Association of Triglyceride and C-reactive Protein Level with Severity of Angiographically Defined Coronary Artery Disease

Coronary artery disease (CAD) is considered as a major cause of morbidity and mortality worldwide. Inflammatory cytokines play an important role in the pathogenesis and progression of atherosclerosis. The aim of the study was to find out the association of C-reactive protein (CRP) and triglyceride (TG) level on the severity of CAD in patients with ischemic heart disease (IHD). This cross-sectional study was performed in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh during the period of March 2018 to February 2021. Total 431 patients with ischemic heart disease were enrolled after taking informed written consent. CRP values were categorized into normal (<6 mg/L), borderline (6-10 mg/L) and high (>10mg/L) and TG level were categorized into normal (<150 mg/dl), borderline (150-199mg/dl) and high (≥200 mg/dl). Patients with ischemic heart disease (IHD) were stratified according to CRP value and TG level. Severity of CAD was assessed by the Gensini score. Most of the patients (33.4%) belonged to age 51-60 years. The mean age was 51.31±10.30 years. The majority (74.5%) of patients were male. Among risk factors, the highest 205(47.6%) patients were smokers followed by hypertension 190(44.1%) and diabetes mellitus 175(40.5%). The association of TG and CRP with the whole spectrum of IHD was found statistically significant (p<0.05). Severe CAD was found higher in high TG and high CRP level group compared with the other groups and was statistically significant. Inflammation assessed by high CRP and hypertriglyceridemia associated with the risk and severity of CAD.

Utility of Median-to-Ulnar Sensory Comparative Nerve Conduction Study to Increase Diagnostic Accuracy in Mild Carpal Tunnel Syndrome

Electro-physiological diagnosis of mild Carpal Tunnel Syndrome (CTS) based on traditional median motor and sensory studies are often inconclusive. Therefore, we wanted to investigate the utility of Median-to-Ulnar Sensory Conduction studies in diagnosis of mild CTS. Data from Nerve conduction study (NCS) of 82 cases with symptoms suggestive of CTS from September 2017 to October 2020 attending electrophysiology department of Mount Adora Hospital, Sylhet, Bangladesh was selected for study. About 54(66.0%) out of 82 symptomatic patients were diagnosed as CTS by the conventional method, and 28(34.0%) patients required further investigation as their test report were found to be inconclusive. combining methods showed 70(85.37%) were found to be positive and 12(14.63%) were negative in comparison study. Thus, it can be concluded that those patients found to be negative in conventional methods; comparison method is an option for diagnostic confirmation.

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.

Evaluation of Fixation for Distal Humeral Diaphyseal Fracture by Locking Compression Plate

Treatment of extra-articular distal humeral shaft fractures with plating techniques is often difficult. The recent development of LCP has improved the surgical treatment of fractures by overcoming the few drawbacks of older fixators. The aim of this prospective observational study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single locking compression plate (LCP) and was conducted from July 2016 to June 2018 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. Thirty (30) patients with closed fracture distal 3rd extra-articular humeral shaft fractures were treated by open reduction and internal fixation by locking compression plate. Two cases were excluded from the evaluation of final outcome due to their discontinued follow up. Detailed clinical conditions of all patients, technical difficulty with the implant, postoperative hospital stay period were recorded. Patients were followed up at 2nd week, 4th week, then 4 weekly upto 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The range of motion of the shoulder and elbow were evaluated according to the criteria by Rommens grading. Functional evaluation was made according to the criteria by Modified Constant and Murley Scoring System. Union was achieved in all the patients after a mean of 15 weeks (range 12-20 weeks). There were no complications like deep infection, nonunion, malunion, implant failure, or nerve injury occurs in any of the patients. Two patients had transient radial nerve palsy. Two patients developed superficial infection. All patients were relieved pain postoperatively. Functional outcome were excellent in 10 patients, good in 15 patients which constituted 89% satisfactory results. The study has shown that the LCP is an effective, dependable solution for the management of distal third diaphyseal fractures of the humerus.

Comparative Study of Stabilization of Humerus Supracondylar Fracture in Children by Percutaneous Pinning From Lateral Side and Both Sides

The aim of this prospective experimental study was to analyze the radiological and clinical results of the supra condylar fracture of Humerus in children and conducted the functional outcome of closed reduction and internal fixation by percutaneous Kirschner-wire from lateral side and crossed technique in the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagor, Dhaka, Bangladesh from July 2011 to June 2013. Patients diagnosed as closed Supracondylar fracture of Humerus in children due to trauma were the study population. Total 30 patients aged 2 to 12 years irrespective of sex were included in the study and were divided in 2 groups. Information obtained included age, sex, type of fracture, management, outcomes and complications. The mean age was 7.80±2.08 and 5.93±2.31 years for Group I and Group II patients. Age range was 2-12 years. Males were predominant 11(73.3%) Group I and Group II. Fractures were primarily caused by fall from tree and left side predominant. In Group I the time elapsed between injury and surgery was minimum 2 hours and maximum 24 hours with mean±SD was 9.20±7.20, while in Group II minimum and maximum of 3 and 48 hours respectively with mean±SD was 9.60±11.01. Minimum and maximum post operative hospital stays were 1 and 2 days in Group I and Group II. Follow-up were carried out after 1, 3, 6 and 12 weeks of operation. Loss of post operative range of motion of elbow and loss of carrying angle was not significant (p>0.05). Functional outcome was analyzed by Flynn's grading. In this study there were 3(20%) cases with excellent, 10(66.67%) were good and 2(13.33%) were fair functional outcomes in Group I. In Group II excellent, good and fair functional outcome were 3(20%), 9(60%) and 3(20%) respectively. After chi-square test there was no significant difference between two groups.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

Status of Serum Zinc in Multidrug Resistant Tuberculosis

Zinc plays a vital role in the immune status. Its deficiency affects host defense by reducing the number of circulating T cells and phagocytosis activity of other cells which ultimately impair cell mediated immunity. The cell-mediated immunity plays a major role in the causation of pulmonary tuberculosis. The present study was carried out to estimate serum zinc level in newly detected multidrug resistant tuberculosis (MDR-TB) in adult population. In this study total fifty (50) MDR-TB patients were enrolled conveniently from the in-patients departments of National Institute of Diseases of the Chest Hospital (NIDCH), Bangladesh. Serum zinc was estimated by atomic absorption spectrophotometry method from early morning fasting blood sample. Serum zinc level was assessed according to normal cut-off value 70-120 μgm/dl and 76% studied population were found lower than this value. The mean±SD serum zinc level was observed 60.40±8.91 μgm/dl. No associations were found between serum zinc level with age (p=0.11) and with sex (p=0.085) of the study population respectively. The low level of serum zinc in MDR-TB patients suggested impaired immune status of our study population.

Association of Blood and Semen Lead and Zinc Level with Semen Parameter in the Male Partner of Infertile Couple

This cross sectional study was carried out in Center for Assisted Reproduction, Dhaka, and in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2012 to December 2012. The study population was 71 consecutive male partners of infertile couple suffering from at least one year of infertility. Lead and Zinc level was measured in blood and semen in the male partner of infertile couple and compared with semen parameters. Serum zinc at different values did not show any statistically significant change in semen volume, total count of sperm and total motility of sperm. At serum zinc level 80-< 90 μg/dl blood lead and semen lead level was lowest 20.6 ± 8.60 μg/dl and 48.17 ± 51.33 μg/dl respectively and showed highest total count of sperm (54.00 ± 46.67 million/ml) but was not statistically significant. Rapid linear motility and normal sperm morphology was also highest at values 80-< 90 μg/dl and was 45.33 ± 26.62% and 36.67 ± 11.60% respectively and was statistically significant. At serum zinc level > 90 μg/dl semen lead level was significantly higher (120.73 ± 58.02 μg/dl) and showed statistically significant decrease in rapid linear motility and normal sperm morphology. Total count of sperm was lowest at blood zinc level of 70-< 80 μg/dl. Sperm morphology also showed statistically significant improvement at Serum zinc values of 80-< 90 μg/dl. The results suggest that Serum zinc level of values 80-< 90 μg/dl is the optimum level to have the best impact on semen parameter as well it is the critical level at which the semen lead level is lowest. Serum zinc levels higher as well as lower than values 80-< 90 μg/dl was associated with increased semen lead values and with negative impact on semen parameters.

Comparison of creatinine clearance estimates with routine measured creatinine clearance in hospitalized chronic kidney disease patients

The aim of this study was to determine the correlation between endogenous creatinine clearance (BSA adjusted), the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (BSA adjusted) equations in a Bangladeshi population with chronic kidney disease. It was an observational study conducted from July 2011 to January 2012 in the department of Medicine of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 50 cases with diagnosed Chronic kidney disease (CKD) patients participated in this study. Results are expressed as mean and standard deviation (SD). Pearson correlation coefficient (r) was used to compare the results of conventional creatinine clearance on 24 hour urine collection (BSA adjusted) and creatinine clearance calculated by Cockcroft-Gault creatinine clearance (BSA adjusted) and MDRD creatinine clearance (ml/min/1.73m²) equation. Among 50 patients 30(60%) were male and 20(40%) were female. Mean age of the cases was 43±12.96 years with age range from 18 to 65 years. Mean creatinine clearance measured on 24 hours urine collection (BSA adjusted) was 13.86±8.72ml/min per 1.73m². Mean BSA adjusted Cockcroft-Gault creatinine clearance and MDRD creatinine clearance were 27.68±11.26 and 24.46±11.05ml/min per 1.73m² respectively. There was a positive correlation between both the Modification of Diet in Renal Disease (r=0.951, p<0.05) equation and the Cockcroft-Gault (r=0.948, p<0.05) equation with measured creatinine clearance; the former being statistically superior comparing the correlation coefficients. The creatinine based formulas with their inherent property of convenience and cost effectiveness can be a useful tool for monitoring the progression of disease.

Evaluation of the results of operative management of lumbar spinal canal stenosis

Lumber spinal canal stenosis is an important cause of low back pain and it frequently presents with low backache with neurogenic claudication. Operative management of lumbar spinal canal stenosis by decompression surgery is an effective method. This prospective interventional (quasi experimental) study was performed in patient having history of characteristic clinical features like low backache with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in the department of Orthopaedic Surgery and Neurosurgery, Dhaka Medical College Hospital and NITOR. Dhaka, from July 2008 to June 2010. Thirty patients were evaluated among those 18(60%) were 50 years and above. Male to female ratio was roughly 9:1. About 87% of the patients had sensory deficit and 50% had neurogenic claudication. Majority (83.3%) of the patients at presentation had a suffering of 12 or >12 months. Diagnosis shows that 3.5% of patients had L4 lesion, 60% L5, 6.5% patients had L4 & L5 and 30% S1. Laminectomy was done in 43.3% of patients, laminectomy and disectomy in 30% and laminectomy, discectomy & foraminal decompression in 26.7% of patients. Relief of symptoms occurred in 25(83.5%) of patients. Over three-quarter (76.7%) of patients exhibited minimal disability and 23.3% moderate disability based on Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

Rockall score for risk stratification in adult patients with non-variceal upper gastrointestinal hemorrhage

The Rockall risk score is a simple, validated predictive index that may serve as a useful clinical decision for assessing the risk of subsequent adverse outcomes in patients with non-variceal upper gastrointestinal hemorrhage (UGIH). The observational study was carried out over a period of 6 months from 10th July, 2012 to 09th January, 2013 in Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 60 patients with non-variceal UGIH were taken for the study during study period to see risk stratification by Rockall score and short term hospital outcome in non-variceal upper GI hemorrhage patients. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test of different variables. Among study population age distribution were 42(70%) <60 years, 16(26.7%) from 60-79 years and 02(3.3%) 80 years or above and sex distribution were 39(65%) male and 21(35%) were female patients. Rockall score of patients 11(18.3%) had score 1, 6(10%) had score 2, 13(21.7%) had score 3, 10(16.7%) had score 4, 6(10%) had score 5, 6(10%) had score 6, 4(6.7%) had score 7, 3(5.0%) had score 8 and 1(1.7%) had score 9. Risk stratification showed 30(50%) had low risk (score 3 or <3), 26(43.3%) had moderate risk (score 4-7) and 4(6.7%) had high risk (score 8 or >8). Outcome after initial Rockall scoring and endoscopy were found that 7(11.7%) died, 46(76.6%) survived and 7(11.7%) patients survived with complication. This study showed that Rockall score of ≤3 was predictive of low risk of adverse outcomes, and a score of ≥8 was predictive of high mortality and was useful in identifying patients with non-variceal UGIH who had low-risk scores in order to triage appropriately, without affecting patient outcomes.

Blood level of lead in women with unexplained infertility

Toxic effect of lead on human reproductive system is a recent concern. Various studies suggest that lead has adverse effect on the reproductive system of both sexes. The present cross-sectional case-control study was done to investigate the blood lead level in women with unexplained infertility. The study was conducted in the Department of Obstetrics and Gynecology and Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2008 - June 2009. A total of 50 women with unexplained infertility (case) ranging from 18-40 years were consecutively included in the study. An equal number of apparently healthy fertile women (control) were included as control. None of the cases and controls was diabetic. Of the infertile women over half (54%) of the patients had primary infertility and 46% secondary infertility. The mean blood level of lead was significantly higher in case group than that in control group (130.0±45.2 vs. 78.3±36.4μg/L, (p<0.001). Correlation between blood lead level and FSH revealed that the two variables had a significantly linear relationship (r=0.213, p=0.033). The correlation coefficient shows that 21% of the variations in FSH can be explained by blood level of lead. Infertile women with absence of the apparent causes of infertility including absence of their male-partner infertility may have unusually high level of lead which could be attributed to infertility.

The management of cubitus varus using Ilizarov method

Cubitus varus is the most common complications of supracondylar fractures. Various combinations of osteotomy and fixation have been described to correct the deformity but each is associated with significant complications. In this study, we used distraction osteogenesis and Ilizarov frame fixation to treat 12 elbows with cubitus varus. The mean time to follow up was 24 months (10-38) and the mean time to frame removed was 14.5 weeks (10-22). The mean carrying angle was corrected from -19.8°(-10°-32°) to 6.2°(2°-12°). In patients with cubitus varus was from 35.5° (22°-45°). There were 11 excellent and one good result.

Clinical and immunological aspects of post-kala-azar dermal leishmaniasis in Bangladesh

We conducted active surveillance for kala-azar and post-kala-azar dermal leishmaniasis (PKDL) in a population of 24,814 individuals. Between 2002 and 2010, 1,002 kala-azar and 185 PKDL cases occurred. Median PKDL patient age was 12 years; 9% had no antecedent kala-azar. Cases per 10,000 person-years peaked at 90 for kala-azar (2005) and 28 for PKDL (2007). Cumulative PKDL incidence among kala-azar patients was 17% by 5 years. Kala-azar patients younger than 15 years were more likely than older patients to develop PKDL; no other risk factors were identified. The most common lesions were hypopigmented macules. Of 98 untreated PKDL patients, 48 (49%) patients had resolution, with median time of 19 months. Kala-azar patients showed elevated interferon-γ (IFNγ), tumor necrosis factor-α (TNFα), and interleukin 10 (IL-10). Matrix metalloproteinase 9 (MMP9) and MMP9/tissue inhibitor of matrix metalloproteinase-1 (TIMP1) ratio were significantly higher in PKDL patients than in other groups. PKDL is frequent in Bangladesh and poses a challenge to the current visceral leishmaniasis elimination initiative in the Indian subcontinent.

Melioidosis in an adult male

Infection with Burkholderia pseudomallei has been described, albeit rarely, patients in Bangladesh. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, which is present in soil and surface water in the endemic region. A 35-year-young male farmer presented with prolonged fever and significant weight loss. Patient gradually deteriorated despite getting different antibiotics including intravenous ceftriaxone and metronidazole. Panels of investigations were done which revealed no diagnostic confirmation except uncontrolled diabetes and multiple abscesses in different organs. Melioidosis was suspected and serum samples were positive for Burkholderia pseudomallei antibody. The case illustrates the importance of non-specific nature of the clinical presentation and high index of suspicion of uncommon diseases like melioidosis where the disease has not been considered as an endemic.

Clinical profile of periodic paralysis

This cross sectional descriptive study was done to find out common clinical presentations, etiologies and laboratory investigation abnormalities in patients of periodic paralysis. Study was carried out in 30 patients with an age range from 8 to 70 years who were enrolled from July 2008 to June 2009 in Mymensingh Medical College Hospital (MMCH) medicine unit. Individuals who were admitted with sudden onset generalized muscle weakness, had history of previous attack and serum potassium level <3mmol/l or >5.5mmol/l were included in this study. In this series, majority of the patients were male (66.67%). Male: female ratio was approximately 2:1. The mean age of the patients was 27.4±4.5 years. Majority (26.67%) of them were in age range of 31-40 years. About 30% of the patients experienced the first attack of paralysis at the age of 20-24 years. Majority of patients (53%) were from middle class family with occupation of private service (26.66%) and farmer (20%). Positive family history was reported in 20% of patients. Regarding the precipitating factors, majority of patients (83.3%) were related to high carbohydrate meal, 56.67% related to temperature, 41.67% to exercise. Flaccid muscle weakness with variables muscle power (MRC grade 4/5 to 2/5 in 60% and 1/5 to 0/5 in 40%) was found. Cerebellar functions, all modalities of sensations and functions of cranial nerves were intact in all patients. In this series, laboratory investigations revealed reduced serum potassium level (<3mmol/l) in 90% of patients. Serum potassium value >5.5mmol/l was found in only 3.33% of patients. Creatine kinase (MM) was raised in 23% of the patients and Thyroid stimulating hormone (TSH) level was 0.8-2mmol/l in 6% of the patients. More than half of the patients (56%) showed variable ECG changes. Impaired nerve conduction function was found in 28.00%. So, careful history taking, meticulous clinical examination and simple laboratory investigations is sufficient to make a prompt diagnosis and rapid management of patients with periodic paralysis.

Arsenic migration to deep groundwater in Bangladesh influenced by adsorption and water demand

Drinking shallow groundwater with naturally elevated concentrations of arsenic is causing widespread disease in many parts of South and Southeast Asia. In the Bengal Basin, growing reliance on deep (>150 m) groundwater has lowered exposure. In the most affected districts of Bangladesh, shallow groundwater concentrations average 100 to 370 μg L(-1), while deep groundwater is typically < 10 μg L(-1). Groundwater flow simulations have suggested that, even when deep pumping is restricted to domestic use, deep groundwater in some areas of the Bengal Basin is at risk of contamination. However, these simulations have neglected the impedance of As migration by adsorption to aquifer sediments. Here we quantify for the first time As sorption on deeper sediments in situ by replicating the intrusion of shallow groundwater through injection of 1,000 L of deep groundwater modified with 200 μg L(-1) of As into a deeper aquifer. Arsenic concentrations in the injected water were reduced by 70% due to adsorption within a single day. Basin-scale modelling indicates that while As adsorption extends the sustainable use of deep groundwater, some areas remain vulnerable; these areas can be prioritized for management and monitoring.

Relationship of blood and semen lead level with semen parameter

Lead has for long been known to affect multiple organs and can affect reproduction in male and female as well as the offspring. The study was done to find out the level of lead in blood and semen of infertile men and to find its effect on the semen parameters, as well as the minimum level of lead in blood and semen that can have negative impacts on semen parameters. The study was cross sectional in design. Male partners of 57 infertile couples attending a tertiary infertility center in Dhaka, Bangladesh were recruited for the study. Blood lead was measured by the Graphite Furnance Atomic Absorption Spectrophotometer and semen analysis was done according to the WHO recommendation (1999). With increasing blood lead concentration there was corresponding increase in the mean semen lead concentration. Reduction of mean semen volume started at level of mean blood lead level of >40mugm/dl. Mean total count of sperm (x106/ml) started decreasing at blood lead level of >30mugm/dl with very significant reduction of the count at level >40mugm/dl. At mean blood lead level >35mugm/dl there was decrease in mean values for total motility and rapid linear motility of sperm. In 12.3 % of the patients mean blood lead level was above >35mugm/dl. Higher mean blood and semen lead level was associated with significant declining semen parameters.

Temporal variability of groundwater chemistry in shallow and deep aquifers of Araihazar, Bangladesh

Samples were collected every 2-4 weeks from a set of 37 monitoring wells over a period of 2-3 years in Araihazar, Bangladesh, to evaluate the temporal variability of groundwater composition for As and other constituents. The monitoring wells are grouped in 6 nests and span the 5-91 m depth range. Concentrations of As, Ca, Fe, K, Mg, Mn, Na, P, and S were measured by high-resolution ICPMS with a precision of 5% or better; concentrations of Cl were measured by ion chromatography. In shallow wells <30 m deep, As and P concentrations generally varied by <30%, whereas concentrations of the major ions (Na, K, Mg, Ca and Cl) and the redox-sensitive elements (Fe, Mn, and S) varied over time by up to +/-90%. In wells tapping the deeper aquifers >30 m often below clay layers concentrations of groundwater As were much lower and varied by <10%. The concentrations of major cations also varied by <10% in these deep aquifers. In contrast, the concentration of redox-sensitive constituents Fe, S, and Mn in deep aquifers varied by up to 97% over time. Thus, strong decoupling between variations in As and Fe concentrations is evident in groundwaters from shallow and deep aquifers. Comparison of the time series data with groundwater ages determined by (3)H/(3)He and (14)C dating shows that large seasonal or inter-annual variations in major cation and chloride concentrations are restricted to shallow aquifers and groundwater recharged <5 years ago. There is no corresponding change in As concentrations despite having significant variations of redox sensitive constituents in these very young waters. This is attributed to chemical buffering due to rapid equilibrium between solute and solid As. At two sites where the As content of groundwater in existing shallow wells averages 102 microg/L (range: <5 to 648 microg/L; n=118) and 272 microg/L (range: 10 to 485 microg/L; n=65), respectively, a systematic long-term decline in As concentrations lends support to the notion that flushing may slowly deplete an aquifer of As. Shallow aquifer water with >5 years (3)H/(3)He age show a constant As:P molar ratio of 9.6 over time, suggesting common mechanisms of mobilization.

Comparison of dissolved and particulate arsenic distributions in shallow aquifers of Chakdaha, India, and Araihazar, Bangladesh

BACKGROUND

The origin of the spatial variability of dissolved As concentrations in shallow aquifers of the Bengal Basin remains poorly understood. To address this, we compare here transects of simultaneously-collected groundwater and aquifer solids perpendicular to the banks of the Hooghly River in Chakdaha, India, and the Old Brahmaputra River in Araihazar, Bangladesh.

RESULTS

Variations in surface geomorphology mapped by electromagnetic conductivity indicate that permeable sandy soils are associated with underlying aquifers that are moderately reducing to a depth of 10-30 m, as indicated by acid-leachable Fe(II)/Fe ratios <0.6 in the solid phase and concentrations of dissolved sulfate >5 mg L(-1). More reducing aquifers are typically capped with finer-grained soils. The patterns suggest that vertical recharge through permeable soils is associated with a flux of oxidants on the banks of the Hooghly River and, further inland, in both Chakdaha and Araihazar. Moderately reducing conditions maintained by local recharge are generally associated with low As concentrations in Araihazar, but not systematically so in Chakdaha. Unlike Araihazar, there is also little correspondence in Chakdaha between dissolved As concentrations in groundwater and the P-extractable As content of aquifer particles, averaging 191 +/- 122 microg As/L, 1.1 +/- 1.5 mg As kg(-1) (n = 43) and 108 +/- 31 microg As/L, 3.1 +/- 6.5 mg As kg(-1) (n = 60), respectively. We tentatively attribute these differences to a combination of younger floodplain sediments, and therefore possibly more than one mechanism of As release, as well as less reducing conditions in Chakdaha compared to Araihazar.

CONCLUSION

Systematic dating of groundwater and sediment, combined with detailed mapping of the composition of aquifer solids and groundwater, will be needed to identify the various mechanisms underlying the complex distribution of As in aquifers of the Bengal Basin.

Analgesic principle from the bark of Careya arborea

Bioactivity guided isolation of the bark of Careya arborea afforded piperine--an alkaloid chemically known as 1-[5-(1,3-benzodioxol-5-yl)-1-oxo-2,4-pentadienyl]piperidine, which was found to possess significant central and peripheral analgesic activity. At oral doses of 10, 20 and 30 mg/kg body weight, piperine exhibited 41 (p < 0.01), 45 (p < 0.01) and 53% (p < 0.001) inhibition of acetic acid induced writhing in mice respectively. At doses of 20 and 30 mg/kg body weight, the compound also showed 31.8 (p < 0.05) and 52.4% (p < 0.01) prolongation of tail flicking time of mice 30 min after the treatments determined by the radiant heat method.

Leptin Concentrations in Maternal and Umbilical Cord Blood in Relation to Maternal Weight, Birth Weight and Weight of the Placenta

Objective: Leptin is a hormone which regulates adipose tissue mass of the body. Substantial increase of leptin during pregnancy and detection of leptin and leptin receptor in placenta have led to the speculation that leptin is a gestational hormone with a possible role in regulation of fetal growth. The study was done to find out whether maternal and cord blood leptin correlate with birthweight and weight of the placenta. Materials and methods: A prospective cross sectional study was undertaken in the Department of Obsterics and Gynecology, Bangabandhu Sheikh Mujib Medical University from January 2005 to June 2005. The study was carried out on 39 pairs of mothers and newborns. Maternal venous blood was sampled just before delivery. Cord blood was obtained, birth weight and placental weight measurements were taken just after delivery of the baby. Serum leptin levels were measured by enzyme linked immunosorbent assay. Results: Maternal serum leptin was 24.50 ng/ml (range- 13.15-45.60 ng/ml) and cord serum leptin was 6.50 ng/ml (range- 2.02-12.30 ng/ml). There was no correlation between maternal leptin and birth weight or between maternal leptin and placental weight. Cord leptin was significantly correlated with birth weight but not with placental weight. There was no correlation between maternal and cord blood leptin. There was no significant gender differences in cord blood leptin concentrations. Conclusions: There may be an important role of leptin in regulation of fetal growth and development. Placenta may not be a major source of leptin in maternal and feto-placental circulation. Maternal leptin cannot be a reliable marker of fetal growth. Keywords: Serum leptin, birth weight, placental weight   doi: 10.3329/bjog.v23i1.3049 Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 3-7