Ambras Syndrome: First Reported Case in Bangladesh and its Oral Rehabilitation

People with rare hypertrichosis syndromes became crowd-drawing money-making phenomena in many 19th century sideshow acts. These individuals have been referred to as dog-men, hair-men, and werewolves. In 1993, Baumister et al. described congenital hypertrichosis lanuginose or Ambras syndrome: a distinct form of congenital hypertrichosis characterized by excessive hair growth over the body and face associated with facial and occasional dental anomalies. Much is not known about this syndrome since fewer than 50 cases have been documented worldwide. In this case report, a nine year old girl presented with excessive hair growth throughout her body that was denser along her midline. Furthermore, her face displayed the typical dysmorphic features characteristic of Ambras syndrome: a round tip nose, thickened nasal cartilage, antiverted nares, prominent philtrum with deep groove, and a trapezoid mouth. Oral examination revealed normal oral mucosa with completely missing and unerupted decidious and permanent teeth. Panoramic radiographs confirmed unerupted deciduous teeth. Previous case reports have mentioned the presence of occasional dental anomalies such as retarded first and second dentition and absence of some teeth. However, this is the first reported case of Ambras syndrome presenting with complete anodontia. Prior cytogenetic studies performed on persons with Ambras syndrome have implicated a balanced pericentric inversion of chromosome 8. However, it is likely that dental anomalies are likely a result of a different genetic rearrangement. Further studies are needed to explore the cause of this rare phenotype of Ambras syndrome with complete unerupted dentition.

Study on Association of Maternal Serum Triglyceride with Pre-eclampsia

Till now pre-eclampsia is a disease of multiple theories. This case control study was carried out in the department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University Hospital and Dhaka Medical College Hospital, from January 2006 to December 2007 to determine the association of maternal serum triglyceride with pre-eclampsia. Ninety pregnant women were studied, among them 45 patients were pre-eclamptic and served as case and 45 normal healthy pregnant women served as control. Estimation of serum triglyceride levels of all study patients was done with the help of enzymatic method. The mean (± SD) systolic blood pressure was 152.4 ± 19.8 mmHg in study group and 112.0 ± 8.9 mmHg in control group (p<0.05). Similarly the mean (± SD) diastolic blood pressure was 103.1 ± 12.2 mmHg in case group and 75.5 ± 6.6 mmHg in control group (p<0.05). Serum triglyceride level was more than the normal reference value in pre-eclamptic group. The mean (± SD) serum triglyceride level was 242.9 ± 36.8 mg/dl in case group and 184.6 ± 12.5mg/dl in control group. Statistically the difference was significant (p<0.05). The level of serum triglyceride positively correlated with the rise of blood pressure and degree of albuminuria. Thus serum triglyceride level increase in pre-eclampsia and the level correlate with the severity of the disease.

Spatially resolved resonant tunneling on single atoms in silicon

The ability to control single dopants in solid-state devices has opened the way towards reliable quantum computation schemes. In this perspective it is essential to understand the impact of interfaces and electric fields, inherent to address coherent electronic manipulation, on the dopants atomic scale properties. This requires both fine energetic and spatial resolution of the energy spectrum and wave-function, respectively. Here we present an experiment fulfilling both conditions: we perform transport on single donors in silicon close to a vacuum interface using a scanning tunneling microscope (STM) in the single electron tunneling regime. The spatial degrees of freedom of the STM tip provide a versatility allowing a unique understanding of electrostatics. We obtain the absolute energy scale from the thermal broadening of the resonant peaks, allowing us to deduce the charging energies of the donors. Finally we use a rate equations model to derive the current in presence of an excited state, highlighting the benefits of the highly tunable vacuum tunnel rates which should be exploited in further experiments. This work provides a general framework to investigate dopant-based systems at the atomic scale.

Role of D-dimer in determining coagulability status in pre-eclamptic and normotensive pregnant women

A cross sectional study was carried out from January 2007 to December 2008 in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka in collaboration with Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Pregnant women with pre-eclampsia attending at Out-patient Department (OPD) and admitted in In-patient Department of Obstetrics and Gynaecology Dhaka Medical College Hospital, Dhaka were selected as cases. Healthy and uncomplicated pregnant women admitted in the same hospital were taken as controls. The study showed that 26-30 years and 21-25 years age category was higher in the case and control groups and the mean age was significantly higher in case group compared to control group (p=0.025). The study showed that 44% of case group had a significantly high level of plasma D-dimer (>0.5μg/ml) as opposed to control group (8%) (p<0.001). Estimation of odds ratio demonstrates that pre-eclamptic women (case) had 9 times (95% of CI = 2.8 - 28.9) more risk of having plasma D-dimer >0.5μg/ml than that of normal pregnant women (control). The mean systolic and diastolic blood pressures in patients with plasma D-dimer >0.5μg/ml were considerably higher than those who had plasma D-dimer ≤0.5μg/ml (p<0.001). The study showed that majority (81.8%) of pre-eclamptic women with plasma D-dimer >0.5μg/ml had systolic blood pressure ≥ 160 mm Hg compared to 46.4% of those who had plasma D-dimer ≤0.5μg/ml (p=0.010). And ninety percent of pre-eclamptic women with plasma D-dimer >0.5μg/ml had exhibited severe proteinuria as opposed to 53.6% of those who had plasma D-dimer ≤0.5μg/ml (p=0.017). The study concludes that plasma D-dimer level can easily be used in screening for the hypercoagulable state in pre-eclamptic patients which have preventive and therapeutic implications.

Policy advocacy and leadership training for formerly incarcerated women: an empowerment evaluation of ReConnect, a program of the Women in Prison Project, Correctional Association of New York

There is limited knowledge on re-entry initiatives for formerly incarcerated women specifically on building women's advocacy and leadership skills. Our research highlights an empowerment evaluation on ReConnect, a 12-session; innovative advocacy and leadership development program rooted in an integrated framework of empowerment, and transformational leadership theories. Using thematic analysis, we coded three focus groups with 24 graduates, for themes that matched our framework's concepts. ReConnect graduates reported being empowered by the information they received on parental rights, housing, and employment. Participants agreed that ReConnect improved their communication skills, preparing them to advocate for themselves and community members.

Surgical delivery of drug releasing poly(lactic-co-glycolic acid)/poly(ethylene glycol) paste with in vivo effects against glioblastoma

INTRODUCTION

The median survival of patients with glioblastoma multiforme (astrocytoma grade 4) remains less than 18 months despite radical surgery, radiotherapy and systemic chemotherapy. Surgical implantation of chemotherapy eluting wafers into the resection cavity has been shown to improve length of survival but the current licensed therapy has several drawbacks. This paper investigates in vivo efficacy of a novel drug eluting paste in glioblastoma.

METHODS

Poly(lactic-co-glycolic acid)/poly(ethylene glycol) (PLGA/PEG) self-sintering paste was loaded with the chemotherapeutic agent etoposide and delivered surgically into partially resected tumours in a flank murine glioblastoma xenograft model.

RESULTS

Surgical delivery of the paste was successful and practical, with no toxicity or surgical morbidity to the animals. The paste was retained in the tumour cavity, and preliminary results suggest a useful antitumour and antiangiogenic effect, particularly at higher doses. Bioluminescent imaging was not affected significantly by the presence of the paste in the tumour.

CONCLUSIONS

Chemotherapy loaded PLGA/PEG paste seems to be a promising technology capable of delivering active drugs into partially resected tumours. The preliminary results of this study suggest efficacy with no toxicity and will lead to larger scale efficacy studies in orthotopic glioblastoma models.

Retinal changes in visceral leishmaniasis by retinal photography

Background

In visceral leishmaniasis (VL), retinal changes have previously been noted but not described in detail and their clinical and pathological significance are unknown. A prospective observational study was undertaken in Mymensingh, Bangladesh aiming to describe in detail visible changes in the retina in unselected patients with VL.

Methods

Patients underwent assessment of visual function, indirect and direct ophthalmoscopy and portable retinal photography. The photographs were assessed by masked observers including assessment for vessel tortuosity using a semi-automated system.

Results

30 patients with VL were enrolled, of whom 6 (20%) had abnormalities. These included 5 with focal retinal whitening, 2 with cotton wool spots, 2 with haemorrhages, as well as increased vessel tortuosity. Visual function was preserved.

Conclusions

These changes suggest a previously unrecognized retinal vasculopathy. An inflammatory aetiology is plausible such as a subclinical retinal vasculitis, possibly with altered local microvascular autoregulation, and warrants further investigation.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-527) contains supplementary material, which is available to authorized users.

Participants' perceptions and understanding of a malaria clinical trial in Bangladesh

BACKGROUND

Existing evidence suggests that there is often limited understanding among participants in clinical trials about the informed consent process, resulting in their providing consent without really understanding the purpose of the study, specific procedures, and their rights. The objective of the study was to determine the subjects' understanding of research, perceptions of voluntariness and motivations for participation in a malaria clinical trial.

METHODS

In this study semi-structured interviews of adult clinical trial participants with uncomplicated falciparum malaria were conducted in Ramu Upazila Health Complex, in Bangladesh.

RESULTS

Of 16 participants, the vast majority (81%) were illiterate. All subjects had a 'therapeutic misconception' i.e. the trial was perceived to be conducted primarily for the benefit of individual patients when in fact the main objective was to provide information to inform public health policy. From the patients' perspective, getting well from their illness was their major concern. Poor actual understanding of trial specific procedures was reported despite participants' satisfaction with treatment and nursing care.

CONCLUSION

There is frequently a degree of overlap between research and provision of clinical care in malaria research studies. Patients may be motivated to participate to research without a good understanding of the principal objectives of the study despite a lengthy consent process. The findings suggest that use of a standard consent form following the current ICH-GCP guidelines does not result in achieving fully informed consent and the process should be revised, simplified and adapted to individual trial settings.

Spatially resolving valley quantum interference of a donor in silicon

Electron and nuclear spins of donor ensembles in isotopically pure silicon experience a vacuum-like environment, giving them extraordinary coherence. However, in contrast to a real vacuum, electrons in silicon occupy quantum superpositions of valleys in momentum space. Addressable single-qubit and two-qubit operations in silicon require that qubits are placed near interfaces, modifying the valley degrees of freedom associated with these quantum superpositions and strongly influencing qubit relaxation and exchange processes. Yet to date, spectroscopic measurements have only probed wavefunctions indirectly, preventing direct experimental access to valley population, donor position and environment. Here we directly probe the probability density of single quantum states of individual subsurface donors, in real space and reciprocal space, using scanning tunnelling spectroscopy. We directly observe quantum mechanical valley interference patterns associated with linear superpositions of valleys in the donor ground state. The valley population is found to be within 5% of a bulk donor when 2.85 ± 0.45 nm from the interface, indicating that valley-perturbation-induced enhancement of spin relaxation will be negligible for depths greater than 3 nm. The observed valley interference will render two-qubit exchange gates sensitive to atomic-scale variations in positions of subsurface donors. Moreover, these results will also be of interest for emerging schemes proposing to encode information directly in valley polarization.

Pregnancy with myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular transmission, caused by auto antibodies against the nicotinic acetylcholine receptor. These antibodies of the IgG isotype are detected in 80-90% of generalized MG and in 50-70% of ocular MG. Seronegative MG is caused by humoral factors. Prevalence of MG lies between 1 in 10.000 and 1 in 50.000, with 2/3 of affected individuals being female. In the case of maternal myasthenia gravis, both the mother and the child may develop myasthenia symptoms with varying degrees of weakness and progressive fatigability of the skeletal muscles. Data for the case report were generated by reviewing labour, delivery, and postpartal records. We present a 26 years old lady who suffered from a generalized form of myasthenia gravis since the age of 15. She got herself admitted to a neurologic clinic for a myasthenic crisis when she was two and half months pregnant. The patient was treated with anticholinesterase medication, corticosteroids and intravenous immunoglobulin. Clinically, the patient's condition improved significantly during pregnancy. Delivery and the post delivery period were also normal for the patient. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management is required.

Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis

BACKGROUND

Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone.

METHODS

We retrospectively analysed 4 studies of 1801 adults with severe falciparum malaria to determine whether the presence of simple clinical findings might assist patient triage.

RESULTS

If present on admission, shock, oligo-anuria, hypo- or hyperglycaemia, an increased respiratory rate, a decreased Glasgow Coma Score and an absence of fever were independently predictive of death. The variables were used to construct a simple clinical algorithm. When applied to the 1801 patients, this algorithm's positive predictive value for survival to 48 hours was 99.4 (95% confidence interval (CI) 97.8-99.9) and for survival to discharge 96.9% (95% CI 94.3-98.5). In the 712 patients receiving artesunate, the algorithm's positive predictive value for survival to 48 hours was 100% (95% CI 97.3-100) and to discharge was 98.5% (95% CI 94.8-99.8).

CONCLUSIONS

Simple clinical findings are closely linked to the pathophysiology of severe falciparum malaria in adults. A basic algorithm employing these indices can facilitate the triage of patients in settings where intensive care services are limited. Patients classified as low-risk by this algorithm can be safely managed initially on a general ward whilst awaiting senior clinical review and laboratory data.

Early surgery for epiretinal membrane preserves more vision for patients

PURPOSE

To establish whether early vitrectomy for epiretinal membrane (ERM) is preferable to delayed surgery.

METHODS

We carried out a retrospective study of 120 eyes from 120 patients with pre-operative visual acuity (VA) of 6/60 or better. Pre-operative logMAR score was considered to act as an appropriate proxy measure for time of surgical procedure, with scores of 0.3 or less considered to represent early surgery, scores of 0.4 or 0.5 considered to represent medium surgery, and scores of 0.6 or more considered to represent late surgery for ERM. Patients were either pseudophakic at the time of vitrectomy or underwent combined phaco-vitrectomy for symptomatic ERM.

RESULTS

Evaluation of parameter coefficients indicated that controlling for other factors, a delay of the surgical procedure from a state of early to medium corresponded to an increase (ie, disbenefit) of 0.074 units in post-operative logMAR score (95% confidence interval -0.001-0.15). A delay of the surgical procedure from a state of early to late corresponded to an increase (ie, disbenefit) of 0.21 units in post-operative logMAR score (95% confidence interval 0.13-0.29). Mean post-operative VA for early surgery was 0.16, out of which 36.2% of patients had a LogMAR score of 0.1 or better. This is in comparison to 17.2% in late ERM (those with a pre-operative logMAR score of 0.6 or more).

CONCLUSION

We conclude that early surgery is associated with a lower (ie, better) post-operative logMAR score. Vitrectomy for early symptomatic ERM, in carefully selected patients, is beneficial in preserving excellent vision and allows quicker visual rehabilitation.

Randomized controlled trial of levamisole hydrochloride as adjunctive therapy in severe falciparum malaria with high parasitemia

BACKGROUND

Cytoadherence and sequestration of erythrocytes containing mature stages of Plasmodium falciparum are central to the pathogenesis of severe malaria. The oral anthelminthic drug levamisole inhibits cytoadherence in vitro and reduces sequestration of late-stage parasites in uncomplicated falciparum malaria treated with quinine.

METHODS

Fifty-six adult patients with severe malaria and high parasitemia admitted to a referral hospital in Bangladesh were randomized to receive a single dose of levamisole hydrochloride (150 mg) or no adjuvant to antimalarial treatment with intravenous artesunate.

RESULTS

Circulating late-stage parasites measured as the median area under the parasite clearance curves were 2150 (interquartile range [IQR], 0-28 025) parasites/µL × hour in patients treated with levamisole and 5489 (IQR, 192-25 848) parasites/µL × hour in controls (P = .25). The "sequestration ratios" at 6 and 12 hours for all parasite stages and changes in microvascular blood flow did not differ between treatment groups (all P > .40). The median time to normalization of plasma lactate (<2 mmol/L) was 24 (IQR, 12-30) hours with levamisole vs 28 (IQR, 12-36) hours without levamisole (P = .15).

CONCLUSIONS

There was no benefit of a single-dose of levamisole hydrochloride as adjuvant to intravenous artesunate in the treatment of adults with severe falciparum malaria. Rapid parasite killing by intravenous artesunate might obscure the effects of levamisole.

Risk factors of acute coronary syndrome among Bangladeshi people

Two hundred consecutive patients of acute coronary syndrome aged 30-80 years (inclusive) admitted to the coronary care unit of National institute of Cardiovascular Diseases, Dhaka, were prospectively recruited as cases. Two hundred controls were prospectively selected either from individuals attending in the Shaheed Suhrawardy Medical College Hospital, admitted for elective surgery or in medicine ward for conditions that were unlikely to confound a comparative analysis. The Cases had significantly lower yearly incomes than controls, and significantly higher number of cases is occupied as sedentary worker. Smoking was an important risk factor. About 70% of cases and 45% of controls smoked previously cigarettes. Consumption of non smoke tobacco is another risk factor. The high risk of IHD in developing countries attributed to low consumption of fruit and vegetables, and in our study regular consumption of fruits (taking fruit at least 4 days a week) shows 20.5% cases and 33% of controls (OR 0.524, 95%CI 0.333-0.823) and p value was 0.005. Around 23.5% of the cases were diabetic compared with 4.5% of controls. We found 5% cases and 1.5% controls having known dyslipidemia. Although the body-mass index of cases was 24.68±3.06 Kg/M² and controls 20.54±4.37 Kg/M². The WHR was also significantly greater in cases 0.98±0.05M vs. controls 0.93±0.102M (p<0.001). About 31% of cases and 2% of controls had past history of myocardial infarction. The most predictive independent variables were previous smoking (p<0.001), WHR (p<0.001), history of hypertension (p<0.001), and income (p<0.001). Smoking and WHR were associated with the highest risks. The variables revealed to be significantly associated with acute coronary syndrome by bivariate analyses were all entered into the model directly. Eleven variables entered into the model. Of them Age, occupation, family income (yearly), fruit consumption, known hypertension, known DM, known dyslipidemia, previous MI, previous smoking, BMI and Waist and hip ratio were found to be the independent predictors of acute coronary syndrome. The study found that smoking tobacco, diabetes mellitus, hypertension, visceral obesity and less fruit intake are the important factors of acute coronary syndrome in Bangladesh.