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.

Short Term Visual and Refractive Outcome following Surgical Intervention for Posterior Capsule Opacification (PCO) in Children in a Tertiary Eye Hospital

BACKGROUND

PCO occurs commonly postoperatively following cataract extraction in children, obscuring vision as did the initial cataract. It may require a second surgical procedure when it is dense. It is expected that this results in restoration of vision and it is important to ascertain that this is the case as well as to examine any significant changes in refraction thereafter.

METHODS

A retrospective observational study extracting demographic and clinical information from case notes of patients who had membranectomy and/or capsule polishing between October 2017 and September 2018.

RESULTS

57 eyes of 51 patients were enrolled. There was a 2:1 male: female ratio. Mean age at cataract surgery was 6.33± 3.59years whilst that for PCO surgery was 9.68±3.89years. Postoperative visual acuity (by WHO definition) was good (between 6/6 and 6/18) in 33.3%, compared to 8.8% preoperatively. Whereas presenting visual acuity was poor (<6/60) in 61.4% preoperatively, this reduced to 30% postoperatively. Visual outcome was influenced by age at cataract surgery, age at PCO surgery, interval between cataract and PCO surgery and type of cataract. Children >8 years of age at time of PCO surgery had a greater proportion of good post-operative best corrected visual acuity (BCVA) (52.6%), whilst 75% of children younger than 8years at time of surgery turned out with poor BCVA after surgery. Developmental cataracts proportionately had the best outcome of visual acuity. There was a range of refractive shift of +0.25D to - 5.25D with a mean myopic shift of -1.51D following membranectomy. CONCLUSION: There was a good proportion of children with significant improvement in visual acuity on the short term, and a mild myopic shift following membranectomy.

Characterization and optimization of ZnS thin film properties synthesis via chemical bath deposition method for solar cell buffer layer

Zinc Sulphide is one of most studied semiconductor with wide band gap (3.5–3.9 eV) versatile material due to its physical and chemical properties. ZnS is a non-toxic material and a suitable candidate to be a buffer layer for heterojunction solar cells. In this study, Zinc Sulphide (ZnS) thin films were deposited by chemical bath deposition technique using Zinc Acetate Dihydrate [Zn (CH3COO)2. 2H2O] and Thiourea [CH4N2S]. The ZnS thin films samples were characterized by UV-Vis NIR Spectroscopy, X-ray diffraction (XRD), Scanning Electron Microscopy (SEM), Energy Dispersive Spectroscopy (EDX), Fourier-Transform Infrared Spectroscopy (FTIR) and Thin-Film Measurement Instrument. FTIR spectra confirmed the presence of ZnS bond in the crystalline thin film. XRD data confirmed the cubic structure of the deposited thin film only when the amount of Thiourea was increased and the complexing agent Hydrazine Hydrate was replaced with Tri-Sodium Citrate. Crystallite size and strain were estimated using Debye-Scherrer model and Williamson-Hall model and lattice constant was estimated using Nelson-Riley plot. Otherwise, XRD showed the amorphous phase. UV-Vis data confirmed ZnS thin films as enough transmittive and it showed higher bandgap. Thin-Film Measurement Instrument was used to measure the thickness of the ZnS thin films. Synthesized ZnS thin films exhibited promising characteristics for using as the buffer layer of the heterojunction solar cells. Highlights • ZnS thin films were prepared successfully by simple, low cost and environment friendly chemical bath deposition method. • XRD measurement confirmed both Amorphous and Crystalline phase of ZnS thin films. • By changing the precursor only can be achieved crystalline phase from amorphous phase of ZnS thin film. • The amount of precursor and deposition conditions can be optimized to produce crystalline ZnS thin film.

Suitability of milk lactate dehydrogenase and serum albumin for pathogen-specific mastitis detection in automatic milking systems

In response to intramammary infection (IMI), blood-derived leukocytes are transferred into milk, which can be measured as an increase of somatic cell count (SCC). Additionally, pathogen-dependent IgG increases in milk following infection. The IgG transfer into milk is associated with the opening of the blood-milk barrier, which is much more pronounced during gram-negative than gram-positive IMI. Thus, milk IgG concentration may help to predict the pathogen type causing IMI. Likewise, lactate dehydrogenase (LDH) and serum albumin (SA) cross the blood-milk barrier with IgG if its integrity is reduced. Because exact IgG analysis is complicated and difficult to automate, LDH activity and SA concentration aid as markers to predict the IgG transfer into milk in automatic milking systems (AMS). This study was conducted to test the hypothesis that LDH and SA in milk correlate with the IgG transfer, and in combination with SCC these factors allow the differentiation between gram-positive and gram-negative IMI or even more precisely the infection-causing pathogen. Further, the expression of these parameters in foremilk before (BME) and after (AME) milk ejection was tested. In the AMS, quarter milk samples (n = 686) from 48 Holstein-Friesian cows were collected manually BME and AME, followed by an aseptic sample for bacteriological culture. Mixed models were used to (1) predict the concentration of IgG transmitted from blood into milk based on LDH and SA; (2) use principal component analysis to evaluate joint patterns of SCC (cells/mL), IgG (mg/mL), LDH (U/L), and SA (mg/mL) and use the principal component scores to compare gram-positive, gram-negative, and control IMI types and BME versus AME samples; and (3) predict gram-positive and gram-negative IMI by inclusion of combined SCC-LDH and SCC-SA as predictors in the model. Overall, the SA and LDH had similar ability to predict IgG transmission from blood into milk. Comparing the areas under the curve (AUC) of the receiver operator characteristic curves, the SCC-LDH versus SCC-SA had lower gram-positive (AUC = 0.984 vs. 0.986) but similar gram-negative (AUC = 0.995 vs. 0.998) IMI prediction ability. The SCC, IgG, LDH, and SA were greater in gram-negative than in gram-positive IMI (BME and AME) in early lactation. All measured factors had higher values in milk samples taken BME than AME. In conclusion, LDH and SA could be used as replacement markers to indicate the presence of IgG transfer from blood into milk; in combination with SCC, both SA and LDH are suitable for differentiating IMI type, and BME is better for mastitis detection in AMS.

Mnemonic Techniques: Characteristics, Educational Suitability and Research Prospects in the Field of Anatomy

The outcome of using different mnemonic techniques have been established through several researches from the ancient time but systematic researches in the field of Anatomy like how and why different mnemonic techniques work better than others are still sketchy. This is likely lead to incomprehensive understanding of how particular mnemonics may work better than others in specific situation and how the exact potentials of mnemonics be objectively understand. For medical undergraduates, even though many things have to be understood, sometimes it is very important to retain a piece of information by memorization and later recall it. A way of easing memorization is using a mnemonic device.

​Prevalence of Various Clinical Diseases and Disorders in Goats at Kasba Upazilla, Bangladesh

Background: Goats are considered poor man’s cow because goat farming remains a profitable venture for decades but diseases and disorders are the sheer hindrances of goat rearing. Clinical studies on prevalence of diseases and disorders in goats are available, but no study has been observed based on etiology, sex and seasons in Kasba Upazilla, Bangladesh. This study was conducted to detect the incidence of clinical diseases and disorders in the study area. Methods: During the study period of January to December 2018 a total number of 786 goats were diagnosed at Upazila Veterinary Hospital by general, physical and clinical examination. Data were assembled through a structured sheet and analyzed by using SPSS software version 12. Result: The clinical cases were primarily categorized into six major groups (1) Viral (2) Bacterial (3) Parasitic (4) Surgical (5) Gynaeco-obstetrical (6) Systemic and other disorders. Systemic and other disorders constituted the highest percentage 26.59% in comparison to viral 19.84%, bacterial 25.19%, parasitic 17.81%, surgical cases 6.74% and gynaeco-obstetrical diseases 3.81%. Among each category of clinical cases, the highest diseases and disorders recorded were PPR 13.10%, pneumonia 15.39%, fascioliasis 5.85%, urolithiasis 3.05%, retained placenta 1.39%, diarrhea 9.54% respectively. Sex-wise disease frequency was 41.41% and 58.21% in male and female respectively, whereas season-wise most sizeable percentage was recorded in rainy season 44.69% than in winter 31.65% and summer 22.98%.

Suitability of somatic cell count, electrical conductivity, and lactate dehydrogenase activity in foremilk before versus after alveolar milk ejection for mastitis detection

Mastitis is responsible for substantial economic loss and significant animal welfare concerns for the dairy industry. Sensors that measure electrical conductivity (EC) and enzyme concentrations of lactate dehydrogenase (LDH) are presently used for automatic detection of mastitis. However, EC is not sensitive enough to detect mastitis, and the ability of LDH activity to identify mastitis caused by different pathogens is a potential option that needs to be investigated. This study was conducted to test the following hypotheses: (a) strict foremilk before milk ejection is more informative in detecting mastitis, in general, than foremilk removed after cows were stimulated for milk ejection; and (b) the value of LDH activity as a mastitis indicator depends on the type of pathogen associated with the infection. Milk samples (before afternoon milking) from 48 Holstein-Friesian cows at the University of Sydney's dairy farm (Camden, New South Wales, Australia) with EC > 7.5 mS/cm in any of the 4 quarters were collected over a period of 2 mo. Quarter milk samples (n = 343) from 48 cows were collected manually in the automatic milking rotary in 3 steps: foremilk before (strict foremilk) and after milk ejection, followed by an aseptic sample for bacteriological culture. The EC (mS), LDH (U/L), SCC (cells/mL), and milk protein and fat content (%) of foremilk in both sampling times were compared and used as predictors for gram-positive and gram-negative mastitis. Quarter (n = 515) observations from 44 cows were analyzed using a logistic mixed or linear mixed model, with cow and quarter nested within cow as random effects. Milk from both sampling times was also assessed by producing a receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC) to determine ability to detect mastitis. Overall, EC and LDH were greater and milk protein (%) was lower in strict foremilk than in milk fractions obtained after milk ejection. Data from strict foremilk samples had slightly higher AUC values (0.98 to 0.99 vs. 0.97 to 0.98, respectively) than did the after-ejection milk samples. Although gram-negative coliform mastitis had significantly higher LDH activity than did gram-positive mastitis (6.19 vs. 5.34 log₁₀ U/L), the robustness of this result is questionable due to limited sample size. We concluded that milk samples taken before ejection can influence major mastitis indicators, suggesting that automatic milking system sensors could be modified to monitor milk before ejection for more efficient mastitis detection.

Young adult pregnancy status and the risk of developing overweight and obesity among women and men

Pregnancies can end in miscarriage, birth or termination. Although it is well known that pregnancy results in weight gain across the life course, it is unknown whether pregnancies which end in termination and miscarriage contribute to this. The study used a sub-sample of 3630 adult offspring from the original cohort of the Mater University of Queensland Study of Pregnancy (MUSP) and its outcomes, in Brisbane, Australia. Anthropometric data were measured at 5, 14 and 21 years of age and experience of pregnancy including termination, miscarriage and births were self-reported at 21 years. Multivariable analyses were conducted to determine whether pregnancy status of young people independently associated with overweight or obesity status. The women who had at least one birth were more likely to have overweight (odds ratio [OR] 1.52; 95% confidence interval [CI]: 1.01, 2.27) or obese (OR 2.38; 95% CI: 1.58, 3.59) compared to women who did not experience any pregnancy. Women whose pregnancies were terminated or miscarried were at the same risk of overweight or obesity as women who did not experience any pregnancy. For men, there is no association between the pregnancies in their partners and the mean difference in their body mass index. Young women whose pregnancies result in a birth, but not terminations or miscarriages, are at greater risk of having overweight or obesity following the birth.

Effect of experimentally increased protein supply to postpartum dairy cows on plasma protein synthesis, rumen tissue proliferation, and immune homeostasis

The effect of experimentally increasing the postpartum protein supply on plasma protein synthesis, rumen tissue proliferation, and immune homeostasis was studied using 8 periparturient Holstein cows in a complete randomized design. At calving, cows were assigned to abomasal infusion of water (CTRL) or casein (CAS) in addition to a lactation diet. Casein infusion was gradually decreased from 696 ± 1 g/d at +2 d relative to calving (DRTC) to 212 ± 10 g/d at +29 DRTC to avoid excessive supply. Synthesis rate of plasma proteins was measured at -14, +4, +15, and +29 DRTC by measuring [C]Phe isotopic enrichment in arterial plasma free Phe, total plasma proteins, and albumin after 3, 5, and 7 h of jugular ring[C]Phe infusion. Plasma volume was determined at +4 and +29 DRTC by dilution of a [I]BSA dose. Synthesis rate of tissue protein in biopsied rumen papillae was determined by measuring [C]Phe isotopic enrichment, and mRNA expression of selected genes was measured by real-time qPCR. Total and differential leukocyte counts were performed and immune responsiveness of monocytes was evaluated by tumor necrosis factor ɑ (TNFɑ) concentration on ex vivo whole blood stimulation with Escherichia coli lipopolysaccharide (LPS) and responsiveness of T-lymphocytes by interferon γ (IFNγ) concentration on stimulation with Staphylococcus aureus enterotoxin β (SEB). Further, ELISA plasma concentrations of IgM, IgA, and IgG were determined. The DRTC affected the majority of investigated parameters as expected. The CAS treatment increased milk protein yield (P = 0.04), and tended to lower TNFɑ (P = 0.06), and lowered IFNγ (P = 0.03) responsiveness per monocyte and lymphocyte, respectively, compared with CTRL. Further, fractional synthesis rate of albumin was greater at +4 DRTC for CAS compared with CTRL but did not differ by +29 DRTC (interaction: P = 0.01). In rumen papillae, synthesis rate of tissue protein was greater for CAS compared with CTRL (P < 0.01) and mRNA expression of genes for cell proliferation tended to be or were greater for CAS compared with CTRL (P ≤ 0.07). In conclusion, increased postpartum protein supply seem to enhance vital body functions as interpreted from increased liver synthesis of albumin, increased rumen papillae proliferation, and stabilized the ex vivo inflammatory responsiveness of leukocytes. Further studies are needed to enlighten the importance of increased postpartum protein supply in periparturient cows.

Variation of Length of Trachea in Different Age & Sex Group of Bangladeshi Cadaver

A cross sectional descriptive study was performed on 70 post mortem human trachea (44 of male and 35 of female) to find out the difference in length of the trachea of Bangladeshi people in relation to age and sex. The specimens were collected from the morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique. All specimens were grouped into three categories, Group A (upto 20 years), Group B (21-40 years) and Group C (41-60 years) according to age. Dissection was performed according to standard autopsy techniques. The length of the trachea was measured with the help of a metallic tape and data was analyzed by using one way ANOVA test. A general trend of increasing tracheal length was observed as age advanced. The mean±SD length of the trachea was 7.88±1.01cm in Group A, 8.81±0.81cm in Group B and 8.94±1.04cm in Group C. The mean length of the trachea in male were 8.1±0.81cm, 8.95±0.69cm and 8.92±1.1cm in Group A, Group B and in Group C respectively and in female the length were 7.57±1.24cm, 8.61±0.96cm and 9±1cm in Group A, Group B and Group C respectively. Variance analysis shows significant difference in mean length of the trachea between the age Group A & B and Group A & C but no significant difference was shown between Group B & C. No significant difference of length of trachea between male and female was observed. The study would help to increase the information pool on the length of the trachea of Bangladeshi people.

Natural killer cells contribute to hepatic injury and help in viral persistence during progression of hepatitis B e-antigen-negative chronic hepatitis B virus infection

Hepatitis B e-antigen negative (e(-)) chronic HBV infection (CHI) encompasses a heterogeneous clinical spectrum ranging from inactive carrier (IC) state to e(-) chronic hepatitis B (CHB), cirrhosis and hepatic decompensation. In the backdrop of dysfunctional virus-specific T cells, natural killer (NK) cells are emerging as innate effectors in CHI. We characterized CD3(-) CD56(+) NK cells in clinically well-defined, treatment-naive e(-) patients in IC, e(-)CHB or decompensated liver cirrhosis (LC) phase to appraise their role in disease progression. The NK cell frequencies increased progressively with disease severity (IC 8.2%, e(-)CHB 13.2% and LC 14.4%). Higher proportion of NK cells from LC/e(-)CHB expressed CD69, NKp46, NKp44, TRAIL and perforin, the last two being prominent features of CD56(bright) and CD56(dim) NK subsets, respectively. The frequencies of CD3(-) CD56(+) NK cells together with TRAIL(+) CD56(bright) and Perforin(+) CD56(dim) NK cells correlated positively with serum alanine transaminase levels in e(-)CHB/LC. K562 cell-stimulated NK cells from e(-)CHB/LC exhibited significantly greater degranulation but diminished interferon-γ production than IC. Further, Perforin(+) NK cell frequency inversely correlated with autologous CD4(+) T-cell count in e(-) patients and ligands of NK receptors were over-expressed in CD4(+) T cells from e(-)CHB/LC relative to IC. Co-culture of sorted CD56(dim) NK cells and CD4(+) T cells from e(-)CHB showed enhanced CD4(+) T-cell apoptosis, which was reduced by perforin inhibitor, concanamycin A, suggesting a possible perforin-dependent NK cell-mediated CD4(+) T-cell depletion. Moreover, greater incidence of perforin-expressing NK cells and decline in CD4(+) T cells were noticed intrahepatically in e(-)CHB than IC. Collectively, NK cells contribute to the progression of e(-)CHI by enhanced TRAIL- and perforin-dependent cytolytic activity and by restraining anti-viral immunity through reduced interferon-γ secretion and perforin-mediated CD4(+) T-cell lysis.

Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial

Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase group receiving both hyaluronidase and local anaesthetic. Pain scores were rated using the visual analogue scale (VAS) by patients immediately after local anaesthetic injection and again immediately after the carpal tunnel release. Results. Preoperative VAS scores, taken after local anaesthetic injection, were greater than postoperative VAS scores. Postoperative VAS scores were significantly lower in the hyaluronidase group and tourniquet times were significantly shorter in the hyaluronidase group. Conclusion. Hyaluronidase addition to local anaesthetic in carpal tunnel release resulted in significant reductions in operative time and pain immediately after operation.

Views of Medical Teachers Regarding the Need of Training or Course on Medical Education

Medical education in Bangladesh is poorly assessed and there is a general lack of documented knowledge about the challenges facing this field and the needs for its development. It was Cross-sectional descriptive type of study carried out among the teachers of two public (Sir Salimullah Medical College, Dhaka and Sher-E-Bangla Medical College, Barisal) and two non-government Medical Colleges (Northern Medical College, Dhaka and IBN Sina Medical College, Dhaka) during the period of July 1, 2011 to June 30, 2012 to explore their views regarding the training or course in medical education. The sample size was 204 who were selected purposively. The data were collected by a semi-structured and self-administered questionnaire. From the study it was revealed that majority 201(98.5%) of respondents showed their interest for training or course on medical education. Among them 123(61.2%) preferred a regular course, 58(28.8%) desired for training program and 20(9.9%) for refresher training on medical education. Most 83(67.4%) of the respondents agreed that there are barriers to participate in a training or course on medical education. Thirty four (43.6%) expressed their opinion that the duration of the training should be at least three months.

Endometrial stromal fibroblasts from women with polycystic ovary syndrome have impaired progesterone-mediated decidualization, aberrant cytokine profiles and promote enhanced immune cell migration in vitro

STUDY QUESTION

Do endometrial stromal fibroblasts (eSF) in women with polycystic ovary syndrome (PCOS) (eSFpcos) exhibit altered estrogen and/or progesterone (P4) responses, which may explain some of the adverse reproductive outcomes and endometrial pathologies in these women?

SUMMARY ANSWER

In vitro, eSF from women with PCOS exhibit an aberrant decidualization response and concomitant changes in pro-inflammatory cytokine, chemokine and matrix metalloproteinase (MMP) release and immune cell chemoattraction. In vivo these aberrations may result in suboptimal implantation and predisposition to endometrial cancer.

WHAT IS KNOWN ALREADY

The endometrium in women with PCOS has several abnormalities including progesterone (P4) resistance at the gene expression level, likely contributing to subfertility, pregnancy complications and increased endometrial cancer risk in PCOS women.

STUDY DESIGN, SIZE, DURATION

Prospective, university-based, case-control, in vitro study.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Cultures of eSFPCOS (n = 12, Rotterdam and NIH criteria) and eSFControl (Ctrl) (n = 6, regular cycle length, no signs of hyperandrogenism) were treated with vehicle, estradiol (E2, 10 nM) or E2P4 (10 nM/1 μM) for 14 days. Progesterone receptor (PGR) mRNA was assessed with quantitative real-time PCR (qRT-PCR) and eSF decidualization was confirmed by insulin-like growth factor-binding protein-1 (IGFBP-1) transcript and protein expression. Fractalkine (CX3CL1), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL) 6, 8 and 11, macrophage chemoattractant protein (MCP) 1 and 3, CCL5 (RANTES) and MMPs (MMP1, 2, 3, 7, 9, 10 and 12) were measured in conditioned media by Luminex multiplex assays, and chemotactic activity of the conditioned media was tested in a migration assay using CD14+ monocyte and CD4+ T-cell migration assay. Effects of IL-6 (0.02, 0.2, 2 or 20 ng/ml) or IL-8 (0.04, 0.4, 4, or 40 ng/ml) or combination (0.2 ng/ml IL-6 and 4.0 ng/ml IL-8) on 14-d decidualization were also tested. ANOVA with pre-planned contrasts was used for statistical analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Hormonal challenge with E2P4 to induce decidualization revealed two distinct subsets of eSFPCOS. Eight eSFPCOS (dPCOS) and all eSFCtrl (dCtrl) cultures showed a normal decidualization response to E2P4 as determined by morphology and IGFBP-1 secretion. However, 4 eSFPCOS cultures showed blunted decidualization (ndPCOS) in morphological assessment and low IGFBP-1 levels even though all three groups exhibited normal estrogen-mediated increase in PGR expression. Interestingly dPCOS had decreased IL-6 and GM-SCF secretion compared with dCtrl, whereas the ndPCOS cultures showed increased IL-6 and 8, MCP1, RANTES and GM-CSF secretion at base-line and/or in response to E2 or E2P4 compared with dCtrl and/or dPCOS. Furthermore, even though PGR expression was similar in all three groups, P4 inhibition of MMP secretion was attenuated in ndPCOS resulting in higher MMP2 and 3 levels. The conditioned media from ndPCOS had increased chemoattractic activity compared with dCtrl and dPCOS media. Exogenously added IL-6 and/or 8 did not inhibit decidualization in eSFCtrl indicating that high levels of these cytokines in ndPCOS samples were not likely a cause for the aberrant decidualization.

LIMITATIONS, REASONS FOR CAUTION

This is an in vitro study with a small sample size, utilizing stromal cell cultures from proliferative and secretory phase endometrium. The effect of PCOS on endometrial epithelium, another major histoarchitectural cell compartment of the endometrium, was not evaluated and should be considered in future studies. Furthermore, results obtained should also be confirmed in a larger data set and with mid/late secretory phase in vivo samples and models.

WIDER IMPLICATIONS OF THE FINDINGS

The alterations seen in ndPCOS may contribute to endometrial dysfunction, subfertility and pregnancy complications in PCOS women. The results emphasize the importance of understanding immune responses related to the implantation process and normal endometrial homeostasis in women with PCOS.

STUDY FUNDING/COMPETING INTERESTS

Sigrid Juselius Foundation, Academy of Finland, Finnish Medical Foundation, Orion-Farmos Research Foundation (to T.T.P.), the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) U54HD 055764-07 Specialized Cooperative Centers Program in Reproduction and Infertility Research (to L.C.G.), the NICHD the Ruth L. Kirschstein National Research Service Awards grant 1F32HD074423-03 (to J.C.C.). The authors have no competing interests.

Immune-driven adaptation of hepatitis B virus genotype D involves preferential alteration in B-cell epitopes and replicative attenuation--an insight from human immunodeficiency virus/hepatitis B virus coinfection

An important driving force behind the sequence diversity of hepatitis B virus (HBV) is viral adaptation to host immune responses. To gain an insight into the impact of host immunity on genetic diversification and properties of HBV, we characterized HBV of genotype D from treatment-naive hepatitis B e antigen-positive (EP) and hepatitis B e antigen-negative (EN) patients with chronic hepatitis B (CHB), where HBV is under stronger immune pressure, with that of HBV derived from human immunodeficiency virus (HIV)/HBV-coinfected individuals, where HIV infection has significantly weakened the immune system. Full-length sequence analysis showed that HBV heterogeneity was most extensive in EN-CHB followed by EP-CHB and HIV/HBV coinfection. The relative magnitude of non-synonymous changes within B-cell epitopes was greater than that in T-cell epitopes of HBV open reading frames (ORFs) in both EP-CHB and EN-CHB. Nine amino acid substitutions were identified in B-cell epitopes and one in a T-cell epitope of HBV in EN-CHB, most of which resulted in altered hydrophobicities, as determined using the Kyte and Doolittle method, relative to wild-type residues found in HBV from the HIV-positive group. Additionally, 19 substitutions occurred at significantly higher frequencies in non-epitope regions of HBV ORF-P in EN-CHB than HIV/HBV-coinfected patients. In vitro replication assay demonstrated that the substitutions, particularly in reverse transcriptase and RNaseH domains of ORF-P, resulted in a decline in replication capacity of HBV. Hence, our results indicate that HBV adapts to increasing immune pressure through preferential mutations in B-cell epitopes and by replicative attenuation. The viral epitopes linked to immune response identified in this study bear important implications for future HBV vaccine studies.

Prevalence of sub-clinical mastitis in dairy farms

A total of 560 lactating cows belonging to Bangladesh Agricultural University dairy farm (n = 59): Local Zebu (L), Local × Friesian (L × F), Local × Jersey (L × J), Local × Red Chittagong Cattle (L × RCC), Local × Sahiwal (L × SL), Red Chittagong Cattle (RCC); and Central Cattle Breeding Station and Dairy Farm (n = 501): Local Zebu, L × F, SL × F, Sahiwal and Australian Friesian Sahiwal (AFS) were selected to measure prevalence of subclinical mastitis (SM). The California Mastitis Test was done and the prevalence of SM was 68% on cow basis and 57% on quarter basis. The prevalence rate was significantly higher in L × F (87%, P < 0.05), SL × F (88%, P < 0.05), L × J (100%, P < 0.01), AFS (89%, P< 0.05) and SL (100%, P < 0.01). The local Zebu (31%) and RCC (28%) were least susceptible to SM. SM was significantly higher in multiparous (P < 0.05) and older cows (P < 0.05). The front quarters were more prone to SM than the rear. Factors such as breed, age, parity and management may have been responsible for high prevalence of SM in both farms. DOI: http://dx.doi.org/10.3329/bvet.v30i2.18257 Bangl. vet. 2013. Vol. 30, No. 2, 70-77

Effects of Bos taurus autosome 9-located quantitative trait loci haplotypes on the disease phenotypes of dairy cows with experimentally induced Escherichia coli mastitis

Several quantitative trait loci (QTL) affecting mastitis incidence and mastitis-related traits such as somatic cell score exist in dairy cows. Previously, QTL haplotypes associated with susceptibility to Escherichia coli mastitis in Nordic Holstein-Friesian (HF) cows were identified on Bos taurus autosome 9. In the present study, we induced experimental E. coli mastitis in Danish HF cows to investigate the effect of 2 E. coli mastitis-associated QTL haplotypes on the cows' disease phenotypes and recovery in early lactation. Thirty-two cows were divided in 2 groups bearing haplotypes with either low (HL) or high (HH) susceptibility to E. coli. In addition, biopsies (liver and udder) were collected from half of the cows (n=16), resulting in a 2 × 2 factorial design, with haplotype being one factor (HL vs. HH) and biopsy being the other factor (biopsies vs. no biopsies). Each cow was inoculated with a low E. coli dose (20 to 40 cfu) in one front quarter at time 0 h. Liver biopsies were collected at -144, 12, 24, and 192 h; udder biopsies were collected at 24h and 192 h post-E. coli inoculation. The clinical parameters: feed intake, milk yield, body temperature, heart rate, respiration rate, rumen motility; and the paraclinical parameters: bacterial counts, somatic cell count (SCC), and milk amyloid A levels in milk; and white blood cell count, polymorphonuclear neutrophilic leukocyte (PMNL) count, and serum amyloid A levels in blood were recorded at different time points post-E. coli inoculation. Escherichia coli inoculation changed the clinical and paraclinical parameters in all cows except one that was not infected. Clinically, the HH group tended to have higher body temperature and heart rate than the HL group did. Paraclinically, the HL group had faster PMNL recruitment and SCC recovery than the HH group did. However, we also found interactions between the effects of haplotype and biopsy for body temperature, heart rate, and PMNL. In conclusion, when challenged with E. coli mastitis, HF cows with the specific Bos taurus autosome 9-located QTL haplotypes were associated with differences in leukocyte kinetics, with low-susceptibility cows having faster blood PMNL recruitment and SCC recovery and a tendency for a milder clinical response than the high-susceptibility cows did.

Effect of dietary citric acid, flavomycin and their combination on the performance, tibia ash and immune status of broiler

The goal of this research was to investigate the effect of citric acid (CA), the antibiotic growth promoter flavomycin (FL) and their combination on the growth performance, tibia ash and immune status of broilers. One hundred and sixty straight run day-old broiler chicks (Hubbard Classic) were randomly distributed into four dietary groups, with four replicate cages having 10 birds in each. Standard corn-soybean-based basal starter diet was given to control birds. Diets for other groups were further fortified by 0.5% CA, 0.001% FL and their combination (0.5% CA plus 0.001% FL). On day 35, CA and its combination (CA + FL) group had 17 and 12% increase in live weight compared with control, respectively (P < 0.05). Total live weight on day 35 was 1141, 1337, 1169, and 1275 g bird-1 in different groups, respectively (P < 0.05). Cumulative feed intake was higher (P < 0.05) in CA and its combination (CA + FL) compared with the control and FL groups on day 28. Supplementation with CA improved (P > 0.05) feed conversion ratio [FCR; feed intake (kg):weight gain (kg)] compared with FL and its combination (CA + FL). Carcass yield was increased (P > 0.05) due to the addition of CA and its combination (CA + FL). Tibia ash content in the CA group (59.0) was higher (P < 0.05) than in the control (53.6%), FL (53.1%) and their combination (57.1%). The lymphocyte cells associated with immunity in the lymphoid organs (caecal tonsil, bursa Fabricius and ileum) were more densely populated, suggesting an increased level of innate immunity in the CA group. Overall mortality was low (1.25%), and there were no treatment-related effects on mortality. Citric acid reduced the pH of formulated feeds, but mild reduction was found in the pH of the faeces. Dietary supplementation of 0.5% CA increase weight gain, feed intake, tibia ash deposition and non-specific immunity (P < 0.05) as well as feed efficiency and carcass yield (P > 0.05) of broilers. Citric acid has potential as a growth promoter to replace the antibiotic growth promoter FL.Key words: Citric acid, flavomycin, growth performance, immunity, tibia ash, broiler

Effect of citric acid, avilamycin, and their combination on the performance, tibia ash, and immune status of broilers

The aim of this study was to determine the effect of the supplementation of an organic acid (citric acid), antibiotic growth promoter (avilamycin), and their combination for a period of 35 d on the growth, feed efficiency, carcass yield, tibia ash, and immune status of broilers. One hundred sixty 1-d-old broiler chicks (Hubbard Classic) were randomly distributed into 4 groups with 4 replicate cages having 10 birds in each. A corn-soybean-based diet was used as the basal diet (control). The basal diet was supplemented with an organic acid (citric acid, 0.5%), an antibiotic growth promoter (avilamycin, 0.001%), and their combination in other groups. The highest BW was attained in citric acid-fed chicks (1,318 g), which was significantly (P < 0.05) higher than control chicks (1,094 g) or avilamycin-fed chicks (1,217 g). The combination-fed chicks showed similar weight (1,246 g) as citric acid- or avilamycin-fed chicks (P > 0.05). Total feed intake was higher in citric acid-fed chicks compared with antibiotic-supplemented chicks. The addition of citric acid improved feed conversion efficiency (g of weight gain/ kg of feed intake) significantly (P < 0.05) compared with control chicks or its combination with avilamycin. Higher carcass weights were found in chicks fed the combination diet. Supplementation of citric acid increased tibia ash percentage significantly (P < 0.05) compared with controls. Addition of citric acid reduced the pH of the formulated diets. An improvement of immune status was detected by densely populated immunocompetent cells in the lamina propria and submucosa of cecal tonsils and ileum and also in the cortex and medulla of bursa follicles in citric acid-supplemented chicks. Supplementation of citric acid at 0.5% in the diet had positive effects on growth, feed intake, feed efficiency, carcass yield, bone ash, and immune status of broilers. Therefore, citric acid might be a useful additive instead of antibiotic growth promoters such as avilamycin, considering performance and health status of broilers.

Mass propagation of Rauwolfia serpentina L. Benth

A protocol for mass propagation through axillary bud proliferation was established for Rauwolfia serpentina L. Benth. (Apocynaceae). MS medium supplemented with 1.5 mg L(-1) BA and 0.2 mg L(-1) NAA elicited the maximum number of shoots (4 multiple shoots) from nodal explants. These adventitious shoots were best rooted on half strength MS medium supplemented with 1.0 mg L(-1) each of IBA and IAA. The in vitro raised plants were acclimatized in glass house and successfully transplanted to field condition with almost 95% survival.

Clinical profile and predisposing factors of cerebral palsy

This was an analysis of one hundred ten children with cerebral palsy (CP) attending at the Child Development & Neurology Care Center of Dhaka Medical College Hospital during January 2002 to December 2003. These children were observed to study their clinical profile, etiological factors and associated problems. The mean age of these children was 2.9 +/- 2.9 years, mostly being males (n=79, 71.8%). Most of the families of these children belonged to poorer socioeconomic strata. Spastic diplegia constituted the predominant group (34.5 per cent), followed by spastic quadriplegia (25.5 per cent). Dyskinetic CP was present in 15.5 percent of the cases. Hypotonic CP constituted a significant proportion of cases. Delayed Motor Function was observed in all 110 cases, delayed speech was complained in 67.3% cases and impaired hearing was identified in 26.8% CP children. Mothers of 43.6% CP cases reported that they had prolonged labour during delivery and almost one third (29.1%) had suffered from pre-eclampsia or eclampsia. Majority (53.6%) of the CP cases were reported to have had perinatal asphyxia. Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities. By proper perinatal care, CP can be prevented.

Effects of ultraviolet (254nm) irradiation on egg hatching and adult emergence of the flour beetles, Tribolium castaneum, T. confusum and the almond moth, Cadra cautella

The eggs of the stored grain pests, Tribolium castaneum (Herbst), T. confusum (Duval) (Coleoptera: Tenebrionidae) and Cadra cautella (Walker) (Lepidoptera; Pyralidae) belonging to three age groups, 1, 2, and 3 days-old, were exposed to ultraviolet (UV) radiation with 254nm wavelength (UV-C) for different durations to determine irradiation effects on egg-hatching and adult emergence. An increase in time of exposure to UV-rays caused a gradual decrease in the percentage of hatching of eggs in all age groups of eggs. No hatching occurred after 24 minutes of exposure in 2 and 3 day-old eggs of T. confusum. C. cautella eggs were less sensitive to UV-rays than were T. castaneum and T. confusum eggs. All the exposure periods significantly reduced the eclosion of adults in all the experimental insects. No adults emerged when 3 day-old eggs of T. castaneum were irradiated for 16 or 24 minutes, or from 2 and 3 day-old eggs T. confusum irradiated for 16 or 24 minutes.

Prevalence of soil transmitted helminthes infections among Bangladeshi males seeking job abroad

This cross-sectional study was undertaken to identify the prevalence of soil transmitted helminthes infections and its relation to socio-demographic characteristics among Bangladeshi males seeking job abroad. The stool sample of each respondent coming for medical check up was collected by code number and examined under microscope to see the presence helminthic ova or larvae. Among 8140 respondents, 68.05% were from rural and 31.95% from urban area. As a whole, helminthic infection was found in 20.22% respondents. Off which rural and urban distribution were 27.58% and 5.22% respectively (p<0.001). Pattern of helminthes as per rural and urban basis were as follows: Ascaris lumbricoides in 12.45% & 2.61%, Trichuris trichurias in 2.61% & 2.50% samples respectively. As per age distribution was concerned, number of positive cases among rural population in all age groups was statistically higher (p<0.001) than that of urban population. Similarly, rate of combined infections among the rural population was also statistically higher (p<0.001). Higher positivity of helminthes was obtained in low-level educated respondents and in the farmers group. Since the study reflected a high proportion of helminthes infections in rural people, so it was recommended to launch regular deworming programme in rural community at national level. Health education activities on proper sanitary practice, safe disposal of excreta and taking safe food-drinks should be meaningful to eradicating helminthes infections. Further study is needed for monitoring the active status in the community.

Chemical sphincterotomy--first line of treatment for chronic anal fissure

Anal fissure is a common disorder which may cause symptoms at any age. Internal anal sphincterotomy is the gold standard surgical treatment which lowers the resting anal pressure and effectively heals the majority of fissures. However the post operative period may be marked by surgical risks, complications and late incidence of incontinence that is some times permanent. These complications has led to a search for alternative therapies for the treatment of chronic anal fissure. Chemical sphincterotomy has been tried using a variety of novel agents including topical glyceryl trinitrate (GTN), calcium channel blockers such as nifedipine or diltiazem and botulinum toxin. Some of these agents were found to be effective in healing chronic anal fissure with negligible side effects and are now considered as first line treatment for chronic anal fissure.

Interleukin-6 (IL-6) and tumour necrosis factor-alpha in open and laparoscopic cholecystectomy

Injury to the human body alters normal physiology across several systems and these alterations are proportional to the extent of the injury. Physiological response to minimally invasive surgery appears to be different than those of traditional open surgery. Acute phase protein response appears to be one example. The important cytokines that are known as major mediators of acute phase response are interleukin-6 and TNF-alpha. Thirty patients were studied in which 14 underwent open cholecystectomy and 16 laparoscopic cholecystectomy. Three blood samples were taken from each patient, one pre-operatively and 2 post operatively at 4 and 24 hours. Interleukin-6 and Tumour Necrosis Factor-alpha (TNF-alpha) were raised significantly in post operative blood sample in both groups but the rise was much more in open group than laparoscopic group. This suggest less stress response in laparoscopic group which also showed a direct effect on patient convalescence in terms of less pain, less analgesic requirement and shorter hospital stay

Clinical studies in persistent diarrhea: dietary management with green banana or pectin in Bangladeshi children

BACKGROUND & AIMS

Because of the beneficial intestinal effects of dietary fibers, we have evaluated the therapeutic effects of green banana or pectin in children with persistent diarrhea.

METHODS

In a double-blind trial, 62 boys, age 5-12 months, were randomly given a rice-based diet containing either 250 g/L of cooked green banana (n = 22) or 4 g/kg pectin (n = 19) or the rice-diet alone (control, n = 21), providing 54 kcal/dL daily for 7 days. Stool weight and consistency, frequency of vomiting and purging, and duration of illness were measured.

RESULTS

Most children (60%) had no pathogens isolated from stools, 17% had rotavirus, 5% Vibrio cholerae, 4% Salmonella group B, and 11% had enterotoxigenic Escherichia coli infections. By day 3 posttreatment, significantly (P < 0.001) more children recovered from diarrhea receiving pectin or banana than controls (59%, 55%, and 15%, respectively). By day 4, these proportions correspondingly increased to 82%, 78%, and 23%, respectively, the study diet groups being significantly (P < 0.001) different than controls. Green banana and pectin significantly (P < 0.05) reduced amounts of stool, oral rehydration solution, intravenous fluid, and numbers of vomiting, and diarrheal duration.

CONCLUSIONS

Green banana and pectin are useful in the dietary management of persistent diarrhea in hospitalized children and may also be useful to treat children at home.

Ruptured uterus: an ongoing tragedy of motherhood

This study aimed to determine the frequency of ruptured uterus, possible aetiologic factors, foetomaternal out come and changes in obstetric care proposed to reduce this catastrophy. From September 1994 to September 1999 in Dhaka Medical College Hospital 39,782 deliveries occurred. All delivery records were reviewed and rupture uterus cases were identified. The result was compared with studies carried out in home and abroad. During the five years period among 39,782 deliveries 424 cases were of rupture uterus with a frequency of 1/93 deliveries. Eighty three percent rupture occurred in intact uterus and 17% occurred in uteri scarred by caesarian section. Common contributing factors were -prolonged/obstructed labour, grand multiparity, injudicious use of uterine stimulants, mismanaged labour by traditional birth attendant, delayed referral to well equipped centre, poor communication, poverty and ignorance.

Absorption of nutrients from an energy-dense diet liquefied with amylase from germinated wheat in infants with acute diarrhea

BACKGROUND

Addition of a small amount of amylase rich flour (ARF) to a thick porridge instantly liquefy the porridge and increase the energy intake even by sick children. The present study examined the absorption of macronutrients and calorie from an energy dense diet liquefied with ARF in children aged 6-11 months with acute watery diarrhea.

METHODS

After adequately hydrated with oral rehydration fluid over a period of 24 hours, children were randomly assigned to receive either an ARF treated liquefied porridge (test diet) or a porridge diluted with water (control diet). A 72-hour metabolic balance was performed to determine the absorption of carbohydrate, fat, protein, and calorie.

RESULTS

Thirteen infants received the test diet, and 15 infants received the control diet. The intake of protein (g/kg/d), carbohydrate (g/kg.d), fat (g/kg.d) and calorie (kJ/kg.d) were 1.97, 20.6, 4.3 and 548 respectively in the test group and those in the control group were 1.12, 13.3, 2.8 and 356. The stool loss of protein, carbohydrate and fat were comparable in the two groups. The absorption coefficient (%) of carbohydrate, fat and energy were 69.6, 61.3 and 65.4 in the test group and were 73.2, 58.6 and 66.7 in the control group. The coefficient of absorption of protein was significantly higher in the test group (37.7% vs. 21.7%). The mean (95% CI) nitrogen balance (g/kg.d) in the test and control groups were 0.064 (0.026, 0.102) and -0.029 (-0.055, 0.003) respectively.

CONCLUSIONS

The results suggest that energy dense diet liquefied with ARF was well absorbed in children with acute diarrhea and there was a positive nitrogen balance that may have a positive impact in preventing weight loss during acute illness.

Absorption of macronutrients from a calorie-dense diet in malnourished children during acute shigellosis

A metabolic balance study was performed to determine the absorption of macronutrients and energy from different food items in 23 malnourished children aged 12 to 48 months with clinically severe acute dysentery due to shigellosis. In a 72-h balance period, the absorption of carbohydrate, protein, fat, and total energy was determined. All the children received a standard hospital diet; 12 children in the test group were offered an additional calorie-dense milk (5.0 kJ/ml with a protein-energy ratio of 11.0), and 11 children in the control group, on the other hand, received a milk formula with an energy of 2.5 kJ/ml with a protein-energy ratio of 11.0. The intakes (g/kg/day) of protein, fat, carbohydrate, and energy between test and control groups were 4.25 versus 2.32 (p = 0.01), 7.63 versus 3.00 (p = 0.01), 21.09 versus 11.14 (p = 0.01), and 711 kJ/kg/day versus 338 kJ/kg/day (p = 0.01), respectively. The coefficients of absorption of protein, fat, carbohydrate, and energy between test and control groups were 61 versus 67% (p = 0.45), 69 versus 82% (p = 0.11), 77 versus 86% (p = 0.13), and 72 versus 82% (p = 0.13), respectively. The losses (g/kg/day) of protein, fat, carbohydrate, and energy between the two groups were 1.61 versus 0.76 (p = 0.00), 2.44 versus 0.55 (p = 0.00), 5.0 versus 1.6 (p = 0.00), and 204 kJ/kg/day versus 60 kJ/kg/day, respectively. The results of this study indicate that during the acute stage of shigellosis (with a substantially enhanced total intake of protein, fat, carbohydrate, and energy), by adding calorie-dense meals in malnourished children younger than 5 years, the absorption of macronutrients is not significantly different from that with the usual diet but suboptimal dietary energy intake, as is the case under ordinary treatment conditions.

Enteric protein loss and intestinal permeability changes in children during acute shigellosis and after recovery: effect of zinc supplementation

The effect of zinc supplementation on intestinal permeability changes and protein loss was studied in 32 children aged between 1 and 12 years during bouts of acute shigellosis and after recovery. An intestinal permeability test and then a 48 hour balance study were performed on all patients. They were then blindly assigned to receive vitamin B syrup either with or without zinc acetate (15 mg/kg per day) for a month. All patients received a five day course of nalidixic acid. The balance study was repeated during convalescence and follow up, but a permeability test was done only at follow up after one month. Intestinal permeability, expressed as a urinary lactulose:mannitol excretion ratio, improved significantly (p = 0.001) along with a significant increase (p = 0.005) in mannitol excretion in the zinc supplemented children, suggesting a resolution of small bowel mucosal damage. The latter was associated with a higher coefficient of nitrogen absorption (p = 0.03), suggesting a possible role of zinc in the treatment of shigellosis. Enteric protein loss, as assessed by faecal alpha 1 antitrypsin clearance, was not influenced by zinc supplementation.

Serum immunoglobulin profiles of septicemic versus healthy neonates

We studied 125 clinically suspected septicemic neonates (Patient) aged from 1 to 28 days and 25 healthy neonates (control) of comparable age and sexes. Cultures of blood were done and serum immunoglobulins (IgG, IgA) were estimated in all the subjects. Blood cultures were found positive in 45 (36%) patients. Preterm patients showed significantly higher number of positive blood cultures as compared to term patients. The mean serum IgG level in patients was found significantly lower than that of the controls. The serum IgG levels were also found significantly lower in 75 preterm as compared to 50 term, and in 45 blood culture positive patients as compared to 80 blood culture negative patients. On the other hand, the mean serum IgM level in patients was found significantly higher as compared to controls. Similarly, serum IgM levels were found higher in preterm patients as compared to term patients and in blood culture positive patients as compared to blood culture negative patients. No significant difference of mean serum IgA level was found among the subjects. It is evident from our study, that blood culture positive patients were mostly preterm, in whom transplacental passage of IgG is insufficient and due to low IgG level, preterm baby cannot counteract bacterial invasion and as such, suffer from septicemia more frequently. Septicemic neonates as a rule showed higher level of serum IgM due to synthesis by themselves in primary response to infection.

Persistent diarrhoea: efficacy of a rice-based diet and role of nutritional status in recovery and nutrient absorption

A diet based on rice powder, soya-bean oil, glucose, egg-white and salts was given to twenty-six patients of different nutritional status aged 4-18 months with persistent diarrhoea and twenty-five age-matched controls without diarrhoea. Clinical response was monitored during 1 week of dietary treatment and absorption of macronutrients was estimated during a 72 h balance study. Twenty-one patients (81%) recovered from diarrhoea within 7 d. There were significant relationships between nutritional indices, recovery, and absorption of total energy, fat and N. The absorption of fat, protein and carbohydrate in the better nourished controls without diarrhoea was significantly higher than in patients with persistent diarrhoea with better nutrition or malnutrition. The duration of diarrhoea was significantly longer in lighter patients (weight-for-age < 65% NCHS (1976) standard), in wasted patients (weight/height < 80% of NCHS) and those with mid upper arm circumference (MUAC) less than 110 mm. There were negative relationships between the period of recovery and the coefficient of absorption of fat (P < 0.001), total energy intake (P < 0.01) and MUAC (P < 0.05). Weight-for-age and MUAC showed most effective discriminative power for absorption of nutrients. However, the coefficients of absorption for carbohydrate were not different for any pair of nutritional groups. Absorption of all nutrients was also correlated negatively with severity of persistent diarrhoea on admission. The results of the present study indicate that a rice-based diet is highly effective in the management of persistent diarrhoea and less malnutrition aggravates nutrient malabsorption, increases duration and severity of diarrhoea and less severely malnourished patients do not absorb nutrients as well as healthy controls. Malnutrition and the initial severity of diarrhoea are significant determinants of clinical prognosis and nutrient absorption in persistent diarrhoea.

Absorption of macronutrients from a high-protein diet in children during convalescence from shigellosis

Absorption of macronutrients and energy intake were determined in 29 children aged 24-59 months, during convalescence from acute shigellosis. A 72 h metabolic balance study was performed to determine the absorption of carbohydrate, fat, and protein. Eighteen children received a high-protein (5 g/kg/day) diet, and 11 children received a standard-protein (2.5 g/kg/day) diet. The mean +/- SD energy intake was 612 +/- 38 kJ/kg/day for children receiving the high-protein diet, compared with 633 +/- 50 kJ/kg/day for the standard-protein group. The coefficient of carbohydrate absorption was 89 and 92% for the high-protein and standard-protein diets, respectively (p = 0.059). The coefficient of protein absorption was 80 and 71% for the high-protein and standard-protein groups, respectively, and was significantly higher in the high-protein group (p < 0.01). Absorption of fat was similar in both groups. The results of the study show better absorption of protein from a high-protein diet during convalescence, which may have a positive impact on catch-up growth of children suffering from shigellosis.

Malabsorption of nutrients in children with diarrhoea due to unknown aetiologies

Intake and coefficient of absorption of nutrients were measured in 72 children during acute diarrhoea and 2 weeks after recovery. No diarrhoeal pathogens could be identified in 18 (25%) children (group I). Aetiology of diarrhoea was identified in rest of the 54 children (group II). Absorption of calorie, fat and carbohydrate during the recovery stage were similar in all 72 children. In group I, absorption of nutrients improved from acute stage to recovery stage as follows: fat from 62 to 85%, calories from 68 to 86% and carbohydrate from 81 to 91%. Absorption of nitrogen during the acute stage was significantly lower (P < 0.01) in group I (mean +/- SD: 2% +/- 56) than in group II (mean +/- SD: 49% +/- 28). The anion gap in the stool of group I children (32) was similar to those with shigellae (37) and rotavirus (38). This could partially be explained by the possible loss of anionic proteins, fatty acids and/or lactic acids in the diarrhoeal stool. Results suggest that the diarrhoea due to unknown aetiology is possibly of the invasive type. Further investigation is necessary to define the mechanism of nitrogen loss in acute diarrhoea of unknown aetiology.

Persistent diarrhoea: factors affecting absorption and clinical prognosis during management with a rice-based diet

Twenty-six persistent diarrhoea patients aged 4 to 18 months were treated with a diet prepared with rice powder, soya oil, glucose, egg white and water. Absorption of macronutrients was estimated in a 72 h balance study and clinical response was examined during one week of dietary treatment. Nutrient absorption was compared with that of 25 healthy age-matched controls treated with the same diet. Twenty-one patients (81%) recovered from diarrhoea within seven days. Absorption of nutrients was significantly reduced among the persistent diarrhoea patients. More malnourished patients had a significantly reduced absorption of nutrients except carbohydrate and an increased severity and longer duration of diarrhoea. Total gut transit time had significant association with nutrient absorption in the persistent diarrhoea patients. The period of recovery negatively correlated with coefficient of absorption and positively with initial stool weight. Failure to recover was associated with severity of diarrhoea and systemic infection. The study indicates that nutrient absorption is significantly reduced in patients with persistent diarrhoea and nutritional status, and that initial purging rate and intestinal hurry are significantly related to the prognosis and nutrient absorption.

Effects of food with two oral rehydration therapies: a randomised controlled clinical trial

To evaluate the impact of food on the efficacy of oral rehydration solution (ORS), a randomised, controlled clinical trial was conducted in 182 adults with cholera. After initial rehydration with an intravenous polyelectrolyte solution for four hours, the patients were randomised to receive one of four rehydration therapies: glucose based ORS and no food for the first 24 hours (group A), glucose based ORS plus food from the beginning of treatment (group B), rice based ORS with no food for the first 24 hours (group C), and rice based ORS plus food from start of therapy (group D). Tetracycline was given after 72 hours to all patients. No significant differences in ORS intake, stool output, and duration of diarrhoea were noted between groups A and B and between groups C and D. A substantial and significant reduction in stool output was, however, shown in the groups who received rice based ORS irrespective of feeding. These results show that food does not potentiate the efficacy of either glucose based or rice based ORS in adults with cholera. Rice based ORS compared with glucose ORS substantially reduces purging in cholera patients.

Male pseudohermaphroditism due to early foetal testicular dysgenesis--a case report

An 8.5 years old girl presented with enlargement of clitoris. She was chromatin-negative with 46XY karyotype. Gonadotropin value was high with slightly raised testosterone level for female. Laparotomy showed only streakes of testicular tissue and no Uterus or Fallopian tubes were found. She was short and had malrotated kidney.

Persistent diarrhoea: clinical efficacy and nutrient absorption with a rice based diet

Twenty six infant boys, aged 4 to 18 months, suffering from persistent diarrhoea and 25 age matched healthy controls without diarrhoea were given a diet based on rice powder, egg white, glucose, and soya oil. The clinical efficacy of the diet was studied and a 72 hour metabolic balance study was done. Twenty one patients recovered from diarrhoea within seven days. Median coefficients of absorption of nutrients in persistent diarrhoea patients were 68.0% (range 28.0 to 92.0) for total energy, 60.0% (range 21.0 to 97.0) for fat, 53.0% (range -122.0 to 82.0) for nitrogen, and 81.0% (range 23.0 to 97.0) for carbohydrates. The corresponding values among the control subjects were 90.0% (range 76.0 to 99.0), 95.0% (range 71.0 to 99.0), 70.0% (range 10.0 to 95.0), and 93.0% (range 85.0 to 98.0) respectively. Absorption of all macronutrients in the control subjects was on average significantly higher than in the patients. Nutrient absorption is substantially reduced in persistent diarrhoea and a rice based diet is clinically effective in most patients.

Food-based oral rehydration salt solution for acute childhood diarrhoea

The efficacy in acute childhood diarrhoea of oral rehydration therapy (ORT) based on staple foods (maize, millet, wheat, sorghum, rice, or potato) was compared with that of standard ORT based on glucose. 266 children aged 1-5 years, with a history of acute diarrhoea for 48 h or less, moderate to severe dehydration, and no complications, were assigned to treatment with one of the food-based oral rehydration salt solutions (ORS) or standard ORS. The mean stool output over the first 24 h of treatment in the group receiving standard ORS was significantly higher than that of any other treatment group, and the groups receiving food-based ORT showed substantial reductions in stool output compared with the standard ORT group. Abnormalities in electrolyte concentrations were corrected in all treatment groups with similar efficiency. The digestibility of the food-based ORS was assessed by the stool pH, glucose content before and after acid hydrolysis, and osmolality; there were no significant differences between the standard ORS and food-based ORS groups. Food-based ORT should be more acceptable to users in developing countries since the mixtures are similar to traditional weaning foods and since, unlike standard ORT, it reduces stool output substantially.