Hypoxia-related Y RNA fragments as a novel potential biomarker for distinguishing metastatic oral melanoma from non-metastatic oral melanoma in dogs

Hypoxia may promote tumor progression, and hypoxically altered noncoding RNA (ncRNA) expression may play a role in metastasis. Canine oral melanoma (COM) frequently metastasizes, and ncRNA expression under hypoxia may be clinically significant. We aimed to elucidate ncRNA fragments whose expression is altered by hypoxia in COM-derived primary KMeC and metastatic LMeC cell lines using next-generation sequencing to validate these results in qRT-PCR, and then compare expression between metastatic and non-metastatic COM. The NGS analysis and subsequent qRT-PCR validation were performed using hypoxic and normoxic KMeC and LMeC cells, and clinical samples [tumor tissue, plasma, and plasma-derived extracellular vesicles] obtained from dogs with metastatic or non-metastatic melanoma were analyzed with qRT-PCR. Y RNA was significantly decreased in metastatic LMeC cells versus primary KMeC cells in hypoxic and normoxic conditions. The expression of Y RNA was decreased in dogs with metastatic melanoma versus those with non-metastatic melanoma for all clinical sample types, reflecting the pattern found with hypoxia. Receiver operating characteristic analysis demonstrated that Y RNA level is a promising biomarker for discriminating metastatic from non-metastatic melanoma in plasma [area under the curve (AUC) = 0.993, p < 0.0001] and plasma-derived extracellular vesicles (AUC = 0.981, p = 0.0002). Overall, Y RNA may be more resistant to hypoxic stress in the metastatic than the non-metastatic state for COM. However, further investigation is required to elucidate the biological functions of Y RNA under hypoxic conditions.

Upregulation and functional roles of miR-450b in canine oral melanoma

Canine oral melanoma (COM) is a common and highly aggressive disease with the potential to model human melanomas. Dysregulated microRNAs represent an interesting line of research for COM because they are implicated in tumor progression. One example is miR-450b, which has been investigated for its molecular mechanisms and biological functions in multiple human cancers, but not human or canine melanoma. Here, we aimed to investigate miR-450b as a potential diagnostic biomarker of COM and its functional roles in metastatic and non-metastatic forms of the disease. We investigated the expression of miR-450b and its target mRNA genes in clinical (tumor tissue and plasma) samples and metastatic and primary-tumor cell lines. Knockdown and overexpression experiments were performed to determine the influence of miR-450b on cell proliferation, migration, colony formation, and apoptosis. miR-450b was significantly upregulated in COM and differentiated between metastatic and non-metastatic tumors, and its potential as a biomarker of metastatic and non-metastatic COM was further confirmed in ROC analysis. miR-450b knockdown promoted cell proliferation, migration, and clonogenicity and inhibited apoptosis, whereas its overexpression yielded the reverse pattern. miR-450b directly binds 3' UTR of PAX9 mRNA and modulates its function leading to BMP4 downregulation and MMP9 upregulation at the transcript level. Furthermore, we surmised that miR-450b activates the Wnt signaling pathway based on gene ontology and enrichment analyses. We concluded that miR-450b has the potential as a diagnostic biomarker and could be a target candidate for COM treatment.

Prevalence and Risk Factors of Psychological Distress among Older People Seeking Health Care at Hospital in Dhaka City

Increasing age is the main risk factor for chronic illnesses. The illnesses are not only physical, but also affect their psychological well-being and this has a significant effect on their quality of life. Numerous researches have shown that there is high prevalence of psychological distress in different medical and surgical patients while considerable percentage that is not detected by doctors. The study was conducted to identify the prevalence and risk factors of psychological distress in older people seeking health care at hospital in Dhaka city. This was a cross-sectional study conducted in the Bangladesh Association for the Aged and Institution of Geriatric Medicine (Bangladesh Probin Hospital) in Dhaka city, Bangladesh. A total of 451 older people seeking for healthcare was interviewed face-to-face using a standard Bengali validated General Health Care Questionnaire-12 (GHQ-12). Recruitment of respondents was based on the systematic random sampling of the older people aged at or more than 60 years who were seeking health care at hospital in Dhaka city. A total of 59.65% (n=269) participants were found to have psychological distress. Age of more than 75, education up to secondary level, being unemployment, living alone, respondents with lower socioeconomic background, not having spouse, history of bereavement was found to be significantly associated with psychological distress. Other factors such as smokers, respondents who consume alcohol, physically inactive older people, older people with multiple comorbidities and having diagnosed with a disease more than 6 months were found to be associated with psychological distress. Majority of the older patients with physical illness were distressed. The prevalence of psychological distress among older peoples seeking for healthcare with multiple comorbidities who seek care in the hospital was very high (59.65%). Age, education, marital status, history of bereavement, smoking, alcohol use, physical activity and presence of multiple comorbidities were independent determinants of psychological distress among older people seeking for healthcare. Encouraging healthy lifestyle through cessation of smoking and alcohol use and increasing physical activity could be an effective step in reducing psychological comorbidities among older people seeking for healthcare.

Evaluation of Serum Iron Profile in Patients with Pulmonary Tuberculosis

Approximately 10.0% of tuberculosis (TB) Infected individuals develop clinical disease in the absence of immune suppression suggests that individual factors may play a role in the response to infection. Body's immune function is boosted by micronutrient and also plays a major role in response to tubercular infection. Someone, may argue that cell mediated immunity is compromised in iron deficiency before anemia becomes apparent. This descriptive observational study intended to assess serum iron profile in patients suffering from pulmonary tuberculosis. This study included 56 newly diagnosed sputum smear positive and negative pulmonary tuberculosis patients as per inclusion and exclusion criteria and was conducted at the department of the Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh with the collaboration of the Biochemistry department, BSMMU, Bangladesh from February 2017 to January 2018. Collected data were recorded in a structured questionnaire and compiled and appropriate analyses were done by using computer-based software Statistical Package for Social Sciences (SPSS) version 23.0. Out of 56 patients, majority was young and at reproductive age, male was predominant (78.6%) with a male to female ratio of 3.7:1. More than three fourth 43(81.0%) patients were found to have low serum iron concentration. Majority 45(80.4%) patients had normal serum TIBC, 6(10.7%) had low serum total iron binding capacity (TIBC) and 5(8.9%) had high serum TIBC. Almost two third 36(64.3%) patients had low serum transferrin saturation and 20(35.7%) had normal serum transferrin saturation. Majority 31(55.4%) patients had normal serum ferritin, 2(3.6%) had low serum ferritin and 23(41.1%) had high serum ferritin. Serum iron concentration and serum ferritin were significantly associated with chest x-ray abnormalities (p<0.01). Half of the patients were smear positive for acid fast bacilli (AFB) (50.0%). No significant association was found between sputum positive for AFB with iron profile status. In smear positive pulmonary tuberculosis patients, more than three fourth (78.6%) patients had low serum iron concentration at baseline and majority 20(80.0%) patients had normal serum iron concentration after 2(two) months. Mean serum iron concentration was 41.8±17.6mcg/l in baseline and 70.4±29.7mcg/l in at 2(two) month. More than sixty percent (60.7%) patients had low serum transferrin saturation at baseline and 20(80.0%) patients had normal serum transferrin saturation after 2(two) months. Mean serum transferrin saturation was 18.1±7.6% at baseline and 31.2±19.4% in at 2(two) months. After 2(two) months follow up serum iron concentration and serum transferrin saturation had significant improvement (p<0.05). Significant iron deficiency status occurred in pulpmonary tuberculosis and which improved after anti-tubercular treatment without iron supplementation.

Haematohidrosis: A Case Series of Five Patients

Haematohidrosisis manifested by sweating mixed with blood. It is a rare disease and there are scarce literature regarding case report. We are describing five cases of haematohidrosis in different age group here in this case series. In case 1- a 20 year old woman was admitted with history of recurrent haemorrhage from various sites without any trauma or anticoagulant or antipletlet medication. There was no evidence of local trauma. Physical examination was unremarkable. Her blood workup came out insignificant. In case 2- a 10 year old boy was admitted with epistaxis, conjunctival bleeding, haematuria and per rectal bleeding without any history of injury. He had no history of medicine which would cause bleeding. Physical examination and laboratory profile were insignificant. In case 3- a 15 year old boy presented with recurrent haematuria and conjunctival haemorrhage without any trauma. No history of medication that would cause the bleeding. His systemic examination and laboratory profile was unremarkable. In case 4- a 25 year old woman presented with bleeding from ear, nose and eyes without any local trauma. She was not on any medication that would cause bleeding. Her systemic inquiry and laboratory profile was unremarkable. In case 5- a 20 year old woman presented with bleeding from eyes, ears and umbilicus. There was no evidence of self-inflicted injury. She had features of anxiety disorder. Other systemic examination and laboratory profile was unremarkable. All the cases were labelled as haematohidrosis and treated with propranolol with successful outcome. We report this case series to build up awareness and disseminate clinical knowledge.

Respiratory Complications of COVID-19 Survivors in Bangladesh: A Radiological Evaluation

Following the COVID-19 pandemic, a growing percentage of COVID-19 survivors exhibit post-COVID symptoms. This cross-sectional study aimed to assess radiological findings in individuals having post-COVID respiratory problems. This study was conducted in the Departments of Radiology and Imaging and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2021 to June 2022 and included 30 COVID survivors aged 40 to 65 years. We employed a pre-tested semi-structured questionnaire including socio-demographic information, clinical data and CT chest imaging parameters. Pearson's correlation coefficient was calculated, as well as multiple linear regressions. Among 30 participants, 56.0% were male. The mean age of the respondents was 51.20 years (standard deviation of 7.09), ranging from 40 to 65 years. Approximately one-third of the participants had at least one co-morbid condition where hypertension (26.67%), diabetes (26.67%), chronic interstitial lung disease (16.67%) and obesity (16.67%) were most commonly recorded. Approximately 20.0% of participants were smokers. The incident of at least one post-COVID symptom was 100.0%. Approximately 73.0% presented with post-COVID lethargy, 16.67% with SoB (Shortness of Breath), and 90.0% of participants complaint of self-reported anxiety. We have found a positive correlation between age and overall lung involvement. The most common lung tomographic findings were fibrosis (93.0%) and diffuse ground glass opacity (70.0%). Interstitial lung thickening was found in 50.0% of cases and bronchiectasis accounted for 16.67%. In 6.6% of cases, there was no pulmonary lesion. It was notifiable that, with time, the feature of DGGO (diffuse ground glass opacity) became subtle and the total lung involvement decreased from 75.0% to about 25.0% during the post-COVID period. Timely assessment for post-COVID pulmonary sequelae by high-resolution CT chest scan might play an important role in modulating a treatment plan for patients suffering from the post-COVID syndrome.

Troponin I Elevation after Elective Percutaneous Coronary Interventions: Prevalence and Risk Factors

Percutaneous coronary intervention (PCI) is one of the most important modalities of treatment for coronary artery disease (CAD). Minor extents of injury to the myocardium have been observed even after successful PCI. This peri-procedural injury might therefore reduce some of the beneficial effects of coronary revascularization. The objective of this hospital based comparative observational study was to determine the prevalence of post procedural Cardiac troponin I (cTnI) elevation after elective PCI and also to find out the relation with risk factors such as age, sex, body mass index (BMI), smoking, anemia, diabetes mellitus, hypertension, dyslipidemia, family history, left ventricular dysfunction, renal insufficiency, type of stent, number of stent and length of stent. This was a hospital based comparative observational study carried out in the Department of Cardiology, Chattogram Medical College Hospital (CMCH), Chattogram, Bangladesh from July 2018 to June 2019. A total of 50 patients who underwent elective PCI were included as sampled by purposive sampling method. Serum cTnI was measured by FIA8000 quantitative immunoassay analyzer with an analytical measurement before and at 24 hours of PCI. Value >1.0ng/ml was considered elevated. Univariate and multivariate analysis were applied to assess predictors for the occurrence of post-procedural elevation of cTnI. The mean±SD age of the study population was 54.96±9.1 years (range 35-74 years) and 34(68.0%) patients were male. Regarding cardiovascular risk factors, 17(34.0%) patients had diabetes mellitus, 27(54.0%) had dyslipidemia, 30(60.0%) had hypertension, 32(64.0%) were current or ex-smokers and 20(40.0%) had a family history of CAD. Eighteen patients (36.0%) had post-procedural cTnI elevation but only 8(16.0%) had significant (>1.0ng/ml) elevation. Change of cTnI before and at 24 hours of PCI was not significant (p=0.057). Cardiac Troponin I increase was related to age, pre-procedural serum creatinine and multi-vessel stenting. Minor elevation of cTnI was common following elective PCI and associated with few risk factors such as elderly patient (more than 50 years), raised serum creatinine and multi-vessel stenting. So, early detection of these risk factors, as well as effective intervention may help to prevent injury to cardiac tissue hence stop elevation of cardiac TnI following elective PCI.

A Case Report of Porphyria Cutanea Tarda with Hepatitis-C Virus Co-infection

Porphyria cutanea tarda is a rare disorder of heme metabolism due to deficiency of the enzyme uroporphyrinogen decarboxylase which is manifested as some typical dermatological features and hepatic dysfunction. The Hepatitis-C virus co-infection is common and it can be aggravated by other environmental factors. We report a case of porphyria cutanea tarda in a 37-year-old woman, who presented with recurrent skin blisters and has concomitant Hepatitis-C virus infection. She was taking oestrogen containing oral contraceptive pill for a long duration. The diagnosis of porphyria cutanea tarda was considered on the basis of clinical features and high level of urine porphyrin level. She was put on hydroxychloroquine and combination drugs for Hepatitis-C virus with significant improvement after 3 months of therapy.

A 60-year-old Man Presented with Relapsing Polychondritis with Haemophagocytic Lymphohistiocytosis

Relapsing polychondritis is a rare autoimmune disorder of unknown etiology, which can affect multiple organs. It usually presents with involvement of elastic cartilage of ear and nose and involvement of other organs like kidney and central nervous system. Here, we report a case of 60-year-old man, who initially presented with fever, polyarthritis, erythema nodosum and painful swelling and redness of both external ears admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 13th December 2019. Two days after hospitalization, he developed sudden onset of proptosis with ophthalmoplegia. After evaluation, he was diagnosed as relapsing polychondritis with haemophagocytic lymphohistiocytosis and was treated with high dose prednisolone. His clinical condition and laboratory parameters significantly improved after treating with prednisolone during follow up.

Paroxysmal Nocturnal Hemoglobinuria in Systemic Lupus Erythematosus: A Rare Manifestation

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disorder of hematopoietic stem cells. The occurrence of PNH in a patient with systemic lupus erythematosus (SLE) is even rarer. One such presentation was seen in a 19 years old woman who presented with fever, multiple joint pain, photosensitivity, oral ulcer, hair loss and was diagnosed as a case of SLE and was admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 7th February 2019. Subsequently she developed progressive anaemia and passing of dark colored urine. Flow cytometry analysis showed PNH clone within red cells. We report this case so that clinicians are aware about this association between PNH and SLE. Informed written consent was obtained from the patient for the publication of this case report, the copy of which is available with the authors.

Comparison of Risk Factors and Angiographic Profile between Younger and Older Patients with Acute Myocardial Infarction

Acute myocardial infarction (AMI) in younger adults (≤40 years) is being increasingly encountered in recent years among the South Asian population. Data regarding the presentation, risk factors and angiographic findings on this important subset of patients is lacking in our country. The aim of this study was to compare the risk factors and pattern of Coronary artery involvement in younger patients presenting with AMI with that of the older age group. This was a cross-sectional observational study conducted during the period from October 2018 to June 2019. Seventy consecutive AMI patients age ≤40 years and another 70 consecutive AMI patients age >40 years undergoing Coronary Angiogram (CAG) were included in the study. After taking informed written consent; demographic, anthropometric, risk factors, CAG findings were recorded in a pre-designed case record form. The severity of Coronary Artery Disease (CAD) was calculated by using Gensini score. The mean age of the younger and older patient groups was 36.89±4.4 years and 57.00±8.4 years respectively. Among the risk factors, smoking (67.1% versus 45.7%, p=0.017), positive family history CAD (38.6% versus 22.9%, p=0.040) and obesity (34.3% versus 20.0%, p= 0.05) were more common in younger group. Whereas, Hypertension (41.4% versus 72.9%, p=0.010) and DM (28.6% versus 50.0%, p=0.024) were more common in older patients. Younger patients mainly presented with STEMI (60.0% versus 48.6%) and predominantly had single vessel disease (42.9%), whereas older patients readily presented with NSTEMI (51.4%) and had a higher incidence of double vessel disease (32.9%) and triple vessel disease (30.0%). The Median Gensini score was significantly higher among the older patients than in the younger age group. Patients in younger age group showed a different pattern of risk factors and coronary artery involvement in comparison to the older age group. Thus, offering younger individuals to make them aware of these risk factors and their early detection, as well as an effective intervention may help to prevent AMI in younger people.

Relationship between Myocardial Performance Index and the Severity of Coronary Artery Disease Assessed with SYNTAX Score in Chronic Stable Angina Patients in Bangladesh

Although improvement in the risk scoring, there are patients with chronic stable angina identified as low risk who experience CAD events, as well as, patients deemed high risk remained free of CAD events. Invasive coronary angiogram is the gold standard method for assessment of extent and severity of CAD. However, search for additional noninvasive tool that may aid in risk discrimination is going on. Myocardial performance index (MPI) is emerging as one of them. To assess the relationship between Myocardial Performance Index and severity of coronary artery disease assessed with SYNTAX Score in chronic stable angina. This cross-sectional study was conducted during the period of January, 2015 to December, 2015 among the patients of chronic stable angina undergoing elective coronary angiogram. Total 90 patients were enrolled by purposive sampling. All the data were recorded in structured questionnaire. Coronary angiogram with SYNTAX scoring was done during index hospital admission. Doppler study was done 1 day prior to CAG to measure MPI. The mean age was found 45.5±26.1 years varied from 36 to 68 years. Male female ratio was 1.9:1. A negative significant correlation (r= -0.792; p=0.001) was found between ejection fraction (EF) and myocardial performance index (MPI). Regarding the association between risk factors with MPI status, the mean MPI was found 0.65±0.10 in diabetes mellitus and 0.57±0.10 in without diabetes mellitus. Mean MPI was significantly higher in diabetes mellitus, others risk factors are not significantly associated with MPI status. Majority (38.9%) patient's SYNTAX score belonged to 0-22, 28(31.1%) was SYNTAX 23-32 score and 27(30.0%) was SYNTAX ≥33 score. The mean MPI was found 0.51±0.04 in low SYNTAX, 0.61±0.03 in intermediate SYNTAX and 0.74±0.07 in high SYNTAX score. The mean MPI was significantly (p<0.05) elevated with increased SYNTAX score. A positive significant correlation (r=0.985; p=0.001) was found between MPI with SYNTAX score. Higher value of SYNTAX score (>22) had a 2.29 times increase (95% CI 0.16 to 33.70%) in odds of having CAD. A subject with diabetes mellitus had 1.52 times increase (95%CI 2.02 to 21.54%) in odds having CAD. Others factors are not significantly associated with CAD in Multiple regression models. The MPI value is independently associated with the extent and severity of CAD. The MPI value measured by Doppler is a cheap, radiation free, available noninvasive method and may be considered as an additional risk stratification tool beyond other investigations.

Health Related Quality of Life in Patients with Pulmonary Tuberculosis

Tuberculosis (TB) is one of the major public health issues in many developing nations especially in Bangladesh. Though most focus is being directed towards mortality and incidence rate, the changes in morbidity and other health status parameters are not been well considered. The aim of the study was a comprehensive assessment of patients with pulmonary tuberculosis by measuring patient's quality of life which may lead to better outcome in patients' health, infection surveillance and prevention programs. This prospective study was conducted in the department of Respiratory and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to March 2017. The quality of life scores of 61 smear positive pulmonary tuberculosis cases were measured by validated Bangla version of SF-36 questionnaire before or at the starting of treatment, after the initial phase and at the end of treatment. Then the score was compared with those of 75 healthy matched controls. The changes of the quality of life with the stage of treatment and with socio-demographic variables were assessed. Before treatment, all domains of HRQoL of the pulmonary TB patients were significantly lower than those of the control group (p<0.001). At the end of six-month treatment period, HRQoL of the pulmonary TB patient had significantly increased compared to before treatment (p<0.001). There was no significant difference of scores after six months of treatment with that of control (p>0.05). The lowest score in tuberculosis patients was related to general health perception and vitality. Patients with low socio economic status, low educational level, prolonged disease duration and increased number of symptoms had lower HRQoL scores.

Development of a hematite nanotube and tyramine-based drug carrier against drug-resistant bacteria Klebsiella pneumoniae

In this study, hematite nanotube (HNT) and tyramine-based advanced nano-drug carriers were developed for inhibiting the growth of Klebsiella pneumoniae (K. pneumoniae). The HNT was synthesized by following the Teflon line autoclaved assisted hydrothermal process and tyramine was incorporated on the surface of the HNT to fabricate the formulated nano-drug. The nano-drug was prepared by conjugating meropenem (MP) on the surface of Tyramine-HNT and characterized using different techniques, such as scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared (ATR-FTIR), etc. Furthermore, the drug-loading efficiency and loading capacity were measured using a UV-vis spectrometer. The pH, amount of Tyr, and HNT required for drug loading were optimized. A controlled and gradual manner of pH-sensitive release profiles was found after investigating the release profile of MP from the carrier drug. The antibacterial activity of MP@Tyramine-HNT and MP was compared through the agar disc diffusion method which indicates that antibacterial properties of antibiotics are enhanced after conjugating. Surprisingly, the MP@Tyramine-HNT exhibits a minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of K. pneumoniae lower than MP itself. These results indicate the nanocarrier can reduce the amount of MP dosed to eradicate K. pneumoniae.

Quality of Life Assessment by SF-36 among the Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) patients have substantial functional disability which poses a significant impact on the quality of life (QoL). So, this study aims to assess the QoL of RA patients by the Short Form Health Survey-36 (SF-36) questionnaire. Total sixty-two (62) rheumatoid arthritis patients were included in this cross-sectional observational study and were performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2018 to September 2019 according to selection criteria. A Bengali validated version of Medical Outcomes Study-36: Item Short Form Health Survey (SF-36) questionnaire was used to assess QoL. Among the sixty-two (62) patients, mean age was 44.18±12.14 years with female preponderance (77.4%). About one-fifth of the patients (19.4%, n=12) were illiterate and the majority (71.0%, n=44) were housewives. Amongst all, 53.2% (n=33) had monthly family income >20,000 taka. Forty percent (n=25) had a disease duration of 1 to 5 years. According to Disease Activity Score Sheet 28 (DAS-28), 36(58.1%) patients had moderate disease activity and 26(41.9%) patients had high disease activity. Among the 8 domains, the mental health domain had the highest score (42.77±13.78) and the role physical domain had the lowest (35.89±15.43). Male, literate patients with higher income had relatively better QoL. Patients with prolonged disease, high disease activity and irregular taking of Disease Modifying Anti-Rheumatic Drugs (DMARDs) had poor quality of life. A significant negative correlation was present between SF-36 scores and the DAS-28 scores (r = -0.803, p<0.001). Rheumatoid arthritis had a relatively poor quality of life regarding both physical and mental health components, but the physical health component was predominantly affected.

Physician's Perception about the Use of PPE, COVID-19 Prevention and Management in Bangladesh

This study aims to explore physician's perceptions about the use of Personal Protective Equipment (PPE), COVID prevention, and management during the COVID pandemic since knowledge on these might explain the reason behind infection and death of physicians in Bangladesh at an unexpected rate. This cross-sectional study was conducted based on an online questionnaire on 346 physicians (n=346) by the Department of Gastroenterology of Mymensingh Medical College Hospital, Bangladesh from 15th July 2020 to 14th September 2020. Physicians of different health care facilities across Bangladesh were invited to take part. Knowledge on specific points of the questionnaire was evaluated, scored, and compared between different groups by Independent sample t-test. Mean knowledge score between the respondents working up to 8 hours and beyond 8 hours per day was 17.28±1.28, 16.90±1.40 respectively (p=0.03). Mean knowledge score observed between graduate and post-graduate physicians and work experience of 5 years and beyond 5 years were 17.26±1.36 vs. 17.16±1.27; (p=0.40), 16.87±1.75 vs. 17.27±1.21; (p=0.11) respectively. Physician's safety should be first concern that is highlighted through proper use of PPE and prevention of COVID. Patient management skills would be better if physicians are trained well on infection prevention and control which in turn will reduce infection and death of physicians.

Role of Rotaviral Antigen Detection by ICT in Acute Diarrhoeic Children below 5 Years in a Tertiary Care Hospital of Bangladesh

Rotavirus is responsible for acute severe watery diarrhoea in young children. Early and rapid detection of Rotavirus infection can help to reduce inappropriate administration of antibiotics and has future positive impact on prevention of drug resistance. This cross-sectional study was designed to determine the role of Rotaviral antigen detection by ICT from stool sample of acute diarrhoeal children below five years admitted in Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology in collaboration with the Department of Paediatrics during the period from 1st January 2018 to 31st December 2018. Total 184 children of under five years of age with acute watery diarrhoea were enrolled in this study. Rotaviral antigen was detected by ELISA (Enzyme Linked Immunosorbent Assay) and ICT (Immunochromatographic test) from stool samples. Out of 184 stool samples, Rotaviral antigen was found positive in 84 and 86 cases by ICT and ELISA methods, respectively. ICT showed sensitivity of 90.70% and specificity of 93.88% when compared with ELISA. The Rotavirus infection was found highest in male children (61.90%) and in age group of 7 to 12 months (51.89%). Considering the importance of Rotaviral diarrhoea, rapid detection of Rotavirus infection by ICT is essentially needed and might be practiced routinely as it is relatively reliable, easy to perform and cost-effective. It is particularly important in Bangladesh, where diarrhoea is still contributing a significant proportion of morbidity and mortality in under five children.

Short Term Outcome of Therapeutic ERCP in the Management of Biliary Ascariasis in a Tertiary Care Hospital of Bangladesh

The history of ascariasis is very old. It is endemic in various parts of Bangladesh. Hepatobiliary ascariasis is a well-known complication of the intestinal ascariasis. Although cosmopolitan, it predominantly affects people in Asia, Africa, and South America. This was a prospective observational study conducted from July to December 2014 to explore the short term outcome of therapeutic ERCP in the treatment of biliary ascariasis in a tertiary care hospital of Bangladesh. A total of 60 cases of biliary ascariasis were selected conveniently in this study. Data were collected by face-to-face interviews and observation with the help of data sheet. Data were checked for quality control and analyzed by computer using SPSS software. The mean±SD age of the patients was 30.96±7.66 years. All the patients were aged between 17 and 55 years and predominantly affect women in the 3rd and 4th decades. The most common presentation was upper abdominal pain in 47(83.32%) of the patients. Ultrasound was the diagnostic tool of choice, where biliary ascariasis was found in 40(66.7%) of patients. ERCP is reserved mainly for therapeutic purposes and found successful in 57(95%) of the patients.

Frequency of Osteoporosis among Chronic Obstructive Pulmonary Disease Patients Attending Respiratory Medicine Out Patient Department, BSMMU

Osteoporosis is an important systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD). Osteoporosis is a systemic disease of bone which may present as low bone mass and micro-architectural disarray that increases the risk of fracture. The World Health Organization defines osteoporosis as bone density ≥2.5 standard deviations below the bone density of a normal young adult. Osteopenia, a less severe form of bone loss, is defined as a bone density between 1 and 2.5 standard deviations below that reference point. The aetiology of osteoporosis in COPD patients remain unclear, but several factors significantly correspond to reduced bone density in COPD, including older age, female sex and body mass index (BMI). However, the relationship to other factors, such as FEV₁, tobacco smoking, physical inactivity and corticosteroid therapy, are still an unresolved issue. This cross-sectional study was done in the Department of Respiratory Medicine, BSMMU from March 2018 to March 2019. A total of 86 patients of which prevalence of osteoporosis is 29.1%, osteopenia 50% and normal BMD in 20.9%, majority of them was belonging to age group 51-60 years. Male were predominant with male-female ratio of 3.5:1. The frequency of osteoporosis was 32.0%, 64.0% and 4.0% in moderate, severe and in very severe COPD patients, respectively. The frequency of osteopenia was 14.0% in mild, 53.5% in moderate, 20.9% in severe and 11.6% were in very severe COPD patients. The p value (p=0.018) was significant for prevalence osteoporosis and osteopenia with increase in severity of COPD. The prevalence of osteoporosis and osteopenia was high in COPD patients under study. The frequency of osteoporosis and osteopenia was more with severity of COPD.

Diagnostic Value of Clinical Profile and Proposed a Clinical Diagnostic Criterion of Enteric Fever

Enteric fever is a common bacterial infection in the tropics and endemic to Bangladesh. The volatile manifestations of enteric fever construct this disease a true diagnostic confrontation. There are limited current objective data on the value of individual clinical features of enteric fever in the diagnosis of enteric fever. The aim of the study was analysis of clinical features and also proposed a clinical diagnostic criterion of enteric fever among adult in Bangladesh. This cross-sectional comparative study was performed among which of fifty confirmed enteric fever and hundred non enteric febrile adult patients in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2015 to December 2015. Purposive sampling technique was implied for convenience of the study. In this study, history of step ladder fever, diarrhoea and relative bradycardia, ceacal gurgle, abdominal distension were proved to be powerful markers of enteric fever with high specificity (100.0%, 90.0%, 95.0%, 92.0% and 95.0% respectively). Tender right iliac fossa (RIF) and coated tongue, hepatomegaly were moderately powerful with 86.0%, 88.0%, 89.0% specificity respectively. Positive predictive value (PPV) was highest for step ladder fever (100%) and negative predictive value (NPV) was highest for headache (92.5%). Highest sensitivity, PPV and NPV were found for relative bradycardia and tender RIF but most of the signs had good specificity. Regarding accuracy it was highest for step ladder fever (91.3%), relative bradycardia (94%), tender RIF (87%), coated tongue (82%) and splenomegaly (84%). Therefore, a clinical diagnostic criterion was submitted with diagnostic accuracy more than 70% were taken into deliberation. The Major criteria were considered step ladder fever, relative bradycardia, tender RIF with diagnostic accuracy 91.0%, 94.0% and 87.0% respectively. Minor criteria included splenomegaly, diarrhoea, coated tongue, ceacal gurgle, chills with diagnostic accuracy 85.0%, 85.0%, 82.0%, 76.0%, 72.0% respectively and after amalgamation of various major and minor criteria a final diagnostic criterion was submitted having accuracy more than 60.0%. In conclusion the clinical profile of enteric fever in culture proven patients with a view to highlight the predictive value of those features which would help general practitioners in the diagnosis and empiric treatment.

Development of an advanced DNA biosensor for pathogenic Vibrio cholerae detection in real sample

Due to the epidemics of emerging microbial diseases worldwide, the accurate and rapid quantification of pathogenic bacteria is extremely critical. In this work, a highly sensitive DNA-based electrochemical biosensor has been developed to detect Vibrio cholerae using gold nanocube and 3-aminopropyltriethoxysilane (APTES) modified glassy carbon electrode (GCE) with DNA carrier matrix. Electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV), Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) experiments were performed to interrogate the proposed sensor at each stage of preparation. The biosensor has demonstrated high sensitivity with a wide linear response range to target DNA from 10^-8 to 10^-14 (R²= 0.992) and 10^-14 to 10^-27 molL^-1 (R²= 0.993) with a limit of detection (LOD) value of 7.41 × 10^-30 molL^-1 (S/N = 5). The biosensor also exhibits a selective detection behavior in bacterial cultures that belong to the same and distant genera. Moreover, the proposed sensor can be used for six consecutive DNA assays with a repeatability relative standard deviations (RSD) value of 5% (n = 5). Besides, the DNA biosensor shows excellent recovery for detecting V. cholerae in poultry feces, indicating that the designed biosensor could become a powerful tool for pathogenic microorganisms screening in clinical diagnostics, food safety, and environmental monitoring.

Glycaemic Status of Asthma Patients Using Inhaled Fluticasone

Inhaled fluticasone is used in asthma for long duration. However, it's adverse effect on glycaemia is debatable. This study observed the outcome of inhaled fluticasone in asthma patients. A cross sectional comparative study was conducted among the normoglycaemic asthma patients aged 18 years and above attending outpatient department of Internal Medicine and Respiratory Medicine department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from June 2017 to May 2018. Study group were getting inhaled fluticasone for minimum three months whereas comparative group were not on any steroids. Each group had 35 eligible participants (n=70). Spirometry and plasma glucose at fasting and 2-hour after 75gm oral glucose intake were measured along with HbA1c%. Statistical analysis was done using SPSS 21.0. In study group mean plasma glucose at fasting was 5.27±0.48mmol/L, 2-hour after 75gm oral glucose was 6.04±1.21mmol/L and mean of HbA1c was 5.57±0.41% whereas in comparative group these were5.17±0.59mmol/L, 5.69±1.09mmol/L, 5.47±0.40% respectively (p=0.25, 0.20, 0.75 respectively). There was no specific co-relation between duration of use of fluticasone inhaler and glycaemic parameters like plasma glucose at fasting, 2-hour after 75gm oral glucose and HbA1c% (r=0.016, p=0.46; r=0.015, p=0.47; r=0.019, p=0.42 respectively). Use of inhaled fluticasone for 3months or more has insignificant effect on plasma glucose levels of asthma patients. Duration of use of inhaled fluticasone has no specific correlation with plasma glucose and HbA1c values.

Role of Angiographic Perfusion Score in Reperfusion Success and Risk Stratification Following Percutaneous Coronary Intervention in Acute Coronary Syndromes without Thrombolytic Pre-treatment

Identifying the reperfusion success angiographically and predicting the prognosis is important following the Percutaneous Coronary Intervention (PCI). Though the assessment of successful PCI is still done by Thrombolysis in myocardial infarction (TIMI) Flow Grades (TFG), TIMI Myocardial perfusion grade (TMPG) is also a well accepted method of predicting outcomes in acute coronary syndrome (ACS) patients. Angiographic perfusion score (APS) that integrates both epicardial (TFG) and Myocardial tissue level perfusion (TMPG) before and after percutaneous coronary intervention may accurately measure the reperfusion success and predict Major adverse cardiac events (MACE) in ACS without any thrombolytic pre-treatment. This observational study was done in the Cardiology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2014 to July 2015. With the appropriate methodological and statistical analysis, the data was drawn from the sample size of 60 eligible patients. APS (0-12) and post-procedure TMPG (0-3) alone were assessed following PCI in all eligible patients and then compared for the reperfusion success and short term (within 30days) clinical outcomes of MACE. Reperfusion success was identified significantly more in APS group versus TMPG alone (STEMI: 69.5% vs. 21.7% (p<0.05); Non STEMI/UA, late perfusion: 81.8% vs. 30.3% (p<0.05) respectively. A significantly lower incidence of MACE was found in the Full as compared to the Failed APS group (2.3% vs. 100%) (p<0.001). But no differences were observed between TMPG 1-3 (12.5%; 3.4% & 6.7%, respectively) (p=NS). Compared to TMPG alone, APS is a better reflector of reperfusion success as well as favorable predictor for short term clinical risk following PCI done during the index hospitalization in ACS.

Prevalence of Organic Colonic Lesions by Colonoscopy in Patients with Irritable Bowel Syndrome Fulfilling Rome III Criteria

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder usually diagnosed by using symptom-based diagnostic criteria. Recent evidence suggests the presence of organic diseases in some patients fulfilling the diagnostic criteria of IBS which may be missed unless investigations are performed. The aim of this cross-sectional study is to find out the prevalence of organic colonic lesions at colonoscopy in patients with IBS fulfilling the Rome III criteria.The study was conducted in the department of Gastroenterology OPD of the North East Medical College, Sylhet, Bangladesh from December 2016 to December 2017. Consecutive 153 patients of IBS diagnosed by validated Bangla version of ROME III criteria were included in this study. Colonoscopy was done for each patient and findings were recorded. Prevalence of colonic disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype. A substantial number of patients 43(28.1%) fulfilling the Rome III criteria were found to have organic colonic lesions at colonoscopy. No significant difference was found regarding colonic lesions among patients with IBS symptoms with or without alarm features (p=0.876). Colonic polyp was the commonest findings in 19(12.1%) subjects at colonoscopy, followed by colonic ulcers in 16(10.5%) subjects. Organic colonic lesions are found to be more common among relatively older age group patients (p=0.011). A significant number of patients with symptoms compatible with IBS exhibited colonic lesions following investigation with a predilection towards older age. Careful clinical evaluation and relevant investigations are necessary to reduce diagnostic uncertainty.

Pembrolizumab Induced Hypophysitis in a Patient Allergic to Triamcinolone: An Increasingly Recognized Endocrinopathy Related to Immunotherapy

We would like to describe the clinical course of a 61-year-old gentleman with the background history of Stage IV left lower lobe lung adenocarcinoma who presented to the outpatient department at Changi General Hospital, Singapore on March 2019 with unintentional loss of weight, easy fatigability and breast pain while showering for last four months. He was started on pembrolizumab immunotherapy about 9 months before presentation which he tolerated well. Subsequent endocrine work ups revealed features consistent with hypophysitis that lead to hypopituitarism in the form of secondary adrenal insufficiency and hypothyroidism. While more and more patients are receiving novel anti-cancer treatment for example immunotherapy, we should never forget and address the side effects it brings along. This study certainly supports above mentioned suggestion.

Correlation of Mean Platelet Volume with ST Segment Resolution after Thrombolytic Therapy in Patients with ST Elevation Myocardial Infarction

Acute occlusive thrombosis of the coronary artery is the principal cause of myocardial infarction where platelets play an important role. Large size platelets, easily measured by mean platelets volume (MPV) are thrombogenic and commonly seen after ST-segment elevation myocardial infarction (STEMI). ST segment resolution has been shown as a simple non-invasive marker that reflects both epicardial and myocardial reperfusion following thrombolysis. The present study intended to investigate whether MPV on admission correlated with ST segment resolution following thrombolysis in STEMI patient. This cross-sectional analytical study was conducted in the department of cardiology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh from December, 2016 to June, 2018. Total 284 patients with first attack of STEMI were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I - Patients with successful ST segment resolution (≥50%). Group II - Patients with impaired ST segment resolution (<50%). MPV on admission was estimated during estimation of Complete Blood Count (CBC) by Automated Haematology Analyzer & compared between two groups. Successful ST segment resolution (≥50%) was seen in 67% of patients after thrombolysis. Admission MPV was higher in patients with impaired ST segment resolution (<50%) group than patients with ≥50% ST-segment resolution group (12.42±0.89fl vs.10.35±0.77fl respectively, p=0.001). Statistically significant strong negative correlation between MPV and ST segment resolution percentage (r = -0.742, p=0.001) suggesting that the higher the level of MPV, the lower the ST segment resolution percentage in first attack of STEMI patients. Multivariate regression analysis found MPV level on admission as an independent predictor of ST segment resolution. The study concluded that high MPV on admission correlate with impaired ST segment resolution following thrombolysis in STEMI patients.

Huge Splenomegaly with Pancytopenia Due to Gaucher's Disease in a 22 Years Old Woman

Gaucher's disease is one of the important storage disorders. It belongs to the lysosomal storage disorders group. There is defective activity of an enzyme named β-glucosidase which ultimately renders the cell of macrophage lineage loaded with glucocerebrosides. There is multi-organ involvement that manifests as hepatosplenomegaly, variable cytopenias, skeletal disorders, neurological features etc. When serum β-glucosidase level is below 15% of mean normal activity Gaucher's disease is confirmed. Enzyme replacement is the definitive treatment. Here we report a case of type 1 or non-neuropathic form Gauchers disease presented with feeling of a lump in left upper abdomen and progressive generalized weakness and hepatosplenomegaly. Her complete blood count revealed pancytopenia and bone trephine biopsy showed Gaucher's cells. Diagnosis and management may be delayed as this disease is rare. Clinical and bone marrow examination is the mainstay of diagnosis. So emphasis should be given in this regard.

Etiological Evaluation of Patients with Lymphadenopathy by Clinical, Histopathological and Microbiological Assessment

Lymph node enlargement is a common presenting complaint in outpatient and inpatient department. The present observational cross sectional study was conducted in department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from December 2014 to May 2016 to evaluate etiologies of significant lymphadenopathy by clinical, histopathological and microbiological assessment. Biopsy/FNA materials of 177 patients of 18-75 years age range with significant lymphadenopathy were sent for histopathology/cytology, Gram stain & culture, AFB stain & culture and Gene Xpert. Among them, 102(57.62%) were granulomatous lymphadenitis, 52(29.38%) were lymphoma, 12(6.78%) reactive lymphadenitis, 7(3.95%) metastatic malignancy, 2(1.13%) atypical lymphoid hyperplasia, 1(0.57%) myeloid sarcoma and 1(0.57%) chronic sialadenitis. Growth of MTB was on 23(22.55%) cases; among 102 granulomatous lymphadenitis and Gene Xpert was positive in 73(71.56%) cases with 100% Rif. sensitive. Gene Xpert is an important tool for diagnosis of tuberculous lymphadenitis. Time of symptoms to diagnosis of most of the TBL patients was within 2-8 months.

Hypertension in School Children of Dhaka City and Associated Risk Factors

Hypertension has its origin in childhood but goes undetected unless specially looked for detection of hypertension in children will increase the awareness and lead to preventive strategies. The objective of the study was to determine the prevalence of hypertension in school children. This cross sectional study was conducted among children aged 10 to 17 years in three secondary level schools of Dhaka city, Bangladesh. This study included 1146 participants (both boys and girls) by systematic random sampling. Blood pressure was measured and plotted in Blood pressure (BP) chart to define hypertension and structured questionnaire were used to collect socio demographic information. The prevalence of hypertension in school children was 1.8% (male was 1.68% and female was 1.99%). It was noted that there was a strong correlation between body weight and BMI of the children with hypertension. A significant portion of the respondents had family history of hypertension, diabetes and obesity. There was also a positive relation between hypertension and food habit that include low vegetables and more fast food. It was concluded that hypertension exists among secondary level school children in Dhaka, Bangladesh and it is related with obesity, increased BMI, family history and dietary habit.

Dengue Myocarditis: An Important Clinical Entity to Consider in Dengue Patient

We are going to report a case study of dengue fever (DF) affecting myocardium and explore the literature. A gentleman of 28 years old experienced DF which was complicated by acute myocarditis, acute kidney injury and hepatitis in the Emergency Department of Apollo Hospitals, Dhaka, Bangladesh on 5th August 2017. Clinically it was considered as an acute coronary syndrome due to depressed ST segment in chest leads ECG, extreme bradycardia but normal serum troponin-I level. He had to undergo temporary pacemaker insertion for symptomatic bradycardia and later on, he was monitored closely. Fortunately, he recovered; pacemaker was removed on day 8 of his admission without any further complication. After 3 days, patient recovered with symptomatic treatment. In different publications, various manifestations of cardiac complications occurred, from self-limiting tachy-brady arrhythmia to severe damage of the myocardium, causing reduced blood pressure and pulmonary edema. To reduce morbidity and mortality, physicians should suspect for cardiac complications in patients with dengue fever and should manage these complications.

A 35 Year Old Bangladeshi Lady with Hereditary Mucinous Ovarian Cancer, Complicated with Omental Metastasis

Approximately 80% ovarian tumors are benign, and these arise mostly in young adult females. Malignant tumors are more prevalent in ageing women, between the ages of 45-65 years. Mucinous ovarian cancer represents about 5% of epithelial ovarian cancers (EOC). We have reported a case of mucinous cystadenocarcinoma in 35-year-old lady with metastasis to momentum. Imaging (Radiograph & CT scan) studies showed a large right sided pelvic mass with probable origin in the right ovary. Cancer antigen-125 was elevated, while carcinoembrionic antigen and alpha-fetoprotein were normal. Mutational profiles shown distinct finding, as KRAS mutations positive nevertheless p53 and BRCA mutations are absent. She had undergone total abdominal hysterectomy with bilateral salphingo-oopherectomy along with pelvic dissection for removal of lymph nodes at the age of 35. She was given 3 cycles of chemotherapy with cisplatin and paclitaxel. To the best of our knowledge, this is the one of the little cases of ovarian mucinous cystadenocarcinoma being reported at a relatively young age and the first case being reported from Bangladesh.

Haemophagocytic Lymphohistiocytosis in a 16-Year-Old Boy

Haemophagocytosis encompasses phagocytosis of erythrocytes, leukocytes, platelets and their precursors by macrophages in bone marrow and other tissues. Haemophagocytic lymphohistiocytosis (HLH) usually presents with high fever, pancytopenia, splenomegaly, lymphadenopathy, haemophagocytosis in bone marrow, liver, lymphnodes or CSF. We report coagulase negative Staphylococcus induced HLH in a 16 year old boy presenting with high grade fever, lymphadenopathy, hepatosplenomegaly, pancytopenia with neutropenic sepsis in the department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 28th November 2016. He responded to high dose dexamethasone and management of neutropenic sepsis. This might give a guidance in the management of haemophagocytic syndrome at the earliest time to prevent morbidity and mortality.

Echocardiographic Assessment of Left Atrial Systolic Function after Percutaneous Mitral Balloon Valvuloplasty Using Tissue Doppler Imaging

Mitral stenosis (MS) affects left atrial (LA) function as a result of hemodynamic and myocardial factors that causes significant symptoms and complications. Conventional echocardiographic methods have been practicing to see the improvement of left atrial function after successful percutaneous mitral balloon valvuloplasty (PMBV). Introduction of tissue doppler imaging allows direct and non-invasive measurement of myocardial velocities. The aim of the study was to evaluate LA functions after PMBV using colour tissue doppler imaging. This cross sectional study was performed in Cardiology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2014 to February 2015. Forty six (46) patients (28 females, mean age: 28.96±5.78 years) presenting with mitral valve stenosis who fulfilled the indications for PMBV were included in the study. Within 24 hours before PMBV, all the patients underwent colour tissue doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the septal and lateral annuli were recorded. All the measurements were repeated 24 hours after PMBV. The PMBV was done using the Inoue technique. After PMBV mitral valve areas (MVA) were significantly increased. Maximum and mean gradients, LA diameter, LA area, LA volume, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly (p<0.001) increased. Lateral and septal A' velocities were correlated with MVA and inversely related to LA pressure measured invasively during PMBV. Tissue doppler velocities illustrated improvement of left atrial systolic function after PMBV in relation to decreased mean left atrial pressure and increased mitral valve area. Therefore, tissue doppler Imaging is a useful tool to detect improvement of left atrial systolic function after PMBV in patients with mitral stenosis.

Serum Zinc Concentrations in Patients with Pulmonary Tuberculosis

Bangladesh is a tuberculosis (TB) burden country. It is one of the most important causes of mortality and morbidity and a major barrier of social and economic development. Zinc is a major trace element and an essential component of the body immune system. It's an important determinant of resistance to infection by maintaining cell mediated immunity. This analytical case control study was conducted in the Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to see the association of serum zinc concentrations with pulmonary tuberculosis (PTB) in adult population (18-60 years) from January 2015 to January 2016. Freshly diagnosed PTB patients before initiating anti-TB chemotherapy as cases (N=43) and TB negative subjects as controls (N=48) were included conveniently in this study with a rigid selection criteria. Serum zinc concentrations were estimated by using atomic absorption spectrophotometer. The mean±SD age and BMI of the case group and control group were 33.30±14.71 and 32.69±11.60 years, 19.88±2.31 and 22.08±2.80 kg/m2 respectively. The concentrations of serum zinc were significantly lower (P=0.01) in PTB group (840.9±230.0 μgm/l) compared with the control group (965.6±219.9 μgm/l). There was marked variation of mean±SD serum zinc concentrations between male (1008.95±246.16 μgm/l) and female (937.24±200.35 μgm/l) in control group (P=0.182) though the variation is minimal in PTB group (P=0.724). The serum zinc concentrations showed positive correlation with BMI (P=0.642) but negative correlation with age (P=0.023) in both case and control. The lower serum zinc concentrations (12.06%) in PTB patients indicate relative immune deficiency. Routine assessment of serum zinc concentration of PTB patients should be considered and further outcome should be assessed with zinc supplementation.

Pattern and Extent of Tricuspid Valve Involvement in Chronic Rheumatic Heart Disease

Rheumatic heart disease causes a significant number of morbidity and mortality in Bangladesh. Although the mitral and the aortic valve are the two most involved valves in rheumatic heart disease, the tricuspid valve disease is not uncommon secondary to, or in association with, mitral or aortic valve disease, but receives less attention as compared to the primary left-sided valve disease. Appropriate treatment of the tricuspid valve disease may improve long-term functional outcome. But the pattern and extent of the tricuspid valve involvement was not studied recently. This study was carried out to observe the pattern and extent of tricuspid valve involvement in Rheumatic Heart Disease patients. This observational analytical study was undertaken in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2010 to September 2011. Considering all ethical issues, data were collected from 173 subjects who underwent Echocardiography for their Chronic Rheumatic heart disease. Pattern of tricuspid valve involvement was observed by using Transthoracic Echocardiography by 2D, M mode and Doppler assessment. One hundred seventy three (173) patients with Rheumatic Heart disease was studied, out of these, 36 patients had evidence of tricuspid valve involvement based on echocardiographic findings. Fifteen (15) patients had Tricuspid stenosis and 36 patients had Tricuspid Regurgitation in the patients with TV involvement. All the patients with TV involvement had thickened leaflets. Doming, restriction of motion and calcification were present in different proportions. From this study, it can be concluded that organic tricuspid valve involvement in RHD is not uncommon in our country.

Study of Angiographic Relationship between Peripheral Arterial Diseases with the Involvement of Specific Coronary Artery Lesion

The purpose of this study was to investigate magnitude, pattern and involvement of previously unheralded coronary artery disease in patients suffering from clinically significant peripheral artery disease of lower limbs. This cross sectional study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2014 to February 2015. Total 58 patients with clinically diagnosed peripheral arterial disease of lower limb undergoing angiographic evaluation. Selective CAG in addition to peripheral arteriography was performed in all the study population as per ACC/AHA guidelines for CAG (class IIa recommendation).In this study, it was documented that the proportion of coronary arterial disease was highest in LAD (63.9%) followed by LCX (55.6%), RCA (52.8%), and lowest LM (11.1%) in lesion with aorto-iliac segment. But the proportion of coronary arterial disease was highest in LCX (41.9%) followed by LAD (38.7%), RCA (35.5%), and lowest LM (12.9%) in lesion with femero-popliteal blood vessels. Similarly, the proportion of coronary arterial disease was highest in LCX (36.4%) followed by RCA (27.3%) and equal percentage in LAD and lowest in LM (9.1%) in tibioperoneal segment. Patients of peripheral arterial disease (PAD) having no symptoms of coronary artery disease (CAD) are more likely to have severe coronary artery involvement. Coronary angiogram should be done in patient with PAD to detect previously undetected CAD and pattern of PAD reflects the severity and involvement of coronary arteries.

A Case of Severe Coarctation of Aorta Associated With Bicuspid Aortic Valve Managed Surgically

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 45-year-old male. Our patient was relatively asymptomatic until he presented with exertional dyspnea and fatigue in his fourth decade of life in Bangabandhu Sheikh Mujib Medical University (BSMMU), on the month of August, 2016. The patient was managed by surgery of aorta. After the 6 months follow-up visit, the patient was in good clinical condition.

Non-invasively Measured Carotid Artery Intima-Medial Thickness May Be a More Useful Marker of Coronary Artery Disease in Diabetic than Non-Diabetic Patients

Carotid intima-medial thickness has long been proposed as a surrogate marker of atherosclerotic vascular disease in other vascular beds, most notably the coronary arteries with its practical implications. This observational study aimed at exploring the relationship of a hypothetical stronger relationship of carotid intima-medial thickness with coronary artery disease in diabetic patients than non-diabetic counterparts. Thirty diabetic patients and 74 non-diabetic patients who were referred for coronary angiogram in the Departments of Cardiology Bangabandhu Sheikh Mujib Medical University and Combined Military Hospital, Dhaka Cantonment, Bangladesh from January, 2002 and December, 2003 were studied. Carotid ultrasound was done to determine intima-medial thickness and coronary angiogram to detect coronary artery lesions. Background demographic data and cardiovascular risk factors were determined. Of the 30 diabetic patients 24 subjects had CAD. Twenty two of these 24 patients showed increased carotid IMT. None of the patients without CAD had shown carotid artery intima-medial thickening (sensitivity 91% specificity 100%). In contrast, in the non-diabetic group 44 patients out of 63 with CAD showed increased carotid artery IMT. Four of the 11 non-diabetic patients without CAD showed positive carotid ultrasound study results (sensitivity 70%, specificity 63%). This study showed a strong association of coronary artery disease with carotid intima-medial thickness in diabetic patients compared to non-diabetic subjects. This finding may be applicable for Bangladeshi diabetic population. This surrogate marker of coronary artery disease can be useful in the management of diabetes as regards their prevention of coronary artery disease. The practical and clinical implications of these findings might be the pioneer study in diabetic subjects and need to be further determined in a larger community level study.

Coronary Artery Bypass Graft with Endarterectomy and Stent Removal in Patient with Multivessel in Stent Restenosis

In the age of stent deployment after balloon angioplasty. In stent restenosis (ISR) has become a major concern. Various coronary interventional measures and coronary artery bypass graft (CABG) has employed to manage the ISR. Although CABG seems to offer advantages over other coronary intervention methods in patients with multi vessel ISR; lack of appropriate graftable vessels often make the surgery difficult and end up with incomplete revascularization. Coronary endarterectomy with stent removal mitigated some of the limitations of CABG but initial results of this surgical measure were not favorable. Later, with improvement of surgical technique and meticulous anticoagulant therapy along with CABG showed promising result but till date only few cases have been reported. Here, we are reporting a case of 65 years old lady who underwent CABG along with endarterectomy with stent removal after she had developed stent restenosis in three vessels. This diabetic and hypertensive patient presented with chest pain and shortness of breath which was developed within three months of PCI with stent deployment in three vessels. Angiogram done prior to admission in the cardiac surgery department reveals restenosis in all the three stented vessels. CABG was done and three grafts given in LIMA to LAD, RSVG to OM and RCA. Endarterectomy done on LAD and RCA with stent removal from RCA. Postoperative anticoagulant therapy was strictly maintained. Patient's postoperative period remained eventless other than superficial wound infection. With skilled hand capable of handling highly technique demanding surgery and postoperative anticoagulation maintenance; endarterectomy along with CABG seems to be safe solution for multi vessel ISR with diffuse coronary artery disease.

Ebstein's Anomaly Associated with Atrial Septal Defect and Wolff-Parkinson-White (WPW) Syndrome

Ebstein's anomaly is a rare congenital heart disorder, accounting for <1% of all cases of congenital heart disease. It is a congenital malformation of the heart that is characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialization of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet. We report the case of a 25 years old female with Ebstein's anomaly which was associated with Ostium Secundum type of atrial septal defect and WPW syndrome, who presented with dyspnea, palpitations, cyanosis, clubbing and cardiomegaly.

Immediate & Short Term Outcome of Using Single Bolus Eptifibatide in Percutaneous Coronary Intervention: A Randomized Control Study

The purpose of this study was to assess the immediate and short term outcome of single bolus dose of eptifibatide in elective percutaneous coronary intervention (PCI). We enrolled 146 patients who underwent elective PCI from May 2013 to May 2014 in University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Among 146 patients, seventy four patients received single bolus dose of eptifibatide (10 mg intra coronary single bolus dose) just after crossing the lesion were selected as case. The other 72 patients, who did not receive eptifibatide, were selected as control. All patients of both the groups were treated with aspirin, clopidogrel before and after the procedure and all received a single bolus dose of Clopidogrel (300mg) before the procedure. All patient received weight adjusted doses of heparin during and after the procedure. The outcome measures were 24-hours and 30-day morbidity (complications or adverse events) and mortality. The patients of eptifibatide group experienced significantly lower incidence of QMI lesions and complete absence of NQMI lesion in 24 hours of PCI as compared to 5.6% and 6.9% of the lesions respectively in their control counterparts (p=0.027 and p=0.025 respectively). However, the incidence of bleeding and target vessel revascularization (TVR) were no different between the groups (p=0.255 and p=0.117). There was no incidence of TVR at all in the eptifibatide group as opposed to 5.6% in the control group in 30 days following stenting (p=0.017). Single bolus dose of eptifibatite reduces the Major adverse cardiac events as immediate and short term outcome in elective percutaneous coronary intervention.

An Unusual Case of Suicide Attempt Using Intravenous Injection of Kerosene

Kerosene belongs to the hydrocarbon group of compounds, used as a fuel for lamps, as well as heating and cooking in developing countries. Accidental kerosene poisoning and intoxication usually occur by inhalation or by occupational percutaneous absorption. Adults usually ingest kerosene for the purpose of self-harm, and children may ingest accidentally. Suicidal attempt using intravenous kerosene is an extra ordinary and very rare occurrence. A very few data are available regarding effects of intravenous administration of kerosene and its management.

Pericardial Tumor Presenting As Recurrent Pericardial Effusion--A Case Report

Pericardial tumors are unusual and may be difficult to characterise with imaging. They manifest as large, non-contractile, solid masses within the pericardium. Presenting symptoms include heart failure, arrhythmias, sudden death, cyanosis and chest pain. But it can also present as recurrent pericardial effusion misdiagnosed as tuberculosis and other infectious causes. Accordingly a patient with pericardial mass (tumor) presented with recurrent pericardial effusion as a rare case.

Panoramic radiography in evaluating the relationship of mandibular canal and impacted third molars in comparison with cone-beam computed tomography

This study evaluated the validity of panoramic radiography and cone beam computed tomography (CBCT) in the assessment of mandibular canal and impacted third molar. In this descriptive-analytical study, 58 mandibular third molars from 42 patients who showed a close relationship between impacted third molar and canal on panoramic radiographs were selected. They were then classified into seven radiographic markers in panoramic radiographs (superimposition, darkening of the root, interruption of the white lines, root narrowing, canal diversion, canal narrowing, and also closed distance in OPG <1mm). The groups of markers were further assessed with CBCT to see presence or absence of contact. The three most common markers seen in panoramic images are superimposition, interruption of white line and root darkening. In CBCT, superimposition marker always presented higher frequency of contact with canal compared to non-contact group. There are 31% of teeth presented with interruption of white lines and there are 29.3% of teeth presented with superimposition. About 55.6% and 35.3% of the impacted mandibular third molars which indicated interruption of white lines and superimposition also indicated contact in the CBCT respectively. Presence or absence of radiological sign in panoramic radiography was not properly predict a close relationship with third molar and it is suggested that in case of tooth-canal overlapping, the patient should be referred for CBCT assessment.

Pyrococcus furiosus ferredoxin is a functional dimer

Pyrococcus furiosus ferredoxin is subject to a monomer/dimer equilibrium as a function of ionic strength. At physiological ionic strength, approximately 0.35 M NaCl, the protein is very predominantly homodimer. The monomeric form exhibits impaired electron transfer on glassy carbon; it also has a decreased S=3/2 over S=1/2 ratio as shown by electron paramagnetic resonance spectroscopy. Even following sterilization at 121 degrees C the dimer is stable in denaturing gel electrophoresis.

Dietary management during pregnancy, lactation and common childhood illnesses in rural Bangladesh

Data were collected on nutritional aspects of women in general and during special time frames such as pregnancy, lactation and common childhood illnesses (diarrhea, acute respiratory infections and measles) from rural areas in Bangladesh. A distinctive gender bias was evident regarding decision making and food allocation within the household. Inadequate feeding practices were observed during diarrhea with 22.2% of the mothers discontinuing breast-feeding. Breast-feeding and nutritional support were comparatively better during ARI and measles. When the children were ill, 97% of the mothers administered a special diet with a variety of food preferences, which were perceived to improve the symptoms of the respective illness. Maternal education influenced both the occurrence of diarrhea and the nutritional management of diarrhea and measles significantly. Therefore, community health education should focus on the importance of breast-feeding and continued nutritional support during illnesses. In order for this health education to be effective, traditional beliefs noted in this study have to be incorporated.

Efficacy of iodine water purification tablets against Cryptosporidium oocysts and Giardia cysts

The ability to control water-borne diseases is critical for soldiers, hikers, and others who may need to drink directly from an outdoor source. Water-borne protozoan parasites that are specifically of concern are Giardia and Cryptosporidium because of their resistance to halogen disinfection. The purpose of this study was to determine the effectiveness of iodine tablets against Giardia and Cryptosporidium under general- and worst-case water conditions that might be found in the field. Giardia cysts and Cryptosporidium oocysts were exposed to iodine according to manufacturer's instructions (two tablets/L = 13-18 mg/L for 20 minutes). This dose inactivated 3-log10 of Giardia in general-case water and pH 9. In worst-case water, however, only about 35% of cysts were inactivated at pH 5. Fifty minutes were required to achieve a 3-log10 reduction at pH 5. Cryptosporidium oocysts were more difficult to inactivate. Only 10% were inactivated after a 20-minute exposure to iodine according to manufacturer's instructions; even after 240 minutes of exposure to iodine only 66-81% oocysts were inactivated. These data strongly suggest that iodine disinfection is not effective in inactivating Cryptosporidium oocysts in water. Because this organism is common in all surface waters, it is recommended that another method of treatment be used before ingestion.

Computer-assisted studies of molecular structure and carcinogenic activity

Both quantitative and qualitative studies of the structure-activity relationships (SAR) of carcinogenic compounds are discussed. Using the ADAPT software system, examples are given of (1) predicting the gas and liquid chromatographic retention behavior of polycyclic aromatic compounds, (2) predicting the carcinogenicity of N-nitrosamines, and (3) predicting the mutagenic behavior of pesticides and other compounds in short-term test systems. It is concluded that the complexity and lack of understanding of the carcinogenic response should not prevent scientists from searching for useful empirical relationships between molecular structure and carcinogenicity. Computer generated molecular descriptors and statistical and pattern recognition techniques can be useful tools in this research.