Quality of Life in Children with Asthma in Bangladesh

Asthma is a public health problem that adversely affects different aspects of quality of life. Childhood asthma is common in Bangladesh affecting their lifestyle. The objective of the study was to assess health-related quality of life in children with bronchial asthma. A descriptive, cross-sectional study was carried out from January 2014 to December 2014 at the Outpatient Department of National Asthma Centre, Mohakhali, Dhaka among hundred sixty-two purposively selected children of both sexes with bronchial asthma aged from 7 to 17 years. Data were collected through interview with children or their parents using an interviewer-administered questionnaire based on Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Data were analyzed by computer software SPSS version 16.0. The mean age was 12.5 years with a standard deviation (SD) of 2.9 years. Overwhelming majority 157(96.9%) of children were literate, while only 5(3.1%) children were illiterate. Eighty (49.4%) children were male, while 82(50.6%) female. As many as 148(91.4%) children were students, while 10(6.2%) children were engaged in some type of job and 4(2.5%) children had no occupation. Parents of 145(89.5%) children were currently married, while 10(6.2%) children had single parent and 7(4.3%) children's parents were divorced or separated. Quality of life in children with asthma decreases with age as the disease intensity increases with age. Female asthmatic children had lower overall score of Quality of life (p=0.017), as well as lower activity domain score (p<0.001). Emotional domain score was found lower in children with single parent (p=0.021) and low monthly family income (p<0.001). Furthermore, children with lower monthly family income and working children had lower Quality of life score in all domains.

Outcome of Upper Gastrointestinal Surgery With or Without Nasogastric Intubation

Nasogastric intubation is a common procedure with both merits and demerits. Controversies exist about the routine use of nasogastric intubation following upper gastrointestinal surgery. Good numbers of literatures were published in favour of selective nasogastric intubation pointing out some complications of routine use of nasogastric tube. In 1995, Cheatham et al. concluded in a meta-analysis that although patients may develop abdominal distension or vomiting without a nasogastric tube, this is not associated with an increase in complications or length of hospital stay. For every patient requiring insertion of a nasogastric tube in the postoperative period, at least 20 patients will not require nasogastric decompression. In July 2004, Cochrane database of systemic review published the result of their systemic review on the prophylactic decompression after abdominal surgery, that review was revised and updated in 2007. According to this database, routine nasogastric intubation should be abandoned in favour of selective use of nasogastric tube. In our country some surgeons are practicing it routinely and some are not. This observation prompted us to conduct this study in order to see and compare the outcome of upper gastrointestinal surgery with and without nasogastric intubation. This will help us to make decision whether nasogastric intubation will be done routinely or not following upper gastrointestinal surgery.

Cooperative Micromanipulation Using the Independent Actuation of Fifty Microrobots in Parallel

Micromanipulation for applications in areas such as tissue engineering can require mesoscale structures to be assembled with microscale resolution. One method for achieving such manipulation is the parallel actuation of many microrobots in parallel. However, current microrobot systems lack the independent actuation of many entities in parallel. Here, the independent actuation of fifty opto-thermocapillary flow-addressed bubble (OFB) microrobots in parallel is demonstrated. Individual microrobots and groups of microrobots were moved along linear, circular, and arbitrary 2D trajectories. The independent addressing of many microrobots enables higher-throughput microassembly of micro-objects, and cooperative manipulation using multiple microrobots. Demonstrations of manipulation with multiple OFB microrobots include the transportation of microstructures using a pair or team of microrobots, and the cooperative manipulation of multiple micro-objects. The results presented here represent an order of magnitude increase in the number of independently actuated microrobots in parallel as compared to other magnetically or electrostatically actuated microrobots, and a factor of two increase as compared to previous demonstrations of OFB microrobots.

Multimodality Treatment Outcome of Hepatoblastoma in a Resource Limited Country

Our objective is to review the records of management of hepatoblastoma (HB) at the Paediatric Haematology and Oncology (PHO) department in the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2004 to December 2012. This is a retrospective study of clinical, radiological and pathological data of hepatoblastoma patients treated at our institution. Thirteen patients were treated for HB between 2004 and 2012. The records of clinical presentations, chemotherapy tolerance and response, surgical procedure undertaken, and complications were analyzed. Median age of the study population was 12 months (3-60 months) and male: female was 3.3:1. Nine patients were treated with neoadjuvant chemotherapy consists of cisplatin and adriamycin. Primary surgery was done in four patients. Extent of hepatic resection in the operated patients varied. Mixed type was the predominant histopathological diagnosis. Adjuvant chemotherapy was well tolerated with no morbidity or mortality. Five-year event-free survival (EFS) and overall survival (OS) of all the 13 patients is 76.9%. All the nine patients who could complete multimodality treatment are alive with no evidence of disease or complications with median follow-up of 63 months (46-122 months). Treatment of HB with multidisciplinary approach was well tolerated. OS and EFS of patients were comparable with published studies.

Childhood Wilson Disease: Bangladesh Perspective

Wilson's disease (WD) is an autosomal recessive disorder affecting copper metabolism causing copper induced damage to various organs. In children liver is commonly involved. Central nervous system, eyes, RBC, kidneys, brain and bones may also be affected. Aim of the study is to evaluate clinical & laboratory profile of Wilson's disease in children. This cross sectional descriptive study was conducted at the department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2011 to December, 2013. One hundred consecutive children of WD between 3 to 18 years of age were evaluated for clinical & biochemical profile. Mean age of studied children was 8.5±1.5 years. Male female ratio was 2:1. Ninety one percent patients were Muslim and nine percent Hindu. Consanguinity of marriage was found in 30% cases. Seven parents were first degree cousin. Family history of chronic liver disease was present in 15% of patients. Most (53%) cases of the hepatic WD presented between 5 to 10 years of age and most of the neurologic WD manifested in 10-15 years age group. Among 100 patients of WD, 69 children presented only with hepatic manifestations, 6 only with neurological manifestations, 14 with both hepatic & neurological manifestation, 10 children was asymptomatic and 1 patient presented with psychiatric features. WD presented as chronic liver disease (CLD) in 42%, CLD with portal hypertension in 34%, acute hepatitis in 20% and fulminant hepatic failure in 4% cases. Stigmata of chronic liver disease were found in 18% patients. Commonest stigmata was thenar and hypothenar wasting (n=8). Keiser- Fleischser ring (K-F ring) was found in 76% of the total patients. K-F ring was present in 84% ( 58 out of 69) of the hepatic only Wilsonian patients and in 90% (18 out of 20) of all neurologic Wilsonian patients. Asymptomatic and psychiatric patient had no K-F ring. About 26% of the WD patients had Coombs negative hemolytic anemia in PBF. Most of the WD patients had altered liver function. Elevated serum transaminase was found in 85% of all cases, prolonged prothrombin time in 59% cases & low serum albumin in 53% cases. Seventy three percent patients had low serum ceruloplasmin, basal urinary copper of >100μgm/day was found in 81% cases and urinary copper following penicillamine challenge of >1200μgm/day was found in 92% cases. In 28 cases with hepatic presentation esophageal varices were identified by upper gastrointestinal endoscopy. WD patient with hepatic presentations were given zinc sulphate along with penicillamine. All patients with neurological manifestation as well as asymptomatic cases were maintained on zinc therapy. WD is a treatable metabolic cause of liver disease. Majority of studied WD children presented with hepatic manifestation of which 76% presented with CLD. Any child presented with jaundice after the age of 3 years should be investigated for WD.

Effect of Monosaccharides in Glycerol-free Tris Extender on Reactive Oxygen Species and Apoptosis in Dog Sperm Cryopreservation

BACKGROUND OBJECTIVE

The present study investigated the effect of monosaccharides in a glycerol-free tris (GFT) extender on reactive oxygen species (ROS) levels and apoptosis in cryopreserved dog spermatozoa.

MATERIALS AND METHODS

The sperm pellets were resuspended (5 × 10⁷ mL^-1) with GFT containing 172 mM glucose (G), 86 mM glucose + 86 mM fructose (GF), 86 mM glucose + 86 mM galactose (Gg), 172 mM fructose (F), 172 mM galactose (g) or 86 mM fructose + 86 mM galactose (Fg). The sperm (500 µL) were loaded in 0.5 mL straws and cooled for 50 min at 4 degree C. The straws were then frozen 7 cm from the surface of liquid nitrogen (LN2) for 20 min and were finally plunged into LN2. After freezing-thawing, the sperm motility and viability were evaluated. The ROS level (H₂O₂) and apoptosis index were assessed by using flow cytometry.

RESULTS

GFT supplemented with GF resulted in significantly higher (P < 0.05) progressive sperm motility and viability followed by only G, which had greater ROS reducing capacity. However, sperm cell apoptosis had no significant differences among all the experimental groups.

CONCLUSION

Cryopreservation of dog sperm in GFT containing GF yields more motile and viable sperm followed by only G, which has greater ROS reducing efficiency.

Diagnostic Importance of Platelet in Patients with Acute Coronary Syndrome Admitted in Mymensingh Medical College Hospital

This cross sectional descriptive study was carried out in the Department of Cardiology, Mymensingh Medical College Hospital from July 2015 to December 2015, included 50 patients admitted with acute coronary syndrome diagnosed on the basis of history, typical anginal type of chest pain, characteristic electrocardiographic changes and increased cardiac biomarkers. Platelet count (PC), Mean platelet volume (MPV) and platelet distribution width (PDW) were measured using automated hematological analyzer and compared them with 50 age and sex matched healthy controls. All platelet parameter indices - platelet count (PC), mean platelet volume (MPV) & platelet distribution width (PDW) - were significantly raised in patients with ACS. In patients with ACS the mean values of platelet count, MPV & PDW were 352.2×10⁹/L), 13.9fL & 15.6fL, respectively; while in normal healthy control the mean values of these indices were 256.2×10⁹/L), 8.1fL & 10.5fL, respectively. Statistically significant difference in mean values of these indices was found (p value <0.05). Larger platelets are haemostatically more active and are a risk factor for developing coronary thrombosis and subsequent acute coronary events (myocardial infarction and unstable angina). Patients with larger platelets can easily be identified during routine hematological analysis and could possibly benefit from preventive treatment.

Clinical Evaluation of Bucco-lingual Crestal Bone Remodeling in Mandibular Posterior Implants placed immediately and Delayed into Extraction Sites

The objective of this cross sectional study was to evaluate the bucco-lingual crestal bone remodeling in mandibular posterior implants placed immediately and delayed into extraction sites and carried out in the department of Prosthodontics of Dhaka Dental College and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2010 to July 2014. Forty patients were evaluated in this study; of them 25(62.5%) patients were males and 15(37.5%) were females with age range from 24 to 70 years. At first surgery during implant placement the mean distance from buccal bone to lingual bone was 11.11mm for immediate implants and 9.265mm for delayed implants. At second-stage surgery the mean distance from buccal bone to lingual bone was 9.765mm for immediate implants and 6.25mm for delayed implants. The mean±SD change of bone reduction at second surgery was 1.28±0.31 for immediate implants and 3.01±0.33 for delayed implants. Unpaired t test was done for statistical analysis and p value was less than 0.05. So, the changes were statistically significant.

New Therapeutic Approach to Treat Allergic Rhinitis & Bronchial Asthma, Considering These Two as One United Airway Disease

The relationship between allergic rhinitis and asthma is now established, and most of the clinical, epidemiological and biological data recommend integrated management. This review discusses rhinosinusitis as a co-morbid condition, a precipitating or triggering condition, and an epiphenomenon as an integrated part of the disease. A better understanding and a more pragmatic method of diagnosis and management is needed using cost-effective long-term strategies. Allergic Rhinitis, though a non-life threatening disease, its pathogenesis reveals that Bronchial Asthma also develops by the same aetiopathogenesis. The United airway disease hypothesis proposes that the upper & lower airway diseases are both manifestations of a single inflammatory process and studies have already proved it. Allergic Rhinitis when once develops if not treated vigorously, can later turn up to Asthma. As chronic inflammation is the central process which is actually continuously changing pathologically the lower respiratory tract & helping to develop Bronchial Asthma. The conventional therapies for Allergic Rhinitis such as antihistamines & decongestants are only symptom relievers, to stop the ongoing pathogenesis of Bronchial Asthma to develop it, the chronic inflammatory process should have to be stopped. This can be done by corticosteroid nasal sprays. Also Asthma with Rhinitis is better controlled by them. Even Bronchial Asthma treatment should be started with inhaler corticosteroid therapy rather than getting it after intermittent use of only bronchodilators (salbutamol) only.

Structural Variations of Nose and Paranasal Sinuses in Various Sinonasal Pathologies: Tomographic Study of 50 Cases in Bangladeshi People

The aim of this study was to determine the frequency of structural variations in nose & paranasal sinuses in computed tomography in Bangladeshi people. This retrospective study was done at the Sir Salimullah Medical College Mitford Hospital and Apollo Hospitals, Dhaka, Bangladesh. Fifty (50) CT scan of Nose and Para nasal sinuses were collected from the patients presented with different sinonasal pathologies in OPD, IPD of both hospitals from July 2013 to June 2014. The scans were reviewed for the presence of different structural variations of nose and paranasal sinuses. The age range of the patients was 25 to 65 years. The most common anatomical variation in this study was hypertrophied inferior turbinate (82%) followed by ethmoidal bulla (70%), deviated nasal septum (64%), agar nasi cell (40%), concha bullosa (38%). In most of the patients we found more than one variation. There is wide range of anatomical variations in nose and paranasal sinuses which might be regarded as the aetiological factors of different sinonasal pathologies. To maximize patients' benefit and to avoid unexpected situations during surgeries as well as dreadful complications, individualized pre-planning through tomographic study should be considered.

Evaluation of Body Mass Index Before and After Prosthetic Rehabilitation with Complete Denture Therapy

The objective of this study was to compare body mass index (BMI) of the edentulous patients before and after complete denture therapy. Forty five (45) patients who had been edentulous for six months to one year and required complete dentures were selected for this study; of them 25(55.56%) were males and 20(44.44%) were females and age range was between 40 to 70 years. Every patient was provided with complete dentures fabricated with ethical standard procedures. Analysis of the body mass index (BMI) was done at base line; and at three and six months follow up. The mean BMI values were found 19.58±1.93; 20.63±1.89 and 22.02±1.80 at base line, at three months follow up and at six months follow up respectively. The differences of the BMI values were found to be statistically significant (p<0.05) both at 3 months and 6 months follow up compared to the base line value.

Dactolisib (NVP-BEZ235) toxicity in murine brain tumour models

Background

Glioblastomas (GBMs) are highly malignant brain tumours with a poor prognosis, and current cytotoxic regimens provide only a limited survival benefit. The PI3K/Akt/mTOR pathway has been an attractive target for therapy due to its high activation in GBMs as well as other cancers. The dual pan-PI3K/mTOR kinase inhibitor dactolisib (NVP-BEZ235) is an anti-neoplastic compound currently under investigation. However, little is known about its efficacy in human GBMs. We aimed at evaluating the efficacy of dactolisib in human glioblastoma cells, as well as in murine models carrying human GBM xenografts.

Methods

To assess the effect of dactolisib in vitro, MTS assay, manual cell count, BrdU incorporation and Annexin V staining experiments were used to observe growth and apoptosis. Furthermore, Akt phosphorylation (S473), a downstream target of PI3K, was explored by western blotting. Animal studies utilizing orthotopic xenograft models of glioblastoma were performed in nude rats and NOD/SCID mice to monitor survival benefit or inhibition of tumor growth.

Results

We found that dactolisib in vitro shows excellent dose dependent anti-growth properties and increase in apoptosis. Moreover, dose dependent inhibition of Akt phosphorylation (S473), a downstream effect of PI3K, was observed by western blotting. However, in two independent animal studies utilizing nude rats and NOD/SCID mice in orthotopic xenograft models of glioblastoma, we observed no survival benefit or inhibition of tumour growth. Severe side effects were observed, such as elevated levels of blood glucose and the liver enzyme alanine transaminase (ALT), in addition to diarrhoea, hair loss (alopecia), skin rash and accumulation of saliva in the oral cavity.

Conclusion

Taken together, our results suggest that despite the anti-neoplastic efficacy of dactolisib in glioma treatment in vitro, its utility in vivo is questionable due to toxicity.

Effects of Intensive versus Non-Intensive Physical Therapy on Children with Cerebral Palsy

Cerebral Palsy (CP) is one of the most common causes of all childhood disorders. There are tone, posture and movements difficulty due to non-progressive damage to the immature brain in CP. The hallmark of CP is a disability in the development of gross motor function (GMF). The influence of gross motor development on fine motor development is more important in early developmental period, specially under three years old and in children with CP. Various therapeutic interventions have been used in the management of GMF development. Among them physical therapy is the most common intervention in CP and is usually a component of mandated programs. Physical therapy means physical stimulations in the form of various therapeutic exercises, touch, massage, limbs and trunk movement, balancing and coordination training, gait and ambulation training, cognitive stimulation as well as speech, language and occupational therapy. Our study focused to see the effect by short term intensive versus non-intensive physical therapy on children GMF development by using gross motor function measure (GMFM) Score sheet, GMFM-88, version 1.0. Study provides the information that physical therapy intervention is effective in GMF development and intensive interventions are more effective in children with spastic CP than non-intensive one. Study also inform that the more early treatment the more effective result.

A Giant Intra Abdominal Mass Mimicking Renal Cell Carcinoma: A Rare Presentation of Renal Angiomyolipoma

Angiomyolipoma (AML) is a benign tumor commonly found in kidney than extra renal sites. Most of the small renal angiomyolipomas are diagnosed incidentally on ultrasound and other imaging studies. Some renal AMLs present clinically when become very big, giant renal angiomyolipoma. Although almost all cases are benign, a relatively rare variant of epitheloid angiomyolipoma has got malignant potential and can even metastasize. Ultrasonography, CT and MRI scan are usually used for diagnosis of angiomyolipoma with high level of accuracy; even though some lesions may be confused as renal cell carcinoma on imaging studies. Here, a 48 year old man presented with a large intra-abdominal mass preoperatively diagnosed as a case of right renal cell carcinoma and radical nephrectomy was performed. Histopathology revealed epitheloid angiomyolipoma (EAML).

Effects of temperature on the embryonic and early larval development in tropical species of black sea urchin, Diadema setosum (Leske, 1778)

Influence of temperature on the embryonic and early development and growth performance of larva in tropical sea urchin, Diadema setosum was investigated in water temperature ranging between 16 and 34?C under controlled laboratory conditions. The critical lower and higher temperature for embryonic development was found at 16 and 34?C, respectively. Embryos reared in both of these two temperatures exhibited 100% abnormality within 48 hrs post-insemination. The time required to reach these embryonic and larval stages increased with temperature from 28 followed by 31, 25, 22 and 19?C in that order. The developmental times of 2-cell stage until 4-arm pluteus larva showed significant differences (P < 0.05) among the tested temperatures. The larvae in the state of prism and 2-arm pluteus, survived at temperature ranging from 19 to 31?C, while the 4-arm pluteus larvae survived at temperature between 22? to 31?C. However, larval development within a temperature range of 22? to 31?C was acceptable since no abnormalities occurred. The morphometric characteristics from prism to 4-arm pluteus larvae in all the temperatures differed significantly (P > 0.05). Among them, 28?C was found to be the best temperature with respect of the highest larval growth and development at all stages. The findings of the study will not only be helpful to understand the critical limits of temperature, but also to identify the most appropriate temperature for optimum growth and development of embryos and larvae, as well as to facilitate the development of captive breeding and mass seed production of D. setosum and other important sea urchins for commercial aquaculture.

Impacts of gamete concentration, age and contact time on the fertilization success in the tropical species of white sea urchin, Salmaciella dussumieri

The globoid sea urchin (Salmaciella dussumieri) occurs abundantly in the Indo-West Pacific from the Island of the West Indian Ocean, East Africa, Magdagascar, Red Sea, South-East Arabia, Ceylon, Bay of Bengal, North Australia, Philippine, China and South Japan and Australia, and also has significant biological, ecological, aquaculture, conservational and medicinal importance. An experiment was carried out to assess the influence of sperm dilution, egg concentration, sperm-egg exposure time, and gamete aging on fertilization success of S. dussumieri in a captive laboratory condition. It has been found that dilution, age and contact time of sperm to egg were successively the most dominant factors effecting the success of fertilization, but concentration of eggs did not significantly so over the range investigated. The sperms retained their competency for more than two hours only in relatively dense sperm concentrations (≥ 10-(4) dilution of 'dry' sperm), although they exhibited lower capability and potency with increasing dilutions and age. In the trials of the egg-sperm exposure time, >80% eggs were fertilized within 10 sec of contact time at lower dilutions (10(-3)-10(-2)) of concentrated sperm, while some longer times were required to get the higher rates of fertilization. On the contrary, eggs remained in good quality for up to a period of 3 h and no abnormality or any adverse effects in fertilization were observed. The findings obtained from the present experiment reveal that limited longevity of diluted sperm have an important effect on fertilization rate of sea urchin eggs during natural spawning seasons in the field. Hence, the globoid sea urchin (S. dussumieri) is under extensive selective pressures to breed synchronously with the purpose of producing high sperm concentrations and higher sperm-egg interactions to maximize the success of fertilization in the water column.

Growth and survival of the tropical sea urchin, Salmacis sphaeroides fed with different macroalgae in captive rearing condition

An experiment was undertaken to develop appropriate culture techniques for high-valued tropical sea urchin, Salmacis sphaeroides under captive aqua-rearing conditions. Three-month-old juveniles produced through induced breeding, larval rearing and metamorphic induction were stocked with 20 juveniles in each of nine well-aerated glass aquaria (46 x 30 x 30 cm).? Juveniles fed with red alga (Amphiroa fragilissima) were designated as Treatment-1 (T1), brown alga (Sargassum polysystum) as Treatment-2 (T(2)) and sea grass (Enhalus acoroides) as Treatment-3 (T(3)). At the time of stocking, juveniles were under the same age group and batch-reared with a mean length and weight of 9.98 ? 0.56 mm and 0.49 ? 0.11 g, respectively. The juveniles were fed ad libitum, and the seawater in each rearing aquarium was changed at bi-monthly intervals. The culture was carried out for one year during which time the juveniles attained sexual maturity. Growth performances (viz., final weight, weight gain, final length, length gain, specific growth rate and daily growth rate) and survival of adults were significantly higher (P < 0.05) in T(1) than those in T(2) and T(3), respectively. Gonad production, in terms of wet gonad weight and gonad index, also followed the same trend as that for growth. Hence, of the three algal feed evaluated, red alga appeared to be the most suitable food for rearing of S. sphaeroides under captive conditions. The present study is the first demonstration of successful culturing of S. sphaeroides in a static aquarium system, the findings of which could be helpful towards the commercial sea urchin aquaculture. ?

Aetiology and Outcome of Acute Liver Failure in Children: Experience at a Tertiary Care Hospital of Bangladesh

Acute liver failure (ALF) is a rapidly progressive, potentially fatal syndrome resulting from rapid death or injury to a large proportion of hepatocytes, caused by a variety of insult, leaving insufficient hepatic paranchymal mass to sustain liver function. The aetiology of ALF varies according to the age of patient and development of the country. The outcome of ALF also varies according to aetiology: survival is better in paracetamol poisoning whereas it is poor in metabolic diseases. The present study was undertaken to observe the underlying aetiology and outcome of ALF in children under 18 years of age admitted at the department of Paediatric Gastroenterology & Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. It was a retrospective review of medical records from November 2011 through October 2014. During this period a total of 35 patients were diagnosed to have ALF. Aetiology was established in 25(71.4%) cases, whereas in 10(28.6%) cases, no identifiable cause was found. Viral hepatitis was the underlying cause in 12(34.3%) cases. After treatment 15(43%) ALF patients survived, 8(23%) left hospital with risk bond (DORB), and 12(34%) patients died. The study showed that among the 12 death patients, 5(41.7%) had viral hepatitis, 3(25%) Wilson's disease, and in 4(33.3%) no cause could be identified. Viral hepatitis and Wilson disease were found to be two common causes of ALF in this study. Future studies with larger sample size are required to know the actual causes of acute liver failure in Bangladeshi children.

B-type Natriuretic Peptide Assay in Differentiating Congestive Heart Failure from Lung Disease in Patients Presenting with Dyspnea

This cross-sectional analytical study was conducted in Cardiology & Medicine Department of Mymensingh Medical College Hospital. After fulfilling the exclusion & inclusion criteria, B-type natriuretic peptide concentrations were measured in a convenience sample of 100 predominantly male (94%) dyspnic patients who got admitted in Cardiology & Medicine Department of Mymensingh Medical College & Hospital from November 2013 to October 2014. The diagnosis of Congestive Heart Failure (CHF) was based on generally accepted Framingham criteria with corroborative information including hospital course (response to diuretics, vasodilators, inotropes or hemodynamic monitoring) and results of further cardiac testing, including echocardiography. Patients with right heart failure from cor pulmonale were classified as having CHF. Pulmonary disease was confirmed by using the following diagnostic tools: i) A chest X-ray without signs of heart enlargement or pulmonary venous hypertension or a chest X-ray with signs of chronic obstructive lung disease, ii) Normal heart function as seen by echocardiography, iii) Abnormal pulmonary function tests or follow-up results and iv) A positive response to treatment with steroids, nebulizers or antibiotics in hospital. Patients with CHF (n=50) had mean BNP level 1146.72pg/ml (range 103 to 5000pg/ml), which is significantly higher than the group of patients with a final diagnosis of pulmonary disease (n=50) whose BNP was 34pg/ml (range 10 to 90pg/ml) (p<0.05). In conclusion, it was found that B-type natriuretic peptide is an important biomarker for differentiating congestive heart failure from lung disease in patients presenting with dyspnea.

Field Performance Evaluation of Push Type Prilled Urea Applicator in Rice Cultivation

CORRECTION: Due to a number of formatting and layout issues, the PDF of this paper was replaced on 10th October 2016. The page numbers of this article have changed from 68-78 to 71-81.BRRI prilled urea applicator was designed and developed to facilitate deep placement of regular urea. Experiments were conducted to evaluate the performance of BRRI prilled urea applicator in the farmers’ fields at Gosaidanga in Shailkupaupazila under Jhenaidah district and at Rashidpur in Mithapukurupazila under Rangpur district during Boro 2015 season. Three treatments: hand broadcasting of urea (recommended dose) (HB), BRRI prilled urea applicator (70% of the recommended dose) (PUA) and BRRI USG applicator (70% of the recommended dose) (USGA) were compared in the experiments. The experiment was laid out in randomized complete block design (RCBD) and replicated in four farmers’ plots in each location using BRRI dhan28 as test crop both the locations. Prior to field experiment, prilled urea applicator was calibrated and urea dispensed was set to 14 gm in one revolution of drive wheel for Boro season. The field capacity of the PUA and USGA was almost similar (0.09-0.10 ha hr-1) in both the locations. Field efficiency of PUA and USGA had 64-65 and 68-69 percent, respectively. PUA and USGA saved 29-32 percent urea fertilizer compared to HB whereas labour requirement of HB (3.74-4.04 man-hr ha-1) in three splits showed similar to single application of urea by PUA (3.68-4.00 man-hr ha-1) and USGA (3.78-3.97 man-hr ha-1). Urea application cost in HB, PUA and USGA was Tk 4,624, 3,216-3,424 and 3,305-3,483 per hectare in both the locations. Prilled urea application method reduced the production cost. Urea application methods showed insignificant effect on grain yield. BRRI prilled urea safely dispensed urea fertilizer in subsurface, increased the efficacy of urea fertilizer and saved urea fertilizer without sacrificing grain yield. BRRI prilled urea applicator could be a viable technology in rice cultivation. Extensive dissemination works should be undertaken in different agro-ecological zones for wide spread adoption of the applicator.Bangladesh Rice j. 2015, 19(2): 71-81

Treatment with the PI3K inhibitor buparlisib (NVP-BKM120) suppresses the growth of established patient-derived GBM xenografts and prolongs survival in nude rats

Glioblastomas (GBMs) are aggressive brain tumours with a dismal prognosis, despite combined surgery, radio- and chemotherapy. Close to 90 % of all GBMs harbour a deregulated PI3K pathway, which is essential in regulating central cellular functions such as proliferation, cell growth, motility and survival. Thus, PI3K represents a potential target for molecular therapy in GBM. We investigated the anti-tumour efficacy of the PI3K inhibitor buparlisib (NVP-BKM120) in GBM cell lines in vitro and in vivo, when treatment was initiated after MRI-confirmed tumour engraftment. We found that buparlisib inhibited glioma cell proliferation in a dose dependent manner, demonstrated by MTS assay, manual cell count and BrdU incorporation. A dose dependent increase in apoptosis was observed through flow cytometric analysis. Furthermore, by immunocytochemistry and western blot, we found a dose dependent inhibition of Akt phosphorylation. Moreover, buparlisib prolonged survival of nude rats harboring human GBM xenografts in three independent studies and reduced the tumours’ volumetric increase, as determined by MRI. In addition, histological analyses of xenograft rat brains showed necrotic areas and change in tumour cell nuclei in buparlisib-treated animals. The rats receiving buparlisib maintained their weight, activity level and food- and water intake. In conclusion, buparlisib effectively inhibits glioma cell proliferation in vitro and growth of human GBM xenografts in nude rats. Moreover, the compound is well tolerated when administered at doses providing anti-tumour efficacy. Thus, buparlisib may have a future role in glioma therapy, and further studies are warranted to validate this compound for human use.

Communication: Electron ionization of DNA bases

No reliable experimental data exist for the partial and total electron ionization cross sections for DNA bases, which are very crucial for modeling radiation damage in genetic material of living cell. We have measured a complete set of absolute partial electron ionization cross sections up to 500 eV for DNA bases for the first time by using the relative flow technique. These partial cross sections are summed to obtain total ion cross sections for all the four bases and are compared with the existing theoretical calculations and the only set of measured absolute cross sections. Our measurements clearly resolve the existing discrepancy between the theoretical and experimental results, thereby providing for the first time reliable numbers for partial and total ion cross sections for these molecules. The results on fragmentation analysis of adenine supports the theory of its formation in space.

Cutaneous Tuberculosis: An Update

Among extra pulmonary tuberculosis cutaneous tuberculosis occurs rarely, despite a high and increasing prevalence of tuberculosis worldwide particularly in developing countries. Cutaneous tuberculosis can be acquired exogenously or endogenously and present as a diverse of differing clinical morphologies. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. Moreover, microbiological confirmation is poor, despite scientific advances, such as the more frequent use of polymerase chain reaction. Furthermore, treatment of cutaneous tuberculosis is also challenging in many cases.

Comparison between Decompressive Craniectomy with Durotomy and Conservative Treatment in Spontaneous Supratentorial Intracerebral Hemorrhage

Large Intracerebral hematoma (ICH), compounded by perihematomal edema can produce severe elevations of intracranial pressure (ICP). Decompressive craniectomy (DC) beneficially addresses mass effect. Therefore this study is aimed to prove that decompressive craniectomy with durotomy has better outcome in patients with spontaneous supratentorial ICH than conservatively treated patients. This Quasi-Experimental study was carried out in the Department of Neurosurgery, Dhaka Medical College & Hospital (DMCH), Dhaka, Bangladesh from July 2012 to December 2013 using purposive sampling procedure. A total of 80 admitted adult hypertensive patients with spontaneous supratentorial ICH were enrolled in the study population fulfilling all selection criteria. Of them 40 patients underwent decompressive craniectomy with durotomy was considered as surgical group and 40 patients were treated conservatively was considered as conservative group. All the cases were continuously followed up and GCS score at 7(th) day of treatment (D7) and at discharge was recorded. Mean±SD hematoma volume was 56.91±13.72ml in surgical patients and in conservative group 51.80±13.58ml. Outcome measured by modified Rankin Scale at 3 months. Sixty percent (60%) patients had good outcome (mRS 0-4) and 40% patients had poor outcome (mRS 5-6) in surgical group. On the other hand, 52.5% patients had good (mRS 0-4) and 47.5% had poor (mRS 5-6) outcome in conservative group. In logistic regression analysis, conservative group was 3.643 times more prone to develop poor outcome than surgical group which was statistically significant (95% CI, 1.040-13.047; p value <0.05) and volume of hematoma [OR (95% CI), 1.131(1.059-1.207); p value <0.001)] was the most important predictor of outcome. This study indicates that decompressive craniectomy with preservation of brain integrity in patients with spontaneous supratentorial ICH is feasible and safe. It can be a useful alternative surgical procedure in the treatment of spontaneous supratentorial ICH.

Total Serum IgE Level Estimation in Asthma Patient and Healthy Volunteers in a Tertiary Care Hospital, Bangladesh

A strong association between total serum Immunoglobulin E (IgE) levels, skin test reactivity to aeroallergens, and asthma phenotype was found in previous studies. The current study has been undertaken to observe the total serum IgE level in asthmatic patients compared with normal healthy volunteers (control) of Bangladeshi subjects and to see its prospect in diagnostic aid. This case-control study was carried out in the department of Respiratory Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka during the period from July 2008 to June 2009. Four hundred & eight (408) cases (asthmatics matching age, sex and geographic location) and 478 controls (non-asthmatics matching age, sex and geographic location) were studied. The level of serum IgE was found more in asthma patients than control group which were 345.88 and 224.64 respectively (p<0.001). In both group, serum IgE level was more in male than female. There was wide variation in serum IgE level in both the asthma and control group (4.2 to 3471.0 iu/ml in asthma group and 1.2 to 1045.7 iu/ml in control). Considerable overlap has been observed between the IgE values of control and asthma group. Due to this overlap its diagnostic significance in allergic condition in Bangladeshi population seems to be limited.

Surgical Closure of Atrial Septal Defect with High Pulmonary Vascular Resistance--A Case Report

We have reported a case of successful pericardial patch closure of atrial septal defect with high pulmonary vascular resistance in a 32 years aged male. Diagnosis was confirmed by Doppler Echocardiography, Cardiac catheterization and lung biopsy. Before starting (orally) bosentan pulmonary arterial pressure was 105 mm Hg and pulmonary vascular resistance was 8 wood's unit. Bosentan was started at a dosage of 125 mg per day (62.5 mg twice a day) for 4 months before operation in this case. Just day before operation pulmonary arterial pressure was 87 mm Hg. Bosentan lowered pulmonary arterial pressure and reversed remodeling of pulmonary arteries and allowed surgical correction. During the post operative course, partial pressure of oxygen was significantly decreased and bilateral radiolucent opacity was present in lower zone of both lungs. All these were managed successfully in postoperative period. This case report has demonstrated that surgical correction of an atrial septal defect is feasible but requires long time pre and post operative treatment with pulmonary vasodilators.

Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

Patterns of Coronary Artery Anomalous Origin Reviewed by Coronary Angiogram in a Cardiac Center of Bangladesh

Coronary Angiogarm (CAG) has been used to detect coronary artery anomalies. This cross sectional observational study aimed to assess the prevalence of anomalous origin of the coronary artery in the Bangladeshi patients. The researchers summarized responses of the target patients who underwent coronary angiography (CAG) from August 2010 to March 2011 in United Hospital Ltd., Gulshan, Dhaka, Bangladesh and data of anomalous origin of the coronary artery in Bangladeshi patients were recorded. Eighteen hundred (1800) patients underwent CAG during that period; 66 patients with an anomalous origin of the coronary artery were detected, giving a prevalence of 3.6%. The prevalence of anomalous origin of the coronary artery in Bangladeshi people in this study is 3.6%. CAG can visualize the anomalous origin of the coronary artery and is a useful screening modality.

Sociocultural and host factors related to extra-pulmonary tuberculosis in rural Bangladesh: A case control study

Bangladesh ranks sixth among higher TB burden countries. Extra-pulmonary TB contributes 12% of all tuberculosis cases in 2008. Risk factors for EPTB in Bangladesh are hypothesized to be different from pulmonary tuberculosis as seen in other high-burden countries. A case control study was conducted to compare the sociodemographic, household condition and lifestyle characteristics between extra pulmonary and pulmonary tuberculosis. This case control study was conducted in thirteen sub districts of Pabna, Shirajgonj and Cox's Bazar districts from January to June 2013. The samples were classified as either extra pulmonary tuberculosis EPTB (cases) or pulmonary tuberculosis PTB (controls). A total of 490 participants including 245 extra pulmonary tuberculosis (cases) and 245 pulmonary tuberculosis (controls), who were being enrolled in DOTS treatment for last six months, were interviewed for epidemiological and clinical information using a standardized questionnaire. Children, adolescent and younger adults had four-time higher risk of being manifested with extra pulmonary tuberculosis [Adjusted odds ratio (AOR) 3.97; 95% Confidence Interval (CI) 1.10 to 14.35] and (AOR 4.50; 95% CI 1.48 to 13.72). Respondents, who lived in their own houses showed three times more chance of getting extra pulmonary disease (AOR 3.11; 95% CI 1.15 to 8.39). Extra pulmonary tuberculosis was seven to eight times more likely to occur among those whose resided in bedrooms ventilated with one (p= .001) or more windows (p =.004) and having window shutter made of glasses or wood slit raised the probability of getting extra pulmonary involvement by twenty times. Households using grain husk and leaves as cooking fuel revealed seven times higher chance of being manifested as extra pulmonary tuberculosis (P <.001). Extra pulmonary cases were three times more common among respondents, who had no history of exposure with known tuberculosis cases than those who had frequent exposure history (AOR 3.01; 95% CI 1.24 to 7.34). Extra pulmonary tuberculosis was found 1.5 times more common among BCG vaccinated respondents than pulmonary tuberculosis (AOR 1.66; 95% CI 1.06 to 2.58). Younger age, house ownership, bedroom ventilation, fuel material used for cooking, contact history and BCG vaccination status might be the important risk factors for the extra pulmonary manifestation of tuberculosis relative to pulmonary tuberculosis.

Two-year survival following discharge from hospital after spinal cord injury in Bangladesh

STUDY DESIGN

Mixed retrospective-prospective cohort study.

OBJECTIVES

To determine 2-year survival following discharge from hospital after spinal cord injury in Bangladesh.

SETTING

Bangladesh.

METHODS

Medical records were used to identify all patients admitted in 2011 with a recent spinal cord injury to the Centre for Rehabilitation of the Paralysed, a large Bangladeshi hospital that specialises in care of people with spinal cord injury. Patients or their families were subsequently visited or contacted by telephone in 2014. Vital status and, where relevant, date and cause of death were determined by verbal autopsy.

RESULTS

350 of 371 people admitted with a recent spinal cord injury in 2011 were discharged alive from hospital. All but eleven were accounted for two years after discharge (97% follow-up). Two-year survival was 87% (95% CI 83% to 90%). Two-year survival of those who were wheelchair-dependent was 81% (95% CI 76% to 86%). The most common cause of death was sepsis due to pressure ulcers.

CONCLUSION

In Bangladesh, approximately one in five people with spinal cord injury who are wheelchair-dependent die within two years of discharge from hospital. Most deaths are due to sepsis from potentially preventable pressure ulcers.

Plasma Leptin Levels in Children Hospitalized with Cholera in Bangladesh

Vibrio cholerae, the cause of cholera, induces both innate and adaptive immune responses in infected humans. Leptin is a hormone that plays a role in both metabolism and mediating immune responses. We characterized leptin levels in 11 children with cholera in Bangladesh, assessing leptin levels on days 2, 7, 30, and 180 following cholera. We found that patients at the acute stage of cholera had significantly lower plasma leptin levels than matched controls, and compared with levels in late convalescence. We then assessed immune responses to V. cholerae antigens in 74 children with cholera, correlating these responses to plasma leptin levels on day 2 of illness. In multivariate analysis, we found an association between day 2 leptin levels and development of later anti-cholera toxin B subunit (CtxB) responses. This finding appeared to be limited to children with better nutritional status. Interestingly, we found no association between leptin levels and antibody responses to V. cholerae lipopolysaccharide, a T cell-independent antigen. Our results suggest that leptin levels may be associated with cholera, including the development of immune responses to T cell-dependent antigens.

Comparative study of early and conventional catheter removal following buccal mucosal graft urethroplasty

The duration of catheterization period following urethroplasty is a great controversy. For buccal mucosal graft urethroplasty recommended catheterization period ranges from 2-4 weeks. In recent years, early catheter removal has been advocated for several reasons. Early catheter removal improves both patient comfort, mobility and reduces catheter related complications and shortens post operative hospital stay. This prospective observational study was done from January 2007 and December 2008, 50 patients underwent dorsal onlay buccal mucosal graft urethroplasty for stricture urethra. Among them 25 cases were selected for early catheter removal on 7th postoperative day and 25 cases for conventional catheter removal at 3 weeks. Three patients (12%) of early catheter removal group and 2 patients (8%) of conventional catheter removal group exhibited periurethral leakage. One patient (4%) and three patients (12%) developed wound infection in early and conventional catheter removal group respectively. No significant difference was observed in urinary flow (p=0.089). In these two groups the mean postoperative hospital stay was significant (p<0.001). Early catheter removal on 7th postoperative day is safe and has better impact on patient comfort with minimum catheter related complications and shortens hospital stay.

Simple top-down preparation of magnetic Bi₀.₉Gd₀.₁Fe₁-xTixO₃ nanoparticles by ultrasonication of multiferroic bulk material

We present a simple technique to synthesize ultrafine nanoparticles directly from bulk multiferroic perovskite powder. The starting materials, which were ceramic pellets of the nominal compositions Bi₀.₉Gd₀.₁Fe₁-xTixO₃ (x = 0.00-0.20), were prepared initially by a solid state reaction technique, then ground into micrometer-sized powders and mixed with isopropanol or water in an ultrasonic bath. The particle size was studied as a function of sonication time with transmission electron microscopic imaging and electron diffraction that confirmed the formation of a large fraction of single-crystalline nanoparticles with a mean size of 11-13 nm. A significant improvement in the magnetic behavior of Bi₀.₉Gd₀.₁Fe₁-xTixO₃ nanoparticles compared to their bulk counterparts was observed at room temperature. This sonication technique may be considered as a simple and promising route to prepare ultrafine nanoparticles for functional applications.

Circulating mucosal associated invariant T cells are activated in Vibrio cholerae O1 infection and associated with lipopolysaccharide antibody responses

Background

Mucosal Associated Invariant T (MAIT) cells are innate-like T cells found in abundance in the intestinal mucosa, and are thought to play a role in bridging the innate-adaptive interface.

Methods

We measured MAIT cell frequencies and antibody responses in blood from patients presenting with culture-confirmed severe cholera to a hospital in Dhaka, Bangladesh at days 2, 7, 30, and 90 of illness.

Results

We found that MAIT (CD3⁺CD4⁻CD161^hiVα7.2⁺) cells were maximally activated at day 7 after onset of cholera. In adult patients, MAIT frequencies did not change over time, whereas in child patients, MAITs were significantly decreased at day 7, and this decrease persisted to day 90. Fold changes in MAIT frequency correlated with increases in LPS IgA and IgG, but not LPS IgM nor antibody responses to cholera toxin B subunit.

Conclusions

In the acute phase of cholera, MAIT cells are activated, depleted from the periphery, and as part of the innate response against V. cholerae infection, are possibly involved in mechanisms underlying class switching of antibody responses to T cell-independent antigens.

Vibrio cholerae is the bacterium that causes cholera, which can be a potentially fatal diarrheal disease that affects millions of people worldwide each year. How our immune system provides protection against cholera is poorly understood. Mucosal Associated Invariant T (MAIT) cells are recently discovered immune cells found in the blood and intestinal tract of humans. In this study of cholera patients in Dhaka, Bangladesh, we found that blood MAIT cells are activated during cholera, and that in children, blood MAIT cells are decreased in number during the course of disease. We also found that the MAIT cell response correlates with the antibody response to V. cholerae O1 lipopolysaccharide, which in the past has been shown to be an important determinant of protection. These findings suggest that MAIT cells may play an important role in the body's defense against cholera.

A comparative study of chemical and immunological method of fecal occult blood test in the diagnosis of occult lower gastrointestinal bleeding

Fecal occult blood test is the most widely used screening test for diagnosis of gastrointestinal bleeding disorders specially colorectal carcinoma. Among the various methods of fecal occult blood tests, chemical method is being used commonly, but the method has some drawbacks like low participation rate, high false positive rate, low sensitivity etc. To overcome these short comings, newer immunological method was introduced. This study evaluated the role of immunological method of fecal blood test in the diagnosis of occult lower GIT bleeding. Stool samples from two hundred patients were examined by both chemical and immunological method. The patients who were positive by any or both methods of occult blood test, were advised for colonoscopy. During colonoscopy tissues were taken for histopathology which was the gold standard of this study. Among 110 OBT positive patients pathological lesions were detected in 65 patients by colonoscopy and histopathology. The diseases detected by colonoscopy and histopathology 18 colorectal polyp, 8 colorectal cancer, 24 ulcerative lesions and 5 inflammatory bowel disease etc. Regarding comparative analysis of chemical and immunological method, the higher sensitivity (95.4% vs. 49.2%), specificity (44.4% vs. 37.8%), accuracy (74.5% vs. 44.5%), PPV (71.3% vs. 53.3%) and NPV (87% vs. 34%) of immunological method than chemical method was observed. Thus immunological method of fecal occult blood test was appeared to be a better alternative to conventional chemical method of fecal occult blood test in the diagnosis of occult lower GIT bleeding. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19641 Bangladesh Med Res Counc Bull 2013; 39: 52-56

Association between elevated B-type Natriuretic Peptide levels with extent of coronary artery disease in patients with unstable angina and NSTEMI

The study was undertaken to find out the correlation of elevated B-type Natriuretic Peptide (BNP) levels with the severity of coronary artery disease in patients with unstable angina and NSTEMI. This cross sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka during a period of August 2011 to June 2012. A total of 100 consecutive patients with unstable angina and NSTEMI undergoing coronary angiography were included in the study. BNP assay was done by Architect system, a chemo luminescent microparticle immunoassay (CMIA). CAG was done by conventional method within 14 days of index hospital admission. Study patients were divided into two groups on the basis of BNP levels. In Group I, BNP Levels were ≤80pg/ml and in Group II, BNP levels were elevated >80pg/ml. with 50 patients in each group. Angiographic severity of CAD was assessed by vessel score and Friesinger score. Vessel score showed single vessel was involved in 21(47.7%) patients while multi vessel in 23(52.3%) patients was found in Group I. On the contrary 11(22.4%) single vessel patients and 38(77.6%) multivessel patients were found in Group II. There was significant association between vessel involvement (p=0.01). Friesinger score revealed that less severe CAD was found in 22(44%) patients and significant severe CAD in 28(56.0%) patients in Group I. On the contrary 7(14.0%) less severe CAD patients and 43(86.0%) severe CAD patients were found in Group II. There was significant difference between severity of CAD among the study groups (p=0.01). There was linear correlation between BNP pg/ml and coronary artery disease severity in terms of Vessel score (r=0.38, p=0.01) and Friesinger score (r=0.51, p=0.01). The present study concluded that increased BNP level >80pg/ml was significantly associated with the presence and severity of CAD in patient with UA and NSTEMI.

Goldenhar syndrome - a case report

Goldenhar syndrome is a developmental abnormality of 1st & 2nd branchial arch involving the craniofacial microsomia with ocular & vertebral abnormality. Though most of the cases are sporadic, some familial association is also found in autosomal dominant or recessive manner. Teratogenic effect of some toxic substances may lead to the condition. Ocular abnormalities are epibulbar dermoid, lipodermoid & coloboma. Otic defects are preauricular tags, microtia, anotia & conductive hearing loss. Cardio-pulmonary & genitourinary abnormalities are common associations. Here we have described the case of a 10 years old girl had ocular, auricular & vertebral changes consistent with Goldenhar syndrome, she was managed with multidisciplinary approach and she was symptomatically improved but corrective surgery was planned as schedule of respective department.

Rapid detection of microbial contamination in Ghanaian herbal medicines by PCR analysis

BACKGROUND

There is widespread use of herbal medicines across the world and the need for regulatory measures to ensure their safety, efficacy and quality is therefore imperative. Conventional microbiological methods are used in carrying out quality control analysis of herbal medicines but these are often slow, may be less sensitive or specific and labour-intensive. In this study we investigated the ability to use Polymerase Chain Reaction (PCR) as a fast, accurate and inexpensive novel method to detect the presence of common pathogens in herbal medicines from Ghana.

METHODS

We employed different DNA extraction techniques including TE buffer, boiling method for DNA extraction as well as commercially available DNA extraction kits from Qiagen, UK: Gentra Pure-gene Yeast/Bact. Kit and DNeasy™ Tissue Kit which is column based to identify Escherichia coli, Staphylococcus aureus and Salmonella sp. in herbal products from Ghana in local African shops on the UK market.

RESULTS

The TE buffer and boiling methods did not yield any bacterial DNA, however both commercial kits yielded significant amounts of DNA. PCR was able to detect pathogens present in the samples directly. Escherichia coli could be detected at 10 cfu/ml whilst Staphylococcus aureus was detectable at a threshold of up to 10(3) cfu/ml when samples were enriched overnight. Salmonella sp. could not be detected in DNA samples extracted from herbal medicines.

CONCLUSION

We conclude that PCR and similar new molecular techniques such as Real Time PCR have the potential as rapid microbiological analytical techniques especially in busy clinical settings and for quality control of herbal medicines.

Antigen-specific memory B-cell responses to enterotoxigenic Escherichia coli infection in Bangladeshi adults

Background

Multiple infections with diverse enterotoxigenic E. coli (ETEC) strains lead to broad spectrum protection against ETEC diarrhea. However, the precise mechanism of protection against ETEC infection is still unknown. Therefore, memory B cell responses and affinity maturation of antibodies to the specific ETEC antigens might be important to understand the mechanism of protection.

Methodology

In this study, we investigated the heat labile toxin B subunit (LTB) and colonization factor antigens (CFA/I and CS6) specific IgA and IgG memory B cell responses in Bangladeshi adults (n = 52) who were infected with ETEC. We also investigated the avidity of IgA and IgG antibodies that developed after infection to these antigens.

Principal Findings

Patients infected with ETEC expressing LT or LT+heat stable toxin (ST) and CFA/I group or CS6 colonization factors developed LTB, CFA/I or CS6 specific memory B cell responses at day 30 after infection. Similarly, these patients developed high avidity IgA and IgG antibodies to LTB, CFA/I or CS6 at day 7 that remained significantly elevated at day 30 when compared to the avidity of these specific antibodies at the acute stage of infection (day 2). The memory B cell responses, antibody avidity and other immune responses to CFA/I not only developed in patients infected with ETEC expressing CFA/I but also in those infected with ETEC expressing CFA/I cross-reacting epitopes. We also detected a significant positive correlation of LTB, CFA/I and CS6 specific memory B cell responses with the corresponding increase in antibody avidity.

Conclusion

This study demonstrates that natural infection with ETEC induces memory B cells and high avidity antibodies to LTB and colonization factor CFA/I and CS6 antigens that could mediate anamnestic responses on re-exposure to ETEC and may help in understanding the requirements to design an effective vaccination strategies.

Enterotoxigenic Escherichia coli (ETEC) is a non-invasive pathogen causing diarrhea in children as well as in adults and travelers in developing countries. After colonizing the intestine using colonization factors, the organisms secrete heat-stable (ST) and/or heat-labile (LT) enterotoxin to cause watery diarrhea. Natural infection with ETEC provides protection against subsequent infection; however, the precise mechanism is unknown. In this study, we have shown that adult patients with diarrhea infected with ETEC develop toxin (LTB) and colonization factor (CFA/I and CS6) specific memory B cell responses as well as highly avid antigen-specific antibodies. The antibody avidity indices were shown to be positively associated with memory B cell responses, suggesting that these processes may occur in concert. This study encourages further evaluation of such responses in children as well as in vaccinees.

Diameter of the lymphoid follicles in the vermiform appendix of Bangladeshi cadaver

Appendicitis is the most common clinical condition of the appendix. Many cases of acute appendicitis result from obstruction of the lumen of the appendix by lymphoid hyperplasia. The vermiform appendix is a worm-like, closed-ended, narrow, small tubular structure, projecting from posteromedial wall of cecum. It is an integral part of the Gut Associated Lymphoid Tissue (GALT) system. The lymphoid follicles of the vermiform appendix vary in respect to their number, diameter and location in different ages. This study was done to measure and establish the normal diameter with age related variation of the lymphoid follicles of vermiform appendix in Bangladeshi population. This descriptive cross sectional study was carried out in the Department of Anatomy, Sir Salimullah Medical College, Dhaka, from January 2008 to June 2009. Sixty (60) postmortem vermiform appendices of different age groups of Bangladeshi cadavers. For studying the diameter of lymphoid follicles in the vermiform appendix in relation to age, the collected samples were divided into five groups namely Group-A between age ranges 0-20 years, Group-B between age ranges 21-30 years, Group-C between age ranges 31-40 years, Group-D 41-50 years and Group-E age above 50 years. From each age group, six (6) fresh samples were selected for histological study. From each vermiform appendix three slides were prepared each from its base, middle part and near the tip and were stained with routine H & E stain. The normal diameter of the follicles of the vermiform appendix ranged from 0.40 mm to 0.66 mm. The highest average group diameter was 0.62±1.10mm in Group-A and the lowest value was 0.45±2.73mm in Group-E. It was obvious that the diameter decreased gradually with advancing age. The average normal diameter of the lymphoid follicles per histological section of vermiform appendix reduced with advancing age and showed a significant negative correlation with age (p<0.001). In the present study, the normal diameter of the lymphoid follicles of the vermiform appendix reduced significantly with advancing age.

Primary adrenal leiomyosarcoma in an adult female

Primary leiomyosarcoma of the adrenal gland is a rare tumour and we describe such a case in a 35 year old female who had dull pain in the left flank for 6 months. There was no weight loss or fever only mild tenderness was in the left subcostal region. She was normotensive and there was no evidence of virilization. CT scan revealed left adrenal mass, after adrenalectomy it was 8.5×7.5×6.2cm³ in size. There was no evidence of local extension or metastasis. Histopathology confirmed adrenal leiomyosarcome.

Peginterferon α-2a and rivabirin in the treatment of chronic hepatitis C

Peginterferon α-2a with ribavirin produces significantly higher sustained virological response (SVR) in comparison to conventional interferon monotherapy in patients with chronic hepatitis C virus (HCV) infection. We evaluated the efficacy and safety of peginterferon α-2a plus ribavirin combination in the treatment of chronic hepatitis C among Bangladeshi patients. A total of 64 patients were randomly selected in this study and were assigned for treatment with peginterferon α-2a 180μg once weekly plus ribavirin daily for 24 weeks in case of genotypes 2 and 3 infections and 48 weeks in case of genotypes 1 and 4 infections. Ribavirin was given 800mg in divided doses in case of genotypes 2 and 3 infections and 1000mg-1200 mg in case of genotypes 1 and 4 infections according to body weight daily(1000 mg in divided doses if body weight <75kg and 1200mg in divided doses if body weight >75kg). Efficacy was assessed by measurements of serum HCV-RNA and serum ALT. A higher proportion of patients (71.87%) who received peginterferon α-2a plus ribavirin had a sustained virological response. It is observed that genotype 3 (a and b) patients showed poor response (SVR-47.05%), where as genotypes 1(a,b), 3 and 4 mixed, 2b and 4 infections showed response rate of 100%. So it can be concluded that once weekly peginterferon α-2a plus daily ribavirin is effective in chronic HCV infection in Bangladesh and overall response rate is similar to that reported in other studies.

Immune responses to O-specific polysaccharide and lipopolysaccharide of Vibrio cholerae O1 Ogawa in adult Bangladeshi recipients of an oral killed cholera vaccine and comparison to responses in patients with cholera

Protective immunity to cholera is serogroup specific, and serogrouping is defined by the O-specific polysaccharide (OSP) of lipopolysaccharide (LPS). We characterized OSP-specific immune responses in adult recipients of an oral killed cholera vaccine (OCV WC-rBS) and compared these with responses in patients with cholera caused by Vibrio cholerae O1 Ogawa. Although vaccinees developed plasma immunoglobulin G (IgG), IgM, IgA antibody and antibody secreting cell (ASC, marker of mucosal response) to Ogawa OSP and LPS 7 days after vaccination, responses were significantly lower than that which occurred after cholera. Similarly, patients recovering from cholera had detectable IgA, IgM, and IgG memory B cell (MBC) responses against OSP and LPS on Day 30 and Day 90, whereas vaccinees only developed IgG responses to OSP 30 days after the second immunization. The markedly lower ASC and MBC responses to OSP and LPS observed among vaccinees might explain, in part, the lower protection of an OCV compared with natural infection.

Does the HPV vaccination programme have implications for cervical screening programmes in the UK?

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Women who did not take up the HPV vaccination were less likely to attend for cervical screening.

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HPV vaccinated women who attended cervical screening had the lowest proportion of cytological abnormalities detected.

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Social deprivation was the main factor-affecting uptake of both HPV vaccination and cervical screening.

In the UK, a national HPV immunisation programme was implemented in 2008 for girls aged 12–13 years. In addition a catch-up programme was implemented for older girls up to 18 years of age from 2009 to 2011, with an uptake rate of 49.4%. Information about future uptake of cervical screening according to vaccination statistics is important in order to understand the impact of the vaccination programme and implications for a national cervical screening programme. We analysed data on a cohort of women who had been offered the HPV vaccine in the catch-up programme and were invited for cervical screening between 2010 and 2012 in Wales (n = 30,882), in a record-linked database study, to describe the cervical screening uptake and clinical outcome according to HPV vaccination status.

In our cohort, 48.5% (n = 14,966) women had had HPV vaccination and 45.9% (n = 14,164) women attended for cervical screening. Women who were unvaccinated were less likely to attend cervical screening (adjusted OR 0.58; 95% CI (0.55, 0.61)). Of those who attended for screening, 13.9% of vaccinated women had abnormal cytology reported compared to 16.7% of women who were unvaccinated. Women who lived in areas with high levels of social deprivation were less likely to be vaccinated (Quintile 5 OR 0.48 95% CI (0.45, 0.52)) or attend cervical screening (Quintile 5 OR 0.70; 95% CI (0.65, 0.75)) compared to those who lived in the least deprived areas.

These data highlight the need for new strategies to address inequalities in cervical screening uptake and can inform further mathematical modelling work to clarify the impact of the HPV vaccination programme on future cervical cancer incidence.

Surgical management of rectourethral fistula in different situations

This study was done to see the outcome of repair of rectourethral fistula (RUF) in different situations between 2002 and 2009 in Chittagong and Dhaka Medical College Hospitals. We prospectively reviewed the records of all the patients who developed rectourethral fistula. Total 18 patients were included and in all cases faecal and urinary diversion was done preoperatively. In 4 patients fistulas size was <1cm where spontaneous closure of RUF occured after 6 months of diversion. In 8 patients repair of fistula was done through the perineal approach where excision of fistulas tract with anastomotic urethroplasty and repair of rectal wound was done. Out of these 8 patients tunica vaginalis flap was applied in 3 and dartos pedicle flap in 5 cases, in the remaining 6 patients transrectal York-Mason repair was done. Out of 6 patients of York-Mason repair, one developed recurrent fistula - which underwent repair with a graft through the perineal approach later on with good result. No patient developed urinary or faecal incontinence. In 2 patients leakage of urine was noted in post operative days in the perineal wound and catheter was kept for 3 weeks more. No one had erectile dysfunction. Both faecal & urinary diversion adds benefit to the outcome of the rectourethral fistula. Transrectal York-Mason repair is easier to do with less morbidity and complication while perineal approach with graft interposition may be done in cases where anastomotic urethroplasty is needed along with fistula repair.

Clinical, biochemical, virological and sonographic profile of incidentally detected asymptomatic HBsAg positive subjects, in Bangladesh

Chronic hepatitis B virus (HBV) is known to be the significant cause of Liver related morbidity and mortality, affecting 400 million people worldwide and a major public health problem in Bangladesh where carrier rates of HBV infection varies from 7.5 to 10%. In Bangladesh prevalence of asymptomatic HBV infection and incidentally detected HBsAg positive subjects were not well studied. The aim of this study is to evaluate the disease activity, replicative status of the virus and to find out the stages of chronic liver disease among incidentally detected asymptomatic HBsAg positive Bangladeshi subjects. Two hundred (200) incidentally detected healthy HBsAg positive subject were evaluated clinically, biochemically, serologically and ultrasonographically from January 2004 to June 2008. HBeAg was found positive in 17(8.5%), anti-HBe was positive in 174(87%), raised serum ALT (>45iu/L) in 45(22.5%), prothrombine time (PT) >3 sec of control in 33(16.5%). Ultrasonography showed coarse hepatic echotexture in 13(6.5%). Evidence of active viral replication and signs of chronic liver disease were observed among incidentally detected healthy HBsAg positive subjects. Such individuals should be followed up at regular interval to evaluate the replicative status of the virus and disease activity so that appropriate measures could be initiated in time.