Endoluminal Ultrasonography versus Computed Tomography for Locoregional Staging of Carcinoma Stomach

Curative surgery remains the mainstay treatment of carcinoma stomach till to date. Preoperative accurate diagnosis of the depth of tumour invasion (T) and nodal involvement (N) in stomach cancer is important in determining the choice of an optimal therapeutic approach. Endoluminal ultrasonography (EUS) is considered as most reliable tools for assessing locoregional staging as it can overcome bones and air barrier on the other hand computed tomography (CT) has increased its' efficacy greatly after introduction of extreme multi-detector and phase-contrast CT. The objective of this study was to compare the accuracy of T and N staging with EUS and CT by comparing with postoperative histopathology in stomach carcinoma. This cross-sectional observational study was conducted in the department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2019 to July 2020. Forty five (45) patients who underwent curative stomach resection surgery due to carcinoma of stomach were enrolled in this study. All patients were investigated by EUS and CT preoperatively to assess locoregional staging. Then patients underwent stomach resection surgery and specimen sent for histopathology. EUS had sensitivity 80.0% to predict T staging but specificity 60.0% and the overall accuracy was 68.89%. CT result showed sensitivity 59.38% to predict T staging but specificity 46.15%, and the overall accuracy was 55.56%. EUS had 65.63% sensitivity to predict nodal involvement but specificity 61.54% and the overall accuracy was 64.44%. CT had 83.33% sensitivity to predict nodal involvement but specificity 55.56% and the overall accuracy was 77.78%. EUS is more accurate than CT in T staging but CT is more accurate than EUS in the N staging of carcinoma stomach. So EUS and CT both should be used as a diagnostic tool for preoperative locoregional staging of carcinoma stomach.

Comparison of Pain Control and Analgesic Consumption With or Without Infiltration of Bupivacaine at Port Sites after Laparoscopic Cholecystectomy

Pain management is an essential component of all surgical procedures. Analgesics are used for this purpose but there are some complications in using them. Local anesthetics like bupivacaine can be used to reduce postoperative pain as well as analgesics consumption. The objective of this study is to observe the result of infiltration of bupivacaine at port sites and to compare the postoperative pain relief with that of opioids and NSAID administration following laparoscopic cholecystectomy for chronic calculus cholecystitis. This is a cross sectional study was conducted over one year in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2018 to August 2019. Here total 40 patients were enrolled by purposive sampling. They were divided in two groups. One group received bupivacaine while other did not. A numerical pain scale was used as tool. Data will be recorded by peer reviewed interview and observation based semi structured data collection sheet. Data analysis was done by SPSS version 23.0. P-value was significant at (p<0.05) and determined by chi square test. Written informed consent was taken from the patient. The mean Numerical Rating Scale (NRS) score of pain at 6 hour was 2.55±0.6 in Group I and 6.8±1.15 in Group II. The mean NRS score of pain at 12 hour was 4.1±1.21 in Group I and 7.95±0.6 in Group II. The mean time of 1st analgesic administration was 13.85±1.57 hours in Group I and 2.75±0.72 hours in Group II. The mean repeat dose of analgesic was in 22±2.29 hours in Group I and 9.5±1.15 hours in Group II. In Group I one third patients (30.0%) single dose analgesic required in 1st 12 hours while in Group II almost 90.0% patients needed analgesics in 1st 12 hours. In Group I, total doses of analgesics required were 2 in 75.0% patients while in Group II at least 3 doses of analgesics were needed. In Group I only one patient needed analgesic in first 6 hours (5.0%) while in Group II, all the patients (100.0%) needed analgesics. The difference was statistically significant (p<0.05) between two groups. The patients receiving bupivacaine at port sites will experience less pain at postoperative period and will need less analgesic medications.

Electrosurgery Dissection versus Sharp Dissection: Effect on Early Postoperative Wound Complications in Modified Radical Mastectomy

Modified radical mastectomy (MRM) is still the most commonly performed operation for breast cancer, despite the trends toward breast-conserving treatment. Since 1970s, electrosurgery (also known as electrocautery, diathermy) has been a widespread surgical tool to raise flaps and excise the breast specimen in order to perform a bloodless mastectomy. Use of diathermy has been well blamed for wound complications. To prevent undue delay in the adjuvant treatment, it is important to minimize the surgical complications. This quasi experimental study was conducted in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to evaluate the effects of electrosurgery and sharp dissection on early postoperative wound complications in MRM. 46 patients were included in the study (23 in each group). Data analysis done in SPSS version 23.0 and 'p' value <0.05 considered significant at 95% confidence interval. In Electrosurgery Dissection (ED) group mean duration of drainage was 7.8±1.2 days and in Sharp Dissection (SD) group 6.4±1.0 days (p value 0.000). Mean total drainage in ED group found 1082±287ml and in SD group 693±194ml (p value 0.000). Seroma formation found 7(30.4%) in ED group and 3(13.0%) in SD group (p value 0.004). Wound dehiscence found 5(21.7%) in ED group and 2(8.7%) in SD group (p value 0.013). Flap necrosis rate was 4(17.4%) and 1(4.4%) in ED and SD group respectively (p=0.003). Demographic and clinical variables were similar or differences were not statistically significant in two groups. No difference found in operating time and wound infection rate in two groups. The result of the study showed that, electrocautery dissection caused early postoperative wound complications more than the sharp dissection.

Role of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Lesions

To evaluate the diagnostic utility of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic lesions, EUS-FNA was carried out on a total of 28 cases at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2015 to August 2016. Clinical impression was compared with the final cytological diagnosis and the percentage of non diagnostic smears was calculated. The lesions were categorized according to cytological report. Out of 28 cases, 3(10.71%) cases were normal, 6 cases (21.43%) were reported as inconclusive while a definite diagnosis was given in 19 cases (67.85%). The mean patient age was 47.82 years. There were 16(57.1%) males and 12(42.9%) females. The most common site biopsied was pancreatic head in 21cases (75%) followed by tail in 5 cases (17.9%) & body in 2(7.1%) cases. The average number of passes made was two. Endoscopic Ultrasound Guided Fine-Needle Aspiration in the diagnosis of pancreatic lesion is a useful procedure.

Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases

A comprehensive germplasm evaluation study of wheat accessions conserved in the Indian National Genebank was conducted to identify sources of rust and spot blotch resistance. Genebank accessions comprising three species of wheat-Triticum aestivum, T. durum and T. dicoccum were screened sequentially at multiple disease hotspots, during the 2011-14 crop seasons, carrying only resistant accessions to the next step of evaluation. Wheat accessions which were found to be resistant in the field were then assayed for seedling resistance and profiled using molecular markers. In the primary evaluation, 19,460 accessions were screened at Wellington (Tamil Nadu), a hotspot for wheat rusts. We identified 4925 accessions to be resistant and these were further evaluated at Gurdaspur (Punjab), a hotspot for stripe rust and at Cooch Behar (West Bengal), a hotspot for spot blotch. The second round evaluation identified 498 accessions potentially resistant to multiple rusts and 868 accessions potentially resistant to spot blotch. Evaluation of rust resistant accessions for seedling resistance against seven virulent pathotypes of three rusts under artificial epiphytotic conditions identified 137 accessions potentially resistant to multiple rusts. Molecular analysis to identify different combinations of genetic loci imparting resistance to leaf rust, stem rust, stripe rust and spot blotch using linked molecular markers, identified 45 wheat accessions containing known resistance genes against all three rusts as well as a QTL for spot blotch resistance. The resistant germplasm accessions, particularly against stripe rust, identified in this study can be excellent potential candidates to be employed for breeding resistance into the background of high yielding wheat cultivars through conventional or molecular breeding approaches, and are expected to contribute toward food security at national and global levels.

Bilateral Tubercular Mastitis - Case Reports

Breast tuberculosis is a rare form of tuberculosis. Moreover the disease is often overlooked and misdiagnosed as carcinoma or pyogenic abscess. Reports on breast tuberculosis have been few; reported incidence of breast tuberculosis amongst the total number of mammary conditions varies between 0.1 and 4 percent. Bilateral involvement is still more uncommon (3%). Here we report 3 cases of adult female ranging from 27 to 35 years who presented with 1 to 4 months history of firm lumps in both breasts and no axillary lymphadenopathy. Fine needle aspiration cytology (FNAC) of breast lump in all 3 cases were done but in 1 case showed evidence of tubercular mastitis and other 2 cases findings were inconclusive. Subsequent Excisional Biopsy of those 2 cases showed features of tuberculosis. All 3 were prescribed with four drug anti-tubercular treatments continued for 12 months in 2 cases and 9 months in other case depending upon their response. The lumps disappeared and ulcer healed after anti-tubercular treatment.

Pylorus Preserving Pancreaticoduodenectomy vs. Standard Whipple's Procedure in Case of Carcinoma head of the Pancreas and Periampullary Carcinoma

Pancreatic carcinoma is a life threatening condition. Surgical resection is the only hope of cure. Advances in surgical technique have reduced the mortality rate. Nevertheless, operative complications related with morbidity still remains high. Two operation techniques in the treatment of periampullary and pancreatic head cancer: the Standard Whipple operation (SW) and Pylorus Preserving Pancreaticoduodenectomy (PPPD) are performed predominantly. This study was performed to compare the results of Pylorus Preserving Pancreaticoduodenectomy (PPPD) with that of the Standard Whipple's (SW) procedure. This prospective study was carried out in the Department of General Surgery, BSMMU in two years duration. All admitted patient's with periampullary carcinoma and carcinoma of the head of the pancreas were included and randomized for a SW or a PPPD resection. Data regarding patients demographics, preoperative assessment, intraoperative and postoperative findings were collected and analyzed. Less blood loss (2.67±0.65 units in Group I and 2.88±0.64 units in Group II), fewer need of blood transfusions and shorter hospital stay in the PPPD group were observed. Gastrointestinal leakage was similar in both groups of patients (1:1). One pancreatic fistula (8.3% in Group I) was observed in PPPD group and one intra-abdominal abscess developed in Standard Whipple's procedure (00.0% in Group I and 12.5% in Group II). Bile leakage was higher in standard Whipple procedure (8.3% in Group I and 37.5% in Group II). Morbidity was more or less similar in both groups (58.0% in Group I and 50.0% in Group II) but one patient (12.5% in Group II) died in standard Whipple's resection. PPPD procedure is more effective treatment for periampullary carcinoma and cancer of the pancreatic head region than the standard Whipple's operation.

Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.

Evaluation of simple hematological screen for early diagnosis of neonatal sepsis

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to evaluate the role of simple hematological test for early diagnosis of neonatal sepsis. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following laboratory investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. Immature and total neutrophil ratio (I/T ratio) detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Absolute neutrophil count (ANC) had low sensitivity (13%) but Micro-ESR, CRP, I/T ratio, platelet count had moderately high sensitivity and specificity. These simple hematological screen are useful marker for early diagnosis of neonatal sepsis.

Effect of zinc on growth of preterm babies

Zinc is being recognized increasingly as an important element in human growth, development and immunological function. It is probably the most intensely studied microelement in newborn nutrition. Zinc deficiency is common in young infants in the developing world and is associated with reduced immunocompetence and increased rates of serious disease. Preterm neonates are especially vulnerable because of preterm delivery and low birth weight. The preterm baby has very limited stored energy and needs an adequate supply of nutrient. Preterm infant have high zinc dietary requirements as 60% fetal zinc is acquired during third trimester of pregnancy. Low concentration of zinc was found in pre-term low birth weight babies in different studies. Studies showed that before supplementation serum zinc level in preterm low birth weight babies were 62+/-12.4 microgm/dl, 65 microgm/dl, 54+/-14.4 microgm/dl and after supplementation serum zinc level were 105.8+/-16.6 microgm/dl, 86.4+/-24.7 microgm/dl respectively. At the same time mean weight & length of supplementation and without supplementation group were 6084 gm vs. 5280 gm, 2779+/-638.7 gm vs. 2474.6+/-441.8 gm and length 23.7 cm vs. 21.4 cm, 46.49+/-2.6 cm vs. 44.1+/-2.8 cm respectively. So supplementation of zinc in preterm babies causes improved growth and development. Various reports showed beneficial effect of long supplement in early growth of pre-term babies. However long term follow up studies are needed to evaluate the beneficial effect of zinc supplementation on growth of preterm babies.

Role of micro-ESR and I/T ratio in the early diagnosis of neonatal sepsis

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to determine the role of micro-ESR and immature and total neutrophil (I/T) ratio in early diagnosis of neonatal septicaemia. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. I/T ratio detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Micro-ESR more than age of the patient in days+3 mm in 1st hour were considered significant for sepsis. I/T ratio more than 0.2 was considered positive for sepsis. Sensitivity and specificity of micro-ESR was 63.3% and 60% respectively. Sensitivity and specificity of I/T ratio was 70% and 56% respectively. Combination of micro-ESR and I/T ratio showed high sensitivity (80%) and specificity (70%).

Excessive use of avoidable therapeutic injections in the upazilla health complexes of Bangladesh

Injection use problem in the hospitals of upazilla health complexes (UHCs) of Dhaka and Noakhali districts was studied through small group discussion with the health personnel of each the UHCs. The group discussion revealed that in the hospitals of UHCs of Dhaka, the antibiotic injections were used in 70% to 100% of the encounters in ARI/pneumonia. In dehydration, I.V. fluid and antimicrobial injections were used in 60% to 100% of the encounters. Similarly 60% to 70 % of the encounters received analgesic and antibiotic injections in injury. Injections were used in > or =30% of the encounters in pyrexia of unknown origin. The use of injections in the hospitals of the UHCs of Noakhali was comparatively less than that of Dhaka, but was still too high. In ARI/pneumonia antibiotic injections were used in 60% to 80% of the encounters. In dehydration, I.V. fluid and antimicrobial injections and in injury, analgesic and antibiotic injections were used in 60% to 80% of the encounters in each of the health conditions. In weakness, I.V. fluid and amino acid injections were used in 100% and 50% of the encounters respectively. In undiagnosed fever antibiotic injections were use in 60% of the encounters. The findings of the retrospective prescribing survey in those health complexes of the two districts corroborated the findings of the small group discussion. In the UHCs of Dhaka districts excessive injections were used in (i) ARI/pneumonia, (ii) dehydration and (iii) in injury. In ARI/pneumonia antibiotic injections were used in 100%, 94%, and 75% of the encounters in Dohar, Savar and Nawabgonj UHCs respectively. In dehydration, I.V. fluid was used in 100% and 89% of the encounters in Dhamrai and Keranigonj UHCs respectively. The I.V. fluid was also used in 76% of the encounters in injury. In the UHCs of Noakhali the injection use was somewhat less than that of Dhaka. Ceftriaxone injection was used in 87% and 77% of the encounters in ARI/pneumonia in Companygonj and Sonaimuri UHCs respectively. In the other three UHCs, analgesic injections were used in 80%, 67% and 67% of the encounters in Subarnochar, Chatkhil and Senbag respectively.

Extended-interval gentamicin administration in malnourished children

Malnourished children have several physiologic abnormalities that can affect drug distribution and elimination. The aim of this study was to determine the efficacy, safety and pharmacokinetics of a once-daily dose of gentamicin compared with conventional thrice-daily dosing in malnourished children. To our knowledge, it has not been investigated in this population so far. A total of 310 malnourished children of either gender aged 6 months to 5 years with diarrhea and pneumonia were randomized to receive intramuscular gentamicin 5 mg/kg/day once-daily (OD) (n=148) or the same total daily amount given in three divided doses (TD) (n=162) in addition to ceftriaxone 75 mg/kg/day. After 48 h at steady state, gentamicin pharmacokinetics was assessed by fluorescence polarization immunoassay in a subgroup of 59 children and 43 children in the OD and TD groups, respectively. The groups were equivalent in baseline demographic, clinical and laboratory characteristics. Good and partial clinical responses occurred in 64 per cent vs. 54 per cent and 25 per cent vs. 27 per cent in the OD and the TD children, respectively (p=NS for both comparisons). Five patients in each treatment group died. Renal toxicity defined by change in serum creatinine was not observed in any patient from either group. In the OD group, mean+/-SD serum gentamicin concentrations at 1 (peak), 3, 5, 8, 23, and 24 (trough value) hours after the dose were 11.7+/-4.1, 4.4+/-1.2, 2.08+/-0.9, 1.01+/-0.6, 0.31+/-0.09 and 0.29+/-0.07 mg/l respectively. In the TD group, mean +/-SD serum gentamicin concentration at 1 hour (peak) was 4.7+/-1.8 mg/l and the trough concentration was 0.48+/-0.21 mg/l. In OD group, the gentamicin trough concentration was significantly lower (p<0.001) and the peak concentration was significantly higher (p<0.001) compared to TD group. The results of this study indicate that once-daily gentamicin is effective and safe in malnourished children. Widespread implementation of once-daily dosing in malnourished children is appropriate and will reduce number of intramuscular injections and hospital costs.

Manifestation of arsenicosis patients and factors determining the duration of arsenic symptoms in Bangladesh

This study analyzed a total of 1482 arsenicosis patients living in 6 of 496 upzilas (sub-districts) of Bangladesh, who were identified through household screening and then confirmed by a trained medical team headed by medical officer. Melanosis was common (97%) among them but about two-thirds (68.7%) of the patients were suffering from keratosis. Average age was 36 years and average duration of arsenic symptoms was 3 (median) years. About 50% of the patients had been drinking tubewell water more than 24 years. Melanosis was significantly associated with younger patients (P=0.031), shallower tubewell (P=0.005), and complication of conjunctivitis (P<0.001). Keratosis was also significantly associated with older age (P=0.022), shallower tubewell (P<0.001), complication of conjunctivitis (P<0.001), bronchitis (P<0.001), loss of appetite (P<0.001), and wasting (P<0.001). Duration of arsenic symptoms was significantly associated with older age (P<0.001), male (P=0.002), married (P<0.001), smoking (P=0.002), longer duration of consuming tubewell water (P<0.001), complication of conjunctivitis (P=0.002), loss of appetite (P<0.001), wasting (P=0.006), and social problem faced having arsenicosis (P=0.040). Multivariate odds ratio (OR) and 95% confidence interval (CI) indicated that keratosis (OR=2.00; 95% CI: 1.56-2.56) was significantly associated with longer duration of arsenic symptoms; loss of appetite (OR=1.40; 95% CI: 1.12-1.74) was a significant complication for longer duration. Similarly smoking (OR=1.33; 95% CI: 1.06-1.68) was positively associated with longer duration of arsenic symptom. These findings will help the policy makers of Bangladesh to understand about the factors that may affect the severity condition of the patients through prolongation of arsenic symptoms.

Predominance of the DEN-3 genotype during the recent dengue outbreak in Bangladesh

A recent outbreak of dengue in Bangladesh was marked by many fatal complications. As clinical virulence varies among the genotypes of dengue virus, a study was conducted to investigate the molecular genotypes of dengue in Bangladesh. Reverse transcription polymerase chain reaction was used to determine viral genotypes using oligonucleotide generic primers that produce a 511 bp product. The resulting product was typed by nested PCR with strain-specific primers, yielding 482 (DEN-1), 119 (DEN-2), 290 (DEN-3) and 392 (DEN-4), visualized on UV transilluminator after electrophoresis on 2% agarose gel stained with ethidium bromide. Of 45 clinically diagnosed dengue patients (mean age 28 years; male/female 30/15), 19 (42.2%) had detectable viral RNA in their blood. However, during the first 5 days of fever in 30 patients, the frequency was 60% (18/30), implying that the sooner serum is drawn after the fever, the greater the chances of detecting viral RNA. DEN-3 was detected in all except 2 patients who were infected with DEN-2. DEN-2 (two cases) and DEN-4 (one case) were present as co-infections with DEN-3. All of the patients presented with fever, anorexia and vomiting; many had headache and general body ache; a few had a rash. About a quarter had suffered episodes of bleeding, while ascites, pleural effusion and CNS symptoms were found in a few patients Patients positive for viral RNA were also positive for anti-dengue IgM (p=0.007) in subsequent sampling. The study suggests the predominance of DEN-3 infection with occasional co-infection with other types, during the recent outbreak of dengue in Bangladesh.

Identification of TSIX, encoding an RNA antisense to human XIST, reveals differences from its murine counterpart: implications for X inactivation

X inactivation is the mammalian method for X-chromosome dosage compensation, but some features of this developmental process vary among mammals. Such species variations provide insights into the essential components of the pathway. Tsix encodes a transcript antisense to the murine Xist transcript and is expressed in the mouse embryo only during the initial stages of X inactivation; it has been shown to play a role in imprinted X inactivation in the mouse placenta. We have identified its counterpart within the human X inactivation center (XIC). Human TSIX produces a >30-kb transcript that is expressed only in cells of fetal origin; it is expressed from human XIC transgenes in mouse embryonic stem cells and from human embryoid-body-derived cells, but not from human adult somatic cells. Differences in the structure of human and murine genes indicate that human TSIX was truncated during evolution. These differences could explain the fact that X inactivation is not imprinted in human placenta, and they raise questions about the role of TSIX in random X inactivation.

Increased nitrite and nitrate concentrations in sera and urine of patients with cholera or shigellosis

OBJECTIVES

Nitric oxide (NO) is an important regulator of cell function. In the intestine, NO regulates blood flow, peristalsis, secretion, and is associated with inflammation and tissue injury. The objectives of this study were to assess and compare the role of NO in cholera, a noninflammatory enteric infection, and in shigellosis, a bacterial inflammation of the colon.

METHODS

We determined serum and urinary concentrations of nitrite and nitrate during acute illness and early convalescence in 45 hospitalized children: 24 with cholera and 21 with shigellosis; 18 healthy children served as controls. Nitrite and nitrate concentrations were determined spectrophotometrically using Greiss reaction-dependent enzyme assay.

RESULTS

Serum nitrite and nitrate concentrations were significantly (p < 0.05) increased during acute illness compared to the early convalescence in both cholera and shigellosis. Urinary nitrite and nitrate excretions were significantly (p < 0.01) increased during acute disease in shigellosis, but not in cholera. Nitrite concentrations correlated with stool volume (r2 = 0.851) in cholera and with leukocytosis (r2 = 0.923) in shigellosis.

CONCLUSIONS

Both cholera and shigellosis are associated with increased production of NO, suggesting its pathophysiologic roles in these diseases.

Low-copy-number human transgene is recognized as an X inactivation center in mouse ES cells, but fails to induce cis-inactivation in chimeric mice

X chromosome inactivation is initiated from a segment of the mammalian X chromosome called the X inactivation center. Transgenes from this region of the murine X chromosome are providing the means to identify the DNA needed for cis inactivation in mice. We recently showed that chimeric mice carrying transgenes from the human X inactivation center (XIC) region also provide a functional assay for human XIC activity; approximately 6 copies of a 480-kb human transgene (ES-10) were sufficient to initiate random X inactivation in cells of male chimeric mice (Migeon et al., 1999, Genomics, 59, 113-121). Now, we report studies of another human transgene (ES-5), which contains less than 300 kb of the human XIC region on Xq13.2 including an intact XIST locus and which has inserted in one or two copies into mouse chromosome 6. The ES-5 transgene is recognized as an X inactivation center in mouse embryonic stem cells, but is not sufficient to induce random X inactivation in somatic cells of highly chimeric mice. Human transgenes in chimeric mice provide a means to uncouple the key steps in this complex pathway and facilitate the search for essential components of the human XIC region.

Prevalence of infectious diseases and drug abuse among Bangladeshi workers

Individuals seeking jobs abroad need health fitness certificates before entering into those countries. Medical screening of 43,213 Bangladeshi job seekers (M/F: 42,290/923) was carried out in our reference center during the period August, 1994 to May, 1996. Albeit male predominance, they represented middle and lower middle socio-economic class of the population from all over the country. All were young adults (age: 27.05+/-3.56 years; mean+/-SD) applying for job visas to different Asian countries. Physical examination and laboratory investigations including markers for several infectious diseases and drugs of abuse were carried out as required by countries recruiting the workers. Serological tests revealed that 1,884 (4.4%) of individuals were positive for hepatitis B surface antigen (HBsAg), 737 (1.7%) for Treponema pallidum hemagglutination (TPHA) and only 83 (0.2%) for antibody to human immunodeficiency virus (anti-HIV). However, we could not confirm any case of infection with HIV. Chest X-ray suggestive of pulmonary tuberculosis was found in 162 (0.4%) and on blood film, malarial parasites could be observed only in 4 cases. Their urine analysis revealed the presence of opiates or cannabinoids in 471 (1.1%) individuals. HBsAg-positive cases (p = 0.003) and abuse of opiates (p = 0.024) or cannabinoids (p = 0.002) were significantly higher among males. TPHA reactivity and chest X-ray suggestive of tuberculosis were found to be higher among opiates (p = 0.002 and 0.027) and cannabinoids (p = 0.000 for both) abused as well as with increasing age (p = 0.000). These results may represent a cross-sectional view of the prevalence of different infectious diseases and abuse of drugs among the young adult population of Bangladesh.

Innate immune responses in children and adults with Shigellosis

An array of pro- and anti-inflammatory mediators of the innate immune system was analyzed in stool, urine, and rectal mucosa samples from adults and children with shigellosis to better understand their role in recovery from and in the immunopathogenesis of the disease. Increased concentrations of lactoferrin (Lf), myeloperoxidase (MPO), prostaglandin E(2), and leukotriene B(4) (LTB(4)) in stool during acute shigellosis in both children and adults indicated that activated cells of the innate defense system at the mucosal site were secreting the mediators. Increased concentration of MPO and 8-iso-prostaglandin F(2alpha) and lower levels of superoxide dismutase (SOD) activity in stool during acute Shigella infection suggested increased formation of reactive oxygen species, free radical-catalyzed peroxidation of membrane lipids, and decreased scavenging of the reactive oxygen radicals. In children, lower expression of SOD in tissue with severe inflammation and lower levels of SOD activity in stool for longer periods compared to adults may further worsen the tissue damage and predispose the children to a lowered defense. Both adult and pediatric patients had significantly higher expression of inducible nitric oxide synthase (iNOS) in the rectum with severe inflammation, compared to that seen with mild inflammation, accompanied by persistently up-regulated iNOS mRNA, reflecting increased production of nitric oxide at the local site. However, in contrast to adults, reduced urinary nitrate levels in pediatric patients during acute shigellosis suggested lower production of nitric oxide in the renal compartment. Persistent production of Lf in pediatric patients may contribute to chronic inflammation in the rectum. In addition, increased production of proinflammatory mediators in the rectum of patients with severe histology suggested contribution of these molecules to the immunopathogenesis of severe colitis caused by shigellae.

Short-chain fatty acids inhibit fluid and electrolyte loss induced by cholera toxin in proximal colon of rabbit in vivo

Short-chain fatty acids (SCFA), acetate, propionate, and butyrate, are produced by bacterial fermentation in the colon and stimulate Na+ and Cl- absorption. We have studied the effects of SCFA on fluid and electrolyte absorption during cholera toxin (CT) -induced colonic secretion in rabbit, using a steady-state perfusion technique with marker (PEG) dilution. Perfusion with SCFA significantly (P < 0.01) reduced colonic water secretion. Butyrate reduced water secretion the most (95%), followed by propionate (90%), and acetate (80%). Butyrate significantly (P < 0.001) reduced secretions of Na+ (95.5%), K+ (75.2%), and Cl-(80.7%) ions but not HCO3- ions. Propionate similarly reduced secretion of HCO3-(45.3%). Acetate significantly (P < 0.001) inhibited Na+ (76.4%) and Cl- (75.7%) secretion, but the inhibitions of K+ (23.6%) and HCO3 (28.8%) were not significantly different from the controls. We conclude that SCFA reduce CT-induced water and electrolyte secretion in the rabbit proximal colon, and its potential as an antidiarrheal agent should be further evaluated.

An immunological study of vitiligo

Estimation of peripheral T lymphocytes T3, T4, T8 and NK cells was carried out in 30 cases of different clinical types of vitiligo by direct immunofluorescence technique. The cases were divided into two broad groups (1) Localised; and (2) Generalised. These cases were again divided into 3 groups as per duration of disease. Thirty healthy subjects served as control. Decrease in T3 and T4 and increase in T8 with decrease of T4/T8 ratio was seen in both localised and generalised variety. But the T4/T8 ratio was decreased to a greater extent in generalised variety. The NK cells showed significant increase in the generalised variety. As per disease T4/T8 ratio was reduced maximally in patients with disease duration less than one year. Of the generalised category NK cells were increased more in patients having disease duration more than 1 year.

Glutamine is superior to glucose in stimulating water and electrolyte absorption across rabbit ileum

L-Glutamine is the primary metabolic fuel of the intestinal mucosa. This in vivo study compares the effect of L-glutamine 50 mM with that of D-glucose 50 mM on water and electrolyte absorption in jejunal and ileal loops of healthy rabbits. Using polyethylene glycol (PEG) as a nonabsorbable marker and an incubation at 37 degrees C, we found that absorption of water (P = 0.000), sodium (P = 0.002), potassium (P = 0.001), and chloride (P = 0.003) from the glutamine electrolyte solution was greater than from the glucose electrolyte solution in the ileum. A similar trend was shown in the jejunum. We conclude that L-glutamine may be a useful component to be tested in oral rehydration solutions for treating diarrheal dehydration.

Intestinal transport of water, sodium & glucose from an electrolyte solution with & without bicarbonate

In this study we have evaluated the role of bicarbonate on water and sodium transport in normal and secreting ilea of rabbits as controversy exists regarding the inclusion of bicarbonate in oral rehydration solution (ORS). In anaesthetized rabbits 10 cm closed ileal loops were constructed and filled with 5 ml of an electrolyte solution with and without bicarbonate, which contained polyethylene glycol (PEG; mol wt 4,000) as a non-absorbable marker. The fluid was withdrawn after an hour and analyzed for PEG, sodium and glucose. Similar studies were carried out in loops one hour after exposure to 1 microgram/ml of purified cholera toxin. Body temperature was maintained at 37 degrees C during the experiment by using a lamp. The mean +/- SE of water and sodium absorption, with bicarbonate versus without bicarbonate, was -1.4 +/- 0.1 vs -1.1 +/- 0.3 ml/h/10 cm, and -340.8 +/- 23.0 vs -308.4 +/- 35.6 mM/h/10 cm, respectively from secreting rabbit ilea. A similar effect was observed in normal ilea. It is concluded that bicarbonate containing electrolyte solution has no additional promoting effect on water and sodium absorption in normal or secreting ilea of rabbits.

Participation of endothelial cells in the development of glomerulosclerosis: a study on murine serum sickness nephritis with mitomycin C

To investigate the participation of endothelial cells in glomerulosclerosis, the study was performed in serum sickness nephritis (SSN) with administration of mitomycin C (MMC). SSN was induced in 8 week male Fisher rats by sensitizing them with albumin, chicken egg (EA). Then MMC (0.5 mg/kg bodyweight) was injected daily for 3 days and they were killed at 1, 2, 4 and 6 week intervals. Significant mesangial expansion and sclerosis were observed in the experimental mixed SSN-MMC group in comparison to the SSN or MMC control group from 1 week to 6 weeks (P < 0.05). Moreover at 1 week, double contour appearance of the glomerular capillary wall, basement membrane splitting and disruption were observed light microscopically in the mixed SSN-MMC group. Electron microscopy revealed peripheral capillary basement membrane disruption with huge subepithelial, mesangial osmiophilic deposits and epithelial foot process effacement. At 6 weeks, disappearance of the endothelial cell fenestration and subepithelial basement membrane-like material formation were observed in the MMC group. Based on these results, it is suggested that MMC induced assault on the glomerular endothelial cell produces prominent glomerular capillary basement membrane disruption at the early phase of SSN, resulting in the accumulation of huge subepithelial and mesangial deposits, mesangial cell proliferation, production of the extracelluar matrix component and initiation of glomerulosclerosis.

Prescribing pattern in acute diarrhoea in three districts in Bangladesh

Irrational use of drugs is a serious problem in the management of diarrhoea in developing countries. Many studies have been conducted in many different countries to document the prescribing pattern in diarrhoeal diseases in the hope of promoting rational use of drugs and thereby improve patient care. In only a few of these studies have standard drug use indicators been used to quantify the extent and nature of irrational prescribing. We report here the findings of a prescribing survey in acute diarrhoea (prescriptions written by graduate doctors) in the government health facilities (GHF) and private dispensaries (PD) in the districts of Dhaka, Tangail and Serajgonj of Bangladesh. In the study a set of standard indicators concerning prescribing, patient care and drug supply developed by the International Network for Rational Use of Drugs (INRUD; and later adopted by WHO) has been employed. Twelve prescriptions given in acute diarrhoea cases in children under 5 years old were prospectively collected on a random basis from each of the 10 centres from three districts. They were analysed by the methods suggested in the INRUD manual.

Performance of RBC coupled to a polyurethane foam to biodegrade petroleum refinery wastewater

Biological treatment of petroleum refinery wastewater was studied in a rotating biological contactor (RBC) coupled to a polyurethane foam (PUF) as a porous biomass support. The PUF was attached on both sides of biodisks. The biodegradation studies were carried out at varying hydraulic and organic loadings. COD removal efficiency of up to 87% was achieved. The results obtained in terms of biodegradation of COD, NH3-N, phenol, hydrocarbons and suspended solids in this study were compared with those in the literature. The RBC-PUF bioreactor was found to have a better performance than a conventional RBC for the biodegradation of the above mentioned parameters. A higher concentration of active biomass (77 g TVS/m2) was observed in the RBC-PUF as compared to other treatment systems. A linear relationship between COD applied and COD removed was observed for the combined four stage system as well as for the individual stages.

Serum levels of gentamicin at peak and trough in neonates and infants

The peak and the trough levels of serum gentamicin were determined in 50 cases of neonates and infants by microbiological assay method. The peak levels in the neonates and the infants were 5.98 +/- 0.48 and 4.63 +/- 0.31 mcg/ml respectively. The trough levels in the corresponding group were 1.06 +/- 0.19 and 0.94 +/- 0.23 mcg/ml. The mean values of the peak and trough levels of the antibiotic were 5.57 and 1.02 mcg/ml respectively. It was observed that there was a significant lower peak concentration in the infants than in the neonates. A significantly higher peak concentration of gentamicin was observed in babies aged under 7 days than in those above 7 days. The route of administration (between I/M and I/V) did not seem to have any effect on the peak and trough levels of the antibiotics.

Efficacy of aqueous extract of garlic & allicin in experimental shigellosis in rabbits

The aqueous extract of garlic (Allium sativum) and allicin both showed significant in vitro antibacterial activity against isolates of multiple drug-resistant Shigella dysenteriae 1, Sh. flexneri Y, Sh. sonnei and enterotoxigenic Escherichia coli. The minimum inhibitory concentrations of the aqueous extract and allicin against Sh. flexneri Y were 5 and 0.4 microliters/ml, respectively. The two agents also showed promising in vivo antibacterial activity against Sh. flexneri Y when tested in the rabbit model of experimental shigellosis, fully curing the infected rabbits within 3 days. On the contrary, 4 of the 5 rabbits in the control group died within 48 h. The rectal swab of rabbits of the experimental groups became free of the challenge bacteria on the second day of treatment. The antibacterial activity against the challenge strain was observed in the sera of the treated rabbits with 30-60 min of administration of the agents. The LD50 values of the aqueous extract and allicin in mice were 173.78 ml/kg and 204.17 microliters/kg of body weight, respectively. At the therapeutic dose, the two agents did not show any adverse effects on the standard biochemical profile of blood.

Management of long standing post burn deformities of hand

A study of 50 cases of long standing post burn deformities of hand in respect to their type of deformities, their operative correction, reconstruction and subsequent recovery had been carried out during the period from January 1979 to May 1986. Contractures were mainly due to shortage of skin and soft tissue; joint deformities developed secondary to that. Purpose of this study was to provide the patient with a good functioning hand. Of them 19 cases required skin grafting and 31 cases required different types of skin flap like groin flap in 13, abdominal flap in 12 and transposition flap in 3,Z-plasty in 2 and buttock flap in one case for resurfacing the raw area which was created following release of contracture of skin and soft tissue. Six patients required capsulotomy and collateral ligament excision, 2 required excision arthroplasty and one patient required excision of lower end of ulna along with a flap cover. Deformities corrected at an earlier date showed better functional recovery than those which were treated at a much later date. In this series, 3 children required secondary correction of their contracted flap due to their growing age, 3 adult patients developed contracture to the grafted skin for not using splint or having any physiotherapy, 2 patients had little extension deformities even after correction flap cover of hyperextension deformity, 2 patients with excision arthroplasty had weak grip and 3 patients were not followed up. Rest had good results. Extensive physiotherapy, proper splinting and regular follow-up at least for 3 to 5 years after operation are the secrets of better functional recovery.

Birth-interval dynamics in rural Bangladesh and maternal weight

This article reports on the results of a study conducted in rural Bangladesh on the influence of maternal weight on the components of birth intervals, including gestation and intrauterine mortality, the duration of postpartum amenorrhea, and the duration of waiting time to conception (the menstrual interval). When biological factors (including maternal age, parity, and supplementation practices) and behavioral variables, including religion, education, and occupation, were controlled, maternal weight was found to be related to the risk of intrauterine mortality and to the probability of resuming menses in the postpartum period. The implications of these findings for policies and programs in developing countries are discussed.

Age at menarche and postmenarcheal growth in rural Bangladeshi females

This study examines the role of chronological age and time since menarche (TSM) as determinants of postmenarcheal growth in height and weight in a chronically malnourished population of rural Bangladeshi females aged 10-20 years. Height and weight measurements were collected for 12 months from 290 postmenarcheal girls, with known times since menarche, and on 118 girls who reached menarche during the one year follow-up. Two stage regression analysis was employed to study the relationship of age and time since menarche to postmenarcheal growth in height and weight, while adjusting for socioeconomic status. TSM is a more important determinant of postmenarcheal growth in height and weight than is age. For postmenarcheal growth in weight, the regression coefficient for TSM is six times greater then the coefficient for age. The effect of TSM was twice as strong as the age effect for postmenarcheal growth in height. Age has a statistically significant negative influence on statural growth and weight gain, but its practical effect on weight gain is small. An interaction between TSM and age suggests that TSM does not have the same implications for biological maturity for all ages at menarche. Findings demonstrate that Bangladeshi adolescents are still in active growth in height and weight into their late teens and past 20 years in some girls. This extended growth period may pose increased health risks to young mothers and their offspring.

Ileal papilloma in a rat

Spontaneous Ileal papilloma was found in an 1-1/2 year old female Sprague-Dawley rat. The lesion was first recorded as a tiny bulge on the absorptive surface of the Ileum. Histologically, the outgrowth was recorded as papilloma showing hyperkeratosis, hyperplasia and acanthosis in the transformed epithelium. This appears to be the first report of its kind in the Ileum of rat in Bangladesh.

Infant mortality in relation to internal migration in rural Bangladesh

In Matlab thana, a rural area of Bangladesh, there is a substantial deficit of males of reproductive age owing to urban migration of males who leave their families behind. These men nevertheless return to visit their families frequently. Thirty percent of the births in this area occur to families with migrant fathers: neonatal mortality rates in these families are nearly double those of families with non-migrant fathers. This high risk, in turn, interacts with educational attainment and maternal nutrition. Only those migrant families where mothers have no education or low body weight experience high neonatal mortality rates. Psychological stress during pregnancy, probably caused by fear and anxiety related to the husband's absence may in part be responsible for such differential risk of mortality during the neonatal period.

Breast feeding as a determinant of severity in shigellosis. Evidence for protection throughout the first three years of life in Bangladeshi children

Little is known about the effect of breast feeding upon the severity of illness due to specific diarrheal pathogens. Using a systematically sampled and evaluated population of children aged less than 3 years, who attended a diarrheal disease hospital in Bangladesh, the authors performed a case-control study that assessed whether breast feeding reduces the severity of illness in shigellosis. From 540 children presenting with shigellosis between 1980-1982, they created a group of cases (n = 53) with severe illness and controls (n = 487) with non-severe illness. Overall, the odds ratio relating breast feeding to the severity of shigellosis (0.49, p = 0.01) suggested a substantial mitigating effect of breast feeding upon clinical severity. The high degree of protection against severe shigellosis was evident for breast-fed children up to 35 months of age, as well as for children at high risk for death because of severe malnutrition or measles. Because shigellosis continues to account for substantial morbidity and mortality in children in developing countries, the results support prolonged breast feeding in these settings.

Nutritional status and age at secondary sterility in rural Bangladesh

In a prospective study of 2324 women in Matlab, Bangladesh, the occurrence of primary and secondary sterility by age groups was examined. The results were related to the nutritional status of the women, as assessed by measurements of height, weight, arm circumference and ponderal index. There is evidence that nutritional status is an important factor in estimated age at sterility, with thinner women experiencing a slightly earlier menopause.

Excess mortality among children discharged from hospital after treatment for diarrhoea in rural Bangladesh

Five hundred and fifty one children aged between 3 months and 3 years were followed up at home for 12 months after treatment of diarrhoea in a rural treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. During follow up the children were found to have a significantly higher mortality than generally observed in the community. The first three months after discharge appeared to be crucial, some 70% of the deaths occurring in that period. Severely malnourished children (nutritional state below 56% of the American National Center for Health Statistics (NCHS) standard of weight for age ratio) had a risk of death 14 times that of their well nourished counterparts (nutritional state 66% or more of the NCHS standard). The highest mortality occurred in 2 year olds, one in three of the severely malnourished children dying compared with one in 10 of the moderately malnourished. This pattern was not seen in children aged under 2 years. Immediate priority should be given to providing nutritional rehabilitation for malnourished children who contract diarrhoea.

Application of a marriage model in rural Bangladesh

The applicability of the Coale-McNeil marriage entry model to a Bangladesh population is examined. The distribution of ages at entry into the marriage market is taken as normal and the general waiting times to marriage as negative exponential. This article examines two types of data from Bangladesh: (1) the distributions of ages at entry to the marriage market and waiting times, to verify the basic assumptions of the model, and (2) cross-sectional survey data, to derive the fitted first-marriage schedule. In both instances, the model showed a good fit with the Bangladesh data. In the absence of accurate marital registration data, the model may be appropriately utilized to estimate the ages of marriage of females in Bangladesh.

Dasherkandi project studies--health of the under fifteen

Morbidity pattern of the under fifteen of a rural community was analysed and related to socio-economic factors. This was a part of Dasherkandi project studies carried out in a village near Dhaka city. 48.26% of the population was under the age of fifteen. Infants under the age of one year had low sickness rate which rose steeply between 1 and 4 years of life and then gradually declined after the age of 5 years. Commonest morbidity was worm infestation which was followed by flu and upper respiratory tract infection. The non-agriculturist and the low income group had the highest level of sickness. It is suggested that children in rural areas suffer mainly from diseases which are related to poor nutrition and hygiene resulting from unsatisfactory socio-economic condition. All the childhood mortality occurred under the age of one year and was found to be due to tetanus in this study.

Education and infant survival in rural Bangladesh

This paper explores the mechanism through which socioeconomic status affects infant deaths. The data used here come from a prospective study in rural Bangladesh. Both neonatal deaths and postneonatal deaths were found to be higher in number among those whose mothers have no schooling. Again, education of the mother has been found to be related to gestational month at termination and this gestational month at termination (which is the maturity of the newborn) determines the neonatal death. The other factors affecting infant mortality were the height of the mother and the weight of the infant. The taller the mother, the fewer the neonatal and post-natal deaths. The weight of the infant has a direct relationship to its survival during infancy.