Prevalence of Thyroid Dysfunction in Type 2 Diabetes Mellitus

The level of thyroid hormones is often changed in uncontrolled diabetic patients. Screening for Thyroid dysfunction (TD) among patients with Type 2 Diabetes mellitus (T2DM) should be performed considering the increased prevalence of thyroid disorders. This cross-sectional comparative study was conducted in outpatient department of Endocrinology and Medicine, Mymensingh Medical College Hospital, Mymensingh (MMCH) from 1st March 2020 to 30th August 2021. One hundred (100) patients with type 2 diabetes along with 100 (hundred) non-diabetic controls of same age group were enrolled in the study. After taking clinical data, patients were investigated to estimate Fasting plasma glucose (FPG), serum free tri-iodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) level to see thyroid dysfunction. Patients were selected with purposive sampling. Thyroid dysfunction was found to be more in T2DM (15.0%) in comparison with non-diabetic controls (5.0%) and this difference was statistically significant (p=0.018). In both diabetic and non-diabetic groups, subclinical hypothyroidism and hypothyroidism were the most common thyroid dysfunction. Thyroid dysfunction was found more in 40-60 years that suggests the prevalence of thyroid dysfunction are increasing in diabetic patients with advancing age. Thyroid dysfunction was found more among overweight and obese patient in both groups. Mean BMI was found higher among diabetic patient with thyroid dysfunction. Logistic regression showed significant association of Thyroid dysfunction with age >50 years and high FPG level. We found thyroid dysfunction was more prevalent in patients with T2DM than non-diabetics. So, screening for thyroid dysfunction among type 2 diabetic patients by estimating Serum TSH, FT4 level should be performed.

A two-generational reproductive study to assess the effects of Juglans regia on reproductive developments in the male and female rats

Environmental pollutants and lifestyle severely threaten human and animal health, leading to disturbances of various functions, including infertility. So, exploring a safe treatment that could effectively reverse infertility remains a challenge. The current study was intended to explore the fertility-enhancing effect of Juglans Regia oil in two successive generations of rats; F0 and F1. J. Regia oil was initially tested for in vitro antioxidant assay via ROS and DPPH, followed by in vivo toxicity testing. In the fertility assessment, eighteen pairs of male and female rats (n=36, 1:1, F0 generation) were divided into three groups and dosed with 1 mL/kg and 2 mL/kg daily of J. Regia oil and saline, respectively, up to pre-cohabitation, cohabitation, gestation and lactation periods. The reproductive performance, including body weight, live birth index, fertility index, and litter size, was assessed. Hormonal and antioxidant markers of F1 generations were assessed with the histopathological evaluation of male and female organs. The oil of J. Regia showed great antioxidant potential (P < 0.05) in DPPH (1,1-diphenyl-2-picrylhydrazyl) and ROS (Reactive Oxygen Species) methods (P<0.05). The continued exposure of the F0 and F1 generations to J. Regia oil did not affect body weight, fertility index, litter size, and survival index. We have found pronounced fertility outcomes in both genders of F0 and F1 generations with J. Regia 2 mL/kg/day in comparison to the control. Results showed that J. Regia significantly increased (P < 0.05) luteinizing hormone (LH), plasma testosterone, follicular stimulating hormone (FSH), glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in both generations. Histology of both generations reveals improved spermatogenesis and folliculogenesis with enhanced architecture. Altogether, the present results suggest that J. Regia improved fertility in both male and female rats by improving hormonal activities and oxidative stress.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Magnetic Resonance Imaging Evaluation of Common Spinal Intramedullary Tumours: Ependymoma and Astrocytoma

This cross-sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2015 to June 2016 in collaboration with Department of Neurosurgery and Department of Pathology of same hospital, to assess MRI findings of common IMSCTs and to find out the validity of MRI in the diagnosis of spinal ependymoma and astrocytoma, thereby differentiating these two common intramedullary entities. For this purpose, 40 patients aged from 15 to 60 years, who were diagnosed or suspected cases of having intramedullary spinal cord tumours were enrolled. These patients underwent preoperative MRI for evaluation of the spinal cord tumours during the study period in department of Radiology and Imaging. Also, patients were diagnosed by MRI as having IMSCTs incidentally was included. All of them were followed by histopathological examination of the same lesions after surgery. Among these 40 patients after exclusion for valid reason 28 cases were included as study population. MR images were obtained on a 1.5 Tesla (Avanto Magnatom, Siemens) unit with a spine surface coil. MRI findings were compared with histopathology after surgery keeping histopathology as gold standard. Out of 28 clinically and MRI diagnosed IMSCTs cases, 19 cases of ependymoma, 8 cases of astrocytoma and one diagnosed as hemangioblastoma by MRI. The mean age was 34.11±9.55 years, ranging from 15 to 56 years for ependymoma, 26.88±8.08 years ranging from 16 to 44 years for astrocytoma. Highest incidence (47.4%) was in between 31 to 40 years for ependymoma, 50.0% were in between 21-30 for Astrocytoma. On MRI majority 12(63.2%) of the cord ependymomas and majority 5(62.5%) of astrocytomas were in cervical region. While considering axial location ependymomas are mostly 17(89.5%) central and astrocytomas 5(62.5%) are eccentric in location. It was observed that out of 19 cases of ependymoma more than half 10(52.6%) had elongated shape, 12(63.1%) had well defined margin. Associated syringohydromyelia was present in 16(84.2%) cases. On T1WI 11(57.9%) and 8(42.1%) cases were iso and hypo respectively. On T2WI 14(73.7%) cases were hyper intense. After Gd-DTPA in most cases, 13(68.4%) cases showed diffuse enhancement. Noticeable and sizeable solid component observed among 13(68.4%) of the cases. Hemorrhage with cap sign was found in more than one third 7(36.8%) cases. Out of 8 cases of astrocytomas 4(50.0%) had lobulated shape, ill-defined margin 5(62.5%). T1WI: Iso 5(62.5%), hypo 3(37.5%), T2WI: hyper 5(62.5%), After Gd-DTPA: focal and heterogenous enhancement 3(37.5%) and rim enhancement 4(50.0%). Component: mixed 4(50.0%), cystic 3(37.5%) and solid 1(12.5%). Hemorrhage without cap sign 2(25.0%), associated syringohydromyelia 1(12.5%). In the case of evaluation of intramedullary ependymoma sensitivity of MRI in the present series is 94.44%, specificity 80.0%, Positive predictive value (PPV) 89.5%, Negative predictive value (NPV) 88.9% and accuracy 89.28%. In case of MRI evaluation of intramedullary astrocytoma sensitivity of MRI in the present study is 85.71%, specificity 90.47%, PPV 75%, NPV 95% and accuracy 89.2%. Thus present study shows MRI is a sensitive and effective noninvasive imaging modality in diagnosing common intramedullary spinal cord tumours.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Antenatal and postnatal factors associated with neonatal death in the Indian subcontinent: a multilevel analysis

OBJECTIVES

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality.

STUDY DESIGN

Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used.

METHODS

Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths.

RESULTS

Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days.

CONCLUSIONS

The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.

Combining machine learning and structure-based approaches to develop oncogene PIM kinase inhibitors

Introduction: PIM kinases are targets for therapeutic intervention since they are associated with a number of malignancies by boosting cell survival and proliferation. Over the past years, the rate of new PIM inhibitors discovery has increased significantly, however, new generation of potent molecules with the right pharmacologic profiles were in demand that can probably lead to the development of Pim kinase inhibitors that are effective against human cancer.

Method: In the current study, a machine learning and structure based approaches were used to generate novel and effective chemical therapeutics for PIM-1 kinase. Four different machine learning methods, namely, support vector machine, random forest, k-nearest neighbour and XGBoost have been used for the development of models. Total, 54 Descriptors have been selected using the Boruta method.

Results: SVM, Random Forest and XGBoost shows better performance as compared to k-NN. An ensemble approach was implemented and, finally, four potential molecules (CHEMBL303779, CHEMBL690270, MHC07198, and CHEMBL748285) were found to be effective for the modulation of PIM-1 activity. Molecular docking and molecular dynamic simulation corroborated the potentiality of the selected molecules. The molecular dynamics (MD) simulation study indicated the stability between protein and ligands.

Discussion: Our findings suggest that the selected models are robust and can be potentially useful for facilitating the discovery against PIM kinase.

Combined Effects of Nickel and Arsenic on Growth and Mineral Nutrients Accumulation in Kalmi (Ipomoea Aquatica), Red Amaranth (Amaranthus SP.) And Spinach (Spinacia Oleracea L.) And Nutrient Release Pattern In Soil at Different Days of Incubation

Arsenic (As) is a broadly distributed toxic metalloid that accumulates in the environment through natural and anthropogenic sources. Numerous techniques were evolved for arsenic remediation from water including adsorption, flocculation, ion exchange and reverse osmosis. Due to the excessive affinity between iron and inorganic arsenic species, iron-based adsorption is an emerging technique for the remediation of arsenic-contaminated water and soil. Whereas iron (Fe) and nickel (Ni) belong to the same chemical group (VIIIB) in the periodic table, it is expected to get similar interaction of Ni with As. An in vitro incubation study and pot experiment were conducted to evaluate the effect of Nickel on mineral release patterns in soil and growth yield of kalmi (Ipomoea aquatica), red amaranth (Amaranthus sp.) and Spinach (Spinacia oleracea L.). Nickel was applied as different doses of Nickel of 10, 40 and 160 mg/kg respectively where As was applied with irrigation water at the rates of 1 mg/L and incubated at field moisture condition for 10, 20 and 30 days individually in different pots. Total organic carbon (C), total nitrogen (N), phosphorus (P), sulfur (S), potassium (K) and 0.1N HCl extractable arsenic (As), iron (Fe) contents were determined at 10, 20 and 30 days of incubation. The pot experiment was carried out in triplicates for 45 days till the plants were grown to maturity. The growth performance of plants and the remedial effect of Ni on As toxicity in soil and plant was examined. Nickel showed a significant impact on fresh and dry yield of three plants and an antagonistic relationship between Ni and As was also observed i.e., Ni in soil was found to lessen the availability of As in soil likewise its accumulation in plants. J. Biodivers. Conserv. Bioresour. Manag. 2022, 8(2): 79-88

Diagnostic Accuracy of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Tear

The anterior cruciate ligament (ACL) is the most generally injured one of the major knee ligaments. These injuries plague both athletes and non-athletes. This cross-sectional and comprehensive study was conducted in the Department of Radiology and Imaging collaborating with Department of Orthopedics of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, completed from January 2014 to December 2015. The study evaluated the role of MRI in the diagnosis of anterior cruciate ligament injury of knee joint, keeping Arthroscopy as standard, compared the MRI and arthroscopic findings to determine accuracy, sensitivity and predictivity of MRI in the diagnosis of ACL injury in knee joint. For this purpose, a total of 50 patients having clinical suspicion of ACL injury in knee joint were enrolled in this study to perform MRI and Arthroscopy. MRI was done in all these patients. Clinically suspected but MRI diagnosed as no ACL injury, patients who were not willing to undergo arthroscopy examination and patient who were not fit for arthroscopy were excluded from the study. More than half (52.0%) of the patients were in 3rd decade and male to female ratio was 3.5:1. Less than one fourth (24.0%) of the patients were service holder. Forty two percent patients had duration of suffering for 2 weeks. Most 49(98.2%) patients had history of trauma, 45(90.0%) had pain in Knee joint, 24(48.0%) had difficulty in walking, 19(38.0%) had swelling in Knee joint and 13(26.0%) had restricted range of motion. Anterior drawer test was 37(74.0%) and Lachman test 16(32.0%). Loss of normal contour of ACL was found in 50.0%. Signal change of ACL in PD and T2W1 was found 42(84.0%) patients, and thickened ACL in 33(66.0%) patients. In MRI diagnosis tear was present in 80.0% of the patients. ACL tear diagnosed by MRI among the patients, 20(40.0%) had partial tear and 20(40.0%) had complete tear. In arthroscopy diagnosis 38(76.0%) had tear present. ACL tear diagnosed by arthroscopy of the patients 15(30.0%) had partial tear and 23(46.0%) had complete tear. Majority 20(40.0%) patients had medial meniscus injury, 15(30.0%) had lateral meniscus injury, 11(22.0%) had PCL injury, 4(8.0%) had lateral co-lateral ligament injury and 2(4.0%) had medial co-lateral ligament injury. In MRI diagnosis of anterior cruciate ligament tear, 37 cases were true positive, three cases false positive, one case false negative and nine cases was true negative. The validity of MRI diagnosis evaluation for anterior cruciate ligament tear was 97.4% sensitivity, 75.0% specificity, 92.0% accuracy, 92.5% positive predictive values and 90.0% negative predictive values.

Structural characterization and conformational dynamics of alpha-1 antitrypsin pathogenic variants causing alpha-1-antitrypsin deficiency

Background: Alpha-1 antitrypsin deficiency (A1ATD) is a progressive lung disease caused by inherited pathogenic variants in the SERPINA1 gene. However, their actual role in maintenance of structural and functional characteristics of the corresponding α-1 anti-trypsin (A1AT) protein is not well characterized. Methods: The A1ATD causative SERPINA1 missense variants were initially collected from variant databases, and they were filtered based on their pathogenicity potential. Then, the tertiary protein models were constructed and the impact of individual variants on secondary structure, stability, protein-protein interactions, and molecular dynamic (MD) features of the A1AT protein was studied using diverse computational methods. Results: We identified that A1ATD linked SERPINA1 missense variants like F76S, S77F, L278P, E288V, G216C, and H358R are highly deleterious as per the consensual prediction scores of SIFT, PolyPhen, FATHMM, M-CAP and REVEL computational methods. All these variants were predicted to alter free energy dynamics and destabilize the A1AT protein. These variants were seen to cause minor structural drifts at residue level (RMSD = <2Å) of the protein. Interestingly, S77F and L278P variants subtly alter the size of secondary structural elements like beta pleated sheets and loops. The residue level fluctuations at 100 ns simulation confirm the highly damaging structural consequences of all the six missense variants on the conformation dynamics of the A1AT protein. Moreover, these variants were also predicted to cause functional deformities by negatively impacting the binding energy of A1AT protein with NE ligand molecule. Conclusion: This study adds a new computational biology dimension to interpret the genotype-protein phenotype relationship between SERPINA1 pathogenic variants with its structural plasticity and functional behavior with NE ligand molecule contributing to the Alpha-1-antitrypsin deficiency. Our results support that A1ATD complications correlates with the conformational flexibility and its propensity of A1AT protein polymerization when misfolded.

Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children

Meningitis literally means inflammation of the meninges. It is mostly caused by bacteria, virus, fungus and protozoa and pyogenic meningitis constitutes a serious neurological disorder associated with significant morbidity and mortality in developing countries. This study was carried out to evaluate the clinical presentation and immediate outcome of pyogenic meningitis in children. This was a prospective observational study and conducted at department of Paeditrics in Cumilla Medical College Hospital, Cumilla, Bangladesh from July 2014 to June 2015. Total 50 children were diagnosed as pyogenic meningitis fulfilling the inclusion criteria was included in this study. Cases were enrolled purposively. Immediately after admission through history and clinical examination, complete blood count, random blood sugar, Cerebrospinal fluid (CSF) examination and blood culture was done in all patients. For statistical analysis chi-square test was done and significance of analysis was made when p value <0.05. This study includes patients aged between 2 months to 12 years and male female ratio was 1.5:1. Several risk factors like male sex (60.0%), age below one year (42.0%), Protein energy malnutrition (PEM) (30.0%), not exclusively breastfed (44.0%) were identified. Common presenting complaints were fever (100.0%), convulsion (96.0%), altered consciousness (42.0%) and vomiting (38.0%). Common physical signs were neck rigidity (56.0%), Kernig's sign (26.0%) and bulged fontanelle (34.0%). CSF was hazy in 54.0%, clear in 38.0% and turbid in 08.0% cases, CSF protein was more than 100mg/dl in 90.0% of the cases and glucose was less than 40mg/dl in most of the cases (94.0%). Streptococcus Pneumoniae (49.0%) followed by Neisseria Meningitidis (38.0%) were the two most commonly isolated organism responsible for pyogenic meningitis. Mortality rate during hospital stay was 18.0% and complications developed in 18.0% of cases. To avoid maltreatment in our resource limited setting due to failure of identifying organism, this study might help to administer appropriate antibiotics against organism and to reduce morbidity and mortality in meningitis. This study revealed less mortality rate in our country than neighbors and severe malnutrition important risk factors for the burden of pyogenic meningitis. It requires large scale multicentre studies to establish the whole scenario of Bangladesh.

Evaluation of Liver Function Tests in β-Thalassemia Major Children

Thalassemia is the most prevalent single gene defect in human beings worldwide. Repeated blood transfusions along with chelation therapy are mainstay of treatment in thalassemia patients. However these recurrent blood transfusions result in iron overload which along with chelation therapy causes deterioration of liver function. Aim of the study was to evaluate the liver function tests in β-thalassemia major patients. This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. In this study, 50 diagnosed patients of β Thalassemia major (Group A) and 50 apparently healthy children (Group B) of both sexes were selected from the department of Paediatrics, Dhaka medical college. The study parameters were serum ferritin, bilirubin, AST, ALT, ALP. The results were compared statistically between groups. Serum ferritin level (mean±SD) in thalassemic major patients in Group A (890±446.38 microgram/L) which is significantly higher above normal level. Serum bilirubin in Group A (3.27±2.62 mg/dl) and in Group B (0.48±0.24 mg/dl), Serum ALT in Group A (53.06±34.0 U/L) and in Group B (16.70±4.81 U/L), AST in Group A (84.56±33.54 U/L) and in Group B (11.60±2.72 U/L) and ALP levels in Group A (422.42±226.99 IU/L) and in Group B (221.86±80.54 IU/L). All the values were significantly higher (p<0.001) in β-thalassemia patient than that of normal children. This study concludes that liver function parameters are significantly higher in β thalassemia major patients. So routine evaluation of liver function tests may be advocated for thalassemic patients to predict early onset of hepatic dysfunction.

Age Related Changes in the Purkinje Cells in Human Cerebellar Cortex in Bangladeshi People

This study was done to see the changes in the number of Purkinje cells per square mm in different age groups of Bangladeshi people. This cross-sectional descriptive type of study was done on total 40 postmortem human cerebellums, in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2016 to June 2017. The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, by purposive sampling technique. All the specimens were grouped into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 to 59 years). Paraffin blocks of cerebellum were cut at 4-5μm thickness and stained with routine "Haematoxylin and Eosin" (H & E) stain. Estimation of number of Purkinje cell was done by using the counting circle and examined under the light microscope. In the present study, the mean±SD number of Purkinje cell was found 128.67±25.15 per sq mm in Group A, 136.53±34.45 in Group B per sq mm, 135.55±29.44 per sq mm in Group C, 127.69±35.31 per sq mm in Group D.

Number and Diameter of White Pulp of Spleen in Different Age and Sex Groups of Bangladeshi People

Spleen is a haemo-lymph organ and belongs to the reticuloendothelial system of human body, develops from mesodermal proliferation between the two leaves of dorsal mesogastrium. The microscopic structure of spleen is variable depending on the developmental stage of the organ, and the age and immune status of the individual. In our country, we depend on foreign data which came from the subjects of different races and from the individuals under different geographic conditions. So the study was carried out to minimize the dependency on foreign standards and to identify the diameter of white pulp in different age and sex of the Bangladeshi individuals with a view to establish local data bank related to spleen of Bangladeshi people. This cross-sectional descriptive study was performed on 65 postmortem human spleens (34 of male and 31 of female) to find out the number and diameter of white pulp of spleen of Bangladeshi people by purposive sampling technique. And done in Autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College, Bangladesh from 16th October 2016 to 15th January 2017. The samples were divided into three age groups including Group A (5-20 years), Group B (21-40 years) and Group C (41-60 years). Dissection was performed according to standard autopsy techniques. For statistical analysis, unpaired student 't' test was done. The mean±SD number of white pulp of male spleen was greater than female spleen in Group A, B and C but mean±SD diameter of white pulp of female spleen was found greater than male spleen in all groups. Comparison of number of white pulp between sexes showed that statistically there was no significant difference within all the age groups at p>0.05 level. No age change was evident in diameter of white pulp but in between sexes, diameter is greater in females than males. Mean difference of diameter of white pulp between sexes showed no significant difference within the age groups at p>0.05.

706 IMPROVING PRESCRIPTION OF PARKINSON’S DISEASE MEDICATIONS FOR PATIENTS ON ELDERLY CARE WARDS AT ROYAL STOKE UNIVERSITY HOSPITAL

Introduction

Patients with Parkinson’s disease (PD) are commonly admitted into hospital with various acute medical conditions. Inaccurate prescription can result in adverse effects, increased hospital stay, and increased morbidity and mortality. We present a QIP conducted to improve PD medication prescription pattern among doctors and medication delivery from the nursing staff.

Method

In PDSA 1, we conducted a survey among doctors and nurses to assess their initial knowledge on PD medications. A baseline review of PD prescriptions on our Frail Elderly Assessment Unit (FEAU) was conducted. Our interventions include Introduction: of PD medication alert sticker attached to drug charts and recorded drug chart when they are taken off the wards. In PDSA 2, repeat survey was carried on Elderly care wards. We also reviewed PD prescriptions over a 2-week period on Elderly care wards.

Results

During the surveys, there were 55 respondents in PDSA 1 and 51 respondents in PDSA 2. The percentage of those who feel PD medications are critical medications remain similar in both cycles (98%). There was an improvement in the awareness of PD stickers from 44% to 83%. Those who feel PD alert stickers are appropriate improved from 93% to 100%. Respondents who chose all included appropriate PD medication sources for improving prescription pattern improved from 38% to 62%. There were 8 prescriptions during PDSA 1 and 21 prescriptions during PDSA 2. The use of PD stickers improved from 0% to 76%. The numbers of PD medications prescribed appropriately improved from 50% to 65%.

Conclusion

An improvement in prescription pattern was demonstrated, as we hope to improve patient safety and increase awareness across the trust. Our recommendations include use of PD medication alert sticker and recorded drug chart. We discussed our plans in Medicine Governance meeting, departmental newsletter, and presented in departmental audit meeting.

Abnormal fractional flow reserve and non-hyperaemic pressure ratios in patients with severe aortic stenosis and non-obstructive coronary artery disease

Background

Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) are well-validated tools that assess the physiological significance of coronary artery disease (CAD). Low coronary lumen to myocardial mass (V/M) ratio on CT is associated with lower FFR/NHPRs and predisposes towards ischaemia in CAD. Whilst CAD and aortic stenosis (AS) frequently co-exist, patients report angina despite obstructive disease.

Purpose

We therefore sought to study the interrelationship between V/M and invasive pressure indices in patients with severe AS.

Methods

35 patients with severe AS were prospectively recruited as part of CAST-FFR study. Patients underwent CT coronary angiography and invasive pressure-wire assessment. All pressure-indices were assessed in the left anterior descending artery (LAD). Data was extracted to calculate FFR, iFR, diastolic pressure ratios (DPR and dPR) and Diastolic Hyperaemia-free Ratio (DFR). Patient-specific V/M were extracted off-site by independent core lab.

Results

Mean age was 75±7.5 years, median V/M ratio was 20.7 and mean aortic gradient and DI were 44.3±11.6mmHg and 0.23±0.4 respectively. 79% of patients had CADRADs score of &lt;2. There were moderate positive correlations between FFR/NHPRs and V/M, including FFR (r=0.60), PdPa (r=0.48), iFR (r=0.59), DPR (r=0.59), dPR (r=0.63), DFR (r=0.67), (all p&lt;0.005). In patients with positive pressure assessments, 69% (FFR), 71% (iFR), 70% (DPR) and 65% (DFR) had CADRADs score &lt;2. In severe AS, lower V/M was associated with lower pressure-indices (FFR 0.75 vs 0.86, iFR 0.79 vs 0.92, DFR 0.80 vs 0.91, all p&lt;0.005), leading to high rates of positive physiologic assessment (FFR 88%, PdPa 72%, iFR 67%, DPR 78%, DFR 74%).

Conclusion

Patients with severe AS exhibit high rates of abnormal FFR and NHPR values, despite having no obstructive CAD. Their propensity for having abnormal physiological results is, in part, influenced by coronary volume to mass ratio. These results are important for clinicians considering using invasive physiological tools to guide revascularisation decisions in patients with severe AS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Monash University, Cardiac Society of Australia and New Zealand Correlation between NHPR/FFR and VMInvasive pressure indices and VM

Correlation between Length of Ala and Transverse Diameter of First Sacral Vertebral Body in both Sexes

Sacrum is a triangular bone formed by the fusion of five sacral vertebrae. It is situated near the lower end of the spinal column, where it joins both hip bones to form the posterio superior wall of the pelvic cavity. It is an important bone for identification of sex in human skeletal system. This cross sectional and descriptive study was done among 150 (59 male and 91 female) fully ossified dry human sacrum in Mymensingh Medical College, Mymensingh, Bangladesh from January 2017 to December 2017. The sex of sacrum was determined by previously measured different parameters. Sample collection was done by purposive sampling technique from anatomy department of Mymensingh Medical College and Community Based Medical College of Bangladesh, Mymensingh. The parameters included the length of ala and transverse diameter of first sacral vertebral body which were measured by digital vernier slide caliper and was expressed in mm. In present study the mean length of ala in male and female were 29.21±6.30mm and 30.77±5.56mm respectively. The mean transverse diameter of first sacral vertebral body in male and female were 48.10±4.83mm and 44.05±6.16mm respectively. Comparison of both length of ala and transverse diameter of first sacral vertebral body was done between male and female by unpaired student 't' test which was statistically significant. There was positive correlation between these two parameters and the differences were statistically highly significant in both sexes.

Doppler Evaluation of Carotid Vessels in Type 2 Diabetes

Type 2 diabetes considered as a compound of metabolic syndrome. It can cause both micro and macrovascular complications. Diabetes is a strong risk factor in the development of atherosclerosis and likewise carotid artery disease. Carotid artery stenosis may cause stroke. Doppler ultrasound is the most common imaging technique for the diagnosis of carotid disease. Objective of the study was to assess the percentage of atherosclerotic carotid disease in asymptomatic Type 2 diabetics (T2D) by Doppler sonography and to find out the association of different risk factors of diabetic patient with atherosclerosis. A cross sectional study was done. A total of 43 type 2 diabetic patients (27 male, 16 female) referred from the out patient department and admitted patients in Mymensingh Medical College Hospital (MMCH) during January 2017 to December 2017 for the purpose of evaluation of intima media thickness (IMT) and carotid artery stenosis by Duplex color Doppler ultrasonography examination were enrolled in this study. Patients with previous history of recent stroke or transient ischemic attack (<6 weeks), history of carotid surgery or cervical radiotherapy were excluded. Carotid artery disease was found 65.1% in asymptomatic type 2 diabetics. Among them increased IMT in 48.8% and carotid stenosis was present in 37.2% and >50% stenosis (Peak systolic velocity >125cm/sec) was present in 9.3%. Age >50% years, smoking, duration of DM >10 years, hypertension, history of ischaemic heart disease and history of diabetic retinopathy were found to be associated with carotid atherosclerosis as well as carotid stenosis. High percentage of carotid artery disease (65.1%) was found in asymptomatic type 2 diabetes mellitus. This result suggests the need for carotid Doppler evaluation of all Type 2 diabetics as a first measure of stroke prevention, with the hope that timely intervention might avert stroke and its accompanying disability.

Prevalence of Diabetic Nephropathy in Patients Attending the Endocrine Department of Mymensingh Medical College Hospital

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Due to severe morbidity and mortality of DN and limited effective therapies, research has mainly focused on prevention of this debilitating illness by modification of risk factors. Aims of this study were to find out the prevalence of diabetic nephropathy, its factors and to correlate the functional status of the kidney. This cross-sectional study was conducted in the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st January 2013 to 30th June 2013. A total 105 patients having clinical diagnosis of Diabetes mellitus were enrolled in this study. Data were collected by interview of the patients, clinical examination and laboratory investigation. Data was analyzed using the Chi-square test for Categorical variables and unpaired Student's 't' test for differences in means for continuous variables. P value <0.05 was considered significant. With DN (30.5%) patients 21.1% had micro-albuminuria and 9.5% had macro-albuminuria. The mean age for the DN patient was 47.9±14.7 years and male female ratio was 1:1. BMI was found significantly low in patients with DN (p<0.05). Prolonged duration of diabetes (>5 years) and uncontrolled diabetes were found as significant risk factors associated with DN. Other risk factors were hypertension, family history of hypertension, family history of diabetes mellitus and irregular treatment of diabetes mellitus. Mean serum creatinine, mean estimated glomerular filtration rate (GFR) and mean blood sugar level was 1.3±0.6mg/dl, 69.4±26.7ml and 15.6±7.1mmol/L respectively in DN patients. Relation was significant for higher serum creatinine and lower eGFR values (p<0.05). Prevalence of diabetic nephropathy was 30.5%. Long standing diabetes (>5 years) and uncontrolled diabetes were the important risk factors for the development of diabetic nephropathy. Diabetic nephropathy is associated with higher serum creatinine and lower eGFR values.

A 12-year-old girl presenting with hematemesis, melena and gradual abdominal distension

This article has no abstract. The first 100 words appear below: A 12-year-old girl, 2nd issue of non-consanguineous parents, immunized as per EPI schedule, presented with the history of hematemesis and melena 3 months back and abdominal distension for 1 year. After the episodes of hematemesis and melena, she received 1 unit of blood trans-fusion. She had no history of fever, jaundice, abdominal trauma, umbilical catheterization, umbilical sepsis, severe dehydration, offending drug intake and abdominal trauma or any surgery.

Length of Umbilical Cord in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh

This cross sectional descriptive study was performed on 80 human placenta and umbilical cord to find out the variation in length of umbilical cord of healthy Bangladeshi mother in relation to different gestational age. This study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January to December 2018. The specimens were collected from the Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh by purposive sampling technique. According to gestational age the collected samples were divided into three groups. They were Group A (28 to 36 weeks), Group B (37 to 40 weeks) and Group C (above 40 weeks) and examined morphologically by fine dissection method. The length of umbilical cord was measured with the help of flexible tape in cm. For statistical analysis, differences of length between age groups were analyzed by using unpaired student 't' test. The mean±SD length of umbilical cord was 56.15±7.61cm in Group A, 62.54±8.78cm in Group B and 68.54±10.53cm in Group C. It was also observed that the mean length of the umbilical cord was increased with increase of gestational age. The mean difference of length of umbilical cord between Groups A and C was statistically highly significant (p<0.001), difference between Groups A and B was statistically moderately significant (p<0.01) but the difference between Groups B and C was statistically significant (p<0.05). This study was done to provide information about the length of umbilical cord in different gestational ages of healthy pregnancies.

Calcium Influx and Release Cooperatively Regulate AChR Patterning and Motor Axon Outgrowth during Neuromuscular Junction Formation

Formation of synapses between motor neurons and muscles is initiated by clustering of acetylcholine receptors (AChRs) in the center of muscle fibers prior to nerve arrival. This AChR patterning is considered to be critically dependent on calcium influx through L-type channels (Ca_V1.1). Using a genetic approach in mice, we demonstrate here that either the L-type calcium currents (LTCCs) or sarcoplasmic reticulum (SR) calcium release is necessary and sufficient to regulate AChR clustering at the onset of neuromuscular junction (NMJ) development. The combined lack of both calcium signals results in loss of AChR patterning and excessive nerve branching. In the absence of SR calcium release, the severity of synapse formation defects inversely correlates with the magnitude of LTCCs. These findings highlight the importance of activity-dependent calcium signaling in early neuromuscular junction formation and indicate that both LTCC and SR calcium release individually support proper innervation of muscle by regulating AChR patterning and motor axon outgrowth.

Diagnostic Evaluation of Isotropic 3D MRCP Images in the Diagnosis of Cholangiocarcinoma

This is a cross sectional study to establish that Magnetic resonance cholangiopancreatography (MRCP) could be accepted as the most effective imaging modality for the diagnosis of cholangiocarcinoma. Cholangiocarcinoma is the most common malignant tumor of the bile duct. It is much less common than hepatocellular carcinoma, accounting for 5-30% of all hepatic malignancies. Clinically suspected patients with obstructive jaundice due to cholangiocarcinoma were referred to the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was carried out in 60 patients, of which 38(63%) were male and 22(37%) were female. Out of 60 cases 56 cases were truly diagnosed by MRCP, 4 were normal, among these 1 case was diagnosed as cholangiocarcinoma as compared with histopathology. Forty four (44) patients (73.2%) of the patients were in sixth decade of life. The overall sensitivity and specificity were found to be 98.2% and 75%. The diagnostic accuracy was 96.7% & positive predictive value was about 98%.

Variations in the Position of Vermiform Appendix in Bangladeshi People

This cross sectional descriptive study was performed on 70 postmortem vermiform appendices (male 34 and female 36) to find out the various positions of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique from October 2016 to March 2017. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy technique. During postmortem examination abdominal cavity was routinely exposed by classical midline incision from xiphoid process to the symphysis pubis and a semicircular incision around the umbilicus and the flaps were reflected to give a good view of the abdominal cavity along with its contents and then the taeniae coli of the caecum were identified. The three taeniae coli of the caecum converge at the base of the appendix and become its longitudinal muscle coat. The anterior caecal taeniae coli acts as the best guide for identification of the vermiform appendix. The relation of the base of the appendix to the caecum is constant but the position of the vermiform appendix, which is variable, was studied in relation to caecum and the terminal part of the ileum. Accordingly the position of the vermiform appendix was noted either retrocaecal, pelvic, preileal or postileal, subcaecal. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. Among 70 specimens, 44(62.9%) vermiform appendices were retrocaecal in position. The next common position was pelvic which was in 22(31.4%) specimen followed by postileal in 3(4.3%) specimen and subcaecal was observed only in 1(1.4%) specimen. In this study in all age groups incidence of retrocaecal vermiform appendix was highest and it was about 67.6%, 50%, 69.2% and 72.7% in Group A, B, C, D respectively. Pelvic position was 7.1%, 46.9%, 23.1% and 27.3% in Group A, B, C, D respectively. Subcaecal vermiform appendix was absent in Group A, B and Group D. On the other hand postileal vermiform appendix was absent in Group C and Group D. The findings of this study may help the physician and the surgeons for proper diagnosis, management and treatment of disease of vermiform appendix.

Performance of Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Sepsis

Neonatal sepsis is one of the major health problems throughout the world and major cause of morbidity and mortality in developing countries. Positive blood culture considers the gold standard for confirmation of neonatal sepsis, but it does not provide rapid diagnosis. So this study was designed to find out the performance of haematological parameters in early diagnosis of neonatal sepsis. The objective of the study was to evaluate the performance of haematological parameters individually and in combination in early diagnosis of neonatal sepsis. It was a cross-sectional study conducted at neonatal ward, SCANU and obstetric ward of Rangpur Medical College Hospital from January 2014 to December 2015. A total of 70 neonates clinically suspected to have features of sepsis were included in this study. Another 70 healthy term neonates were included in the study as reference group. Blood sample were obtained to estimate TLC, ANC, immature neutrophil count, degenerative changes in PMNs, platelet count, I/T and I/M ratio. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the individual test and tests combination were calculated. Among the haematological parameters, performance of combined tests had high sensitivity, specificity, with PPV and NPV. Among the individual tests I/T and I/M ratio had high sensitivity (95%), specificity (85%, 90%), PPV (90%, 75%) and NPV (90%). There were 22 out of 70 neonates (31.42%) who had culture proven sepsis. Among 22 culture proven sepsis most commonly found organism were Escherichia Coli 12(54.5%) followed by Klebsiella 3(13.63%), Proteus 3(13.63%), Staphylococcus aureus 2(9.9%) and Salmonella 2(9.9%). There is no ideal test for diagnosis of early diagnosis of neonatal sepsis haematological parameters is useful adjunct test in identifying clinically suspected neonatal sepsis.

A Study of Sacral Index for Identification of Sexual Dimorphism

Sacrum is an important bone for identification of sex in human skeletal system. Being a component of axial skeleton it contributes to formation of pelvic girdle. This cross sectional and descriptive study was done among 150 (59 male and 91 female) fully ossified dry human sacrum in Mymensingh Medical College, Mymensingh, Bangladesh from January 2017 to December 2017. Sample collection was done by non-random purposive sampling technique from Anatomy department of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. The parameters included the straight length of sacrum and width of sacrum which was measured by digital vernier slide caliper and was expressed in millimeter (mm) and sacral index was calculated from these measurements. In present study the mean straight length of sacrum in male and in female was 104.27±5.76mm and 92.82±7.59mm respectively. The mean width of sacrum in male and in female was 99.51±5.80mm and 102.98±6.69mm respectively. Mean sacral index were 95.42±3.14 and 111.27±7.66 in male and female respectively. Comparison of straight length and width of sacrum and sacral index were done between male and female by unpaired student 't' test which was statistically significant.

External Diameter of Vermiform Appendix in Bangladeshi People of Different Age & Sex

This cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the external diameter of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The external diameter of vermiform appendix was measured with the help of digital slide calipers. Three measurements were taken at its base, middle and near the tip (1cm away from the tip) and expressed in mm. The data were analyzed by using student unpaired 't' test and compaired with the findings of other national and international studies and standard text books. It was observed that external diameter of vermiform appendix gradually decreased as age advanced. The mean±SD external diameter of vermiform appendix at base was 6.50±0.82 mm, 6.22±0.60 mm, 6.00±0.51 mm and 5.51±0.57 mm in Group A, B, C & D respectively. The mean±SD external diameter of vermiform appendix at middle was 6.09±0.89 mm, 5.67±0.65 mm, 5.38±0.59 mm and 4.95±0.76 mm in Group A, B, C and D respectively. The mean±SD external diameter of vermiform appendix near the tip (1 cm away from the tip) was 5.73±0.88 mm, 5.21±0.72 mm, 4.81±0.74 mm and 4.34±0.74 mm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of external diameter of vermiform appendix at its base between Group A&D, B&D were statistically moderately significant at p<0.01 level. Between Group C&D was statistically significant at p<0.05 level and between Group A&B, B&C, A&C were statistically non significant at p = or >0.05 level. Mean differences of external diameter of vermiform appendix at its middle between Group A&D, B&D were statistically moderately significant at p<0.01 level. Between Group A&C was statistically significant at p<0.05 level and between Group A&B, B&C, C&D were statistically non significant at p = or >0.05 level. Mean differences of external diameter of vermiform appendix near its tip (1 cm away from the tip) between Group A&D was statistically highly significant at p<0.001 and mean differences between Group B&D, A&C were statistically moderately significant at p<0.01 level. Between Group A&B was statistically significant at p<0.05 level and between Group B&C, C&D were statistically non significant at p = or >0.05 level. Mean external diameter of vermiform appendix in male was higher than that of female in all age group at its base, middle and near the tip (1cm away from the tip) but mean difference between sexes in the different study groups was statistically non significant at p = or >0.05 level. The present study will help to increase the information pool on the external diameter of vermiform appendix of Bangladeshi people.

Variation in the Position and Diameter of Basilar Artery in Different Ages of Bangladeshi People

Basilar artery is formed by the fusion of right and left vertebral artery and terminates as right and left posterior cerebral arteries. The aim of the study is to observe the diameter of basilar artery at three different levels (at its formation, at its midlevel and at its termination). This cross sectional descriptive study was performed on total 60 postmortem human hindbrain to find out the variation of position and diameter of the basilar artery of Bangladeshi people in relation to age. The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh medical College, Mymensingh, Bangladesh by purposive sampling technique. All the specimens were grouped into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 to 59 years). Diameter of basilar artery was measured with the help of digital slide calipers at three different levels. At the level of its formation, mean±SD diameter was 3.76±0.37 mm, 3.75±0.32 mm, 3.68±0.24 mm & 3.54±0.46 mm in Group A, B, C & D respectively. At mid-level, it was 3.49±0.36 mm, 3.48±0.30 mm, 3.45±0.21 mm & 3.36±0.44 mm in Group A, B, C & D respectively. At the termination, it was 3.55±0.35 mm, 3.51±0.30 mm, 3.48±0.22 mm & 3.38±0.38 mm in Group A, B, C & D respectively. This knowledge of variations of the diameter of basilar artery is of diagnostic importance for the neurosurgeons and radiologists for clinical investigation and surgery.

Correlation of Foot Height with Stature in 5-10 Years Aged Bangladeshi Children

This cross sectional, descriptive and analytic type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat) on 109 Bangladeshi children (70 male and 39 female) from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of foot deformity resulting either from congenital or physical injury were excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding foot height, to measure correlation of stature with foot height and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Stature of the subject was measured with the stadiometer and foot height was measured using flexible measuring tape. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean foot height of both sides of 5, 6, 7, 8, 9 and 10 years aged male were 5.90±0.76cm, 5.76±0.64cm, 6.80±0.35cm, 6.86±0.35cm, 7.24±0.46cm and 7.28±0.66cm respectively and those of female were 5.48±0.67cm, 6.25±0.28cm, 6.19±0.58cm, 6.42±0.34cm, 6.30±0.49cm and 6.30±0.39cm respectively. Correlation between stature and foot height was made. Foot height showed non-significant positive correlation with stature in 5 years old male, 6 years old male, 7 years old male and female, 8 years old male, 9 years old male and female and 10 years old male and female. In case of 5 years old female, it showed significant positive correlation with stature.

Spectrum of MDP Bone Scan in Paediatric Patients - Experience at NINMAS

Objective: To assess the clinical indications and spectrum of MDP bone scan findings in paediatric patients referred to the National Institute of Nuclear Medicine and Allied Sciences (NINMAS).Materials and Methods: Paediatric patients, age ranged from 2-18 years referred to NINMAS from January 2014 to November 2015 for bone scintigraphy were included in this study. All patients had 99mTc MDP bone scan for various clinical indications. The spectrum of clinical indications and bone scan findings were recorded and analyzed.Results: Total 2323 bone scans with 99mTc MDP were done in NINMAS in the above mentioned period. Among them 91 (3.917%) cases were in paediatric age group. Of which 82 (90.11%) patients with known malignancy were referred for radionuclide skeletal survey. The most common clinical indications were osteosarcoma 30 (32.96%) cases and Ewing’s sarcoma 25 (27.47%) cases followed by five neuroblastoma (5.49%), four (4.39%) rhabdomyosarcoma, three (3.29%) Langerhans cell histocytosis and rest others. Bone scan was positive in 58 (63.7%) cases and normal in 33 (36.3%) cases. Out of 58 cases 38 had features of primary bony lesion, 10 cases had multiple metastases, four cases had primary bone tumour of Ewing’s sarcoma as well as metastases.Conclusion: Bone scan is a popular imaging modality for skeletal survey of paediatric patients in malignancy, both primary and metastatic bone diseases. Bone scanning in paediatric patients contributes a major role in detecting the cause and localizing the pathology of bone. High quality imaging, interpreted by physicians familiar with paediatric diseases, correlation with clinical records and other imaging are mandatory to maximize the benefit.Bangladesh J. Nuclear Med. 19(1): 28-31, January 2016

Radionuclide Lymphoscintigraphy in the Diagnosis of Idiopathic Congenital Lymphedema– a Case Report

Congenital lymphedema is the rarest form of primary lymphedema, accounting for approximately 1: 60,000 live births. Congenital lymphedema can be classified into familial (hereditary) and idiopathic (non hereditary) subgroups. When congenital lymphedema is of the hereditary form the eponym Milroy disease is applied. Lymphedema without any dysmorphic features and no family history of lymphedema the eponym idiopathic congenital lymphedema is utilized. Etiology of idiopathic primary congenital lymphedema is unknown and a de novo genetic event of genes involved in lymphangiogenesis is a possibility. Radionuclide lymphoscintigraphy is considered as a gold standard for the diagnosis of lymphedema. This reported interesting case was an eleven months old girl having swelling of right lower limb since birth. There was no family history of lymphedema and no any dysmorphic features consistent with Milroy disease. The primary diagnosis was congenital lymphedema of idiopathic (non hereditary) subtype. Lymphoscintigraphic with Technetium-99m (Tc- 99m nanocolloid) revealed no lymphatic channels or inguinal lymph nodes on right side in early or delayed images up to 2 hours views and the diagnosis of primary idiopathic congenital lymphedema was confirmed.Bangladesh J. Nuclear Med. 18(2): 183-185, July 2015

Correlation of Ball Circumference with Body Weight in 5-10 Years Aged Bangladeshi Children

This cross sectional, descriptive and analytic study was conducted among 5-10 years aged 109 Bangladeshi children (70 male and 39 female) at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat), Bangladesh from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of congenital and acquired foot deformity was excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding ball circumference, to measure its correlation with body weight and this attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Weight of the subject was measured with the digital weighing machine and ball circumference was measured using flexible measuring tape. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean ball circumference of right side of 5, 6, 7, 8, 9 and 10 years aged male were 16.93±1.05cm, 17.00±0.72cm, 18.10±1.28cm, 18.33±.99cm, 19.37±1.12cm and 19.94±1.30cm respectively and those of female were 16.27±1.10cm, 16.85±0.59cm, 17.44±0.92cm, 18.02±0.82cm, 18.00±1.58cm and 19.23±1.40cm respectively. The mean ball circumference of left side of 5, 6, 7, 8, 9 and 10 years aged male were 16.86±1.05cm, 16.94±.70cm, 18.02±1.29cm, 18.26±.99cm, 19.27±1.12cm and 19.87±1.29cm respectively and those of female were 16.18±1.10cm, 16.77±0.62cm, 17.36±0.92cm, 17.98±0.87cm, 17.90±1.58cm and 19.13±1.40cm respectively. In this study on both sides, ball circumference showed non-significant positive correlation with body weight in 5 years old male and female, 6 years old male and female, 7 years old male and female, 8 years old female, 9 years old male and female and 10 years old male and female. In case of 8 years old male, it showed non-significant negative correlation with body weight.

Scaling up child development centres in Bangladesh

BACKGROUND

Child Development Centres (CDCs) have been established within government medical college tertiary hospitals across Bangladesh. Services entail a parent-professional partnership in a child and family friendly environment with a focus on assessment, diagnosis, and management of a range of neurodevelopmental disorders in children and adolescents 0-16 years of age. Services are provided by a multidisciplinary team of professionals (child health physician, child psychologist, and developmental therapist) who emphasize quality of services over the numbers of children seen.

METHODS

In 2008, Dhaka Shishu (Children's) Hospital was given the mandate by the government to conceptualize, train, and monitor CDCs nationwide. Here, we describe the rationale and processes for the establishment of the national network of CDCs and discuss lessons learned on scaling up early childhood development services in a low resource setting.

RESULTS

Fifteen CDCs were established in major government hospitals across Bangladesh and have recorded 208,866 patient visits. The majority (79%) of children were from the lowest and middle-income families, and about one third (30%) were < 2 years of age at first presentation. Two thirds of children seen in follow-up demonstrated improvements in functional skills since their first visit, 77% in their adaptive behaviour (i.e., activities of daily living) and 70% in cognitive functions.

CONCLUSIONS

CDCs are expanding coverage for child neurodevelopment services across Bangladesh through a tiered system of home-based screening, community- and clinic-based functional assessment, and CDC-based diagnosis, support, and referral. Vulnerable populations-the lowest income groups and younger children-comprised the majority of patients, among whom there is high unmet need for psychological services that is being met for the first time. Innovative human resource development, including a 3-month training for the multidisciplinary teams, enabled wide coverage for assessment and diagnosis of a range of neurodevelopmental problems. Demand for services is growing, especially among non-government and private hospitals.

Chikungunya-dengue co-infection during pregnancy requiring preterm Caesarean section: first case report from Bangladesh

We report the first case of chikungunya-dengue co-infection during pregnancy requiring emergency Caesarean section (CS) because of fetal distress in a Bangladeshi primigravida. Though previously unreported, this situation may become increasingly common.

School Refusal: How to Address When He is an Adolescent with Asperger’s Syndrome - A Case Report

A fifteen and a half years old adolescent boy was referred by the psychiatrist to the Child Development Centre (CDC) for an evaluation of his mental status as he was stubbornly resisting to take medication in spite of regular counselling efforts. This boy presented with school refusal with manifestations of Obsessive Compulsive Disorder (OCD) with a complicated family dynamic to the psychiatrist. His interesting atypical development in early childhood led to clinician’s concern of excluding Autism Spectrum Disorder (ASD). He was finally diagnosed and jointly managed as a case of High Functioning Autism (HFA) with co-morbid conditions by a joint multidisciplinary team approach of CDC and Psychiatry Department of AHD.Pulse Vol.9 January-December 2016 p.64-68

Neonatal outcomes following planned preterm delivery in diabetic mothers

OBJECTIVE

Women with diabetes may need elective preterm delivery due to pregnancy or diabetes related complications. The aim of this study was to describe the neonatal outcomes arising from elective preterm delivery in diabetic women.

METHOD

Suitable patients were identified by the obstetric team at Hull Royal Infirmary Women and Children's Hospital and data was extracted from their case notes. 45 diabetic women with planned preterm delivery were identified within a set time frame, resulting in 48 babies.

RESULTS

Of the 48 babies born, 47 survived. 36 out of 48 were delivered via caesarean section. Gestational ages ranged from 29+3 to 36+6 weeks, and 24 out of 48 (50%) had a birth weight greater than the 90th centile for gestational age.34 out of the 48 babies experienced some form of neonatal complication and were admitted to the neonatal unit. The median duration of stay in the neonatal unit was 7 days. 14 of the surviving neonates suffered from respiratory distress, although only 4 required surfactant therapy to regain respiratory function. However, the incidence of serious neonatal complications in those born after 34 weeks was shown to be low.

CONCLUSIONS

Elective preterm delivery after 34 weeks had little effect on overall neonatal outcome. Therefore it could be proposed that elective preterm delivery after 34 weeks gestation may be an acceptable option in diabetic women if there are maternal or obstetric complications.

Study on Neurological Consequence of Eclampsia

The present study was carried out in the Department of Obstetrics and Gynecology at Mymensingh Medical College Hospital, Mymensingh, Bangladesh for a period of one year from 1st June 2009 to 30th June 2010 to see the Neurological Consequence of Eclampsia. A total number of 37 patients were enrolled in this study. Among 37 patients majority are in the age group of 21-30 years which is 19(51.4%) cases followed by less than or equal to 20 years and more than 30 years which are 13(35.1%) cases and 5(13.5%) cases respectively. Knee jerk is present in 28(75.7%) cases and absent in 8(21.6%) cases. The exaggerated knee jerk is present in only in 1(2.7%) case. The rate of Glasgow coma scale is less than 5 in 21(56.8%) cases, 14(37.8%) cases in 5-10 and 2(5.4%) cases is in more than 10. Focal sign is absent in 22(59.5%) cases and present in 15(40.5%) cases. Majority of the patients is presented with absence of neck stiffness which is 35(94.6%) cases and the rest 2(5.4%) cases are presented with neck stiffness. Flexor planter response is found in 20(54.1%) cases which is the highest in number followed by extensor which is 15(40.5%) cases. In only 2(5.4%) cases the planter reflex is not elicitable. Presence of infarct is found in 15(40.5%) cases which is the highest number. Cerebral edema and Presence of haemorrhage is found in 3(8.1%) cases in each. Leuko-encephalopathy is found in 2(5.4%) cases. Encephalopathy and Both infarct & haemorrhage is found in 1(2.7%) case of each. Normal CT scan findings of brain are found in 12(32.4%) cases.

CRP (C-reactive protein) in Early Pregnancy Predictor for Development of GDM

This case-control study was done to find out whether elevated serum CRP in early pregnancy is a predictor of GDM and conducted under joined supervision of Obstetrics & Gynecology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital and Biomedical Research Group (BMRG), BIRDEM, from August 2005 to November 2007. Pregnant mothers at their first 16 weeks of gestation without any medical disorder of pregnancy were included in the study. For the purpose of this study blood samples were again collected for OGTT at their 16weeks, 24-28 weeks and 32 weeks of pregnancy to detect GDM. After confirmation of GDM, C-reactive protein and C-peptide were done from the preserved fasting serum sample at the end of this study to compare GDM with control group. A total of 297 patients were included in this study. Among them 145(48%) patients completed follow up, 59(20%) lost from follow-up and 11(4%) patients had abortion; 82(28%) are due for follow up 31(10%) pregnant patients developed GDM subsequently. Finally 28 GDM patients were taken as cases and 71 were control matched for their gestational age and parity. At earlier weeks of gestation, hsCRP could predict (PPV) development of GDM in 59% with NPV 84%, sensitivity 61% and specificity 83%. C-peptide in the 50th percentile could predict (PPV) development of GDM in 58% with NPV 96%, sensitivity 72% and specificity 93%. The present data indicates that hsCRP and C-peptide both is sensitive markers in predicting GDM.