Comparative Efficacy and Safety of Amlodipine and Losartan Potassium in Essential Hypertension in a Tertiary Hospital of Bangladesh

Hypertension is a common disorder of major clinical, public health and economic importance. It affects men and women of all ages, and the prevalence is increasing in most countries. Maintenance of blood pressure below 140/90 mm of Hg is recommended by most of the guideline available around the world. Various classes of drugs are being used in the treatment of hypertension. Losartan potassium and amlodipine are two different antihypertensive agents belonging to two different groups used commonly around the world in treating essential hypertension. Losartan potassium is non-peptide Angiotensin-II receptor antagonist. Amlodipine which is the third generation dihydropyridine group of calcium channel blocker. The aim of the study was to compare the efficacy and safety of amlodipine and losartan for the treatment of essential hypertensive patients (18-75 years). A non-randomized comparative observational study was conducted in the Department of Pharmacology and Therapeutics in collaboration with Department of Medicine, Sylhet, MAG Osmani Medical College, Sylhet, Bangladesh from July 2021 to June 2022. In this study non-randomization was in two groups. Group A received amlodipine 5mg daily at morning and Group B received losartan potassium 50mg daily at night. The study parameters were systolic blood pressure (SBP), diastolic blood pressure (DBP), ankle oedema, serum K+ level. The result of treatment outcome was compared between two groups. After treatment the reduction of SBP was 5.19±2.93mm of Hg versus 3.27±1.34mm of Hg (p<0.001); reduction of DBP was 1.7±0.70 mm of Hg versus 0.68 mm of Hg (p<0.001) and serum K+ level 4.22±0.27mmol/L versus 4.21±0.16mmol/L (p<0.719) in amlodipine and losartan group respectively. Amlodipine is more effective than losartan potassium in respect to treatment of essential hypertension. Regarding adverse events losartan potassium causes angioedema, hyperkalemia, headache, dizziness etc. The study concluded that amlodipine is superior to losartan potassium in treating essential hypertension.

Astrocyte and L-lactate in the anterior cingulate cortex modulate schema memory and neuronal mitochondrial biogenesis

Astrocyte-derived L-lactate was shown to confer beneficial effects on synaptic plasticity and cognitive functions. However, how astrocytic Gi signaling in the anterior cingulate cortex (ACC) modulates L-lactate levels and schema memory is not clear. Here, using chemogenetic approach and well-established behavioral paradigm, we demonstrate that astrocytic Gi pathway activation in the ACC causes significant impairments in flavor-place paired associates (PAs) learning, schema formation, and PA memory retrieval in rats. It also impairs new PA learning even if a prior associative schema exists. These impairments are mediated by decreased L-lactate in the ACC due to astrocytic Gi activation. Concurrent exogenous L-lactate administration bilaterally into the ACC rescues these impairments. Furthermore, we show that the impaired schema memory formation is associated with a decreased neuronal mitochondrial biogenesis caused by decreased L-lactate level in the ACC upon astrocytic Gi activation. Our study also reveals that L-lactate-mediated mitochondrial biogenesis is dependent on monocarboxylate transporter 2 (MCT2) and NMDA receptor activity - discovering a previously unrecognized signaling role of L-lactate. These findings expand our understanding of the role of astrocytes and L-lactate in the brain functions.

Medical Undergraduates' Assessment Status Regarding Clinical Neuroanatomy

The study of Anatomy is essential to the learning of different subjects of medicine. Neuroanatomy is a fundamental part of the Anatomy portion of the undergraduate medical (MBBS) curriculum of different universities of Bangladesh. The clinical relevance of Neuroanatomy is beyond doubt in the context of increasing numbers of cases like stroke, head injury and meningitis in Bangladesh. Contemporary Neuroanatomy books are inclined to a clinically-oriented approach in their presentation. However, there is no organized attempt to analyze these recent trends of highlighting the significance of clinically-oriented approach reflected in the learning pattern or student-assessment in the medical undergraduate courses of Bangladesh. Such analyses can offer an insight into the situation and facilitate teachers and curriculum planners to make necessary modifications. The present study was planned- i) to analyze the Neuroanatomy portion of the recent undergraduate Anatomy written question papers of four public universities of Bangladesh for understanding how clinically relevant knowledge has been assessed in the questions ii) to determine the ability of the medical undergraduates to answer clinically-oriented written questions as compared to their ability to answer non-clinically-oriented questions in Neuroanatomy. It was a comparative study with some descriptive components. For Part-A of the study, all the 'Question-segment's of question (SAQ and MCQ) dealing with Neuroanatomy in all the available First Professional MBBS Exams' Anatomy written question papers of four public universities of Bangladesh of the last five years (2005 to 2009) were identified. The frequency of 'Question-segment's those assessing the ability of the clinically relevant knowledge were determined. It was a descriptive study. For Part-B of the study, total 136 New 3rd year medical undergraduates of one Bangladeshi governmental medical college and one private medical college were taken as participants. The medical undergraduates of each medical college were divided into two equal groups by randomization. One group was given 100 clinically-oriented questions and the other was given 100 non-clinically-oriented questions based on the content of Snell. The scores (frequencies of correct responses) of the two groups were compared using an unpaired 't' test. The frequencies of 'Question-segment's assessing clinically relevant knowledge was 6.14%. The performance of the undergraduates answering clinically-oriented questions was significantly poorer (p=0.01) than answering non-clinically-oriented questions (the mean score being 38.49±10.50 and 45.04±8.48 respectively). Teaching and assessment of Neuroanatomy should be designed in a way to orient medical undergraduates towards more clinically-oriented understanding and performance in Neuroanatomy. The clinically relevant knowledge dealing with Neuroanatomy needs to be addressed with appropriate weighting in the First Professional MBBS written questions of Bangladesh. Necessary changes in the curriculum are also suggested in meeting the above expectations.

Patients' characteristics and 30-day mortality for those undergoing elective surgeries during the COVID-19 pandemic in Bangladesh

BACKGROUND

The COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021.

METHODS

This serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients.

RESULTS

The prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery.

CONCLUSIONS

This study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.

Exogenous L-lactate administration in rat hippocampus increases expression of key regulators of mitochondrial biogenesis and antioxidant defense

L-lactate plays a critical role in learning and memory. Studies in rats showed that administration of exogenous L-lactate into the anterior cingulate cortex and hippocampus (HPC) improved decision-making and enhanced long-term memory formation, respectively. Although the molecular mechanisms by which L-lactate confers its beneficial effect are an active area of investigations, one recent study found that L-lactate supplementation results in a mild reactive oxygen species burst and induction of pro-survival pathways. To further investigate the molecular changes induced by L-lactate, we injected rats with either L-lactate or artificial CSF bilaterally into the dorsal HPC and collected the HPC after 60 minutes for mass spectrometry. We identified increased levels of several proteins that include SIRT3, KIF5B, OXR1, PYGM, and ATG7 in the HPC of the L-lactate treated rats. SIRT3 (Sirtuin 3) is a key regulator of mitochondrial functions and homeostasis and protects cells against oxidative stress. Further experiments identified increased expression of the key regulator of mitochondrial biogenesis (PGC-1α) and mitochondrial proteins (ATPB, Cyt-c) as well as increased mitochondrial DNA (mtDNA) copy number in the HPC of L-lactate treated rats. OXR1 (Oxidation resistance protein 1) is known to maintain mitochondrial stability. It mitigates the deleterious effects of oxidative damage in neurons by inducing a resistance response against oxidative stress. Together, our study suggests that L-lactate can induce expression of key regulators of mitochondrial biogenesis and antioxidant defense. These findings create new research avenues to explore their contribution to the L-lactate’s beneficial effect in cognitive functions as these cellular responses might enable neurons to generate more ATP to meet energy demand of neuronal activity and synaptic plasticity as well as attenuate the associated oxidative stress.

Erratum: Chemogenetic activation of astrocytes promotes remyelination and restores cognitive deficits in visceral hypersensitive rats

[This corrects the article DOI: 10.1016/j.isci.2022.105840.].

Adrenergic signalling to astrocytes in anterior cingulate cortex contributes to pain-related aversive memory in rats

Pain contains both sensory and affective dimensions. We identify the role of norepinephrine in colorectal distention (sub-threshold for acute pain) induced conditioned place avoidance and plasticity gene expression in the anterior cingulate cortex (ACC). Activating locus coeruleus (LC)-projecting ACC neurons facilitates pain-evoked aversive consolidation and memory, while inhibiting LC-projecting ACC neurons reversibly blocks it. Optogenetic activation of ACC astrocytes facilitates aversive behaviour. ACC astrocytic Gi manipulation suppressed aversive behaviour and early plasticity gene expression induced by opto-activation of LC neurons projecting to ACC. Evidences for the critical role of β2AR in ACC astrocytes were provided using AAV encoding β2AR miRNAi to knockdown β2AR in astrocytes. In contrast, opto-activation of ACC astrocytic β2ARs promotes aversion memory. Our findings suggest that projection-specific adrenergic astrocytic signalling in ACC is integral to system-wide neuromodulation in response to visceral stimuli, and plays a key role in mediating pain-related aversion consolidation and memory formation.

Chemogenetic activation of astrocytes promotes remyelination and restores cognitive deficits in visceral hypersensitive rats

Using a well-established chronic visceral hypersensitivity (VH) rat model, we characterized the decrease of myelin basic protein, reduced number of mature oligodendrocytes (OLs), and hypomyelination in the anterior cingulate cortex (ACC). The results of rat gambling test showed impaired decision-making, and the results of electrophysiological studies showed desynchronization in the ACC to basolateral amygdala (BLA) neural circuitry. Astrocytes release various factors that modulate oligodendrocyte progenitor cell proliferation and myelination. Astrocytic Gq-modulation through expression of hM3Dq facilitated oligodendrocyte progenitor cell proliferation and OL differentiation, and enhanced ACC myelination in VH rats. Activating astrocytic Gq rescued impaired decision-making and desynchronization in ACC-BLA. These data indicate that ACC hypomyelination is an important component of impaired decision-making and network desynchronization in VH. Astrocytic Gq activity plays a significant role in oligodendrocyte myelination and decision-making behavior in VH. Insights from these studies have potential for interventions in myelin-related diseases such as chronic pain-associated cognitive disorders.

Cooperative cargo transportation by a swarm of molecular machines

Cooperation is a strategy that has been adopted by groups of organisms to execute complex tasks more efficiently than single entities. Cooperation increases the robustness and flexibility of the working groups and permits sharing of the workload among individuals. However, the utilization of this strategy in artificial systems at the molecular level, which could enable substantial advances in microrobotics and nanotechnology, remains highly challenging. Here, we demonstrate molecular transportation through the cooperative action of a large number of artificial molecular machines, photoresponsive DNA-conjugated microtubules driven by kinesin motor proteins. Mechanical communication via conjugated photoresponsive DNA enables these microtubules to organize into groups upon photoirradiation. The groups of transporters load and transport cargo, and cargo unloading is achieved by dissociating the groups into single microtubules. The group formation permits the loading and transport of cargoes with larger sizes and in larger numbers over long distances compared with single transporters. We also demonstrate that cargo can be collected at user-determined locations defined by ultraviolet light exposure. This work demonstrates cooperative task performance by molecular machines, which will help to construct molecular robots with advanced functionalities in the future.

A Rare Case of Polyorchidism: Sonographic and MR Evaluation of Four Testes

Polyorchidism is a rare congenital anomaly reported about 200 cases in the world text. A number of theories have been planned concerning the making of polyorchidism, but the real explanation is still not acknowledged. Here we are going to present a case study of polyorchidism. A 70 years old gentleman complained with left supernumerary testes in the left hemiscrotum. His left hemiscrotum was painless with mass. Polyorchidism without malignancy or any other concomitant features were revealed by both ultrasound and MRI examinations. In most cases the ultrasonograph alone is diagnostic. In complicated cases of polyorchidism MRI may provide additional information.

Multicenter Study of 342 Anorectal Malformation Patients: Age, Gender, Krickenbeck Subtypes, and Associated Anomalies

INTRODUCTION

 Published studies based on Krickenbeck classification of anorectal malformations (ARMs) are still insufficient to assess the global as well as regional relative incidence of different ARM subtypes, gender distribution, and associated anomalies. The primary purpose of this study was to provide an estimate of those in Global Initiative for Children's Surgery (GICS) research group.

MATERIALS AND METHODS

 We collected ARM data prospectively for 1 year from four institutes of different geographic locations. A total of 342 patients were included in this study (195, 126, 11, and 10 from Bangladesh, Iran, Papua New Guinea, and Oxford, United Kingdom, respectively).

RESULTS

 Overall male to female ratio was 1:1. The most frequent ARM subtype was perineal fistula (23.7% = 81/342). About 48.5% (166/342) patients had at least one associated anomaly. Cardiac and genitourinary systems were the most commonly affected systems, 31.6% (108/342) and 18.4% (63/342), respectively. These organ-systems were followed by anomalies of vertebral/spinal (9.9% = 34/342), musculoskeletal (4.4% = 15/342), and gastrointestinal/abdominal (3.2% = 11/342) systems. Rectovesical fistula had the highest percentage (96.4% = 27/28) of associated anomalies. About 18.1% (62/342) patients had multiple anomalies. ARMs (both isolated and with associated anomalies) occurred equally in males and females. Comparison between patients from Bangladesh and Iran showed differences in relative incidence in ARM subtypes. In addition, Iranian patient group had higher percentage of associated anomalies compared with Bangladeshi (73 vs. 35.4%).

CONCLUSION

 Our study provides important insights about ARM subtypes, gender distribution and associated anomalies based on Krickenbeck classification especially from Bangladesh and Iran.

Medical Undergraduates' Written Assessment Profile of Illustration-based Neuroanatomy

Neuroanatomy is an integral part of Anatomy and it is one of the most visually dependent and visually-demanding one. Analysis of recent trends of emphasizing the importance of illustrations which are being reflected in the learning pattern or student-assessment can provide an insight into the situation and help teachers and curriculum planners. Thus, the present study was planned i) to analyze the Neuroanatomy portion of the recent undergraduate Anatomy written question papers of four public universities of Bangladesh for understanding how the ability to draw and label has been assessed in the questions and ii) to determine the ability of the undergraduate students to answer illustration-based questions as compared to their ability to answer non-illustration-based (text-based) questions in Neuroanatomy. For Part-A of the study, all the 'segment's of item (SAQ and MCQ) dealing with Neuroanatomy in all the available Anatomy written question papers of all the First Professional MBBS Exams of four public universities of Bangladesh of the last five years (2005 to 2009) were identified. The frequency of 'segment's those were assessing the ability to draw and label was determined. For Part-B of the study, 214 students were taken as participants. They were divided into two equal groups by randomization. The first group was given 100 illustration-based questions based on the illustrations representing different 'purpose's and 'form's in Snell1. The other group was given 100 non-illustration-based questions on the corresponding textual material. The scores of the two corresponding groups were compared using an unpaired 't' test. The frequency of segments was assessing the ability to draw and label was 3.86%. The performance of the undergraduates answering illustration-based questions was significantly poorer (p=0.0) than non-illustration-based questions (mean±SD being 23.36±14.02 and 44.75±9.50 respectively). Teaching and assessment of Neuroanatomy should be planned in a way to orient undergraduates towards more illustration-based understanding and performance. Necessary modifications in the curriculum are recommended.

P-Functionalized tetrathiafulvalenes from 1,3-dithiole-2-thiones?

Synthesis of mono- and bisphosphanylated 1,3-dithiole-2-thiones is presented, including phosphite-mediated reductive C,C coupling reactions. Computational studies point to a spirothiaphosphirane and a S-heterocyclic carbene as key intermediates.

Cost Incurred by the Family for Surgery in Their Children: A Bangladesh Perspective

BACKGROUND

Cost of getting health services is a major concern in Bangladesh as well as in many other countries. A family has to bear more than half of the health care cost despite many facilities provided by the public hospitals. This out-of-pocket (OOP) expenditure drives many families under the poverty line. The aim of this study was to find out the exact cost incurred by the family for a surgical operation of their child in the public and private sectors in Bangladesh.

METHODS

A cross-sectional study was conducted to find out the cost of child surgery in different settings of public and private hospitals in Chittagong division, Bangladesh. Cost of herniotomy was then compared across different settings.

RESULTS

In this study, cost of operation in urban private hospitals was highest mostly due to surgeon and anesthetist fee. The cost was lowest in outreach programs as surgeon fee, anesthetist fee and accommodation cost was nil; food and transport cost was minimum. However, cost of accommodation, food, transport and medicine contributed significantly to OOP expenditure especially in tertiary-level public hospitals, in both indoor and day care settings, and also in private urban hospitals.

CONCLUSIONS

Our study provides some insight into the OOP expenditure in different health care settings in Bangladesh. This study might be useful in developing a strategy to minimize the OOP expenditure in this country.

In vitro cytotoxicity and antibiotic application of green route surface modified ferromagnetic TiO2 nanoparticles

The enormous numbers of applications of TiO₂ nanoparticles (NPs) cause concern about their risk to the environment and human health. Consequently, motivated by the necessity of searching for new sources of TiO₂ NPs of low cytotoxicity with antibacterial activity, we synthesized TiO₂ NPs by a green route using a solution of titanium(iv) isopropoxide as a precursor and an aqueous extract of Artocarpus heterophyllus leaf as a reducing and surface modifying agent. We investigated their structure, shape, size, and magnetic properties, and evaluated their antibiotic application and cytotoxicity. The synthesized TiO₂ NPs were applied against two Gram-negative bacteria (E. coli and S. typhimurium) and two Gram-positive bacteria (S. aureus and B. subtilis) to observe their antibacterial activity; and eventually clear zones of inhibition formed by the TiO₂ NPs were obtained. Moreover, after exposing the synthesized TiO₂ NPs to HeLa cells (carcinoma cells) and Vero cells (normal cells), no toxic effect was found up to a dose of 1000 mg L⁻¹, indicating the safe use of the samples up to at least 1000 mg L⁻¹. However, toxic effects on HeLa cells and Vero cells were observed at doses of 2000 mg L⁻¹ and 3000 mg L⁻¹, respectively. These results indicate the safe use of Artocarpus heterophyllus leaf extract mediated synthesized TiO₂ NPs in their potential applications.

Artocarpus heterophyllus leaf extract mediated green synthesized TiO₂ nanoparticles exhibit less toxicity with high antibacterial activity.

Epidemiological characteristics of Hirschsprung's disease (HSCR): Results of a case series of fifty patients from Bangladesh

BACKGROUND

The epidemiology of Hirschsprung's disease (HSCR) in Bangladesh has never been studied. The aim of this study was to determine the epidemiological characteristics of HSCR in Bangladesh.

METHODS

Data from fifty patients were collected prospectively from two hospitals in Chittagong, Bangladesh.

RESULTS

The rate of consanguinity (16%) among parents of HSCR patients was higher than that of the general population (10%). Maternal age at the time of birth of the affected child was ≤30years in all cases except one. No association was found between parents' occupation and HSCR. No patient was born preterm and only three patients (6%) had low birth weight. Nine patients (18%) had associated anomalies. We found coexistence of bilateral accessory tragi and ankyloglossia in one patient, and coexistence of rectal duplication cyst in another. Neither anomaly had been previously reported in HSCR patients.

CONCLUSIONS

Our study suggests that consanguinity might increase the risk of HSCR whereas advanced maternal age does not. HSCR patients were found more likely to born at term and with normal birth weight. The coexistence of HSCR with previously unreported anomalies highlights the diversity of conditions that can co-occur with HSCR.

LEVELS OF EVIDENCE

IV.

Analyses of the Neuroanatomy Portion of the Anatomy Question Papers for Written Summative Assessment at the Medical Undergraduate Level in Bangladesh

Neuroanatomy is a vital part of the undergraduate medical (MBBS) Anatomy curriculum of different universities of Bangladesh. The teaching-learning and assessment of Neuroanatomy have gone through significant changes in current times in various parts of the world. Neuroanatomy textbooks are supposed to be useful reflectors of these changes and of the present inclinations. The importance of an understanding approach towards Neuroanatomy is beyond doubt. Consequently, the contemporary Neuroanatomy books are inclined more towards an understanding approach in their presentation. However, there has been no organized effort in analysing how such trends are being reflected in the student-assessment in the medical undergraduate courses of Bangladesh. This kind of study can provide useful insight into the present circumstances and assist teachers and curriculum planners in formulating crucial changes. The present study was aimed at analysing the Neuroanatomy written questions of five years' First Professional MBBS Exams regarding content coverage and level of cognitive domain addressed. The study was a descriptive observational one involving qualitative analyses (and quantitation) of questions. All the 'segment's of every item (SAQ and MCQ) dealing with Neuroanatomy in all the available Anatomy written question papers of all the First Professional MBBS Exams of four public universities of Bangladesh of five years (2005 to 2009) were analysed. The frequencies of item- 'segment's dealing with different chapters (or similar parts) of a Neuroanatomy textbook commonly recommended to the medical undergraduate course of the country1 were estimated to determine the content coverage and the item- 'segment's addressing different levels of cognitive domain were identified. The relative coverage of different chapters (or similar parts) of the textbook by Snell1 in the question papers showed considerable differences from the relative proportions of the corresponding chapters (or similar parts) in the book itself. Most (97.64%) of the item-'segment's addressed the recall-level of cognitive domain. The understanding-level was addressed by only 2.36% of 'segment's, but no application-level 'segment' could be identified. The findings of the present research assist teachers, paper- setters and moderators of questions as well as the curriculum planners in integrating the current trends in Neuroanatomy in the respective domains so that pre-clinical undergraduates can be made better prepared for the upcoming years and occupation.

Green synthesis of bio-molecule encapsulated magnetic silver nanoparticles and their antibacterial activity

Persuaded by the necessity of finding new sources of antibiotics, silver nanoparticles (Ag NPs) were synthesized by adopting a newly developed green synthesis technique and subsequently, their antibacterial activity against different pathogenic bacteria was evaluated. We have successfully synthesized bio-molecule capped ferromagnetic Ag NPs with an average crystallite size of 13 nm using AgNO₃ solution as a precursor and Artocarpus heterophyllus leaf extract as a reducing and capping agent. The characterization of the synthesized Ag NPs was carried out using various techniques such as UV-visible (UV-Vis) spectroscopy, energy dispersive X-ray (EDX) spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), thermogravimetry (TG), and vibrating sample magnetometer (VSM) analyses. After exposing the synthesized Ag NPs to two Gram-positive bacteria – Staphylococcus aureus and Bacillus cereus and two Gram-negative bacteria – Escherichia coli and Salmonella typhimurium, the zones of inhibition were found to be 15, 16, 19, and 18 mm, respectively. These results imply that the Artocarpus heterophyllus leaf extract mediated green synthesized bio-molecules encapsulated Ag NPs can be considered as a potential antibiotic against human pathogens which is very encouraging.

Persuaded by the necessity of finding new sources of antibiotics, Ag NPs were synthesized by adopting a newly developed green synthesis technique and subsequently, their antibacterial activity against different pathogenic bacteria was evaluated.

Abandonment and Outcome of Childhood Acute Myeloid Leukemia in A Tertiary Level Hospital

Acute leukemias are the most common child hood malignancy, of which acute myeloid leukemia (AML) are 15 to 20%. Abandonment is one of the most important causes of treatment failure in AML in developing countries. Lost to follow-up is also a big problem in low income countries. Many patients stop therapy soon after diagnosis due to cost, distance and ignorance. To determine the abandonment, outcome and treatment related mortality (TRM) and morbidity among children with AML. This prospective observational study was conducted in the Department of Pediatric hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from February 2013 to January 2014. Fifty (50) patients of AML visited to out patient department (OPD) of Pediatric hematology and Oncology. Among them 11(22%) patients refuse treatment from outdoor. Thirty nine (78%) patients of AML were selected as per inclusion and exclusion criteria. After proper evaluation and clinical examination of these patients, CBC and Bone marrow examination was done for confirmation of diagnosis. A total of 39 patients were recruited in this study. Seventeen (43.6%) patients were male and 22(56.4%) were female. Mean±SD of age was 7.80±4.42 years and range was 1 year to 18 years. Out of 39 patients, 18(46.1%) patients were abandoned, 15(38.4%) expire, relapse 2(5.2%) & alive 4(10.3%). High abandonment (46.1%) and treatment related toxic death (38.4%) has compromised the outcome of acute myeloid leukemia. However AML can be treated with better outcome if improved the supportive care, reduce toxic death, refusal or abandonment.

PREVALENCE AND CLINICAL IMPORTANCE OF CRYPTOSPORIDIUM AND GIARDIA IN HUMAN AND ANIMALS

The protozoan parasites Cryptosporidium and Giardia duodenalis are worldwide considered as an important cause of gastrointestinal disease in human patients and in animals. The high number of (oo) cysts excreted shortly after infection, together with the low infectious dose, results in an easy spread of infection. The aim of this literature review is to introduce Cryptosporidium and Giardia by addressing their taxonomy, life cycle, prevalence and clinical importance for both human and animals.

Can 3T MR angiography replace DSA for the identification of arteries feeding intracranial meningiomas?

BACKGROUND AND PURPOSE

For identifying the arterial feeders of meningiomas, the usefulness of 3D TOF MRA at 3T has not been systematically investigated. This study was intended to assess whether unenhanced 3D TOF MRA at 3T can replace DSA for the identification of arteries feeding intracranial meningiomas and whether it is useful for assessing their dural attachment.

MATERIALS AND METHODS

Twenty-one consecutive patients with intracranial meningiomas (18 women, 3 men; aged 42-77 years, mean 57 years) underwent DSA, conventional MR imaging, and 3D TOF MRA. Two neuroradiologists independently evaluated the primary and secondary feeders of each tumor on maximum-intensity-projection and source MRA images. They also identified the location of dural attachments based on information from MR imaging/MRA images. Interobserver and intermodality agreement was determined by calculating the κ coefficient.

RESULTS

For the identification of primary and secondary feeders on MRA images, interobserver agreement was very good (κ=0.83; 95% CI, 0.66-1.00) and moderate (κ=0.58; 95% CI, 0.34-0.82) and intermodality agreement (consensus reading of MRA versus DSA findings) was excellent (κ=0.94; 95% CI, 0.84-1.00) and good (κ=0.72; 95% CI, 0.51-0.93), respectively. With respect to the dural attachment of meningiomas, interobserver agreement was very good (κ=0.95; 95% CI, 0.84-1.00). The agreement in the diagnosis between MR imaging/MRA and surgery was excellent (κ=1.00).

CONCLUSIONS

Unenhanced 3D TOF MRA at 3T cannot at present supplant DSA for the identification of the feeding arteries of intracranial meningiomas. This information may be useful for evaluating their dural attachment.

Impacts of Plough Pan on Physical and Chemical Properties of Soil

The experiment was carried out to find out the impacts of plough pan on physical and chemical properties of soil. For this purpose, soil samples were collected from two locations of Basail upazila in Tangail dristrict, one having compact plough pan layer in subsoil (site-1) and other one with no plough pan layer (site-2). A survey was also conducted on land use pattern in these areas to get the causes of plough pan formation. In site-1, rice is the dominant crop and in site-2 shallow rooted crops such as mustard, potato, onion etc. are grown. In site-1, organic C, N, K, S, Zn contents were found higher and the concentrations of C, N, K, P, S and Zn decreased from topsoil to lower layers, whereas, concentrations increased to subsoil layer except P in case of site-2.   DOI: http://dx.doi.org/10.3329/jesnr.v5i1.11594   J. Environ. Sci. & Natural Resources, 5(1): 289-294, 2012  

Clinical profile of periodic paralysis

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

Characterization of spinal cord lesion in patients attending a specialized rehabilitation center in Bangladesh

STUDY DESIGN

This study was designed as a cross-sectional study.

OBJECTIVES

The objective of this study was to find out the clinical types and sociodemographic characteristics of patients with spinal cord lesion (SCL).

SETTING

Centre for the Rehabilitation of the Paralysed (CRP).

METHODS

Data were collected by face-to-face interview, with a structured interview schedule from admitted patients. Descriptive measures and χ(2)-test were applied for data analysis.

RESULTS

Of 107 patients, majority (20%) belonged to age group of 25-29 years (mean 31±12.2 years). About 83% were males; 65% married and 54% illiterate. Agricultural and other day laborers constituted the major occupation groups with mean monthly family income of US $60 (±$53). About 92% came from rural area and 84% belonged to nuclear family. About one-third of the patients were referred by the medical college hospitals. About 65% of the patients were admitted at 1-29 days of lesion with longest duration of 3 years. Patients were mostly (93%) traumatic. Fifty-four percent had paraplegia and most common skeletal level segment was cervical (44%). About 43% had pressure sores at admission. Eighty-nine percent needed management for bladder function through the use of catheter. Age, sex and occupation were associated with type of paralysis, skeletal level of injury and neurological condition; physical status, causes of lesion, type of injury and skeletal level of injury; and skeletal level of injury, respectively (P<0.05).

CONCLUSION

Major cause of SCL was traumatic. Available treatment facilities were inadequate and needed improvement through government and private initiatives.

Assessment of vascular supply of hypervascular extra-axial brain tumors with 3T MR regional perfusion imaging

BACKGROUND AND PURPOSE

The vascular supply of extra-axial brain tumors provided by the external carotid artery has not been studied with RPI. The purpose of this work was to determine whether RPI assessment is feasible and provides information on the vascular supply of hypervascular extra-axial brain tumors.

MATERIALS AND METHODS

Conventional ASL and RPI studies were performed at 3T in 8 consecutive patients with meningioma. On the basis of MRA results, we performed RPI by placing a selective labeling slab over the external carotid artery. Five patients underwent DSA before surgery. Two neuroradiologists independently evaluated the overall image quality, the degree of tumor perfusion, and the extent of the tumor vascular territory on conventional ASL and RPI.

RESULTS

In overall quality of conventional ASL and RPI, no images interfered with interpretation. In comparisons of the vascular tumor territory identified by the conventional ASL and RPI techniques, the territories coincided in 3 cases, were partially different in 4, and completely different in 1. The interobserver agreement was very good (kappa = 0.82). In 5 patients who underwent DSA, the 4 patients in whom the dominant supply was the external carotid artery were scored as coincided or partially different. The 1 patient in whom the vascular supply was from the internal carotid artery was scored as completely different.

CONCLUSIONS

RPI with selective labeling of the external carotid artery is feasible and may provide information about the vascular supply of hypervascular extra-axial brain tumors.

Prognostic value of perfusion MR imaging of high-grade astrocytomas: long-term follow-up study

BACKGROUND AND PURPOSE

Although the prognostic value of perfusion MR imaging in various gliomas has been investigated, that in high-grade astrocytomas alone has not been fully evaluated. The purpose of this study was to evaluate retrospectively whether the tumor maximum relative cerebral blood volume (rCBV) on pretreatment perfusion MR imaging is of prognostic value in patients with high-grade astrocytoma.

MATERIALS AND METHODS

Between January 1999 and December 2002, 49 patients (30 men, 19 women; age range, 23-76 years) with supratentorial high-grade astrocytoma underwent MR imaging before the inception of treatment. The patient age, sex, symptom duration, neurologic function, mental status, Karnofsky Performance Scale, extent of surgery, histopathologic diagnosis, tumor component enhancement, and maximum rCBV were assessed to identify factors affecting survival. Kaplan-Meier survival curves, the logrank test, and the multivariate Cox proportional hazards model were used to evaluate prognostic factors.

RESULTS

The maximum rCBV was significantly higher in the 31 patients with glioblastoma multiforme than in the 18 with anaplastic astrocytoma (P < .03). The 2-year overall survival rate was 67% for 27 patients with a low (< or =2.3) and 9% for 22 patients with a high (>2.3) maximum rCBV value (P < .001). Independent important prognostic factors were the histologic diagnosis (hazard ratio = 9.707; 95% confidence interval (CI), 3.163-29.788), maximum rCBV (4.739; 95% CI, 1.950-11.518), extent of surgery (2.692; 95% CI, 1.196-6.061), and sex (2.632; 95% CI, 1.153-6.010).

CONCLUSION

The maximum rCBV at pretreatment perfusion MR imaging is a useful clinical prognostic biomarker for survival in patients with high-grade astrocytoma.

Differentiation between paraclinoid and cavernous sinus aneurysms with contrast-enhanced 3D constructive interference in steady- state MR imaging

BACKGROUND AND PURPOSE

Differentiation between paraclinoid and cavernous sinus aneurysms of the internal carotid artery (ICA) is critical when considering treatment options. The purpose of this study was to determine whether contrast-enhanced (CE) 3D constructive interference in steady state (CISS) MR imaging is useful to differentiate between paraclinoid and cavernous sinus aneurysms.

MATERIALS AND METHODS

This study included 11 aneurysms in 10 consecutive female patients, ranging from 52 to 66 years of age. All aneurysms were adjacent to the anterior clinoid process. After conventional and CE 3D-CISS imaging on a 1.5T MR imaging unit, all patients underwent surgery, and the relationship between the aneurysms and the dura was confirmed. Two neuroradiologists evaluated the location of the aneurysms on CE 3D-CISS images and classified them as intradural, partially intradural, and extradural aneurysms. Operative findings were used as a reference standard. To understand the imaging characteristics, we assessed the boundary and signal intensity of the cavernous sinus, CSF, and carotid artery on the side contralateral to the lesion.

RESULTS

Operative findings disclosed that 5 aneurysms were intradural and 6 were extradural. All except 2 were accurately assessed with CE 3D-CISS imaging. One intradural aneurysm adjacent to a large cavernous aneurysm and 1 cavernous giant aneurysm were assessed as partially intradural. On CE 3D-CISS images, the boundary between the CSF, cavernous sinus, and carotid artery was identified by high signal-intensity contrast in all cases.

CONCLUSION

CE 3D-CISS MR imaging is useful for the differentiation between paraclinoid and cavernous sinus aneurysms.

Multiple prominent dilated perivascular spaces do not induce Wallerian degeneration as evaluated by diffusion tensor imaging

It is unknown whether dilated perivascular spaces can affect the adjacent neuronal fibers. We describe conventional MR and diffusion tensor imaging findings of a case with multiple, prominent dilated perivascular spaces in the left cerebral hemisphere. Diffusion tensor imaging showed no alterations in the fractional anisotropy and apparent diffusion coefficient values for the corona radiata, posterior rim of the internal capsule, and the cerebral peduncle, indicating no wallerian degeneration associated with dilated perivascular spaces.