First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation

First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.

Factors affecting the adoption of improved varieties of mustard cultivation in some selected sites of Bangladesh

Mustard is a leading oil crop in Bangladesh. Relevant data and information on the adoption of improved mustard varieties is very scanty and sporadic in Bangladesh. Therefore, an attempt was made to assess the extent of adoption of improved mustard varieties and their management practices at farm level. The study used data from 540 mustard growing farmers under Manikgonj, Rajshahi and Dinajpur districts. Probit regression model along with other descriptive statistics were used to analyze the collected data. Analysis revealed that the farm level adoption of different production practices were not encouraging as most farmers did not follow the recommendations made by Bangladesh Agricultural Research Institute (BARI) for mustard cultivation. The variety adoption scenario was also discouraging since only 40% of the farmers cultivated improved mustard varieties. However, farmers showed positive attitude towards adoption of improved mustard varieties since about 53% of the adopters wanted to increase area under improve mustard cultivation in next growing season considering the high yielding ability, low cultivation cost, high profit, and less labour requirements. Although mustard is considered to be a profitable crop, many farmers showed negative attitude towards its production due to some drawbacks. Non-availability of improved mustard seed was also found to be a barrier to its adoption at farm level.Bangladesh J. Agril. Res. 40(3): 363-379, September 2015

Re-DCR with Silicone Tube Intubation: An Effective Method of Management of Failed DCR

This prospective observational study was performed with twenty nine eyes of Twenty eight patients who were operated upon for chronic dacryocystitis eight months to two years six months before, presented with history of persistent watering and discharge. Number of male was 6(21%) and female was 22(79%). Re-DCR with silicone tube intubation was performed in all the patients. Post operative follow up for a period of 12-24 months revealed absence of symptoms in 28 eyes (97%) while 1(3%) eye persisted with watering and discharge despite uncomplicated surgical procedure. There are so many options for management of Failed DCR, among them Re-DCR with Silicone Tube Intubation is the most safe and less cost effective method.

Comparison of P2Y12 receptor inhibition by clopidogrel and prasugrel in patients undergoing percutaneous coronary intervention

Dual antiplatelet treatment (DAPT) with aspirin and clopidogrel is vital after percutaneous coronary intervention (PCI). Clopidogrel and prasugrel act on P2Y12 platelet surface receptors. Both these P2Y12 inhibitors are pro-drugs and depend on cytochrome system of the liver for their conversion to active metabolite. There is growing concern regarding suboptimal response in platelet inhibition by clopidogrel. Verify Now system got approval by Federal Drug Administration, USA, for assessing platelet function as its result is almost comparable to gold standard Light Transmission Aggregometry (LTA). There are no data on the prevalence of clopidogrel resistance in Bangladeshi population. Prasugrel, as an antiplatelet drug, is a newer introduction in this country. This study will show light on the efficacy of these drugs on our population especially in patients who undergo PCI where DAPT is mandatory. A total 120 (60 diabetics) patients with Acute Coronary Syndrome (ACS), were alternatively given 600 mg clopidogrel loading dose (LD) followed by 75 mg maintenance dose (MD) daily or 60 mg LD of prasugrel followed by 10 mg MD daily. Five samples of blood were taken at different time intervals over a period of 2 weeks. Measurement of percent inhibition of P2Y12 was done by VerifyNow. Patients who showed less than 20% inhibition (clopidogrel resistant) at any stage were switched to prasugrel. The outcomes of clopidogrel, prasugrel and clopidogrel switched to prasugrel groups were then compared. Nearly half (46.7%) of the patients in the clopidogrel group was found resistant to the drug as opposed to none in the prasugrel group. No difference was found between diabetic and non-diabetic subjects with respect to drug resistance. Intracoronary blood samples showed high degree of platelet inhibition with prasugrel. There was a gradual decline of platelet inhibition over two weeks with prasugrel. Almost fifty percent of the population is clopidogrel resistant in our study. Prasugrel is a much more potent antiplatelet drug and should be preferred in patients undergoing PCI. Prasugrel may also show resistance over time.

Fertility and Hatchability of Pekin and Muscovy Duck Eggs and Performance of Their Ducklings

Five hundred ten duck eggs of Pekin and each of Muscovy duck eggs were incubated to determine fertility and hatchability. The eggs were cleaned and stored at 18-21oC for 6 days prior to setting in the incubator. The eggs were incubated in a forced-draft electric incubator and the hatching performances were recorded. Ninety Pekin and ninety Muscovy day-old ducklings were randomly selected from the hatched ducklings for a growth trial. Each breed was divided into three replications and each replication had 30 ducklings. They were reared up to 10 weeks of age. Fertility of Muscovy duck eggs tended to be higher (P>0.05) than that of Pekin duck eggs. Hatchability of Pekin egg on fertile egg was higher (P<0.05) than that of Muscovy eggs. But, dead in shell of Muscovy duckling was higher (P<0.05) than that of Pekin duckling. Feed consumption was higher (P<0.01) in Muscovy ducklings than that of Pekin ducklings. Feed conversion was slightly higher (P>0.05) in Muscovy ducklings than that of Pekin. At 10 weeks of age, Muscovy ducklings were slightly heavier (P>0.05) than that of Pekin. It was concluded that the fertility of Pekin and Muscovy ducks are more or less similar while hatchability is higher in Pekin ducks. Muscovy ducks are superior in respect of feed conversion and growth rate.DOI: http://dx.doi.org/10.3329/pa.v20i1-2.16859 Progress. Agric. 20(1 & 2): 93 – 98, 2009

Neurofibroma of paranasal sinuses - a case report

Primary neurogenic tumors in nose and paranasal sinuses are unusual entities. The majority of the reported cases have dealt with neurilemmomas and isolated neurofibromas are extremely rare. Here a case of neurofibroma of the paranasal sinuses is described.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

Pattern of congenital heart diseases

This prospective observational study was done to find out the frequency of various forms of congenital heart disease (CHD) diagnosed by echocardiography. During the study period (January 2002 to December 2005) 2050 patients were screened by echocardiography. All patients were evaluated by cardiologists and had chest radiograph, electrocardiogram and echocardiography. Total 2050 patients were studied and among them 1071 had congenital heart disease. Male was 561(52.38%) and female was 510(47.62%). Atrial septal defect (ASD) was 374(34.92%), ventricular septal defect (VSD) was 318(29.69%), patent ductus arteriosus (PDA) 83(7.75%), pulmonary stenosis (PS) 58(5.42%), tetralogy of Fallot 162(15.13%), transposition of great vessels (TGA) 16(1.49%), Ebstein anomaly 5(0.4%), coarctation of aorta 1(0.09%) and single ventricle 2(0.19%). This distribution is more or less similar to that reported in studies at home and abroad. In this study atrial septal defect (ASD) was the commonest in acyanotic CHD and tetralogy of Fallot was the commonest cyanotic CHD.

Anhidrotic ectodermal dysplasia presenting as atrophic rhinitis

Ectodermal dysplasia is a complex group of familial disorders with numerous clinical characteristics, with an incidence of 7 in 10000 born alive children. Ectodermal dysplasia affects structures of ectodermal origin like the skin and its appendages as well as other non-ectodermal structures. The most common sites of involvement are the defects in the skin, hair, teeth, nails and sweat glands,which are of ectodermal origin. Though the dermatologists and paediatricians often manage such cases, we report one case of ectodermal dysplasia presenting with atrophic rhinitis.

Outcome of pregnancy in patients with congenital heart diseases

This prospective study was conducted to evaluate the outcome of pregnancies in women with congenital heart diseases. In this study 50 pregnant women age between 20-45 years with congenital heart diseases were included. Twenty two (44%) were presented with atrial septal defect, 12(24%) with ventricular septal defect, 5(10%) were with patent ductus arteriosus, 6(12%) with Fallot's tetralogy, 2(4%) with pulmonary stenosis, 2(4%) with Eisenmenger syndrome, 1(2%) with dextrocardia. Shortness of breath (60%) was the main presenting complaint. Normal vaginal delivery (52%) was done in majority of cases. Spontaneous abortion occurred in 16% of pregnancies. Major complications were heart failure 16%, arrhythmias 21%, cardiovascular mortality 4%, preeclampsia 4%, and eclampsia 2%. Premature birth 16%, fetal demise 4%, neonatal death 2% and cardiac anomaly at birth 2% were also observed. The outcome of pregnancy in women with congenital heart diseases is favourable with considerable maternal and neonatal complications.

Valvular heart disease in pregnancy: maternal and fetal outcome

The aim of this study was to evaluate the maternal and fetal outcome of pregnancy in Valvular Heart Disease (VHD). A better understanding of the effects of valvular abnormalities on pregnancy outcome is of value for risk assessment and the design of a therapeutic plan from the available information of a series of patient. A multicenter prospective study was carried out over a period of 5 years (2005-2009) involving 60 pregnant patients with valvular heart disease. Thirty eight patients (64%) had single valve involvement and mitral stenosis was the most predominant lesion (50%). Ten patients (16.7%) had undergone interventional and surgical correction prior to the pregnancy. Fourteen (24%) patients were identified as a NYHA class III-IV. Women with VHD had 8.35% pulmonary edema, 15.03% developed different types arrhythmia. The incidence of preterm birth and small for gestational age newborn was 11.69% and 13.36% respectively. There was one (1.67%) maternal death. Pregnancy in women with valvular heart disease is associated with remarkable unfavourable effect on maternal and fetal outcome which are related to severity of disease.

Carbonyl reductase 1 protects pancreatic β-cells against oxidative stress-induced apoptosis in glucotoxicity and glucolipotoxicity

Carbonyl reductase 1 (CBR1) plays an important role in the detoxification of reactive lipid aldehydes. Oxidative stress has been implicated in the pathogenesis of pancreatic β-cell failure. However, the functional role of CBR1 in pancreatic β-cell failure has not been studied yet. Therefore, we investigated the role of CBR1 in pancreatic β-cell failure under glucotoxic and glucolipotoxic conditions. Under both conditions, knockdown of CBR1 by specific siRNA increased β-cell apoptosis, expression of lipogenic enzymes (such as ACC, FAS, and ABCA1), intracellular lipid accumulation, oxidative stress, ER stress, and nuclear SREBP1c, but decreased glucose-stimulated insulin secretion. In contrast, overexpression of CBR1 showed the opposite effects. The antioxidants N-acetyl-l-cysteine and Tiron, as well as the FAS inhibitor cerulenin, reversed the effects of CBR1 knockdown. Interestingly, the expression level and enzyme activity of CBR1 were significantly decreased in pancreatic islets of db/db mice, compared with those of wild-type mice. In conclusion, CBR1 protects pancreatic β-cells against oxidative stress and promotes their survival in glucotoxicity and glucolipotoxicity.

Balloon mitral valvuloplasty: immediate and short term haemodynamic and clinical outcome

This prospective study was carried out in the Department of Cardiology, University Cardiac Center, Banghabandhu Sheikh Mujib Medical University, Dhaka, to evaluate the short term clinical and haemodynamic outcome of Balloon mitral valvuloplasty in mitral stenosis. Total 100 patients underwent percutaneous mitral commissurotomy out of which 60 cases had pure mitral stenosis and 40 patients had concomitant other nonsignificant valvular disease. Mitral valve dilatation increases in mitral valve area from 0.5+/-0.22 to 1.80+/-0.41 cm2. Mitral valve mean pressure gradient decline from 24.0+/-6.48 mm of Hg to 6.1+/-3.0 mm of Hg: mean left arterial pressure decline from 21.40+/-4.80 mm of Hg to 6.50+/-2.82 mm of Hg (p<0.001). The pulmonary artery systolic pressure decreased from 78.7+/-20.34 mm of Hg to 30.18+/-10.8 mm of Hg (p<0.001). Procedural success, as defined final mitral valve area>1.5 cm2 or>50% increase in area, was achieved in 95% patients. Serious complications occurred in 2(2%) patients and no death occurred in the study. Minor complications such as vasovagal reaction (03%), balloon rupture without sequelae (1%), hypotension, Seizure etc. during the procedure were also noted. Although percutaneous transvenous mistral commissurotomy appears to be effective at relieving the hemodynamic effects of rheumatic mitral stenosis, it is not without risk. In properly selected patients, however, it appears to have low morbidity and mortality. The overall results of this study demonstrate that the short term clinical and haemodynamic outcome of the procedure were excellent and the incidence of related complications were reasonable.

The effect of composite pig islet-human endothelial cell grafts on the instant blood-mediated inflammatory reaction

Instant blood-mediated inflammatory reaction (IBMIR) causes rapid islet loss in portal vein islet transplantation. Endothelial cells are known to protect against complement-mediated lysis and activation of coagulation. We tested composite pig islet-human endothelial cell grafts as a strategy to overcome IBMIR. Porcine islets were cocultured with human endothelial cells in specially modified culture medium composed of M199 and M200 for 1-9 days. A positive control group, negative control group, and the endothelial cell-coated group were examined with an in vitro tubing loop assay using human blood. The endothelial cell-coated group was subdivided and analyzed by degree of surface coverage by endothelial cells (< or = 50% vs. > 50%) or coculture time (< 5 days vs. > or = 5 days). Platelet consumption and complement and coagulation activation were assessed by platelet count, C3a, and thrombin-antithrombin complex (TAT), respectively. After 60-min incubation in human blood, the endothelial cell-coated group showed platelet consumption inhibition and low C3a and TAT assay results compared to uncoated controls. When the endothelial cell-coated group was subdivided by degree of surface coverage, the < or = 50% coated group showed less platelet consumption and less activation of complement and coagulation compared with the positive control (uncoated) group. On analysis by coculture time, only the subgroup cocultured for < 5 days showed the same protective effect. Human endothelial cell-coated pig islets, especially the partially coated and short-term cocultured pig islet-human endothelial cell composites, reduced all components of IBMIR. If the optimal endothelial cell-islet coculture method could be identified, human endothelial cell coating of pig islets would offer new strategies to improve xenogenic islet transplantation outcomes.

New salirepin derivatives from Symplocos racemosa

The phytochemical investigation of the n-butanol soluble fraction of the bark of stem of Symplocos racemosa Roxb. yielded two new phenolic glycosides of salirepin series, symplocuronic acid (1) and sympocemoside (2), while salirepin (3) was isolated for the first time from this plant. The structures of the new compounds were identified by 1D and 2D NMR techniques along with other spectral evidences and by comparison with the published data of closely related compounds.

[Calcified aortal stenosis and osteoporosis: bone metabolism of systemic calcium metabolism in the elderly]

AIM

To examine bone tissue, systemic calcium metabolism and bone remodeling in patients with calcified aortal stenosis of degenerative origin (DAS).

MATERIAL AND METHODS

The examination of 310 patients (mean age 73.2 years) was made with application of questioning, echocardiography, double energetic x-ray absorptionmetry, measurements of C-telopeptides, osteocalcin, vitamin D, parathyroid hormone with solid phase enzyme immunoassay.

RESULTS

Bone tissue mineral density (BTMD) was abnormal in 71% of examinees (osteopenia--40%, osteoporosis--31%). Vitamin D concentration under 50 nmol/l was in 76.3%, parathyroid hormone elevated above 100 pg/ml in 15.8% patients.

CONCLUSION

The severity of lumbar spine affection depended on severity of calcinosis of aortic valve, was associated with lowering of osteosynthetic activity and was not associated with the presence of osteoporosis risk factors, constitutional parameters, calcium metabolism changes. This suggests the existance of a special form of BTMD disorder in elderly patients with aortal stenosis.

Evaluation of results of radiotherapy alone vs combined surgery and postoperative radiotherapy in carcinoma external auditory canal-10 years review

Forty-one patients of external auditory canal (EAC) cancer attended the Department of Radiotherapy (RT), Medical College Hospital, Kolkata during the period from 1987 to 1996. Majority were above 50 years of age with slight female preponderance. Out of 41 patients 36 patients completed the full course of treatment of which 12 patients underwent combined modality treatment (RT 50-55 Gy plus surgery) and 24 patients received primary RT alone (55-60 Gy). Radiation therapy was given in standard fractionation schedule. Retrospective analysis revealed complete response in 8/12 (66.7%) in combined modality treatment group and in 3/24 (12.5%) in RT alone group. The actuarial 2 year survival was 19%. following RT alone, 85% following combined modality, 70% in early lesions and 18% in advanced lesions. The study suggests, surgical resection followed by postoperative irradiation is an effective method and better treatment option than RT alone as primary treatment modality for carcinoma of EAC.