Flavonoids: A treasure house of prospective pharmacological potentials

Flavonoids are organic compounds characterized by a range of phenolic structures, which are abundantly present in various natural sources such as fruits, vegetables, cereals, bark, roots, stems, flowers, tea, and wine. The health advantages of these natural substances are renowned, and initiatives are being taken to extract the flavonoids. Apigenin, galangin, hesperetin, kaempferol, myricetin, naringenin, and quercetin are the seven most common compounds belonging to this class. A thorough analysis of bibliographic records from reliable sources including Google Scholar, Web of Science, PubMed, ScienceDirect, MEDLINE, and others was done to learn more about the biological activities of these flavonoids. These flavonoids appear to have promising anti-diabetic, anti-inflammatory, antibacterial, antioxidant, antiviral, cytotoxic, and lipid-lowering activities, according to evidence from in vitro, in vivo, and clinical research. The review contains recent trends, therapeutical interventions, and futuristic aspects of flavonoids to treat several diseases like diabetes, inflammation, bacterial and viral infections, cancers, and cardiovascular diseases. However, this manuscript should be handy in future drug discovery. Despite these encouraging findings, a notable gap exists in clinical research, hindering a comprehensive understanding of the effects of flavonoids at both high and low concentrations on human health. Future investigations should prioritize exploring bioavailability, given the potential for high inter-individual variation. As a starting point for further study on these flavonoids, this review paper may promote identifying and creating innovative therapeutic uses.

Phyto-pharmacological evaluation and characterization of the methanolic extract of the Baccaurea motleyana Müll. Arg. seed: promising insights into its therapeutic uses

Introduction: Plants and their extracts have been integral to the development of medicinal treatments throughout history, offering a vast array of compounds for innovative therapies. Baccaurea motleyana Müll. Arg., commonly known as Rambai, is an evergreen tree with economic importance in the Old-World Tropics. Method: The study investigates its phytochemical composition through Gas Chromatography-Mass Spectrometry (GC-MS) and evaluates its pharmacological properties, including antidiabetic, antidiarrheal, antimicrobial, and antidepressant effects. Result and Discussion: The GC-MS analysis revealed 15 bioactive compounds in the methanol extract, with Phenol, 3,5-bis(1,1-dimethylethyl)-, Methyl stearate, and Hexadecanoic acid, methyl ester being the predominant ones. The cytotoxicity assay demonstrated significant activity in the ethyl acetate fraction. Antimicrobial assays indicated mild to moderate antibacterial activity. In vivo studies on mice revealed significant hypoglycemic, antidiarrheal, and antidepressant properties. Molecular docking studies against EGFR, DHFR, GLUT-3, KOR, and MOA identified promising compounds with potential therapeutic effects. The identified compounds exhibited favorable ADME/T properties, emphasizing their potential for drug development. The study underscores the promising therapeutic potential of Baccaurea motleyana, showcasing its diverse bioactive compounds with significant medicinal properties. Conclusion: These findings lay the groundwork for future research, emphasizing the exploration of B. motleyana as a source of natural remedies for addressing prevalent health conditions.

Prediction of Coronary Artery Disease Severity by Using CHA2DS2-VASC-HSF Score in Patients with ST-Elevation Myocardial Infarction

CHADS₂ and CHA₂DS₂-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that the factors comprising the newly defined CHA₂DS₂-VASC-HSF score promote atherosclerosis and associated with severity of CAD. Objective of the study was to find out the association of the CHA₂DS₂-VASC-HSF score with the severity of CAD in patients with ST elevation myocardial infarction (STEMI). One hundred (100) patients with STEMI were enrolled in this study after considering inclusion and exclusion criteria over a one year period from October, 2017 to September, 2018 in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Coronary angiogram was done within index hospitalization and coronary artery disease severity was assessed by SYNTAX score system. Patients were divided into two groups on the basis of SYNTAX score. Patients with SYNTAX score ≥23 assigned as Group I and SYNTAX score <23 assigned as Group II. The CHA₂DS₂-VASC-HSF score was calculated. Cut-off value of high CHA₂DS₂-VASC-HSF score was ≥4.0. In this study mean age of study population was 51.8±9.8, male patients were predominant (79.0%). Among the studied patients, highest percentage had history of smoking followed by hypertension, diabetes mellitus and family history of CAD in Group I patients. It was found that DM and family history of CAD and history of stroke/TIA were significantly higher in Group I than Group II. An increasing trend of SYNTAX score was observed according to the CHA₂DS₂-VASc-HSF score. SYNTAX score was significantly higher in CHA2DS2-VASc-HSF score ≥4 than CHA₂DS₂-VASc-HSF score <4 (26.3±6.3 vs. 12.1±7.7, p<0.001). Patients with CHA₂DS₂-VASC-HSF score ≥4 had severe coronary artery disease than CHA₂DS₂-VASC-HSF score <4 assessed by SYNTAX score with 84.4% sensitivity and 81.9% specificity (AUC:0.83, 95% CI: 0.746-0.915, p<0.001). CHA₂DS₂-VASc-HSF score was positively correlated with the severity of CAD. This score could be considered as a predictor of coronary artery disease severity.

Diagnostic Dilemma of Frozen Shoulder in Post CABG Patient: A Case Report

Frozen shoulder, also known as adhesive capsulitis, is a condition featured by stiffness and pain in shoulder joint. In this report, we present a case of 58 years old diabetic male patient with the history of coronary artery bypass grafting (CABG) 06 months back. He presented with persistent right shoulder pain for 05 months. Clinical examinations reveal restriction of the right shoulder joint movement in all directions and wasting of the right supraspinatus, infraspinatus and trapezius muscles. Both active and passive range of motions was restricted with painful right shoulder joint. Pain free abduction range was about 40 degrees in right shoulder. Plain X-ray of right shoulder joint and other relevant investigations show normal findings. Considering the clinical and laboratory findings decision was taken to treat the patient with exercise, pain killer and ultrasound therapy which were found to be optimistic.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

A Case of Bilateral Middle Cerebral Artery Stenosis with Unilateral M1 Stenting

Stroke is not only the third leading cause of death in Bangladesh but it also causes a high number of disability adjusted life years loss (485 per 10,000 people). Appropriate treatment of recurrent stroke has to be established. Here we present A 60 year's old male patient with history of recurrent stroke who came in our out patient department. He had progressing bilateral middle cerebral artery atherosclerotic stenosis (100.0% on right side and 52.0% on left side) which was less severs but symptomatic at dominant hemisphere (left). Percutaneous transluminal angioplasty with stenting was done to prevent further ischemia and to increase the blood supply of remaining brain parenchyma. On post stenting follow-up patient did not suffered from any new event of stroke for about 22 months. Percutaneous transluminal angioplasty with stenting is an effective procedure to prevent recurrent stroke for intracranial atherosclerotic disease.

Observation of Myocardial Involvement in Patients Recovered From COVID-19 by Using Cardiac Magnetic Resonance Imaging, In a Tertiary Care Hospital, Bangladesh

It was previously reported that coronavirus caused myocardial injury in hospitalized patients. However, delayed cardiac involvement in symptomatic patient recovery from COVID-19 is not yet well known. The objective of this study was to evaluate cardiac involvement by using cardiac magnetic resonance (CMR) in symptomatic post-COVID-19 recovered patients. Thirty (30) patients who recovered from COVID-19 and had recently reported cardiac symptoms were studied in a prospective observational study performed at Popular Medical College Hospital, Dhaka, Bangladesh from March 2021 to September 2021. They underwent CMR examinations. CMR scanning protocol included the following: black blood, cine sequence, both short-axis and long-axis, T2-weight short tau inversion recovery (STIR) sequence, T2- weighted imaging (T2WI) and late gadolinium enhancement (LGE) and quantitative mapping sequences-native T1/T2 mapping and post-contrast T1 mapping. Myocardial edema and late gadolinium enhancement were assessed in all patients. Quantitative evaluation of native T1/T2 and ECV value and cardiac function were evaluated. There were 30 people in all in this study. The average age of the participants in the study was 36.6 years. Fourteen (46.6%) of the patients had abnormal cardiac MRI results, while the remaining 15(53.3%) had negative CMR findings. Among positive findings patients, 8(57.1%) of 14 had increased T2 signal. Increased myocardial edema was found in the same no of patients, involving 53.2% (128 of 224) of LV segments. Only 2 cases (2 of 14) showed mid myocardial and subepicardial LGE, involving 18 of 224, 8.03% of myocardial segments. Global native T1, T2 and ECV values are significantly elevated in all CMR positive findings patients. Native T1 1231ms (IQR: 1281.25-1257.5 versus 1155.5 (IQR: 1137.25-1172.75), T2 40 (IQR: 34.5-43.25) versus 35.5 (IQR: 34-37), ECV 31 (29.75-33.25) versus 23.5 (21.25-24.0), p<0.001; p<0.011 and p<0.001 respectively. Reduced RV functional were found in positive as compared with negative CMR findings patients, EF, 32.05 (IQR: 25.25-39.0) versus 54.5 (IQR: 52.0-57.75) and EDV, 117.5 (IQR: 102.0-134.25) versus 95.0 (IQR: 71.75-99.75), p<0.001 and p<0.001 respectively. In this study cardiac involvement was found in the post-COVID-19 recovered patient with cardiac symptoms. Cardiac MRI findings included myocardial edema, fibrosis and reduced right ventricular function. So attention should be paid to symptomatic post-COVID-19 recovered patients.

Quality of Life of Bangladeshi Doctors in the COVID-19 era: Are We Taking Good Care of Our Carers?

The Coronavirus pandemic has been affecting our healthcare professionals physically as well as psychologically since March 2020. Whilst various measures have been taken to protect their physical health, their mental wellbeing has not been brought into attention. We aimed to assess the well-being of Bangladeshi doctors and identify the high-risk group using a core-10 validated form. We performed an observational cross-sectional survey among Bangladeshi healthcare professionals. One hundred one (101) doctors filled out the core-10 form. We collected data over a 1-month-period during the first peak of COVID-19. According to our data, majority of the participants (49%) felt anxious or nervous at some point. Thirty one percent (31%) felt hopeless, unhappy even panic attacks but most significant finding was that 21% participants had at least once thought about ending their lives. This is a matter of concern and the workplaces should identify the vulnerable professionals so that they can be supported better mentally and socially. More than half of the participants (55%) were found to have moderate to severe depression in the first peak of COVID 19 pandemic. This is not over yet; more waves are coming. Therefore, it is really important that we address this issue before it is too late and ensure regular counselling, better childcare for working parents, safety measures to protect their families and financial security. Otherwise, we might exhaust our carers to a level where even they cannot help us survive this global challenge.

1214 A Combined Approach to Prioritise Patients for Colonoscopy

Aim

Correlating colonoscopy finding with presenting features to assess the diagnostic yield of different symptoms.

Method

We looked at findings of 100 patients retrospectively who had colonoscopy in Dhaka Medical College Hospital, Bangladesh during first peak of COVID (August 2020 to December 2020). We reviewed NICE guideline for high-risk symptoms and NHS guideline for prioritisation of colonoscopy patients.

Results

100 cases were reviewed, 67% were male among the patients, average age was 42.11 (4 – 75 years). 47 were found to have significant pathology. Findings included colorectal malignancy (28%), Polyp (9%), IBD (6%), tuberculosis (2%) etc. PR bleed had highest diagnostic yield (21.27%), followed by abdominal lump (17.02%) and lower abdominal pain (14.89%). Weight loss showed lowest diagnostic yield (4.25%). 28% colonoscopy findings were normal. Patients were chosen based on clinical assessments and imaging results, as stool biochemical marker tests (FIT test, faecal calprotectin) are not available in DMCH.

Conclusions

Being an aerosol generating procedure which has a considerable amount of risk of transmitting COVID infection from patient to clinician or vice versa, it is important to triage patients with lower GI symptoms for colonoscopy. In a developing country like Bangladesh, it is essential to make the most reasonable use of limited resources. Symptoms-based triaging systems are poor predictors of clinically significant disease on colonoscopy. Therefore, a more holistic and novel approach needs to be studied and formulated using a combination of symptoms, blood, and stool biomarkers in order to reduce the need for a ‘negative’ colonoscopy and avoid unnecessary risks.

Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study

Eosinophilic esophagitis (EoE) is a disease of modern era. It was first described 40 years back. Since then it has drawn an immense interest among the clinicians. It is diagnosed by the presence of eosinophils count ≥15/HPF on esophageal biopsied mucosa in patients with symptoms of esopohageal dysfunction. It is more prevalent among patients with gastroesophageal reflux disease. As its symptoms overlap with that of gastroesophageal reflux disease (GERD), it is frequently overlooked & misdiagnosed which increases patients' sufferings. No data is available in Bangladesh. The objective of the study was to find out the frequency of eosinophilic esophagitis among patients with gastroesophageal reflux symptoms. The study was conducted at the Outpatient department of the department of Gastroenterology of Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2018 to April 2019. One hundred and thirty three (133) consecutive patients with symptoms suggestive of gastroesophageal reflux disease based on validated questionnaire underwent upper GI endoscopy. Biopsies were taken from proximal and distal esophagus as well as any other endoscopically abnormal esophageal mucosal lesion. Among 133 patients with gastroesophageal reflux symptoms, 7 patients (5.3%) were found to be positive for eosinophilic esophagitis. Mean age at diagnosis was 37.28±13.38 years. It was more common in younger age group. Female patients (56%) were more than male patients (44%). Heart burn was the major symptom followed by acid regurgitation. Nocturnal cough showed statistically significant relationship with eosinophilic esophagitis. Although the frequency is low, it may be considered as a differential diagnosis among patients with GERD.

Serum Iron Profile and Red Cell Indices in Children with Severe Acute Malnutrition in A Tertiary Level Hospital

This cross-sectional analytical study was conducted in the department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from March 2017 to August 2018 to assess the pattern of serum iron profile and red cell indices in children with severe acute malnutrition. Seventy children having severe acute malnutrition were compared with 70 age matched children those had normal growth. Age range of the studied children was 6 months to 59 completed months. Male was found predominant (54.3%) in both study group and comparison group. Mean serum iron, serum ferritin, serum total iron binding capacity and transferrin saturation in severely malnourished children were 45.3±19.3μg/dl, 26.5±20.0ng/ml, 246.3±47.5μg/dl and 16.4±2.0% respectively which were significantly lower than that of healthy children (p<0.05). Mean Hb level in children with severe acute malnutrition was found 8.3±1.6gm/dl which was also found significantly lower than that of normal children (p<0.05). Anaemia was found in all (100%) severely malnourished children compared to 25.7% of children in comparison group. Mean MCV, MCH and MCHC in children with severe acute malnutrition was found 71.7±13.5fl, 24.0±5.8pg and 31.4±4.0gm/dl respectively which were significantly lower than that of comparison group (p<0.05). Serum iron profile and red cell indices should be routinely done in severely malnourished children for early intervention and management of iron deficiency anaemia.

Status of Plasma Vitamin-D Level in Predicting Adverse In-Hospital Outcome in Patients with First Attack of Acute Myocardial Infarction

Acute myocardial infarction has many risk factors and etiologies. Different factors are responsible for adverse in-hospital outcome after acute MI. Status of plasma vitamin D level has been found to be a good predictor of future adverse cardiovascular outcomes in patients with acute MI. Plasma vitamin D level has been considered as a potential marker for identifying individuals under risk of CAD and associated events. This study was done to investigate the role of plasma vitamin D level in predicting in-hospital adverse cardiac events in patients with acute MI. This cross sectional descriptive type of study was conducted in the cardiology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2017 to March 2019. Total 257 patients of first attack of acute MI were included considering inclusion and exclusion criteria. Fasting blood samples were analyzed for plasma vitamin D level. Sample population were grouped at first into two, normal and low vitamin D level, taking 30ng/ml as cut-off value, low vitamin D level is further subdivided into insufficiency (21-29ng/ml), deficiency (10-20ng/ml) and severe deficiency (<10ng/ml). Adverse in-hospital cardiac outcomes were observed. In-hospital adverse outcomes occurred in 42.9% patients having normal vitamin D level (>30ng/ml), 66.2% of patients having vitamin D insufficiency (21-29ng/ml), 78.2% of patients having vitamin D deficiency (10-20ng/ml) and 94.4% patients having severe vitamin D deficiency (<10ng/ml), which was statistically significant (p<0.05). Heart failure (30.3%, 47.7%, 63.6% and 77.8%, p<0.05), cardiogenic shock (12.6%, 27.7%, 34.5% and 33.3%, p<0.05), Arrhythmias (14.3%, 21.5%, 23.6% and 22.2%, p>0.05), death (2.5%, 0%, 3.6% and 11.1%, p>0.05) occurred more in low vitamin D groups. Mean vitamin D level was significantly different between Group I and Group II (42.59±10.08 vs. 18.64±6.54, p<0.0001). Multivariate regression analysis showed vitamin D is an independent predictor of in-hospital adverse cardiac events (p=0.001). Age (p=0.001) and obesity (p=0.048) were also other predictors of in-hospital adverse cardiac events. Low plasma vitamin D level is an important predictor for in-hospital adverse cardiac events in patients hospitalized with first attack of acute MI.

Relationship of Plasma Vitamin-D Level with Left Ventricular Ejection Fraction in Patients with First Attack of Acute Myocardial Infarction

It has been widely reported that vitamin D deficiency is associated with Coronary heart disease (CHD), especially acute Myocardial infarction (MI). Many factors are responsible for reduced Left ventricular ejection fraction (LVEF) and acute Left ventricular fraction (LVF) after acute MI. This cross sectional descriptive type of study was conducted in the Cardiology department of Mymensingh Medical College Hospital from October 2017 to March 2019 to investigate the relationship of plasma vitamin D with LVEF in patients with first attack of acute MI. Total 185 patients of first attack of acute MI were included considering inclusion and exclusion criteria. Fasting blood samples were analyzed for plasma vitamin D level. Sample population were grouped at first into two, normal and low vitamin D level, taking 30ng/ml as cut-off value, low vitamin D level is further subdivided into insufficiency (21-29ng/ml), deficiency (10-20ng/ml) and severe deficiency (<10ng/ml). LVEF among the patients was observed. LVEF was found 49.88±8.58% patients having normal vitamin D level (>30ng/ml), 47.60±8.24% of patients having vitamin D insufficiency (21-29ng/ml), 44.38±8.12% of patients having vitamin D deficiency (10-20ng/ml) and 40.61±8.64% patients having severe vitamin D deficiency (<10ng/ml), which was statistically significant (p<0.05). So, low plasma vitamin D level is associated with reduced LVEF in patients hospitalized with first attack of acute MI.

Vitamin D Profile in Juvenile Idiopathic Arthritis Patients in a Tertiary Care Hospital in Bangladesh

There are multi-factorial causes of decrease in bone mass in Juvenile Idiopathic Arthritis (JIA) patients who correlate with the duration of active disease. By measuring the vitamin D level we can assess the deficiency or insufficiency earlier and can predict the risk of osteoporotic bone fracture & can give appropriate supplementation of vitamin D & calcium. This study was done to determine the status of serum 25(OH)D in patients with JIA and to see the relationship among various subtypes and disease duration. In this cross sectional study 30 (Thirty) newly diagnosed cases of JIA attending the pediatric rheumatology clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2014 to December 2015 were included. Thirty age and sex matched control were selected and serum 25(OH)D was measured in cases and controls. Among JIA patients, 60% and among controls 33% had hypo-vitaminosis D. In JIA group the mean level of serum 25(OH)D was lower than control group and the result is statistically significant in cases of poly-articular JIA and systemic JIA (SJIA). There is significant difference of the mean values of vitamin D levels in JIA and control groups for the cases of hypo-vitaminosis D. Level of serum 25(OH)D significantly decreased as disease duration continue increased. More than half of JIA patients had hypo-vitaminosis D. It is more significant in cases of poly-articular JIA and systemic JIA (SJIA). There was negative relationship between serum 25(OH)D level and disease duration.

Platelet Count as a Severity of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary disease (COPD) is a heterogenous respiratory disease characterized by a progressive, not fully reversible airflow limitation associated with an abnormal inflammatory response of the lung to noxious stimuli. It is a disease presenting with pulmonary inflammation as well as a systemic one. Measurement of inflammatory marker is difficult but platelet count estimation is easy and less costly. This descriptive, cross-sectional study was carried out at Department of Medicine, Mymensingh Medical college Hospital, Mymensingh, Bangladesh for a period of twelve months among fifty-nine COPD patients. Data were collected through interview, physical examination and laboratory investigations. Statistical analysis was performed using SPSS version 22.0 for consistency and completeness. Age range of the patients was 40 to 49 years with a mean of 56.3±10.9 years. Age group 40-49 years contained the highest number (19; 32.3%) of patients. Majority 57(96.6%) of the respondents were male. Thirty seven (62.7%) of patients were illiterate. Majority 56(94.9%) of patients resided in rural area, of them most 38(64.4%) were farmers. According to Spirometric measurement among 59 respondents of COPD patient, 3(5.1%) were in GOLD stage-I, 9(15.3%) in GOLD stage-II, 27(45.8%) in GOLD stage-III and 20(33.9%) in GOLD stage IV group. Mean platelet count (10³/μl), 241.6±86.5 was found in mild, whereas 315.0±47.7 in moderate, 337.2±76.3 in severe, and 412.4±67.5 in very severe group of COPD patients. So increase in platelet count is statistically significant in severity of COPD. In conclusion, platelet count measurement is less costly to categorize COPD and may be a diagnostic marker.

Exploring the relationship between age at first drink, low-risk drinking knowledge and drinks counting: six rounds of a country-wide survey in Australia

OBJECTIVE

Although a reasonable volume of research has been conducted around health impacts of age at first drink of alcohol on adverse health outcomes, the effects of age at first drink of alcohol on knowledge of low-risk drinking and drinks counting habits were rarely researched. The objective of this study is to examine the associations between age at first full serve of alcohol, knowledge of low-risk drinking and frequency of drinks counting.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data of six rounds of the National Drug Strategy Household Survey, conducted during the period 2001-2016, were analysed. Multivariable log-binomial regression models were used to explore the associations.

RESULTS

Most people drank the first full serve of alcohol during adolescence, and the age at first full serve of alcohol was consumed increased over time. The levels of knowledge of low-risk drinking and frequency of drinks counting increased with age at first drink of alcohol more steeply during adolescence than in the later period. Participants' age at drinking the first full serve of alcohol was significantly associated with knowledge of low-risk drinking and drinks counting. There was an increasing trend of significant risk ratio between knowledge score and the frequency of drinks counting.

CONCLUSION

It seems conceivable that those who reported drinking the first full serve of alcohol before 16 years of age were indifferent to drinks counting, and they lacked necessary knowledge of standard drink of alcohol or low-risk drinking. Tailored prevention programs are recommended among adolescents to delay age at first drink of alcohol and to enhance their knowledge base on low-risk drinking.

Development of Simple, Objective Chair-Standing Assessment of Physical Function in Older Individuals Using a KinectTM Sensor

BACKGROUND

With increasing interest in addressing quality of life of older individuals, tests such as the Functional Independence Measure (FIM) are widely used measures of infirmity and burden of care. However, these scales are largely qualitative and especially problematic when assessing movement-based tasks. While effective, reliable analysis of human movement is technically complicated and expensive; an infrared depth sensor is potentially a low-cost, portable devise which may provide a quantitative aspect to clinical testing.

OBJECTIVE

to assess the utility of the KinectTM sensor in providing an objective evaluation of human movement using an oft measured ADL (chair stand).

DESIGN

Cross-sectional study.

SETTING

Community, geriatric day-care center in Japan.

PARTICIPANTS

Men (n=136) and women (n=266) between 50 and 93 years of age, consisting of healthy (HE; n=312) and physically frail (FR; n= 90) individuals.

MEASUREMENTS

Subjects completed two trials of the chair stand, conducted without assistance. Trials were timed and recorded with KinectTM v2. Coronal plane angle (CPA) was determined by a line transecting the shoulder-center and waist relative to the vertical axis and was used to assess quality of the chair stand movement pattern.

RESULTS

Age, height, and body mass were not different between groups. CPA was significantly greater in FR (29.3 ± 8.3°) than HE (19.5 ± 6.5°). CPA and age were significantly related (r=0.148, p<0.01). An optimal threshold for CPA identifying frailty was determined by a receiver-operator characteristic curve with a CPA of 23.1° providing the greatest combination of sensitivity (79%) and specificity (73%).

CONCLUSION

During the chair stand, frail older adults adopted a forward lean position (increased CPA) compared to healthy older adults. This compensatory posture appears to facilitate torso rotation while reducing lower-limb muscular effort during standing. As such, CPA serves as an indicator of reduced lower-body function in older, frail adults.

Effects of arsenic and phosphorus on the growth and nutrient concentration in rice plant

A pot experiment was carried out with arsenic (As) viz. 0, 0.1, 1 and 2 mgL-1 as sodium arsenite and phosphorus viz, 0, 15 and 30 μgmL-1 as ammonium dihydrogen phosphate to evaluate their effects on dry matter yield and nutrients concentration in rice plants (Oryza sativa L.) in the net house. Arsenic toxicity caused more damage to root than to shoot. As reduced plant height and dry matter yields but lower level increased the same significantly. A maximum diminution of 26.70% shoot weight and 32.30% root weights were observed where 2 mgL-1As and 0 μgmL-1 P were applied. Micronutrients were found to be more strongly antagonized by arsenic than the macronutrients. Maximum and minimum accumulation of different nutrients was found at 30 μgmL-1 and 0 μgmL-1 P applications, respectively. The lowest concentration of most of the nutrients were found at 2 mgL-1As and 0 μgmL-1 P. Experiment revealed that the concentrations of nitrogen, potassium, sulphur, iron, copper, zinc and manganese in the root and shoot of rice plants showed an antagonistic effect with As and synergistic effect with P. J. Biodivers. Conserv. Bioresour. Manag. 2019, 5(1): 31-38

Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies

We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14-1.28, p < 0.0001). These results could be taken into consideration with caution, and patients should also be concerned about the inappropriate use of PPIs.

INTRODUCTION

Proton pump inhibitors (PPIs) are generally considered as first-line medicine with great safety profile, commonly prescribed for gastroesophageal reflux disease (GERD) and peptic ulcer disease. However, several epidemiological studies documented that long-term use of PPIs may be associated with an increased risk of hip fracture. Although, the optimal magnitude of the hip fracture risk is still undetermined. We, therefore, performed a meta-analysis of relevant studies to quantify the magnitude of the association between PPIs and risk of hip fracture.

METHODS

We collected relevant articles using MEDLINE, EMBASE, Google Scholar, and Web of Science from January 1, 1990, to March 31, 2018. We included only the large (n ≥ 500) observational studies with a follow-up duration of at least one year in which the hip fracture patients were identified by a standard procedure. Two of the authors extracted data from each included study independently according to a standardized protocol.

RESULTS

A total of 24 observational studies with 2,103,800 participants (319,568 hip fracture patients) met all the eligibility criteria. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14-1.28, p < 0.0001). An increased association was also observed in both low and medium doses of PPI taken and hip fracture risk (RR 1.17, 95% CI 1.05-1.29, p = 0.002; RR 1.28, 95% CI 1.14-1.44, p < 0.0001), but it appeared to be even greater among the patients with higher dose (RR 1.30, 95% CI 1.20-1.40, p < 0.0001). Moreover, the overall pooled risk ratios were 1.20 (95% CI 1.15-1.25, p < 0.0001) and 1.24 (95% CI 1.10-1.40, p < 0.0001) for the patients with short- and long-term PPI therapy, respectively, compared with PPI non-users.

CONCLUSION

Our results suggest that PPI use is significantly associated with an increased risk of hip fracture development, which is not observed in H2RA exposure. Physicians should, therefore, exercise caution when considering a long-term PPI treatment to their patients who already have an elevated risk of hip fracture. In addition, patients should be concerned about the inappropriate use of PPIs; if necessary, then, they should continue to receive it with a clear indication.

Detection of novel mutations associated with independent resistance and cross-resistance to isoniazid and prothionamide in Mycobacterium tuberculosis clinical isolates

OBJECTIVES

Prothionamide, a structural analogue of isoniazid, is used mainly for treating multidrug-resistant tuberculosis (MDR-TB). Both drugs have a common target InhA, so prothionamide can be ineffective against isoniazid-resistant (INH^R) Mycobacterium tuberculosis. We aimed to investigate the prevalence of mutations in katG, ethA, ndh, ethR, mshA, inhA and/or its promoter associated with independent resistance and cross-resistance to INH^R and/or prothionamide-resistant (PTO^R) M. tuberculosis isolates.

METHODS

We sequenced the above genes in 206 M. tuberculosis isolates with susceptibility testing against ten drugs.

RESULTS

Of the 173 INH^R PTO^R isolates, 170 (98.3%) harboured mutations in katG, 111 (64.2%) in ethA, 58 (33.5%) in inhA or its promoter, 5 (2.9%) in ndh, 3 (1.7 %) in ethR and 2 (1.2%) in mshA. Among the 18 INH^R PTO^S isolates, mutations in katG were found in all of them; one had a mutation in the inhA promoter and another in ndh. Of the five INH^S PTO^R isolates, four showed mutations in ethA and two in the inhA promoter. Notably, 55 novel non-synonymous mutations were found in them and 20.2% of the PTO^RM. tuberculosis isolates harboured no known mutations.

CONCLUSIONS

This is the first report to investigate cross-resistance between INH^R and/or PTO^R isolates. Among INH^R (94.4% MDR-TB) M. tuberculosis isolates, the high diversity of mutations for independent resistance and cross-resistance with prothionamide highlight the importance of both phenotypic susceptibility and genotypic diagnosis when using it to treat patients with INH^R-TB. The high proportion (one-fifth) of PTO^RM. tuberculosis isolates showed no known mutation related to PTO^R genes, so uncovered resistance mechanism(s) of prothionamide exist.

Outcome of Transcanalicular Endolaser and External Dacryocystorhinostomy in Chronic Dacryocystitis

Nasolacrimal duct obstruction due to chronic dacryocystitis is the most common cause of epiphora. Dacryocystorhinostomy (DCR) is the treatment of choice for chronic dacryocystitis. This can be carried out by external, endoscopic and endolaser surgical approach. Though external DCR is still a gold standard and most popular method, the latest procedure of less traumatic DCR is transcanalicular approach. The study was done to evaluate the outcome of Transcanalicular Endolaser DCR regarding epiphora and surgery related complications by measuring anatomical success rate (patency assessed by irrigation), functional success rate (symptom free) and complication rate and to compare with External DCR (Ext-DCR). This prospective interventional study was conducted from October 2011 to September 2012 in Ophthalmology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 62 patients included in the study as per inclusion and exclusion criteria of them 31 for TCEL-DCR and 31 for Ext-DCR. But during follow-up one patient was dropped from each group and finally outcome of 30 patients analyzed in each group. Mean age of the patients TCEL-DCR was 38.3±11.54 and of Ext-DCR was 38.4±14.01. In both groups females were the most sufferer (female: male = 1.5: 1). Functional and anatomical success rate of TCEL-DCR showed 93.3% and 83.3% after 3 months; 83.3% and 76.7% after 6 months respectively. Statistically non-significant difference was observed about success rate in comparison between groups. Per-operative complications were pain excessive bleeding. In TCEL-DCR pain complained 13.3% and excessive bleeding occurred in 3.3%. Where as in Ext-DCR pain complained 16.7% and excessive bleeding occurred in 20%; difference was statistically significant (p=0.001). Post-operative complications were bleeding and scar formation. Bleeding occurred in TCEL-DCR 6.67% and in Ext-DCR 10%. So, TCEL-DCR could be an alternative option for the treatment of chronic dacryocystitis especially for those patients who are conscious about scar formation and afraid about Ext-DCR technique.

Correction: Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications

Correction for 'Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications' by R. Ravichandran et al., J. Mater. Chem. B, 2016, 4, 318-326.

Current Trends of Using Antimicrobials at Obstetrics and Gynaecology Department in a Tertiary Care Hospital

This cross-sectional descriptive study was done to analyse the current trends of using antimicrobials in various surgical procedures at Obstetrics and Gynaecology department in Mymensingh Medical College Hospital, Mymensingh from July 2014 to June 2015. Among 300 postoperative obstetrics and gynaecological surgery cases, samples were selected as non-random purposive selection method where pattern of using antimicrobials were analysed by SPSS method 20.1 versions. The incidence of antimicrobial resistance is on continued rise with a threat to return to the pre-antibiotic era. This has led to emergence of such bacterial infections which are essentially untreatable by the current armamentarium of available treatment options. Now-a-days variation of choosing antibiotic are quietly accepted in Obstetrics and Gynaecology department as prophylaxis purpose to control life threatening conditions such as postoperative wound infection, septicaemia, urinary tract infection etc. The data analysis revealed that among 300 obstetrical and gynaecological surgeries, Nitroimidazoles (93.33%), Cephalosporins (91%) and Aminoglycosides (59%) group were most commonly used antimicrobials in both obstetrics and gynaecological surgeries. Metronidazole (93.33%), Ceftriaxone (68.66%), Gentamicin (60.33%), Cefuroxime (48%), Flucloxacillin (42%), Cefixime (27%) were the most commonly used antimicrobials at obstetrics and gynaecology department. Combination of Ceftriaxone, Metronidazole and Gentamicin (37.66%), Ceftriaxone and Metronidazole (25.33%), Cefuroxime, Metronidazole and Gentamicin (16%), Ciprofloxacin, Metronidazole and Gentamicin (5.33%) were most commonly used antimicrobials postoperatively. Total mean duration of antimicrobial therapy was 10.45 days. Antibiotics are useful in prevention of infection. But indiscriminately use of antibiotics without any guideline may lead to antimicrobial resistance. So, antimicrobial surveillance committee should be formed by hospital authority to know the local using pattern of antibiotics.

Macrophage Activation Syndrome in Paediatric Rheumatic Diseases

Macrophage activation syndrome (MAS) is a potentially fatal complication of rheumatic disorders, which commonly occurs in systemic juvenile idiopathic arthritis (sJIA).This study was carried out with the aims of describing the clinical features, laboratory findings and outcomes of MAS associated with paediatric rheumatic diseases in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) and compare these results with previous studies on MAS. This retrospective study was conducted in the paediatric rheumatology wing of the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Clinical and laboratory profile of all the diagnosed cases of MAS were analyzed from the medical records from January 2010 to July 2015. Among 10 MAS patients, 6 were female and 4 were male. Seven patients of systemic JIA, two patients of SLE and one patient with Kawasaki Disease developed MAS in their course of primary disease. Mean duration of primary disease prior to development of MAS was 2.9 years and mean age of onset was 9.1 years. High continued fever and new onset hepatosplenomegaly were the hallmark of the clinical presentation. White blood cell count and platelet count came down from the mean of 16.2 to 10.2×10⁹/L and 254 to 90×10⁹/L. Mean erythrocyte sedimentation rate was dropped from 56 to 29 mm/hr. Six patients had abnormal liver enzyme level (ALT) and 5 had evidence of coagulopathy (prolonged prothrombin time and APTT) at the onset of disease. Hyperferritinnemia were found in all the patients. Bone marrow study was done in 5 patients but features of hamophagocytosis were found only in 2 patients. All patients received intravenous steroid and 3 patients who did not respond to steroid received additional cyclosporine. Mortality rate was 30% in this series. Macrophage activation syndrome is a fatal complication of paediatric rheumatic diseases among which s-JIA was predominant. Early diagnosis and aggressive therapy is essential to reduce the morbidity and mortality of this illness.

Measurement of neutral gas pressure in the D-module of GAMMA 10/PDX by using ASDEX type fast ionization gauge

In the divertor simulation experiments in the GAMMA 10/PDX tandem mirror, pressure of the neutral gas was investigated by using a fast ionization gauge. The gauge was absolutely calibrated for hydrogen gas by using a capacitance manometer. Change of the gauge sensitivity due to the magnetic field of GAMMA 10/PDX was also evaluated. The typical gas pressure measured in detached plasma experiments was 0.1-10 Pa. The degree of plasma detachment determined from the reduction of heat flux was enhanced as the gas pressure increases. Rapid increase of the gas pressure under the plasma flow was also observed.

Response of Dapsone in Refractory Chronic Immune Thrombocytopenia

This was a prospective study. A total number of 19 patients with chronic ITP with platelet count <50×10⁸/L, treated with dapsone at a dose of 100 mg/day for nine months and followed up to 12 months were included in this study. Among them 13 patients (76.5%) were responded well shortly to dapsone which persisted during Dapsone therapy. Response rate of Dapsone was declining after Dapsone therapy. Response persisted in 6 patients (35.3%) after stoppage of dapsone up to last follow up at 1 year. Mean platelets count during Dapsone therapy was 168.35×10⁸/L. Shorter duration of thrombocypenic patients were responded well. Except one all patients experienced mild to moderate anaemia. Mean fall of Haemoglobin was 1.4gm/dl during dapsone therapy observed which come back to normal shortly after stoppage of dapsone. Only 2 patients were suffered from moderate anaemia. Dapsone syndrome and methemoglobinamia caused permanent discontinuation of therapy in 2 patients (10.5%) which was revert back to normal shortly after stoppage of drug. This study demonstrates that dapsone is an effective, inexpensive and well tolerated treatment for chronic, refractory ITP.

In Vitro Determination of Minimum Inhibitory Concentration of Aqueous Garlic Extract and Imipenem against Staphylococcus aureus and Escherichia coli

An interventional study was performed to determine and compare the MICs of aqueous garlic extract (AGE) and Imipenem against standard strains of Staphylococcus aureus ATCC 25923 & Eschericha coli ATCC 25922. The study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2014 to January 2015. The MIC of AGE and antibiotic Imipenem were determined with the help of broth dilution method. The MIC of AGE was determined as 400μg/ml and 700μg/ml against Staphylococcus aureus, and Escherichia coli respectively and the MIC of Imipenem was 1μg/ml against Staphylococus aureus and 1.5μg/ml against Escherichia coli. The MICs of Imipenem was much lower in comparison to MICs of AGE for the test organisms. The subculture study showed the same results with that of the primary isolates. From the study it was clearly observed that AGE have anti bacterial effect but is not potent like antibiotic Imipenem. In this regard active ingredient present in garlic needs to be separated & purified for further study.

Associations and Risk Factors of Diabetic Maculopathy

Diabetic maculopathy is characterised by increased capillary leakage in the main retinal vessels and by alterations in the microcirculation of the macula. Maculopathy occurs frequently in type 1 and type 2 diabetic patients. Prevalence is higher in type 2 than in type 1 diabetic patients. Factors associated with the development of maculopathy are mostly unknown. As maculopathy is the main cause of vision deprivation in diabetic patients it is essential to know the associations and risk factors of diabetic maculopathy so that appropriate measures can be taken to prevent as well as treat diabetic maculopathy. We started the research work to find out the relation between diabetic maculopathy and various associated factors and risk factors for patients with diabetic retinopathy with maculopathy. This cross-sectional observational study done at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka & National Institute of Ophthalmology & Hospital (NIO & H), Sher-e-Bangla Nagar, Dhaka, Bangladesh from January 2006 to June 2006. In this study out of 50 patients, diabetes was controlled in 20(40%) patients and uncontrolled in 30(60%). A significant percentage of patients (40%) had elevated blood pressure. Diabetic autonomic neuropathy was observed in 24% cases and polyneuropathy was observed in 36% cases. It is evident that diabetic maculopathy has association with dyslipidaemia, abnormal renal function due to nephropathy. This study lighted on the association of diabetic maculopathy with diabetic nephropathy, cardiac abnormalities and diabetic neuropathy.

Vitamin-D status is not a confounder of the relationship between zinc and diarrhoea: a study in 6-24-month-old underweight and normal-weight children of urban Bangladesh

BACKGROUND/OBJECTIVE

The role of micronutrients particularly zinc in childhood diarrhoea is well established. Immunomodulatory functions of vitamin-D in diarrhoea and its role in the effect of other micronutrients are not well understood. This study aimed to investigate whether vitamin-D directly associated or confounded the association between other micronutrient status and diarrhoeal incidence and severity in 6-24-month underweight and normal-weight children in urban Bangladesh.

SUBJECTS/METHODS

Multivariable generalised estimating equations were used to estimate incidence rate ratios for incidence (Poisson) and severity (binomial) of diarrhoea on cohorts of 446 normal-weight and 466 underweight children. Outcomes of interest included incidence and severity of diarrhoea, measured daily during a follow-up period of 5 months. The exposure of interest was vitamin-D status at enrolment.

RESULTS

Normal-weight and underweight children contributed 62 117 and 62 967 day observation, with 14.2 and 12.8 days/child/year of diarrhoea, respectively. None of the models showed significant associations of vitamin-D status with diarrhoeal morbidity. In the final model, zinc-insufficient normal-weight children had 1.3 times more days of diarrhoea than sufficient children (P<0.05). Again zinc insufficiency and mother's education (1-5 and >5 years) had 1.8 and 2.3 times more risk of severe diarrhoea. In underweight children, older age and female had 24-63 and 17% fewer days of diarrhoea and 52-54 and 31% fewer chances of severe diarrhoea.

CONCLUSION

Vitamin-D status was not associated with incidence and severity of diarrhoea in study children. Role of zinc in diarrhoea was only evident in normal-weight children. Our findings demonstrate that vitamin-D is not a confounder of the relationship between zinc and diarrhoea.

Anti-Bacterial effect of Aqueous Garlic Extract (AGE) determined by Disc Diffusion Method against Escherichia coli

The study was performed to determine the antibacterial effect of aqueous extract of garlic (Allium sativum) against standard strain of Escherichia coli ATCC 25922. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. Antibacterial effect of AGE was determined by disc diffusion method. Sensitivity of AGE determined in disc diffusion and the zone of inhibition (ZOI) was 4 mm, 10 mm and 20 mm at 25 μg/10 μl, 50 μg/10 μl and 100 μg/10 μl concentrations respectively. From the findings it is clearly determined the extract has definite antibacterial effect upon Escherichia coli. Further studies are required to detect and isolate the active ingredients present in the Garlic extract as well as detail steps of mechanism responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account.

Longitudinal Stent-Shortening during Percutaneous Transluminal Angioplasty with Stenting of Right Superficial Femoral Artery: A Case Report

Longitudinal stent deformation (LSD) involving coronary arteries during PCI have been reported in several literatures. But, LSD occurring during PTA (Percutaneous Transluminal Angioplasty) involving peripheral arteries is rare. We had such a case who presented with coronary and peripheral artery disease. Longitudinal stent deformation occurred during PTA with stenting of right superficial femoral artery (SFA). For CAD, PCI to RCA and LAD was done beforehand and the peripheral procedure was done 4 days later to avoid increased contrast load. Due to LSD occurring during PTA to Rt. SFA, we had to deploy another stent to cover the lesion over that artery. There was no technical fault or difficulty during negotiating the stent and positioning it covering the lesion. So, we did not find any obvious reason for this complication. Since longitudinal stent deformation is uncommon during PCI of coronary arteries and probably rare during PTA of peripheral arteries and we did not find any literature regarding this, we decided to report this case.

Orthodontic Management of A Young Girl with Class II Div1 Malocclusion

We describe the treatment of a young girl age, 25 years, with Class II Div1 malocclusion. She presented with an over jet of 12 mm, and the overbite was 10 mm and incomplete. Teeth on upper anterior segment of jaw were proclined and spaced. Teeth on lower jaw were crowded with buccaly placed 1st premolar on right side. Molar relationship was Class II on both sides. Incisior relation was class II div1. Her oral hygiene was good. Treatment consisted mainly of premolars extractions, canine retraction, labeling and alignment with Edgewise fixed appliances by multi loops technique. Once the canine retraction was complete, arch contraction was accomplished with 0.016×0.022 inch closing-loop arch wires followed by finishing with 0.014 inch round wires. The treatment resulted in Class I molar occlusion with proper alignment of both upper and lower anterior segment, an ideal over jet, overbite and incisor angulation.

Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC.

Pattern and determinants of birth weight in Oman

OBJECTIVES

The aim of this study was to analyse the pattern of birth weight (BW) and identify the factors affecting BW and the risk factors of low birth weight (LBW) in Oman.

STUDY DESIGN

The data for the study came from the 2000 Oman National Health Survey conducted by the Ministry of Health. The survey covered a nationally representative sample of 2037 ever married Omani women of reproductive age.

METHODS

Data on birth weight were gathered from health cards of the infants born within five years before the survey date. The study considered 977 singleton live births for whom data on birth weights were available. LBW was defined as BW less than 2500 g. Descriptive statistics, analysis of variance, multivariate linear regression and logistic regression models were used for data analysis.

RESULTS

The mean BW was found to be 3.09 (SD 0.51) kg. BW was found to be significantly lower among the infants with the following characteristics: born in Ad-Dhakhliyah region, born in rural areas, and whose mothers had low economic status, low parity (0-2), and late initiation of antenatal care (ANC) visit. The incidence of LBW was found to be 9% in Oman in 2000. Mother's education, economic status, region of residence, late initiation of first ANC visit and experience of pregnancy complications appeared as the significant determinants of LBW in Oman. In contrast to most other studies, this study demonstrates that mothers with an advanced level of education (secondary and above) are more likely to have infants with LBW in Oman.

CONCLUSION

The study findings highlight the need of intervention for specific groups of women with higher risk of adverse BW outcomes.

Orthodontic management of a young girl with class I malocclusion and severe crowding: a case report

We describe the treatment of a young girl age, 16 years, with Class I malocclusion. Both upper and lower anterior segment of jaws were crowded with buccally placed canines. Treatment consisted mainly of premolars extractions, canine retraction, labeling and alignment with Edgewise fixed appliances by multiloop technique. The patient did not show good cooperation, hence treatment time was prolonged. However the treatment resulted in Class I molar occlusion with proper alignment of both upper and lower anterior segment, an ideal overjet, overbite and incisor angulation.

Comparative sequence-structure analysis of Aves insulin

Normal blood glucose level depends on the availability of insulin and its ability to bind insulin receptor (IR) that regulates the downstream signaling pathway. Insulin sequence and blood glucose level usually vary among animals due to species specificity. The study of genetic variation of insulin, blood glucose level and diabetics symptoms development in Aves is interesting because of its optimal high blood glucose level than mammals. Therefore, it is of interest to study its evolutionary relationship with other mammals using sequence data. Hence, we compiled 32 Aves insulin from GenBank to compare its sequence-structure features with phylogeny for evolutionary inference. The analysis shows long conserved motifs (about 14 residues) for functional inference. These sequences show high leucine content (20%) with high instability index (>40). Amino acid position 11, 14, 16 and 20 are variable that may have contribution to binding to IR. We identified functionally critical variable residues in the dataset for possible genetic implication. Structural models of these sequences were developed for surface analysis towards functional representation. These data find application in the understanding of insulin function across species.

Pregnancy diagnosis in Black Bengal goat by progesterone assay

Pregnancy is the main event in the life of a female mammal to reproduce the progeny and maintain the descents of the species. Progesterone level in the plasma is one of the indications of stages of pregnancy of an individual and the present study was undertaken to determine the progesterone level in different stages of pregnant Black Bengal does and to correlate blood progesterone level with stages of pregnancy in Black Bengal does. For this experiment the blood samples were collected from different stages of pregnant and non-pregnant Black Bengal does, kids and bucks, and subjected to use for further study.  The progesterone level was measured at 3 different stages of pregnancy (25-30 days, 60- 70 days, and 90-92 days) using the test kit (EIA TEST KIT Progesterone, Biocheck, Inc. Foster city, CA 94404 USA). Progesterone was also assayed in different ages of non-pregnant does, kids and bucks blood as the control. The logarithmic graph paper was used to calculate the progesterone level.  The progesterone levels were found 1.5 ng/ml, 6.6-9.3 ng/ml and 14-15.5 ng/ml in 25-30 days, 60-70 days and 90-92 days of pregnancy, respectively.  In case of non-pregnant does the progesterone level varied from 0.19-6.6 ng/ml in different ages.  Whereas the progesterone level was found between <0.1 ng/ml and 4.4 ng/ml in kids blood samples and in case of bucks the progesterone level was <0.1 ng/ml.  So, it is clear that the progesterone level simultaneously increased as the stages of pregnancy advanced in the blood of pregnant Black Bengal does.DOI: http://dx.doi.org/10.3329/bjas.v43i3.21645 Bang. J. Anim. Sci. 2014. 43 (3): 180-184

Effects of Citrus junos by-products fermented with multistrain probiotics on growth performance, immunity, caecal microbiology and meat oxidative stability in broilers

1. The present study was conducted to develop Citrus junos probiotics (CJP), using by-products of Citrus junos fermented with multispecies probiotic bacteria including Saccharomyces cerevisiae, Enterococcus faecium, Lactobacillus acidophilus and Bacillus subtilis. The effects of dietary CJP on the growth performance, immune status, caecal microbiology and meat oxidative stability of broiler were investigated. 2. A total of 240 one-day-old Ross broiler chicks were used in a 35-d experiment in which the chicks were randomly allotted to one of the 4 dietary treatments (0, 5, 10 and 20 g CJP/kg diet) in a completely randomised design. 3. Dietary supplementation of 5 g/kg CJP significantly increased body weight, average daily gain and average daily feed intake of broiler during the overall experimental period. 4. Serum immunoglobulin (Ig)M concentration was significantly increased by 10 and 20 g/kg CJP, whereas the IgG and IgA concentration remained unaffected. In addition, 20 g/kg CJP significantly inhibited proliferation of Escherichia coli without affecting the concentration of Lactobacillus or Bacillus spp. 5. A significant reduction in the thiobarbituric acid reactive substances values of breast and thigh meat was observed in response to increasing concentration of dietary CJP. 6. Thus, the results suggest that CJP up to a concentration of 20 g/kg can be used in the diet of broilers to improve immunity and to reduce caecal E. coli and TBARS values of breast and thigh meat without any adverse effects on growth performance.

Effect of Sea Tangle (Laminaria japonica) and Charcoal Supplementation as Alternatives to Antibiotics on Growth Performance and Meat Quality of Ducks

A total of 150 growing ducks were assigned to five dietary treatments to study the effect of sea tangle and charcoal (STC) supplementation on growth performance and meat characteristics in a completely randomized design. There were six replicates and five ducklings in each replication. The five dietary treatments were control, antibiotic, and 0.1%, 0.5%, and 1% STC supplemented diets. No significant differences were found on ADG, ADFI, and gain:feed among treatments in different weeks. The overall (0 to 3 weeks) ADFI decreased in antibiotic treatment (p<0.05) whereas the gain:feed increased significantly upon 1.0% STC supplementation compared to control (p<0.05). No significant variation was found in meat chemical composition except crude fat content which was high in 1.0% STC dietary group (p<0.05). Meat cholesterol was reduced in 0.1% STC group (p<0.05) compared to other dose levels while serum cholesterol was unaffected. High density lipoprotein (HDL) content was high in 1.0% STC (p<0.05) and low density lipoprotein (LDL) was low in 0.1% and 1.0% STC dietary groups (p = 0.06). No significant effect was found on the thiobarbituric acid reactive substances (TBARS) of fresh meat, whereas the TBARS value of meat preserved for 1 week was reduced significantly in STC dietary groups (p<0.05). The 0.1% STC dietary group showed an increased myristic acid (p = 0.07) content whereas, the content of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids increased in STC supplementation than antibiotic group (p<0.05). An increased concentration of omega-3 fatty acids and a reduced ratio of n-6/n-3 PUFA ratio was found upon 1.0% STC supplementation compared to antibiotic dietary group (p<0.05). Therefore, 1.0% STC dietary supplementation can be used as alternatives to antibiotics in duck production.

Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation

Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2μgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex.

Effects of fermented corni fructus and fermented kelp on growth performance, meat quality, and emission of ammonia and hydrogen sulphide from broiler chicken droppings

1. Corni fructus is the fruit of Cornus officinalis, a dogwood species. This study was conducted to prepare fermented corni fructus preparation (FCFP) and fermented kelp (FK) from corni fructus and by-products of Laminaria japonica fermented with Bacillus subtilis and Aspergillus oryzae. 2. The effects of dietary FCFP and FK as replacer of oxytetracycline (OTC) on growth performance, meat composition, meat oxidative stability, and emissions of ammonia (NH3) and hydrogen sulphide (H2S) from broiler chicken droppings were investigated. 3. A total of 140 d-old broiler chicks were randomly allotted to 4 dietary treatments including control, OTC (0.05 g/kg), FCFP (5 g/kg), and FK (5 g/kg). 4. Overall, inclusion of FCFP resulted in lower weight gain and feed intake during the overall experimental period. Broilers fed FCFP diets tended to have lower crude fat and higher crude ash content in the carcasses. 5. In the fresh state, the malondialdehyde (MDA) value of broiler meat was lower in the FK supplemented group. At one week, meat from broilers fed antibiotic and FK diets had lower MDA values, whereas at 2 weeks broiler meat from all dietary treatment groups had lower MDA values than the control. 6. Dietary supplementation with FK significantly reduced faecal NH3 emissions throughout the experimental period, whereas dietary OTC and FCFP supplementation increased NH3 emissions at 2 and 4 weeks. There were no significant effects of dietary treatments on H2S emissions throughout the experimental period, except during week one, when FCFP supplementation reduced the emission. 7. In conclusion, dietary supplementation with 5 g/kg FK improved the oxidative stability of broiler meat and reduce faecal NH3 emissions without affecting growth performance.

Regional metastasis in supraglottic and glottic carcinoma of larynx

This cross sectional study was conducted in Sir Salimullah Medical College Hospital, Mitford and Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2009 by purposive sampling method. Among the 50 cases, involvement of supraglottic (72%) region is significantly higher than glottic (28%) region. Affected peoples are mainly male and mean age was 58.1±10.4 years. Frequency of regional metastasis of supraglottic carcinoma (47.22%) was higher than glottic carcinoma (7.14%). Most of the lymphnode involvement was at level-II to IV. Most of the patients presented at stage-I & stage-II.

Energy ordering of grain boundaries in Cr2O3: insights from theory

The grain boundaries (GBs) of corundum Cr2O3 are known to play an important role in the diffusion of ions within the oxide, which is an important phenomenon for the corrosion of stainless steels. The extent of the growth of oxide layers in stainless steel depends upon which interfaces are preferred within Cr2O3. Therefore, we have constructed four different grain boundary planes (rhombohedral, basal, prismatic and pyramidal) and their various associated interface symmetries known in literature for corundum Al2O3. Their structural, electronic, and energetic properties are investigated theoretically with periodic boundary conditions using the DFT + U approach. We find that the prismatic screw GB with a Cr–O plane interface is the energetically preferred GB with the rhombohedral GB with screw symmetry and Cr vacancy termination being the second energetically preferred GB. The increase of the number of in-plane Cr atoms at the interface of prismatic GB enhances the stability, which is also evident in the electronic density of states.

The Effects of Mushroom Powder on the Quality of Cake

The fresh mushroom and mushroom powder were analysed for their composition. Mushroom powder was incorporated in the formulations of cake at 0, 5, 10, 15 and 20% by weight. The effect of various levels of mushroom powder on the physico-chemical properties and nutritional quality of cakes had been observed. Mushroom powder at 15% addition level significantly improved colour, flavour and texture of cake. Cakes were also prepared by incorporating various levels (0-20%) of mushroom powder in plane cake formulations to evaluate optimum level of powder addition. It was observed that in achieving acceptable cake quality, in terms of volume significantly higher amount (10-15%) of mushroom powder could be incorporated in cake formulations. Compositional analysis of cake showed that cake containing mushroom powder had higher protein and fat content and lower carbohydrate content than the control cake. The cakes containing various levels of mushroom powder were evaluated for their sensory attributes by a panel of 10 tasters. The results revealed that the colour and flavour of cake containing mushroom powder was significantly different from the control cake. The texture of the cakes with mushroom powder was equally acceptable to the control cake. The overall acceptability of the cakes with mushroom powder was equally acceptable to the control cake.DOI: http://dx.doi.org/10.3329/pa.v21i1-2.16769 Progress. Agric. 21(1 & 2): 205 - 214, 2010

Serum calcium level among smear positive pulmonary tuberculosis patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Outpatient Department and Medicine Units of Mymensingh Medical College Hospital, Fulbaria Upazilla Health Complex, Mymensingh and some DOTS centers of BRAC, a non-government organization during the period of July 2006 to June 2007. The aim of the study was to explore the status of serum calcium level in smear positive Bangladeshi pulmonary tuberculosis patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control; n=60) apparently healthy people selected matching by age, sex and socioeconomic status with the cases and Group II (Case; n=60) people with smear positive pulmonary tuberculosis. Serum calcium was estimated by colorimetric principle. Serum calcium was adjusted by serum albumin concentration. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of adjusted serum calcium in Group II (2.41±0.15mmol/L) was significantly higher (p<0.001) than that in Group I (1.85±0.11mmol/L). It is evident from the study that serum calcium level significantly increases in smear positive Bangladeshi pulmonary tuberculosis patients.

Haemodynamic and end tidal CO₂ changes during laparoscopic cholecystectomy under general anaesthesia

A prospective observational study was done on 50 patients to investigate the haemodynamic and end tidal CO₂ (EtCO₂) changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in head up position under standard protocol of general anaesthesia. During surgery, intra abdominal pressure was maintained at 15 mmHg by a CO₂ insufflator and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. Haemodynamic parameters, EtCO₂, SpO₂ and ECG were recorded before and after induction and positioning of the patients and at 5 minutes interval for the first 30 minutes, then 10 minutes interval for the rest of the period. Highly significant increase (p<0.001) in pulse rate, systolic, diastolic and mean arterial pressure occurred at 30 minutes after insufflations and positioning of the patient. A very highly significant (p<0.001) increase in EtCO₂ from the base line was at 40 minutes after insufflations and positioning of the patients. There was no change in SpO₂ and ECG. This study supports the significant physiological changes in terms of haemodynamic and EtCO₂ during laparoscopic cholecystectomy and recommends the meticulous monitoring of these parameters during the surgery and balance the benefit of laparoscopy against the intra operative risk.

Effect of Trichoderma on Seed Germination and Seedling Parameters of Chili

T. virens IMI-392430, T. pseudokoningii IMI-392431, T. harzianum IMI-392432, T. harzianum IMI-392433 and T. harzianum IMI-392434 were evaluated for their potentiality on seed germination and seedling parameters in chili both laboratory and field conditions. Chili seeds were coated with spore suspension of each test strains of Thichoderma supplemented with 2 % of starch (w/v) as an adhesive. Seed germination percentages and the vigour index were significantly affected by the application of different strains of Trichoderma. Among the five Trichoderma strains, T. harzianum IMI-3924332 gave the highest germination percentage followed by T. harzianum IMI-3924333, T. harzianum IMI-3924334, T. virens IMI-392430 and T. pseudokoningii IMI-392431 treatment both in laboratory and field conditions, respectively while control decrease these value. Chili seeds also gave the highest vigour index values with T. harzianum IMI-3924332 which confirmed to better germination. Seed treatment with T. harzianum IMI-3924332 can be useful to enhance the germination of chili seeds as well as reduce to delayed germination. Further investigations however are required to study in vivo effect of Trichoderma strains on morphological and physiological characteristics in chili plant and fruit production. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14637 J. Sci. Foundation, 8(1&2): 141-150, June-December 2010

Molecular Characterization of Phomopsis vexans Isolates of Eggplant of Bangladesh

Forty-four isolates of Phomopsis vexans were collected from eggplant producing areas of Bangladesh during the 2008-2009 growing seasons. The polymerase chain reaction (PCR) -variable number of tandem repeats (VNTR) technique was used to develop molecular markers. The MR-20 primer amplified template DNA for all isolates studied and resulted in distinct bands. The banding patterns of P. vexans isolates were separated into five groups after results with Taq polymerase. The highest genomic DNA concentration 50 ng/?l was found in the isolates of 8, 14, 26, 27 and 38, and the lowest concentration of genomic DNA was found 12.5 ng/?l in the isolates of 1, 2, 5, 15, 17, 22, 30, 31, 33, 34, 36, 40, 41, 42 and 43. Based on the fingerprinting the 44 isolates of Phomopsis vexans were categorized into five different groups. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14636 J. Sci. Foundation, 8(1&2): 131-140, June-December 2010

Role of Fruits on Public Health

An investigation was carried out on the role of fruits on public health. Amount of nutrition value on different fruits of Bangladesh also examined. Fruits are not only good source of vitamins and minerals but also highly nutritive with anti carcinogenic value. The role of sufficient intake of fruits can prevent many life threatening diseases of human beings like diabetics, blood pressure, heart diseases and cancer. Altogether 39 fruits, the highest water portion 96.6 g was found in black berry and Jamun, and the lowest 4.3 g were found in coconut. The highest total minerals 1.7g was measured in date palm and the lowest 0.1 g was found in orange, black berry and Jamun. The maximum fiber 6.6 mg was found in coconut and the lowest 0.2 g was found in jackfruit and water melon. The highest Calorie 662 Kcal was found in coconut and the lowest 11 Kcal was measured in black berry and Jamun. The highest protein 3.5 g was found in elephant’s foot apple and the lowest 0.2 g was found in water melon. The highest fat 62.3 g was found in coconut and the lowest 0.1 g was found in jackfruit, ber, elephant’s foot apple, orange, Bullock’s heart/Custard apple, Hogplum, Olive, Aonla, River ebony and Water chestnut. The highest Carbohydrate 33.8 g was found in date palm and the lowest 1.4 g was found in black berry and Jamun. The highest 90 mg was found in Lime and the lowest 0.01g was found in River ebony. The highest amount of Fe 7.9 mg was found in water melon and the lowest 0.2 mg was found in Pummelo. The highest amount of Carotene 8300 ?g was found in mango and the lowest 0 ?g was found in litchi, ber, elephant’s foot apple, orange, lemon, Bullock’s heart/Custard apple, coconut, banana, Aonla and water chestnut. The highest amount of vitamin B-1 0.8 mg was found in elephant’s foot apple and the lowest 0.01 mg was found in Wax apple, tamarind and Rose apple. The highest amount of vitamin B-2 0.19 mg was found in Burmese grape and the lowest B-2 0.01 mg was found in orange, coconut and olive. The highest amount of vitamin C 463 mg was found in Aonla and Stargareberry, and the lowest 1 mg was found in coconut and water melon. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14633 J. Sci. Foundation, 8(1&2): 111-118, June-December 2010

Antimicrobial, Antioxidant and Cytotoxic Activities of Callistemon citrinus (Curtis) Skeels

The petroleum ether, ethyl acetate and methanol extracts of the stem bark of Callistemon citrinus were subjected to screenings for antimicrobial and antioxidant activities and brine shrimp lethality. The ethyl acetate  extract and its column fractions XVIII and XIV exhibited moderate antimicrobial activity, while the methanol extract  revealed significant antioxidant activity having IC50 of 3.84 ?g/ml. The methanol extract and fraction-II showed  potent cytotoxic its cytotoxicity with the LC50 of 11.27 and 11.35 ?g/ml, respectively. DOI: http://dx.doi.org/10.3329/dujps.v11i1.12487 Dhaka Univ. J. Pharm. Sci. 11(1): 51-54, 2012 (June)