Expression of Cyclin D1 in Urothelial Carcinoma of Urinary Bladder and its Association with Tumour Grade

Urothelial carcinoma (UC) is the most common malignancy of urinary bladder. It is the 9th leading cause of death worldwide and second most common genitourinary malignancy among male. Incidence is increasing in developing countries like Bangladesh. About 80% of patients are found between 50 to 80 years of age. It is 3-4 times more common in male than in female. Determination of therapeutic strategy and prediction of progression of urothelial carcinoma is a major clinical challenge. Treatment of urothelial carcinoma still now mostly depends on pathological stages. Amplification or genomic alteration of Cyclin D1 (a proto-oncogene) may cause protein overexpression which is frequently realized as a clonal pathology in various human neoplasms including bladder cancer. Evaluation of Cyclin D1 expression is promising for guiding therapeutic strategies, risk stratification and prediction of tumor progression. The aim of the study was to determine the expression of Cyclin D1 in urothelial carcinoma of urinary bladder and its association with tumour grade. This cross-sectional observational study was conducted in Department of Pathology, Dhaka Medical College, Dhaka, Bangladesh from July 2019 to June 2021. Histomorphologically diagnosed 51 urothelial carcinomas were included. Sections were stained with hematoxylin and eosin. Immunostaining with Cyclin D1 antibody was also done. Relevant information was collected and recorded in a predesigned data sheet. Statistical analysis was carried out as required. Mean age ±SD was 57.8±10.55 years. Male female ratio was 4.6:1. In this study 39(76.5%) patients were smoker. Regarding clinical presentations 36(70.6%) patients presented with painless hematuria alone. Lateral wall (64.7%) was the most frequent tumor location. Among 51 cases, 38(74.5%) cases were high grade urothelial carcinoma (HGUC) and 13(25.5%) cases were low grade urothelial carcinoma (LGUC). Considering Cyclin D1 expression, most of the LGUC cases showed high level of expression by both percentage (84.6%) and intensity (84.6%). Most of the HGUC cases showed low level of expression by both percentage (63.2%) and intensity (60.5%). Cyclin D1 showed significant inverse association with HGUC (p<0.05). In urothelial carcinoma of urinary bladder, Cyclin D1 expression was decreased with increasing grade of the tumor. Cyclin D1 expression was inversely associated with tumour grade.

Sensitive Cr3+ sensor based on novel poly(luminol-co-1,8-diaminonaphthalene)/CeO2/MWCNTs nanocomposites

In this study, poly(luminol-co-1,8-diaminonaphthalene) (PLim-DAN) was synthesized and subsequently modified with MWCNTs and CeO2 NPs. The synthesized nanocomposites were analyzed using IR, SEM, TEM, and XRD. Furthermore, a comprehensive set of thermal behavior measurements were taken using TGA/DTG analysis. Next, the electroactivity of the developed nanocomposites was tested as an electrochemical sensor to measure the concentration of Cr3+ ions in phosphate buffers. The GCE adapted with the PLim-DAN/CeO2/CNTs-10% nanocomposite (NC) exhibited the highest current response among the other compositions and copolymers. The fabricated nanocomposite sensor showed high sensitivity, with a value of 19.78 μA μM-1 cm-2, and a low detection limit of 4.80 ± 0.24 pM. The analytical performance was evaluated by plotting a current calibration curve versus the concentration of Cr3+ ions. It was found to be linear (R2 = 0.9908) over the range of 0.1 nM to 0.1 mM, identified as the linear dynamic range (LDR). This electrochemical sensor demonstrated that it could be a useful tool for environmental monitoring by accurately detecting and measuring carcinogenic Cr3+ ions in real-world samples.

Comparison of Decaying Antibody Level After SARS-CoV-2 Infection in Case of Home Treated and Hospital Treated Patients at Different Interval

The aim of the study was to evaluate the quantities difference and persistence of antibody in home and hospital treated patients at different interval. A cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology, BIRDEM General Hospital, from July, 2020 to June, 2021. This study protocol was approved by Institutional Review Board (IRB), BIRDEM. SARS-CoV-2 caused death of huge number of people. The disease most commonly represents with fever, cough, loss of smell sensation, fatigue etc. Who had mild symptoms did not admit at hospital. But when the disease progress to respiratory distress, involvement of lung field more than 50.0% and other complications then the patients need hospital admission. Hospital treated patients showed higher antibody status in comparison to home treated patients. Moreover it was reported that increased amount of antibody developed after 3rd and 4th months of SARS-CoV-2 infection. In this study, statistically significant difference of decaying antibody level between home and hospital treated patients was observed.

Ear Infections by Non albicans Candida Species with Isolation of Rare Drug Resistant Species in a Tertiary Care Hospital of Bangladesh

Otomycosis, a fungal infection of external ear, is challenging for both patients and otolaryngologist as it requires long term treatment and follow up. Candida spp. is second common organism causing otomycosis with Aspergillus being first. Among Candida species, C. albicans is considered as most common but in recent years there is increasing incidence of Non albicans Candida (NAC) species with greater resistance and recurrence. This descriptive type of observational study was planned to determine the species distribution and antifungal susceptibility of Candida spp. causing otomycosis. From March 2021 to February 2022, 60 patients clinically suspected of Candida associated otomycosis at Mymensingh Medical College Hospital, Bangladesh were enrolled. Specimens were taken by an otorhinolaryngologist. After culture and microscopic examination, isolated Candida species were identified by phenotypic and genotypic method and antifungal susceptibility was determined at Department of Microbiology, Mymensingh Medical College. From 60 samples 18(30.0%) were positive for Candida on microscopy and culture. Of the isolates, C. albicans were 2(11.11%) and Non albicans Candida (NAC) 16(88.89%). Five different NAC species were identified of which C. parapsilosis was predominant 5(27.77%) followed by C. tropicalis 4(22.22%) and C. famata 3(16.67%). Rare species of C. ciferrii 2(11.11)%, Kodamaea ohmeri 2(11.11%) were isolated. Candida spp. showed highest resistance to Clotrimazole 8(44.0%) followed by Itraconazole 6(33.0%), Nystatin 4(22.0%) and Fluconazole 3(17.0%). C. ciferrii and Kodamaea ohmeri showed resistance to all antifungals except Nystatin. Outcomes from this study showed a different picture of species distribution, with isolation of rare and emerging drug resistant threatening species like C. ciferri and Kodamea ohmeri which necessitates more detailed survey.

Species Identification and Antifungal Susceptibility Pattern of Candida Isolates in Patients with Vulvovaginitis from Mymensingh, Bangladesh

Vulvovaginal Candidiasis (VVC), a frequent and cumbersome reproductive tract infection affects women's physical and mental health. Although Candida albicans was reported as the most common agent of VVC yet, recently there are significant changes in the pattern of Candida species causing VVC with varying antifungal susceptibility pattern. Therefore this cross-sectional, descriptive type of observational study conducted to identify the spectrum of Candida species associated with VVC and assesses their antifungal susceptibility pattern from March 2021 to February 2022. High vaginal swabs from 175 patients clinically suspected of VVC were collected and cultured on Sabouraud dextrose agar with Chloramphenicol. Species were identified by phenotypic methods like- germ tube test, sub-culture in chromogenic agar media and genotypic methods like- Polymerase chain reaction (PCR), Restriction fragment length polymorphism (RFLP). Antifungal susceptibility was done by disk diffusion method. Out of 175 patients, 52(29.7%) were positive for Candida species. Of the isolates- C. albicans 34(65.0%), Non albicans Candida (NAC) 18(35.0%). Among NAC, C. glabrata 5(9.6%), C. tropicalis 5(9.6%), C. parapsilosis 4(7.7%) and each of C. krusei, C. kefyr, C. ciferrii, C. dubliniensis were 1(1.9%). On susceptibility testing highest resistance was to Clotrimazole 31.0% followed by Nystatin 13.0%, Itraconazole 12.0% and Fluconazole 10.0%. Resistance to azole was higher in NAC than in albicans. Of these patients, 16(31.0%) had history of recurrent VVC (RVVC) of which 12(75.0%) were by NAC, predominantly C. glabrata 5(32.0%). The results showed the increasing incidence of NAC associated vaginitis with higher resistance and recurrence that should be considered in gynecology clinics.

Comparison of Risk Factors between Younger and Older Patients of Myocardial Infarction among Bangladeshi Rural People: A Hospital Based Study

Myocardial infarction among patients is a concern as young patients live longer in the aftermath of this critical illness. Still, there is a wide knowledge gap about modifiable risk factors that may help to alter the course of this extreme end of coronary artery disease spectrum among young patients. The trend of socioeconomic changes in developing countries like Bangladesh has resulted in increasing non-communicable diseases like coronary artery disease. Prevalence and risk factors of myocardial infarction among people living in a rural community are largely unknown, particularly in the younger age group. We tried to find out the risk factors differences between young and old MI groups as well as proportion of myocardial infarction among patients out of total hospitalized MI patients. This cross-sectional analytical study was done among the patients admitted to a rural cardiac center. For risk factor analysis, patients with new MI, including both non-ST-elevation and ST-elevation myocardial infarction were included according to preset inclusion and exclusion criteria. Patients were grouped as young (age ≤45 years) MI and old (age >45 years) MI. Data was collected using a questionnaire after informed consent was taken. American Heart Association's continuous dietary scoring system and Holmes Rahe Stress Scale were used to identify dietary patterns and mental stress levels, respectively, among the sample. Logistic regression analysis was performed to explore the risk factors of premature MI. On the other hand, to identify the proportion of young MI patients among the hospitalized MI patient's hospital registry was used to count the cases over almost one year. For risk factor analysis between young and old MI groups, 137 MI patients were selected according for inclusion and exclusion criteria. Out of them 62 and 75 patients were in the young and old age groups, respectively. The mean ages of younger and older groups were 39.0±5.9 years and 58.8±8.2 years, respectively. In both groups, 112(81.8%) patients were male. Only 42(30.7%) patients had BMI ≥25kg/m². In the unadjusted analysis, hypertension, family history of hypertension, consumption of fatty food, dairy products, and free-range chicken were found to be associated with premature MI. No significant difference in triglyceride, cholesterol or LDL level was found between the groups. But in the multivariate analysis, only the male gender was a significantly higher risk of premature MI (aOR 7.00; 95% CI: 1.51-42.42). Interestingly, HTN (aOR 0.46; 95% CI: 0.19-1.14) and smoking (aOR 0.26; 95% CI: 0.05-0.98) tend towards increased the risk of MI among the older age group compared to the younger group. According to hospital registry analysis, 22.9% of total MI patients admitted in the cardiac center were younger than 45 years. The incidence of myocardial infarction among young patients in rural areas in Bangladesh is probably more than what is known. Other than the male gender, which is a significant un-modifiable risk factor for young myocardial infarction patients; dietary factors, diabetes, and increased body mass index may play a vital role. On the contrary, hypertension and family history of hypertension are significantly higher among the older age group.

A Case of Congenital Coronary Ostial Stenosis with Systemic Lupus Erythematosus

Congenital coronary ostial stenosis or atresia (COSA) is a spectrum of rare developmental conditions with different pathophysiologic mechanisms and clinical implications. Although COSA includes various entities, these entities have two features in common. First the defect is congenital, although it may progress during pre-natal and post natal life. Second the developmental defect may cause ostial or proximal coronary obstruction (that is stenosis or atresia). Coronary ostial stenosis or atresia affects the left coronary (L-COSA) more frequently than it does the right coronary artery. Systemic Lupus Erythematosus (SLE) is not an uncommon disease in young female, but combination of congenital coronary ostial stenosis with systemic lupus erythematosus make the case very rarer. Here we presented A 17 years old girl got admitted to Bangabandhu Sheikh Mujib Medical University, Bangladesh for evaluation of on and off chest pain of CCS-III to CCS-IV for 1 day on 17 September 2019.

Mitral annular plane systolic excursion and global longitudinal strain for the prediction of cardiotoxicity or heart failure in lymphoma patients treated with anthracycline-based chemotherapy

Background

Assessing cardiac performance of patients receiving chemotherapy is a cornerstone for adequate cardiovascular care. Mitral annular plane systolic excursion (MAPSE) has been considered as a surrogate for Ejection Fraction (EF). However, little is known about its role in predicting Cardiotoxicity or Heart Failure in Lymphoma patients, as its relationship with Global Longitudinal Strain (GLS) and EF.

Purpose

Our aims were: i) to evaluate if MAPSE and GLS can predict the development of CT and/or HF in lymphoma patients treated with anthracyclines and ii) to evaluate its correlation with GLS and EF.

Methods

For this prospective observational study, 325 Hodgkin (HL) & non-Hodgkin (NHL) lymphoma patients (n=325) treated with anthracyclines were recruited from 2013 to 2021 and followed for 1 year. MAPSE by M-mode and GLS by Speckle-Tracking (ST) were measured at baseline (T0), during treatment (T1), and up to 1 year after chemotherapy completion (T2). CT was defined as a decrease in EF by &gt;10% to a value &lt;50% and HF by a cardiologist as the first occurrence after the initiation of anthracyclines. Logistic regression analyses with Receiving operator characteristics (ROC) and Area under the curve (AUC) were performed. Pearson's correlation coefficient was also calculated. A p-value &lt;0.05 was considered statistically significant.

Results

Two hundred sixty-four patients (81.2%) had NHL and 61 (18.8%) HL. Of these, fifteen (4.6%) and 21 individuals (6.4%) developed CT at T1 and T2, respectively. Nine subjects (2.8%) developed HF at T1 and 14 (4.3%) at T2. MAPSE at T0 had the highest AUC to predict both HF at T1 (AUC=0.865, cut-off 14.9, sensitivity 100%, specificity 63%, p=0.008) and at T2 (AUC=0.757, cut-off 10.9, sensitivity 67%, specificity 93%, p=0.045). This same variable at T1 predicted HF at T2 with an AUC of 0.752 (cut-off 11.4, sensitivity 67%, specificity 94%, p=0.004). For CT prediction at T2, MAPSE at T1 had an AUC of 0.738 (cut-off 12.5, sensitivity 56%, specificity 85%, p&lt;0.0001). GLS at T0 predicted CT at T1 (AUC=0.657, cut-off −19, sensitivity 67%, specificity 63%, p=0.012) and when obtained at T1, it predicted CT at T2 (AUC=0.776, cut-off −17, sensitivity 74%, specificity 75%, p-value &lt;0.0001) (Table 1). Pearson's correlation between MAPSE and GLS at T0 (coefficient −0.25, p=0.023) at T1 (coefficient −0.38, p&lt;0.0001) at T2 (coefficient −0.037, p&lt;0.0001) and MAPSE with EF at T0 (coefficient 0.33, p=0.0002) at T1 (coefficient 0.28, p&lt;0.0001) and T2 (coefficient 0.29, p&lt;0.001).

Conclusions

To our best knowledge, this is the first time that MAPSE and GLS were compared to predict CT and HF in lymphoma patients receiving anthracycline-based chemotherapy; we have demonstrated that MAPSE measured at T0 was a very good predictor of HF at T1. Either MAPSE or GLS assessment at T0 and T1 were able to predict CT or HF. Future studies could explore the combination of these two variables to predict either CT or HF.

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): Department of Cardiovascular Medicine. Mayo Clinic, Rochester-MN

Basic or comprehensive strain analyses, which variable is better to predict hard endpoints as clinical heart failure in lymphoma patients receiving anthracyclines

Background

Speckle tracking echocardiography (STE) has shown to be a good tool to foresee early myocardial dysfunction in lymphoma patients who receive anthracycline based chemotherapy. Conventional STE such as global longitudinal strain (GLS) is a good predictor of cardiotoxicity in these patients, however, a more in-depth characterization of conventional and comprehensive STE parameters to predict a hard end-point as chemotherapeutic related heart failure (HF) has not been evaluated.

Purpose

The aim of this prospective study was to evaluate predictability of cancer therapeutic-related clinical HF by conventional and comprehensive STE.

Methods

We enrolled 269 Hodgkin & non-Hodgkin lymphoma patients who underwent chemotherapy at Mayo Clinic from 2013 through 2021. All patients had an echocardiogram performed at baseline (T0), during chemotherapy (T1) and after (T2). HF was diagnosed by a cardiologist and defined as the first occurrence after the initiation of chemotherapy. Conventional (GLS) and comprehensive strain analyses that included: global circumferential strain (GCS), global radial strain (GRS), global longitudinal early diastolic strain rate (GLSRe), global longitudinal systolic strain rate (GLSRs), global circumferential early diastolic strain rate (GCSRe), global circumferential systolic strain rate (GCSRs), global radial early diastolic strain rate (GRSRe), and global radial systolic strain rate (GRSRs), were performed offline. Logistic regression analyses were used to evaluate the association of 2D and 3D STE measurements with the development of clinical HF.

Results

Overall, 215 (79.9%) patients had non-Hodgkin lymphoma while 54 (20.1%) had Hodgkin lymphoma. Mean age was 58.4±16.1 years and 64.7% of the patients were males. The most prevalent comorbidities were hypertension (101/37.5%), dyslipidemia (87/32.3%) and diabetes (28/10.4%). HF occurred in 21 (7.8%) patients, including 9 (3.3%) during chemotherapy and 12 (4.5%) after chemotherapy. The best predictors of HF were: i) GLSRe and GCSRs performed at baseline (T0) to predict HF at T1 with an AUC of 0.85 each and p values of 0.0006 and 0.0005 respectively (Table 1); ii) GCSRs and GCS at baseline (T0) to predict HF at T1 or T2 with AUCs of 0.82 (p, &lt;0.0001) and 0.81 (p, 0.0004), respectively. Basic strain (GLS) was able to predict HF when measured at T0 but not when measured at T1. All the AUCs for GLS were below 0.75 (Figure 1).

Conclusions

To our knowledge this is the first study to evaluate the use of conventional and comprehensive STE to predict a hard end-point as heart failure in patients with lymphoma who received anthracyclines. Comprehensive STE measurements as GLSRs, GLSRe, GCS, GCSRs and GCSRe are better than GLS to predict HF in patients with lymphoma who received anthracycline based chemotherapy. These findings can be crucial for the management of these patients by guiding when to start cardioprotection and/or avoid interruptions of cancer treatment.

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): Department of cardiovascular diseases, Mayo Clinic, Rochester, MN

Use of BODE Index to Assess Prognosis of Patients with COPD

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation which is irreversible or partially reversible. COPD is associated with morbidity and increased mortality. The risk of death in patients with COPD is traditionally graded with the use of the forced expiratory volume in one second (FEV₁), but it correlates better with recently developed the BODE index- (B) Body mass index; (O) airflow obstruction measured by the forced expiratory volume in one second (FEV₁); (D) dyspnoea measured by the modified Medical Research Council (MRC) scale; and (E) exercise capacity measured by the 6 minute walk distance (6MWD). This prospective study was conducted in outpatient department of Sheikh Sayera Khatun Medical College Hospital, Goplaganj, Bangladesh from June 2016 to November 2018. Among total 126 patients, mean age was 60.63.0±10.65, male 94 and female 32, 94 smokers, 32 non-smokers. During the study period, 20 patients died, 12 from non-respiratory causes and 8 from pulmonary causes (corpulmonale and respiratory failure). All patients died from respiratory causes had BODE score 10. The higher the BODE score points, the higher the risk of death from respiratory causes.

Predictors of Malignancy in Thyroid Nodules

Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary thyroid nodule. There is no robust, feasible method for malignancy differentiation has not been well established. The study evaluated thyroid nodules for risk of malignancy and compared history, clinical, sonographic features and FNAC findings with histopathology. This was a cross sectional study on 160 consecutive subjects of thyroid nodules done in the department of ENT and Head Neck Surgery of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh during from July 2018 to December 2019. All patients were admitted and diagnosed by detail history, clinical examination, investigations and underwent thyroidectomy. Detailed history, clinical examination, ultrasonographic finding and FNAC variables were documented retrospectively and a mathematical model was established for malignancy prediction. In this study mean age of the patients of thyroid nodules was 37.54±11.49 years and majority of the patients were within 21-40 years of age. Frequency of thyroid nodules is more in female with male female ratio 1:7. Most of the thyroid nodules appeared in this study within 0-2 years (61.9%). In this series of thyroid nodules constituted 88.1% firm, 8.8% hard, 3.1% cystic. Among the patients 89(55.6%) cases have solitary thyroid nodule and 71(44.4%) cases have multinodular goitre Majority of the nodules were warm 57.5% followed by cold 42.5%. FNAC showed nodular goitre 72.5%, Follicular neoplasm 1.3%, Papillary carcinoma of thyroid 7.5%, colloid goitre 9.4%, suspicious papillary carcinoma 3.8% and lymphocytic thyroiditis 1.3%. In this study out of 85 solid nodule, 69(81.18%) were benign and 16(18.82%) was malignant and out of 3 cystic nodule 3(100%) were benign. In this study most of the benign and malignant nodules were predominantly solid. Study showed the malignancy is significantly (p=0.001) more in solid than cystic nodules. Final diagnosis in this study was done on the basis of histopathological reports. Out of 160 patients, histopathologically benign lesion was 120(75%) and malignant was 40(25%). Among malignant cases 36(22.5%) cases were papillary carcinoma, 1 case was medullary carcinoma and 3 cases were follicular carcinoma.

Simple Treadmill Score: Does It Have Better Predictability for Coronary Artery Disease?

Coronary artery disease is one of the most prevalent causes of increasing mortalitiy in current time. Early detection of such dreadful condition by a non-invasive test like exercise treadmill test, is a much-required option to prevent future complications like myocardial infarction. The aim of this study was to find out how different the predictability of simple treadmill score in comparison to other treadmill scores namely the well-known Duke treadmill score and Cleveland clinic score. In a cross-sectional analytical study of total 130 individuals with stable angina were included according to criteria set before the study. The treadmill scores of these patients were calculated and compared to coronary angiogram findings where coronary artery angiograms were done according to clinical need. Simple treadmill test had similar predictability for coronary artery disease when we compared it with much-applied Duke Treadmill Test and Cleveland Clinic Score- which is currently used for mortality prediction. Receiver Operator Characteristics (ROC) Curve showd all scores had around 0.7 area under the curve (AUC) which is highly statistically significant (p<0.0001) though simple treadmill score in females has higher sensitivity (92.3%). Simple treadmill score can be considered to exclude female patients from undergoing invasive investigation as it has higher sensitivity than other currently practiced treadmill scores i.e., Duke treadmill score.

Short Term Outcome of Therapeutic ERCP in the Management of Biliary Ascariasis in a Tertiary Care Hospital of Bangladesh

The history of ascariasis is very old. It is endemic in various parts of Bangladesh. Hepatobiliary ascariasis is a well-known complication of the intestinal ascariasis. Although cosmopolitan, it predominantly affects people in Asia, Africa, and South America. This was a prospective observational study conducted from July to December 2014 to explore the short term outcome of therapeutic ERCP in the treatment of biliary ascariasis in a tertiary care hospital of Bangladesh. A total of 60 cases of biliary ascariasis were selected conveniently in this study. Data were collected by face-to-face interviews and observation with the help of data sheet. Data were checked for quality control and analyzed by computer using SPSS software. The mean±SD age of the patients was 30.96±7.66 years. All the patients were aged between 17 and 55 years and predominantly affect women in the 3rd and 4th decades. The most common presentation was upper abdominal pain in 47(83.32%) of the patients. Ultrasound was the diagnostic tool of choice, where biliary ascariasis was found in 40(66.7%) of patients. ERCP is reserved mainly for therapeutic purposes and found successful in 57(95%) of the patients.

Pulmonary artery capacitance a simple and novel prognostic variable in acute pulmonary embolism

Background

The non-invasive calculation of right ventricular hemodynamics such as the pulmonary artery capacitance (PAC) has proven to be feasible and easy to perform. The simplified pulmonary embolism severity index (sPESI) and pulmonary vascular resistance (PVR) are other prognostic tools that have been used in the past.

Purpose

To evaluate if baseline PAC can outperform PVR and sPESI to predict all-cause short-term mortality in patients with acute pulmonary embolism (PE).

Methods

373 patients with acute PE and a transthoracic echocardiogram performed within one day of diagnosis from March 2013 through June 2020 were followed prospectively. PAC was calculated as: Left ventricular stroke volume/ (Pulmonary artery systolic pressure – Pulmonary artery diastolic pressure). PVR was calculated as: Tricuspid regurgitant velocity / Right ventricular outflow tract velocity time integral x 10 + 0.16. The sPESI was used to evaluate prognosis by categorizing patients into low and high-risk categories. Multiple logistic regression analyses and receiver-operating characteristic curves were used to evaluate the ability of PAC, PVR, and sPESI to predict all-cause mortality up to six months. The Youden index was used to determine the cut-off value with the highest sensitivity and specificity. Kaplan–Meier curves were performed to determine event-free survival rate, differences between groups were assessed using the Wilcoxon Test.

Results

Mean age was 64±15 years (58% male, 28% cancer). PAC was associated with mortality at thirty days (p 0.0003), three months (p 0.003), and six months (p 0.011) (Table). PVR was associated with mortality at thirty days, three months, and six months (p 0.045, 0.012, and 0.031 respectively). The sPESI score ≥1 (high risk) was associated with all-cause mortality at three months and six months (p 0.0136 and &lt;0.0001 respectively). PAC was the strongest predictor of all-cause mortality with an AUC of 0.95 (CI 0.82- 0.99) at thirty days, 0.84 (CI 0.65–0.99) at three months, and 0.77 (CI 0.57–0.96) for six months. Corresponding Kaplan-Meier survival curve of PAC and thirty days all-cause mortality is presented in the Figure. PVR had an AUC of 0.75 (CI 0.48–0.95) at thirty days, 0.79 (CI 0.58–0.94) at three months, and 0.72 (CI 0.50–0.90) at six months. The sPESI had an AUC of 0.62 (CI 0.54–0.66) at three months and 0.64 (CI 0.59–0.67) at six months.

Conclusion

In patients with acute PE, PAC outperforms sPESI and PVR as a predictor of short-term all-cause mortality at thirty days, three months, and six months. These three variables should be explored head to head prospectively for their utility to predict short term all-cause mortality.

Funding Acknowledgement

Type of funding sources: None.

Photocatalytic performance, anti-bacterial activities and 3-chlorophenol sensor fabrication using MnAl2O4·ZnAl2O4 nanomaterials

A MnAl₂O₄·ZnAl₂O₄ nanomaterial was synthesized by co-precipitation and characterized by XRD, SEM, EDS, TEM, AFM, FTIR, PL, CV and EIS. The photocatalytic activity of the nanocomposite against MV dye and its MDR anti-bacterial functions were studied. The nanocomposite shows excellent photocatalytic as well as anti-bacterial activity. A MnAl₂O₄·ZnAl₂O₄ nanomaterial/Nafion/GCE electrode was fabricated and implemented as the working electrode of a 3-CP sensor. The sensor exhibited good sensitivity, with the lowest detection limit, fast response time, large linear dynamic range (LDR), and long-term stability in the chemical environment. The estimated sensitivity is 70.07 μA mM^-1 cm^-2. The LDR, limit of detection (LOD), and limit of quantification (LOQ) are 0.1 nM to 0.01 M, 0.0014 ± 0.0001 nM, and 0.004 nM, respectively. The MnAl₂O₄·ZnAl₂O₄ nanomaterial/Nafion/GCE is a promising fabricated sensor probe for the selective detection of 3-CP for the environmental safety and healthcare fields on a large scale.

Determinants of Pre-Hospital Delay after Myocardial Infarction in Bangladesh: A Rural Center Experience

Determinants of pre-hospital delay after myocardial infarction, strictly among South-Asian rural community, till now is largely unknown. And Bangladesh is not an exception. It is a fact that though around two third of its population still live in villages, we do not know what factors are having influence on such delay. To find out these primers of time consumption before seeking medical help, this is a picture of a medical college hospital situated in a rural precinct. This cross-sectional analytical study was conducted among 98 patients came with Myocardial Infarction (MI) who had met inclusion and exclusion criteria from July 2019 and December 2019. Both STEMI & NSTEMI patients were selected as they have similar attributes. Data was collected in the coronary care unit using a preformed questionnaire. Among 98 MI patients, where 16 female and 82 male patients had average age 53±12 years. Average income rural community was around 100 USD. Almost 50% of sample were illiterate or below 5th grade. On average 6.6 hours (95% CI: 3.5-12.3) were required to reach CCU after symptom onset, whereas distance to first medical contact (FMC) was about 10.2 Km (95% CI: 6.4-16.2). Median distance to nearest PCI-capable hospital was 140 Km (IQR- 20 Km). Only 28% of patients could reach hospital within 2 hours, where 85% had onset of symptom while they were at home. Tertiary level medical college (74.5%) followed by Upazilla (Sub-urban) government health complex (22.4%) were frequent site of FMC. Principle mode of transport to hospital was CNG-three-wheeler (75% of cases). Logistic regression analysis showed only low literacy was as significant predictor about more than 2 hours pre-hospital delay (OR=2.58; p=0.043). Other factors such as low income (OR=2.51; p=0.126), diabetes mellitus (OR=2.99; p=0.059), female sex (OR=1.56; p=0.753), house wife (OR=1.88; p=0.547), previous MI (OR=1.52; p=1.000), symptom ignorance (OR=2.14; p=0.455) increases pre-hospital delay and distance to FMC <10 Km (OR=0.44; p=0.079) no significant prediction of pre-hospital delay after myocardial infarction. As rural community has less access to education low literacy has a significant impact on pre-hospital delay after myocardial infarction. So measures should be taken in rural areas through patient education and social awareness program regarding MI symptom and danger of delayed medical attention.

Assessment of Melamine in Different Water Samples with ZnO-doped Co3 O4 Nanoparticles on a Glassy Carbon Electrode by Differential Pulse Voltammetry

In this investigation, a melamine electrochemical sensor has been developed by using wet-chemically synthesized low-dimensional aggregated nanoparticles (NPs) of ZnO-doped Co₃ O₄ as sensing substrate that were decorated onto flat glassy carbon electrode (GCE). The characterization of NPs such as UV-Vis, FTIR, XRD, XPS, EDS, and FESEM was done for detailed investigations in optical, functional, structural, elemental, and morphological analyses. The ZnO-doped Co₃ O₄ NPs decorated GCE was used as a sensing probe to analyze the target chemical melamine in a phosphate buffer at pH 5.7 by applying differential pulse voltammetry (DPV). It exhibited good performances in terms of sensor analytical parameters such as large linear dynamic range (LDR; 0.15-1.35 mM) of melamine detection, high sensitivity (80.6 μA mM^-1  cm^-2 ), low limit of detection (LOD; 0.118±0.005 mM), low limit of quantification (LOQ; 0.393 mM), and fast response time (30 s). Besides this, the good reproducibility (in several hours) and repeatability were investigated under identical conditions. Moreover, it was implemented to measure the long-time stability, electron mobility, less charge-transfer resistance, and analyzed diffusion-controlled process for the oxidation reaction of the NPs assembled working GCE electrode, which showed outstanding chemical sensor performances. For validation, real environmental samples were collected from various water sources and investigated successfully with regard to the reliability of the selective melamine detection with prepared NPs coated sensor probe. Therefore, this approach might be introduced as an alternative route in the sensor technology to detect selectively unsafe chemicals by an electrochemical method with nanostructure-doped materials for the safety of environmental, ecological, healthcare fields in a broad scale.

Efficacy of Clotrimazole 1% Solution Compared to Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% Cream in Patient with Otomycosis

Fungal infection of the ear canal is called Otomycosis. It is more common in hot and humid condition. There are many modalities of treatment or therapeutic agent for treatment of otomycosis. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream is a topical antifungal agent described to be effective in the treatment of otomycosis. This study was performed to compare the efficacy of topical application clotrimazole 1% solution and Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream in the treatment of otomycosis. A controlled, randomized and open clinical trial was carried out in ENT department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to July 2020. Patients diagnosed with fungal otitis externa who were treated with topical antifungals were included in this study. They were randomized into two treatment groups: i) Clotrimazole 1% solution, 2) Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream. Patients were microscopically evaluated at two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed, follow up and final outcomes (absence of infection) were compared between two groups. One hundred & two (102) patients were included, 51 in the clotrimazole 1% solution group and 51 in the Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group. Predominant symptoms are pain, pruritus, aural fullness and hearing loss. Aspergillus organism was isolated most frequently (63.73%). Treatment with clotrimazole 1% solution groups resulted in 88.23% resolution vs. 80.39% resolution with Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream at 2 weeks of treatment. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group demonstrated higher treatment failure 11.76 and 19.60 respectively. Clotrimazole 1% solution is more effective than Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream for uncomplicated otomycosis. More study is needed to corroborate our results.

Norovirus Gastroenteritis Outbreaks, Genomic Diversity and Evolution: An Overview

Norovirus, often called winter vomiting bug, is the most common cause of outbreaks of acute gastroenteritis in all age groups all over the world. It was discovered in 1972; belong to the genus Norovirus in the family Caliciviridae. Based on genomic organization and phylogenetic analysis, the family Caliciviridae is divided into four genera- Norovirus, Sapovirus, Vesivirus and Lagovirus. The aim of this review article was to find out the present status of prevalence and evolution of norovirus strains in developed and developing countries. In this article various literature on norovirus from different countries was reviewed. The detection of norovirus in the lower middle income countries (LMIC) was reported 15% in cases and 8% in controls during 1997 to 2018. On the other hand, detection rate of norovirus in low income countries (LIC) was 11% in cases and 9% in controls during the same period. Overall detection rate of norovirus was 14% in LIMC and 8% in LIC during 1997 to 2018. Noroviruses are divided genetically into seven different type of Geno groups namely GI, GII, GIII, GIV, GV, GVI and GVII which are further classified into different genetic clusters or genotypes. For example, Geno group II, the most prevalent human Geno group, presently contains 19 genotypes. Among the genogroups I, II and IV infect humans, on the other hand genogroup III infects bovine species and genogroup V was isolated from mice. Several new noroviruses were reported and the number of genogroups increased to 10 (GI-GX) and the number of genotypes expanded to 49: 9 GI, 27 GII, 3 GIII, 2 GIV, 2 GV, 2GVI, 1 GVII, 1 GVIII, 1 GIX, 1 GX. Noroviruses are spread directly from individual to individual as well as indirectly via contaminated food and water. They are highly contagious, and around twenty virus particles can cause an infection. This virus usually exhibits winter seasonality. The global norovirus prevalence in under-5 years, ≥5 years and mixed age was similar (16% - 19%). Norovirus infection is characterized by diarrhea, vomiting, fever, headache and stomach pain. It may be complicated with dehydration and electrolyte imbalance. Gastroenteritis develops 12 to 48 hours after exposure and recovery typically occurs within 1 to 3 days. There is no specific treatment of norovirus gastroenteritis. Prevention includes proper hand washing and cleaning or disinfection of contaminated surfaces. Various genotypes of norovirus may be circulating around the world and can emerge either nationally or globally. In this overview, general characteristics of norovirus, current status of genomic diversity and classification, recent status of norovirus gastroenteritis outbreaks in the developed and developing countries is outlined for comprehensive understanding of the present status of prevalence and evolution of norovirus strains to develop strategies for prevention and control of norovirus infection in human.

Electrochemical Detection of 2-Nitrophenol Using a Glassy Carbon Electrode Modified with BaO Nanorods

Here, an electrochemical detection approach (differential pulse voltammetry) was employed to develop a 2-nitrophenol (2-NP) sensor probe using a glassy carbon electrode (GCE) coated by wet-chemically synthesized nanorods (NRs) of BaO. The prepared BaO NRs were characterized by field-emission scanning electron microscopy (FESEM), energy-dispersive X-ray spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS) and powder X-ray diffraction (XRD) analysis. The peak currents by differential pulse voltammetric (DPV) analysis of 2-NP are plotted against the concentration to obtain the calibration curve of the 2-NP detection. It was found to be linear from 1.5 to 9.0 μM, defined as the dynamic range (LDR) for 2-NP detection in phosphate buffer solution. The sensor sensitivity was calculated from the slope of LDR by considering the active surface area of NRs coated on GCE (0.0316 cm² ) and found as 17.6 μAμM^-1  cm^-2 . The limit of detection (LOD) was calculated as 0.50±0.025 μM from the signal/noise (S/N) ratio of 3. Moreover, the sensor analytical parameters such as reproducibility, long-term performing ability (stability), response time and validity in real environmental samples were found acceptable and to give satisfactory results. The development of a nanomaterial-based electrochemical chemical sensor might be an effective approach to sensor technology to detect carcinogenic and hazardous toxins for environmental safety and healthcare fields in a broad scale.

Comparison between Efficacy of Combined Use of Hyaluronidise and Triamcinolone versus Hyaluronidise, Triamcinolone Acetonide and Oral Colchicine in the Treatment of Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) is a chronic complex potentially pre-malignant condition caused by chewing areca nut and other irritants. It is an insidious process characterized by Juxta-epithelial deposition of fibrous tissue in the oral cavity and pharynx. OSF is very common in Southeast Asia and also now a days increase in Europe and North America. The aim of this study to compare the effectiveness of intralesional injection of triamcinolone and hyalurunidase versus intralesional injection of triamcinolone plus injection hyalurunidase with oral colchicine. The study included 60 patients of clinically diagnosed case of oral submucous fibrosis. Patients were divided into two Groups A and B. Group A patients received combination intralesionsl injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml. 15 days interval in 3 months and Group B received intralesional injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml in each 15 days interval for 3 months with oral colchicine 0.5mg twice daily for 3 months. Diagnosis based on burning sensation of mouth, blanching of mucosa, ulceration in oral cavity and also reduced mouth opening. Follow up assessment was done at intervals 1st follow up on 21st days after starting of treatment then 2nd follow up after 3 months and last 3rd follow up after 6 months. Before starting of treatment all patients were properly explained about the study and took their written consent. Much more improvement occurred in Group B patients, reducing in burning sensation and also increases in opening of mouth. In both groups blanching mucosae were improved. Treatment regimen of Group B is more effective in increasing mouth opening and improves burning sensation of oral cavity. No side effects were seen in both groups' patients.

Giant Villous Adenoma: A Rare Case of Colorectal Adenoma that Mimic Colorectal Cancer

Colorectal cancer being the 4th most common cause of cancer death in which most arise from a preexisting adenomatous polyp. Among the various adenomas Giant villous adenoma (GVA) is less common. We came across a 65 years female with intermittent per rectal mucus discharge for last 10 years and intermittent fresh, painless, scanty per rectal bleeding along with weakness and fatigue for last 5 years. No members of her family had been suffering from colorectal malignancy. DRE revealed irregular gritty feelings of rectal mucosa starting 2cm from anal verge and the examining fingertip was blood tinged mixed with mucus. On proctoscopic examination the accessible rectum was studded with thousands of polyps with granular appearance, with variable sizes and there was mucus mixed blood within the rectum. Colonoscopy reveals- polypoid lesion starting 2cm from anal verge and extends up to 2cm with granular and velvety appearance. Biopsy was done 2 times for suspicious lesion and histopathology reveals tubulovillous adenoma with dysplasia. However as clinical suspicion of an adenocarcinoma was strong but histopathological report of colonoscopic biopsy was contradictory, intersphincteric ultra-low anterior resection with coloanal anastomosis with covering ileostomy was done. Resected specimen was sent for histopathological study and it reveals- villous adenoma with low grade dysplasia. Two months later reversal of ileostomy was done and now the patient is under regular follow up and now she is asymptomatic.

Fabrication of selective and sensitive chemical sensor probe based on ternary nano-formulated CuO/MnO2/Gd2O3 spikes by hydrothermal approach

In this approach, thin spikes (NSs) of ternary nano-formulated mixed CuO/MnO₂/Gd₂O₃ were synthesized by the hydrothermal approach for efficient detection of 3-methoxyphenyl hydrazine (3-MPHyd) chemical from various environmental samples. The NSs were systematically characterized by using XPS, EDS, TEM, FTIR, UV/vis, and XRD. The fabricated NSs onto the glassy carbon electrode (GCE) was successfully applied for the selective and sensitive detection of 3-MPHyd in the phosphate buffer system (PBS), which displayed the highest sensitivity, good selectivity with ultra-trace detection limit, high stability, good reproducibility, and quick response time. The real environmental samples were tested for validation from stand point of the ternary doped nanomaterials for sensing in the practical applications using by electrochemical method.

Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma

This prospective study was conducted at Department of ENT, Mymensingh Medical College Hospital, a tertiary care center in Bangladesh January 2017 to December 2018 to report hearing results and post operative complications of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma where ossicular chain is eroded or has to be removed either partially or totally. Total 42 patients underwent Intact canal wall (ICW) tympanoplasty for cholesteatoma with at least intact stapes footplate and in conjunction, cartilage ossiculoplasty was done during the same procedure. Patients were followed up regularly at 1 week, 1 month, 3 month, 6 month and at 1 year as usual follow up protocol to note complications and hearing status in 1 year follow up. In intact stapes suprastructure group, in the preoperative period, the mean air conduction thresholds (AC), bone conduction threshold (BC) and air-bone gap (ABG) were 48.3db, 9.5db and 38.8db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG were 27.6db, 9.7db and 17.9db respectively. In missing stapes supra structuregroup, in the preoperative period, the mean air conduction thresholds (AC), Bone conduction threshold (BC) and air-bone gap (ABG) were 57.4db 13.5db and 43.9db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG, were 33.9db, 14.2db and 19.7db respectively. For management of cholesteatoma cases, cartilage ossiculoplasty can be done effectively in conjunction with of intact canal wall tympanoplasty in a single setting. Complications are a few and easily manageable. Hearing results are at least as good as with other prosthesis and helps in avoiding subsequent surgery, discomfort and cost to the patients.

Photocatalysis, photoinduced enhanced anti-bacterial functions and development of a selective m-tolyl hydrazine sensor based on mixed Ag·NiMn2O4 nanomaterials

In this work, a tri-metal based nanocomposite was synthesized and characterized. A detailed investigation of the photocatalytic dye degradation efficiency of the nanocomposite under visible light showed promising results in a wide pH range, both acidic and basic medium. Studies on anti-bacterial activity against seven pathogenic bacteria, including both Gram positive and Gram negative species, were conducted in the presence and absence of light and compared with the standard antibiotic gentamicin. The minimum inhibitory concentration (MIC) values of Ag·NiMn₂O₄ against multidrug-resistant (MDR) pathogens ranged from 0.008 to 0.65 μg μL^-1, while the minimum bactericidal concentration (MBC) was found to be 0.0016 μg μL^-1. The nanomaterial, Ag·NiMn₂O₄ was deposited onto the surface of a glassy carbon electrode (GCE; 0.0316 cm²) as a thin film to fabricate the chemical sensor probe. The proposed sensor showed linear current (vs. concentration) response to m-THyd (m-tolyl hydrazine) from 1.0 pM to 0.01 mM, which is denoted as the linear dynamic range (LDR). The estimated sensitivity and detection limit of the m-THyd sensor were found to be 47.275 μA μM^-1 cm^-2 and 0.97 ± 0.05 pM, respectively. As a potential sensor, it is reliable due to its good reproducibility, rapid response, higher sensitivity, working stability for long duration and efficiency in the analysis of real environmental samples.

Bacteriology of Chronic Supporative Otitis Media (CSOM) at a Tertiary Care Hospital, Mymensingh

Chronic suppurative otitis media (CSOM) is a notorious infection in developing countries causing serious local damage and threatening complications. It was a cross sectional observational study to isolate and identify aerobic bacteria and to analyze the susceptibility pattern of the aerobic bacterial isolates. It was carried out from March 2017 to July 2018 in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Samples were collected from Outpatient of ENT department, MMCH. Out of a total 300 patients with CSOM were enrolled in this study and 209 were culture positive. Among them gram negative organisms were 129(61.72%) and gram positive organisms were 70(33.49%). The most frequently isolated organism in this study was Pseudomonas aeruginosa 72(34.44%), gram positive organisms S. aureus 63(30.14%), E. coli 21(10.04%), other Pseudomonas spp (other than P. aeruginosa) 15(7.17%), mixed bacterial infectios 10(4.78%), Proteus spp 9(4.30%), CoNS 7(3.34%), Klebsiela lspp 7(3.34%), Acinetobactor spp 5(2.39%). P. aeruginosa isolates had least resistant to imipenem and colistin, S. aureus were showed high sensitivity to Vancomycin and Linezolid and E. coli were sensitive to imipenem and amikacin, ciprofloxacin and amikacin respectively. Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Piperacillin-Tazobactum, Ciprofioxacin, Gentamicin and Amikacin were found to be the most suitable drug for Pseudomonas aeruginosa, S. aureus and E. coli. The resistance against ceftriaxone and aztreonam was found to be very high.

Measuring public awareness about blood donation in Assir, South-Western Saudi Arabia

OBJECTIVES

Blood transfusion is a life-saving measure in many acute and chronic conditions. Voluntary blood donation by healthy donors has been promoted by the World Health Organization (WHO) to ensure the availability of safe blood. Difficulty in the recruitment of donors and their retention is a problem faced in most populations. A paucity of research to identify barriers to blood donation in the Southwestern region of Saudi Arabia prompted us to explore this important public health issue.

MATERIALS AND METHODS

A cross-sectional survey was performed using a pre-tested, structured, self-administered questionnaire comprising of questions on demographical details, awareness regarding blood donations, perceived barriers to blood donations, attitude towards blood donation, etc. was distributed to the general population in Assir region through one to one contact in big malls, hospital area as well as electronically through social media. The data thus collected was statistically analysed using appropriate tests.

RESULTS

A total of 844 subjects were surveyed. Most of the respondents (65.0%) reported not having donated blood in the past. The blood donation was found to have a significant relationship (≤0.05) with age, gender, occupation, and education status. Roughly, 40.0% of the respondents suggested that blood donation could be promoted by raising public awareness.

CONCLUSION

Gaps were identified in the awareness of the studied population regarding blood donation. Specific awareness drives may help overcome these barriers to voluntary blood donation.

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.

Comparison between Outcomes of Endoscopic Sinus Surgery and Surgical Excision in Case of Rhinosporiodiosis

Rhinosporiodiosis is a chronic granulomatous infection of the mucus membranes caused by Rhino sporidium seeberi that manifest as vascular friable polyps and arise in the nasal mucosa. The mode of infection is probably trans-epithelial penetration. Rhinosporiodiosis is endemic in India, Pakistan and Srilanka. It occurs sporadically in the United States of America. The aim of this study was to compare betweenthe outcomes of endoscopic sinus surgery andsurgical excision in rhinosporiodiosis. The cross sectional comparative study was conducted among 40 patients with rhinosporiodiosis from January 2018 to April 2019 in the department of Otolaryngology and Head-neck surgery of Mymensingh Medical College Hospital, Bangladesh. All the patients were following up to 6 month after surgery. Most of them are male 24(60.0%) and female are 16(40.0%). Age of the patients in this study was (Mean±SD) 34.8±13.5 years. More than half of the patients had rhinosporiodiosis in the inferior turbinate (25, 62.5%) followed by 8(20.0%) in nasal septum and 7(17.5%) in the nasal floor. Endoscopic Sinus Surgery was done purposively among 20 patients and surgical excision was done purposively among another 20 patients. At the time of operation no complication occurs in case of endoscopic sinus surgery but in case of surgical excision small of amount bleeding was present. All the patients were followed up to 6 month after surgery. No recurrence was found in patients with endoscopic sinus surgery but 7(35.0%) patients who underwent surgical excision had recurrence of rhinosporiodiosis at follow up after six months of surgery. Chi-square test showed that the incidence of recurrence after 6 months of surgery was significantly lower in endoscopic sinus surgery (p=0.004). The study results concluded that endoscopic sinus surgery is better option for rhinosporiodiosis.

Facile and efficient 3-chlorophenol sensor development based on photolumenescent core-shell CdSe/ZnS quantum dots

Quantum dots (QDs) are semiconducting inorganic nanoparticles, tiny molecules of 2-10 nm sizes to strength the quantum confinements of electrons. The QDs are good enough to emit light onto electrons for exciting and returning to the ground state. Here, CdSe/ZnS core/shell QDs have been prepared and applied for electrochemical sensor development in this approach. Flat glassy carbon electrode (GCE) was coated with CdSe/ZnS QDs as very thin uniform layer to result of the selective and efficient sensor of 3-CP (3-chlorophenol). The significant analytical parameters were calculated from the calibration plot such as sensitivity (3.6392 µA µM-1 cm-2) and detection limit (26.09 ± 1.30 pM) with CdSe/ZnS/GCE sensor probe by electrochemical approach. The calibration curve was fitted with the regression co-efficient r2 = 0.9906 in the range of 0.1 nM ∼ 0.1 mM concentration, which denoted as linear dynamic range (LDR). Besides these, it was performed the reproducibility in short response time and successfully validated the fabricated sensor for 3-CP in the real environmental and extracted samples. It is introduced as a noble route to detect the environmental phenolic contaminants using CdSe/ZnS QDs modified sensor by electrochemical method for the safety of healthcare and environmental fields at broad scales.

Legg-Calve-Perthes Disease: Correlation between Computed Radiography and Magnetic Resonance Imaging

The purpose of this study is to diagnose Legg-Calve-Perthes disease by computed radiography and Magnetic resonance imaging and accurate staging and correlating the findings of these two modalities. Thirty five (35) patients complaining pain in groins and painful walking, after thorough physical examinations were sent to Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh for computed radiography and Magnetic Resonance Imaging examination. This cross sectional study was conducted in the Department of Radiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2018. Legg-Calve-Perthes disease among the selected 35 cases were started at the age of 5(2.9%) and age range of the patients were 5-13 years; mean age was (9.63±1.82) years and most of them belonged to 8-10 years of age (51.4%). Patients with Legg-Calve-Perthes disease had been suffering from pain in right and left groins forvarious durations. Maximum duration was 1-2 years (~88.57%). Maximum proportion of diagnosed patients was delivered by normal delivery (60%) and maximum proportion of patients was premature (65.7%). Most of the patients were low birth weight baby (65.7%). Here chi-square test was done and found no significant relationship between delivery mode and birth weight in case of Legg-Calve-Perthesdisease (x²=1.712) (P=0.191). The result of the X-ray and MRI findings by cross table of chi square test found fair inter relationship between two diagnostic instruments. Result found fine difference in staging of the disease between X-ray and MRI findings. It can be said that MRI definitely a better tool for early diagnosis of Legg-Calve-Perthes disease and its staging but X-ray modality can be used. A primary tool for diagnosis and staging of the disease can be done where the MRI facility is not available or cost expensive for patient.

Evaluation of Breast Lump - Comparison between True-cut Needle Biopsy and FNAC in MMCH: A Study of 100 Cases

One-fourth of all women suffer from breast disease in their lifetime. World Health Organization estimated that over 508,000 women died in 2011 due to breast cancer worldwide.For several years, fine needle aspiration cytology (FNAC) was the most practiced method for the pathological diagnosis of breast lump specially differentiation of benign from malignant. The advent of core needle or True-Cut biopsy (TCB) in the new millennium has resulted in many surgeons switching to TCB since it provides a sufficient amount of tissue for pathologists to make an accurate histological diagnosis.During the study period, patients present with clinically palpable breast lump admitted in different surgicalunits of MMCH, among them 100 patients selected purposively. Then a prospective comparative study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2017 to February 2018. Out of a total of 100 patients, who presented with suspicious breast lump, as clinically diagnosed 68 patients had benign breast lump and 32 patients had malignant breast lump. FNAC confirmed the diagnosis of breast carcinoma in 27 patients with sensitivity 89.65% and specificity 66.66%. True-cut biopsy confirmed the diagnosis of breast carcinoma in 29 patients with sensitivity 96.66% and specificity 100%. It also gave the definitive histological type and grade which correlated with the final histopathology report in 29 out of the 30 patientsTCB also provides adequate tissue for the evaluation of molecular markers which have extreme therapeutic value.

Assessment of Quality of Life of Chronic Kidney Disease Patients Receiving Hemodialysis with Kidney Disease Quality of Life™-36 Scale

Chronic kidney disease and the methods of its treatment play an important part in shaping the Quality of Life QOL of patients receiving dialysis. KDQOL™-36 is the most widely used instrument to evaluate health related quality of life of chronic kidney disease patients. The aim of the study was the subjective assessment of the quality of life (QOL) of patients treated with hemodialysis and also to understand the distribution of component scores of the scale with distribution of responses to individual items of the scale among the selected sample. This cross sectional study was conducted among randomly selected 151 patients of chronic kidney disease receiving hemodialysis with pre-dialysis proper education at Inpatient Department in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh during the period of June 2018 to December 2018. The instrument to measure the QOL was Kidney Disease and Quality of Life Bangla version 36 (KDQOL™-36). Recruited patients were interviewed with questionnaire technique to collect data with the scale which is a structured questionnaire comprised of four subscales. Mean scores ±SD of the domain of the physical and mental component summary, burden of kidney disease, symptoms and problems of kidney disease and effects of kidney disease subscales were 29.3±16.03, 16.93±13.0, 81.09±13.14 and 61.67±13.84 respectively. The mean ±SD of the combined score for all the four domains was 47.24±11.52. The rate of those with impaired QOL (mean score <66.7) was 96.7%. The most bothersome domain was burden of the kidney disease domain, where the mean scores of all the items were below 66.7. The study provides information that regular pre-dialysis attendance helps to provide the patient with proper education and thereby achieve better QOL among patients of chronic kidney disease receiving hemodialysis. By using the KDQOL™-36 scale this study finds that the domain of symptom of the kidney disease appeared to have least effect on the quality of life as the mean scores ranged higher from other subscales and in most cases the scores were above 66.7.

Effective dynamic properties of random complex media with spherical particles

The effective dynamic bulk modulus and density are presented for random media consisting of particles in a viscous host fluid, using a core-shell, self-consistent effective medium model, under the large compressional wavelength assumption. These properties are relevant to acoustic or dynamic processes in nano- and micro-particle fluids including particle density determination, resonant acoustic mixing, and acoustic characterisation. Analytical expressions are obtained for the effective bulk modulus and mass density, incorporating the viscous nature of the fluid host into the core-shell model through wave mode conversion phenomena. The effective density is derived in terms of particle concentration, particle and host densities, particle size, and the acoustic and shear wavenumbers of the liquid host. The analytical expressions obtained agree with prior known results in the limit of both static and inviscid cases; the ratio of the effective bulk modulus to that of the fluid is found to be quasi-static. Numerical calculations demonstrate the dependence of the effective mass density on frequency, particle size (from nano- to micro-regime), and concentration. Herein it is demonstrated both theoretically and numerically that the viscosity, often neglected in the literature, indeed plays a significant role in the effective properties of nanofluids.

Expansion of a novel lead targeting M. tuberculosis DHFR as antitubercular agents

A series of 1-(1-benzyl-2-methyl-5-((1-phenyl-1H-1,2,3-triazol-4-yl)methoxy)-1H-indol-3-yl)ethanone and ethyl 1-benzyl-2-methyl-5-((1-phenyl-1H-1,2,3-triazol-4-yl)methoxy)-1H-indole-3-carboxylate derivatives were designed based on bioisosteric replacement of previously reported antitubercular agent (IND-07). Twenty ligands were successfully synthesized and some of them were found to have good in vitro activity (MIC < 10 μM) against the H₃₇Rv strain of Mycobacterium tuberculosis. Among these compounds, KC-08 and KC-11 inhibited Mtb-DHFR with 4- and 18-fold selectivity for Mtb-DHFR over h-DHFR, respectively. Compound KC-11 display acceptable ADME, and better pharmacokinetic profiles than IND-07. Docking studies were performed to predict the binding mode of the compounds within the active site of Mtb-DHFR and h-DHFR. The results of our study suggest that compound KC-11 may serve as a valuable lead for the design and development of selective inhibitors of Mtb-DHFR with potential therapeutic application in tuberculosis.

Knowledge and Practice of Hepatitis B among Biological and Biomedical Sciences Students in a Public University of Bangladesh

A large numbers of biological and biomedical sciences students intricate themselves in health care professions, which makes them vulnerable to occupational exposure of Hepatitis B. This study aimed to determine the level of knowledge and practice of hepatitis B among biological and biomedical sciences students in a public university of Bangladesh. A cross-sectional study was conducted in Noakhali Science and Technology University (NSTU), Noakhali, Bangladesh from March 2017 to July 2017. Data was collected from students through purposive sampling technique using self-administered structured questionnaire and analyzed by using IBM SPSS 23.0. Out of the 303 participants, 213(70.3%) were within adequate knowledge range and 30(9.9%) of the students were in good practice range. Only 71(23.14%) of the students were fully vaccinated against Hepatitis B. Knowledge level of Participant's were significantly associated with their age and father's education. The practice level was significantly associated with age and all educational variables. Moreover, significant positive but weak linear correlations between knowledge and practice score were identified. The study indicates adequate knowledge, but poor practice of students towards HB. Thus, we recommend all students to implement their knowledge in real life and should be vaccinated prior to entry into health profession.

Development of an efficient phenolic sensor based on facile Ag2O/Sb2O3 nanoparticles for environmental safety

The facile hydrothermal method was used to prepare low-dimensional doped Ag₂O/Sb₂O₃ nanoparticles (NPs) at low temperature in alkaline medium. The calcined NPs were characterized in detail by FTIR, UV/vis, FESEM, XPS, EDS, and XRD. A thin layer of Ag₂O/Sb₂O₃ NPs was deposited onto a glassy carbon electrode (GCE) using Nafion (5% Nafion suspension in ethanol) conducting binder, which formed the working electrode of the selective 3-methoxyphenol electrochemical sensor probe. The proposed chemical sensor exhibits high sensitivity, long-term stability, and enhanced electrochemical responses towards 3-methoxyphenol. Response to 3-methoxyphenol is linear over the concentration range (LDR) of 0.09 nM to 0.09 mM. The analytical parameters of the sensor such as sensitivity, stability, response time, linearity, LDR, robustness, selectivity etc. were evaluated by an electrochemical approach. The sensor probe fabricated with Ag₂O/Sb₂O₃ NPs seems to be a promising candidate for effective and reliable electrochemical detection of hazardous and carcinogenic chemicals in the environment and health care fields in large scales.

An Overview on Epidemiology of Tuberculosis

Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. Tuberculosis in human is mostly by Mycobacterium tuberculosis and primarily affects lungs causing pulmonary tuberculosis. It can also affect intestine, meninges, bones, joints, lymph nodes, skin and other tissues of the body causing extra-pulmonary tuberculosis. Human TB is transmitted mainly through droplet infection and droplet nuclei. Infection of human with M. avium and M. africanum is very rare. M. microti is not known to cause TB in human, while M. bovis has a wider host range. Human may be infected by M. bovis through milk and milk products or meat of an infected animal. It is estimated that in some developing countries up to 10% of human tuberculosis is due to bovine TB. Tuberculosis causes more than 2 million deaths annually and the death toll is worsened by the emergence of drug resistant Mycobacterium tuberculosis. The South East Asia Region accounts for 39% of global burden of TB in terms of incidence. It is estimated that about 3.4 million new cases of TB continue to occur each year in this region, most of them in India, Bangladesh, Indonesia, Myanmar and Thailand. Tuberculosis is a social disease with medical aspects. It has also been described as a barometer of social welfare. The social factors include poor quality of life, poor housing, overcrowding, population explosion, under-nutrition, smoking, alcohol abuse, lack of education, large families, early marriages, lack of awareness regarding cause and transmission of TB. These factors are interrelated and contribute to the occurrence and transmission of tuberculosis. It is estimated that approximately 10% of total TB is occurred in children. Childhood deaths from TB are usually caused by tuberculous meningitis or disseminated disease. The number of individuals infected with both HIV and TB is increasing worldwide. The HIV affects the body's immune system and enhances the speed at which TB progresses from a innocuous infection to life threatening condition. TB is a major cause of death of HIV positive individuals. Diabetes has been shown to be an independent risk factor for tuberculosis in community based studies from south India and multiple studies globally. It is suggested that diabetes accounts for 14.8% of all tuberculosis and 20.8% of smear positive TB. Understanding of epidemiology of tuberculosis is essential for its effective control. This review tried to summarize the epidemiological aspects of tuberculosis in global, regional and Bangladesh perspectives. For this review article, data available in books and at the official websites of WHO, MBDC, NTP, DGHS, The Ministry of Health and Family Welfare, Government of Bangladesh were consulted through PubMed central and Google scholar search engines. This paper has been written with an aim to offer general education to health professionals, policy makers, patients and the public.

Investigation of methicillin-resistant Staphylococcus aureus among clinical isolates from humans and animals by culture methods and multiplex PCR

Background

Staphylococcus aureus is responsible for large numbers of hospital-related and community-acquired infections. In this study, we investigated the presence of S. aureus and methicillin-resistant S. aureus (MRSA) in 100 samples from animals (55 cattle, 36 dogs, and 9 cats) and 150 samples from hospitalized human patients. The samples were collected from healthy and diseased animals and from diseased humans and included milk, wound swab, pus, exudates, nasal swab and diabetic ulcer. Initially, S. aureus was isolated and identified by colony morphology, Gram staining, and biochemical tests (catalase and coagulase tests). The S. aureus-positive samples were examined by polymerase chain reaction (PCR) to determine their MRSA status.

Results

Of the 100 animal samples, 29 were positive for S. aureus. Four samples (13.8%) from dogs were MRSA-positive, but samples from cattle and cats were MRSA-negative. Of the 150 human samples we collected, 64 were S. aureus-positive and, of these, 34 (53.1%) were MRSA-positive. Most (28%) of the MRSA samples were isolated from surgical wound swabs, followed by the pus from skin infections (11%), exudates from diabetic ulcers (6%), exudates from burns (4%), and aural swabs (3%). By contrast, a low MRSA detection rate (n = 4) was seen in the non-human isolates, where all MRSA bacteria were isolated from nasal swabs from dogs. The antimicrobials susceptibility testing results showed that S. aureus isolates with mecA genes showed resistance to penicillin (100%), oxacillin (100%), erythromycin (73.5%), ciprofloxacin (70.6%), and gentamicin (67.7%). The lowest resistance was found against ceftazidime, and no vancomycin-resistant isolates were obtained.

Conclusions

We detected S. aureus and MRSA in both human and canine specimens. Isolates were found to be resistant to some of the antimicrobials available locally. MRSA carriage in humans and animals appears to be a great threat to effective antimicrobials treatment. The prudent use of antimicrobials will reduce the antimicrobial resistance. Our findings will help to find the most appropriate treatment and to reduce antimicrobial resistance in the future by implementing prudent use of antimicrobials. Further studies are required to better understand the epidemiology of MRSA human–animal inter-species transmission in Bangladesh.

Electronic supplementary material

The online version of this article (10.1186/s12917-018-1611-0) contains supplementary material, which is available to authorized users.

Fabrication of 1,4-dioxane sensor based on microwave assisted PAni-SiO2 nanocomposites

In this study, conducting polyaniline (PAni) and silicon dioxide (SiO₂) nanocomposites (NCs) were synthesized for chemical sensing applications by microwave assisted reaction technique. Facile synthesis and characterization of the PAni-SiO₂ nanocomposites were investigated in details and discussed in this report. For the potential application, 1,4-dioxane chemical sensor was fabricated with the PAni-SiO₂ nanocomposites deposited onto glassy carbon electrode (GCE). A very thin uniform film was deposited onto GCE with nanocomposite by using conducting 5% nafion binder at room conditions. To evaluate the sensor analytical performances, a calibration plot such as current versus concentration of 1,4-dioxane was drawn and calculated the analytical parameters from the slope of calibration curve. Results are found as sensitivity (0.5934 µAµmol^-1 L^-2 cm^-2), detection limit (16.0 ± 0.8 pmol L^-1), and quantification limit (LOQ; 53.3 ± 1.5 pmol L^-1) in this observation. Considering the linear region in calibration plot, the linear dynamic range of 1,4-dioxane chemical sensor was found (0.12 nmol L^-1 ∼ 1.2 mmol L^-1). Besides this, the proposed 1,4-dioxane chemical sensor was exhibited good reproducibility, long-term stability, high accuracy in detecting of 1,4-dioxane in real environmental samples. This research is to develop of a selective and an efficient electrochemical sensor. It might be a simple and easy way by applying electrochemical method to ensure the safe and sustainable green environment.

Content specificity of attentional bias to threat in post-traumatic stress disorder

BACKGROUND

Attentional bias to affective information and reduced cognitive control may maintain the symptoms of post-traumatic stress disorder (PTSD) and impair cognitive functioning. However, the role of content specificity of affective stimuli (e.g., trauma-related, emotional trauma-unrelated) in the observed attentional bias and cognitive control is less clear, as this has not been tested simultaneously before. Therefore, we examined the content specificity of attentional bias to threat in PTSD.

METHODS

PTSD participants (survivors of a multistory factory collapse, n=30) and matched controls (n=30) performed an Eriksen Flanker task. They identified the direction of a centrally presented target arrow, which was flanked by several task-irrelevant distractor arrows pointed to the same (congruent) or opposite direction (incongruent). Additionally, participants were presented with a picture of a face (neutral, emotional) or building (neutral=normal, emotional=collapsed multistory factory) as a task-irrelevant background image.

RESULTS

We found that PTSD participants produced overall larger conflict effects and longer reaction times (RT) to emotional than to neutral stimuli relative to their healthy counterparts. Moreover, PTSD, but not healthy participants showed a stimulus specific dissociation in processing emotional stimuli. Emotional faces elicited longer RTs compared to neutral faces, while emotional buildings elicited faster responses, compared to neutral buildings.

CONCLUSIONS

PTSD patients show a content-sensitive attentional bias to emotional information and impaired cognitive control.

3,4-Diaminotoluene sensor development based on hydrothermally prepared MnCoxOy nanoparticles

A facile hydrothermal process was used to prepare MnCo_xO_y nanoparticles (NPs) in alkaline medium (pH~10.5) at room temperature. The NPs were characterized by Fourier-transform infrared spectroscopy (FTIR), ultraviolet visible spectroscopy (UV/vis), field emission scanning electron microscopy (FESEM), X-ray photoelectron spectroscopy (XPS), energy-dispersive X-ray spectroscopy (EDS), and powder X-ray diffraction (XRD). A thin layer of NPs film as a chemical sensor was fabricated on a glassy carbon electrode (GCE) with the help of a conducting binder. The sensor was implemented successfully for the detection 3,4-DAT with reliable I-V approach at low potential. The sensor-features include good sensitivity (0.37 mAµmolL^-1cm^-2), low detection limit (LOD=0.26±0.01 pmolL^-1 at a signal to noise ratio of 3), low limit of quantification (LOQ=7.80±0.01 pmolL^-1), good reliability, good reproducibility, ease of integration, and long-term stability were investigated. The sensor response towards 3,4-DAT is linear in logarithmic scale over a large concentration range (1.0 pmolL^-1 to 1.0 µmolL^-1). This work is introduced a route for future sensitive sensor development based on MnCo_xO_y NPs by reliable I-V method for the detection of hazardous and carcinogenic toxins in environmental and health care fields.

Peste des Petits Ruminants risk factors and space-time clusters in Mymensingh, Bangladesh

Using a hospital-based case-control study design, our aim was to identify risk factors for-and space-time clusters of-Peste des Petits Ruminants (PPR) in Mymensingh, Bangladesh. Three hundred and eighty PPR cases diagnosed between January 2005 and December 2014 at the Bangladesh Agricultural University Veterinary Teaching Hospital (BAUVTH) were selected; three controls per case from BAUVTH were then selected (n = 1,048). From records, data extracted included information on date of report, location, age, breed, sex and body weight of goats. A mixed multivariable logistic regression model was built to identify risk factors. Location was included as a random effect and season and demographic variables as fixed effects. The approximate geographic coordinates of locations were collected, and the scan statistic (Bernoulli model) was used to identify space-time clusters of PPR. Compared with goats <4 months of age, the odds of PPR were 3 (95% confidence interval [CI]: 1.95-4.66), 1.9 (CI: 1.34-2.76) and 1.8 times (95% CI: 1.19-2.58) greater in goats aged 4-6, >6-12 and >12-24 months, respectively. The occurrence of PPR was also significantly higher (odds ratio [OR] 3.2; 95% CI: 1.15-8.59) in the Jamunapari breed than Black Bengals. Significantly higher odds of PPR were observed in winter (OR 1.6; 95% CI: 1.06-2.14) and the monsoon season (OR 1.5; 95% CI: 1.04-2.11) compared with the post-monsoon season. Two significant (p < .05) space-time clusters were identified between 2 December 2006 and 6 September 2007 (two locations) and 28 November 2006 and 13 February 2007 (five locations). Peste des Petits Ruminants is endemic in Bangladesh, but also occurs as discrete outbreaks. Control efforts-such as vaccination-should focus on high-risk groups (4-24 months of age, Jamunapari breed), prior to the onset of winter and the monsoon season so as to increase immunity during high-risk periods, and focus on disease hotspots.

A Retrospective Histopathological Study on Extra-pulmonary Tuberculosis in Mymensingh

Tuberculosis is a very common disease in our country. This retrospective histopathological study was designed to assess the distribution of extra-pulmonary tuberculosis (EPTB) in various organs through examination of biopsy specimens. A total of 216 specimens were diagnosed as tubercular lesion by histopathological evaluation in the Department of pathology, Community Based Medical College and a private laboratory during the period from January 2014 to December 2014. Mean age of the case was 32 years. Majority of the cases were female (126 out of 216). Lymph nodes were the most common site of EPTB (62.96%) followed by skin and subcutaneous tissue (17.59%), intestine (11.11%), breast (2.77%), female genital tract (2.31%), male genital tract (1.38%), bone and joint (1.85%). Out of 136 cases of tubercular lymphadenitis, 96(70.58%) were cervical, 18(13.23%) were axillary, 12(3.82%) were mesenteric and 10(7.35%) were inguinal. This study reveals, in our locality, EPTB is very common in adulthood with female preponderance. Cervical lymph node is very common sites for EPTB.

Study on Neurological Consequence of Eclampsia

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

Outcome of Endoscopic Sinus Surgery in the Treatment of Chronic Rhinosinusitis

This prospective study was conducted to compare the outcome of endoscopic sinus surgery (ESS) using SNOT-20 score chart (subjective) and Lund & Kennedy scoring chart (objective) and carried out in the Department of Otolaryngology & Head-Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Dhaka Medical College Hospital (DMCH) & Shaheed Suhrawardy Medical College Hospital (ShSMCH) from July 2010 to March 2012. Total 73 admitted cases were selected purposively for ESS, male 53(72.60%) and female 20(27.40%). Among the study participants 10(13.7%) had chronic rhinosinusitis with bilateral polyposis and 26(35.62%) had chronic rhinosinusitis with unilateral polyposis and 12(16.44%) had bilateral chronic rhinosinusitis without polyposis and 25(34.25%) had unilateral chronic rhinosinusitis without polyposis. Surgical procedures done among the patients were Uncinectomy (infundibulectomy), Middle Meatal Antrostomy; Anterior Ethmoidectomy; Sphenoidotomy, Associated septoplasty and no significant per or post operative complications were noted. In Chronic rhinosinusitis (CRS) with polyposis pre operative SNOT-20 mean and SD 1.322±0.341 and post ESS snot-20 mean and SD 0.3472±0.0755, CRS without polyposis pre operative SNOT-20 mean and SD 0.9297±0.86 and post ESS SNOT-20 mean and SD 1986±0.0558. In CRS with polyposis pre operative Lund & Kennedy score of endoscopic assessment, mean and SD 5.333±2.255 and post ESS mean and SD 1.31±1.009. In CRS without polyposis pre op Lund & Kennedy score mean and SD 3.108±1.074 and post ESS mean and SD 0.76±0.641.Post ESS SNOT-20 in CRS with Polyposis, 't' test result was 27.58 which was significant (p<0.001) and in CRS without Polyposis was 21.622 which was significant (p<0.001); Lund & Kennedy Score of post ESS in CRS with Polyposis 't' test result was 7.763 which was significant (p<0.001), CRS without Polyposis was 7.177 which was significant (p<0.001).This implies that outcome of ESS in treatment of CRS with or without polyposis had statistically significant role. Symptomatic relief and quality of life improvement after ESS was compared by improvement in post operative scores of SNOT-20 & Lund-Kennedy score of endoscopic assessment. Post operative lower values were considered to be better improvement status. The results of the study suggests that ESS performed in Chronic Rhinosinusitis without Polyposis cases, relief of symptoms and quality of life improved was better than Chronic Rhinosinusitis with Polyposis cases postoperatively as compared by SNOT-20 and Lund & Kennedy score of endoscopic assessment.

Prognostic Role of Multiple Cardiac Biomarkers in Newly Diagnosed Acute Coronary Syndrome Patients

Acute coronary syndrome includes unstable angina and myocardial infarction with or without ST-segment elevation, is life-threatening disorders that remain a source of high morbidity and mortality despite advances in treatment. The aim of the study was to evaluate the prognostic role of serum cTnI, CK-MB, hsCRP, MPO and BNP in newly diagnosed acute coronary syndrome patients. This cohort study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University in cooperation with the Department of Cardiology, BSMMU and NICVD during the period of March 2013 to February 2014. A total 100 newly diagnosed acute coronary syndrome patients were purposively enrolled in this study within 24 hours of attacked, among them 30 were NSTEMI, 65 were STEMI and 5 were unstable angina. Serum cTnI, CK-MB, hsCRP, MPO and BNP concentrations were measured at enrollment and grouping of the study subjects were done on the basis of their empirical cut off values into two groups. In cTnI: Group I (n=20) having cTnI <4ng/ml and Group II (n=80) having cTnI ≥4ng/ml. In CK-MB: Group I (n=18) having CK-MB <10ng/ml and Group II (n= 82) having CK-MB ≥10ng/ml. In hsCRP: Group I (n=36) having hsCRP <5mg/L and Group II (n=64) having hsCRP ≥5mg/L. In MPO: Group I (n=30) having MPO <285.5pmol/L and Group II (n=70) having MPO ≥285.5pmol/L. In BNP: Group I (n=26) having BNP <135pg/ml and Group II (n=74) having BNP ≥135pg/ml. All the study subjects were treated and managed identically by standard management protocol and were followed up periodically up to three months from the onset of events during hospital stay and after discharge. Clinical outcomes of the study subjects such as good recovery, morbidity (recurrent ACS, heart failure, arrhythmia and revascularization) and mortality were evaluated with respect to their base line cTnI, CK-MB, hsCRP, MPO and BNP concentrations. Increased levels of base line cardiac biomarkers in Group II patients showed significantly high morbidity and mortality cTnI (p=0.044), CK-MB (p=0.045), hsCRP (p=0.009), MPO (p=0.003), and BNP (p=0.001) in compared to Group I. In relative risk ratio analysis showed significantly worse outcome in Group II acute coronary syndrome patients in comparison to Group I. In case of cTnI RR - 1.85 at 95% CI 1.19-2.88, in case of CK-MB RR- 1.88 at 95% CI 1.21-2.92, in case of hsCRP RR- 2.05 at 95% CI 1.30-3.25, in case of MPO RR- 2.59, at 95% CI 1.49-4.49, and in case of BNP RR- 3.47 at 95% CI 2.5-5.36. It was concluded from this study that base line serum cTnI, CK-MB, hsCRP, MPO, and BNP can be used clinically as prognostic biomarkers of acute coronary syndrome.