurgery department, BSMMU to observe effect of hematoma and perihematomal edema volume on GCS at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage. The duration of study period was from November 2005 to April 2007.Results: a total 48 patients were included in the study and the variables that were analyzed included site of hematoma, volume of hematoma, perihematomal edema and the initial GCS score. Associations between the hematoma and perihematomal edema, site of hemorrhage and perihematomal edema, hematoma volume and GCS at the time of admission, perihematomal edema volume and GCS at the time of admission were evaluated. Level of consciousness (GCS) at the time of admission is the key factor in predicting outcome and neurological deterioration. In our study we found significant association between- hematoma and perihematomal edema volume, hematoma volume and GCS at the time of admission, perihematomal edema volume and GCS at the time of admission. But there was no significant association found between hemorrhage site and perihematomal edema.Conclusion: more the volume of hematoma more was the volume of perihematomal edema. More the volume of hematoma less was the GCS. More the volume of perihematomal edema less was the GCS. But we found no significant association between site of hemorrhage and perihematomal edema volume. GCS is an established predictor of outcome in patients with SICH (spontaneous intracerebral hemorrhage). Accurate prediction of the outcome in ICH patients is important for several reasons: a reliable prognosis must be given to patient and relatives as soon as possible, realistic rehabilitation goals should be set and resources should be allocated in the most efficient way.Pulse Vol.7 January-December 2014 p.22-28

In vitro assessment of antibacterial effect of garlic (allium sativum) extracts on pseudomonas aeruginosa

The study was aimed to determine the antibacterial effect of crude and aqueous extract of garlic (Allium stivum) against standard strain of Pseudomonas aeruginosa ATCC 27853. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. The minimum inhibitory concentration (MIC) of aqueous garlic extract (AGE) and antibiotic Imipenem were also determined with the help of broth dilution method. Inhibitory effect of crude garlic extract (CGE) was determined by inoculation of bacteria in CGE incorporated nutrient agar (NA) media and for AGE antibacterial effect was determined by disc diffusion method. All experiments except disc diffusion procedure were reconfirmed by subculture in pure NA media. In case of CGE the growth inhibition of test organism was observed in 30% CGE incorporated NA media. On the other hand sensitivity of AGE also determined in disc diffusion and the zone of inhibition (ZOI) was 7 mm, 12 mm and 20 mm at 25 μg/10 μl, 50 μg/10 μl and 100 μg/10 μl concentrations respectively. The MICs of AGE and Imipenem were 600 μg/ml and 1μg/ml. The MIC of imipenen was far less in comparison with the MIC of AGE. From the findings it is clearly determined that both the extracts have definite antibacterial effect upon Pseudomonas aeruginosa. Further studies are required to detect and isolate the active ingredients present in the Garlic extract responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account. Only then the Garlic extracts fulfilled the criteria for its therapeutic use. Still then external application advised for burn and superficial skin infections and may be used in food poisoning, and respiratory tract infection along with conventional antibiotics which are used in those conditions.

Rapid Immuno-Chromatographic Assay for the Detection of Antibodies to HIV Compare with Elisa among Voluntary and Replacement Blood Donor of Mymensingh Medical College Hospital

Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from voluntary and replacement blood donors & HIV-infected patients (positive samples from BSMMU, Dhaka). Five rapid HIV assays: Determine™ HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1-2.0 (PMC Medical India Pvt Ltd.), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold™ HIV-1/2 (Biotech) were evaluated between 1st February to 30th June, 2013 using 400 whole blood samples from voluntary and replacement blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). Only 01 sample including ten positive samples from BSMMU were confirmed HIV-1 antibody positive, while 399 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold™ was 100% (95% CI; 99.1-100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2-99.9) and 97.7% (95% CI; 95.7-98.9) respectively, which increased to 100% (95% CI; 99.1-100) on repeat testing. The initial specificity of the Uni-Gold™ assay was 100% (95% CI; 99.6-100) while specificities were 99.6% (95% CI; 99-99.9), 99.4% (95% CI; 98.8-99.7), 99.6% (95% CI; 99-99.9) and 99.8% (95% CI; 99.3-99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold™, Determine and SD Bioline assays. An alternative confirmatory HIV testing strategy based on initial testing on either SD Bioline or Determine assays followed by testing of reactive samples on the Determine or SD Bioline gave 100% sensitivity (95% CI; 99.1-100) and 100% specificity (95% CI; 96-99.1) with Uni-Gold™ as tiebreaker for discordant results.

Knowledge and practices of mothers on childhood diarrhoea and its management attended at a tertiary hospital in bangladesh

This descriptive cross sectional study was conducted in Pediatric out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) from March 2014 to August 2014 to assess the knowledge and practices of the mothers in acute diarrhoeal diseases in children under-five years of age regarding use of oral rehydration solution (ORS), zinc, other drugs and feeding practices. Four hundred children under-five years of age having acute diarrhoea were included in the study by systematic random sampling. A structured, pretested, interviewer-administered questionnaire was used to collect data from mothers of children having diarrhoeal diseases. ORS was offered by 360(90.00%) of the mothers. Out of which 279(77.50%) used it by their own knowledge. One hundred and ninety-one (53.06%) mothers prepared it correctly, while 169(46.94%) prepared it incorrectly. Of 169, 129(35.83%) mothers used less amount of water, while 40(11.11%) mothers used much amount of water to prepare ORS. Of 360 mothers, 89(24.72%) mixed part of the content of ORS sachet at a time. Of 360 mothers, only 55(15.28%) offered correct amount of ORS after each purging. Zinc was offered in 142(35.50%) children. Of 400, only 13(3.25%) mothers used recommended home-based fluid, while 70(17.50%) mothers offered increased amount of fluid to their child. Drugs other than zinc and ORS were used in 247(61.75%) children. Among drugs, other than zinc and ORS, antibiotics was used in 109(44.13%) cases, whereas antiprotozoal in 97(39.27%) cases. Amount of liquid given was more than usual in 70(17.50%) children, same as usual in 57(14.25%) children and less than usual in 273(68.25%) children. Amount of food given was same as usual in 59(14.75%) children, while less than usual in 341(85.25%) children. Control of diarrhoeal diseases programme is successful in introducing ORS at mass level. Great emphasis is needed to educate mothers about preparation and quantity of ORS to be given to children with diarrhoeal diseases.

Surgical Decompression of Resistant Cases of DeQuervain's Disease

DeQuervain's disease of the first dorsal compartment of the wrist, is a common wrist pathology, pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendon in the fibroosseous canal. Management of resistant cases of DeQuervain's disease with failed conservative treatment treated by surgical decompression yield satisfactory outcomes. A large number of patients being dissatisfied with the medical treatment, still present with persistent pain and positive clinical finding. Surgical decompression is an effective method for the treatment of resistant cases of DeQuervain's disease. Outcome variables were measured by Scheller, Forget and Macey evaluation criteria. Most of our patients were female 28(93.3%), housewife 17(56.7%) with mean age of 41.57 years, ranging from 25-60 years. Right sided involvement was 20(66.7%) and Left sided involvement was 10(33.3%). Restricted movement of thumb in 30(100%) were the predominant symptoms. One (3.3%) patient develop chronic tenosynovitis, 1(3.3%) patient develop hypertrophic scar. There was no wound infection in the follow-up period of 3-18 months. Satisfactory results were found in 29(96.7%).

Experience of Exchange Transfusion in a Newly Established SCANU at a Tertiary Care Hospital in Bangladesh

Hyperbilirubinemia is common in neonates. The value of exchange transfusion (ET) is recognized. The procedure has some risks and complications. This descriptive observational cross sectional study was done in the Neonatology department during the period of January 2013 to December 2013. Total 62 patients were studied. ET was done in 47 patients. Among 47 patients, 29(61.7%) were male and 18(38.3%) were female. The most common cause of ET was Rh incompatibility (46.8%). In order of frequency, major findings were ABO incompatibility (25.5%), unidentified (14.9%), Sepsis (6.4%), minor blood group incompatibility (4.3%) and others (2.1%) respectively. Mean Serum bilirubin level was 22±5.1mg/dl. Most common complications following ET were anemia (12.7%), Sepsis (10.6%), and omphalitis (6.4%). The overall mortality observed was 6.4%. The majority of the adverse events associated with ET were treatable.

Soft tissue tumours and tumour like lesions - a demographic and clinicopathologic study of 461 cases from different regions of Bangladesh

Soft tissue tumours and tumour like lesions are relatively rare. They pose diagnostic difficulty due to wide morphological variation as well as overlapping clinical and pathological features. The relative frequency of soft tissue tumours varies throughout world. This study was undertaken to find out the distribution of soft tissue tumours and tumour like lesions in Babgladesh. Four hundred and sixty one cases of soft tissue tumour and tumour like lesions were studied to see the demographic and clinicopathologic pattern. Benign 320(69.4%) and malignant 141(30.6%) cases were recorded. Of all cases mean age was 31.07±16.87 years with M:F ratio of 1:0.71 (p=0.001). Upper extremity was the most common site. Majority of the benign cases (84.1%) were superficially located whereas majority of malignant cases (89.2%) were deep seated (p=0.001). Lipoma and fibrosarcoma was the most common benign and malignant tumour respectively observed in this study. In childhood group, rhabdomyosarcona was the commonest one. The distribution pattern of soft tissue tumours in Bangladeshi population is roughly similar to that described in other countries with few exceptions.

Signalling profiles of H3 relaxin, H2 relaxin and R3(BΔ23-27)R/I5 acting at the relaxin family peptide receptor 3 (RXFP3)

BACKGROUND AND PURPOSE

Relaxin family peptide receptor 3 (RXFP3) is expressed in brain areas important for processing sensory information and feeding, suggesting that it may be a target for anti-anxiety and anti-obesity drugs. We examined the effects of H3 relaxin, the biased agonist H2 relaxin and the antagonist, R3(BΔ23-27)R/I5, on RXFP3 signalling to establish their suitability as tools to assess the physiological roles of RXFP3.

EXPERIMENTAL APPROACH

The signalling profile of the RXFP3 ligands was determined using reporter gene assays, multiplexed signalling assays and direct examination of receptor-G protein and receptor-β-arrestin interactions using BRET.

KEY RESULTS

H2 relaxin activated p38MAPK and ERK1/2 with lower efficacy than H3 relaxin, but had similar efficacy for JNK1/2 phosphorylation. H2 or H3 relaxin activation of p38MAPK, JNK1/2 or ERK1/2 involved Pertussis toxin-sensitive G-proteins. R3(BΔ23-27)R/I5 blocked H3 relaxin AP-1 reporter gene activation, but not H2 relaxin AP-1 activation or H3 relaxin NF-κB activation. R3(BΔ23-27)R/I5 activated the SRE reporter, but did not inhibit either H2 or H3 relaxin SRE activation. R3(BΔ23-27)R/I5 blocked H3 relaxin-stimulated p38MAPK and ERK1/2 phosphorylation, but was a weak partial agonist for p38MAPK and ERK1/2 signalling. p38MAPK activation by R3(BΔ23-27)R/I5 was G protein-independent. H3 relaxin-activated RXFP3 interacts with Gαi2 , Gαi3 , Gαo A and Gαo B whereas H2 relaxin or R3(BΔ23-27)R/I5 induce interactions only with Gαi2 or Gαo B . Only H3 relaxin promoted RXFP3/β-arrestin interactions that were blocked by R3(BΔ23-27)R/I5.

CONCLUSION AND IMPLICATIONS

Understanding signalling profile of drugs acting at RXFP3 is essential for development of therapies targeting this receptor.

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

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

Effect of production phase on growth, enzyme activities and feed selection of broilers raised on vegetable protein diet

This study consisted of two experiments, conducted to assess the impact of phase at which vegetable protein (VP) diets are introduced to broiler chicks, and preference of birds for diets based on soybean or canola meal (CM). Two hundred and ten day-old Cobb 500 chicks were randomly distributed into five dietary groups in the main experiment. One group was fed on animal protein (AP) diet all through to 21 days of age; two other groups were started on AP diet for 7 days and then switched to diets containing soybean meal (AP-SBM) or AP-CM, while two other diets (SBM-AP and CM-AP) were started on one of the VP diets for 7 days and then switched to AP diet. A sub-experiment on thirty birds raised on a commercial diet to 7 days was used in a feed selection test to quantify the preference of birds for the diets containing mainly CM or SBM. Chicks were reared under similar care and management conditions and the diets were iso-caloric and iso-nitrogenous. Results of the main experiment showed that chicks on CM-AP diet ate more (p<0.05) than those on the other diets up to day 7. Body weight gain was highest (p<0.001) on the AP-SBM diet while birds on the CM-AP diet weighed the least at 7 d. Feed intake, body weight gain, feed conversion ratio, mortality, bone growth, visceral organ development, and activities of digestive enzymes were similar between the groups from hatch to 21 days of age. Results of the second sub-experiment showed that chicks preferred the CM-based diets to the SBM-based diets at 8 to 14 d (p<0.001) and 15 to 21 d (p<0.01) when given a choice. Overall, the birds were not affected by the nature of the starter diet although they tended to prefer the canola to soybean diets.

Cyclic adenosine 5'-diphosphoribose (cADPR) cyclic guanosine 3',5'-monophosphate positively function in Ca(2+) elevation in methyl jasmonate-induced stomatal closure, cADPR is required for methyl jasmonate-induced ROS accumulation NO production in guard cells

Methyl jasmonate (MeJA) signalling shares several signal components with abscisic acid (ABA) signalling in guard cells. Cyclic adenosine 5'-diphosphoribose (cADPR) and cyclic guanosine 3',5'-monophosphate (cGMP) are second messengers in ABA-induced stomatal closure. In order to clarify involvement of cADPR and cGMP in MeJA-induced stomatal closure in Arabidopsis thaliana (Col-0), we investigated effects of an inhibitor of cADPR synthesis, nicotinamide (NA), and an inhibitor of cGMP synthesis, LY83583 (LY, 6-anilino-5,8-quinolinedione), on MeJA-induced stomatal closure. Treatment with NA and LY inhibited MeJA-induced stomatal closure. NA inhibited MeJA-induced reactive oxygen species (ROS) accumulation and nitric oxide (NO) production in guard cells. NA and LY suppressed transient elevations elicited by MeJA in cytosolic free Ca(2+) concentration ([Ca(2+)]cyt) in guard cells. These results suggest that cADPR and cGMP positively function in [Ca(2+)]cyt elevation in MeJA-induced stomatal closure, are signalling components shared with ABA-induced stomatal closure in Arabidopsis, and that cADPR is required for MeJA-induced ROS accumulation and NO production in Arabidopsis guard cells.

Use of modified blood agar plate for identification of pathogenic campylobacter species at Mymensingh Medical College

This cross sectional study was carried out from July 2011 to June 2012 in the Department of Microbiology, Mymensingh Medical College to diagnose etiology of diarrhea caused by Campylobacter species. A total of 200 clinically diagnosed diarrheal pediatric patients were included in this study. Among the 200 stool specimens evaluated, 23(11.5%) samples were positive for Campylobacter species, isolation rate was 15(65.2%) in upto 1 year age group and 08(34.7%) in more than 1 year age group. Among 23 positive cases, 20(86.95%) were C. jejuni and 03(13.05%) were C. coli. The prevalence of Campylobacter infection found in the present study was higher below 1 year age group and was very much close to other countries of this Sub continent.

The Ameliorating Effects of Garlic (Allium sativum) against Lead (Pb) Intoxication on Body Weight, Dressing Percentages, Feed Consumption and Feed Conversion Ratio in Lead Induced Broiler Chickens

Lead (Pb) has extensive commercial and industrial use despite of its recognized as health hazard. The therapeutic application of garlic (Allium sativum) was investigated for preventing the toxic effect of lead (Pd) in lead exposed chickens. 350 commercial broiler chickens were grouped into five such as T0, T1, T2, T3 and T4consisting of 70 birds each where T0 served as control. T1 was provided with lead acetate at 100mg/kg body weight, T2 had 100mg/kg lead acetate + 1% garlic supplement, T3 was fed with 100mg/kg lead acetate + 2% garlic supplement and T4 had 100mg/kg lead acetate + 4% garlic supplement for 42 days. Garlic was found to be capable of elimination of lead (Pb). Analysis of variance statistically revealed that significant (P<0.01) lower level of live weight (g), carcass weight (g) and eviscerated fresh carcass weight (%) were 2015.26±49.73, 1124.45±11.67 and 60.63±3.18, respectively in the chickens in group T1 at 42nd day of treatment in comparison to other groups. All garlic treatment groups satisfactorily increased live weight and carcass weight. Following the application of dietary garlic, mean values of live weight (g), carcass weight (g) and eviscerated fresh carcass weight (%) were significantly (P<0.01) increased at 2156.63±74.52, 1455.85±9.21 and 63.96±2.18 in group T3. Feed conversion ratio showed non-significant differences between different groups, but the most significant (P<0.01) FCR values were recorded in T3 among the treatment groups. It can be recommended from the present study that garlic might be played an active role to antagonize lead (Pb) toxicity.DOI: http://dx.doi.org/10.3329/bjvm.v12i1.20453 Bangl. J. Vet. Med. (2014). 12 (1): 1-7 

Pattern of Elevated Serum Alkaline Phosphatase (ALP) Levels in Hospitalized Patients: A Single Centre Study

Background: Persistent elevation of serum ALP is frequently encountered and can pose a diagnostic dilemma due to its association with a wide range of clinical conditions. However, the significance of ALP in these clinical conditions in routine practice is often underestimated or overrated. Objectives: This study was determined to assess the pattern of ALP with an aim to elucidate its clinical utility among hospitalized patients. Method & materials: The inpatients with high ALP level were enlisted & analysed between January to December 2012 excluding cases of (a) patients who have bone involvements with malignancies and (b) HIV-seropositive patients attending a tertiary care Hospital at Dhaka. Extremely high levels of ALP were defined as being more than 1000 U/L. These patients were divided into different groups according to their final diagnosis. Results: A total of 154 hospitalized patients with eligible medical records were identified (98 male and 56 female, mean age 36 years). Their ALP levels are ranging from 1,006 to 3,067 IU/L; very extreme values of > 3000 IU/L being rarely (only about 2%) documented. Patients with sepsis can have an extremely high alkaline phosphatase level (1,648.2 ± 328.4 IU/L) and a normal bilirubin. Conclusion: High serum ALP levels in hospitalized patients were commonly found in three major groups having obstructive biliary diseases, infiltrative liver disease and sepsis. A variety of other causes were also noted. This routine laboratory test should receive more attention in clinical decision-making than has previously been given. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20329 Pulse Vol.6 January-December 2013 p.20-26

Detection of Giardia lamblia and Cryptosporidium parvum by direct immunofluorescence assay in stool specimen

Giardia and Cryptosporidium are the pathogens which transmitted through contaminated soil and contaminated water are significant causes of diarrhea and nutritional disorders in institutional and community peoples. Children and immune compromise persons are more vulnerable for these infections. Both Giardiasis and Cryptosporidiosis were included in 2004 as WHO Neglected Disease. So this is a major public health problem in developing countries. The present study was carried out to detect the Giardia and Cryptosporidium from diarrheic or patient having loose stool by Direct Immunofluorescence assay. The study was conducted during July 20012 to February 2013 and the work was done in Mymensingh Medical College in the department of Microbiology and in Bangladesh Agricultural University in the department of Veterinary Medicine. A total of 100 loose stools were collected from school children of different area and hospital under sadar upazilla, Mymensingh. The detection of Giardia lamblia and Cryptosporidium parvum showed the individual prevalence 8% and 4% respectively. The highest cyst/oocyst count was 85,000 and 1,000/gm of stool and the lowest being 100 and 50/gm of stool for Giardiasis and Cryptosporidiosis respectively. The detection rate of Giardia and Cryptosporidium by Immunofluorescence assay was relatively higher than the previous study done in Bangladesh and this was the first report from Bangladesh over human stool specimen using Immunofluorescence assay. So, Immunofluorescence assay could be adapted for rapid and accurate detection of Giardia and Cryptosporidium.

Comparison between azithromycin and cefixime in the treatment of typhoid fever in children

An intervention study was carried out in the department of paediatrics of Mymensingh Medical College Hospital, Mymensingh to compare the clinical efficacy of Azithromycin in the treatment of childhood typhoid fever with that of cefixime for a period of one year from January 2011 to December 2011. A total of 60 cases of typhoid fever were enrolled in to a randomized clinical trial and was divided into two groups. The inclusion criteria of the cases were: Documented fever for more than 4 days plus two or more of the following clinical features: toxic physical appearance, intestinal complaints, coated tongue, ceacal gurgling, hepatomegaly and splenomegaly, diarrhoea and constipation plus positive Widal test and/or blood culture positivity. Patients who had complication like GIT heamorrhage; intestinal perforaion and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg/day for a period of 07 days Cefixime was given at a dose of 20mg/kg/day in two divided dose for 14 days. The mean time of defervesence was 4.05+1.14 days with azithromycin and 3.41+0.95 with cefixime respectively. The minimum defervesence time was 02 days and maximum defervesence time was 07 days. Clinical cure rate was 87% in azithromycin group and 93% in cefixime group. No serious adverse effect was noted related to azithromycin and cefixime therapy except nausea, vomiting, diarrhoea and jaundice. It was found that azithromycin is almost as effective as cefixime in the treatment of typhoid fever.

Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial

This study was done to determine the effects and outcome of inhaled budesonide in addition to standard management of asthma exacerbations in pediatric age groups. A randomized, double-blind, placebo controlled trial was done in a tertiary care urban hospital. Sixty six children aged 5 to 15 years with moderate to severe asthma exacerbations were eligible. All patients received a single dose of prednisolone 1mg/kg orally as first dose of systemic corticosteroids and then salbutamol (0.15mg/kg) and ipratropium bromide (500mcg) was nebulized every 20 minutes for 3 doses and then hourly for 2 hours as a part of standard treatment of asthma exacerbations. The intervention was 2mg (4mL) of budesonide or 4mL of normal saline which was nebulized immediately after the 1st dose of nebulized salbutamol and ipratropium bromide. The baseline characteristics of the budesonide group (n=33) and placebo group (n=33) were similar, but at 1 hour, 2 hour and 3 hour PEFR, respiratory rate, pulse rate, SaO2 and asthma score were significantly improved in the budesonide group compared to placebo group (p<0.01). The positive immediate effect of nebulized budesonide added to standard treatment of asthma exacerbations is an encouraging finding for further investigations of its routine use in the treatment of asthma exacerbations in children.

Multiplex polymerase chain reaction for detection of Campylobacter from stool specimen

This was a study to prospectively evaluate the sensitivity and specificity of multiplex polymerase chain reaction (PCR) to identify Campylobacter. Multiplex polymerase chain reaction (PCR) based on cadF, hipO & asp gene for Campylobacter genus, C. jejuni & C. coli were tested for detection of Campylobacter jejuni & C. coli in naturally infected faecal samples of human. All the samples were subjected to the cultural isolation of organism and biochemical characterization. The samples resulted in the amplification of a DNA fragment of size 400 bp, 500 bp &735 bp in PCR assay. Two hundred faecal samples comprising diarrheal stools, 23(11.5%) could be detected by isolation whereas 24(12.0%) were found positive by PCR. All culture positive cases were positive by PCR and among 01 culture negative case, were positive by PCR. PCR was found to be more sensitive for Campylobacter detection in faecal samples 12.0% as relative to culture isolation which could detect the organism in 11.5% samples. Sensitivity and specificity of PCR were 100% and 99.4% respectively taking Culture as gold standard. The results depicted the superior efficacy of PCR for rapid screening of samples owing to its high sensitivity, specificity and automation potential.

Competitive adsorption of metals on cabbage waste from multi-metal solutions

This study assessed the adsorption capacity of the agro-waste 'cabbage' as a biosorbent in single, binary, ternary and quaternary sorption systems with Cu(II), Pb(II), Zn(II) and Cd(II) ions. Dried and ground powder of cabbage waste (CW) was used for the sorption of metals ions. Carboxylic, hydroxyl, and amine groups in cabbage waste were found to be the key functional groups for metal sorption. The adsorption isotherms obtained could be well fitted to both the mono- and multi-metal models. In the competitive adsorption systems, cabbage waste adsorbed larger amount of Pb(II) than the other three metals. However, the presence of the competing ions suppressed the sorption of the target metal ions. Except the case of binary system of Cd(II)-Zn(II) and Cd(II)-Cu(II), there was a linear inverse dependency between the sorption capacities and number of different types of competitive metal ions.

Coupled Skyrmion sublattices in Cu(2)OSeO(3)

We report the observation of a Skyrmion lattice in the chiral multiferroic insulator Cu2OSeO3 using Cu L3-edge resonant soft x-ray diffraction. We observe the unexpected existence of two distinct Skyrmion sublattices that arise from inequivalent Cu sites with chemically identical coordination numbers but different magnetically active orbitals. The Skyrmion sublattices are rotated with respect to each other, implying a long wavelength modulation of the lattice. The modulation vector is controlled with an applied magnetic field, associating this moirélike phase with a continuous phase transition. Our findings will open up a new class of science involving manipulation of quantum topological states.

Fasting serum glucose and glycosylated hemoglobin level in obesity

Obesity is a condition in which the body fat stores are increased to an extent which impairs health and leads to serious health consequences. The amount of body fat is difficult to measure directly, and is usually determined from an indirect measure - the body mass index (BMI). Increased BMI in obese persons is directly associated with an increase in metabolic disease, such as type 2 diabetes mellitus. This Analytical cross sectional study was undertaken to assess the relation between obesity and glycemic control of body by measuring fasting serum glucose and glycosylated hemoglobin. This study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh from 1st July 2011 to 30th June 2012 on 120 equally divided male and female persons within the age range of 25 to 55 years. Age more than 55 years and less than 25 years and diagnosed case of Hypothyroidism, Cushing's syndrome, polycystic ovary, Antipsychotic drug user and regular steroid users were excluded. Non probability purposive type of sampling technique was used for selecting the study subjects. Measurement of body mass index was done as per procedure. Fasting serum glucose was estimated by glucose oxidase method and Glycosylated hemoglobin by Boronate Affinity method. Statistical analysis was done by SPSS (version 17.0). Data were expressed as Mean±SE and statistical significance of difference among the groups were calculated by unpaired student's 't' test and Pearson's correlation coefficient tests were done as applicable. The Mean±SE of fasting serum glucose was significant at 1% level (P value <0.001) for obese group of BMI. There was no significant difference of glycosylated hemoglobin level between control and study groups. But there was positive correlation within each group. Fasting serum glucose also showed a bit stronger positive correlation with BMI. Both obese male and female persons showed higher levels of fasting serum glucose and glycosylated hemoglobin. The observed positive correlation between BMI with fasting serum glucose and glycosylated hemoglobin emphasizes the importance of maintenance of normal BMI to prevent early onset of type 2 diabetes mellitus.

Miliary nodules in a patient of allergic bronchopulmonary aspergilosis

Allergic bronchopulmonary aspergilosis (ABPA) is immunological pulmonary disease caused by hypersensitivity of aspergillus fumigatus usually occurs in patients with chronic asthma, cystic fibrosis and bronchiactasis. This disease may present with divers radiological presentation like; fleeting pulmonary opacities, bronchiactasis, mucoid impaction, perihilar opacity (hailer lymphadenopathy), and lung mass or pleural effusion. We describe the case of a 30 year old housewife who presented with progressive dysponea, low grade fever, dry cough, weight loss and miliary nodule in chest radiograph and high-resolution CT (HRCT) in a tertiary level hospital of Bangladesh. A diagnosis of ABPA was established on the basis of sputum routine microscopy and culture examination for fungus (Aspergillus).

Culture of pathogenic campylobacter species at Mymensingh Medical College

Childhood diarrhea represents a major public health problem in developing countries, where campylobacteriosis is widespread and causes significant morbidity and mortality in infants and children. Despite the increasing importance of campylobacteriosis, most developing countries and even many developed countries do not have surveillance systems to measure the health and economic burden of human campylobacteriosis, nor detect trends in outbreaks. The present study was carried out to diagnose etiology of diarrhea caused by Campylobacter species. A total of 150 clinically diagnosed diarrheal pediatric patients were included in this study, of which 98(65.3%) were male and 52(34.6%) female from the Department of Pediatrics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2011 to April 2012. Stool specimens were collected from each of the cases. The specimens were cultured in appropriate media and Campylobacters were isolated and identified by recommended tests. Among 150 cases, 17(11.3%) were culture positive for Campylobacter species, of which 15(88.2%) were C. jejuni and 02(11.7%) were C. coli. Of the cases, below 1 year of age group were 106(70.6%) cases showing 12(70.5%) positive for Campylobacters and 44(29.33%) cases were above 1 year of age group showing 05(29.41%) positive. The prevalence of Campylobacter infection found in the present study was higher below 1 year age group and was very much close to other countries of this subcontinent.

Prevalence of HBV and HCV among the multi-transfused beta thalassemic major patients in a day care centre of blood transfusion department of Mymensingh Medical College Hospital

Though regular blood transfusion improves the overall survival of patients with β-thalassemia which is one of the most common genetic diseases in the world, carries a definite risk of infection with blood-borne viruses. It is a major health problem, brings much morbidity, early mortality and a great deal of misery for a family both financially and emotionally. World Health Organization (WHO) reported that there is about 3% beta thalassemia carrier and more than two thousand thalassemic children are born every year in Bangladesh. We carried out this study to provide epidemiologic data on hepatitis B virus (HBV) & hepatitis C virus (HCV) infection among β-thalassemic patients. Moreover, HBV & HCV infection-associated risk factors were investigated in this study. Two hundred patients with β-thalassemia major were enrolled in this study. Using Rapid Immuno-chromatographic Test and their sera were tested for HBsAg and HCVAb. The positive HBsAg & HCVAb results were confirmed by ELISA. The study sample 200 consisted of 165 males (82.5%) and 35 females (17.5%), with a mean±SD age of 5.9±9.0 years. Four (2%) patients were HCV-Ab positive; 13(6.5%) were HBsAg positive. Univariate analysis showed that (P=0.01), older age (P=0.001), longer transfusion duration (P=0.000), HBsAg seropositivity (P=0.03), and higher serum ferritin level (P=0.002) were significantly associated with a higher prevalence of HCV. Using multivariate analysis, age (P<0.001), serum ferritin level (P< 0.001) were independent factors associated with HCV infection. Improvement of the people's knowledge about TTI risk factors, blood screening strategies and HBV vaccination have led to a dramatically decrease in prevalence of TTIs particularly HBV during the last decades in Bangladesh.However, post-transfusion transmission of HCV has still remained a major health concern in multi-transfused patients. As the prevalence of HCV infection is much higher among β-thalassemic patients as compared with HBV infections routine screening of donated blood for HCV is highly recommended by ELISA.

Prevalence of sub-clinical mastitis in dairy farms

A total of 560 lactating cows belonging to Bangladesh Agricultural University dairy farm (n = 59): Local Zebu (L), Local × Friesian (L × F), Local × Jersey (L × J), Local × Red Chittagong Cattle (L × RCC), Local × Sahiwal (L × SL), Red Chittagong Cattle (RCC); and Central Cattle Breeding Station and Dairy Farm (n = 501): Local Zebu, L × F, SL × F, Sahiwal and Australian Friesian Sahiwal (AFS) were selected to measure prevalence of subclinical mastitis (SM). The California Mastitis Test was done and the prevalence of SM was 68% on cow basis and 57% on quarter basis. The prevalence rate was significantly higher in L × F (87%, P < 0.05), SL × F (88%, P < 0.05), L × J (100%, P < 0.01), AFS (89%, P< 0.05) and SL (100%, P < 0.01). The local Zebu (31%) and RCC (28%) were least susceptible to SM. SM was significantly higher in multiparous (P < 0.05) and older cows (P < 0.05). The front quarters were more prone to SM than the rear. Factors such as breed, age, parity and management may have been responsible for high prevalence of SM in both farms. DOI: http://dx.doi.org/10.3329/bvet.v30i2.18257 Bangl. vet. 2013. Vol. 30, No. 2, 70-77

Correlation between grades of intraventricular hemorrhage and severity of hypoxic ischemic encephalopathy in perinatal asphyxia

This study was done to find out the correlation between various grades of Intraventricular Hemorrhage (IVH) and stages of HIE in perinatal asphyxia and to determine the short-term outcome of the affected baby. This observational study was conducted in Neonatal ward of Dhaka Shishu Hospital (DHS) and Dhaka Medical College Hospital for period of 37 months from January 2004 to January 2007. Total 189 perinatally asphyxiated babies were enrolled for HIE staging and cranial Ultrasonogram (USG) to find out grades of IVH. Finally 178 newborns were fulfilling all the necessary criteria for statistical analysis of the collected data on prescribed questionnaire. Among 178 perinatally asphyxiated newborns HIE stages - I, II, III were 50(28%), 10(56%) and 28(16%) respectively. Out of this 178 neonates total 50(28%) developed various grades IVH. Grades of IVH, I, II, III, IV were 15(30%), 18(36%), 10(20%) and 7(14%) respectively. There was significant correlation between the severity of HIE staging and grades of IVH. Short term outcome was poor in HIE-III, IVH grade III and IV. There is a direct relationship between different grades of IVH and stages of HIE. That is more the severe stages of HIE there is more chances to develop severe grades of IVH, Immediate morbidity and mortality is dependent on the grades of IVH and severity of stages of HIE.

Campylobacteriosis - an overview

Campylobacteriosis is a collective term, used for infectious, emerging foodborne disease caused by Campylobacter species comprising Gram negative, curved, and microaerophilic pathogens. The true incidence of human campylobacteriosis is unknown for most countries of the world including Bangladesh. But campylobacteriosis is not uncommon in our country. Due to its increasing incidence in many countries of the world, it is an important issue now a day. Animals such as birds are the main sources of infection. Farm animals such as cattle, poultry are commonly infected from such sources and raw milk, undercooked or poorly handled meat becomes contaminated. Transmission of campylobacteriosis to human occurs through consumption of infected, unpasteurized animal milk and milk products, undercooked poultry and through contaminated drinking water. Contact with contaminated poultry, livestock or household pets, especially puppies, can also cause disease. Due to variability of clinical features and limited availability of laboratory facilities, the disease remains largely under-reported. Early and specific diagnosis is important to ensure a favourable outcome regarding this food borne disease. Antibiotic treatment is controversial, and has only a benefit on the duration of symptoms. Campylobacter infections can be prevented by some simple hygienic food handling practices.

Regional metastasis in supraglottic and glottic carcinoma of larynx

This cross sectional study was conducted in Sir Salimullah Medical College Hospital, Mitford and Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2009 by purposive sampling method. Among the 50 cases, involvement of supraglottic (72%) region is significantly higher than glottic (28%) region. Affected peoples are mainly male and mean age was 58.1±10.4 years. Frequency of regional metastasis of supraglottic carcinoma (47.22%) was higher than glottic carcinoma (7.14%). Most of the lymphnode involvement was at level-II to IV. Most of the patients presented at stage-I & stage-II.

Evaluation of TH agglutinin titres of Widal test in the diagnosis of typhoid fever

This prospective study was evaluated the role of TH agglutinins and reevaluate the diagnostic value of Widal test in the diagnosis of typhoid fever by identifying the S. typhi specific antibody. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July 2010 and June 2011, including 200 individuals of different ages and sexes. Widal test and blood culture were performed for each of the cases and controls. Among 150 blood samples from the suspected cases, 23(15.3%) were culture positive for S. typhi and 67(44.7%) had high titres of ≥1:160 for 'O' or 'H' or both agglutinins. Out of 23 culture positive cases, 3(13%) had TO ≥:160, 5(21.7%) had significant TH ≥1:160. Based on the above findings, it was concluded that judicious interpretation of Widal test play an essential role in diagnosis of typhoid fever, especially in the resource poor countries like Bangladesh.

Role of adenosine deaminase in diagnosis of tubercular pleural effusion

The diagnosis of pleural tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. It is produced during the inflammatory process triggered by the M. tuberculosis. Usefulness of adenosine deaminase (ADA) estimation in pleural fluid has been shown as a reliable chemical bio-marker specially when there is suspicion of tuberculosis in endemic areas. ADA level was determined in the pleural fluid of 100 patients present with pleural effusion admitted at Mymensingh Medical College Hospital during the period of March 2012 to September 2012. ADA level was >40IU/L among the 52 tubercular pleural effusion patients with sensitivity & specificity is 100% and 66% respectively. Thus is evident that ADA level can be used along with conventional methods for diagnosis of pleural TB.

Instrumented posterior lumbar interbody fusion (PLIF) with interbody fusion device (Cage) in degenerative disc disease (DDD): 3 years outcome

This prospective interventional study carried out at Bangabandhu Sheikh Mujib Medical University and a private hospital in Dhaka, Bangladesh during the period from October 2003 to September 2011. Surgical treatment of degenerative disc disease (DDD) should aim to re-expand the interbody space and stabilize until fusion is complete. The present study conducted to find out the efficacy of using interbody fusion device (Cage) to achieve interbody space re-expansion and fusion in surgical management of DDD. We have performed the interventional study on 53 patients, 42 female and 11 male, with age between 40 to 67 years. All the patients were followed up for 36 to 60 months (average 48 months). Forty seven patients were with spondylolisthesis and 06 with desiccated disc. All subjects were evaluated with regard to immediate and long term complications, radiological fusion and interbody space re-expansion and maintenance. The clinical outcome (pain and disability) was scored by standard pre and postoperative questionnaires. Intrusion, extrusion and migration of the interbody fusion cage were also assessed. Forty seven patients were considered to have satisfactory outcome in at least 36 months follow up. Pseudoarthrosis developed in 04 cases and 06 patients developed complications. In this series posterior lumbar interbody fusion (PLIF) with interbody cage and instrumentation in DDD showed significant fusion rate and maintenance of interbody space. Satisfactory outcome observed in 88.68% cases.

Effectiveness of radioiodine therapy in treatment of hyperthyroidism

The present non randomized clinical trial was conducted in the Center for Nuclear Medicine and Ultrasound, Mymensingh, Bangladesh for duration of one year. Total 30 patients with hyperthyroidism diagnosed by clinical and biochemical profile were included in the study. All patients received radioiodine treatment and regular follow up at 1st month, 3rd month, 6th month & 9th month were done to evaluate clinical and biochemical status and complications. Data were analyzed by computer with SPSS programme using 't' test and chi-square test. In the present study, out of 30 respondents more than three fourth of the respondents (76.6%) were in the age group of 31-50 years followed by less than 30 years are group (16.7%) and rest of respondents were in the age group of more than 50 years (06.7%). Mean±SD and range of age of the respondents were 39.80±10.02 years and 17-65 years respectively. Among the 30 respondents 11(36.7%) were male and 19(63.3%) were female. Male to female ratio was 1:1.73. Out of 30 patients 26(86.7%) presented with goiter and among them 21(80.8%) has diffused goiter and five (19.2%) had nodular goiter. Baseline mean±SD, median, range of serum T₃ level were 5.24±3.62, 4.34, 1.48-14.65nmol/L respectively. Base line mean±SD, median range of serum T₄ level were 192.25±99.17, 201.77, 1.75-336.25nmol/L respectively. Baseline mean±SD, median range of serum TSH level were 6.33±23.93, 0.15-0.07, 130.46nmol/L respectively. In the present study serum T₃, T₄ level among the respondents sharply decrease from baseline to 2nd follow up then gradually decrease from 2nd to 4th follow up. Serum TSH level gradually increases from baseline to 3rd follow up and then gradually decreases from 3rd to 4th follow up. The result showed radioiodine is an effective option for the treatment of thyrotoxicosis.

Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.