Demographic and Clinical Characteristics of Functional Dyspepsia and Its Subtypes in Adult Patients: An Experience from a Tertiary Care Centre in Bangladesh

Functional dyspepsia (FD) is a common gastrointestinal problem in the world. The Rome III consensus subdivided functional dyspepsia into two groups: meal-related postprandial distress syndrome (PDS) and meal-unrelated epigastric pain syndrome (EPS). Limited data are available regarding FD in Bangladesh. The aim of this study was to investigate the demographic and clinical characteristics of FD and its sub-types. This cross-sectional study was conducted in which we recruited patients who attended the outpatient department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2017 to February 2018. Patients fulfilling Rome III FD criteria and a negative upper GIT endoscopy were included for this study. The patients were then subdivided into 'pure' PDS (i.e. meeting criteria for PDS without EPS symptoms), 'pure' EPS (i.e., meeting criteria for EPS without PDS symptoms), and overlapping PDS-EPS (i.e., symptoms of both PDS and EPS) groups. Total of 368 FD patients (56.0% females, mean age 32.8±8.6 years, BMI: 22.0±2.7), were included in this study. Out of them, 112(30.4%) patients (57.2% females, mean age 33.9±9.3 years, BMI: 22.0±2.7) fulfilled criteria of pure EPS and 64(17.4%) patients (68.8% females, mean age 33.2±7.8 years, BMI: 22.1±2.4) fulfilled criteria of pure PDS. However, the majority of patients [192(52.2%), 52.1% females, mean age 32.0±8.4 years, BMI: 21.9±2.8] had symptoms of overlapping EPS-PDS. More than 40% of patients in our study presented with 3 or more of the four key symptoms of FD. A longer duration of presenting symptoms was seen among patients with overlapping EPS-PDS in comparison to pure EPS and pure PDS (p<0.001). A significant overlap of symptoms of both EPS and PDS was noticed among patients with FD. The value of dividing functional dyspepsia into the subgroups of PDS and EPS is thus questionable. Further research and modification of the diagnostic criteria for FD subtypes are necessary.

A facile and green synthesis of Mn and P functionalized graphitic carbon nitride nanosheets for spintronics devices and enhanced photocatalytic performance under visible-light

Manganese and phosphorus co-doped, graphitic carbon nitride (g-C₃N₄) nanosheet (Mn/P-g-C₃N₄) is prepared by facile and green calcination process of melamine (C₃H₆N₆), manganese chloride tetrahydrate (MnCl₂·4H₂O), and ammonium dihydrogen phosphate ((NH₄)H₂PO₄). The Mn/P co-doping significantly enhances magnetic values compared to pristine-g-C₃N₄, phosphorus-doped g-C₃N₄ (P-g-C₃N₄), and manganese-doped g-C₃N₄ (Mn-g-C₃N₄). We find that Mn/P-g-C₃N₄ is a half-metallic ferromagnetic material having a magnetic moment and Curie temperature of 4.51 μ_B and ∼ 800 K, respectively. The ultraviolet-visible (UV-vis) absorption spectrum of Mn/P-g-C₃N₄ reveals superior absorption in broader wavelength compared to pristine-g-C₃N₄, P-g-C₃N₄, and Mn-g-C₃N₄. The methyl orange degradation efficiency of Mn/P-g-C₃N₄ photocatalyst is 94 %, which is three times more than that of pristine-g-C₃N₄ (29 %) and more significant than the P-g-C₃N₄ (46 %) and Mn-g-C₃N₄ (58 %). Furthermore, density functional theory (DFT) calculation explains the origin of high magnetic behavior, the boosted photocatalytic efficiency of Mn/P-g-C₃N₄, and the essential material properties like structure, bandgap, the density of states (DOS), and atomic level interaction. This work may be helpful for reasonably designing ferromagnetic material for spintronics devices and boosting visible-light (VL) photocatalytic performance for environmental remediation.

Exfoliated two-dimensional molybdenum disulfide reinforced epoxy syntactic foams

In this paper, we report the effect of introducing molybdenum disulfide (MoS2) nano-platelets: a two-dimensional metal chalcogenide, on the mechanical properties of hollow glass microballoon (HGM)–epoxy syntactic foams. MoS2 reinforced syntactic foams were prepared by mixing MoS2 nanoplatelets to epoxy containing HGMs; with the amount of MoS2 being varied from 0.01 to 0.04% v/v, while maintaining a constant total filler volume fraction of 40% for all compositions. The mechanical behaviour of reinforced syntactic foam was studied under varied loadings including compressive, tensile and flexural under different strain rate regimes. Introduction of MoS2 led to significant improvements in characteristic mechanical properties, particularly in terms of compressive strength and toughness, which suggest intercalation of MoS2 within the epoxy matrix; however, the presence of relatively larger MoS2 micro particles couldn’t be completely negated. The toughness of the foam, as indicated by the area under the compressive stress-strain curve, was found to increase by ∼21% under optimal conditions. Our results highlight the potential of the two-dimensional MoS2 sheets as a reinforcing agent in syntactic foams.

Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study

Background

Pregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.

Methods

This prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.

Results

Prevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.

Conclusion

Prevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.

Evaluation of Duodenal Eosinophil Count in Adult Patients with Functional Dyspepsia

Several mechanisms have been proposed to explain the symptoms of functional dyspepsia but actual pathogenesis is still poorly understood. Recent studies support duodenal abnormality to be the most important causal link to explain symptoms and to understand abnormal pathophysiology of functional dyspepsia. The aim of this prospective observational study is to compare eosinophil count in duodenal mucosa between patients with functional dyspepsia and control subjects without dyspepsia and was done at the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2015 to December 2016. Total 42 patients of functional dyspepsia based on Bangla validated version of ROME III criteria and 42 controls who were referred for upper gastrointestinal endoscopy for reasons other than dyspepsia were included. Biopsy specimens were collected from the second part (D2) of the duodenum of all participants. Eosinophil count was quantitatively evaluated by hematoxylin and eosin staining and expressed in numbers per 5 HPF. Significantly increased duodenal eosinophil count was found in functional dyspepsia group than non dyspeptic patients (22.78±08.78 vs. 14.90±10.70, p=0.001). Higher duodenal eosinophil count was found in patients with postprandial distress syndrome. Increased duodenal eosinophil count was found in patient of functional dyspepsia. It requires further large scale multicenter studies to establish duodenal eosinophilia as a biomarker of functional dyspepsia.

Bimatoprost in Dermatology

Bimatoprost is a prostamide analogue used for treatment of glaucoma in ophthalmology. Surprisingly, the side effects such as increased pigmentation of eyelids and hypertrichosis in patients being treated with prostaglandin analogues for glaucoma have opened new areas of application in various dermatological disorders such as alopecia mainly affecting eyelashes, eyebrows, and vitiligo.

Epoxy-glass Microballoon Syntactic Foams for Blast Mitigating Applications

Polymeric syntactic foams refer to a class of cellular material created using preformed hollow spheres bound together with a polymeric matrix. These cellular materials possess exceptional ability to respond against high impact dynamic loads. This paper is an attempt to fabricate polymeric syntactic foams of epoxy containing hollow glass microballoon at varying loading (40 % - 60 %) and explore their potential towards blast mitigation. The tensile, compressive and flexural strength were found to be inversely proportional to the microballoon loading in the quasi-static regime. The strain rate sensitivity of the foams was confirmed by performing high strain rate studies using split hopkinson pressure bar. The flow stress of these foams was found to increase with increasing strain rates. The syntactic foams were subjected to controlled transient blast loadings using a shock tube. The samples remained intact and no strain was observed on the strain gauge, even under a blast load of ~ 90 psi, which clearly highlight their potential as core materials for blast mitigating applications.

Dermoscopy of alopecia areata-a retrospective analysis

Background

Dermoscopy devices can overcome the refractive properties of stratum corneum by interface medium or cross polarization such that the lesion can be easily seen.

Aim

To examine the dermoscopic feature in alopecia areata and correlate the severity of disease with dermoscopic features.

Materials and methods

Retrospective analysis of 72 patients suffering from alopecia areata (AA), irrespective of age and sex, who visited the dermatology outpatient department of a tertiary care center in Eastern India was carried out. The most recently developed cases of AA were examined dermoscopically. Variables included yellow dots (YDs), black dots (BDs), broken hair (BH), short vellus hair (SVH), and exclamation mark hair (EMH) on the basis of available literature and expertise.

Results

Yellow dots was the most common finding seen in 57 cases (79.16%), black dots in 51 cases (70.8%). Short vellus hair was seen in 32 cases (44.44%), broken hair was seen in 31 cases (43.05%), and exclamation mark hair in 23 cases (31.9%). YDs per field of vision was considered as the most common finding with increased severity of AA.

Conclusion

YDS, in increased number per field of vision, is the most consistent finding seen in severe cases of AA, as they are in progressive AA and alopecia universalis. An increased number of SVH and terminal hairs were seen in patients who were being treated.

Peptic Ulcer Disease in Bangladesh: A Multi-centre Study

The incidence of peptic ulcer has steadily declined through out the world. This decreasing trend is also noticeable in this subcontinent. The point prevalence of peptic ulcer (PUD) in Bangladesh was around 15% in eighties. The aim of this study was to see the present prevalence of peptic ulcer at endoscopy and to identify changing trends in the occurrence of peptic ulcer in Bangladesh. This retrospective analysis of the endoscopic records of multiple tertiary referral centres of Dhaka city were done from January 2012 to July 2013. A total of 5608 subjects were the study samples. We included those patients having peptic ulcer in the form of duodenal ulcer, benign gastric ulcer including pre-pyloric ulcer and gastric outlet obstruction due to peptic ulcer. Duodenal ulcer and benign gastric ulcer were found in 415(7.4%) and 184(3.28%) patients respectively and gastric outlet obstruction due to peptic ulcer was found in 23(0.40%) patients.

Pattern of Changes in the Findings among the Patients Undergoing Diagnostic Esophagogastroduodenoscopy in Bangladesh

This cross-sectional observational study was conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College and Mitford Hospital, Holy family Red Crescent Medical College and Hospital and Popular Diagnostic Centre, Shantinagar branch, Dhaka, Bangladesh from January 2012 to July 2013. Study subjects were included in the study irrespective of age and sex having different upper GI tract. Complaints like dysphagia, heart burn, abdominal pain/dyspepsia, nausea, vomiting, haematemesis and/or malena, anorexia, unexplained anemia, weight loss etc. All the findings of oesophagus, stomach and duodenal lesions were observed and data were recorded. The results were considered positive based on the macroscopic appearance using standard diagnostic criteria. During the study period endoscopy was performed in 5608 subjects. Among which 2968(52.92%) were male and 2640(47.07%) were female. The patients age range from 7 years to 108 years. The majority of the patients were from 40-50 years. Normal findings were observed among 3321(59.21%) cases. Gastroduodenal erosions were present among 684(12.19%) cases, Oesophageal varices in 444(7.91%) cases, duodenal ulcer diseases in 415(7.40%) cases and gastric ulcer in 184(3.28%) cases. Ca stomach was found among 165(2.94%) cases. A number of diseases were identified through this procedure. Current study observed a large proportion of patients (40.79%) had positive upper GI endoscopy.

Polyurea coatings for enhanced blast-mitigation: a review

Major developments in the area of blast mitigation using polyurea coatings as retrofit or existing structures are discussed.

Genotypes of hepatitis C virus infection in Bangladeshi population

Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide also in Bangladesh. Prevalence of Hepatitis C virus infection in rural adult population of Bangladesh is reported to be 0.6% but the exact pattern of existing genotype has not been well studied. Genotyping of HCV is important for the planning of treatment duration and predicting the response to treatment in HCV infection. This study was done to identify the existing HCV genotypes in the diagnosed cases of chronic hepatitis C infection in Bangladesh. This study was a prospective as well as retrospective cross-sectional observational study done in the department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh. Cases were also taken from department of Hepatology of Bangabandhu Sheikh Mujib Medical University and Square General Hospital, Dhaka. The study was from January 2010 to March 2011. In total, 417 patients having chronic HCV confirmed by positive anti-HCV and HCV-RNA tests attending to above mentioned institutions were included in this study. Out of the 417 study subjects, 303 were males (72.66%) and 114 (27.34%) were females between 05 to 78 years of age. Most cases were in the age group 30-50 years (57.06%). The study showed that 209 (50.19%) were infected with Genotype 3. Next common identified genotype of HCV was a combination of type 3 & 4, which accounted for 120 (28.77%) and genotype -1 represented 59 (14.14%) of the cases. Other less common identified genotypes were 2, 4, 5 and mixed genotypes -1 & 3, 5 & 6 and 2 & 3; the figure being 12(2.87%), 8(1.91%), 1(0.23%), 5(1.19%), 2(0.47%) and 1(0.23%) respectively. Several subtypes were also found. Genotype 3 was the commonest HCV genotype among the Bangladeshi population. Different HCV genotypes will give a good idea regarding the plan of treatment and possible response rate as well as prognosis of HCV infection in Bangladesh. This study had some limitation like relatively smaller sample size and shorter period for the study. Further studies over a larger population are needed to draw any conclusive opinion.

Efficacy of adefovir dipivoxil therapy in patients with chronic hepatitis B viral infection

Hepatitis B virus (HBV) infection is a major public health problem in the world. About 30% of world population has serological evidence of HBV infection. The prevalence of chronic hepatitis B in Bangladesh is reported to be 7.8%. Several potentially effective agents with different mechanisms of action have entered clinical practice and adefovir dipivoxil is one of them. Studies on the efficacy of adefovir dipivoxil in Bangladeshi patients are lacking. This was a prospective study to find out the effect of one year adefovir therapy in patients with chronic hepatitis B virus infection who were HBeAg positive. Total number of patients included in this study was 68. Among them 53(77.94%) patients continued the therapy and completed follow up. At the end of one year of therapy, intention to treat analysis showed that the rate of response (HBeAg seroconversion and HBV DNA negative) was 37.73% which was comparable to the results obtained in other studies. There was major difference in the pre treatment serum ALT level between the responders and non-responders. Comparison of reduction of serum ALT level before treatment and after treatment showed that ALT level to be lower in both responder group and non responder group. Adefovir was effective in replicative HBV infection in Bangladeshi population. So we suggest that treatment can be started and subsequent follow up can be done in chronic HBV patients who are HBeAg positive without liver biopsy.

Prevalence of colorectal diseases in immunological fecal occult blood test (I-FOBT) positive patients in a tertiary care hospital in Bangladesh

Bleeding lesion anywhere in the GI tract can cause positive reaction to Immunological Fecal Occult Blood Test (FOBT). Although any colonic lesion can cause occult lower GI bleeding, relative frequency of this lesion not known. Guaic based tests require prior preparation and dietary restriction and less sensitive and specific than IFOBT for detection of occult bleeding .IFOBT is specific for human hemoglobin and is more sensitive and specific for detection of occult bleeding from any colonic lesion. Aim of this study was to diagnose occult gastrointestinal bleeding with positive IFOBT and the prevalence of colorectal disease in IFOBT positive patients in a tertiary care hospital in Bangladesh. This was a prospective cross sectional study conducted in Department of gastroenterology in collaboration with clinical pathology, BSMMU, Dhaka during the period of January 2009 to December 2009. In this study 200 patients meeting the inclusion criteria were included. Detailed clinical history and physical findings were recorded; FOBT was done on single stool specimen. Positive occult bleeding was confirmed in 90 patients of whom 80 patients underwent colonoscopy. The mean age of study population was 36.73±13.64 (range 16 to 72) years. At colonoscopy lesion were identified in 46(57.50%) patients, of which colonic polyp in12 (15%), colorectal cancer in 11(13.7%), inflammatory bowel disease in 3(3.75%), hemorrhoids and anal fissure in 7(8.75%), tuberculosis in 5(6.25%), and proctitis in 1(1.25%) cases. A positive IFOBT is more sensitive and specific test than other FOBT for detection of occult lower GI bleeding of colonic origin. In this study colorectal diseases were detected in 57.50% of the IFOBT positive patients, so IOBT can be used as an important diagnostic tool for detection of occult lower GI bleeding.

Disease extent and local complication of ulcerative colitis in Bangladeshi population

Ulcerative colitis may involve anywhere from the rectum alone to the entire colon. Local complications like perforation, life threatening haemorrhage, toxic megacolon, pseudo polyps, stricture, and carcinoma of colon are seen. Patients who were diagnosed as Ulcerative Colitis in Departmental Ulcerative Colitis record book from January 1990 to June 2010 was considered as study population. Information regarding the extent of the disease and local complications were taken from earliest documented Lower GIT Endoscopy. Out of 164 patients disease extent were seen in 126(76.83%) patients and among them proctitis/proctosigmoiditis were seen in 57(45.24%) patients, left sided colitis were seen in 11(8.73%) patients, extensive/pan colitis were seen in 58(46.03%) patients. Complication were seen in 164 patients and 1(0.60%) patient had life threatening haemorrhage, 25(15.24%) patients developed pseudo polyps. There was no report of perforation, toxic megacolon, stricture or carcinoma of colon. The differences found between our study and studies from other Western and Asian countries in terms of complication rate and disease extent for were probably due to low index of suspicion, incomplete workup, or incomplete records, and influence of various environmental factors. So, further large scale prospective evaluation is suggested.

Efficacy of Peppermint oil in diarrhea predominant IBS - a double blind randomized placebo - controlled study

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder which is associated with considerable sufferings of patient and Peppermint oil is volatile oil, its active principle is menthol-contain a cyclic monoterpine which has anti-spasmotic properties due to its ability to block calcium channel of intestinal smooth muscles. This study observed the efficacy of peppermint oil for relieving the symptoms and changes of quality of life (QOL) in diarrhea predominant IBS. This was a prospective double blind randomized placebo-controlled study conducted in the Bangabandhu Sheikh Mujib Medical University during July 2008 to September 2009. Patients who fulfilled ROME II were initially selected but those had red flag signs or any organic disease was excluded from the study. Seventy four patients were enrolled in the study and randomly allocated to receive either peppermint oil or placebo three times daily for six weeks. Changes of symptoms were assessed three week interval during treatment and two weeks after the end of treatment. Data were analyzed by paired and unpaired 't' test. Finally sixty five patients completed the trial. It was observed that, at six weeks of therapy abdominal pain is markedly improved (mean±SD) 4.94±1.30 in peppermint oil group compared with 6.15±1.24 in placebo group and the difference was statistically highly significant (p>0.001). But two weeks after end of trials pain score again increased (6.09±1.93). Other symptoms and quality of life did not improve significantly. So the study result concludes that peppermint oil is effective in reliving only abdominal pain in diarrhea predominant IBS transiently.

Clinicopathological profile of patients with abdominal tuberculosis

BACKGROUND

Tuberculosis (TB) is not a uncommon problem throughout the world particularly in the developing countries like Nepal, India and Bangladesh. Abdominal Tuberculosis accounts for nearly 2% of tuberculosis worldwide. The aim of this study was to evaluate the clinicopathological profile with the help of other investigations in the diagnosis of patients with abdominal TB and their response to anti-tubercular therapy. This was a prospective cross-sectional study conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of October 2002 to June 2009.

METHODS

Total 53 patients with abdominal TB diagnosed on the basis of clinical profile and supported investigation data like gross morphological findings at endoscopy, colonoscopy, diagnostic laparoscopy , laparotomy or histologically proven caseating granulomas were selected for this study. Detailed demographic, clinical profile, investigations and treatment response were recorded properly in a predesigned data collection sheet which were analyzed and compared with other studies.

RESULTS

Out of the 53 patients, 33 were males and 20 females with age ranging 16-70 (Mean 30.01±11.7) years. Abdominal pain was the most common presenting symptom in 47 (88.68%), fever in 45 (84.9%) and weight loss in 37 (69.81%) cases. Anemia was found in 41 (77.36%), cachexia 40 (75.47%), ascites 20 (37.74%), palpable abdominal mass in 14 (26.42%) and features of intestinal obstruction in 5 (9.43%) cases. Five patients had positive family history of TB and five had past history of pulmonary TB. The diagnosis of abdominal TB was confirmed microscopically in 5 (9.43%), histopathologically in 31 (58.49%) and the remaining 17 (32.07%) cases were diagnosed by a positive response to anti-TB therapy. According to site of involvement, 31 (58.51%), patients had intestinal TB, 9 (16.98%) had peritoneal TB and disseminated TB in 20 (37.74%) of the case. Twenty seven patients were given 3 drugs regimen for 12 months and 26 patients received 4 drugs regimen for 9 months under close supervision. By 9 months of therapy 51 patients become symptom free and no pathological findings were observed thereafter at follow up visits after 6 months. Response was not satisfactory in two patients and subsequent follow up investigation revealed to have crohn's disease rather than TB and none of them died.

CONCLUSIONS

Abdominal TB is an important clinical entity having varied mode of clinical presentation. So the diagnosis of abdominal TB is difficult and careful approach to the patients and supportive investigation data are necessary to make the final diagnosis. Neither clinical features, laboratory, radiological and Endoscopic methods nor bacteriological and histopathological findings by themselves provide a gold standard in the diagnosis of abdominal TB. In this series of abdominal TB, intestinal TB was the most frequent clinical type and the common presenting symptoms were abdominal pain, fever and weight loss. If diagnosed early, it can be treated successfully with anti-TB drugs.

Cochlear Implant : Anaesthesia Challenges

BACKGROUND

Cochlear implants are now an acceptable therapeutic option for those patients with irreversible hearing loss and deaf-mutism. The surgery is time consuming and complicated. Hence, the technique of anaesthesia plays a crucial role in success of cochlear implant surgery. Cochlear implant patients have various types of syndromes which are important from anaesthetic as well as surgical point of view. Pre-implant preparation requires objective assessment of hearing, plain X-rays of skull and a CT scan of the temporal bone. Anaesthesia is required for objective assessment of hearing in children under five years of age, to obtain X-rays of skull, magnetic resonance imaging (MRI), CT scan, brain evoked response audiometry (BERA) testing and finally for cochlear implant surgery. Anaesthetic considerations include preoperative familiarisation with the patient and his family. Syndromal illnesses have specific anaesthetic significance such as presence of difficult airway or prolonged QT interval. Parental presence is highly desirable during induction of anaesthesia. Electro-surgical instruments especially monopolar ones, should not be used once the cochlear implant is in place.

METHODS

In our institution, all cases (15 children) received their cochlear implants under general anaesthesia and formed the study group. Children were administered midazolam orally and inj ketamine during CT scan. Our techniques of general anaesthesia were modified to permit use of nerve stimulators during surgery. To minimise the incidence of vertigo particularly after cochleostomy, postoperative nausea and vomiting, all patients received glycopyrrolate and fentanyl citrate intravenously prior to induction. Other agents used were, thiopentone, suxamethonium and end-tidal 1.3 MAC halothane in 1:2 mixture of oxygen and nitrous oxide (O2 and N2O). Electro diathermy was switched off, before the cochlear device was implanted on the patient. Patients were allowed to breathe spontaneously whenever nerve stimulator was used to locate the facial nerve. Inj Ondansetron 0.1 mg/kg was used as anti-emetic agent. Postoperative pain relief was initially provided with fentanyl 1 μg/kg IV and later with syrup ibuprofen.

RESULTS

There were no remarkable anaesthetic or surgical complication in our series except perilymph leakage in two cases.

Engineering generalized synchronization in chaotic oscillators

We report a method of engineering generalized synchronization (GS) in chaotic oscillators using an open-plus-closed-loop coupling strategy. The coupling is defined in terms of a transformation matrix that maps a chaotic driver onto a response oscillator where the elements of the matrix can be arbitrarily chosen, and thereby allows a precise control of the GS state. We elaborate the scheme with several examples of transformation matrices. The elements of the transformation matrix are chosen as constants, time varying function, state variables of the driver, and state variables of another chaotic oscillator. Numerical results of GS in mismatched Rössler oscillators as well as nonidentical oscillators such as Rössler and Chen oscillators are presented.

Impact of Various In Situ Preoxidation Process Perturbations on Gate Oxide Quality

This work describes an orthogonal array (OA8) designed experiment involving several insitu process perturbations during oxidation to develop a 90 Å gate oxide for 0.5μm CMOS technology. The biggest impactors were (i) the insitu preoxidation anneal at oxidation temperature, Tox, (ii) 90% N2 dilution of the ambient during ramp-up, and (iii) lowering the Tox to 850°C. Significant improvements in leakage, breakdown, and wear-out characteristics of the oxide are probably due to the reduction of poor quality ramp oxide grown by 90% N2 dilution and improved Si/SiO2 interfacial substructure attained by the insitu preoxidation anneal.

A Two-Step, Lightly Nitrided Gate Oxidation Process For Sub-0.5 μm Cmos Technology

This work describes a two-step, lightly nitrided gate oxidation process for sub-0.5 jtm CMOS technology. This process is a simple extension of conventional oxidation using an in-situ N2O post oxidation anneal for nitrogen incorporation. Light nitrogen incorporation (∼3%) near the Si/SiO2 interface has improved oxide characteristics such as defect density (Do.), wear-out (Nbd), breakdown (Vbd) and tunneling (VFN) without altering its charge trapping behavior. Impacts of nitridation are more significant for thinner (<65Å) gate oxides (GOX).

Li+ ion emission from a hot-plate alumina-silicate source stimulated by flash heating with an infrared laser

The Neutralized Drift Compression Experiment-II accelerator under construction at Lawrence Berkeley National Laboratory has been designed to employ a lithium-doped alumino-silicate (Al-Si) hot-plate surface-ionization ion source. In order to achieve the design 1 mA∕cm(2) current density, the emitter must be constantly kept at a high temperature, leading to the accelerated loss of Li material as ions or neutrals. As a result, the estimated lifetime of the source is 50 h. This lifetime can be extended if the source is kept at low temperature during standby, and pulse heated to the high temperature during the ion extraction phase only. A pulsed heating technique based on an infrared laser (CO(2) gas discharge, λ = 10.6 μm) is described in this paper. The feasibility of ion current emission stimulated by flash heating with an infrared (IR) laser was demonstrated. High repeatability of the laser-stimulated ion current was observed, creating an opportunity for modulation and gating of the ion current with a laser pulse. It was found that with the available low power (≈115 W∕cm(2)) IR laser, current densities as high as 0.8 mA∕cm(2) could be achieved with a 2.8 mm diameter source. Various approaches for scaling to a larger (10 cm diameter) source and the application of short pulse, high power lasers are discussed. The results and conclusions of this paper may apply to various species of hot-plate ion sources.

Optimal Power Flow with TCSC and TCPS Modeling using Craziness and Turbulent Crazy Particle Swarm Optimization

This paper presents two new Particle swarm optimization methods to solve optimal power flow (OPF) in power system incorporating flexible AC transmission systems (FACTS). Two types of FACTS devices, thyristor-controlled series capacitor (TCSC) and thyristor controlled phase shifting (TCPS), are considered. In this paper, the problems of OPF with FACTS are solved by using particle swarm optimization with the inertia weight approach (PSOIWA), real coded genetic algorithm (RGA), craziness based particle swarm optimization (CRPSO), and turbulent crazy particle swarm optimization (TRPSO). The proposed methods are implemented on modified IEEE 30-bus system for four different cases. The simulation results show better solution quality and computation efficiency of TRPSO and CRPSO algorithms over PSOIWA and RGA. The study also shows that FACTS devices are capable of providing an economically attractive solution to OPF problems.

Histopathological alterations in post-infectious irritable bowel syndrome in Bangladeshi population

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder encountered in general practice. Although enormous progress in the pathogenesis of IBS has been made, it is still poorly understood. A significant proportion of patients with IBS, report onset of symptoms following an episode of acute gastroenteritis. Aim of the study was to determine whether post infective irritable bowel syndrome (PI-IBS) has histological or clinical features that are distinct from those of IBS patients with no history of preceding infection. A total of 50 consecutive IBS out patients and 10 healthy control subjects completed a questionnaire detailing symptoms, mode of onset, and previous psychiatry history. All underwent a full diagnostic workup including colonic biopsy and histopathology. Patients were divided according to onset of symptoms into post infectious IBS (PI-IBS, N=18) and non-post infectious IBS (non-PI-IBS, N=32) patients. Diarrhea predominantly occurred more frequently in PI- IBS (70%) than in non-PI-IBS (40%) patients (p<0.05). Histopathological examination of the biopsy specimen from the sigmoid colon of the observed individuals showed a significant increase in the number of chronic inflammatory cells in both groups of IBS patients comparing to the control group (p<0.001). Lymphoid follicles were increased in both groups of IBS patients in comparison to control group (p<0.05). Mast cells were increased in IBS patients comparing to the control group (p<0.05) and it was significantly increased in the PI-IBS patients than the non-PI-IBS patients (p<0.001). Individuals with PI-IBS are clinically distinct subgroup characterized by predominant diarrheal symptoms and increased mast cells compared to those with non PI-IBS.

Sero-epidemiology of sporadic acute hepatitis in Bangladesh: high prevalences of infection with type-B, type-E and multiple types of hepatitis virus

In a recent investigation of hepatitis in Bangladesh, the sera from 74 adult patients (aged 15-67 years) who had been clinically diagnosed as cases of sporadic acute hepatitis were collected at various hospitals in and around Dhaka. Five cases were positive for IgM antibody against the hepatitis A virus and 30 were positive both for the surface antigen of the hepatitis B virus (HBV) and for IgM antibody against the HBV core (HBc). The six cases found positive for antibodies against the hepatitis D virus were all also positive for the HBV surface antigen but negative for anti-HBc IgM. Thirteen patients harboured hepatitis C virus RNA and 29 were positive for IgM antibody against the hepatitis E virus (HEV). There were 14 non-A-to-E subjects, whose illness was of unknown aetiology. Of the 83 infections with hepatitis viruses detected in the other 60 patients, 6%, 36%, 16%, 7% and 35% were of types A, B, C, D and E, respectively. Each of 28 of the patients (47% of those confirmed to have viral hepatitis) had concomitant infection with more than one type of hepatitis virus. The predominance of HBV and HEV infections and the high prevalence of multiple infection seen among these Bangladeshi cases have not been observed among hepatitis cases in developed countries.

Variable stiffness colonoscope versus regular adult colonoscope: meta-analysis of randomized controlled trials

BACKGROUND AND STUDY AIMS

The variable stiffness colonoscope (VSC) may have theoretical advantages over standard adult colonoscopes (SACs), though data are conflicting. We conducted a meta-analysis to compare the efficacies of the VSC and SAC.

STUDY DESIGN

We searched Medline (1966 - 2008) and abstracts of gastroenterology scientific meetings in the 5 years to February 2008, only for randomized clinical trials (RCTs) of adult patients. Trial quality was assessed using the Delphi list. In a meta-analysis with a fixed effects model, cecal intubation rates, cecal intubation times, abdominal pain scores, sedation used, and use of ancillary maneuvers, were compared in separate analyses, using weighted mean differences (WMDs), standardized mean differences (SMDs), or odds ratios (ORs).

RESULTS

Seven RCTs satisfied the inclusion criteria (1923 patients), four comparing VSC with SAC procedures in adults, and three evaluating the pediatric VSC. There was no significant heterogeneity among the studies. The overall trial quality was adequate. Cecal intubation rate was higher with the use of VSC (OR = 2.08, 95 % confidence interval [CI] 1.29 to 3.36). The VSC was associated with lower abdominal pain scores and a decreased need for sedation during colonoscopy. Cecal intubation time was similar for the two colonscope types (WMD = - 0.21 minutes, 95 % CI - 0.85 to 0.43). Because of the nature of the intervention no studies were blinded. There was no universal method for using the VSC.

CONCLUSIONS

Compared with the SAC, VSC use was associated with a higher cecal intubation rate, less abdominal pain, and decreased need for sedation. However, cecal intubation times were similar for the two colonoscope types.

Haemodialysis induces mitochondrial dysfunction and apoptosis

BACKGROUND

Mitochondria play a crucial role in the regulation of the endogenous pathways of apoptosis activated by oxidant stress. Nuclear factor-kappaB (NF-kappaB) is a central integration site for pro-inflammatory signals and oxidative stress.

MATERIALS AND METHODS

Peripheral blood mononuclear cells (PBMC) were isolated from eight end-stage renal disease (ESRD) patients before haemodialysis (Pre-HD) and during the last 10 min of HD (End-HD). A new polysulfone membrane (F70, Fresenius) was used for dialysis. Intracellular generation of reactive oxygen species (ROS), mitochondrial redox potential (Deltapsim) and PBMC apoptosis were determined by flow-cytometry.

RESULTS

Plasma levels of interleukin-6 (IL-6) (24.9+/-7.0 vs. 17.4+/-5.5 pg dL(-1), P<0.05), IL-6 soluble receptor (52.2+/-4.9 vs. 37.6+/-3.2 ng dL(-1), P<0.02) and IL-6 gp130 (405.7+/-41.0 vs. 235.1+/-38.4 ng dL(-1), P<0.02) were higher end-HD compared to pre-HD. IL-6 secretion by the isolated PBMC (24.0+/-2.3 vs. 19.3+/-3.5 pg dL(-1), P<0.02) increased end-HD. Percentage of lymphocytes exhibiting collapse of mitochondrial membrane potential (43.4+/-4.6% vs. 32.6+/-2.9%, P<0.01), apoptosis (33.4+/-7.1% vs. 23.7+/-7.7%, P<0.01), and generation of superoxide (20.7+/-5.2% vs. 12.5+/-2.9%, P<0.02) and hydrogen peroxide (51.1+/-7.8% vs.38.2+/-5.9%, P<0.04) were higher at end-HD than pre-HD. NF-kappaB activation (3144.1+/-208.1 vs. 2033.4+/-454.6 pg well(-1), P<0.02), expression of B-cell lymphoma protein-2 (6494.6+/-1461 vs. 3501.5+/-796.5 ng mL(-1), P<0.03) and heat shock protein-70 (9.81+/-1.47 vs. 6.38+/-1.0 ng mL(-1), P<0.05) increased during HD.

CONCLUSIONS

Intra-dialytic activation of cytokines, together with impaired mitochondrial function, promotes generation of ROS culminating in augmented PBMC apoptosis. There is concomitant activation of pathways aimed at attenuation of cell stress and apoptosis during HD.

Role of infection on the stability of a predator–prey system with several response functions—A comparative study

In this paper, we have proposed and analyzed a mathematical model of an infected predator-prey system with different predators' functional response. The existence and uniqueness of solutions are established and solutions are shown to be uniformly bounded for all nonnegative initial values. Our overall mathematical and biological studies reveal that if the prey population is infected by a lethal disease, coexistence of all three species (i.e. host, parasite and predator) for any of three functional responses is never possible but different interesting dynamical behaviors are possible by varying two key parameters viz. the rate of infection and the attack rate on susceptible prey. Interplay between these two factors yields a diverse array of biologically relevant behavior, including switching of stability, extinction and oscillations.

Drift compression of an intense neutralized ion beam

Longitudinal compression of a velocity-tailored, intense neutralized beam at 300 keV, 25 mA has been demonstrated. The compression takes place in a 1-2 m drift section filled with plasma to provide space-charge neutralization. An induction cell produces a head-to-tail velocity ramp that longitudinally compresses the neutralized beam, enhancing the beam peak current by a factor of 50 and producing a pulse duration of about 3 ns. This measurement has been confirmed independently with two different diagnostic systems.

Effects of dietary tamarind on cholesterol metabolism in laying hens

An experiment was conducted to evaluate the potential for dietary tamarind to alter serum and egg yolk cholesterol concentrations and overall performance in different layer strains. Thirty, 43-wk-old, Hisex Brown, ISA Brown, Lohmann Brown, Starcross Brown, Babcock B-300, and Starcross-579 strains (5 hens per strain) were fed diets supplemented with 0 (control), 2, 4, 6, or 8% oven-dried tamarind for 6 wk. Egg production, egg mass, and efficiency of feed utilization followed a quadratic response with a maximum when the diet contained 2% tamarind and a minimum when 8% tamarind was fed (P < 0.05). There were no differences (P > 0.05) among strains for egg production, egg weight, yolk weight, egg mass, feed consumption, or feed efficiency. Yolk weight increased linearly (P < 0.05) with increasing levels of dietary tamarind in wk 1, 2, and 3 as well as when averaged over 6 wk. Egg yolk cholesterol concentrations were not affected by dietary tamarind. Serum cholesterol concentrations, however, decreased quadratically with increasing levels of dietary tamarind (P < 0.05). It was concluded that 2% supplemental dietary tamarind could decrease serum cholesterol concentrations and increase layer performance.

Abdominal tuberculosis--a study of 25 cases

Abdominal tuberculosis is one of the common extra pulmonary tubercular infections. Its clinical presentation is protean and it has diagnostic dilemma, as most of the investigations are non-specific and less sensitive. Therefore this study was undertaken to define the most suggestive clinical features of abdominal tuberculosis, to find out the efficacy of most commonly available investigations and also to evaluate the response of abdominal tuberculosis to conventional antitubercular therapy. Twenty five cases of either sex were studied in department of gastroenterology in BSMMU (earlier IPGMR), Dhaka from January 2001 to June 2003. All patients were clinically evaluated and were investigated by available tests. Eighteen patients were diagnosed by investigations (One by detecting AFB, 9 with caseating granuloma in biopsy specimen and 8 with suggestive radiological findings). Diagnosis of 7 patients were made from the common clinical features (fever, weight loss, altered bowel habit, abdominal pain and distension, positive non-specific findings and from response by antitubercular therapy. All patients received conventional 9 month anti-tubercular treatment with Rifampicin, Isoniazide and Pyrazinamide and were followed up clinically during and one year after completion of treatment. All patients were improved with minimum side effects of drug. Therefore, it is observed that a representative tissue biopsy (when approachable) and radiological findings are good method of diagnosis of abdominal tuberculosis. Strongly suggestive clinical features with positive non specific investigation findings are also an indication for anti tubercular treatment in all endemic countries like Nepal, Bangladesh and India. Treatment of abdominal tuberculosis is in no way different from that of other conventional anti-TB therapy.