Serum Uric Acid and Serum Lipid Levels in Patients with Acute Ischemic Stroke Admitted in Mymensingh Medical College Hospital

Stroke is the second-leading cause of death and also a leading cause of combined death and disability. In Bangladesh, stroke prevalence is 11.39 per 1000 population, but highest prevalence of stroke is 14.71 per 1000 population in the Mymensingh division. Hyperuricemia has been reported as an independent risk factor for stroke in different studies and a significant association between serum uric acid and dyslipidemia has also been stated. On the contrary, some studies suggest that uric acid has a neuroprotective role. This cross-sectional study was completed in the Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2021 to January 2023. In this cross-sectional study, 352 adult acute ischemic stroke patients were included from the Medicine Department of Mymensingh Medical College Hospital. Serum uric acid and fasting serum lipid levels were measured within 48 hours of admission. The mean age ±SD of the respondents was 61.9±12.8 years. Hyperuricemia was found among 18.2% of respondents, whose mean ±SD serum uric acid was 5.7±1.9 mg/dl. Dyslipidemia was present in 88.4% of patients. The mean ±SD of the National Institutes of Health Stroke Scale (NIHSS) score was 12.0±5.9. Most of the patients (65.6%) were suffering from moderate stroke, followed by moderate to severe stroke (15.1%), severe stroke (10.8%) and minor stroke (8.5%). After multiple linear regressions, the independent variables age, gender, serum uric acid and total cholesterol were found to be significant predictors of the NIHSS score of the respondents. In conclusion, the majority of acute ischemic stroke patients have an association with dyslipidemia, but only around one-fifth of patients have hyperuricemia. There is a significant association of high serum uric acid and high serum total cholesterol with stroke severity (NIHSS score). But low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and, triglycerides have no association with stroke severity.

Ocular Involvement in Transfusion Dependent Thalassemia Children

Thalassemia is one of the most common haemoglobinopathies in the world. Transfusion dependent thalassemia patients need regular blood transfusion. Repeated blood transfusions lead to iron overloads which can affect various organs in the body including eyes. The present study aims to evaluate the ocular involvements in transfusion dependent thalassemia children and their relationship with duration of the disease and serum ferritin level. This cross-sectional observational study included 46 multi-transfused thalassemia children aged 3-18 years. Detailed ophthalmological examination including visual acuity, slit lamp bio microscopy, direct and indirect ophthalmoscopy was done. Statistical analysis was done using SPSS version (IBM) 23.0. Student's t-test and chi-square (χ²) test was done and p value of <0.05 was considered significant. Out of 46 thalassemia children male were 25(54.3%) and female were 21(45.7%). Mean age of the children was 8.94±5.04 years, mean duration of disease was 7.02±3.5 years and mean serum ferritin level 1543.68±914.43ng/dl. Ocular involvements were detected in 19(41.3%) children. Among them 8(17.39%) children had more than one ocular involvements. The ocular manifestations were decreased visual acuity in 17(36.95%), corneal dryness in 7(15.21%), lens opacity in 6(13.04%), optic disc atrophy in 7(15.21%), peripheral retinal pigmentation in 5(10.86%) and retinal vessels tortuosity in 3(6.52%) children. Higher serum ferritin level and increased duration of the disease were significantly (p<0.001) related with ocular involvement. Various ocular involvements were found in transfusion dependent thalassemia children. Therefore, transfusion dependent thalassemia children should be screened periodically for early detection and proper management of ocular changes.

Role of Intra-arterial Nitroglycerin (Post Procedural, Prehemostasis) to Reduce Radial Artery Occlusion after Transradial Catheterisation: A Doppler-guided Study

The study was intended to evaluate efficacy of Intra-arterial nitroglycerin through the sheath at the end of a transradial procedure to preserve the patency of the radial artery. This prospective observational study was done in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2017 to April 2018, by including a total 200 patients undergoing coronary procedures (CAG and / or PCI) through TRA. RAO was defined as an absence of antegrade flow or monophasic flow or invert flow on Doppler study. In this study 102 patients (Group I) received 200 mcg intra-arterial nitroglycerine, prior to trans-radial sheath removal. Another 98 patients (Group II) did not receive intra-arterial nitroglycerine prior to trans-radial sheath removal. Conventional haemostatic compression methods were applied (average 2 hours) in both groups of patients. Evaluation of radial arterial arterial blood flow by colour Doppler study was done on next day after the procedure in both groups. Results of this study in which RAO was determined by vascular doppler study showed that frequency of radial artery occlusion were 13.5% one day after transradial coronary procedures. We found the incidence was 8.8% vs. 18.4%, (p=0.04) in Group I and Group II respectively. The incidence of RAO was significantly lower in post procedural nitroglycerine group. From multivariate logistic regression analysis diabetes mellitus (p = 0.02), hemostatic compression time for more than 02 hours after sheath removal (p = <0.001) and procedure time (p = 0.02) was predictors of RAO. So, the administration of nitroglycerin at the end of a transradial catheterization reduced the incidence of RAO, as shown by 1 day after the radial procedure by doppler ultrasound.

Management of Neglected Rupture of Tendoachilles with Long Gap by Flexor Hallucis Longus Tendon Transfer

The tendo achilles is one of most important tendon in human body which often injured through direct trauma or indirect stress on a weakened tendon. Longer the duration after injury the injured parts likely to move apart, fibrosis and degeneration leading to difficulty in repair or reconstruction. Usually a phase of 4 weeks or more without specific treatment is regarded as chronic or neglected rupture. Different authors described many management protocols about the tendo achilles rupture but there is no procedure of choice for neglected rupture with long gap. Prospective case series of 21 patients of neglected tendo achilles rupture with long gap treated with flexor hallucis longus tendon (FHLT) transfer was taken for study from January 2019 to December 2020 in Mymensingh Medical College Hospital, Bangladesh. Average age of patients was 39.47 years with range 22-65 years. Fifteen (15) cases of traumatic rupture in this study with average age 32.66 years and pathologic 6 cases with average age 56.5 years were recorded. We grafted FHLT from channel by incising Henry's knot. Krackow et al.'s technique was followed for tendon mobilization and bone fixation. We made procedure simpler and cheaper; instead of using interference screw the sutured tendon pulled through the heel and anchored over rubber tube or button by Cole method. Post-operative complications were less with one patient with superficial infection which eventually recovered 3 cases of mild pain and 2 cases of numbness. Questionnaire for surgical outcome measure are satisfactory in 19 patients (90.47%). Final follow up AOFAS score at 6 month (91.61±5.41) was highly significant (p<0.001) in comparison to preoperative score (38.71±9.78). These are comparable to other study. Above mentioned scores indicate the reliability of the surgical system. But our study is a prospective case series with minimum cases. To establish the best procedure for neglected tendo achilles rupture with long gap we recommend further study with larger group and Randomized Controlled Trial (RCT) study among different procedure.

Risk Factors of UTI in Children with Nephrotic Syndrome

Urinary tract infection (UTI) is a common complication in nephrotic children and leads to most morbidity and mortality in developing countries like Bangladesh. This case control study was conducted in the Department of Pediatrics and Pediatric Nephrology ward of Dhaka Medical College Hospital, Dhaka from July 2016 to June 2018 to identify the risk factors of UTI in children with nephrotic syndrome. Total 90 patient of nephrotic children aged 2-12 years, who were fulfilling the inclusion and exclusion criteria were selected as Group I (case) and Group II (control) according to urine culture report. Group I was UTI positive and Group II was UTI negative. The mean age of Group I was 5.26±3.18 years and Group II was 6.03±2.85 years. There was male predominance in both groups. No significant difference has been found regarding age and sex (p>0.05). No significant difference was also observed regarding economic status and educational level of mother among both groups (p>0.05). Fever, dysuria, abdominal pain, anasarca, vomiting and pallor were found as common presentations in Group I. Children with dysuria and abdominal pain were significantly higher in Group I than Group II (p value <0.001). UTI was found more in relapsed cases than initial attack. E. coli was the most common etiologic agent (37.8%). Mean Hb (gm/dl), serum total protein, serum albumin and serum IgG level were found significantly lower and spot urine protein creatinine ratio was significantly higher in Group I, which implies that those biochemical factors were associated with development of UTI in nephrotic children. Younger age group (<6 years), Constipation and uncircumcised male were found as risk factors and has association with UTI in nephrotic children.

Clinical Outcome on Comminuted Femoral Shaft Fractures in Adults Treated by Minimally Invasive Plate Osteosynthesis (MIPO) with Locking Plate

Intramedullary nailing is a pillar in the treatment of femoral shaft fractures. But it is not possible in all cases especially in comminuted fractures. This study has been designed to explain the importance of Minimally Invasive Plate Osteosynthesis (MIPO) with the locking plate in the treatment of comminuted Femoral Shaft Fracture. Twenty (20) such patients were treated by MIPO and analysis has been done in this study to get fruitful result and to find out the effectiveness of this procedure who were admitted at Mymensingh Medical College Hospital, Mymensingh, a tertiary level hospital of Bangladesh from February 2018 to January 2019. Mean age of the patients were 49.20±14.41 years. Based on AO classification, there were 4, 8 and 8 patients belong to type A, B and C respectively. The union period for all the patients was in between 12 to 14 weeks. The mean union period was 12.90±1.997 weeks. Mean follow up period was 19.70±2.77 weeks. Mean full weight bearing period was 16.50±1.10 weeks. In Thoresen scoring system excellent result was 9(45%), good result was 10(20%) and fair result was 01(5%). Mal-alignment happened in two cases. However, delayed union and broken screws were found in two cases each of which was treated accordingly. Comminuted Femoral shaft fracture with MIPO procedure is more effective treatment than intramedullary nailing. Furthermore, mal-alignment is the basic complexity that must be taken away intraoperatively.

Core Decompression with Non Vascularized Fibular Graft as Modern Surgical Treatment of Early Hip Avascular Necrosis

Cellular death of bone due to impairment of the blood supply leading to collapse resulting in pain, and loss of joint function is known as avascular necrosis (AVN). The head of femur is the most common bone affected by avascular necrosis followed by talus and scaphoid. We evaluate the results of core decompression with non-vascularized fibular graft in avascular necrosis of femoral head. This quasi experimental study was done at Mymensingh Medical College Hospital, Dhaka Medical College Hospital and some other private hospitals of Bangladesh. The study includes patients who underwent core decompression and non-vascularized fibular grafting in avascular necrosis of femoral head from January 2017 to December 2018. In this study we evaluated total 20 patients and majority of the patients belongs to the group of 20-30 years. Out of 20 patients, 8 of them were unilaterally involved rest 12 had bilateral involvement. Out of 24 hips of bilateral involvement 4 were grade III and IV (Ficat and Arlet classification) therefore not included in the study. So, we study 28 hips only. The average success rate was 90% after core decompression and non-vascularized fibular bone grafting. Harris hip score of 60 on presentation had poorer outcome. Patients with less than 80 degrees of flexion had poorer outcome.

Study on Precipitating Factor of Chronic Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a neuro-psychiatric manifestation of chronic liver disease causing significant morbidity and mortality worldwide. Though the exact mechanism is unknown but it is well accepted that various precipitating factors are involved in hepatic encephalopathy. Aim of the study was explore the precipitating factors of chronic hepatic encephalopathy. This cross sectional descriptive study was conducted in the Department of Medicine and Department of Hepatology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period from April 2016 to October 2016. One hundred patients with hepatic encephalopathy fulfilling the inclusion and exclusion criteria were enrolled. Inclusion criteria were designed for all diagnosed cases of hepatic encephalopathy associated with cirrhosis of liver aged 18 years or above irrespective of sex. Patients with acute fulminant hepatitis and non-cirrhotic hepatic encephalopathy were excluded. The result of the study was mean age of hepatic encephalopathy was 52.81±8.15 years and 94.0% patients were above 40 years. Male (66.0%) were predominant over female (34.0%). HBsAg and Anti HCV were positive in 49.0% and 11.0% patients respectively. Stage of hepatic encephalopathy was stage-I in 8.0%, stage-II in 37.0%, stage-III in 39.0% and stage-IV in 16.0% patients. Changes of biochemical parameters were low haemoglobin level (70.0%), raised total count of leukocyte (25.0%), low platelet count (68.0%), low serum albumin (98.0%) raised prothrombin time (60.0%), low serum sodium (34.0%) and low serum potassium (63.0%). The recoded precipitating factors were gastrointestinal bleeding (14.0%), constipation (37.0%), hyponatremia (34.0%), hypokalemia (28.0%) infections (20.0%), use of diruretics (8.0%), use of sedatives (4.0%) and excess intake of protein (6.0%). While precipitating factor was absent in 11.0% of cases. In conclusion there are different factors which play a key role in precipitating hepatic encephalopathy but electrolytes imbalance, constipation, infections, Upper GI bleed, diuretics are the most common precipitating factors.

Quality of Life among Patients with Bipolar Disorder

Bipolar Disorder is a major psychiatric disorder. It has a chronic course of remitting and relapsing episodes of mania and depression and tends to deteriorate mental and cognitive functions of patients. This disorder affects deeply the function and feelings of subjects and impacts negatively on quality of life. We found out the quality of life in patients with Bipolar Disorder with that of general population and order of impairment among domain of physical health, psychological health, social relationship and environment domain. This was a descriptive, cross-sectional, comparative and analytical study. The study was conducted in the department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2015 to October 2016. Eighty (80) patients with Bipolar Disorder who fulfilled inclusion criteria were selected as sample from department of psychiatry in BSMMU and National Institute of Mental Health, Dhaka. Clinical diagnosis of patients was done by consultant psychiatrist with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I CV). Then Bengali version of WHO Quality of Life Scale brief version (WHOQOL BREF 1998) was applied to evaluate quality of life in different domains including physical health, psychological health, social relationship and environment domain. Semi structural questionnaire were used for collecting sociodemographic information. In this process of study age and sex matched 80 healthy controls from hospital staff and patient's attendants without physical or psychiatric illness were recruited for comparison. Data were analyzed by Statistical Package for Social Science Version 16. The study revealed that mean score of overall quality of life of patients were 3.11 and healthy controls were 3.95, mean score of overall health of patients were 2.94 and healthy control were 3.88, mean score of physical health domain of patients were 3.14 and healthy control were 4.00, mean score of psychological domain of patients were 3.01 and healthy control were 3.87, mean score of social relationship domain of patients were 2.31 and healthy control were 3.72, mean score of environment domain of patients were 2.73 and healthy control were 3.35. Among patients quality of life showed impaired in low socio-economic condition. Result of this study may help to encourage further research.

Childhood Adversities as Risk Factors and Persistence of Suicidal Behavior: A Descriptive Cross-Sectional Study

Suicide is one of the important cause of death worldwide. The precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour are not well understood. A descriptive cross sectional study was carried out in the department of Psychiatry, Cumilla Medical College, Cumilla, Bangladesh. All cases were selected from patients attending at Cumilla Medical College hospital and Private Hospitals in Cumilla City from April 2017 to September 2018. We found out the association between childhood adversities and suicidal behaviour over the life course and delineated the types of suicidal behavior. Total 120 cases were included in the study. Respondents provided socio-demographic and diagnostic information, childhood adversities as well as an account of suicide-related thoughts and behaviours. A participation rate was 77.5% female. Of 120 suicidal behavior participants physical abuse was 2.5%, sexual abuse was 16.67%, parental death was 5%, parental divorce was 2.5%, other parental loss was 4.17%, family violence was 5%, physical illness was 1.67%, financial adversity was 3.33% and composite adversity was 59.16%. Among childhood adversities participants suicidal ideation was 70%, suicidal plans was 15.83%, suicidal attempts was 45%, ideators only proceeded to plans was 22.5%, ideation to attempt was 63.33%, planned attempts was 10.83% and impulsive attempts was 52.5%. Among suicidal behavior participant's psychiatric disorders were 65%. Where neurotic disorders were 17%, psychotic disorders were 13%, personality disorders were 44% and others disorder was 26%. Most of the suicidal behavior patients were female 77.5% and age group of 18-24 years. Childhood sexual abuse emerged as a particularly robust risk factor for suicide attempts in younger participants. Childhood physical and sexual abuse emerged as risk factors for the emergence and persistence of suicidal behaviour, especially in adolescence. Two or more childhood adversities were associated with a three fold higher risk of lifetime suicide attempts. Childhood adversities are main risk factors for the onset and persistence of suicidal behaviour. The risks being are the greatest in childhood, adolescence and early adult. A longitudinal follow-up study is required to give a more reliable in Bangladesh.

Methylene-linked bis-phenylbenzimidazoles - a new scaffold to target telomeric DNA/RNA hybrid duplex

We report a series of novel methylene-linked bis-phenylbenzimidazoles intercalators that stabilize telomeric DNA/RNA hybrid (tDRH) structures by up to 7.2 °C at a 1 μM ligand concentration while having negligible affinity for DNA/DNA duplexes, although with a low affinity for quadruplex DNA. We have used molecular modelling studies to rationalize this selectivity, concluding that the methylene spacer between the terminal benzimidazole and phenylene moieties plays a key role in facilitating the bis-intercalating process. This scaffold may be used to develop chemical tools or new therapeutics to selectively target the telomeric DNA/RNA duplex without affecting normal genomic DNA.

NITROXYNIL UNCOUPLES OXIDATIVE PHOSPHORYLATION IN THE CELL MITOCHONDRIA AND A DRUG WHEREVER INJECTABLES ARE PREFERRED OVER DRENCHES

In the absence of effective vaccines and because of practical limitations in management options to control the snail intermediate hosts, the control of liver fluke infection and disease in livestock relies heavily on the use of flukicidal anthelmintics. Nitroxynil is a nitrate derivative from benzene compounds and presents a flukicide effect and is commonly used as the one with best spectrum from all the nitrate derivative trematocides. The drug is in fact, a low spectrum anthelmintic effective against fascioliasis, an important parasitic disease caused by flukes like Fasciola hepatica, Fasciola gigantica, affecting significantly the ruminant production by means of reducing the growth, conversion rate, milk production, quality and quantity of meat and reproduction. Nitroxynil also does hold efficacy against few roundworms mainly blood-sucking species as well as certain myiasis. It is not effective against most of the tape worms or external parasites. It is chemically constitute of yellow benzene crystals, slightly soluble in water and soluble in organic solvents, almost odorless and is characterized for being a stable solution, but it precipitates in presence of calcium and other salts. It is marketed as bright orange-red injectable solution due that by this route is six times more efficient than by oral route. Nitroxynil is a safe drug and it can be used at any stage of pregnancy. It does not affect fertility, gestation or fetus formation and in no way impede the reproductive performance of stallions. It’s presented as two salts, nitroxynil megaglumine and nitroxynil eglumine. The nitroxynil in salt is hydrosoluble having neutral pH and is exclusively administered to animals by subcutaneous route. The flukicide resistance phenomenon is already present in many countries in the same way that resistance against other anthelmintic drugs is spreading around worldwide. Because of the absence of new drugs against fluke infections, it is necessary to prove and compare the efficacy of the anthelmintics to prevent resistance development. In view of that we endeavored elucidating the latest progress of one such widely used flukicide nitroxynil.

Risk Factors and Immediate Outcome of Very Low Birth Weight Babies (Appropriate For Gestational Age) In Newly Established SCANU, Mymensingh Medical College Hospital

Low birth weight (LBW) is the most important preventable cause in the neonatal period leading to very high neonatal mortality and morbidity in developing countries like Bangladesh. A cross sectional study was conducted in the neonatology ward, Mymensingh Medical College Hospital, Mymensingh from July 2014 to December 2014 to identify the risk factors and immediate hospital outcome of Very Low Birth Weight (VLBW) Appropriate for Gestational Age (AGA) babies in context of present neonatal hospital care standard. Total 100 preterm very low birth weight babies were enrolled and selected by weight, intra uterine growth chart and new ballad score. There is slight preponderance of male babies (64%) over female babies (36%). The overall survival and mortality rate was 50% and 50% respectively in the present study. Mortality is highest (76.47%) in babies whose gestational age 28 weeks and the mortality rate gradually decrease as gestational age increases. Correlation co-efficient (r) between gestational age and number of died is -0.85. It indicates highly opposite relation between the variables, p value (<0.069) which is strong opposite relation. Mortality is highest (66.66%) in babies whose birth weight below1100gm, in comparison to those whose birth weight above 1100gm and correlation co-efficient (CC) r = -0.433 (p<0.466) which is not significant. That means not only birth weight but also other factors are responsible for mortality of very low birth weight baby. Neonatal mortality bears inverse relationship with birth weight and gestational age. This emphasized the need for large scale study which will provide the guideline for appropriate measures to be taken to combat the situation.

Effects of the main extraction parameters on chemical and microbial characteristics of compost tea

The rising popularity of compost tea as fertilizer or foliar spray against pathogens has encouraged many researchers to evaluate its performance without standardizing its quality, so obtaining inconsistent and controversial results. The fertilizing and pesticide-like effects of compost tea are due to its chemical and microbiological properties. Therefore, this study aimed to identify the best combination of the compost tea extraction parameters for exalting both chemical and microbiological features. A factorial design was adopted to evaluate the effects of compost/water ratio, extraction time, storage duration and storage temperature in different combination on physical, chemical and microbiological characteristics of compost tea, and the results were elaborated through different statistical analyses. Compost tea nutrients and microorganisms were influenced by compost/water ratio and extraction time. In addition, the storage duration affected the microbial populations, whereas the storage temperature influenced only the fungal population of compost tea. Results suggested that the best combination of the studied parameters was: 1:2.5 compost/water ratio, 2days of extraction time and the compost tea should be utilized immediately after the extraction, since the storage reduced the microbial populations.

Modelling and analysis of the effect of different parameters on a parabolic-trough concentrating solar system

Concentrating solar power technologies are potential energy-harvesting systems.

Outcome of single-stage transanal endorectal pull through for short segment Hirschsprung's disease in neonates and infants

Hirschsprung's disease (HD) is developmental disorder of the enteric nervous system. Diagnosis can be confirmed by rectal biopsy. The surgical management of HD includes so many procedures. The purpose of this study was to evaluate the out come of single-stage transanal endorectal pull-through operation for short segment HD in neonates and infants. This prospective study was carried out in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh during the period from January 2004 to December 2009. The study included neonates & infants (age 1 day to 1 year) of both sex, who were clinically suspected and biopsy proven HD with barium enema suggesting rectosigmoid HD. We excluded patients with short segment HD who had associated anomalies, and with hugely dilated proximal colon, operated cases with less than 6 months' follow up. During study period, single-stage transanal endorectal pull through (TEP) operation done in 68 neonates and infants patients (8 excluded) of short segment HD. The mean operative time, postoperative hospital stay, followed up time were 120 minutes, 7.94 days and 12 months respectively. Transeverse colostomy was needed in 4 patients because of anastomotic leakage and they were complicated with anastomotic stenosis, however managed by progressive dilatation. Overall parents' satisfaction was achieved. Single-stage primary transnanl endorectal pull-through for short segment HD is feasible in neonates and infants. It preserves all the advantages of minimally invasive surgery. TEP is a better option in terms of comfort, operative success, postoperative morbidity, cosmetic appearance and parents' satisfaction.

HYPOLIPIDEMIC EFFECT OF GINGER EXTRACT IN VANASPATI FED RATS

The aim of the present study was to evaluate the hypolipidemic effect of ginger in vanaspati fed rats. A total of 18 rats of Long Evans strain weighing 200-250 g were randomly assigned to three groups: Group I, normal control; Group II, 5% vanaspati supplement and Group III, 5% vanaspati + ginger extract (300 mg/ 100ml/ kg b. wt./ day) orally. Serum lipid profile was measured at day 1st and day 49th. The administration of vanaspati augmented the total cholesterol, LDL-C, triglycerides levels and decreased the HDL-C level significantly (p <0.05). Simultaneous administration of ginger extract significantly (p <0.05) prevented the rise in total cholesterol, LDL-C(bad cholesterol), triglycerides levels and rise HDL(good cholesterol). In histopathological study, no significant changes were found in the liver and aorta of all treated groups as compared with control group. It is concluded that ginger extract showed hypolipidemic effect in vanaspati supplemented rats.DOI: http://dx.doi.org/10.3329/bjvm.v10i1-2.15652

Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia

Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ≥2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial.

A CROSS SECTIONAL STUDY ON FASCIOLA GIGANTICA AND GIGANTOCOTYLE EXPLANATUM BURDENS IN NATURALLY INFECTED BUFFALOES IN BANGLADESH

A cross sectional study on Fasciola gigantica and Gigantocotyle explanatum burdens in buffaloes in relation to their age, sex and health condition was carried out in the Laboratory of Parasitology, Bangladesh Agricultural University, Mymensingh, Bangladesh during the period from June to November 1997. A total of 460 faecal samples were examined to determine the egg per gram of faeces (epg) of F. gigantica. Higher epg was counted in female buffaloes (159.67 ± 6.80) than in males (153.24 ± 8.29). The epg counts were also found significantly (p < 0.01) higher in poor conditioned buffaloes (164.41 ± 6.67) than in buffaloes with normal health (128.57 ± 7.08). In relation to age, the young adult buffaloes were found to bear more parasitic burdens. The highest mean epg was recorded in the buffaloes of 2-3 years old (184.21 ± 19.14), followed by 3-5 years old (169.23 ± 30.77). The older buffaloes had relatively lower parasitic burden and the lowest mean epg was recorded in the growing buffaloes of up to 1 year old (125 ± 25.0). Examination of 106 livers from slaughtered buffaloes, revealed that the load of Fasciola gigantica and Gigantocotyle explanatum in the livers ranged from 13-424 (69.20 ± 6.46) and 41-427 (161.45 ± 10.79) respectively. In males the burden of F. gigantica (13-210) was lower than that of the females (15-424). The mean number of F. gigantica in the buffaloes of 5- 10 years old (100 ± 15.32) was significantly higher (p < 0.01) than those of the buffaloes of above 10 years old (52.92 ± 4.29). In case of single infection with F. gigantica, the mean number of parasites per liver was significantly (p < 0.05) higher (88.70 ± 11.48) than that of mixed infection cases (49.74 ± 4.20). Significantly (p < 0.01) higher number of G. explanatum was recovered from the buffaloes of 5-10 years old (207.53 ± 26.72) than from the buffaloes of above 10 years old (141.58 ± 9.23) and from single infected cases than from buffaloes with mixed infection. There were almost no differences in the number of both flukes in relation to sex of buffaloes. The length and breadth of immature and mature parasites were 5-15 min x 2-3 min and 16-72 mm x 4-14 mm respectively. No significant variation was found in the average size of F. gigantica in relation to the age and sex of buffaloes. But in case of single infection, the body size of mature F. gigantica (38.63 mm ± 0.38 mm x 9.96 mm ± 0.12 mm) was significantly (p < 0.05) higher than that of the mixed infection (33.68 mm ± 0.52 mm x 8.76 mm ± 0.07 mm) cases. This study fairly suggests that the young adult buffaloes harbour more F. gigantica parasites than their younger and older counterparts. The concomitant infection of buffaloes with F. gigantica and G. explanatum may hamper the parasites each other in establishing their infection and attaining growth in some way as measured by their burdens and morphological dimensions.

Laparoscopic versus open pyloromyotomy for infantile hypertropic pyloric stenosis: an early experience

This prospective comparative study was conducted with an initial experience in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital during the period of December 2007 to January 2009, with the infants of 2-12 weeks age, diagnosed as Hypertrophic pyloric stenosis. Patients selection was done by simple random technique by means of lottery. For open pyloromyotomy conventional method & for laparoscopic pyloromyotomy three trocher techniques was applied. In this study, among 60 cases with infantile hypertrophic pyloric stenosis, 30 cases were finally selected for analysis irrespectively both in laparoscopic (Group A) & in open pyloromyotomy (Group B) group. Patients were studied under variables of operative time, required time of full feeds after operation, post operative hospital stay & both per and post operative complications. Regarding operative time, in Group A, mean±SD operating time (in minutes) was 61.59±51.73 whereas in Group B it was 28.33±8.40 & P value was 0.001. The result was statistically significant. The mean±SD time (in hours) of full feeds (ad libitum) was 35.00±31.70 hours in Group A compared to 28.95±10.99 hours in Group B and P value was found 0.342ns which was not statistically significant. On study of total length (in days) of post operative hospital stay, mean±SD was 3.09±2.25 & 2.58±1.15days in laparoscopic group & open pyloromyotomy group respectively. The p value was 0.355ns, which was statistically insignificant. Again, on study of complications, per operatively 6(19.5%) patients had developed haemorrage, 1(3.33%) had mucosal perforation & 4(13.36%) had developed duodenal serosal injury in laparoscopic group whereas only 1(3.33%) patient in open pyloromyotomy group had nothing else except simple hemorrhage. The p value (0.051ns) was also statistically insignificant. In regard to post operative complications, 2(6.6%) patients had developed wound hematoma, 2(6.6%) had wound infection, 1(3.33 %) had developed wound dehiscence and incisional hernia respectively in Group A. But in group B there was no subject with any complication. This result was also statistically insignificant. So, the overall study results denote that, laparoscopic pyloromyotomy would not be considered as a superior procedure or as safe as that of traditional open pyloromyotomy for the beginners.

Non-Hodgkin's lymphoma is a pathological lead point causing large gut (colo-colic varity) intussusception

Intussusception secondary to Primary Non-Hodgkin lymphoma presenting colo-colic variety is a very rare clinical entity and sometimes causing diagnostic dilemma due to non-specific, varied & wide spectrum presentation. In this study, a 9 years female child presented with recurrent, intermittent, colicky abdominal pain with occasional bilious vomiting, along with a left illiac fossa swelling & occasional per rectal bleeding and constipation for 3 months was clinically diagnosed as a case of recurrent obstructing intussusception. At laparotomy, a colo-colic intussusception with prolapsed intussusception was marked & finally on histopathology, she was diagnosed as a case of colo-colic variety of intussusception due to primary Non-Hodgkin lymphoma- a pathological lead point in mid transverse colon. After uneventful recovery of post operative period she was treated with combination chemotherapy accordingly & follow up was given up to 5 years. She had been found alright without any recurrence or organ involvement. The study focused on the avoidance of unusual delay in diagnosis as well as in proper management of rare variants of intussusception.

Ultrasonographic evaluation of contralateral exploration of patent processus vaginalis in unilateral inguinal hernia

To see accuracy of ultrasound scan to detect patent processus vaginalis in padiatric patient. We investigated the presence of contralateral patent processus vaginalis (CPPV) by Ultrasound scan (US) in children with clinically diagnosed unilateral inguinal hernia. Thirty patents (17 boys and 13 Girls) with unilateral inguinal hernia underwent US examination using a 7.5 MHZ transducer. If a CPPV was visible as a hydrocele (inflow of peritoneal fluid) in to a processus vaginalis on straining, then US scanning was performed while the patient was at rest and while inducing straining by standing, coughing and or crying. A groin with hydrocele in the inguinal canal on straining was diagnosed as a CPPV and was explored bilaterally through surgery. The US findings were compared with surgical results. In 30 patients, 12 cases were diagnosed by US as patients with a CPPV, these patients underwent bilateral surgery. Eleven of 12 Cases were confirmed surgically as CPPV. From the findings of the present study it could be concluded that a PPV could be correctly detected by US in pediatric patients with the accuracy of 91.67%. US is a non invasive and accurate method for evaluating the presence of a PPV. Preoperative diagnosis of CPPV is important to remove the need for a second operation with patients presenting with unilateral inguinal hernia.

Comparison of post operative morbidity between laparoscopic and open appendectomy in children

This prospective comparative study was conducted in the department of Pediatric Surgery, Dhaka Shishu (children) Hospital during the period of June 2007 to September 2008 with the children of <12 years, diagnosed as acute Appendicitis. Patient selection was done by simple random technique by means of lottery. For open Appendectomy (OA) conventional method & for Laparoscopic Appendectomy (LA) 3 trocher technique was applied. Data was analyzed with the help of SPSS version 10. In this study 60 cases with acute Appendicitis including both gender were studied by two groups, group-A include 30 cases for laparoscopic and group-B include 30 cases for open appendectomy. Postoperative pain was assessed in both groups by using FLACC scale and compared at 1st 6-hours, 24 hours, 72 hours, 96 hours & at day 7. At 1st 6-hours, most of the children 24(80%) of group A had moderate pain whereas 17(56.7%) children of group B had severe pain (p<0.001). At 24 hours most of the patient 17(56.7%) of group A had mild pain compared to 27 (90%) patients of group B had moderate pain (p<0.0001). At 48 hours in group A most of the children 23(76.7%) had mild pain compared to moderate pain in 18(60%) children of group B (p<0.0001). Subsequently at 72 hours and at 96 hours most of the patients of LA group were free of pain compared to OA group. At final follow-up on day 7, 29(96.7%) children of group A had no pain compared to 26(86.7%) of group B. Regarding analgesics requirement both qualitative & quantitative requirements of analgesics were less in LA group than OA group. About post operative wound infection in group A only 1(3.3%) case had developed post operative wound infection whereas in group B 7(23.3 %) cases had. The mean (+/-SD) of post operative length of hospital stay was 52.00+/-11.62 (range 48-96) hours for group A and 76.00+/-12.74 (range 48-96) hours for group B children (p<0.001). Laparoscopic Appendectomy is more effective, preferable & superior procedure than that of open Appendectomy to reduce the post operative morbidity in children undergone appendectomy for acute appendicitis.

Molecular characterization of a blood-induced serine carboxypeptidase from the ixodid tick Haemaphysalis longicornis

Ticks feed exclusively on blood to obtain their nutrients, but the gene products that mediate digestion processes in ticks remain unknown. We report the molecular characterization and possible function of a serine carboxypeptidase (HlSCP1) identified in the midgut of the hard tick Haemaphysalis longicornis. HlSCP1 consists of 473 amino acids with a peptidase S10 family domain and shows structural similarity with serine carboxypeptidases reported from other arthropods, yeasts, plants and mammals. Endogenous HlSCP1 is strongly expressed in the midgut and is supposed to localize at lysosomal vacuoles and on the surface of epithelial cells. Endogenous HlSCP1, identified as a 53 kDa protein with pI value of 7.5, was detected in the membrane/organelle fraction isolated from the midgut, and its expression was upregulated during the course of blood-feeding. Enzymatic functional assays revealed that a recombinant HlSCP1 (rHlSCP1) expressed in yeast efficiently hydrolyzed the synthetic substrates specific for cathepsin A and thiol protease over a broad range of pH and temperature values. Furthermore, rHlSCP1 was shown to cleave hemoglobin, a major component of the blood-meal. Our results suggest that HlSCP1 may play a vital role in the digestion of the host's blood-meal.

Urogenital anomalies associated with anorectal malformations in children

The urogenital tract is the most severe and common site of associated defects in anorectal malformations (ARM). Urogenital anomalies and their complications significantly increase the morbidity in these children after the ARM is corrected. The purpose of this study was to estimate the incidence of different types of urogenital anomalies with various types of anorectal malformations and to discuss the possible management and outcome. A retrospective study of patients with ARM and associated urogenital abnormalities admitted in the department of paediatric surgery of Sylhet MAG Osmani Medical College Hospital between 1998 and 2002 was undertaken. A total of 155 patients with Anorectal malformations were admitted of which 47 (30.32%) patients had associated anomalies involving other systems. Urogenital abnormalities were found in 25 (16.13%) patients. Patients of Anorectal malformations with urogenital abnormalities require careful assessment and well-timed intervention to minimize the morbidity.

Fluoride exposure inhibits protein expression and enzyme activity in the lung-stage larvae ofAscaris suum

Sodium fluoride (NaF) is an anion that has been previously shown to block the moulting process ofAscaris suumlarvae. This study describes moulting and development-specific protein expression profiles ofA. suumlung-stage L3 (AsLL3) following NaF exposure. AsLL3s cultured in the presence or absence of NaF were prepared for protein analysis using two-dimensional (2D) electrophoresis. NaF exposure inhibited at least 22 proteins in AsLL3 compared with moulted larvae (i.e. AsLL4). A further comparison of AsLL4 with those of pre-cultured AsLL3 and NaF-exposed AsLL3 revealed 8 stage-specifically and 4 over-expressed proteins. Immunoblot analysis revealed an inhibition by NaF of 19 immunoreactive proteins. Enzyme assay and immunochemical data showed an inhibition of the moulting-specific inorganic pyrophosphatase activity by 41% and a decreased expression in NaF-treated larvae, indicating its significance in the moulting process. A protein spot associated with NaF inhibition was isolated and identified by peptide mass spectrometry and bioinformatics approaches to be a member of 3–hydroxyacyl–CoA dehydrogenase/short-chain dehydrogenase enzyme families. These results have implications for the identification of proteins specific to the moulting process as potential chemotherapeutic targets.

Molecular cloning and partial characterization of a nematode-specific 24 kDa protein fromAscaris suum

The cloning and molecular characterization of a cDNA encodingAscaris suum24 kDa antigen (As24) are described. The cDNA sequence consists of 853 bp with an open reading frame coding for a protein of 147 amino acids with an inferred signal peptide of 19 amino acids. The predicted molecular mass and pI were 16 kDa and 8·35 respectively. The endogenous protein in adultA. suumwas 24 kDa with the expected pI. A search of the public databases revealed over 50% homology with proteins from filarial parasites but not to other known proteins, suggesting that As24 is a nematode-specific protein. Immunohistochemical studies using polyclonal antibodies raised againstEscherichia coli-expressed recombinant As24 demonstrated that the endogenous As24 proteins were intensely localized in unembryonated eggs within the uterus, uterine and gut epithelium, muscle tissues and in the hypodermis of an adult femaleA. suum. Endogenous As24 was expressed throughoutA. suumdevelopment and was detected in the excretory/secretory products by immunoblot analysis. Importantly, a homologous protein(s) was detected inAscarisfrom human andToxocara canisfrom dog, suggesting that As24 is a nematode-specific protein.

Characterization of the protective response against a homologous challenge infection with Strongyloides venezuelensis in rats

The protective response in rats against a homologous challenge infection with Strongyloides venezuelensis was characterized. In an initial infection with 1000 filariform larvae and migrating larvae (L(3)) of S. venezuelensis, the population of L(3) in the lungs on day 3 postinfection (PI), and that of adult worms in the small intestine on day 7 PI, were 180.8+/-14.5 and 336.8+/-70.7, respectively. The latter were gradually expelled towards day 42 PI. After the initial infection, the rats developed strong immunity against a homologous challenge infection as manifested by a marked reduction in worm populations, stunted body length and width, damage to reproductive organs, impaired egg production and rapid expulsion of the worms by day 14 after challenge. Expulsion of the worms was preceded by a significantly elevated (P<0.05) peripheral blood eosinophil (PBE) count, both in the initial (200.0+/-26.5 x 10(3)ml) and the challenge infection (400.9+/-165.4 x 10(3)ml). These findings suggest that rats acquire strong homologous immunity following initial exposure to S. venezuelensis. It is suggested that PBEs are involved in worm expulsion. A major target of these effector mechanisms is the reproductive system of S. venezuelensis.

Formal and informal care for people with dementia: factors associated with service receipt

Details of service receipt by 132 people diagnosed with dementia and their carers were collected in South London (boroughs of Lewisham, Camberwell, Southwark and Croydon), a geographical area served by several health and social care providers. The data collected included the Caregiver Activity Survey, which details the informal care given. This paper reports the formal and informal services received by the people with dementia at entry to the study. The amount of time spent on specific caring tasks by all informal carers of people with dementia averaged seven hours per week, but was significantly higher for co-resident carers, even when controlling for the level of dependency of the person cared-for. The odds ratios of receipt of formal services are given, according to where people were living: in the community or residential care, with co-resident carers or alone.

Congenital Penile Urethrocutaneous Fistula

Congenital Penile Urethrocutaneous Fistula (CPUF) is an extremely rare anomaly. Commonly congenital urethrocutaneous fistulae are associated with anorectal anomalies and urethral duplication. The posterior urethra is the part, which is mostly affected. To the best of our knowledge, only 11 such cases have been reported so far in the English literature. A case of CPUF with a short review of literature.

A simplified shielding approach for limiting fetal dose during radiation therapy of pregnant patients

PURPOSE

To investigate the effectiveness of a simple and practical shielding device to reduce fetal dose for a patient undergoing radiation therapy of nasopharyngeal carcinoma.

METHODS AND MATERIALS

Using 5-cm-thick lead bricks and a heavy-duty steel cart, a 50 x 50-cm portable shield was designed and fabricated to reduce fetal dose due to collimator scatter and head leakage radiation. With the gantry at 90 degrees /270 degrees the shield can be easily positioned between the machine head and the fetus to reduce peripheral dose. Dose measurements for 6-MV X-rays and 9-MeV electrons have been made, utilizing a Rando phantom, to quantify the effect of the shield.

RESULTS

Measurements show that the peripheral dose to the fetus can be reduced by 60% when the simple shielding device is used.

Examination of gastrointestinal helminth in livestock grazing in grassland of Bangladesh

To determine association of grassland with parasitic diseases of livestock in Bangladesh, the 'Tracer' animals (two cow calves and two goats) were released for a month in a grassland used for communal grazing of livestock near school premise in Kanthal, Trishal, Mymensingh, Bangladesh. After slaughtering of the tracer animals, their gastrointestinal tract examination revealed six species of nematode and one cestode. The nematode species were Haemonchus contortus, Trichostrongylus axei, Mecistocirrus digitatus, Oesophagostomum spp., Trichuris spp. and Bunostomum sp. The cestode was one of the genus Moniezia. With this preliminary study, grasslands are thought to be one of the main sources of gastrointestinal parasitic diseases of livestock in Bangladesh.

Partial cross-resistance between Strongyloides venezuelensis and Nippostrongylus brasiliensis in rats

Rats were immunized through an initial infection with 1,000 filariform larvae (L3) of Nippostrongylus brasiliensis and after complete expulsion of worms they were challenged with 1,000 L3 of Strongyloides venezuelensis to investigate whether cross-resistance developed against a heterologous parasite. Nippostrongylus brasiliensis-immunized rats developed a partial cross-resistance against S. venezuelensis migrating larvae (MSL3) in the lungs and adult worms in the small intestine. The population of MSL3 in the lungs were significantly lower (P < 0.05) in immunized rats (22.0 +/- 7.4) compared with controls (105.0 +/- 27.6). The populations of adult worms, egg output and fecundity were initially decreased but from day 14 post-challenge they did not show any significant difference between immunized and control rats. However, the length of worm in immunized rat was revealed as retardation. Peripheral blood eosinophilia was significantly decreased (P < 0.05) on day 7 post-challenge and then gradually increased, which peaked on day 42 post-challenge when most of the worms were expelled. These results suggest that peripheral blood eosinophilia is strongly involved in the worm establishment and expulsion mechanisms.

The potential for social mobilisation in Bangladesh: the organisation and functioning of two health insurance schemes

Health insurance schemes are usually assessed according to technical indicators. This approach, however, neglects the dynamic perspective of insurance schemes as an element of people's mobilisation for participation in organising and managing health care delivery and financing. The first part of this paper describes the technical performance and the level of community involvement in management of the two largest health insurance schemes in Bangladesh, both in the rural areas and in the non-government sector. Part two discusses these achievements in light of the schemes' potential role as a mechanism for people's management of health care. A review of documents and key-informant interviews were conducted. Key findings include that (1) subscribers currently are not actively participating in scheme management. However, existing family groups, involved in credit programmes may serve as entry-points for interaction. This is sustained by the 'natural link' between health insurance as a means of spreading the risks of treatment costs and credit programmes as a means of decreasing the relative impact of illness on household income. (2) The schemes' role could be further enhanced, by improving their technical performance and applying health care systems elements with the input of all partners involved. These issues are avoidance of service duplication with other providers; better protection of the poorer households; inclusion of hospital care in the coverage package; simplification of scheme administration by introduction of episode-based co-payments instead of the current itemised ones and concentrating the schemes at the level of community-based services, which may be self-financed and also self-managed by the community, given available sensitisation, training and interaction. A shift to episode-based co-payments would also introduce solidarity among patients and among individuals at higher risk, such as pregnant women and under-fives. Finally, action-research is needed to document the process of increased community involvement.

Effects of in vitro culture methods on morphological development and infectivity of Strongyloides venezuelensis filariform larvae

The effects of in vitro culture methods on morphological development and infectivity of Strongyloides venezuelensis filariform larvae (L3) to rats were investigated. A significantly higher body length was observed in L3 from filter paper culture (597.3 +/- 32.2 microns) than those in fecal (509.9 +/- 35.0 microns) and nutrient broth culture (503.3 +/- 31.0 microns) (P < 0.05). Larval infectivity was assessed by exposing rats to 1,000 L3 from each culture and worms were recovered from the lungs and small intestines. Recovery rate of these worms did not show any significant difference. A significantly greater body length of adults was recorded in those corresponding to the L3 harvested from filter paper (2,777.5 +/- 204.4 microns) and nutrient broth culture (2,732.5 +/- 169.8 microns) than those corresponding to the L3 obtained from fecal culture (2,600.5 +/- 172.4 microns) (P < 0.05). Although worm fecundity and EPG counts differed among culture methods but worm burdens and course of infection did not. These findings suggest that the methods of cultures have a significant effect on the morphological development of the larvae to the L3 stage, but do not influence the infectivity to rats.

Viability of eggs, filariform larvae and adults of Strongyloides venezuelensis (Nematoda: Strongyloidea) maintained in vitro

The present study was performed to check the viability of eggs, filariform larvae and adults of Strongyloides venezuelensis exposed to various conditions for an in vitro maintenance. The eggs in the feces remained viable for about 25 days at 4 degrees C and 15 days at room temperature. However, the isolated eggs in sterile saline lost their viability within 24 hr at 4 degrees C. The eggs in morula stage were very sensitive to air drying and rapidly lost their viability (< or = 12 hr). Filariform larvae survived for a maximum period of 45 days in fecal suspension and 28 days in 0.12% nutrient broth in polyvinyl culture bags maintained at 20 degrees C. On the other hand, those isolated from nutrient broth cultures survived for a maximum period of 32 days in tap water and 22 days in sterile saline at 20 degrees C. The mature adult worms obtained from experimentally infected rats survived maximally for 9 days in serum supplemented (10% rat-serum) 0.12% nutrient broth and 4 days in serum free nutrient broth at 37 degrees C while the culture media were changed at an alternate day. The adult female worms deposited fertile eggs in serum supplemented and serum free nutrient broth cultures, however, the hatched larvae (L1) were not able to develop to the filariform stage in the culture media and found to die within 24 hr of maintenance. The present findings on an in vitro maintenance of different stages of S. venezuelensis may provide useful information for biological and biochemical studies with Strongyloides species.

Development of an in vitro culture method for harvesting the free-living infective larvae of Strongyloides venezuelensis

An in vitro culture technique was established for harvesting Strongyloides venezuelensis free-living infective larvae using a nutrient broth medium as a substitute for rat-feces in polyvinyl culture bags (10 x 12 cm). The egg hatch rate (Y) in sterile saline at different incubation temperatures (X) was expressed as the quadratic function, Y = -0.192X2 + 8.673X - 19.550 (r = 0.901). The highest (100%) egghatch rate was observed at 25 degrees C. A significant difference (p < 0.05) in development rate (Y) of free-living infective larvae was observed between different concentrations of nutrient broth (X) which was highest (20.6%) in 0.12% nutrient broth concentrations, incubated at 20 degrees C for 5 days [Y = -864.032X2 + 245.995X - 0.560 (r = 0.875)]. Yields (Y) of infective larvae were observed relatively high when the culture medium was incubated at higher temperatures (X) which peaked at 25 degrees C (20.0%) than at lower temperatures, 15 degrees C (10.9%) and 20 degrees C (18.1%) [Y = -0.189X2 + 8.387X - 72.795 (r = 0.981)]. The period (Y) required for the development of infective larvae decreased with higher incubation temperatures (X) [Y = 0.035X2 - 2.025X + 32.375 (r = 0.995)]. The highest yield (19.2%) of infective larvae was obtained from culture bag inoculated with 15,000 eggs than with below and over 15,000 eggs in 0.12% nutrient broth and incubated at 25 degrees C for 4 days. The newly adapted culture method (from egg to third-stage larva) may be useful as a bio-bar/bioassay system for screening new chemical products, anthelmintics and pesticides, as well as for parasito-immunological studies with Strongyloides species.

Effects of scatter generated by beam-modifying absorbers in megavoltage photon beams

Transmission through a beam-modifying absorber consists of attenuated primary beam and scattered radiation generated by the absorber. The primary component of the transmitted beam is characterized by the narrow beam attenuation coefficient which depends upon the energy of the beam and type of the absorber. In addition to beam energy and absorber material, the scatter component also depends on field size, thickness and shape of the absorber, location of the absorber with respect to the source, and the point of calculation. Based upon Compton first-scatter, a method has been developed to calculate effective broad beam transmission through any arbitrarily shaped absorber with variable thickness for any points on and off the central axis. The method requires predetermined narrow beam attenuation coefficients as a function of thickness. Transmission calculations for various absorbers such as wedges and attenuators were performed for cobalt-60 and 6-MV beams and were compared with measured data. For a cobalt-60 beam, the measured transmission fraction through a 1.33-cm-thick absorber (alloy, consisting of 55% bismuth and 45% lead) for a field size of 24 x 24 cm2 is 17% higher than the calculated value using a narrow beam attenuation coefficient. Also, for the same absorber, measured central axis transmission is as much as 3.6% higher compared to off-axis locations. The measured transmission fraction through a 1.33-cm absorber was found to differ by as much as 13% and 14% for Cobalt-60 and 6 MV, respectively, as the chamber-to-source distance was varied from 70 to 110 cm. The agreement between calculated and measured values is within 0.5% for both energies whereas conventional narrow beam calculations would have yielded errors of 18% and 19%, respectively. Similar agreement was obtained when comparing calculated and measured wedge factors as a function of field size, with the maximum deviation being 0.7%. Measured scattered doses, due to an attenuator covering part of a beam, show a maximum for a thickness of approximately one mean-free path. This is also predicted by calculations with an agreement of 0.3%.

A simple method of producing depth ionization data for electron energy constancy check

A simple method has been developed to reproduce depth ionization data of electron beams for energy determination. The method utilizes a simple set of equipment, a combination of a specially designed wedge-shaped polystyrene phantom and a linear array of detectors, to collect the necessary data. The wedge-shaped phantom provides varying depths to various detectors in the array. The ionization readings received from the detectors were corrected for off-axis ratio and plotted against corresponding ray-line depths to produce depth ionization curves. The instrument setup was fast and simple. The relevant data, for a high-energy linear accelerator with multiple electron energies, were collected in minutes. The depths of 80% and 50% ionization determined by this method were found to differ by 2 and 3 mm, respectively, at the most, with those determined by a conventional method.