Transmigrated and Impacted Upper 2nd Premolar Associated with Dentigerous Cyst

A male patient about 45 years old came to my private clinic "The Dental Aid", Dhanmondi, Dhaka, Bangladesh last year (February 2016) with the complaint of pain at right palatal premolar region. On clinical examination we found the absence of upper left 2nd premolar from the series of dentition but on the right side premolars are present. The oral mucosa was intact and normal in color. There was no caries, dental pocket or any other pathology in the teeth of both jaws. On palpation we found soft area on the right palatal side at the premolar area. We took intraoral peri-apical radiograph and found impacted left 2nd premolar whose crown was encircled by radiolucent area at the palatal side. Here, we present a rare case of transmigrated and impacted left 2nd maxillary premolar associated with dentigerous cyst. The cyst was successfully treated under general anaesthesia by enucleation along with extraction of the involved maxillary transposed and impacted left second premolar.

Arafat M. Groundwater Quality Evaluation for Irrigation and Drinking Utilities Collected from Sadar Upazila of Jamalpur District, Bangladesh

The study was undertaken to evaluate groundwater quality both for drinking and irrigation usage collected from the Sadar upazila of Jamalpur district, Bangladesh. Total 20 groundwater samples were collected from the whole area and analysed for various physicochemical parameters following standard protocols at the Department of Agricultural Chemistry, Bangladesh Agricultural University, Mymensingh during March to December 2017. Concentrations of different heavy metal (Fe, Mn, Cu, Pb, Cr, Cd and Zn) in groundwater samples were measured by an atomic absorption spectrophotometer (AAS). Major cation chemistry showed their dominance in order of Ca > Mg > Na > K. Among the anions, HCO3 was the most dominating ion, which makes all groundwater unsuitable for irrigation. But considering major cations and anions, all groundwater samples were rated as suitable for drinking. In context of heavy metals, the amounts of Mn, Cd and Pb in groundwater were comparatively higher than the standard limits, which makes 14, 8 and 19 samples problematic for irrigation, and 13, 18 and 1 samples unsuitable for drinking, respectively. Electrical conductivity (EC) and sodium adsorption ratio (SAR) reflected that all groundwater samples were low to medium salinity (C1-C2) and low alkalinity (S1) hazards classes. As regards to hardness, out of 20 groundwater samples, 9 samples were classified as moderately hard, 10 were hard and only 1 sample was very hard in quality. According to residual sodium carbonate (RSC), 18 groundwater samples were found in suitable class, 1 sample was rated as marginal and the rest 1 was categorised as unsuitable class. The study concluded that HCO3, Mn, Cd and Pb were the major contaminants in groundwater of Sadar upazila of Jamalpur district, Bangladesh. Finally, the study suggested that the groundwater in this area needs to treat to minimise the amount of contaminants before using both for irrigation and drinking.

Integrating Cervical Cancer Screening and Syndromic Management of Sexually Transmitted Infections in Resource-Limited Settings in India

Background: In India, annually, there are more than 120,000 women diagnosed with cervical cancer and more than half of them die of the disease. The link between cervical cancer and high-risk type of human papilloma virus (HPV) is well-established. In addition to this, low-risk type HPV can lead to sexually transmitted infections (STIs). It is believed that 6% of Indian adult population is affected by one or more STIs. However, due to geographical and socioeconomic barriers, rural and poor women do not always have access to updated sexual and reproductive health (SRH) information and relevant services, resulting in the delay of treatment. To address these challenges and to strengthen the existing health system, Family Planning Association of India (FPA India), a national level voluntary organization, integrated cervical cancer and STIs services into a 2-year project and delivered it in urban slums and rural areas. Aim: To evaluate the impact of integrated cervical cancer and STIs services in the resource-limited settings in India. Methods: FPA India implemented the integrated package through six branch health facilities to raise people's awareness and build institutional capacity for the screening of women. All detailed process is summarized in Fig 1. Data, such as the number of cervical cancer screening and syndromic treatment, was collected. Results: More than 14,000 people were reached and 14 service providers including midlevel providers were trained. The number of services significantly improved in the selected 6 branches and in all branches of FPA India. The numbers for syndromic treatment of STIs almost doubled in the selected 6 branches and showed a 50% rise in all the branches. The number of cervical cancer screenings was 2938 and 9862, before and after the project, respectively in the selected 6 branches. The progress nearly doubled at the whole association level. Additionally, in this project, the progress of visual inspection of the cervix with acetic acid (VIA) and Lugol´s iodine (VILI) was remarkable whether in 6 selected branches or in all branches. At the end of project implementation, VIA/VILI accounted for 90% of all cervical cancer screenings. Data are summarized in Table 1. Conclusion: This study presents FPA India's operational experience in carrying out integrated cervical cancer and STIs services, in urban slums and rural areas. This project reaffirms that raising people's awareness and building institutional capacity are core approaches to deliver certain SRH information and services as well as achieve better SRH outcomes. The shift from Papanicolaou test to VIA/VILI may be related to VIA/VILI's sensitivity, quick results and affordability. However, more studies are needed to explain this change.[Figure: see text][Table: see text]

Primary Non-Hodgkin Lymphoma of Sphenoid Sinus Involving Cavernus Sinus and Clivus with Isolated 3rd Nerve Palsy

Lymphomas are group of malignant neoplasm having origins from lymphoreticular cells. B cell Non Hodgkin Lymphoma (BNHL) of sphenoid sinus as primary site for lymphomas are very rare and whenever involves comes usually with ocular manifestations. The proximity of the lesion to optic nerve and cavernous sinus present a high risk of developing unilateral ophthalmoplegia or even blindness. The vast majority of cases of localized sphenoid sinus lymphomas are usually curable to surgery, chemotherapy alone or combination of both, sometimes radiotherapy. Here we report a case of 58 years old male attended at Bangabandhu Sheikh Mujib Medical University (BSMMU) on 9th February 2017 at 9:00 AM having headache and gradually developing ptosis in left eye over 15 days. MRI of brain revealed homogeneously enhancing lesion occupying sphenoid sinus, clivus extending towards left cavernous sinus. Gross total resection of tumor was achieved by endoscopic endonasal approach. Histopathology revealed non-Hodgkin lymphoma and immunohistochemically it was positive for CD 20, CD 45, CD 79 and BCL 2, strongly compatible with diffuse large B cell lymphoma. Treatment with R-CHOP regimen following surgery resulted in initiation of improvement of the condition of the patient. Primary B cell Non-Hodgkin Lymphoma (PBNHL) of the sphenoid sinus is a rare entity which can be perplexing and misleading for a surgeon until the histopathological proof is in hand. Early diagnosis with strong suspicion of sphenoid lymphoma in mind during workouts and timely management, close monitoring and follow ups have high potential for cure and longer disease-free survival of the BNHL patients.

Biogenic fabrication and characterization of silver nanoparticles using aqueous-ethanolic extract of lichen (Usnea longissima) and their antimicrobial activity

Background

Biogenic fabrication of silver nanoparticles from naturally occurring biomaterials provides an alternative, eco-friendly and cost-effective means of obtaining nanoparticles. It is a favourite pursuit of all scientists and has gained popularity because it prevents the environment from pollution. Our main objective to take up this project is to fabricate silver nanoparticles from lichen, Usnea longissima and explore their properties. In the present study, we report a benign method of biosynthesis of silver nanoparticles from aqueous-ethanolic extract of Usnea longissima and their characterization by ultraviolet–visible (UV-vis), Fourier transform infrared (FTIR) spectroscopy, transmission electron microscopy (TEM) and scanning electron microscopy (SEM) analyses. Silver nanoparticles thus obtained were tested for antimicrobial activity against gram positive bacteria and gram negative bacteria.

Results

Formation of silver nanoparticles was confirmed by the appearance of an absorption band at 400 nm in the UV-vis spectrum of the colloidal solution containing both the nanoparticles and U. longissima extract. Poly(ethylene glycol) coated silver nanoparticles showed additional absorption peaks at 424 and 450 nm. FTIR spectrum showed the involvement of amines, usnic acids, phenols, aldehydes and ketones in the reduction of silver ions to silver nanoparticles. Morphological studies showed three types of nanoparticles with an abundance of spherical shaped silver nanoparticles of 9.40–11.23 nm. Their average hydrodynamic diameter is 437.1 nm. Results of in vitro antibacterial activity of silver nanoparticles against Staphylococcus aureus, Streptococcus mutans, Streptococcus pyrogenes, Streptococcus viridans, Corynebacterium xerosis, Corynebacterium diphtheriae (gram positive bacteria) and Escherichia coli, Klebsiella pneuomoniae and Pseudomonas aeruginosa (gram negative bacteria) showed that it was effective against tested bacterial strains. However, S. mutans, C. diphtheriae and P. aeruginosa were resistant to silver nanoparticles.

Conclusion

Lichens are rarely exploited for the fabrication of silver nanoparticles. In the present work the lichen acts as reducing as well as capping agent. They can therefore, be used to synthesize metal nanoparticles and their size may be controlled by monitoring the concentration of extract and metal ions. Since they are antibacterial they may be used for the treatment of bacterial infections in man and animal. They can also be used in purification of water, in soaps and medicine. Their sustained release may be achieved by coating them with a suitable polymer. Silver nanoparticles fabricated from edible U. longissima are free from toxic chemicals and therefore they can be safely used in medicine and medical devices. These silver nanoparticles were stable for weeks therefore they can be stored for longer duration of time without decomposition.

The effect on clinical results of adding recombinant LH in late phase of ovarian stimulation of patients with repeated implantation failure: a pilot study

OBJECTIVE

To evaluate the efficacy of recombinant LH (r-LH) addition in the late phase of ovarian stimulation in patients with repeated implantation failure (RIF).

PATIENTS AND METHODS

66 infertile couples undergoing ICSI treatment due to male factor were allocated to group A (33) and to group B (33). Group A (29 subjects) received recombinant FSH (r-FSH) supplemented by r-LH in the late follicular phase starting the same day of GnRH-antagonist (GnRH-ant) administration, and group B (32 subjects) received r-FSH alone. All patients were stimulated with a GnRH-ant flexible protocol starting r-FSH on day 2 of a spontaneous or induced cycle. hCG (10000 IU) was administered by intramuscular route when at least 2 follicles reached 18 mm in diameter.

RESULTS

Metaphase II (MII) oocytes with cytoplasmic maturation showed a significant difference in the r-LH group (89.02%) compared to the one with FSH alone (81.15%) (p < 0.01). The number of positive pregnancy test, 14 (48.3%) and 8 (25%), was significantly greater in the r-LH group compared to the group treated with r-FSH alone (p < 0.03). The number of gestational sacs was 20 in the r-LH group vs. 9 in the r-FSH group (p < 0.001). The implantation rate was significantly higher in the r-LH group compared to the r-FSH only group (19% vs. 7% respectively; p < 0.01). Also, a lower abortion rate was found in the r-LH group (21% vs. 37.5% respectively - p < 0.01).

CONCLUSIONS

Ovarian stimulation should be personalized because it seems that some subgroups of patients, like those with RIF, reach a better clinical outcome with the addition of r-LH in the advanced follicular phase stimulation.

Human health risks and socio-economic perspectives of arsenic exposure in Bangladesh: A scoping review

Arsenic contamination of drinking water, which can occur naturally or because of human activities such as mining, is the single most important public health issue in Bangladesh. Fifty out of the 64 districts in the country have arsenic concentration of groundwater exceeding 50µgL^-1, the Bangladeshi threshold, affecting 35-77 million people or 21-48% of the total population. Chronic arsenic exposure through drinking water and other dietary sources is an important public health issue worldwide affecting hundreds of millions of people. Consequently, arsenic poisoning has attracted the attention of researchers and has been profiled extensively in the literature. Most of the literature has focused on characterising arsenic poisoning and factors associated with it. However, studies examining the socio-economic aspects of chronic exposure of arsenic through either drinking water or foods remain underexplored. The objectives of this paper are (i) to review arsenic exposure pathways to humans; (ii) to summarise public health impacts of chronic arsenic exposure; and (iii) to examine socio-economic implications and consequences of arsenicosis with a focus on Bangladesh. This scoping review evaluates the contributions of different exposure pathways by analysing arsenic concentrations in dietary and non-dietary sources. The socio-economic consequences of arsenicosis disease in Bangladesh are discussed in this review by considering food habits, nutritional status, socio-economic conditions, and socio-cultural behaviours of the people of the country. The pathways of arsenic exposure in Bangladesh include drinking water, various plant foods and non-dietary sources such as soil. Arsenic affected people are often abandoned by the society, lose their jobs and get divorced and are forced to live a sub-standard life. The fragile public health system in Bangladesh has been burdened by the management of thousands of arsenicosis victims in Bangladesh.

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.

Female Sex and Alzheimer's Risk: The Menopause Connection

Along with advanced age and apolipoprotein E (APOE)-4 genotype, female sex is a major risk factor for developing late-onset Alzheimer's disease (AD). Considering that AD pathology begins decades prior to clinical symptoms, the higher risk in women cannot simply be accounted for by their greater longevity as compared to men. Recent investigation into sex-specific pathophysiological mechanisms behind AD risk has implicated the menopause transition (MT), a midlife neuroendocrine transition state unique to females. Commonly characterized as ending in reproductive senescence, many symptoms of MT are neurological, including disruption of estrogen-regulated systems such as thermoregulation, sleep, and circadian rhythms, as well as depression and impairment in multiple cognitive domains. Preclinical studies have shown that, during MT, the estrogen network uncouples from the brain bioenergetic system. The resulting hypometabolic state could serve as the substrate for neurological dysfunction. Indeed, translational brain imaging studies demonstrate that 40-60 year-old perimenopausal and postmenopausal women exhibit an AD-endophenotype characterized by decreased metabolic activity and increased brain amyloid-beta deposition as compared to premenopausal women and to age-matched men. This review discusses the MT as a window of opportunity for therapeutic interventions to compensate for brain bioenergetic crisis and combat the subsequent increased risk for AD in women.