Frequency of Regional Metastasis in Supraglottic Carcinoma of Larynx

Background: Incidence of laryngeal cancer still high among the upper aerodigestive tract. 85–95% of these laryngeal cancer is squamous cell carcinoma. Locally advanced laryngeal cancer metastasize more. Supraglottic cancers have the highest prevalence of regional metastases among laryngeal cancers. Objectives: To evaluate the frequency of regional metastasis in supraglottic carcinoma of larynx. Methods: This cross-sectional study was conducted including 40 patients with supraglottic Carcinoma of Larynx over a period of six months from June to November 2014 in the ENT and Head Neck Surgery department of Rajshahi Medical College Hospital, Rajshahi. Those with glottic carcinoma, subglottic carcinoma, hypopharyngeal carcinoma, metastatic neck node without any primary site (Occult primary) were excluded from the study. FNAC from neck node was done in patients with palpable neck node. Results: Most of the patients 19 (47.5%) was in age group 50-60 years with mean age 54.5±13.2 years. Most of the patients present with more than one symptom & the commonest presenting symptoms was cough and irritation 35(87.5%) followed by dysphagia 26(65%) and change of voice 24(60%). A good number of patients, 16(40%) was presented with neck swelling. Among 40 patients, 16(40%) had their regional lymph nodes involved. Level-II lymph nodes were involved in higher number of cases 10(62.5%). Nodes in early stage of involvement were found in most cases 9(56.5%). Homolateral involvement of nodes was found in most cases 13(81.3%).Most of the supraglottic growths 22(55.0%) was exophytic in appearance. The common site of supraglottic carcinoma in this study was aryepiglottic fold and arytenoids 20(50.0%). Among the patients, 31(77.5%) had T2 tumours. Amon them, 16(40%) were in stage-III followed by stage-II 10(25%). Conclusion: Regional metastasis is a very useful prognostic indicator. Supraglottis is rich in lymphatic drainage and a high proportion of these tumors spread to lymph nodes. Bangladesh J Otorhinolaryngol 2022; 28(2): 180-185

Medical Treatment of Adenotonsillar Hypertrophy- Study of 50 cases

Objective: To examine the efficacy of combined use of intranasal steroids, antibiotics and monteleukast for improving adenotonsillar hypertrophy. Materials and Methods: This prospective study was done at Bangladesh ENT Hospital, Dhaka from January 2020 to June 2021. 50 children were included with primary symptoms of mouth breathing, snoring and sleep disturbances. X-ray soft tissue nasopharynx lateral view was done before and after treatment for comparison. All were prescribed intranasal fluticasone, phenoxymethyl penicillin and monteleukast for 3 months and followed up after completion of 3 months treatment. Results: The age of the children ranged from 2-12 years with mean age 5.4 years. There were 30 female and 20 male with female male ratio 3:2. 30 patients (60%) got complete relief of primary symptoms, 12patients (24%) got moderate improvement of symptoms and 8(16%) patients got no benefit of medical treatment and referred for surgery. Conclusion: Intranasal steroid along with oral penicillin and monteleukast are effective reducing size of adenotonsillar hypertrophy, relieving symptoms and reducing the need for surgery. Bangladesh J Otorhinolaryngol 2022; 28(1): 16-21

Outcome of Total Laryngectomy in Regional Hospitals of Bangladesh

Objectives: To analyze post operative complications, local recurrence, functional outcome of speech & swallowing and survival rate following total laryngectomy. Methods: This prospective observational study was done in four major tertiary care medical college hospitals of Bangladesh from July 2000 to December 2019. All operations were done by a single surgeon, one of the authors of this study based on the personal experience. 45 patients were selected who underwent total laryngectomy for biopsy proven advanced (T3 and T4) laryngeal cancer as primary case & recurrent cases following radiotherapy. Patients were followed up monthly for three months and then six monthly for two years and yearly for rest of their life. Results: Age of the patients ranged from 42 to 80 years with mean age 56.7 years. In postoperative period 03 (6.6%) patients developed wound infection, 03 (6.6%) stomal stenosis, 03 (6.6%) stomal recurrence, 02 (4.4%) seroma, 02 (4.4%) pharyngo-cutaneous fistula and 01 (2.2%) case developed pharyngeal stenosis. In post laryngectomy voice rehabilitation 33 (73.3%) cases used esophageal voice, 07 (15.5%) cases used electrolarynx and 05 (11.1%) cases used bloom singer valve. Out of oesophageal speech, 2 patients had poor speech, Regarding swallowing all patients had very good swallowing except one patient who got pharyngeal stenosis, needed dilation. 3 patients died in subsequent 2 years follow-up and overall survival was 93.3%. Conclusion: Outcome of total laryngectomy depends on site and size of tumour, nodal metastases, recurrent cases and co-existing co-morbidities. Total laryngectomy with or without radiotherapy offers significantly higher local control and survival benefit with advanced laryngeal cancer, compared to radiotherapy only. Bangladesh J Otorhinolaryngol 2021; 27(2): 139-144

Incidence of Thyroid Cancer in Thyroid Swelling, Study of 200 Cases

Objective: The incidence of thyroid cancer has rapidly increased in the United States (US) and other developed countries over the past 30 years but there is no study to find out the true incidence of thyroid cancer in Bangladesh. The aim of this study is to compare FNAC with histopathology reports and to find out the true incidence of thyroid malignancy in thyroidectomy patients presenting with thyroid swelling. Methods: This is a prospective study of 200 thyroid swelling patients underwent thyroid surgery done at Shaheed Suhrawardy Medical College Hospital, a tertiary Care Hospital in Dhaka from July 2017 to December 2020. FNAC and histopathology reports were studied to find out the incidence of benign and thyroid malignancy among the thyroid swelling. Results: The age of the patients ranged from 8 to 75 years. The mean age was 37.2 years. There were 156 female and 44 male patients with female male ratio 3.54:1. Diagnostic categorization of 200 thyroid swelling underwent surgery, FNAC based on Bathesda classification showed that 163 (81.5%) cases were cytologically benign, 37 (18.5%) cases were malignant category. Out of 200 cases histopathology showed134 cases(67.0%) are benign and 66(33.0%) are malignant thyroid swelling. Among the benign lesions96.31% are colloid goiter and among the malignant lesions 93.4% are papillary thyroid carcinoma. Conclusion: Although FNAC is an essential diagnostic test to rule out thyroid malignancy but histopathological examination is the only way to give true incidence of thyroid malignancy among the thyroid swelling and it is observed that there is high incidence of thyroid malignancy(33.0%) among the thyroid swelling patient underwent thyroid surgery. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 12-16

Medicolegal Issues in ENT Practice

Abstract not available Bangladesh J Otorhinolaryngol; April 2021; 27(1): 1-3

Synthesis and characterization of nanozeolite based composite fertilizer for sustainable release and use efficiency of nutrients

In this research work, we propose macronutrients incorporated slow-release based nano-fertilizer using nanozeolite as a carrier. A simple chemical approach was used to synthesis the proposed nanozeolite composite fertilizer (NZCF). To gain an insight into the properties, morphology and structure of the synthesized NZCF, it was further characterized by different techniques such as powder XRD, FT-IR, SEM, and TG/DTA. A considerable enhancement of the quality and the water retention capacity of the soil was observed as a result of applying the proposed NZCF when compared with a commercial fertilizer. Furthermore, the swelling ratio and the equilibrium water content of NZCF were compared to the commercial fertilizer and their effect on plant growth was observed. Slow-release studies were carried out for both NZCF and the commercial fertilizer. The results of these studies reveled that NZCF possessed a long-term release pattern of the macronutrients and that showed a great potential for promoting plant growth. Hence, the prepared nanocomposite fertilizer can be safely used as an environment-friendly source of nutrients to enhance plant growth.

Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

BACKGROUND

The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain.

METHODS

We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale.

RESULTS

A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events.

CONCLUSIONS

Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).

Mesenchymal Chondrosarcoma of the Parotid Gland

Mesenchymal Chondrosarcomas of the parotid are extremely rare tumours. They are broadly classified under extra skeletal form of mesenchymal chondrosarcomas and account for less than 1% of all sarcomas. It is characterized by a multinodular architecture, abundant myxoid matrix, and malignant chondroblast like cells arranged in cords. The tumor is an entity from chondrosarcomas of bones, commonly found in the soft tissues of the lower extremities at 80%. There are very limited reports of this tumor in the head and neck, especially in the parotid gland. We report a rare case of a parotid mesenchymal chondrosarcoma in a 55 years old man and discuss the pathogenesis, clinical presentation and management of such a rare tumour Bangladesh J Otorhinolaryngol; October 2020; 26(2): 158-160

Flood inundation mapping- Kerala 2018; Harnessing the power of SAR, automatic threshold detection method and Google Earth Engine

Flood inundation maps provide valuable information towards flood risk preparedness, management, communication, response, and mitigation at the time of disaster, and can be developed by harnessing the power of satellite imagery. In the present study, Sentinel-1 Synthetic Aperture RADAR (SAR) data and Otsu method were utilized to map flood inundation areas. Google Earth Engine (GEE) was used for implementing Otsu algorithm and processing Sentinel—1 SAR data. The results were assessed by (i) calculating a confusion matrix; (ii) comparing the submerge water areas of flooded (Aug 2018), non-flooded (Jan 2018) and previous year’s flooded season (Aug 2016, Aug 2017), and (iii) analyzing historical rainfall patterns to understand the flood event. The overall accuracy for the Sentinel-1 SAR flood inundation maps of 9th and 21st August 2018 was observed as 94.3% and 94.1% respectively. The submerged area (region under water) classified significant flooding as compared to the non-flooded (January 2018) and previous year’s same season (August 2015–2017) classified outputs. Summing up, observations from Sentinel-1 SAR data using Otsu algorithm in GEE can act as a powerful tool for mapping flood inundation areas at the time of disaster, and enhance existing efforts towards saving lives and livelihoods of communities, and safeguarding infrastructure and businesses.

Structural and optical properties of sol-gel synthesized h-MoO3 nanorods treated by gamma radiation

High energy external gamma radiation has always an impact on semiconductor material by altering its physico-chemical properties. In this paper, the effect of gamma-radiation is observed on sol-gel synthesized metastable h-MoO3 nanorods with absorbed dose variation. The irradiated sample shows a remarkable change in their structural parameters such as average crystallite size decreased, strain, and dislocation density increased and so on are confirmed from the x-ray diffraction (XRD). Functional groups and the corresponding vibration and stretching are analyzed from the Fourier transform infrared spectroscopy (FTIR). The change in surface morphology is observed from the field emission scanning electron microscopy (FESEM) image and found no remarkable change. However, the optical band gap decreases with increasing absorbed dose and calculated 2.84 eV, 2.82 eV, 2.80 eV and 2.77 eV for 0 kGy, 40 kGy, 80 kGy, and 120 kGy, respectively by Kubelka-Munk (K-M) function from the diffuse reflectance data of UV–vis-NIR spectrophotometer.

Video Head Impulse Test (vHIT) and Vestibular Evoked Myogenic Potential (VEMP) Test for Assessment of Vertigo: Our Initial Experience

Introduction: Loss of balance causes the sensation of vertigo. Balance is maintained by vestibular afferent from labyrinth, eyes and proprioceptors and their central integration. For diagnosis of vertigo, along with history different vestibulometric tests can be done to identify the specific anatomical part that is involved. Material and methods: A cross sectional study was done among 82 patients who did video Head Impulse Test (vHIT) and among 75 patients who did Vestibular Evoked Myogenic Potential (VEMP) test at AudiovestibularCentre(AVC) at Bangladesh ENT Hospital Ltd. during the period from April 2018 to September 2019. Results: Age range of the sample was 16 to 80 years. Among the 82 patients who did vHIT 62(75.6%) had abnormality in either Semi Circular Canal. Among 75 patients who did VEMP 27(36%) were detected to have abnormality in either in saccule or utricle. Conclusion: For diagnosis of cause of vertigo the appropriate test for individual part of vestibule is essential. vHIT and VEMP are two tests which are complementary to each other in explaining common peripheral causes of vertigo. Bangladesh J Otorhinolaryngol; April 2020; 26(1): 5-9

IMRT: Is it superior to formal radiotherapy in the treatment of head neck cancer?

Abstract not available Bangladesh J Otorhinolaryngol; October 2019; 25(2): 64-65

Papillary thyroid carcinoma with neck metastasis in a 6 year old child: A case report

Thyroid cancers account for 0.5-3.0% of all childhood malignancy. But these cancers are extremely rare in paediatric age group before the age of 6 years. Although the disease is biologically more aggressive in children when compared with adults, the prognosis is better in several series. We report and discuss a case of 6 years old child with papillary thyroid carcinoma, which is the youngest reported case in Bangladesh. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 60-63

Coblation versus Diode Laser Tonsillectomy in Children: A Randomized Controlled Trial

Objective: This study aimed to compare the efficacy of diode laser and coblation tonsillectomy in paediatric patients in relation to operative time, amount of blood loss, post operative pain, healing of tonsillar fossa and returns to normal diet. Methods: A total of 200 patients ,100 for coblaton and 100 for diode laser, aged 3-12 years with recurrent tonsillitis with or without snoring and sleep apnoea were recruited. Participants were prospectively randomised to diode laser and coblation tonsillectomy. Operative time and blood loss were recorded. Pain was recorded by VAS or assessed by using analgesic. Results: The operative time were recorded 07-15 minutes,mean 10 minutes in coblation group and 12-20 minutes ,mean 14 minutes in laser group., Blood loss was recorded 0-15 ml mean 8 ml in coblation group and 10-25 ml mean 13.5 ml in diode laser group . However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with coblationtonsillectomy groups.Coblation group started normal soft diet on day 5 whereas diode laser started on day 8 Conclusion: Coblation tonsillectomy is associated with less operative time and blood loss, early returns to normal diet and less pain score in comparison to Diode laser tonsillectomy Bangladesh J Otorhinolaryngol; October 2017; 23(2): 140-145

Pleomorphic Adenoma of the Nasal Vestibule – A Rare Case

Pleomorphic adenomas arising in the nasal cavity are extremely uncommon, despite the large numbers of minor mucous and serous glands in the region. We present a rare case of a pleomorphic adenoma arising from the right nasal vestibule in a 65-year-old man complained of right nasal obstruction for 6 months. Anterior rhinoscopy showed a reddish, firm, polypoid mass in right nasal cavity which is free from the nasal septum and from the inferior tubinate but it was attached to the nasal vestibule. Flexible nasal endoscopy showed no extension of the mass towards the posterior choana or nasopharynx. The mass was completely excised from the nasal vestibule through intranasal approach and sent for histology which confirmed a pleomorphic adenoma with a predominant stromal component. The main treatment modality is surgical resection with histological clear margins. Recurrences and evolution to malignancy are not frequent, but long tern follow-up is recommended. In our case, the patient demonstrated satisfactory cosmetic results with no evidence of recurrence. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 88-91

Socio-economic performance of Bt eggplant cultivation in Bangladesh

A study was conducted in 35 districts of Bangladesh during 2016-17 winter season for assessing the farm level performance of Bt eggplant in reducing pesticide use, cultivation cost and increase farm income. Five hundred five Bt eggplant farmers were selected purposively and 350 non-Bt eggplant farmers were selected randomly for the study. Net returns per hectare were Tk. 179,602/ha for Bt eggplant as compared to Tk. 29,841/ha for non-Bt eggplant. Pesticides were applied 11 times to Bt eggplant where as it was 41 times to non-Bt eggplant for controlling sucking pests. The Bt eggplant farmers saved 61 percent of the pesticide cost compared to non-Bt eggplant farmers, experienced no losses due to fruit and shoot borer, and received higher net returns. The experience with Bt eggplant technology was good for most of the locations and up to the mark and off course this technology will be significantly improved to their socio-economic conditions in future as reported by the Bt respondents. All Bt and 86% non-Bt farmers wanted to cultivate Bt eggplant in the next year if they can obtain the seeds/seedlings from the research station. For getting higher yield and economic benefits, in the course of technology dissemination, the importance of good production practices must be emphasized.Bangladesh J. Agril. Res. 43(2): 187-203, June 2018

Septoplasty in children: Results of 250 cases

Backround: Septoplasty in children is still a matter of debate, because it is thought that a surgical procedure on a developing structure might produce some adverse effects on normal nasal and facial growth.On the other hand septal deviation in children may alter the early physiological process of breathing, causing obligatory mouth breathing and consequently changing craniofacial development and even intellect.Objectives: The goal of this retrospective study is to indicate the importance of septoplasty in children,to evaluate the effects of paediatric nasal septal surgery on normal nasal and facial growth, improvement of symptoms and any complications of surgery.Methods: This is a retrospective study of 250 children in the age group of 7-14 years done at Maleka nursing Home , Bogra, Human care hospital, Rajshahi and Khidma hospital Dhaka,from January 1999 to December 2014.All patients were selected from history, clinical examination and selected investigations. All patients had X-ray soft tissue nasopharynx done to see adenoid enlargement.Some patients had done PTA and tympanometry to confirm OME. All patients had septoplasty done with left hemitranfixional incision with elevation of left mucoperichondrial flap and elevation of both mucoperiosteal flaps. In addition adenoidectomy was done for adenoid enlargement and myringotomy with grommet insertion for OME. Patients were followed up on day 8, day 15, 1 mothh, 6 month and one year after operation.Results: Out of 250 children there were 163 male(65.2%)and 87 female(34.8%).Age ranged from 7 to 14 years,lowest number of patients were between 7 and 8 years old-64(25.6%),between 9 and 11 years-73(29.2) and 113(45.2%) between 12 and 14 years.210 patients had septal deviation to left side(84%) Patient felt improvement in nose breathing in 85% of cases.The most often complication was nasal blockage due to insufficient removal of deviated septum in 9.2 % of cases.We had synechia in 8 cases and septal haematoma in 2 cases.There were no asthetic deformities.Conclusion: Effective septal correction by septoplasty in children not only relieves nasal blockage but also controls the associated symptoms.Septolasty in early childhood does not produce any untoward events in terms of the growth and development of the nose and face.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 110-114

Haemangiopericytoma of the Larynx: A Rare Clinical Entity

Haemangiopericytomas are rare vascular neoplasms of the head and neck.Laryngeal involvement is even extremely rare ,with only 11 previously reported cases in the literature .We present an unusual case of a 45 years old man with obstructing left glottic mass .Tracheostomy was done for the stridor and FOL showed huge reddish vascular mass which was attached along the whole length of the undersurface of the left vocal cord.Microlaryngoscopic excisionof the whole mass was done ,with biopsy consistent with a haemangiopericytoma.Following operation tracheostomy tube was put off and he got his voice back.The patient is currently 2 years post op follow-up with no recurrence. Otolaryngologists need to be aware of this rare tumour that can be treated successfully with surgical resection.Close long term follow up is needed since recurrence can present many years after initial treatment.Bangladesh J Otorhinolaryngol; April 2015; 21(1): 47-50

Diode laser versus blunt dissection tonsillectomy

Introduction: Tonsillectomy is the commonest operation performed in Ear, Nose and Throat Department. Various methods of tonsillectomy have been practiced over the century aimed at  reducing or eliminating intra-operative and postoperative morbidity.Aim: This prospective study is aimed at evaluation of advantages and disadvantages of laser tonsillectomy over blunt dissection tonsillectomy in respect of operative time, intra-operative blood loss, postoperative pain, rate of healing of tonsillar fossa and other postoperative complications.Method: This prospective randomized study was done for 18 months from April 2010 to September 2011.One hundred patients were divided into two groups of equal number. In one group, the tonsillectomy performed by Diode laser and in the other group the tonsillectomy performed by conventional dissection technique.Results: Age ranged from 5 - 34 years with mean age 15.4 in laser group and 4-35 years with mean age 15.98 in dissection group. Operative time and amount of blood loss is significantly reduced in the laser group (10-25 min, mean 12 min in laser group, 15-45 min, and mean 25 min in dissection group). Tonsillectomy by using laser has shown less intra-operative bleeding (5ml-20 ml, mean 10 ml compared with 45-250 ml, mean 70 ml in dissection method). Patients experienced mild to moderate pain in laser group and moderate to severe pain in dissection group in first 24-48 hours. Pain increased in intensity after 5-6 days in laser group. On 8th post operative day thin to thick white coating is observed with smooth tonsillar fossa in laser group whereas granulation tissue is observed in dissection group.Conclusion: In conclusion laser tonsillectomy has some advantages over dissection method.  There is less operative time and intra-operative bleeding and less immediate post operative pain. Disadvantage of laser tonsillectomy is that there is more pain in 5th to 6th post operative period this may be due to thick slough formation. DOI:http://dx.doi.org/10.3329/bjo.v18i2.11983 Bangladesh J Otorhinolaryngol 2012; 18(2): 114-118

Characterization of Mycobacterium africanum subtype I among cows in a dairy farm in Bangladesh using spoligotyping

Acid-fast bacilli (AFB) were detected in the autopsy lung tissue homogenate samples of four cows (variety Frisian cross) in a dairy farm in Bangladesh. Histopathological examination of the lung tissue demonstrated prominent granulomas, caseating necrosis and calcification indicative of tuberculosis (TB) infection. Mycobacteria could not be cultured from the tissue homogenate samples by Lowenstein-Jensen based conventional culture method though AFB were evident by Ziehl-Neelsen (ZN) staining of the smears of tissue homogenate and in paraffin embedded tissue slices. Spoligotyping performed on DNA extracts of paraffin embedded lung tissue samples confirmed the AFB as a member of the M. tuberculosis complex (MTBC) with a pattern assigned to M. africanum subtype I. This characterization by spoligotyping was confirmed by subjecting M. africanum subtype I isolates from other parts of the world to an alternative identification method based on DNA polymorphism in the gyrB gene (Hain Life Science, GmbH, Nehren, Germany). Since M. africanum is believed to be a human pathogen, general infection in cattle may be a public health threat. The presence of these bacteria in the animal reservoir most likely originated from a caretaker.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

A profile of 100 complicated cases of chronic suppurative otitis media

A two year study of cases of chronic suppurative otitis media admitted in the Ear, Nose and Throat (ENT) Department of Sir Salimullah Medical College and Mitford Hospital from January 1991 to December 1992 was done. 112 patients of chronic suppurative otitis media (CSOM) were admitted during this two year period, out of which 100 patients (89.3%) presented with different types of complications and only 12 patients (10.7%) presented with no complications. Factors associated with the late presentation of the disorder, including poor socioeconomic conditions and lack of hospital facilities, are identified. Measures to prevent the rate of complications and hearing loss in children are suggested.

Etiology and clinical profile of hepatocellular carcinoma in Bangladesh

Sixty-four consecutive subjects with hepatocellular carcinoma were prospectively studied in the department of Hepatology, IPGMR, Dhaka. Their mean age was 50.11 years. Fifty-two were male and 12 female. Cirrhosis was present in 12 (18.75%) subjects. Thirty subjects (46.88%) had HBsAg in their sera. Seven (58.33% of females) patients gave history of use of oral contraceptives. Cirrhosis, HBV infection, male sex, middle age, and probably the use of oral contraceptives in females appeared to be important risk factors for development of HCC in Bangladesh. Majority of patients presented with upper abdominal pain, weight loss and anorexia. Hepatomegaly was invariably present. Alpha fetoprotein was significantly higher in cirrhotic HCC patients than in non-cirrhotic ones. Median survival was two months. None of the clinical or laboratory features predicted the prognosis.

Prescribing pattern in acute diarrhoea in three districts in Bangladesh

Irrational use of drugs is a serious problem in the management of diarrhoea in developing countries. Many studies have been conducted in many different countries to document the prescribing pattern in diarrhoeal diseases in the hope of promoting rational use of drugs and thereby improve patient care. In only a few of these studies have standard drug use indicators been used to quantify the extent and nature of irrational prescribing. We report here the findings of a prescribing survey in acute diarrhoea (prescriptions written by graduate doctors) in the government health facilities (GHF) and private dispensaries (PD) in the districts of Dhaka, Tangail and Serajgonj of Bangladesh. In the study a set of standard indicators concerning prescribing, patient care and drug supply developed by the International Network for Rational Use of Drugs (INRUD; and later adopted by WHO) has been employed. Twelve prescriptions given in acute diarrhoea cases in children under 5 years old were prospectively collected on a random basis from each of the 10 centres from three districts. They were analysed by the methods suggested in the INRUD manual.

Effect of intratracheally administered lindane on aldrin and benzo(a)pyrene contents in lungs of rats

Pretreatment with lindane resulted in inhibition of benzo(a)pyrene hydroxylase activity in the lungs of rats. The enzyme activity tended to return to normal 5 days after the administration of lindane. Studies with benzo(a)pyrene and aldrin indicated reduced elimination of these compounds from the lungs of lindane-treated animals, suggesting that lindane may alter the clearance of certain substances or compounds from lungs. The delayed clearance of these compounds from lungs may be an indirect effect of lindane related to inhibition of certain metabolizing enzymes.

Mutagenicity of the bile of dogs with an experimental model of an anomalous arrangement of the pancreaticobiliary duct

To learn the reasons for the high incidence of biliary carcinoma in patients with anomalous arrangement of the pancreaticobiliary duct (APBD) mutagenicity of the bile of APBD-modeled dogs that had received a dorsal pancreatico-cholecystostomy was assayed by the Ames Salmonella mutation test. The bile from two out of 18 APBD dogs was mutagenic for Salmonella typhimurium strain TA98 under the condition of metabolic activation by rat liver S9 fraction, while the bile from 17 normal dogs was not mutagenic. Furthermore, the bile from five APBD dogs i.p. administered 1-nitropyrene (1-NP), which is a typical environmental mutagen, was more mutagenic for strain TA98 than that from 1-NP-treated normal dogs. The bile from the APBD dogs had very high amylase activity, indicating that the bile contained pancreatic juice as a result of the pancreatico-cholecystostomy. When pancreatic juice from a normal dog was added to the bile from 1-NP-treated normal dogs, mutagenicity of the bile increased 1.6- to 2.0-fold. Furthermore, sulfatase increased the mutagenic activity of the bile in the presence of the pancreatic juice. HPLC revealed that the bile from a 1-NP-treated APBD dog contained mutagenic 1-nitro-6/8-hydroxypyrene and 1-nitro-3-hydroxypyrene, while bile from a 1-NP-treated normal dog did not contain these deconjugated products. The pancreatic juice from a normal dog had very high gamma-glutamyltransferase (GGT) and aminopeptidase activities and low sulfatase activity, but it had no beta-glucuronidase activity. In addition, the bacteria that easily infect the biliary duct of APBD dogs, Escherichia coli, Klebsiella, Enterobacter and Proteus, had high beta-glucuronidase activity. In particular, Klebsiella showed a very high sulfatase activity. These results suggest that pancreatic juice enzymes and bacteria infecting the biliary duct deconjugate the detoxified mutagens in the bile and induce mutagenicity of the bile from APBD dogs or APBD patients.

Neurotoxic esterase activity in brain, spinal cord and platelets of certain birds and mammals

The level of neurotoxic esterase in brain, spinal cord and platelets of certain birds and mammals has been determined. The enzyme activity for the birds was maximal in hens and for the mammals was maximal in rats. The activity decreased progressively in the cerebral cortex, corpus striatum, spinal cord and blood platelets of the birds as well as the mammals. The difference in the susceptibility of birds and mammals to organophosphate-induced delayed neurotoxicity may be related to differences in the relative concentrations of the enzyme in the different species.

The role of adrenals in diazinon-induced changes in carbohydrate metabolism in rats

Treatment of rats with diazinon (40 mg/kg, i.p.) resulted in hyperglycaemia and depletion of glycogen from the brain and peripheral tissues two hours after administration. The activities of glycogen phosphorylase and phosphoglucomutase were significantly higher in the brain and liver; that of glucose-6-phosphatase was not altered. The activities of the glycolytic enzymes hexokinase and lactate dehydrogenase were increased only in the brain. The cholinesterase activity in the brain was reduced by treatment with diazinon. The activities of the hepatic gluconeogenic enzymes fructose 1,6-diphosphatase and phosphoenolpyruvate carboxykinase were significantly increased. The lactate level was increased in the brain and blood, whereas that of pyruvate was not changed. The activity of glucose-6-phosphate dehydrogenase was not changed to any major extent. Cholesterol and ascorbic acid contents of adrenals were depleted in diazinon-treated animals. The changes were pronounced after intraperitoneal administration of 40 mg/kg diazinon, they were slight but significant after 20 mg/kg, and absent after 10 mg/kg. Hyperglycaemia and changes in carbohydrate metabolism were abolished by adrenalectomy suggesting possible involvement of adrenals.

Modification of malathion induced neurochemical changes by adrenalectomy in rats

The neurochemical changes induced by malathion, an organophosphate compound, were determined in rats. Maximal changes were found in the brain 2 h after the administration of malathion in a dose of 500 mg/kg ip. The activities of cholinesterase and succinic dehydrogenase were reduced whereas those of glycogen phosphorylase, phosphoglucomutase, and hexokinase were increased; the lactate content of brain was also increase. In malathion treated adrenalectomized animals, changes in the activities of cerebral cholinesterase and succinic dehydrogenase were still present; other changes were, however, abolished by adrenalectomy. Activities of certain enzymes, glucose-6-phosphatase, glucose-6-phosphate dehydrogenase, and lactate dehydrogenase were not significantly altered by malathion in normal or adrenalectomized animals. The results indicate that cerebral cholinergic mechanism in malathion treated animals was not modified by adrenalectomy which, however, abolished or reduced changes in the activities of certain glycolytic and glycogenolytic enzymes that are involved in the utilization or metabolism of glucose. The brain lactate content in malathion treated adrenalectomized animals was, also, not significantly different from the control values, suggesting that modification of induced changes by adrenalectomy.

Modification of diazinon-induced changes in carbohydrate metabolism by adrenalectomy in rats

Treatment with diazinon (40 mg/kg, i.p.) resulted in hyperglycemia and depletion of glycogen from cerebral and peripheral tissues 2 hr after its administration in rats. The activities of the glycogenolytic enzymes glycogen phosphorylase and phosphoglucomutase were increased significantly in brain and liver, whereas that of glucose-6-phosphatase was not altered. The activities of the glycolytic enzymes hexokinase and lactate dehydrogenase were increased only in the brain. The cholinesterase activity of the brain was reduced by treatment with diazinon. The activities of the hepatic gluconeogenic enzymes fructose 1,6-diphosphatase and phosphoenolpyruvate carboxykinase were also increased significantly in diazinon-treated animals. The level of lactate was increased in brain and blood, whereas that of pyruvate was not changed. The activity of glucose-6-phosphate dehydrogenase was not changed significantly. The cholesterol and ascorbic acid contents of adrenals were depleted in diazinon-treated animals. The hyperglycemia and changes in carbohydrate metabolism were abolished by adrenalectomy, suggesting the possible involvement of the adrenals in the induced changes in diazinon-treated animals.

Effect of adrenalectomy on diazinon-induced changes in carbohydrate metabolism

Treatment with diazinon resulted in hyperglycaemia and depletion of glycogen from cerebral and peripheral tissues 2 h after its administration in rats; the changes were maximal after 40 mg/kg diazinon, administered intraperitoneally. The activities of glycogen phosphorylase and phosphoglucomutase were significantly increased in brain and liver, while that of glucose-6-phosphatase was not altered. The activities of the glycolytic enzymes hexokinase and lactate dehydrogenase were increased only in brain. The cholinesterase activity of the brain was reduced by treatment with diazinon. The activities of hepatic gluconeogenic enzymes (fructose 1,6 diphosphatase and phosphoenolpyruvate carboxykinase) were also significantly increased in diazinon-treated animals. The level of lactate was increased in brain and blood while that of pyruvate was not changed. The activity of glucose-6-phosphate dehydrogenase was not significantly changed. Cholesterol and ascorbic acid contents of adrenals were depleted in diazinon-treated animals. Adrenalectomy abolished the hyperglycaemia and changes in carbohydrate metabolism, suggesting the possible involvement of adrenals in the induced changes in diazinon-treated animals.

Biliary stones and bacteriae in bile study in 211 consecutive cases

A retrospective study have been performed to investigate the correlation between stone formation and bacteriae in the bile of 211 consecutive biliary stone patients (133 females and 78 males, age ranged 1.3 to 87.0 years old, 196 cholecystolithiasis, 54 choledocholithiasis and 9 hepatolithiasis). They had undergone surgery since January 1980 to December 1987. Bile was collected to perform bacterial culture from the gallbladder and common bile duct during operation and all stones had been classified according to morphology after surgery and confirmed with component analysis if necessary. Totally 5115 stones had been collected and 20.4% had been classified as pure cholesterol stone, 16.8% as combination stone, 17.2% as mixed stone, 23.6% as calcium bilirubinate stone, 17.6% as black stone, 0.8% as calcium fatty acid stone and 3.6% as unknown. In bile culture, 84 from the gallbladder and 31 from the common bile duct were positive. Streptococci were the most frequent and followed by Klebsiella, Escherichia coli and so on. A higher incidence of positive culture was shown in calcium bilirubinate and lower incidence was shown in cholesterol stones. These results suggest that bacteriae in the bile may play a role in the formation of pigment biliary stones.

Distribution of neurotoxic esterase in certain brain regions of laboratory animals

Certain organophosphorous compounds caused the inhibition of 'neurotoxic esterase' present in central nervous system. The role of this enzyme is different from that of cholinesterase. The level of neurotoxic esterase in brain, corpus striatum and spinal cord of rats, mice, guineapigs and hens was measured. Maximum level of the enzyme was found in hens, followed by guineapigs, rats and mice in the order. The concentration of the enzyme was higher in corpus striatum greater than whole brain greater than spinal cord. The determination of the normal level of neurotoxic esterase may be useful in monitoring the exposure to organophosphorous compounds.

Convulsions as the etiology of lactic acidosis in acute diazinon toxicity in rats

Diazinon, in acute doses (40 mg/kg, i.p.) in rats produced tremors and convulsions with lactic acidosis which was accompanied by depletion of glycogen and activation of glycogen phosphorylase activity in triceps and diaphragm muscles, 2 h after its administration. Prevention of convulsions with phenobarbitone administered immediately before diazinon, resulted in neither the development of lactic acidosis nor mobilization of muscle glycogen or activation of glycogen phosphorylase. Lactic acidosis was due to depletion of glycogen through enhanced activity of glycogen phosphorylase in muscles on account of tremors and convulsions induced by diazinon in rats.

Cerebral glycogenolysis and glycolysis in malathion-treated hyperglycaemic animals

Treatment with malathion resulted in an increase in the level of blood glucose and lactate and reduced cerebral glycogen, 2 hr after its administration. The blood pyruvate level was not changed. The activities of glycogenolytic enzymes (glycogen phosphorylase and phosphoglucomutase) were increased significantly in the brain, whereas that of glucose-6-phosphatase remained unchanged. The activity of the glycolytic enzyme-hexokinase was increased significantly in malathion-treated animals, whereas those of the glucose-6-phosphate and lactate dehydrogenases were not significantly changed. The changes in enzyme activities may be a compensatory mechanism to provide energy in the form of glucose to cerebral tissue on account of stimulatory effects in malathion-treated animals.

Changes in cerebral glycogenolysis and related enzymes in diazinon treated hyperglycaemic animals

Effect of diazinon (10,20 and 40 mg/kg, i.p.) on the level of blood glucose in rats was investigated. Hyperglycaemia peaked 2 h after i.p. treatment with 40 mg/kg diazinon. The cerebral acetylcholinesterase activity was significantly reduced. The blood level of pyruvic acid was unchanged while that of lactic acid was significantly increased. Convulsions and biochemical changes caused by diazinon (40 mg/kg) were prevented by diazepam injected immediately after diazinon. In diazinon-treated hyperglycaemic animals, the glycogen content of the brain was depleted, the activities of glycogen phosphorylase, phosphoglucomutase and hexokinase were significantly increased and the activity of glucose-6-phosphatase remained unchanged. Lactate dehydrogenase activity was also increased by treatment with diazinon. The induced changes may compensate for the energy requirement of stimulatory effects caused by diazinon.

Cerebral glucose and glycogen metabolism in diazinon-treated animals

The intraperitoneal (IP) treatment of rats with diazinon (40 mg/kg) resulted in a variety of changes in the brain. Glycogen was depleted, but there was an increase in the activities of glycogen phosphorylase, phosphoglucomutase, hexokinase, lactate dehydrogenase, and fructose 1,6 diphosphatase. The activity of glucose-6-phosphatase was unaffected while that of cholinesterase was significantly reduced. Lactic acid content was increased, while that of pyruvate was not altered. Animals developed tremors and convulsions, which were maximal two hours after treatment. The induced changes may be compensatory mechanisms to provide extra energy to cerebral tissue as a result of the stimulatory effects in diazinon-treated animals.

Striatal neurochemical changes and motor dysfunction in mipafox-treated animals

5 mg/kg mipafox [N,N'-bis(1-methylethyl)phosphordiamidic fluoride] was administered s.c. daily for 60 days in rats. The animals developed motor dysfunction-muscle twitchings, fasciculations and slight ataxia towards the end of the experimental period; the motor dysfunction was accompanied by neurochemical changes in the corpus striatum which included significantly reduced levels of cholinesterase, neurotoxicesterase, dopamine and GABA. The neurochemical imbalance in the corpus striatum may be related to motor dysfunction in mipafox-treated animals.

Landholding, wealth and risk of blinding malnutrition in rural Bangladeshi households

The 1982-1983 Bangladesh nutritional blindness study visited 11,618 rural households and examined 18,660 preschool-age children in an effort to determine the prevalence and determinants of eye lesions and loss of sight due to vitamin A deficiency (xerophthalmia). Risk of xerophthalmia was significantly higher for children from households without any of the indicators of relative wealth used. Almost 80% of blind children from landless households, and even a very small garden reduced considerably the chances of a household having a xerophthalmic child. Poorer households with access to less than 0.3 acres land or no garden or without a tin roof, wristwatch, radio or cycle were at least twice as likely as their more fortunate neighbours to have a young child with any type of xerophthalmia. Taking account of such socio-environmental risk factor weightings would direct the scarce resources of intervention programmes to households and children who most need them.

Effect of acetylcholine acetyl-hydrolase (E.C. 3.1.1.7) inhibition on the accumulation of pp' DDT in various brain regions of rats

The concentration of pp' DDT given intraperitoneally in rats was determined in different brain regions. Maximum accumulation of pp' DDT was found in the corpus striatum, followed by cerebellum and cerebral cortex in that order; following pretreatment with paraoxon the concentrations of pp' DDT were increased in all brain regions studied

A possible neurochemical basis of the central stimulatory effects of pp'DDT

The striatal neurochemical changes induced by pp'DDT (600 mg/kg) in mice were: an increase in the concentration of free ammonia, a decrease in the level of GABA and a reduction in the level of acetylcholine. These changes were maximal 5 h after treatment with pp'DDT, when the animals developed 'severe' convulsions. The convulsions and striatal neurochemical changes were modified to different degrees by barbiturates. Phenobarbitone protected all the animals from pp'DDT-induced convulsions. The levels of striatal acetylcholine and GABA in these animals were within normal limits. Prominal reduced the severity of convulsions in pp'DDT-treated animals. The levels of striatal acetylcholine and GABA were significantly lower than control values in these animals. Primidone neither modified the convulsions nor the striatal neurochemical changes in pp'DDT-treated animals. The increase in the concentration of free ammonia, in pp'DDT-treated animals, was not modified by barbiturates. Aminooxyacetic acid raised the GABA level above normal and abolished the convulsions in pp'DDT-treated animals; the level of acetylcholine was within normal limits in these animals. Hydroxylamine produced a similar but less marked effect. Pyridoxine had no effect on convulsions or striatal neurochemical changes induced by pp'DDT. The increase in the concentration of free ammonia in pp'DDT-treated animals was not modified by these agents. It is likely that pp'DDT produced stimulatory effects by increasing the concentration of free ammonia which may be involved in reducing the level of GABA, while changes in the level of acetylcholine may be an effect of pp'DDT-induced convulsions.

Comparative blood values of Macaca mulatta and Macaca fascicularis

Hematological and clinical biochemistry values of two species of monkeys (Macaca mulatta and Macaca fascicularis) were measured by using auto-analyzers. WBC and RBC counts of M. fascicularis were high and Hb, MCV, MCH and MCHC values of M. fascicularis were low in comparison with those of M. mulatta. Albumin and creatinine levels of M. fascicularis were lower than those of M. mulatta. Total protein and A1P values of female M. fascicularis were higher than those of female M. mulatta. Differences between the sexes were observed in MCV, inorganic phosphorus, total protein, albumin and creatinine in M. mulatta, whereas in M. fascicularis, such differences were demonostrated as to creatinine, phospholipids and triglycerides.