Evaluation of Knowledge Regarding Oral Anti-diabetic Agents among Hospitalized Diabetic Patients

Knowledge regarding oral anti-diabetic agents help to enhance compliance among diabetic patients. Though it is an important aspect of management, data evaluating it is scarce in our country. This cross sectional observational study carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2013 to February 2014 and was undertaken to determine basic knowledge about oral anti-diabetic agents among hospitalized diabetic patients taking or took oral anti-diabetic agents. In this study main outcome measures were socio-demographic characteristics, knowledge regarding oral anti-diabetic agents, frequency of previous hospital admission, regularity in taking oral anti-diabetic agents, causes of irregularity in taking medicine and knowledge related to hypoglycemia. Mean±SD age was 55±7.14 years, of the patients who were included in this study. Only 33% of patients knew side effects of oral anti-diabetic agents, 34% didn't know that drug should not be stopped before giving blood for glucose estimation, in answering to 9 basic question related to oral anti-diabetic agents 56% obtained score within 0-5, overall mean 5.2±1.47. Among them 38% used to take drug irregularly. Correlation with knowledge score and regularity in taking drug showed significant relation (p<0.01). This study has demonstrated unsatisfactory knowledge on oral anti-diabetic agents among type 2 diabetic patients and significant relation with knowledge on oral anti-diabetic agents and patients compliance. An improvement with this respect may be achieved through continuing patients education about diabetes and its treatment.

Effect of dairy milk, eggs, meat, fish and fruits intake on academic performances of secondary school students in Bangladesh

Background: Contribution of dairy milk and other food items and schools to academic performances of students are the important factors to build a peaceful meritorious nation with sound mental and physical health.Objective: This experiment was designed to study the contribution of dairy milk and other food item intake pattern and schools to academic performances.Method: Students of class nine in Bangladesh were enumerated using a preprescribed questionnaire during March 2016 to June 2016 by direct interview method. Collected primary data were analyzed using the Statistical Package for the Social Sciences version 14.015.Results: Male (69.63%) students and students of schools in the town (84.97%) performed better. Majority of the students in towns (46.85%; 49.65%) and villages (45.51%; 50.90%) drank dairy milk and ate meat respectively, once or twice in a week. Many students in towns (30.77%) and villages (38.92%) ate eggs for 3 to 4 days in a week. Maximum students in town (53.50%) and in village (46.71%) took fish for 5 to 7 days and 3 to 4 days in a week, respectively. Many students in town (39.86%) and in village (59.88%) took fruits 1 to 2 days and 5 to 7 days in a week, respectively. Most (74.31%) of the students who took dairy milk, meat (73.68%), fruits (66.67%), fish (65.81%) and eggs (64.71%) everyday in a week obtained A grade.Conclusions: Schools, availability of dairy milk, meat, fruits, fish and eggs, Tiffin intake status and gender affected the academic performances but educational institutions had no effect on weekly dairy milk, eggs and meat intake of the students but weekly fish and fruits intake status were affected.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.355-359

Impact of heat stress on milk yield and composition in early lactation of Holstein Friesian crossbred cattle

The aim of the study was to know the effect of heat stress on milk yield and its composition of Holstein Friesian crossbred dairy cows rearing under intensive management system.Heat stress in dairy cows is caused by a combination of environmental factors i.e. temperature, relative humidity, solar radiation and air movement, etc. Grading-up of local cattle by temperate breeds for greater performance results to increase the sensitivity to heat stress. The trial was conducted during hot (May-July) and cool period (December-February) on a total of 12 crossbred dairy cows in early lactation period (first 60 days of lactation). The selected cows were divided into two groups namely as G1 (Holstein-Friesian 50% × Local 50%) and G2 (Holstein-Friesian 75% × Local 25%) and each group containing three cows of 3rd lactation in both periods of trail. Cows of each group were offered same quality and quantity of feed and reared in same management condition in both the trail periods. The mean average temperature humidity index (THI) of the stanchion barn were 70.83± 0.535 and 83.87± 0.375 in cool and hot period, respectively. The differences of THI of cool and hot season was significant (p<0.05). The average rectal temperature (0F) of G1 group was 101.51± 0.027and 102.15±0.049 in cool and hot period, respectively. On the other hand, the average rectal temperature (0F) of G2 group was 101.68± 0.035 and 102.5±0.052 in cool and hot period, respectively. The differences of rectal temperature of both groups between cool and hot season were significant (p<0.05). The average milk yield (Liter/day) of both groups was significantly (p<0.05) higher in cool period (14.92±0.019 and 19.54± 0.116 for G1 and G2 group, respectively) than in hot period (12.84±0.152 and 15±0.137 for G1 and G2 group, respectively). The milk yield of G2 group hampered more compare to G1 group due to higher THI during hot season. The milk fat, protein and lactose of both groups were significantly higher (p<0.05) during lower THI period compare to higher THI period, while the higher values of minerals detected in higher THI period but the differences were not statistically significant (p<0.05). From the result it is evident that the milk yield and composition are greatly affected by the heat stress during early lactation period.Bang. J. Anim. Sci. 2017. 46 (3): 192-197

Measurement of Length of Umbilical Cord in Different Gestational Age Groups in Bangladesh

The umbilical cord and placental have been considered to significantly contribute to the perinatal outcome. Long or short cord can lead to intrauterine fetal demise. So this type of study in placenta and umbilical cord can yield information for immediate and later management of newborn. This information may also be essential for protecting the attending physician in the event of a fetal outcome. This Cross sectional descriptive study would provide information about the length of umbilical cord in different gestational age groups in Bangladesh. To fulfill this aim the study was performed on 60 human placentas and umbilical cords and Gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), and Group C 38 weeks and above. These samples were collected from normal pregnancy in Gynecology and Obstetrics Department of Mymensingh Medical College Hospital from July 2009 to June 2010. After preservation in 10% normal saline, study was done in the department of Anatomy of Mymensingh Medical College. In this present study the mean±SD length of umbilical cord was found in different gestational age groups in Group A 63.00±5.40, Group B 63.69±8.80 and Group C 67.03±10.64cm and also observed that the mean length of umbilical cord increased with gestational age. The mean length of umbilical cord was maximum in Group C (67.03cm) and was minimum in Group A (63.00cm). The mean difference of length of umbilical cord among different groups was statistically not significant. Observed findings of this study were compared with those of western and Bangladeshi researches.

Length of Vermiform Appendix in Bangladeshi People of Different Age and Sex

A cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the length of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The length of the vermiform appendix was determined by measuring the distance from its base to tip with the help of a flexible thread. Then the thread was placed on measuring scale graduated in centimeter which represents the length of vermiform appendix. The data were analyzed by using student unpaired 't' test and compared with the findings of other national and international studies and standard text books. It was observed that length of vermiform appendix gradually decreased as age advanced. The mean±SD length of vermiform appendix was 9.41±1.26cm, 8.63±1.32cm, 7.96±1.20cm and 6.81±0.75cm in Group A, B, C and D respectively. Mean length of vermiform appendix in male was 9.92±1.55cm in Group A, 9.09±1.19cm in Group B, 8.04±1.10cm in Group C, 6.88±0.86cm in Group D and in female mean length of vermiform appendix was 9.12±1.06cm in Group A, 8.31±1.34cm in Group B, 7.79±1.60cm in Group C, 6.69±0.63cm in Group D. Statistical analysis shows that the mean differences of the length of vermiform appendix between A & D, B & D were statistically highly significant. The mean difference between Group A & C was moderately significant. Between Group C & D the difference was statistically significant and between Group A & B, B & C were statistically non significant. No significance difference of length of vermiform appendix between male and female was observed. The present study will help to increase the information pool on the length of vermiform appendix of Bangladeshi people.

Joubert's Syndrome: A Report of Two Cases

Joubert's syndrome and related disorders are primarily disorder of cerebellar development. It has heterogeneity of presentation that varies from patient to patient. In the recent past we encountered a pair of children who presented with developmental delay, hypotonia and abnormal eye movements. Classic Joubert's syndrome was confirmed on the basis of clinical and neuro-imaging findings. So careful clinical assessment and appropriate neuro-imaging should be done in suspected cases for confirmation of diagnosis. Multidisciplinary evaluation and periodic follow up are needful for every case.

Management of Traumatic Unstable Thoracolumbar Spine: Conservative versus Operative Treatment

Traumatic thoracolumbar spine injury result in significant instability of the spine and leads to an acute on delayed neurological deficit. Objective of the study is to find a better option in the management of unstable traumatic thoracolumbar spine with incomplete neurological lesion. This was quasi-experimental study. The study was carried out at National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh from January 2006 to December 2008. A total number of 40 patients with traumatic thoracolumbar spine injuries with incomplete neurological lesion were selected purposively. Out of 40 cases 1 patient missed from final follow up. Rest of 39 patients was included in this study. All patients were admitted within 3 weeks of injury. Most were referred from peripheral hospital & some were admitted in emergency and outpatient department of NITOR. Among those 25 patients were conservatively treated and 14 were operatively treated. Neurological status improvement was assessed by Frankel grading; it was remarkable in operative group. In 56% of the conservative group improved by one grade but 21.42% of operative group had of similar improvement. This one-grade improvement has been classified as fair. Whereas two grade improvement was termed as good. So, good result was obtained in 40% of conservatively treated patients and 57.16% in operatively treated patients. In this study, an overall result was classified as excellent, good, fair andll poor. Three grade upper shifts were categorized as excellent. In excellent result was obtained by operative procedures and it was 21.42%. On the other ward, no patient showed excellent result in conservatively treated group. In Celbeti et al. reported that 16(33.3%) patients had excellent results, 23(57.9%) had good, 70(4.58%) had fair and 20(4.36%) Patients had poor results.

Multidrug-resistant tuberculosis in Bangladesh: results from a sentinel surveillance system

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh.

METHODS

Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Löwenstein-Jensen medium.

RESULTS

Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged 65 years.

CONCLUSIONS

The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.

The Pattern of Serum Calcium, Phosphate and Parathyroid Hormone Levels in Pre-Diagnosed Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is an international health problem affecting 5-10% of the world population. Patients with chronic kidney disease were known to have higher prevalence of changes in serum calcium, phosphate and parathyroid hormone in Western countries, but data on the impact of CKD on serum calcium, phosphate and parathyroid hormone in our country are scarce. This cross-sectional type of descriptive study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2016 to September 2016. The aim of this study is to estimate serum calcium, phosphate and parathyroid hormone levels in chronic kidney disease (CKD) patients for early recognition of abnormalities, understanding of their patho-physiological consequences & planning management strategies to prevent their progression, thus reducing the morbidity & mortality. This study shows Hypocalcemia, hyperphosphataemia and elevated serum PTH levels are noted in later CKD stages & worsen with disease progression.

Correlation of Ball Circumference with Body Weight in 5-10 Years Aged Bangladeshi Children

This cross sectional, descriptive and analytic study was conducted among 5-10 years aged 109 Bangladeshi children (70 male and 39 female) at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat), Bangladesh from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of congenital and acquired foot deformity was excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding ball circumference, to measure its correlation with body weight and this attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Weight of the subject was measured with the digital weighing machine and ball circumference was measured using flexible measuring tape. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean ball circumference of right side of 5, 6, 7, 8, 9 and 10 years aged male were 16.93±1.05cm, 17.00±0.72cm, 18.10±1.28cm, 18.33±.99cm, 19.37±1.12cm and 19.94±1.30cm respectively and those of female were 16.27±1.10cm, 16.85±0.59cm, 17.44±0.92cm, 18.02±0.82cm, 18.00±1.58cm and 19.23±1.40cm respectively. The mean ball circumference of left side of 5, 6, 7, 8, 9 and 10 years aged male were 16.86±1.05cm, 16.94±.70cm, 18.02±1.29cm, 18.26±.99cm, 19.27±1.12cm and 19.87±1.29cm respectively and those of female were 16.18±1.10cm, 16.77±0.62cm, 17.36±0.92cm, 17.98±0.87cm, 17.90±1.58cm and 19.13±1.40cm respectively. In this study on both sides, ball circumference showed non-significant positive correlation with body weight in 5 years old male and female, 6 years old male and female, 7 years old male and female, 8 years old female, 9 years old male and female and 10 years old male and female. In case of 8 years old male, it showed non-significant negative correlation with body weight.

Evaluation of Intraoral Burning Sensation in Response to Heat-Cured and Self-Cured Acrylic Resin Denture Base Material

The objective of this prospective experimental clinical trial was to evaluate intraoral burning sensation in response to heat-cured and self-cured acrylic resin denture base material and carried out in the department of Prosthodontics of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from February 2014 to September 2015. Forty eight patients were evaluated in this study; of them 35(72.92%) patients were male and 13(27.08%) patients were female with age range from 24 to 70 years. In this study 48 patients were evaluated in term of burning sensation, of them 24 patients were provided with heat-cured acrylic resin denture and were considered as Group A and 24 patients were provided with self-cured acrylic resin denture and were considered as Group B. In Group A 14(58.4%) at 1st week, 2(8.4%) at 1st month, 10(41.8%) at 3rd month and 5(21.0%) at 6th month developed burning sensation. On the other hand the values were 18(75.0%), 22(91.6%), 14(58.2%) and 2(8.4%) at 1stweek, 1st month, 3rd month, and 6th month respectively. Chi-square test was done for statistical analysis and p value was <0.05. So, results were statistically significant.

Double Heterozygous For Haemoglobin S and Haemoglobin E

Here we present a Bangladeshi family where out of four family members two (mother and son) inherited both haemoglobin (HbS) S and haemoglobin (HbE) E gene confirming the diagnosis of double heterozygous state for HbS and HbE, presented in the Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh on the month of July 2016. Among other two members, one (daughter) inherited HbS and other (father) HbE. Double heterozygous state for HbS and HbE is a rare condition in this subcontinent especially in Bangladesh. HbS is rare but HbE is prevalent in Bangladesh. Co-inheritance of both HbS and HbE is therefore uncommon in this country in comparison to HbE/β - thalassaemia. Though the double heterozygous state for HbS and HbE is rare and the patients are usually asymptomatic but their documentation is important for genetic counseling and to determine the reproductive risk of the family.

Non-convulsive Status Epilepticus in Children: Clinical Profile, EEG Characteristics and Treatment

Non-convulsive status epilepticus (NCSE) is a term used to denote a range of conditions in which electrographic seizure activity is prolonged and results in non-convulsive clinical symptoms. This study was done to describe the clinical spectrum, EEG findings and to evaluate the efficacy of different therapeutic agents in children with NCSE in 33 patients from January 2011 to December 2015 period. All patients had EEG before and after treatment. Age range was 6 months to 14 year, 25 were male. Regarding development status, 48% had developmental delay, 21% had normal development, 9% had regression and 21% had both developmental delay and regression. Twenty nine cases were previously diagnosed as epilepsy. EEG diagnosis was as follows: Generalized NCSE 23(69%), focal 9(27%), unknown 1(3%). Eighteen patients were treated with Midazolam drip out of which 1 patient had complete remission in EEG, 6 had >80% remission, 5 had >50% remission and 5 patients had minimal or no response. Thirteen patients were treated with methyl prednisolone bolus out of which 2 patients had complete remission, 4 patients had >80% remission while 4 patients had >50% remission and 3 patients showed no response. NCSE may present with various clinical feature without any convulsion. Midazolam, methyl prednisolone and oral drugs are equally effective for treatment of NCSE. However, further randomized controlled study is needed to chalk out management of NCSE.

A Case of Severe Coarctation of Aorta Associated With Bicuspid Aortic Valve Managed Surgically

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 45-year-old male. Our patient was relatively asymptomatic until he presented with exertional dyspnea and fatigue in his fourth decade of life in Bangabandhu Sheikh Mujib Medical University (BSMMU), on the month of August, 2016. The patient was managed by surgery of aorta. After the 6 months follow-up visit, the patient was in good clinical condition.

Age Related Variation in the Number of Endometrial Gland in Bangladeshi Cadaver

This cross-sectional descriptive study was done to see the variation in the number of endometrial gland in Bangladeshi cadaver in different age groups to find out the anatomical variation and to compare it with other study findings. For this purpose 30 post mortem specimens containing female genital organs particularly uterus were collected by purposive sampling technique from cadavers of different age groups. All the collected specimens were fixed in 10% formalin solution. This study was carried out in the department of Anatomy, Mymensingh Medical College from July 2006 to June 2007. After dissection of specimen, microscopic study was done to count the number of the endometrial glands. Mean±SD numbers of gland per square mm area were 5.88±1.56, 14.75±6.90, and 7.35±1.79 in age Group A (2-12 years), B (13-45 years) & C (46-80 years) respectively. Highest number of gland was seen in Group B (5.66 to 22.48 per sq mm) & lowest number of gland was seen in Group A (3.30 to 9.95 per sq mm). The present study findings were compared with that of the references.

Gliomatosis Cerebri: A Rare Brain Tumor

Gliomatosis Cerebri is a rare brain tumor. There is diversity of presentation in cases due to the nature of its diffuse involvement. Very recently, on February 2016 in the department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh we encountered a 10 years old boy who initially mimicked as tuberculoma of brain but later on diagnosed as Gliomatosis Cerebri on the basis of brain MRI and brain biopsy. Prognosis is always very gloomy regardless of the treatment strategy adopted. The boy died within one year after confirmation of diagnosis even after getting adequate medical management and radiation therapy.

Ultrasonographic Evaluation of Malignant Pediatric Abdominal Tumour with Histopathological Correlation

Ultrasonography is a very useful diagnostic tool to evaluate pediatric abdominal mass. This cross sectional study was conducted among clinically suspected patients having malignant abdominal mass attending in the department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2008 to December 2009. Total 56 patients were included in this study. Patients were scanned by high resolution gray scale ultrasonography of the abdominal masses. After surgical procedure, biopsy specimen were collected in a container containing 10% formalin and sent for histopathological examination. Mean age of the patients group was 5.91 years with a standard deviation of ±3.21 years. All patients were within 2 to 13 years age. Out of all patients, male were 33(58.9%) and 23(41.1%) were female. Male and female ratio was 1.4:1. Ultrasonographic diagnosis as Wilm's tumour were 27(48.2%), hepatoblastoma 8(14.3%), lymphoma 7(12.5%), neuroblastoma 6(10.7%), suspected malignancy 6(10.7%) and lastly teratoma were 2(3.6%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ultrasonography in the evaluation of Wilm's tumour were 100.0%, 90.6%, 88.9%, 100.0% and 94.6% for neuroblastoma 83.3%, 98.0%, 83.3%, 98.0% and 96.4% for lymphoma 83.3%, 96.0%, 71.4%, 98.0% and 94.6% and for hepatoblastoma 100.0%, 100.0%, 100.0%, 100.0% and 100.0% respectively. It is a noninvasive and cost effective modality. Carefully performed ultrasonographic study would give reliable and accurate information needed in the diagnosis of abdominal malignancy in children.

Entropy, specific heat, susceptibility, and Rushbrooke inequality in percolation

We investigate percolation, a probabilistic model for continuous phase transition, on square and weighted planar stochastic lattices. In its thermal counterpart, entropy is minimally low where order parameter (OP) is maximally high and vice versa. In addition, specific heat, OP, and susceptibility exhibit power law when approaching the critical point and the corresponding critical exponents α,β,γ respectably obey the Rushbrooke inequality (RI) α+2β+γ≥2. Their analogs in percolation, however, remain elusive. We define entropy and specific heat and redefine susceptibility for percolation and show that they behave exactly in the same way as their thermal counterpart. We also show that RI holds for both the lattices albeit they belong to different universality classes.

Prevalence of GERD in Type II Diabetes Mellitus Patients Admitted in A Tertiary Care Hospital of Bangladesh

Gastroesophageal reflux disease (GERD) is defined as symptoms or complications associated with regurgitation from the stomach and/or the duodenum to the esophagus. Patients with type II diabetes mellitus (DM) were known to have higher prevalence of GERD in the Western countries, but data on the impact of GERD on DM patients in our country are scarce. The aim of this cross-sectional study was to evaluate the presence of GERD in type II DM patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2015 to September 2015. A total of 137 type II DM cases were purposively collected. Reflux Disease Questionnaire (RDQ) was used to check the presence of GERD. Patient's characteristics, laboratory data, face-to-face interview data were analyzed. Out of 137 type 2 DM patients 108 were suffering from GERD giving a prevalence rate of 78.8% which is quite high. Pathophysiological factors like age, sex, duration of DM, weight, waist circumference (WC) had no significant difference between GERD-DM and non-GERD-type II DM patients. Only hypertension and frequent eating fatty food were found to have significant differences between the two groups. From the study findings it could be said that the higher rate of GERD in patients with type II DM may be associated with lifestyle factor and some pathophysiological factors like hypertension. Psychiatric factors may also play role in contributing GERD. Further in-depth and large scale studies are necessary in our country in this regard.

Detection of Ovarian Tumor by Color Doppler Ultrasonography and CA-125

Ovarian cancer is the most frequent cause of death from all gynaecological malignancies because of its insidious onset, vague symptoms and late presentation. This cross-sectional study was carried out on purposively selected 43 patients with suspected ovarian tumor in the Department of Radiology and Imaging in collaboration with the Department of Gynaecology and Obstetrics and Department of Pathology, Mymensingh Medical College Hospital, Bangladesh from January 2015 to December 2016 to assess the diagnostic performance of color Doppler ultrasonography and CA-125 in a combination described as Novel Index in detection of ovarian tumor. Highest number of patients of ovarian tumor 10(23.26%) were in age group 35 to 44 years and 45 to 54 years with a mean of 37.72±15.65 years with a range of 8-70 years. Histopathology findings revealed 19(44.18%) benign tumors and 24(55.82%) malignant tumors. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Resistance Index (RI) in diagnosis of ovarian tumor were 91.67%, 89.47%, 91.67%, 89.47% and 90.69% respectively. Sensitivity, specificity, PPV, NPV and accuracy of serum CA-125 were 83.33%, 89.47%, 90.90%, 80.95% and 86.04% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Novel index were 95.83%, 89.47%, 92.00%, 94.44% and 93.02% respectively. Novel index showed better diagnostic performance. Based on the current study it is concluded that the combination of color Doppler ultrasonography and serum CA-125 can be useful for diagnosis of ovarian tumor.

Correlation between Seropositivity of Chlamydia Trachomatis and Tubal and/or Pelvic Pathology Detected by Diagnostic Laparoscopy in Subfertile Women

This prospective observational study was carried out in the Infertility Unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February 2011 to December 2013. Sixty-nine (69) subfertile women who were seropositive for Chlamydia Trachomatis were included in this study. Inclusion criteria was patients with sub-fertility having age between 22 and 40 years, seeking infertility treatment, normal ovarian function, all normozoospermic male partner, duration of infertility ranged from 1.5 to 14 years. Exclusion criteria were patients having sub-fertility with extensive pelvic and/or ovarian surgery, endometriosis, ablation of endometriotic spots, pelvic tuberculosis and history of ectopic pregnancy. Before laparoscopic evaluation, all study women were screened for Chlamydia Trachomatis Specific IgG & IgM antibodies using ELISA in the Microbiology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All the study women had positive results for IgG antibodies. All study women underwent diagnostic laparoscopy. During laparoscopy, we observed the condition of pelvic cavity, uterus, fallopian tubes, ovaries, peritubal adhesions, tubo-ovarian relationship, status of Pouch of Douglas (POD), fimbriae etc. During dye test procedure, dilute methylene blue dye was injected through the cervical canal and the dye spill out was observed to confirm the tubal patency or blockage or pattern of flow of dye. The results of laparoscopic findings demonstrated that mobility of uterus was restricted in 20(29%) cases, adhesion of uterus with peritoneum was in 8(11.6%) cases, uterine fibroid was present in 11(15.9%) cases, hydrosalpinx in right fallopian tubes were in 27(39.1%) cases, in left fallopian tubes were in 32(46.4%) cases and in both fallopian tubes in 16(23.2%) cases, inflamed right fallopian tubes in 32(46.4%) cases, inflamed left fallopian tubes in 36(52.2%) cases and inflamed both fallopian tubes in 26(37.7%) cases, adhesions in pouch of Douglas was in 4(5.8%) cases, collections in pouch of Douglas was in 7(10.1%) cases and obliterations in pouch of Douglas was in 5(7.2%) cases. Results of Dye test during laparoscopy were that right fallopian tube was blocked in 32(46.4%) cases, left fallopian tube was blocked in 32(46.4%) cases and both fallopian tubes were blocked in 21(30.4%) cases. This study shows that by laparoscopy, significant number of cases of tubal and pelvic pathology was diagnosed in the chlamydia trachomatis seropositive subfertile female. This indicates strong correlation between seropositivity of chlamydia trachomatis and/or pelvic pathology detected by diagnostic laparoscopy.

An Evaluation of the Result of Fenestration and Discectomy for the Treatment of Prolapsed Lumber Intervertrebal Disc (PLID)

The aim of this study is to asses the result of fenestration and discectomy for the treatment of PLID. This Prospective quasi experimental study was conducted on 29 Patient of PLID with different ages at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2014 to June 2016. Post Operative outcome was assessed through Modified Macnab Criteria & Visual Analogue Score (VAS). The mean age of patient were 38.14±9.20 years and ranging from 24 to 55 years. The mean age of male was 37.21±9.72 years and female patient was 39.90±8.32 years. Overall subjective assessment of this study revealed that 79.2% patients had excellent functional outcome, 13.8% good and 6.9% fair and there was no poor functional outcome a according to modified Macnab criteria.

A Comparative Study of Magnetic Resonance Imaging and Transabdominal Ultrasonography for the Diagnosis and Evaluation of Uterine Fibroids

Uterine fibroids often cause symptoms of pelvic pain, pressure, and bleeding and a significant cause of morbidity for women of reproductive age. A new, Food and Drug Administration approved noninvasive treatment option is magnetic resonance guided focused ultrasound surgery, which has the potential to become a treatment of choice for selected patients. The purpose of the study was to compare and evaluate the usefulness of MRI and transabdominal ultrasonography for the diagnosis of uterine fibroids. A cross sectional study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of January' 2010 to December 2011. A total number of 40 consecutive patients having suspected uterine fibroids underwent MRI and transabdominal ultrasonography and they were followed up from the admission upto the tissue diagnosis of uterine fibroids for histopathological correlation were included in this study. The test of validity of MRI and transabdominal ultrasonography in diagnosis of uterine fibroids was calculated. In the diagnosis of uterine fibroids, USG was 88.2% sensitive, 66.7% specific, 85.0% accurate, 93.8% positive predictive values and 50% negative predictive values. However MRI was 97.1% sensitive, 83.3% specific, 95.0% accurate, 97.1% positive predictive values and 83.3% negative predictive values for prediction of uterine fibroids. The study shows that the MRI is more efficient diagnostic modality than transabdominal ultrasonography in detecting uterine fibroid presence and evaluation.

Why Abortion is Illegal? Comparison of Legal and Illegal Abortion: A Critical Review

Abortion is the termination of pregnancy that occurs spontaneously or purposely. In the most developed world, abortion is legally allowed for women seeking safe termination of pregnancies. Particularly, when access to legal abortion is restricted, abortion is the resort to unsafe methods. The aim of this review is to necessitate safe abortion and to accentuate the consequences of illegal abortion in case of legal prohibition. We used Pubmed, MedLine and Scopus databases to review previous literatures of safe, unsafe, legal and illegal abortions. Research work and reports from organizations such as World Health Organization (WHO), World Bank (WB) and United Nations (UN) were included. Snowball sampling was used to obtain relevant journals. Abortion is conventional whether it is safe, unsafe, legal or illegal. The intention of the antiabortion policy was to reduce the number of abortions globally. However, instead of decreasing rates, evidences show significant increase in abortions. When abortion is legal, the preconditions to be ensured are availability, accessibility, affordability and acceptability for the safe abortion facilities. When abortion is illegal, risk reduction strategies are needed to decrease maternal morbidity and mortality. We can reduce abortion related morbidity and mortality, whether it is legal or illegal if we can ensure the appropriate access to health care, including abortion services, education on sexuality, access to contraceptives, post abortion care, and suitable interventions and liberalization of laws. The paper reviewed the Mexico City Policy and the US foreign aid strategies and highlighted the evidence based analysis for policy reform. The liberalized abortion law can save pregnant women from abortion related complications and death.

Surgical Treatment of Hepatolithiasis: Our Experience in Bangabandhu Sheikh Mujib Medical University

Recurrent cholangitis and sepsis are common complications after surgical treatment for hepatolithiasis as total clearance is not always possible. This retrospective study is designed to see the effect of our treatment for hepatolithiasis on stone clearance and post operative complications. We have treated 60 patients with hepatolithiasis surgically from September 2010 to September 2016 in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Various operative procedures were applied on the basis of location of stone and status of biliary tree. Choledocoscopic examination was performed during surgery for checking and cleaning of intrahepatic duct. Regular follow up was given and outcome was assessed. The chronological changes of treatment methods for patients with hepatolithiasis were analyzed for appropriate treatments for particular type. There were 22 males and 38 females with age ranges from 15 to 60 years. The stone were located in left duct (56.6%), right duct (10%) and both duct (33.4%). The most commonly performed operation was extended choledocholithotomy and hepatolithotomy and it was performed in 28 patients (46.7%). Segmentectomy and lobectomy was performed in 17 patients (28.3%). Common bile duct (CBD) excision, hepatolithotomy and hepaticojejunostomy with or without segmentectomy, lobectomy and Houston access loop formation was performed in rest of the patients. Stones could be removed completely in all patients who underwent lobectomy or segmentectomy. In contrast stone clearance was possible only in 57.2% and 55.5% who underwent extended choledocholithotomy and hepatolithotomy, and excision of CBD, hepatolithiasis with hepaticojejunostomy for unilateral or bilateral hepatolithiasis respectively. Houston's access loop to stomach was made in 2 patients for future endoscopic removal of stone. There was no mortality in the present series but morbidity occurred in 18 patients; wound infection (n=15, 25%), bile leakage (n=1, 1.7%), and renal dysfunction (n=1, 1.7%), septicemia (n=1, 1.7%). Patients who underwent lobectomy or segmentectomy did not develop cholangitis or sepsis on 1 to 3 years follow up. In contrast who underwent extended choledocholithotomy and hepatolithotomy, 70.8% patients developed cholangitis and sepsis, and the patients who underwent excision of CBD, hepatolithotomy with hepaticojejunostomy 50% developed cholangitis and sepsis within 1 to 3 years of follow up, required re-operations or conservative treatment. The difference of developing postoperative cholangitis and sepsis is significant (p<0.05) between patient who underwent extended choledocolithotomy and hepatolithotomy, and who underwent excision of CBD, hepatolithotomy and Roux-en-Y hepaticojejunostomy. In conclusion, lobectomy or segmentectomy is the best option for hepatolithiasis if the stones are limited to a lobe or segment. Excision of CBD, hepatolithotomy with hepaticojejunostomy is better than extended choledocholithotomy and hepatolithotomy for bilateral hepatolithiasis. Huston's access loop formation associated with other procedures may be considered for bilateral hepatolithiasis for future minimal invasive stone retrieval procedure as residual stones and recurrent stone formation is common.

Local Juvenile Hormone activity regulates gut homeostasis and tumor growth in adult Drosophila

Hormones play essential roles during development and maintaining homeostasis in adult organisms, regulating a plethora of biological processes. Generally, hormones are secreted by glands and perform a systemic action. Here we show that Juvenile Hormones (JHs), insect sesquiterpenoids synthesized by the corpora allata, are also synthesized by the adult Drosophila gut. This local, gut specific JH activity, is synthesized by and acts on the intestinal stem cell and enteroblast populations, regulating their survival and cellular growth through the JH receptors Gce/Met and the coactivator Tai. Furthermore, we show that this local JH activity is important for damage response and is necessary for intestinal tumor growth driven by activating mutations in Wnt and EGFR/Ras pathways. Together, our results identify JHs as key hormonal regulators of gut homeostasis and open the possibility that analogous hormones may play a similar role in maintaining vertebrate adult intestinal stem cell population and sustaining tumor growth.

Multi-scale model of food drying: Current status and challenges

For a long time, food engineers have been trying to describe the physical phenomena that occur during food processing especially drying. Physics-based theoretical modeling is an important tool for the food engineers to reduce the hurdles of experimentation. Drying of food is a multi-physics phenomenon such as coupled heat and mass transfer. Moreover, food structure is multi-scale in nature, and the microstructural features play a great role in the food processing specially in drying. Previously simple macroscopic model was used to describe the drying phenomena which can give a little description about the smaller scale. The multiscale modeling technique can handle all the phenomena that occur during drying. In this special kind of modeling approach, the single scale models from bigger to smaller scales are interconnected. With the help of multiscale modeling framework, the transport process associated with drying can be studied on a smaller scale and the resulting information can be transferred to the bigger scale. This article is devoted to discussing the state of the art multi-scale modeling, its prospect and challenges in the field of drying technology. This article has also given some directions to how to overcome the challenges for successful implementation of multi-scale modeling.

Molecular Detection and Differentiation of Mycobacterium Tuberculosis Complex and Non-tuberculous Mycobacterium in the Clinical Specimens by Real Time PCR

Mycobacteria are subdivided into three groups: the Mycobacterium tuberculosis complex, the non-tuberculous mycobacteria called NTM or MOTT (Mycobacteria Other Than Tuberculosis) and Mycobacterium leprae. Over the past few decades, the incidence of infections caused by NTM has increased world wide. The differentiation of Mycobacterium tuberculosis complex from NTM is of primary importance for infection control and choice of antimicrobial therapy. However, there is so far no report in Bangladesh about the detection of NTM and hence differentiation of MTB and NTM. Neither acid-fast bacilli (AFB) staining nor histopathology can discriminate MTB and NTM. In order to detect and differentiate Mycobacterium tuberculosis complex and NTM we used commercially available LyteStar TB/NTM Real Time PCR kit (Altona Diagnostics, Germany) and analyzed 782 clinical specimens from tuberculosis suspected patients. We have found 49 MTB and 74 NTM positive samples from variety of clinical specimens such as sputum, bronchial lavages, body fluids, tissues, needle aspirates and swabs. Many of the PCR positive specimens were AFB negative on direct microscopic examination thus, indicating strong sensitivity of PCR than AFB staining. This is the first report in the country about detection of NTM and it warrants further elaborate investigation. Moreover, our results showed that multiplex real-time PCR assay is an effective sensitive tool for the rapid identification and differentiation of MTB and NTM directly from clinical specimens.

Incidental Thyroid Carcinoma in Patients Treated Surgically for Presumably Benign Thyroid Disease

Incidental Thyroid Carcinoma (ITC) is quite high as been reported in the world's Journal. This study reviews the frequency of the ITC in patients treated surgically for otherwise benign Thyroid disease in one of the Endocrine surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This study was developed by the investigating the outcome of one hundred and twenty seven patient who underwent partial or total thyroidectomy for benign thyroid pathology in a single Endocrine Surgery Unit of BSMMU from January 2011 to July 2015. This observational study was done to find out the actual incidence of thyroid malignancy among the patients admitted for surgical management with thyroid pathology. All patients underwent at least FNAC and Ultrasonography of the Neck before surgery. Patients with undetermined cytology and follicular nodules were excluded from the study. Overall 19(14.96%) incidental thyroid carcinoma was recorded. Among the ITC 11(8.66%) Papillary Carcinoma, 7(5.51%) Follicular Carcinoma & 1(0.79%) is poorly differentiated carcinoma. The Overall incidence of papillary carcinoma is higher among the incidental carcinoma of Thyroid. Increased incidence associated with follicular adenoma present as an isolated thyroid nodules or multifocal lesion and should be considered malignant potential and total thyroidectomy would be the right choice as surgical management of the both cases. In case of multinodular goiter, total thyroidectomy is currently practiced in majority of the centers and our observations reinforced the attitude further.

Ebstein's Anomaly Associated with Atrial Septal Defect and Wolff-Parkinson-White (WPW) Syndrome

Ebstein's anomaly is a rare congenital heart disorder, accounting for <1% of all cases of congenital heart disease. It is a congenital malformation of the heart that is characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialization of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet. We report the case of a 25 years old female with Ebstein's anomaly which was associated with Ostium Secundum type of atrial septal defect and WPW syndrome, who presented with dyspnea, palpitations, cyanosis, clubbing and cardiomegaly.

Correlation of Stature with Foot Length in 5-10 Years Aged Bangladeshi Children

This cross sectional, descriptive and analytic type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat) on 109 Bangladeshi children (70 male and 39 female) from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of foot deformity resulting either from congenital or physical injury were excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding foot length, to measure correlation of stature with foot length and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Stature of the subject was measured with the stadiometer and foot length was measured using slide calipers. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean foot length of 5, 6, 7, 8, 9 and 10 years aged male were 16.72±1.11cm, 17.12±.72cm, 19.04±1.27cm, 19.10±.76cm, 20.11±1.25cm and 20.88±1.01cm respectively and those of same aged female were 16.44±1.2cm, 17.85±0.50cm, 18.53±0.76cm, 19.14±0.58cm, 19.87±1.88cm and 20.95±1.36cm respectively. Correlation between stature and foot length was made. Foot length showed non- significant positive correlation with stature in 5 years old male and female, 6 years old male, 7 years old male and female, 8 years old male and female, 9 years old and 10 years old female. In case of 9 years and 10 years old male, it showed significant positive correlation with stature. Comparison of foot length between male and female children was done by Unpaired Students 't' test which was statistically non-significant.

Response & Side Effects of Injectable Labetalol in Pregnancy Induced Severe Hypertension

The study was performed to assess the response & side effects of injectable Labetalol in the treatment of pregnancy induced severe hypertension. This interventional study was carried out on 72 patients having pregnancy induced severe hypertension attended in the Department of Obstetrics & Gynaecology, Mymensingh Medical College & Hospital (MMCH), Mymensingh, Bangladesh from November 2009 to October 2010. All patients were treated with intravenous Labetalol 20mg & the dose was repeated at sequential escalating dosages every 15 minutes until a therapeutic goal of systolic blood pressure <160mm of Hg & diastolic blood pressure <105mm of Hg were achieved. Among 72 respondents highest number were observed having systolic blood pressure 160-169 and 180 & above mm of Hg. The mean systolic & the diastolic blood pressure at the initiation of the study were observed 198±13.17mm of Hg & 119±8.6mm of Hg respectively. After use of injection Labetalol mean systolic blood pressure were 138.61±15.43mm of Hg, which is statistically significant (p value <0.001) & mean diastolic blood pressure were 96.18±9.7mm of Hg, which is also statistically significant (p value <0.001). It was observed that majority patients' blood pressure was controlled by 1-2 doses. It was noticed that injection Labetalol controls blood pressure in 80% antenatal cases & 86% postnatal cases. Out of 72 patients 4 cases (5.5%) experienced nausea & vomiting and only 1 case (1.1%) experienced headache. Regarding fetal outcome 48% patients delivered healthy baby, about 31% patients delivered asphyxiated baby & neonatal death were noticed in 4% cases. This study assessing the response & side effects of intravenous antihypertensive drug in the treatment of pregnancy induced severe hypertension shows that Labetalol fulfils the criteria of an antihypertensive drug for this purpose.

Explosive percolation on a scale-free multifractal weighted planar stochastic lattice

In this article, we investigate explosive bond percolation (EBP) with the product rule, formally known as the Achlioptas process, on a scale-free multifractal weighted planar stochastic lattice. One of the key features of the EBP transition is the delay, compared to the corresponding random bond percolation (RBP), in the onset of the spanning cluster. However, when it happens, it happens so dramatically that initially it was believed, although ultimately proved wrong, that explosive percolation (EP) exhibits a first-order transition. In the case of EP, much effort has been devoted to resolving the issue of its order of transition and almost no effort has been devoted to finding the critical point, critical exponents, etc., to classify it into universality classes. This is in sharp contrast to the situation for classical random percolation. We do not even know all the exponents of EP for a regular planar lattice or for an Erdös-Renyi network. We first find the critical point p_{c} numerically and then obtain all the critical exponents, β, γ, and ν, as well as the Fisher exponent τ and the fractal dimension d_{f} of the spanning cluster. We also compare our results for EBP with those for RBP and find that all the exponents of EBP obey the same scaling relations as do those for RBP. Our findings suggest that EBP is not special except for the fact that the exponent β is unusually small compared to that for RBP.

Ultrasonographic Evaluation of Palpable Breast Mass and Correlation with Histopathology

Breast cancer is the most common malignancy in women and the second most common cause of cancer-related mortality. The distinction by physical examination of physiologic nodularity from abnormal masses can be difficult, while the clinical differentiation of a malignant mass from a benign one is difficult; the medical as well as potential legal consequences of missing a palpable carcinoma are high. There are significant number of reported cases of false-negative findings on mammography and the great desire not to miss a malignant lesion in the early stage of disease lead to aggressive biopsy, but the biopsy rate for cancer is only 10.0% to 30.0%. This means that 70.0% to 90.0% of breast biopsies are performed for benign diseases, which induce unnecessary patients discomfort and anxiety in addition to increasing costs to the patient. Clearly, there is a great need for development of additional reliable methods to complement the existing diagnostic procedures to avoid unnecessary biopsy. This cross sectional study was carried out on 43 patients having palpable breast mass, attended in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st January 2012 to 31st December 2013 for the period of two year. These patients were evaluated by USG at the Department of Radiology and Imaging and histopathological examination at the Department of Pathology of the same College to confirm the diagnosis. In diagnosis of malignant mass by USG, 9(20.9%) cases were diagnosed as malignant and 34(79.1%) cases as other than malignant. Eight out of 9 were sonographically diagnosed as malignant lesions also proved as malignant lesion by histopathology and 1 other than malignant. Out of 34 sonographically diagnosed cases of other than malignant lesions 32 were proved histopathologically and 2 did not match with sonographic findings. USG, in diagnosis of malignant lesion, sensitivity was 80.0%, specificity 96.97%, positive predictive value (PPV) (88.89%), negative predictive value 94.12% and accuracy was 93.02% and comparable to other study. In diagnosis of benign lesion by USG, sensitivity was 96.97%, specificity 80.0%, positive predictive value (PPV) (94.12%), negative predictive value 88.89% and accuracy was 93.02%. So, USG is an appropriate imaging method for diagnosis & differential diagnosis of palpable breast mass.

Primary and Revision Lumbar Discectomy: A Four-Year Review from Our Private Practice

The surgical treatment of symptomatic lumbar disc herniation is now focused on nerve root decompression with preservation of the bony and ligamentous stabilizers of the spine. Various techniques of discectomy have been devised in accordance with this principle and irrespective of the technique used; primary disc surgeries have generally known to give good results. This retrospective study was done in different private clinics & hospitals of Dhaka city, Bangladesh from January 2012 to December 2015. Of the 105 lumbar discectomies performed during the study period, 95(90.4%) patients fulfilled the inclusion criteria and were included in the analysis. Of these, 90 patients had primary discectomy, while the remaining 5 were revision surgeries. The follow-up varied from 1-4 years, but the clinical outcomes were evaluated at the end of one year from surgery in all the patients. In the primary surgery group there were 50(55.56%) men and 40(44.44%) women, while the revision group had 01(20%) men and 04(80%) women. The age distribution was similar in both the groups, with the maximum numbers (44% and 42.9%) in the fourth decade of life. Of the 05 patients who underwent revision surgery, 03 belonged to the primary surgery group of this study, while the remaining 02 had undergone their primary surgery elsewhere. Excluding the two residual discs, the remaining 03 patients with recurrences gave a history of complete resolution of symptoms after the primary surgery. Amongst these, 3(60%) had a history of a precipitating event prior to onset of pain, 2 had a definitive history of significant lack of physical activity. The time interval between the primary and revision surgery ranged from three months to 10 years (average 2.6 years).

Bopyrid isopods parasitizing on the cultured fresh water prawn, Macrobrachiummalcolmsonii in South India

The bopyrid isopods are common in wild Macrobrachium spp. but not common in aquaculture condition. This is the first study that reports the parasitizing of bopyrid isopods on the cultured M. malcolmsonii. Bopyrid isopod (Probopyrus buitendijki) was identified in the branchial cavities of the fresh water prawn, M. malcolmsonii from grow-out culture pond at Kuriyamangalam, India. Macrobrachium malcolmsonii is a new host for P. buitendijki. A total of 1323 M. malcolmsonii were checked for this study. The overall prevalence of the parasitic infestation was reached 46.2 %. The parasitic infection was higher in female (83 %) than in male (3.4 %). Highest prevalence of infestation was found in the median size group (7-8 cm) (58.7 %). Infected females were not berried unlike uninfected prawns. The parasites cause infertility and does not found any organ deformities due to the infestation. The parasite was inversely attached in the gill chamber with no lesion on the gill but the infected branchial chamber became bulged.

Flow Cytometric Immunophenotyping of Acute Leukemia the Essential Considerations

Objective: This article serves to promote the interest of participants involved in management of hematological malignancies in the efficacy of flow cytometry in the immunophenotypic characterization of leukemias and lymphomas. This well-defmed characterization plays a crucial role in diagnosis, classification, prognostic evaluation, and detection of minimal residual disease, in the context of clinical features and morphological diagnosis.Methodology: Relevant literature was retrieved to highlight the principles of operation of flow cytometly, applications, derivable clinical information, sources of errors, necessary antibodies and general considerations towards definitive diagnosis of acute leukemia.Conclusion: Hematological malignancy is an extremely heterogeneous disorder. Use of flow cytometric immunophenotyping in these disorders is already proven over two decades and allowed clinicians for proper classification along the latest WHO classification guidelines and will pave the way for targeted therapy and better patient management. The flow cytometric immunophenotyping services in the country will significantly outweigh the cost by reducing the duration of hospital stay and patient management in right way.Pulse Vol.9 January-December 2016 p.27-36

Detection of Nontuberculous Mycobacterium by Real Time PCR from Variety of Clinical Specimens

Aim: Nontuberculous mycobacterium (NTM) causes many types of infections including respiratory and non-respiratory infections such as skin and soft tissue infections, lymphadenitis, meningitis, gastro-intestinal infections, disseminated infections and even intravenous catheter-related infections. Increasing incidence of NTM is reported worldwide in last decade. However, incidence of NTM in Bangladesh is not known as detection of NTM is not undergoing in Bangladesh which is necessary to know as these NTM species are resistant to first-line anti-TB drugs and, when mistaken for M. tuberculosis, give rise to erroneous identification of multidrug-resistant TB (MDR-TB). We wanted to know the existence of NTM from various clinical specimens including tissues from tuberculosis suspected patients visited in Apollo Hospitals Dhaka in 2013 to 2015.Material and Method: Sample processing, DNA extraction and real time PCR (polymerase chain reaction) were done according to the commercial LyteStar TB/NTM PCR kit developed by Altona Diagnostics, Germany. The target DNA sequences are amplified with IS61 10-specific primers for MTB complex and ITS-specific primers for NTM. Probes specific for MTB complex and NTM DNA are labeled with fluorophore dye FAM and HEX, respectively. We have analyzed 579 clinical specimens from tuberculosis suspected patient.Result: Among 579 specimen different types of tissues were 201 and histopathology data were available for 166 cases. In tissues NTM was detected by PCR in 3 1(19%) cases, 8 of which were compatible with histopathology findings and rest 23 cases showed no evidence of granulomatous lesion. We analyzed 378 different varieties of clinical specimens such as sputum, bronchial lavages, body fluids, pus and swabs. Among 378 samples 215 samples were requested for AFB staining. NTM was detected by PCR in 19(8.8%) samples and out of 19 NTM positive specimens only one was AFB positive.Conclusion: This is the first report in the country about detection of NTM in variety of clinical specimens and warrants further elaborate investigation. Our results showed that PCR is an effective tool for the rapid identification of NTM from tissues and AFB negative clinical specimens having suspicion for mycobacterial infection.Pulse Vol.9 January-December 2016 p.15-21

Abstract P6-17-04: Mechanisms of drug sensitization by DHA on doxorubicin-resistant human breast adenocarcinoma

This abstract was not presented at the symposium.

Dental Anomalies and Gender Dimorphism in Tooth Size of Malay Patients

Objectives: To determine the prevalence of dental anomalies, sexual dimorphism and antimere differences of tooth size of Malay in Malaysia.Methods: Orthodontic patients for the years 2008-2010 were selected. Among these two hundred patients’ were selected based on file records. Their panoramic radiographs were examined. The prevalence of various dental anomalies was determined. Mesiodistal and buccolingual diameters of the teeth were measured using electronic calipers with accuracy of up to 0.01mm. Analysis was carried out using SPSS statistical package version 18.0 (2009).Results: In the Malay patients the frequency of hypodontia was 7.5%, followed by hyperdontia (2%), microdontia, dens evaginatus and short root were 1%, respectively. In addition, their macrodontia, germination and dilaceration were 0.5% , while the remaining 86% did not display any dental anomalies. This study demonstrated greater tooth sizes in male compared to female subjects except for buccolingual site of upper canine and lower incisors. Greatest dimorphism in mesiodistal dimension was noted in the lower canine while buccolingual dimension was presented by upper lateral incisor. It was found that there was no significant difference (P>0.05) in tooth measurements for right and left antimeres observed for the majority of tooth classes.Conclusion: In the Malay subjects, hypodontia was the commonest dental anomaly. The Malay males had greater tooth sizes than their female counterparts. There were almost no significant antimere differences in tooth sizes.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.115-121

Risk Factor Pattern of Ischemic Heart Disease in Young Male Patients with Vertex Baldness

Acute coronary syndrome (ACS) is increasingly evident in all parts of the globe as well in our country. There are accumulating evidences regarding many physical markers, like vertex baldness to predict ACS. This cross sectional study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2014 to September 2015. The main objective of the study was to assess the risk factors of premature coronary artery disease (CAD) of male patient of Acute Coronary Syndrome with or without vertex baldness. A total of 100 male patients with age between 25 to 55 years was included as study population. The study population was divided into two groups; each group consisted of 50 patients. Acute coronary syndrome in patients with vertex baldness mentioned as Group A and ACS in patients without vertex baldness mentioned as Group B. All risk factors were higher in group A than group B. But diabetes mellitus, metabolic syndrome and family history of ischemic heart disease (IHD) were significantly higher in group A than in group B (p=0.003, p=0.008, <0.001). Probably as first study in Bangladesh, it may label vertex baldness as a cutaneous marker of premature CAD.

Apical extrusion of sodium hypochlorite irrigation during root canal treatment using monoject or hypodermic irrigation needle

Objective: Sodium hypochlorite has been routinely delivered into the pulp canal via irrigation needle. The study aimed at to determine the advantage and disadvantage of apical extrusion of sodium hypochloride using monoject or hypodermic irrigation needle in root canal treatment.Materials and Methods: Eighty single rooted teeth with closed apices were used in this in vitro study to determine apical extrusion of sodium hypochlorite using the gel diffusion technique. Extracted human anterior teeth were used as study samples. Monoject (size 27G) and hypodermic (27G× ½, 0.40×13mm, Terumo Needle) irrigation needle were used. The highest concentration of 5.25% hypochlorite solution was used for irrigation. To standardize the time diffusion of the dye, the gel was photographed at exactly 20 minutes after the initial irrigation with sodium hypochlorite.Results: A total of 36 out of 40 (90%) teeth in the hypodermic needle group showed positive apical extrusion compared to 14 of 40 teeth (35%) in the monoject group regardless of apical size. The discoloration of agar was clearly obtained after the sample tooth had been irrigated with sodium hypochlorite indicating the sign of apical extrusion. It is therefore; recommend that monoject irrigation needle should be used by students regardless of costs during root canal treatment in the polyclinic or dental clinic due to its safety in order to prevent sodium hypochlorite accident.Conclusion: Monoject needle showed significantly less sodium hypochlorite extrusion compared to hypodermic needleBangladesh Journal of Medical Science Vol.15(4) 2016 p.575-578

Dental intervention perspective: Anatomical Variation of Mental and Mandibular Foramen in Selected Malay Patients

Background: Anatomical structures of head are essential to carry out almost all of dental procedures. In this regard to study the variation of mental and mandibular foramens are prerequisite for the intervention of clinical dentistry. The study was undertaken to determine the anatomical position of the mental foramen (mF) and mandibular foramen (MF) and their relationship.Methods and Methods: Eighty-seven selected Malay patients were examined at Universiti Kebangsaan Malaysia Dental Clinics in which 34 were male and 53 were female. The size and position of the mF in relation to tooth position were recorded. The size and position of the MF were recorded based on the horizontal and vertical dimensions consisting of reference point’s namely anterior and posterior border of ascending border of ramus as well as mandibular notch and lower border of mandibular ramus, respectively.Results: The mF was found to be most in line with second premolar (49%) on both sides in both sexes. The size of mF was larger on the right side and in male (p<0.05). The size of MF on the right and left side for both male and female did not differ significantly (p>0.05). The mean distance between the MF to occlusal plane was 10 mm (SD ±1.56) for both sides. There was no significant difference between mF and MF position (p>0.05).Conclusion: In the Malay population, anatomical relationship and variation between mental and mandibular foramen were not found to be significant. The information would be useful in dental intervention of the clinicians.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.450-454

Universality class of site and bond percolation on multifractal scale-free planar stochastic lattice

In this article, we investigate both site and bond percolation on a weighted planar stochastic lattice (WPSL), which is a multifractal and whose dual is a scale-free network. The characteristic property of percolation is that it exhibits threshold phenomena as we find sudden or abrupt jump in spanning probability across p_{c} accompanied by the divergence of some other observable quantities, which is reminiscent of a continuous phase transition. Indeed, percolation is characterized by the critical behavior of percolation strength P(p)∼(p_{c}-p)^{β}, mean cluster size S∼(p_{c}-p)^{-γ}, and the system size L∼(p_{c}-p)^{-ν}, which are known as the equivalent counterpart of the order parameter, susceptibility, and correlation length, respectively. Moreover, the cluster size distribution function n_{s}(p_{c})∼s^{-τ} and the mass-length relation M∼L^{d_{f}} of the spanning cluster also provide useful characterization of the percolation process. We numerically obtain a value for p_{c} and for all the exponents such as β,ν,γ,τ, and d_{f}. We find that, except for p_{c}, all the exponents are exactly the same in both bond and site percolation despite the significant difference in the definition of cluster and other quantities. Our results suggest that the percolation on WPSL belongs to a new universality class, as its exponents do not share the same value as for all the existing planar lattices. Besides, like all other cases, its site and bond type belong to the same universality class.

Comparison of Low Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh Region of Bangladesh

Altered metabolic and hormonal status of the body in pregnancy leads to changes in lipid profile. High Lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the Department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh during the period from July 2011 to December 2012 to compare the changes in low density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hrs. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has being found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum Low Density Lipoprotein (LDL) cholesterol increases in third trimester (174.83±13.78 mg/dl) than second trimester (156.77±7.96 mg/dl) of pregnancy. Therefore, lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

Doppler Assessment of Hepatic Venous Waves for Evaluation of Large Varices in Cirrhotic Patient

This cross sectional study was conducted to evaluate the role of doppler ultrasonography of hepatic venous waves for evaluation of large varices in cirrhotic patients from July 2013 to June 2015 in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Patients getting admitted in the ward with a diagnosis of cirrhosis were enrolled in the study and purposive sampling technique was adopted. The sample size was 43. Data were collected by face to face interview and some data were gathered by records review and analyzed with the help of SPSS windows version - 12 software programs. Statistical significance was set at P<0.05 and confidence interval set at 95%. The research protocol was approved by the local ethical committee. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although and it can certainly demonstrate the presence of varices. In 60.47% of patient's monophasic wave pattern was seen and in 39.53% of cases biphasic & triphasic wave pattern were detected. Endoscopic examination was performed in all selected patients. In this study, 67.44% is large varices, 32.66% is small varices. Chi Square test was done for hypothesis testing and it was found significant (<0.05) and it indicates monophasic wave in Doppler USG signifies large varices. This test was also done to find out whether any significant difference of hepatic venous waveform in between male and female but it was not significant (>0.05). Diagnostic performance of USG for evaluation of varices showed, Sensitivity: 86.2%, Specificity: 92.85%, PPV: 96%, NPV: 76.47%, Accuracy 88%. Correlation co-efficient was 0.0064 which indicates moderately positive correlation in between monophasic hepatic venous waveform pattern by Doppler USG and large varices in oesophagogastroduodenoscopic findings Normal hepatic wave form shows triphasic pattern. Loss of this pattern in cirrhosis is mainly due to loss of compliance of liver. In conclusion, the loss of triphasic pattern of hepatic wave form is highly sensitive in predicting the presence of large varices in cirrhotic patients and this doppler parameter may be used as a non-invasive test for cirrhotic patients, who wish to avoid upper GI endoscopy. Further studies using a combination of various doppler parameters are needed to create indices with a better predictive value.

Detection of CTX-M-type ESBLs Escherichia coli at Universiti Kebangsaan Malaysia Medical Centre

Objective: To determine ESBLs and CTX-M-type ESBL-producing Escherichia coli at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) by multiplex PCR.Materials and Methods: ESBL producing E. coli strains were confirmed by disk diffusion method. On the contrary, CTX-M-type ESBL-producing E. coli strains were confirmed by multiplex PCR.Results: Out of 554 collected E. coli isolates from UKMMC, 96 of these were detected as ESBL-producers. In 96 isolates, 76 viable strains were subjected to multiplex PCR for the detection of blaCTX genes. In which 70 (92.1%) were CTX-M-type ESBLs with the majority of CTX-M-1 group (77.1%), followed by CTX-M-9 group (21.4%) and one (1.4%) from CTX-M-2 group. Conclusions: CTX-M-type ESBLs were the predominant ESBL types isolated at UKMMC. CTX-M-1 and -9 groups were found in majority of the clinical isolates. Although phenotypic characteristics based on disk diffusion test provided similar results, however, molecular detection of genes of organisms is important for further epidemiological investigations.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.257-261

BCG lymphadenitis of a healthy infant

This is a case of a 2-month-old infant who had suppurative lymphadenitis at left axilla after Bacille Calmette Guérin (BCG) vaccination. She presented with a non-healing BCG wound and left axillary swelling associated with one-week fever at 2 months of age. Aspiration under general anaesthesia was done and pus sent for mycobacterium culture grew Mycobacterium tuberculosis complex. The patient improved without anti-tuberculosis treatment.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.283-285 

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.

Migraine in Children: A Review

Recurrent headache is common in children. Among them migraine is the most common disabling cause of primary headache. It causes serious disability in child's life and family. It causes negative impact on their quality of life. Clinical characteristic of migraine in children differ from adult. It may be shorter in duration and bifrontal or bitemporal in location in contrast to adult which is longer in duration and usually unilateral. It is less common before 3 years of age. Males are more affected before puberty. But after puberty females are predominantly affected. Intensity of pain is moderate to severe. There are some triggering factors. Positive family history usually present. Disability can be assessed by PedMIDAS scale in children and adolescents which is modified version of MIDAS scale for adult. Diagnosis of migraine usually clinical but evaluation should be done to exclude severe underlying secondary cause. Management consists of pharmacological and non pharmacological approach. Parental education, life style modification is the mainstay of management. Acute treatment consists of Acetaminophen, NSAIDs and Triptans. Among Triptans, Sumatriptan nasal spray is only found effective for children. Preventive therapy aims to decrease frequency and severity of headache. Flunarizine, Propranolol, Amitryptylline, Levetiracetam, Valproate, Topiramate are found effective in pediatric age group. Pediatrician should evaluate the child to exclude secondary cause of headache when indicated. They should have also proper knowledge and skills to manage a child having migraine to improve their quality of life and academic achievement.