Evaluation of Intradialytic Complications and Protein Catabolic Rate on Maintenance Hemodialysis Patients in Bangladesh

Among patients with chronic kidney disease stage-5 who are treated with dialysis, intradialytic complications commonly occur during routine hemodialysis (HD). It could be either patient related or mechanical. Protein catabolic rate during hemodialysis is a determinant of the mortality. nPCR was aimed to targets according to International guideline. This observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020 to compare two groups of nPCR and different value of biochemical parameters. This study was involving all patients and inclusion criteria were patients who underwent routine HD for at least three months. All patients under-went conventional intermittent HD with low-flux dialyser. A total of 179 patients enrolled. Serum albumin, serum calcium, phosphate, hemoglobin and pre-dialysis urea, post dialysis urea were measured from blood sample. The nPCR was calculated by the standard international equation. nPCR value of 14.0% patients was more than 1.0 gm/kg/day and average nPCR (mean±SD) of all patients was 0.903±0.09gm/kg/day and 86.0% patients nPCR was less than 1.0 gm/kg/day. Biochemical parameters were not significantly differing between two groups. The nPCR is an indicator, can help the determination of nutritional status. This study aimed to find out the intradialytic complications, mean value of nPCR and correlation of biochemical parameters among ESRD patients on maintenance hemodialysis.

Measurement of energy and directional distribution of neutron ambient dose equivalent for the 7Li(p,n)7Be reaction

Double differential neutron fluence distributions were measured in the 7Li(p,n)7Be reaction for proton beam energies 7, 9 and 12 MeV. Seven liquid scintillator based detectors were employed to measure neutron fluence distributions using the Time of Flight technique. Neutron ambient dose equivalents were determined from the measured fluence distribution using ICRP (International Commission on Radiological Protection) recommended fluence to dose equivalent conversion coefficients. Neutron dose equivalents were also measured using a conventional BF3 detector based REM counter. Ambient dose equivalent measured by the REM counter is found to be in agreement with that determined from the neutron fluence spectra within their uncertainties. Angular distributions of the ambient dose equivalents were also determined from the measured fluence distributions at different angles.

Assessment of Dialysis Adequacy Using Small Solute Clearance Indices among Twice versus Thrice Weekly Maintenance Hemodialysis Patients in a Tertiary Care Hospital of Bangladesh

This observational study was carried out in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020. A total of 179 patients were included in this study according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients were underwent detail history taking, thorough physical examination and relevant investigations. Data collection was conducted through a structured questionnaire. Collected data were analyzed using the statistical software SPSS 23.0. Mean age ±SD of the study patients was 47.06±14.1 with a majority in age group 41-50 years. Male predominance was observed with a male: female ratio of 2.19:1 and 68.7% male patients. Level of pre-dialysis, post-dialysis urea in the study population was 123.77±26.86mg/dl, 50.27±15.70mg/dl respectively and mean ±SD of Urea Reduction Ratio (URR) in hemodialysis (target >65.0%) was 67.2±1.9. Most of the 8 hours (two times) per week hemolysis patients could not achieve the target value of dialysis adequacy parameters. On the other hand, maximum people in 12 hours (three times) per week hemodialysis group achieved the target value of dialysis adequacy parameters. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.

Pattern of Glomerular Disease in a Tertiary Care Hospital of Bangladesh

Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.

Growth dynamics among adolescent girls in Bangladesh: Evidence from nationally representative data spanning 2011-2014

Background

Adolescence is the last opportunity to reverse any growth faltering accumulated from fetal life through childhood and it is considered a crucial period to optimize human development. In Bangladesh, a growing double burden of underweight and obesity in adolescents is recognized, yet limited data exists on how, when, and where to intervene. This study assesses the dynamics of growth among adolescent girls in Bangladesh, providing insight about critical junctures where faltering occurs and where immediate interventions are warranted.

Methods

We pooled data from Bangladesh’s Food Security and Nutrition Surveillance Project collected between 2011 and 2014 to document the age dynamics of weight and linear growth. 20,572 adolescent girls were measured for height and 19,345 for weight. We constructed growth curves for height, weight, stunting, and underweight. We also stratified growth dynamics by wealth quintile to assess socioeconomic inequities in adolescent trajectories.

Results

Height-for-age z-score (HAZ) in Bangladeshi girls deteriorates throughout adolescence and especially during the early years. Mean HAZ decreases by 0.20 standard deviations (sd) per year in early adolescence (10–14 years) vs 0.06 sd/year during late adolescence (15–19 years), while stunting increases by 16 percentage points (pp) vs 6.7 pp, respectively. Conversely, BMI-for-age z-score (BAZ) increases by 0.13 sd/year in early adolescence vs 0.02 sd/year in late adolescence, and underweight decreases by 12.8 pp vs 3.2 pp. Adolescent girls in all socioeconomic groups show a similar pattern of HAZ and BAZ dynamics, but the curve for the richest quintile stays above that of the poorest across all ages.

Conclusions

Trends and levels of stunting and underweight among adolescent girls in Bangladesh are worrisome, suggesting substantial linear growth faltering in early adolescence, with improving weight-for-age occurring only as linear growth slows and stops. Given the rising burden of non-communicable diseases (NCDs) in Bangladesh and emerging evidence of the link between stunting and later chronic diseases, greater attention to adolescent growth and development is needed. Our findings suggest that, to address stunting, interventions in early adolescence would have the greatest benefits. School-based interventions could be a way to target this population.

Correlation of eGFR By MDRD and CKD-EPI Formula with Creatinine Clearance Estimation in CKD Patients and Healthy Subjects

This cross sectional comparative study was conducted in the Nephrology and Medicine outdoor and in-patients department of Mymensingh Medical College Hospital, Bangladesh from April 2014 to March 2015. A total of 100 patients with CKD and 100 healthy subjects were included in the study. Data were collected by interview of the patients, clinical examination and laboratory investigations using a semi-structured case record form. Among all subjects, 50.0% had no CKD and 50.0% patients had CKD: Stage 3 CKD were 8.5%, CKD Stage 4 CKD were 21.0%, CKD Stage 5 CKD were 20.5%. Serum creatinine was 4.32±3.08mg/dl in patients with CKD and 1.00±0.22mg/dl was in healthy subjects. Mean±SD of CCR/ml/min was found 17.67±11.63ml/min in patients with CKD and 79.31±13.31ml/min was found in healthy subjects. On the other hand, Mean±SD CCCR/ml/m/1.73m² was found 19.79±12.85 ml/m/1.73m² in patient with CKD and healthy subjects had 83.83±13.33 ml/m/1.73m². Urinary creatinine was 45.59±15.63 & 57.66±11.45mg/dl respectively. CKD-EPI eGFR was 22.10±15.02 & 90.61±23.27ml/m/1.73m²; MDRD eGFR was 22.15±14.18 & 89.35±26.19 ml/m/1.73m² respectively. Difference between all the variables between CKD group and healthy group was found statistically significant (p<0.001). CKD-EPIeGFR and MDRDeGFR were increased both in CKD patients and healthy subjects in respect to CCR and CCCR. There was a strong positive correlation between CCCR (ml/m/1.73m2) and CKD-EPI (ml/m/1.73m²) among all patients (r=0.934 and p<0.001) and also a positive correlation of CCCR with MDRD among all patients (r=0.913 and p<0.001). A positive correlation of CCCR was found with CKD-EPIeGFR among CKD patients (r=0.848 and p<0.001). A positive correlation of CCCR was also found with MDRDeGFR among CKD patients (r=0.841, p<0.001). There are positive correlations between CCCR and CKD/EPI among healthy subjects (r=0.616 and p<0.05) and between CCCR with MDRD among healthy subjects (r=0.568 and p<0.05). Various formulae were used to calculate GFR on the basis of serum creatinine levels. The Overall correlation of population (healthy and CKD patients) between CCCR and CKD EPI and MDRD formula was (r=0.93 and 0.91) respectively, among CKD patients it was (r=0.848 and r=0.841) in healthy subjects it was (r=0.616 and r=0.568) respectively. CKD EPI eGFR and MDRD eGFR formula had fairly good correlation with conventional 24 hours creatinine clearance in both CKD patient and healthy subjects, there was even more strong correlation especially in CKD patients. The performance of CKD-EPI equation is better than MDRD equation to estimate the eGFR in both CKD patients and healthy subjects.

Prevalence of Subclinical Hypothyroidism in Hospitalized Pre-dialysis Patients with Chronic Kidney Disease

Among general population sub-clinical primary hypothyroidism is common. The cross sectional descriptive type of observational study was conducted in medicine and allied wards in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2010 to December 2010; among 230 purposively selected hospitalized pre-dialysis patients with chronic kidney disease. The purpose of the study was to find out the prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease. Data were collected from the patients using a case record form by face to face interview, clinical examination and laboratory investigations. The collected data were entered into SPSS version 20.0 and analyzed accordingly. Mean age of the patients was 47.2 years with a SD of ±2.05 years. Maximum patients were male with a male female ratio of 5:1. A significant number of patients were smoker- 11.8% of sub-clinical hypothyroidism group and 13.6% of euthyroid group. Among the patients 40 (17.40%) had sub-clinical hypothyroidism while the majority 190 (82.60%) did not have it. Estimated prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease was 17.40%. Co-morbidities found in the patients were hypertension, diabetes mellitus, chronic glomerulonephritis and obstructive uropathy. All the patients (40, 100.0%) with sub-clinical hypothyroidism were hypertensive. On the other hand, 184 (97.1%) patients without sub-clinical hypothyroidism were hypertensive. Presence of co-morbidities in patients with sub-clinical hypothyroidism did not differ significantly (p>0.05) from patients without sub-clinical hypothyroidism. Patients in group with sub-clinical hypothyroidism were more over weight in comparison to patients without sub-clinical hypothyroidism (p<0.05). Biochemical parameters of patients with sub-clinical hypothyroidism differed significantly (p<0.05) from those of patients without sub-clinical hypothyroidism. There was no significant difference between urinary albumin of two groups of patients (p>0.05). Stage 4 CKD patients were more in sub-clinical hypothyroidism group in comparison to euthyroid group. As this study may not reflect the actual picture, further large scale multi-centric study is recommended to explore the real situation of sub-clinical hypothyroidism in patients with chronic kidney disease.

Clinical Profile and Immediate Outcome of Children Admitted With Acute Glomerulonephritis in Pediatrics Department of A Tertiary Level Hospital

Acute post-streptococcal glomerulonephritis (APSGN) is the commonest cause of acute glomerulonephritis (AGN), which usually present with gross hematuria, mild edema, oliguria, hypertension and varying degree of renal insufficiency. It is more common among the population of school going age where poverty, overcrowding and poor hygienic conditions are prevailing. This cross sectional observational study was aimed to know the socio-demographic variables, clinical profile and immediate outcome of AGN in hospitalized children and was conducted in the Pediatric department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2014 to April 2015. A detailed history was taken from the parents in each case with a written questionnaire. A written consent was also taken from the guardian of the including patients and also permission was taken from the ethical committee of MMCH. Thorough clinical examination and available relevant investigations were done in all patients. Progresses of the patient were monitored by daily clinical examinations and also by investigations. Data were analyzed by statistical package for social science (SPSS) windows version 18. Results were verified by doing standard test for significance. Among total 60 cases male was 58.3% & female was 41.7%. The common age group of presentation was between 7-12 years (73%), peak age of incidence was 7-9 years. Most of them came from low socioeconomic status (83.3%), 63.3% from rural area with average 5-6 member's family size. Most of the parents were illiterate. History of (H/O) skin infection was present in 35(58.3%) patients, 15(25%) had H/O sore throat, 15% did not give any H/O infection before presentation. Average duration of gap between infection and appearance of clinical feature was 7-14 days in 73.40%and 15-21 days was in 45.7% in case of sore throat & skin infection respectively. Almost all (95%) patients presented with puffiness of face, others presented with scanty micturition, gross hematuria, respiratory distress, fever, convulsion and altered sensorium. Edema (75%), hypertension (88.3%), pallor (38%), tachypnea (25%), tachycardia (26.7%) were the important clinical findings. Microscopic hematuria was present among 96.66% patients; low complement level was found in 85% cases. There is significant association between low socioeconomic statuses with more hospital stay. Only one patient died due to heart failure and 98.3% patient had complete recovery. Results of this study conclude that most of the patients came from rural illiterate family with low socioeconomic background. Skin infection is the commonest cause of acute glomerulonephritis. Edema, scanty micturation, hematuria and hypertension are the common mode of presentation. Heart failure and hypertensive encephalopathy are the common complication of AGN. Immediate prognosis of AGN was excellent.

Comparison of Serum Amylase and Lipase Levels between Predialysis and Maintenance Haemodialysis CKD Patients

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.

Renal Involvement as a Presenting Feature of Multiple Myeloma

Renal involvement may be the presenting feature in a vast majority of patients with multiple myeloma and is one of the key for clinical manifestations of symptomatic multiple myeloma. The purpose of the study was to find out the pattern of renal involvement at the time of presentation of multiple myeloma and to explore its association with clinical, laboratory and pathologic features of these cases. This cross sectional study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from February 2016 to September 2017. Forty seven (47) patients of newly diagnosed multiple myeloma having renal involvement were included in the study. Multiple myeloma was diagnosed as per criteria proposed by the International Myeloma Working Group, 2003. Renal involvement was considered to be present when any one of proteinuria, microscopic haematuria, renal impairment or urinary tract infection (UTI) was found in the patient. Renal biopsy was done in suitable patients under ultrasound guidance after taking informed written consent. The pattern of renal involvement was detected and status of renal function was assessed and its clinical, laboratory and pathologic associations were analyzed. Data were managed by using computer based software, the Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp.). Median age at presentation was 59 years with the range of 37-76 years. Female (53.2%) was slightly predominant than male (46.8%) and male to female ratio was 1:1.14. Renal impairment, microscopic haematuria, proteinuria, nephrotic range proteinuria, urinary Bence Jones protein and UTI were found in 70%, 19%, 79%, 25%, 19% and 17% of patients respectively. Median serum creatinine and proteinuria were 256μmol/l and 1.24gm/day. Hypercalcaemia and Bence Jones proteinuria were detected in 36% and 27% of patients respectively with renal impairment which were statistically significant. The precipitating factors for renal impairment were NSAIDs use (67%), hyperuricaemia (49%), hypercalcaemia (36%), dehydration (27%), UTI (18%) and no identifiable factor (3%). Dialysis was required in 15% new myeloma patient. Renal biopsy and histopathological examination revealed myeloma cast nephropathy (30%), amyloidosis (30%), glomerulosclerosis (chronic kidney disease) (20%), monoclonal immunoglobulin deposition disease (MIDD) (10%) and interstitial nephritis with fibrosis (10%). Renal involvement was a common and severe complication of multiple myeloma. Renal impairment was strongly associated with hypercalcaemia, NSAIDs use, hyperuricaemia, Bence Jones proteinuria etc.

OBESITY: A CAUSATIVE RISK FACTOR OF BREAST CANCER

Background. Obesity, a global health burden and one of the most deleterious diseases have substantially increased prevalence attributable to changing lifestyle of modern times. Persuasive evidence indicates obesity as an independent prognostic factor for developing malignancy in the form of breast cancer particularly in post-menopausal women. Objective. This review aims to focus in comprehensive manner on the biochemical, hormonal and immunological pathways governing the obesity linked breast cancer so that potential treatments may be improvised consequently to provide a cure to this menace, threatening the lives of many. Methods. Literature review of published materials that provide examination of recent or current literature on problem of obesity. Results. Increased body fatness, mainly visceral adiposity may account for predisposing an obese individual to the risk of encountering cancer although the mechanisms for such cancers may vary depending upon the organ affected. Metabolic and biochemical alterations influencing obesity related carcinogenesis, consisting of heightened oxidative stress and bodily inflammation levels with the concomitant rise in pro-inflammatory cytokines are discussed. Pertinent references about elevated levels of serum insulin, insulin-like growth factor, sex steroids and the imbalance in adipokines (adiponectin and leptin) are included as well. Conclusions. Persuasive evidence indicates obesity as an independent prognostic factor for developing malignancy in the form of breast cancer particularly in post-menopausal women. Generation of novel and effective therapeutic interventions for combating the ailment along with positive lifestyle modifications may be improvised consequently to provide a cure to this menace, threatening the lives of many.

Response of Proliferative Lupus Nephritis with Pulse Cyclophosphamide Therapy during Induction Period: A Single Centre Study in Bangladesh

This prospective study was conducted to assess the response of proliferative lupus nephritis with pulse cyclophosphamide therapy during induction period in the department of Nephrology of Dhaka Medical College, Dhaka, Bangladesh from December 2012 to November 2013. A total of 35 clinically diagnosed SLE patients of class III/IV lupus nephritis were included. But 3 patients were dropped out during follow-up, therefore finally 32 patients (class III = 4, class IV = 28) were studied. The patients were evaluated for response on the basis of proteinuria, serum creatinine & active sediment in urine after 6th cycle of cyclophosphamide and 62.5% patients achieved complete response, 25% patients achieved partial response & 12.5% patients achieved no response. The factors favored complete response was early clinical presentation (7 months duration), proteinuria ≤3gm/day& normal renal function during their initial presentation. And higher anti ds DNA titre was an independent predictor for partial response/no response.

Prevalence of Microalbuminuria and Overt Proteinuria in Diabetes Mellitus and their Association with Renal Function

This cross sectional observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2009 to March 2010. Samples were collectedfrom rural area of Khalishaur union of Purbadhala upazilla in Netrakona District, 30km away from Mymensingh Town. The main objective of the study was to find out the prevalence of microalbuminuria as well as overt proteinuria in diabetes mellitus in a rural population and to observe their association with renal function. In this study 1048 adult participants of 18 to 65 years in a rural area of Netrakona were included purposively as study subjects. Among them 54% were male and 46% were female. Mean age of study subjects was 42.4±13.4 years. Prevalence of microalbuminuria among diabetic participants was 29.72% where as in non diabetic non hypertensive participants it was 6.62%. Diabetic persons 9.45% and 3.9% of non diabetic participants showed overt proteinuria by dipstick test. Prevalence of hypertension in diabetic and non diabetic participants was 45.94% and 16.52% respectively. The mean eCCr of the diabetic patients and non-microalbuminuric healthy persons was 78.4±25.4 ml/min/1.73m² and 94.67±24.8 ml/min/l.73m² respectively according to Cock Croft-Gault equation. The mean eCCr of diabetic participants with overt proteinuria was 57.44±28.33 ml/min/l.73m² but diabetic patients with microalbuminuria had better mean eCCr 80.62±21.17 ml/min/1.73m² which justifies the importance of detection of microalbuminuria for early intervention. By regression analysis it was found that degree of microalbuminuria had linear relation with renal function and random blood sugar level. Neither BMI nor duration of diabetes showed any correlation with urine microalbumin. There was no effect of sex on the prevalence of microalbuminuria in diabetes mellitus. Microalbuminuria is the first sign of renal involvement in diabetic patients which is a risk factor for overt nephropathy. Monitoring of this condition is important because early treatment of microalbuminuria can prevent or postpone overt nephropathy.

Acute Kidney Injury in Patients with Acute Viral Hepatitis: A Study in a Tertiary Care Hospital

This cross sectional observational study was done in the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2013 to April 2014 to find out the proportion of acute kidney injury among patients with acute viral hepatitis and to identify risk factors associated with development of acute kidney injury (AKI). A total of 100 patients with acute viral hepatitis were included purposively as study subjects. Among them 61 were male and 39 were female. They were divided into AKI group (n=6) and non-AKI group (n=94) on the basis of development of AKI. There was no significant difference in mean age (39.0±13.1 years vs. 32.2±10.8 years, p=0.335) and sex (67% vs. 61% & 33.0% vs. 39.0%) p=0.769) between AKI group and non-AKI group. There were 27% acute viral hepatitis A, 21% acute viral hepatitis B and 52% acute viral hepatitis E but no case of acute viral hepatitis C was found in this study. Acute kidney injury (AKI) developed in 6 of 27 patients with acute viral hepatitis A. This study showed that 22.2% patients with acute viral hepatitis A developed acute kidney injury but patients with acute viral hepatitis B (HBV) and hepatitis E (HEV) did not develop acute kidney injury. Majority of the patients with acute kidney injury were smokers and hypertensive with elevated mean arterial pressure (p=0.0001) at presentation and had higher total bilirubin (p=0.0001), alanine aminotranseferase values (p=0.040), prolonged prothrombin time (INR) {p=0.0001}, lower albumin (p=0.0001), lower haematocrit level (p=0.0001), high CRP concentration (p=0.0001), leucocytosis (p=0.0001) and thrombocytopenia (p=0.0001) at presentation than patients without acute kidney injury. It is evident from the study that acute kidney injury is not a rare complication in patients with acute viral hepatitis.

Outcome of Pregnancy Related Acute Kidney Injury Observed in a Tertiary Care Hospital

This prospective case control study was carried out in Mymensingh Medical College Hospital (MMCH) from April 2011 to March 2012. The main objective of the study was to determine the short term maternal outcome of pregnancy related Acute Kidney Injury and to identify aetiological factors and to observe clinical features of pregnancy related Acute Kidney Injury. Total 60 pregnant women with AKI were included in the study as sample and equal (60) number of pregnant women with normal renal function was taken as control. Mean ages (±SD) of study and control group were observed 31.6±6.9 years and 25.5±4.7 years respectively. It was observed that most patients were from rural area with low income group. Most women were multiparous and presented in third trimester and postpartum period. Majority of the study subjects did not receive antenatal care at any stage of pregnancy. Fifty (86.7%) of the study subjects were oligo-anuric, forty-nine (81.7%) were edematous and fifty one (85%) were anaemic. Twenty-five (41.7%) patients presented with abnormal vaginal bleeding. Sepsis (including septic abortion and puerperal sepsis) was responsible for of Pregnancy Related AKI (PR-AKI) in more than two fifths of cases. Haemorrhage (APH & PPH combined) was the next common cause of Pregnancy Related AKI (PR-AKI). Toxemia of Pregnancy was responsible in one fourth of cases. Dialysis (HD & IPD combined) was required for two fifths of the patients. Rest patients were treated conservatively with antibiotics, blood transfusion, maintenance of fluid and electrolytes balance etc. Maternal outcome of Pregnancy related acute kidney injury was considered for the period of patient's hospital staying. 56.6% patients recovered completely, 15.0% patients recovered partially, 6.7% did not recover at the time of hospital discharge; while 21.7% died. So it can be concluded that, pregnancy related acute kidney injury is a critical condition, associated with worse prognosis.

Significant Enhancement in the Conductivity of Al-Doped Zinc Oxide thin Films for TCO Application

Nanostructured Al-doped Zinc oxide (ZnO) thin films were deposited on glass substrate by chemical bath deposition (CBD) using aqueous zinc nitrate solution and subjected for different characterizations. Effect of Al[Formula: see text] substitution on the properties of ZnO annealed at 400[Formula: see text]C was studied by XRD and UV-Vis for structural studies, SEM and TEM for surface morphology and DC four probe resistivity measurements for electrical properties. Al[Formula: see text] substitution does not influence the morphology and well-known peaks related to wurtzite structure of ZnO. Electron microscopy (SEM and TEM) confirms rod shaped Al-doped ZnO nanocrystals with average width of 50[Formula: see text]nm. The optical band gap determined by UV–Visible spectroscopy was found to be in the range 3.37[Formula: see text]eV to 3.44[Formula: see text]eV. An EPR spectrum of AZO reveals peak at [Formula: see text] is due to shallow donors Zn interstitial. The DC electrical resistivity measurements of Al-doped ZnO show a minimum resistivity of [Formula: see text]-cm. Therefore, these samples have potential use in n-type window layer in optoelectronic devices, organic solar cells, photonic crystals, photo-detectors, light emitting diodes (LEDs), gas sensors and chemical sensors.

Pulmonary function in young females of Kolkata, India - Revisited

Rapid economic and industrial growths imposed significant impact on human health including the pulmonary health. Questions were raised regarding the validity of the existing prediction norms of pulmonary function tests (PFTs) in a particular population. The present study was conducted to investigate the applicability of the existing norms for PFTs in young healthy non-smoking female university students of Kolkata, India. Significant difference was noted in vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV₁) when the present data were compared with the earlier study in similar population. Correlation statistic revealed significant relationship of age and body height with all the PFT parameters. Body mass had significant correlation with VC, FVC, FEV₁ as a percentage of FVC (FEV_1%), and peak expiratory flow rate (PEFR). Regression equations have been computed for predicting PFTs from age and body height. There has been a change of PFTs in the studied population for the last couple of decades due to increased environmental pollution in the course of economical and industrial developments. Regression equations computed in this study are not only recommended to predict PFT parameters in the studied population, but they are also considered more reliable owing to their substantially smaller standard error of estimate than those proposed in the previous study.

Maternal mortality in obstetrics and gynaecology in a tertiary care hospital

Maternal mortality is the leading causes of death and disability of reproductive age in the developing countries. Bangladesh is one of the developing countries where maternal mortality is very high. The purpose of the present study was to see the causes of maternal deaths at Obstetrics and Gynaecology ward. This retrospective study was carried out in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital (DMCH). All maternal deaths were included in this study from July 2003 to June 2004 for a period of one year. The incidence of maternal death was 18.5/1000 live birth. Hypertensive disorder of pregnancy (41.84%) was the most common cause of maternal death followed by unsafe abortions (21.4%), PPH (10.2%), obstructed labour (8.2%). Among 98 patients 36(36.7%) cases are died due to eclampsia. Death due to pre-eclampsia (5.1%), unsafe Abortion (21.4%), Obstetric haemorrhage (18.4%) and obstructed labour (8.3%) were commonly found in this study. The study permits to conclude that Hypertensive disorder of pregnancy is the leading cause of pregnancy related deaths followed by unsafe abortions and obstetric haemorrhage. Other causes include obstructed labour, anaesthetic complications and others.

ANTHROPOMETRIC PROFILE, BODY COMPOSITION AND VERTICAL JUMP SCORE IN BOXERS AND SWIMMERS

<p><strong>Background.</strong> Vertical jump test (VJT) is used in some sport disciplines to evaluate an individual’s lower extremity power. However, VJT data is unavailable in young Indian boxers and swimmers.<br /><strong>Objective.</strong> The given study was aimed to evaluate the VJT, anthropometric profile and body composition in young male Indian swimmers and boxers and compare the data with sedentary control group. The study also explored the relationship of VJT with anthropometric parameters and different components of body composition in the studied groups.<br /><strong>Methods</strong>. Male boxers (n=40), swimmers (n=40) and sedentary subjects (n=40) with similar socio-economic background with age ranging between 21 and 25 years were sampled for the study from Kolkata, India. Body composition was determined by skinfold measurements and VJT was evaluated by Sargent Jump Test.<br /><strong>Results. </strong>One way ANOVA shows significant (p&lt;0.001) difference in body mass, %fat, total body fat (TF), lean body mass (LBM) and VJT score in boxers, swimmers and sedentary groups. Significant positive correlation of LBM with VJT score was associated with a greater jumping height in swimmers. On the other hand, VJT had significant negative (p&lt;0.05) correlation with sum of all the skinfolds, individual skinfold and total fat in both athlete group as well as in the sedentary group.<br /><strong>Conclusion.</strong> Significant intergroup difference was found in the studied parameters. VJT scores obtained in all the groups were well comparable. Higher value of body %fat imposed the unfavourable effect towards achieving higher jumping height mainly in sedentary group.<br /><strong></strong></p><p><strong>KEY WORDS:</strong> VJT, boxers, swimmers, %fat, LBM.<strong></strong></p>

An evaluation of serum magnesium status in pre-eclampsia compared to the normal pregnancy

Pre-eclampsia is a disease which causes significant maternal and fetal morbidity and mortality, especially in the developing countries. Despite numerous studies, the etiology of pre-eclampsia has not yet been fully elucidated. Although several evidences indicate that various elements such as serum Magnesium, Calcium etc. might play an important role in pre-eclampsia. The present study prospectively determines and evaluate whether maternal serum levels of magnesium has any association with pre-eclampsia or not. It was a cross sectional study carried out in the Department of Biochemistry, Mymensingh Medical College from July 2009 to June 2010. A total of 108 subjects were selected with the duration of pregnancy from 28th week of gestation to term of which 42 were normal pregnant women (as control) and 66 were pre-eclamptic (34 with mild and 32 with severe preeclampsia) admitted in the Obstetrics and Gynaecology department of Mymensingh medical college hospital. Serum Magnesium level was determined in the laboratory by colorimetric method using recommended commercial kit. Student's unpaired t-test was used to see the statistical significance of the difference between the mean values of the estimated parameters. The mean serum levels of Magnesium in normal pregnant group was 1.91±0.08mg/dl, mild pre-eclamptic group was 1.8±0.11mg/dl,and in severe pre-eclamptic group was 1.75±0.10mg/dl. The mean serum Magnesium of women with mild pre-eclampsia as well as severe pre-eclampsia was significantly (p<0.001) decreased in comparison to that of the control. A significant (p<0.05) decrease in serum magnesium was also found in subject with severe pre-eclamptic compared to that of the mild pre-eclamptic. So, these results indicate that reduction in serum levels of magnesium during pregnancy might be a possible contributor in the etiology of pre-eclampsia and supplementation of this element as diet or drugs may be of value to prevent pre-eclampsia.

Wandering biliary ascariasis with hepatic abscess in a postmenopausal woman

Hepatobiliary ascariasis is common in developing countries where there is a low standard of public health and hygiene. We are reporting a rare case of ascariasis which induced multiple liver abscesses in a post menopausal woman who presented with fever, anorexia, nausea, vomiting and mild hepatomegaly. Ultrasonography revealed biliary ascariasis with multiple hepatic abscesses. Laparoscopic drainage of hepatic abscesses was done and microscopic examination of drainage materials showed decorticated eggs of Ascaris Lumbricoides. The post operative recovery of the patient was uneventful. Ultrasonography is a reliable modality to diagnose and follow up of such cases.

Serum iron status among visceral leishmaniasis patients

This case control cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Department of Microbiology, Medicine units of Mymensingh Medical College Hospital and Fulbaria & Muktagacha Upazilla Health Complexes, Mymensingh during the period of July 2006 - June 2007. The aim of the study was to explore the status of serum iron among visceral leishmaniasis patients in Bangladesh as a means to monitor the possibility of management of these patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control) consisting of 60 apparently healthy persons matched by age, sex and socioeconomic status with the cases and Group II (Case) consisting of 60 "ICT for Kala-azar" positive VL patients. Serum iron was estimated by colorimetric method with ferrozine from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum iron were 100.67±20.83 and 76.76±8.64μgm/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum iron (P<0.001). It is evident from the study that serum iron level significantly decreases among visceral leishmaniasis patients in Bangladesh.

Complications of neck dissection at a tertiary level hospital: study of 30 cases

Metastatic dissemination into lymph nodes of neck occurs frequently in head neck cancers which down grade the patient's curability and survival. Neck dissection is a curable option for its management. To evaluate the complications following different types of neck dissection. This cross sectional study was conducted among patients undergone different types of neck dissection due to cervical nodal metastasis and attended follow up during July 2010 to June 2011 in Department of ENTs and Head-Neck surgery Dhaka Medical College Hospital, Dhaka, Bangladesh. Among 30 selected patient, 23 were male (76.67%) and 7 were female (23.33%), age ranged from 31-72 years (Mean=59.1±5.44). In different modalities of neck dissection 11 were modified neck dissection (36.67%) and 10(33.33%) were radical neck dissection. Common indication was carcinoma of unknown origin (66.67%). Involved neck nodes were commonly level II-IV (69.99%). Nodal stage was N2(50%) and N3 (40%).Common immediate complications were bleeding 03(10%), facial oedema 02 (6.67%) and thoracic duct injury 02(6.67%). Intermediate complications were seroma 05(16.67%), wound infection 04(13.33%) and chylous fistula 02(6.67%), Late Complications were hypertrophic scar 07(23.33%) and shoulder syndrome 06(20%). Proper indications, skilled surgery along with early recognize and treatment in both early and late manifestations of neck dissection preventing its grave sequence.

A Recyclable Heterogeneous Copper(II) Schiff Base Catalyst for the O-Arylation Reaction of Phenols with Aryl Halides

Immobilisation of copper acetate onto a modified polystyrene provided a polymer-supported copper(II) Schiff base catalyst, which is effective in the O-arylation reaction of phenols with aryl halides to give diaryl ethers in high yields. This catalyst is air-stable and was recycled for five times with minimal loss of activity.

Quantum fluctuations and the closing of the Coulomb gap in a correlated insulator

The "switchable mirror" yttrium hydride is one of the few strongly correlated systems with a continuous Mott-Hubbard metal-insulator transition. We systematically map out the low temperature electrical transport from deep in the insulator to the quantum critical point using persistent photoconductivity as a drive parameter. Both activated hopping over a Coulomb gap and power-law quantum fluctuations must be included to describe the data. Collapse of the data onto a universal curve within a dynamical scaling framework (with corrections) requires znu=6.0+/-0.5, where nu and z are the static and dynamical critical exponents, respectively.

Job displacement effects of Canadian immigrants by country of origin and occupation

"Some previous Canadian studies have shown that considering the labor market as a whole and also pooling all immigrants as a group, immigrants do not have any job displacement effects on the Canadian born. This study presents some new evidence. It disaggregates immigrants by country of origin and by occupation groups and provides an analysis of job displacement effects of immigrants on the native-born Canadians by these dimensions. The study finds that (1) U.S. immigrants and the Canadians are substitutes [for] competing groups in the labor market and the effect is quite significant; (2) Canadians and Europeans are competing groups in certain occupations, while they have complementary skills in others; and (3) immigrants from the Third World and the Canadians are slightly competing groups in certain occupations."

Light-induced metal-insulator transition in a switchable mirror

Rare earth hydride films can be converted reversibly from metallic mirrors to insulating windows simply by changing the surrounding hydrogen gas pressure at room temperature. At low temperatures, in situ doping is not possible in this way as hydrogen cannot diffuse. However, our finding of persistent photoconductivity under ultraviolet illumination offers an attractive possibility to tune yttrium hydride through the T = 0 metal-insulator transition. Conductivity and Hall measurements are used to determine critical exponents. The unusually large value for the product of the static and dynamical critical exponents appears to signify the important role played by electron-electron interactions.

Incidence of non-compliance with unemployment insurance regulations and associated claimant characteristics

Using a national random sample of active claims from the Longitudinal UI file, this study provides an analysis of the incidence of non-compliance with UI regulations. These findings are then compared with the administrative reporting of detected non-compliance incidence obtained for the same period from routine operation. The study of the random sample showed a lower incidence of non-compliance than that obtained from the administrative data, indicating that the targeted investigation strategies used to maintain the integrity of the UI Account were effective and working. The paper also provides a logit analysis of the incidence of non-compliance and claimant characteristics which shows that the probability of non-compliance is relatively high in the case of females, younger claimants, and low wage workers. Detected UI non-compliance level was found to be lower in local labour markets with relatively high unemployment.

Attitude of children towards medication and health in urban and rural schools of Tamil Nadu

In most cases of Pediatric practice, medicine is prescribed to the child without taking into consideration his likes and dislikes. The medicines are usually thrust upon them. Though our foremost aim is to cure the patient, we should give due importance to make the process of cure as comfortable as possible. Keeping this in mind, opinion poll of around nine hundred school students from rural and urban population of age ranging from 11 years to 16 years was taken. The result is analysed and suggestion is given to rationalise the treatment for better compliance.

Simple anthropometry and peak expiratory flow rate in elite South Asian athletes

The athletes (n = 40) of South Asian Federation (SAF) Games were examined each taking a very short time. The athletes were runners (short distance, long distance and marathon), jumpers and throwers who were persuaded for the purpose. The throwers and the jumpers respectively comprised the oldest and youngest group of athletes in the study. The throwers were observed to be the tallest (mean height 179.96 +/- 1.49 cm) and heaviest (mean weight 92.27 +/- 3.81), whereas the long distance runners were of short height (mean value 162.80 +/- 2.61 cm) and light weight (mean value 50.41 +/- 2.58 kg). The highest mean values of PEFR (lit/min) were noted among the throwers (596.60 +/- 27.53) followed by marathon (590.0 +/- 32.18) and long distance runners (588.0 +/- 27.35). The lower values of PEFR were noted among the short distance runners (528.60 +/- 15.83) and jumpers (525.70 +/- 22.60). The PEFR values, when arranged according to height, were noted to be insignificantly increasing with the increase in age. The overall values of height, weight and PEFR were all found to be higher in these elite sportsmen when compared with their non-sportsman Indian counterparts.

Pulse rate, pre-competition tension and performance in 10,000 meter elite runners of both sexes

Five male and 3 female runners who participated in 10,000 meter distance run in South Asian Federation (SAF) Games, 1987 were volunteered for this pilot study. The pulse rate at rest, 1 hour prior to competition and post-run for 30 min at 5 min intervals were recorded. It was observed that the runners who showed less rise of pulse prior to competition, performed better. This might be attributed to less pre-competition tension in them which helped the athletes to perform better.