Assessment of Primary Hemostasis by Platelet Function Analyzer-100 and its Relation with TSH and FT₄ Levels in Newly Diagnosed Overt and Subclinical Hypothyroid Patients

Various abnormalities of coagulation such as primary hemostasis, secondary hemostasis and fibrinolysis have been reported in patients with subclinical and overt hypothyroidism. Platelets are major elements of primary hemostasis and endothelial repair. Platelet size, shape and number are the determinant of platelet function. The objective of this study was to assess primary hemostasis by PFA-100 (Platelet Function Analyzer-100) and its relation with TSH and FT₄ levels in newly diagnosed overt and subclinical hypothyroid patients. This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Bangladesh from January 2016 to December 2016. Twenty overt and 20 subclinical hypothyroid patients with age ranging from 18 to 55 years were selected as study group and twenty age and sex matched healthy subjects were considered as control group. Patients were selected from Outpatients Department of Endocrinology and Nuclear Medicine & Allied Sciences of Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. For assessment of primary hemostasis, PFA-100 was analyzed by SIEMENS-INNOVANCE-PFA-200. For statistical analysis Unpaired Student's 't' test, Chi square test and Pearson's correlation co-efficient (r) test were performed. PFA-100 was significantly higher (p<0.001) in overt and subclinical hypothyroid patients as compared to healthy adult subjects. In overt and subclinical hypothyroidism using PFA-100, we found that the existence of a hypocoagulable state is due to a defect in primary hemostasis. Moreover, PFA-100 may replace the in-vivo bleeding time as a screening test for primary hemostasis in routine clinical practice.

Risk factors associated with elevated intraocular pressure: a population-based study in a rural community of Bangladesh

OBJECTIVE

High intraocular pressure (IOP) is one of the major modifiable risk factors for glaucoma. The objective was to examine socio-demographic and clinical factors related to IOP.

METHODS AND ANALYSIS

This study was conducted among 3097 adults residing in a rural area of Bangladesh, with all participants undergoing clinical and ophthalmological evaluations. The measurement of IOP was carried out using of a rebound Tonometer called Icare pro. Multiple logistic regression analysis was employed to identify variables associated to IOP levels of 21 mm Hg or above. Adjusted OR (aOR) and 95% CI were reported.

RESULTS

This study found that, in total, 9% of the study population had high IOP in one or both eyes. Elevated IOP was significantly associated with respondents who were service holders (aOR 2.52; 95% CI 1.48 to 4.31), had a lower education level (aOR 1.55, 95% CI 1.07 to 2.23), used biomass fuel (aOR 2.00; 95% CI 1.09 to 3.67), belonged to a higher socioeconomic position (aOR 1.55, 95% CI 1.07 to 2.23) and had obesity (aOR 2.00; 95% CI 1.07 to 3.73), hypertension (aOR 1.32; 95% CI 1.01 to 1.73) or history of diabetes (aOR 2.44; 95% CI 1.67 to 3.55), after adjusting for covariates including age, sex, marital status, light source and tobacco consumption, in a multiple regression analysis.

CONCLUSION

Chronic diseases, such as hypertension and diabetes, obesity and sociodemographic characteristics such as high socioeconomic status and use of biomass fuels, have all been linked to elevated IOP. Patients with chronic diseases should undergo for IOP testing regularly.

Assisted reproductive technologies (ARTs) in Mithun (Bos frontalis): What progress has been made so far? An overview

Mithun, a unique bovine species, endemic to parts of North East India and plays an important role in the socioeconomic, cultural and religious fabrics of the local tribal population. To date, Mithuns are reared in a traditional free-range system by communities and increased deforestation, agricultural commercialization, disease outbreaks and indiscriminate slaughtering of elite Mithun for table purposes have significantly decreased its habitat and the elite Mithun population. Greater genetic gain is achieved with the implementation and effective use of assisted reproductive technologies (ARTs); however, presently it is limited to organized Mithun farms. At a slow pace, Mithun farmers are adopting semi-intensive rearing systems and interest in the use of ARTs is gradually escalating in Mithun husbandry. This article reviews the current status of ARTs such as semen collection and cryopreservation, estrus synchronization and timed artificial insemination (TAI), multiple ovulation and embryo transfer and in vitro embryo production and future perspectives in Mithun. Mithun semen collection and cryopreservation have been standardized, and estrus synchronization and TAI are suitable technologies that can be easily implemented under field conditions in near future. The establishment of an open nucleus-breeding system under community participatory mode along with the introduction of the ARTs is an alternative to the traditional breeding system for rapid genetic improvement of Mithun. Finally, the review considers the potential benefits of ARTs in Mithun and future research should include the use of these ARTs which will provide additional opportunities for improved breeding regimens in Mithun.

Relationship between Cholesterol Level and Spontaneous Intracerebral Hemorrhage: A Case-Control Study in Bangladesh

Spontaneous intracerebral hemorrhage is one of the leading causes of mortality and morbidity. Genetic factors play an important role in this disease. Among the non-genetic causes cholesterol level is one of the risk factors. The aim of the study was to evaluate the association between ICH (Intracerebral hemorrhage) and cholesterol level as well as to find out the risk of total cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL) and Low-density lipoprotein (LDL) for the disease. This was a case-control retrospective study with 60 cases and 60 controls. The study place was in the Neurosurgery department of Sylhet Women's Medical College Hospital and the study period was 2 years (from January 2020 to December 2021). The mean age ±SD of the cases was 57.08±9.47 years and the highest number of participants was in the 51-60 year group. Commonest location of ICH was deep (67.0%) followed by intraventricular hemorrhage (IVH) (28.3%) and lobar (5.0%). The means of TC (p=0.0004), TG (p=0.00013) and LDL (p<0.00001) were significantly lower than those of control group. The mean of HDL (36.48) of cases was significantly (p=0.00003) higher than the mean HDL (28.9) of controls. TC participants had 52.0% less risk to develop ICH. Raised TG had 46.0% and raised LDL had 52.0% lower risk of ICH.

Admission Plasma Glucose as In-Hospital Outcome Predictor in First Attack of Non-ST Segment Elevation Myocardial Infarction in Non Diabetic Patient

Coronary artery disease is the leading cause of death and disability globally. The presentation of Non-ST segment elevation myocardial infarction (NSTEMI) is heterogeneous, with different risk levels in terms of death, infarction and recurrence of infarction. Current evidence suggests that plasma glucose level or hyperglycemia is a mediator of worse prognosis of MI. The objective of the study was to correlate on admission plasma glucose level in non-diabetic patient with in-hospital outcome of patients after first attack of NSTEMI. This prospective analytical study was conducted among purposively selected 280 patients with NSTEMI admitted in coronary care unit of Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Data were collected from the informant by face to face interview, clinical examination and investigations using a pretested semi-structured case record form. Data were analyzed by SPSS. Patients were categorized into two groups; Group A: NSTEMI with admission plasma glucose level below 7.8mmol/l, (n=150, Male-110, Female-40). Group B: NSTEMI with admission plasma glucose level ≥7.8mmol/l, (n=130, Male-95, Female-35). Group B (n=130) is divided into two subgroups. Subgroup-I: NSTEMI with Hyperglycemia (7.8-9.3mmol/l), n = 67 (male 44, female 23), Subgroup-II: NSTEMI with Hyperglycemia (≥9.4mmol/l), n = 63 (male 51, female 12). All Patients were non diabetic excluded by HbA₁c. The mean left ventricular ejection fraction (LVEF) of Group B, Subgroup-II was significantly less than that of Subgroup-I (p<0.05). Correlation between LVEF levels and on admission plasma glucose level showed statistically significant moderate negative correlation, suggesting that the higher was the level of on admission plasma glucose level; the lower was the LV ejection fraction level in first attack of NSTEMI patients. Correlation coefficient between Troponin-I and plasma glucose level on admission of the study population (r=0.030) suggesting that the higher was the level of admission plasma glucose level the higher was the Troponin-I level in first attack of NSTEMI patients. The more was the plasma glucose level, less was LVEF, more was the heart failure and prolonged hospital stay. The study showed a strong predictor of adverse in-hospital outcome in the various levels of plasma glucose and NSTEMI. There was association between the concentration of the plasma glucose and the extent, severity of disease in the means of mean LVEF, the rate of heart failure and duration of hospital stay. The importance of this finding is even clear that RBS is a standard, valuable diagnostic tool for evaluation of severity and prediction of outcome of patients with NSTEMI.

Linseed oil in boar's diet during high temperature humidity index (THI) period improves sperm quality characteristics, antioxidant status and fatty acid composition of sperm under hot humid sub-tropical climate

Environmental heat stress in sub-tropical climates negatively impacts boar semen production and its quality. The present study aimed to examine the heat stress alleviating effects of dietary linseed oil on semen quality and antioxidant status of boar, in the summer and winter seasons in sub-tropical climate. Six Hampshire crossbreed boars were fed with 90 mL linseed oil (treatment) whereas six boars of the same breed were fed 90 mL vegetable oil (control) for sixteen weeks during both season. Sperm quality was assessed for motility, viability, abnormality, acrosomal integrity, and Hypo-osmotic swelling test (HOST). Sperm velocity attributes were assessed by computer-assisted semen analysis (CASA). Antioxidants (glutathione peroxidase; GPx, catalase; CAT, total antioxidant capacity; TAC and nitric oxide; NO) and lipid peroxidation (malondialdehyde; MDA) were measured in seminal plasma and serum. Gas chromatography-mass spectrometry (GC-MS) was used for the estimation of fatty acid composition of seminal plasma and spermatozoa. Feeding linseed oil to the boars significantly (p < 0.05) improved sperm quality at the fresh stage and after 72 h of liquid storage in both season. There was a significant (p < 0.01) effect of treatment and season on semen quality parameters. Significant boar (p < 0.05) effect was recorded on reaction time, semen volume, sperm abnormality, acrosomal integrity and HOST reactive sperm. There was a significant (p < 0.01) effect of treatment and season on the velocity attributes viz. VAP, VSL, VCL, ALH, BCF and STR%. Linseed oil supplementation significantly (p < 0.01) enhanced antioxidant and lowered MDA levels in serum as well as seminal plasma. The concentration of alpha-linolenic (ALA), arachidonic and docosahexaenoic (DHA) fatty acids were significantly (p < 0.01) increased in seminal plasma and sperm after linseed oil supplementation. In conclusion, linseed oil supplementation to boar during high THI months improved the semen quality parameters viz. semen volume, sperm concentration, and progressive motile sperm, along with enhanced antioxidant capacity.

Case-Control Study to Evaluate Zinc Deficiency as a Risk Factor for Oxygen Requirement in Patients with COVID-19

Zinc is one of the important trace elements of blood. It helps in maturation of immune system in our body. In the past studies originate the relationship between viral disease and serum zinc deficiency. This was a multicenter case-control study to measure the serum zinc level of COVID-19 patients with different respiratory supports and to evaluate the Odds Ratio (OR) and Relative risk (RR) of zinc deficiency for oxygen requirement for COVID-19 patients. Study places were COVID-19 unit of three tertiary hospitals of Sylhet, a Northern district of Bangladesh. There were 30 controls and 90 cases in this study. The mean zinc level of cases (53-38mcg/dl) was significantly (p=0.000072) lower than the level of controls (73-23mcg/dl). The mean zinc level of the COVID-19 patients required oxygen (49-33mcg/dl) was significantly (p=0.0054) lower than the patients were not treated by oxygen therapy (64-51mcg/dl). The RR of getting affected by COVID-19 was 1-91 for the low zinc level people. Among the COVID-19 affected participants the lower zinc level people had a RR of 1-93 to receive oxygen supplementation. Lower zinc level people are more likely to be affected by COVID-19 in comparison to the normal zinc level people. Among the COVID-19 patients the lower zinc level people had nearly double (RR 1-93) risk of becoming hypoxic and eventually prone for oxygen support.

Standardization of in vitro micropropagation procedure of Oriental Lilium Hybrid Cv. 'Ravenna'

Micropropagation protocol of Oriental Hybrid Lilium cv. Ravenna was developed using bulb scale segments (Basal and Tip) as explants. Surface sterilization of healthy bulb scales with carbendazim 200 ppm for 30 min, then 0.1 percent mercuric chloride for 10 min, then 70% ethyl alcohol for 30 s was superior to all other treatments in recording highest culture asepsis (77.08%) and higher explant survival (86.12%). Explant survival was higher in basal segments (88.54%) compared to tip segments (85.52%). Highest culture establishment was recorded in basal scale segments (68.26%) followed by tip scale segments (55.21%). MS medium augmented with 0.50 mgl⁻¹ Naphthalene acetic acid and 2.0 mgl⁻¹. 6-Benzylamino Purine recorded maximum culture establishment (76.17%), highest bulblet number/explant (5.52) with maximum length of shoots (2.20 cm) and number of leaves (3.39). This treatment combination of growth regulators resulted in highest shoot proliferation (83.33%) along with maximum shoot number (2.41explant⁻¹), shoot length (2.35 cm) and leaf number (5.44) of micro shoots during proliferation stage. Rooting of explants was superior with Indole-3-butyric acid compared to Naphthalene acetic acid. Highest rooting of 92.71% along with maximum number of primary roots shoot⁻¹ (12.06), maximum primary root length (3.17 cm) was documented in Murashige and Skoog medium added with Indole-3-butyric acid 1.50 mgl⁻¹ with best ex vitro survival rate (98.96%) of rooted plantlets during primary hardening in perlite + vermiculite (1:1) mixture.

Insilco identification and characterization of superoxide dismutase gene family in Brassica rapa

Superoxide Dismutase SODs are defense associated proteins that detoxify ROS and primarily serve as scavengers. They have been described in numerous plant species, but their in-depth characterization in Brassica rapa has not been reported. Therefore, the present investigation on genome wide study of SOD gene family was conducted to identify BrSOD genes, their domain-based organization, gene structure analysis, phylogenetic analysis, intron-exon structure of genes and expression analysis. The sequence characterization of Super oxide dismutase gene family in Brassica rapa, their syntenic associateship of conserved motifs and phylogenetic correlationship, prediction of cis-elements and determing the expression analysis in distinct tissues namely plant callus, root, stem, leaf, flower, and silique under abiotic conditions have been analysed using different software’s. The study on SOD gene family identified 17 BrSOD genes which were grouped into eight BrCu-ZnSODs and nine BrFe-MnSODs domain-based organization. Furthermore, the conserved character of BrSODs were confirmed by intron-exon organisation, motif arrangements and domain architectural investigations. Expression analysis using RNA Sequence data of different developmental stages proclaimed that genes were manifested in all six tissues with an exception of BrCu-ZnSOD3, which was not manifested in roots; however, whose transcript was detected in all other tested tissues. The study has genome wide insight into the occurrence and functional specifications of BrSOD gene family in Brassica rapa that can be potentially utilized in breeding program for resilience to climate change and abiotic stresses tolerance Brassica variety.

Cross-Sectional Analytic Study to Compare the Efficacy Between of Clinical Skill Learning (CSL) and Multimedia Lecture as Teaching Tool in Case of Endotracheal Intubation

Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group.

Pandemic Now and Then: A Historical Perspective of Non-Pharmaceutical Interventions Adopted In Covid-19

The coronavirus disease 2019 (COVID-19), first reported in Wuhan, China is now a major global health threat - a pandemic. Public health control measures are the cornerstones in the fight against COVID-19 in the absence of an effective vaccine or proven treatment. The aim of this review was to explore the historical use case of various public health measures adopted today to tackle COVID-19 spread. Although our knowledge about this novel coronavirus transmission is evolving over time, the fundamental non-pharmaceutical interventions e.g., handwashing, wearing a mask, physical distancing, isolation, quarantine and border control which are adopted globally at present are not new. This review highlighted that historically and religiously similar approaches were practised in the medieval past for controlling disease outbreaks. The successful implementation of the public health control measures largely depends on health systems resilience, community engagement and changes in population behaviour. Combined global efforts are essential to strengthen health systems, improve the capability of research and transparent information sharing with both public and international bodies to combat the pandemic.

Measuring Sensitivity, Specificity and Accuracy of HRCT of Chest and Comparison with Biomarkers in COVID-19 Suspected Patients: A Cross Sectional Study

COVID-19 is a declared pandemic by World Health Organization. The diagnostic tests are not of high specificity and sensitivity, so far. Pro-inflammatory biomarkers and High Resolution Computed Tomography (HRCT) of chest are the common investigations performed to evaluate the diagnosis and prognosis of COVID-19. The objective of this study was to estimate the sensitivity, specificity and accuracy of HRCT and to find out the relationship between the biomarkers and HRCT findings. This was a cross-sectional descriptive study carried out in the COVID-19 suspected isolation unit of a tertiary hospital from July 2020 to November of 2020. Data were collected from electronic medical record (EMR). Relationship test were done by t-test and one-way-ANOVA test. Total 123 cases were enrolled after matching with selection criterion. Mean age of male was 62.5 years and female 57.7 years. Highest frequency of participants was observed in the 60-69 year age group. According to HRCT% findings 4 groups were made. They are below 25%, 25%-50%, 51%-75% and 76%-100%. The distribution of case among these groups was 15%, 44%, 35% and 6% respectively. The relationship between biomarkers (NLR, D-dimer, Ferritin and CRP) and HRCT% was found significant (p<0.05). In HRCT 92.5% lesion were peripherally placed and 99.2% cases were affected by both lungs. The sensitivity and specificity of HRCT were found 46% and 72.6% respectively with 62% accuracy. Raised biomarkers are significantly related to the more lung involvement in case of COVID-19 suspected pneumonia patients. These biomarkers will be helpful as diagnostic and prognostic markers for this disease. HRCT percentage can play an important role as diagnostic and prognostic tool in case of COVID-19 suspected cases.

Daily and seasonal rhythmic secretary pattern of endocrinological profiles in mithun bull

Mithun (Bos frontalis) is a unique domestic free-range bovine species available in North Eastern hilly (NEH) regions of India and is reared for its protein rich meat. Mithun suffers severe non-cyclical population fluctuations; however, it is not yet declared as endangered species. Mithun follows some sort of seasonality based on the calving trend and semen production, although it is a perennial breeder. However, there is need to study the rhythmic changes of endocrine profiles to understand the hormone flow pattern in mithun to select the suitable time for blood collection to assess the exact endocrine profiles and to select the suitable time for natural breeding or semen collection by artificial methods for further research, conservation and propagation of its germplasm. Therefore, the present study was designed to evaluate the reproductive as well as metabolic endocrinological profiles in 24:00 h in intact adult mithun bulls during different seasons (winter, spring, summer and autumn) to know the rhythmic changes and flow pattern of the endocrinological profiles to improve its reproductive efficiency. Experimental mithun bulls (n = 6; age: 5-6 years; body condition score: 5-6 out of 10, classified as good) were selected for the study. Endocrinological profiles, follicle stimulating hormone (FSH), luteinizing hormone/interstitial cell stimulating hormone (LH/ICSH), testosterone, cortisol, thyroxine (T4), insulin like growth factor-1 (IGF-1), prolactin and melatonin (MT) were estimated at 04:00 h interval for one whole day in four seasons. The analysis was completed in two different ways as different times of collection (08:00, 12:00, 16:00, 20:00, 24:00 and 04:00 h) and day (08:00 to 16:00 h) & night time (20:00 to 04:00 h) collections. Repeated measures ANOVA analysis revealed that the bulls in winter and spring had significantly (p < 0.05) higher FSH, LH, testosterone, T4, IGF-1 and MT than those in summer whereas the bulls in summer had significantly higher cortisol and prolactin than those in winter and spring seasons. Similarly FSH, LH, testosterone, T4, IGF-1 and MT were significantly (p < 0.05) higher in night than in day time collections whereas cortisol and prolactin were significantly (p < 0.05) higher in day than in night time collections in different seasons. Correlation analysis revealed that FSH, LH, testosterone, T4, IGF-1 and MT had significant (p < 0.05) positive correlation with each other whereas these had significant (p < 0.05) negative correlation with cortisol and prolactin. The study concludes that season and time of blood collection had significant effect on the endocrinological profiles in mithun bulls. Estimation of FSH, LH, testosterone, T4, IGF-1 and MT during night time and cortisol and prolactin during day time was more appropriate to get correct value of the endocrinological profiles. Spring and winter have significantly greater beneficial effects than summer on reproduction and artificial breeding programs in mithun species in the semi-intensive management in the present location.

Retroperitoneal Lymphangioma in Adult: A Case Report

Lymphangioma is a rare, benign tumour occurring due to congenital malformation of the lymphatic channels. It occurs due to obstruction in the lymphatic channel and results in lymphangiectasia. The tumour is most commonly encountered in the head and neck regions and almost 90% are in the children below the age of 2 years. Retroperitoneal Lymphangioma in an adult is a rare clinical condition. We have presented a 41 year old female with retroperitoneal lymphangioma who came to Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 10 October 2017 with the non-specific complains of upper abdominal discomfort, occasional nausea, vomiting and aorexia for the last 1.5 years. She was managed surgically by exploratory laparotomy followed by de-roofing of the cyst. Histopathological examination of the cyst wall was consistent with lymphangioma.

Dietary flaxseed oil improve boar semen quality, antioxidant status and in-vivo fertility in humid sub-tropical region of North East India

Environmental stress in the form of high temperature humidity index (THI) in tropical and sub-tropical region negatively affects semen quality and fertility of boar. Therefore, the present study was done to evaluate the effect of supplementing flaxseed oil (FLO) to boar's diet on its semen quality, antioxidant status, fatty acid composition of seminal plasma and fertility under sub-tropical climate. For this purpose, six Hampshire crossbreed (50% Hampshire and 50% Gunghroo) boars were divided into two groups i.e control (CON) and treatment (FLO). In FLO and CON group, flaxseed and vegetable oil, respectively, was top dressed at the rate of 3% in basal diets for each boar on daily basis for 16 weeks during monsoon season. A total of 60 ejaculates, comprising 30 ejaculates from each group (ten ejaculates from each boar) were collected. Semen samples were evaluated for sperm quality parameters (SQPs: motility, viability, abnormality, acrosomal integrity and Hypo-osmotic swelling test) and velocity attributes by computer assisted semen analysis (CASA) at fresh and after 72 h of preservation at 17 °C. Antioxidant (glutathione peroxidase; GPx, catalase; CAT, total antioxidant capacity; TAC and malondialdehyde; MDA) were analyzed in seminal plasma and serum. Fatty acid compositions of seminal plasma were analyzed by gas chromatography-mass spectrometry (GC-MS). In-vivo fertility study was also conducted. Reaction time and false mounts were significantly (p < 0.05) reduced in FLO group as compared to CON group. Semen quality parameters were significantly (p < 0.05) improved at fresh stage and after 72 h of liquid storage in FLO group as compared to CON group. Velocity attributes (VAP, VSL, VCL, ALH, BCF and LIN) were significantly (p < 0.05) higher in FLO group. Flaxseed oil supplementation significantly (p < 0.01) enhanced serum GPx and CAT concentration. Serum and seminal plasma MDA concentration decreased significantly (p < 0.01) in FLO group. Similarly, GPx, TAC and CAT were significantly (p < 0.01) elevated in seminal plasma of FLO group. The study revealed that feeding of flaxseed oil altered the fatty acid composition of seminal plasma and significantly (p < 0.05) improved the farrowing rate. In summary, flaxseed oil supplementation improved the semen quality parameters and fertility of boars in sub-tropical climate by improving the antioxidant capacity and altering the fatty acid composition of seminal plasma.

Role of Laparoscopic Appendicectomy in the Treatment of Acute Appendicitis and Its Complications

The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of acute appendicitis and its complications. The study was conducted between January 2011 to February 2019 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and some private hospitals of Dhaka, Bangladesh. A total of 641 patients who presented with acute appendicitis and its complications were treated by laparoscopic method. Around 70% (449) patients had classical presentation, 20% (128) were atypical and 10% (64) were recurrent or chronic presentation. Maximum (527, 82%) came with acute appendicitis. Eighty eight (13.72%) patients had burst (perforated) appendicitis, 12(1.87%) patients had appendicular abscess, 11(1.71%) showed early appendicular lump, 2(0.4%) had stump appendicitis and 1(0.2%) had previous laparoscopic clip control of stump. Energy source was unipolar diathermy. Intracorporeal knotting, endoloop and haemoclip were used for haemostosis and ligation of appendicular stump. Mean duration of surgery was 20minutes and mean hospital stay was 36 hours. Histopathological patterns were acute appendicitis (554, 86.42%), gangrenous appendicitis (58, 9.04%), catarrhal (13, 2.02%), chronic appendicitis (10, 1.56%) lymphoid hyperplasia (6, 0.93%) and carcinoid tumor (1, 0.15%), among the complications (25) were single or multiple port infections, port TB, paralytic ileus and diarrhea. Conversion was 1(0.15%) for controlling haemorrhage of burst appendicitis. The rest of the patients recovered quickly and uneventfully. In conclusion, it can be stated that laparoscopic appendicectomy is safe, convenient and achievable and can become the gold standard of management of acute appendicitis and its complications.

Evaluation of Preoperative Ultrasonography in Gall Stone Disease to Predict Technical Difficulties during Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. This study was carried out to determine the technical difficulties that can be encountered during laparoscopic cholecystectomy and to evaluate the role of ultrasonography in identifying patients at risk of conversion returning to open surgery. The objective of this study was to evaluate the efficacy of preoperative ultrasonography in assessing technical difficulty faced during laparoscopic cholecystectomy in gallstone disease. This was an observational comparative study which was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh from January 2016 to January 2017. A purposive sampling method was applied to select the study sample. A total of 160 patients were included this study. Data processing and analysis were done using SPSS (statistical package for social sciences), version 20. The summarized data were presented in the form of figures and tables with due statistical interpretation. In this study, there was a total of 160 cases, among which 90(56.25%) turned out to have undergone normal laparoscopic cholecystectomies. Seventy (43.75%) were difficult, among which 6(3.75%) were converted to open cholecystectomies. Among 160 patients, 120(75%) were female and 40(25%) were male. There is a total of 136/160 (85%) patients with gallbladder wall thickness <3mm and 24/160 (15%) patients >3mm. Among the 136 patients with gallbladder wall thickness <3mm, there was difficulty in holding the gallbladder in 28(25%) cases, 28(20.6%) had undergone gallbladder perforation, 32(23.5%) had undergone moderate bleeding and only 2(1.5%) had undergone severe bleeding. Among the 24 patients with gallbladder wall thickness >3mm, there was difficulty in holding the gallbladder in 22(91.7%) cases, 18(75%) had undergone gallbladder perforation, 18(75%) had undergone moderate bleeding and only 2(8.33%) had undergone severe bleeding. It shows a total of 124/160 (77.5%) patients with normal gall bladder, 26/160 (16.25%) patients with contracted gallbladder and 10/160 (6.25%) patients with distended gallbladder. Among the 124 patients with normal gallbladder, 16(12.9%) had undergone difficult Calot's dissection, 26(21%) had undergone difficult gallbladder bed dissection, 26(21%) had undergone moderate bleeding and none had undergone severe bleeding. Among 26 patients with contracted gallbladder, 20(76.9%) underwent difficult Calot's dissection, 24(92.3%) had undergone difficult gallbladder bed dissection, 18(69.2%) had undergone moderate bleeding and 4(15.4%) had undergone severe bleeding. Among 10 patients with distended gallbladder, 4(40%) underwent difficult Calot's dissection, 6(60%) underwent difficult gallbladder bed dissection, 6(60%) had undergone moderate bleeding and none had undergone severe bleeding. From this study, we conclude that preoperative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Correlation of Troponin-I Level with Left Ventricular Ejection Fraction and In-hospital outcomes after First Attack of Non-ST Segment Elevation Myocardial Infarction

Coronary heart disease (CHD) is the most common cause of heart disease and is the single most important cause of premature death in developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has been shown to be a very sensitive and specific marker for acute myocardial infarction (AMI). Ventricular function is the best predictor of death after an acute coronary syndrome. It serves as a marker of myocardial damage, provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of elevated Troponin-I level on LV ejection fraction and in-hospital outcomes in patients with first attack of Non ST-segment Elevation Myocardial Infarction (NSTEMI). This prospective analytical study was conducted in the Department of Cardiology in Mymensingh Medical College Hospital from December 2015 to November 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I - Patients with first attack of NSTEMI with good LV function (LVEF: ≥55%). Group II - Patients with first attack of NSTEMI with LV systolic dysfunction (LVEF: <55%). Then Troponin-I and LVEF levels were correlated using Pearson's correlation coefficient test. In this study mean Troponin-I of Group I and Group II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). Echocardiography showed that patients with high Troponin-I level had low ejection fraction (LVEF) and patients with low Troponin-I level had preserved ejection fraction (LVEF). Analysis showed that patients with severe left ventricular systolic dysfunction (LVEF <35%) had the highest level of Troponin-I with worse in-hospital outcomes and vice versa-the patients with the preserved systolic function (LVEF ≥55%) had the lowest levels of Troponin-I with better in-hospital outcomes. In our study, it also showed that the levels of Troponin-I had negative correlation with LV ejection fraction levels, with medium strength of association (r= -0.5394, p=0.001). The study enabled us to conclude that, the higher was the Troponin-I level, the lower was the LV ejection fraction level and thus worse in-hospital outcomes in first attack of NSTEMI patients.

Primary Angioplasty for the Treatment of Acute ST Elevated Myocardial Infarction: Single Centre Experience

Worldwide primary angioplasty is a recommended strategy of reperfusion in patient with acute myocardial infarction as because it ensures reperfusion of the infarct-related vessels more than 90% whereas, with thrombolytics it is only 60-70%. This retrospective observational study includes all patients treated with primary angioplasty at United Hospital from Between March 2007 to January 2011. Total 114 consecutive patients with acute myocardial infarction were treated with primary angioplasty included. Those presented beyond 12 hours of onset of chest pain, in cardiogenic shock, resuscitate and intubated before the procedure were excluded from the study. Majority (89%) of the patient were male, age was minimum 30 years and maximum 90 years, 41.5% were diabetics, 58.4% were hypertensive, 43.5% were dyslipidaemic, 17% were smoker, 29.3% with positive family history. Fifty seven percent patients presented with anterior MI , 42 % with inferior MI and 1% with lateral MI. Left anterior descending (LAD) is the most common vessel involved (57%), followed by Right coronary artery (RCA) 31%, Left circumflex artery (LCX) 8 %, Ramus 1.3% and Graft vessel 2.7%. Our door to balloon time was minimum 23 min, maximum 184 min. We used drug eluting stents for most of the patients, GP IIb- IIIa receptor blockers used in 50% cases and thrombus suction device were used when indicated. We faced complications like arrhythmias in 24%, hypotension in18%, no flow or slow flow in 45%, cardiac arrest in 3% and coronary perforation in 1%. Our overall survival was 97.9%. Primary angioplasty is an emerging area in context of our country. Many of the new centers start this novel strategy which helps to save many lives Primary angioplasty is feasible and safe method of reperfusion in patient with acute myocardial infarction in our center. With the help of our initial experience we can perform PAMI with confidence to those who can afford and who need most.

Sonographically Detected Non Alcoholic Fatty Liver Disease in Apparently Healthy Adults and Associated Factors

This hospital-based study was done to see the prevalence of sonologically detected non alcoholic fatty liver disease and associated factors in the apparently healthy adults. Apparently healthy and non alcoholic companions of the patients visiting the Centre of Nuclear Medicine and Ultrasound, Sylhet were subjected to abdominal ultrasonography to see the presence of fatty liver. Demographic features and other relevant data were collected in a semi structured questionnaire to find out the associated factors for non alcoholic fatty liver disease (NAFLD). Total 1019 persons with mean age of 37.23 years were included in the study. Among them 703 (69%) were female and 316 (31%) were male. Out of them 189 (18.5%) persons had sonologically detectable nonalcoholic fatty liver disease. NAFLD was more prevalent in male than female (25.6% vs. 15.4%, p=0.000). In univariate analysis NAFLD were more in male (25.6%) 41-50 years age group (29.3%, p=0.000), over weight (32.3%)/obese subjects (51.4%), businessmen (24.0%), service holders (28.7%), high income group, diabetics (27.0% vs. 18.0%, p=0.000) and hypertensive subjects (43.3% vs. 15.24%, p=0.000). In multivariate analysis, BMI over 23kg/m² (OR 6.683, p=0.000), age >30 years (OR 1.787, p=0.006) and higher income (OR 1.788, 95% CI 0.970-3.293) were independent factors associated with NAFLD. Sonologically detected nonalcoholic fatty liver disease (18.5%) is common in our apparently healthy adults. BMI over 23kg/m² was the most important predictor for NAFLD.

Experience of Percutaneous Versus Surgically Placed Catheter for Continuous Ambulatory Peritoneal Dialysis in Children with Chronic Kidney Disease Stage-V

The lifespan and outcome of end stage renal disease (ESRD) children have dramatically improved since the development of continuous ambulatory peritoneal dialysis (CAPD), it offers several advantages over hemodialysis. Percutaneous placement of CAPD catheters in children is minimally invasive, reliable, safe and cost-effective method. Percutaneous method of CAPD catheter insertion can be used in children to avoid the complications of general anesthesia and surgery. This study was done to evaluate the efficacy of CAPD in children, to find out the complication profile of CAPD & to compare the advantages of surgical versus percutaneously placed CAPD catheters in children. This prospective longitudinal comparative study was carried out in the department of Pediatric Nephrology, Dhaka Medical College Hospital (DMCH), Bangladesh from July 2011 to June 2014. A total of 8 children with ESRD were included (Age 5-14 year, M: F=1: 1). All underwent CAPD, Group I = surgically placed CAPD catheter (N=5), Group II = percutaneously placed CAPD catheter (N=3). Average duration of CAPD in Group I and Group II were 31.6 vs. 9 (months) with a total of 158 vs. 27 patient months of CAPD respectively. The rate of complications of the 2 groups and their outcome were compared. Common complications being observed were peritonitis 1 episode per 12.1 vs. 1.8 patient months (p<0.001), catheter obstruction by omental capture 1 vs. 3 in Group I and Group II respectively. Catheter tip dislocation was commonly found in all Group II children (p<0.01) and all needed laparotomy and omentectomy. Three out of 5 in Group I is still on CAPD, 1 transferred to HD and another 1 expired due to uncontrolled hypertension with congestive heart failure. Among 3 of Group II, 2 died of repeated peritonitis and hypertensive complications and rest 1 is transferred to HD after 1year due to exit site fluid leaking. Satisfactory level of improvement of mean weight, mean serum albumin and declining of serum creatinine in both groups has been found after CAPD. Although CAPD is an effective modality of renal replacement therapy for children, but percutaneous method of catheter insertion is associated with higher rate of complications. Placement of catheter by surgical method with elective omentectomy will reduce catheter related complications. Early detection of peritonitis and prompt therapy is essential for a favourable outcome.

Reproductive disorders in dairy cattle under semi-intensive system of rearing in North-Eastern India

Aim:

This study was conducted to determine the incidence of major reproductive problems of dairy cattle reared under a semi-intensive system by small and marginal farmers in Meghalaya province of North-Eastern India.

Materials and Methods:

In a 3 years study, a total of 576 crossbred dairy cattle (212 Holstein Friesian cross and 364 Jersey cross) from all districts (n=11) of Meghalaya were assessed with the survey, clinical examination, and personal observations.

Results:

Out of the total animal assessed, 33.85% (n=195) were found to be affected with one or more of the clinical reproductive problems. Repeat breeding (RB), anestrus, retention of fetal membrane, and abortion were found to be the major clinical reproductive problems. Out of the total animal affected with reproductive disorders, the incidence of anestrus, RB, retention of fetal membrane, and abortion was found to be 31.79% (n=62), 24.61% (n=48), 14.35% (n=28), and 11.25% (n=22), respectively. In addition, dystocia (5.12%), prolapse (1.53%), endometritis (4.61%), and pyometra (6.66%) were minor clinical reproductive problems. There was a significant difference in the incidence of reproductive disorders with respect to breed, age, and parity.

Conclusion:

It was revealed from this study that RB, anestrus, retention of fetal membrane, and dystocia are the major clinical reproductive problems in Meghalaya. Results indicated unsatisfactory feeding, housing, and health management practices are the main cause of low fertility of dairy cows. Lack of scientific knowledge, low access to breeding, and health services further contributed to low productivity and fertility.

Factors Associated with Periodontal Disease in Pregnant Diabetic Women

There have been an association between systemic diseases and hormonal changes particularly diabetes which has been cited as a risk factor in the progression of periodontitis in pregnant women. The incidence and severity of periodontal diseases are increasing at a higher rate and a common condition in pregnant diabetic women among Bangladeshi population. This cross sectional study included 200 pregnant women who were selected from gynecological department and examined at the dental unit. The clinical parameters used were the Silness and Loe plaque index (PI), gingival scores and periodontal status and any relationship to socio demographic variables (age, occupation, level of education and urban or rural residence) and clinical variables (gestation period, previous pregnancy, type of diabetes and periodontal maintenance) were evaluated. The results showed that these clinical parameters increased concomitantly with an increase in the stage of pregnancy and in women with multiple pregnancies. Increased age, lower level of education, unemployment and patients residing in rural areas were associated with significantly higher gingival scores and periodontal measures. Women with increased age and multiple pregnancies usually have less interest to frequent periodontal maintenance showing a significant statistical relation between an increased age and changes in gingival and periodontal status; however no significant association was found between increased age and plaque index. It is concluded that gingival inflammatory symptoms are aggravated during pregnancy in diabetic women and are related to different clinical and demographic variables.

Comparison between Angiographic Findings of Coronary Artery Disease in STEMI and NSTEMI Patients of Bangladesh

Coronary Angiogram (CAG) has been used to detect coronary artery disease in myocardial infarction (both STEMI and NSTEMI) patients. The purpose of this study was to compare the degree of coronary artery disease among STEMI and NSTEMI patients. Among acute coronary syndrome in NSTEMI we found more widespread coronary artery disease other than STEMI. Lack of documentations encouraged us to perform this study in our center. In this retrospective observational study we summarized all myocardial infarction (MI) patients who underwent coronary angiography (CAG) from August 2013 to August 2014 at Enam Medical College Hospital, Dhaka, Bangladesh and data of degree of coronary artery disease were recorded. Data of 100 consecutive MI patients who underwent CAG during that period were recorded. Among them 50 patients having STEMI as Group I (male 45, female 5) & other 50 patients sustained NSTEMI as Group II (male 38, female 12). Among NSTEMI patient group 80% were having multi-vessel disease and in STEMI patient group 80% having single vessel disease and remaining having multi-vessel disease. The degree of coronary artery disease is extensive in NSTEMI patients than in STEMI group. Coronary angiogram can visualize the degree of coronary artery involvement and is a useful screening modality to compare disease extent in MI patients.

Morphometric Study of Nutrient Foramen in Adult Human Dry Left Humerus

The major blood supply to long bones occurs through the nutrient arteries, which enter through the nutrient foramen. The supply of nutrient artery starts during the early phases of ossification. It is essential in operative procedures such as bone graft, tumour resection, trauma healing and bone transplant techniques both in orthopedics and micro vascular surgery. The present study is an observational analytic type of study which was performed on two hundred (n=200; male=117 & female=83) left sided dry humerus bones. In this present study the majority of the bones had a single nutrient foramen which may represent a single source of blood supply. The location of the nutrient foramen is predominant on the antero-medial aspect of humerus. The position of the nutrient foramen is predominant on the middle 1/5th of the shaft humerus. There was no significant difference (p=0.319) in presence, absence, number, location and position of nutrient foramen in male and female left human humerus. This study and recorded data may help in surgical procedures in orthopedics and in micro vascular surgery.

Biomass Fuel Smoke and Tuberculosis: A Case-Control Study

This case control study was done to ascertain the association between exposures to biomass cooking fuel smoke and pulmonary tuberculosis. Cases were all newly diagnosed pulmonary tuberculosis patients, randomly collected from the Hospital (DOTS centers) Registry from January 2012 to June 2012 from two Upazillas of Sirajganj district, Bangladesh. A home visitation program was done subsequently. Healthy controls were recruited from the neighbourhood of each case through a predefined procedure. Total 276 new pulmonary tuberculosis cases and 276 neighbourhood controls were enrolled. A semi-structured questionnaire containing demographic information, smoking habits, cooking place, kitchen condition, use of biomass fuel for cooking was used for interview. Crude (unadjusted) odd ratios and their corresponding 95% confidence limits for independent variables were determined by binary logistic regression. All significant variables were entered into a multivariate conditional logistic regression model and a final fitted model was determined by backward elimination methods. In univariate analysis, member of a nuclear family {Unadjusted odd ratio (Unadj. OR) 1.570, 95% CI 1.008-2.44)}, having non-formal education (Unadj. OR 2.739, 95% CI 1.219, 6.153) or primary (Unadj. OR 3.407, 95% CI 1.492, 7.782) to secondary level (Unadj. OR 2.392, 95% CI 1.032, 5.544) education, using cow dung (Unadj. OR 3.961, 95% CI 1.267, 12.376) and biomass fuel i.e. plant origin (Unadj. OR 3.382, 95% CI 1.087, 10.518) for cooking, past smoker (Unadj. OR 2.504, 95% CI 1.061, 5.910), using open oven (Unadj. OR 3.109, 95% CI 0.995, 9.716), having small kitchen area (Unadj. OR 0.99, 95% CI 0.989, 0.999) all were significantly associated with tuberculosis. When all significant variables were entered into a multivariate conditional logistic regression model nuclear family {Adjusted odd ratio (Adj OR) 1.808, 95% CI 1.127, 2.9)}, primary level education (Adj OR 2.86, 95% CI 1.23, 6.647) and non formal education (Adj OR 2.312, 95% CI 1.013, 5.276), biomass fuel (plant origin, Adj OR 3.497, 95% CI 1.059, 11.55), and cow dung (Adj OR 4.368, 95% CI 1.319, 14.464)) used in cooking and irregular smoker (who stop smoking at least 6 month back) (Adj OR 2.806, 95% CI 1.141, 6.901) were significantly associated with tuberculosis cases. From this study significant association have been found between exposure to combustion of biomass cooking fuel and tuberculosis.

Patterns of Coronary Artery Anomalous Origin Reviewed by Coronary Angiogram in a Cardiac Center of Bangladesh

Coronary Angiogarm (CAG) has been used to detect coronary artery anomalies. This cross sectional observational study aimed to assess the prevalence of anomalous origin of the coronary artery in the Bangladeshi patients. The researchers summarized responses of the target patients who underwent coronary angiography (CAG) from August 2010 to March 2011 in United Hospital Ltd., Gulshan, Dhaka, Bangladesh and data of anomalous origin of the coronary artery in Bangladeshi patients were recorded. Eighteen hundred (1800) patients underwent CAG during that period; 66 patients with an anomalous origin of the coronary artery were detected, giving a prevalence of 3.6%. The prevalence of anomalous origin of the coronary artery in Bangladeshi people in this study is 3.6%. CAG can visualize the anomalous origin of the coronary artery and is a useful screening modality.

Ambras Syndrome: First Reported Case in Bangladesh and its Oral Rehabilitation

People with rare hypertrichosis syndromes became crowd-drawing money-making phenomena in many 19th century sideshow acts. These individuals have been referred to as dog-men, hair-men, and werewolves. In 1993, Baumister et al. described congenital hypertrichosis lanuginose or Ambras syndrome: a distinct form of congenital hypertrichosis characterized by excessive hair growth over the body and face associated with facial and occasional dental anomalies. Much is not known about this syndrome since fewer than 50 cases have been documented worldwide. In this case report, a nine year old girl presented with excessive hair growth throughout her body that was denser along her midline. Furthermore, her face displayed the typical dysmorphic features characteristic of Ambras syndrome: a round tip nose, thickened nasal cartilage, antiverted nares, prominent philtrum with deep groove, and a trapezoid mouth. Oral examination revealed normal oral mucosa with completely missing and unerupted decidious and permanent teeth. Panoramic radiographs confirmed unerupted deciduous teeth. Previous case reports have mentioned the presence of occasional dental anomalies such as retarded first and second dentition and absence of some teeth. However, this is the first reported case of Ambras syndrome presenting with complete anodontia. Prior cytogenetic studies performed on persons with Ambras syndrome have implicated a balanced pericentric inversion of chromosome 8. However, it is likely that dental anomalies are likely a result of a different genetic rearrangement. Further studies are needed to explore the cause of this rare phenotype of Ambras syndrome with complete unerupted dentition.

Morphometric Study of Fully Ossified Dry Head and Shaft of Left Human Humerus

Humerus is the largest bone of upper limb. Upper limb is the most movable part and main working tools of human body. This is a cross sectional, analytic type of study carried out in the department of Anatomy, Sir Salimullah Medical College (SSMC), Dhaka from July 2011 to Dec 2012. The present study was performed on two hundred (n=200; male=117 & female=83) left sided fully ossified dry humerus bones collected from Department of Anatomy and the medical students of 1st and 2nd year MBBS course of Sir Salimullah Medical College (SSMC), Dhaka and Dhaka National Medical College (DNMC), Dhaka. Morphometric study was carried out on all samples by direct physical method. There was statistically significant difference (p=0.001) between male and female bone in the diameter of the head and shaft of the left humerus. The present study was attempted to provide a morphometric base line data of fully ossified human left humerus.

Disability adjusted life years among arsenicosis patients in an arsenic-affected area of southern Bangladesh

Disability adjusted life years (DALY) is the sum of the present value of future years of lifetime lost through premature mortality, and the present value of years of future life-time adjusted for the average severity of any mental or physical disability caused by a disease or injury. As a method for estimating the global burden of disease, DALY was first introduced in the World Development Report in 1993 by the World Bank. The aim of this study was to estimate DALY among arsenicosis patients. DALY was calculated for 104 arsenicosis patients from an arsenic-affected rural area of southern Bangladesh using the estimated years they lived with disability (YLD). The mean (SD) of cumulative arsenic exposure level was 5.0 (3.2) mg/l-years. Among the patients, 64% reported reduction in working ability. The portion of the patients with disability for more than 50 years was as high as 58.7%. The mean (SD) of YLD and DALY was 54.0 (9.8) and 9.2 (1.5), respectively. A total of 5621 YLD equivalent to 961.7 DALY was lost due to arsenicosis (when life expectancy at birth according to Bangladesh Bureau of Statistics was applied, the YLD and DALY were 3899.2 and 868.9, respectively). There was significant relationship of YLD with education of the patients (p < 0.05). There was significant relationship between DALY and education of the patients (p < 0.05). There was also significant relationship between DALY and reduction in working ability of the patients (p < 0.05). The findings of the study justify for the policy makers to adopt adequate measures such as prevention, treatment and rehabilitation to alleviate the sufferings of the arsenicosis patients.Mediscope Vol. 2, No. 1: 2015, Pages 4-12

Prevalence and Risk Factors of Asymptomatic Gallstone Disease in North-East Part of Bangladesh

Background

The study was designed to assess the prevalence of asymptomatic gallstone disease in North-East part of Bangladesh.

Materials and methods

Randomly selected asymptomatic persons, unknown to have gallstone disease, from both rural and urban areas were enrolled. They were subjected to abdominal ultrasonography and findings were recorded in a data sheet.

Results

Total 1,019 persons (316 males and 703 females) were examined. Age of them varied from 18 to 80 years with mean age of 37.22 years. Out of them, 61 (6%) persons were found to have gallstone. Among them, 14 were males and 47 were females. Both male and females of age below 40 years were more affected. Gallstone disease was found more commonly among housewives and middle class people. Among 61 patients with gallstone, seven were underweight (11.47%), 32 (52.45%) had normal weight and 22 (36.06%) were overweight, obese or extremely obese. But, this difference was not statistically significant (p = 0.894).

Conclusion

Prevalence of asymptomatic gallstone disease was found in 6% apparently healthy subjects of North-East part of Bangladesh. It was more prevalent among housewives and middle class group of population. It is also common among the people of age group below 40 years.

How to cite this article

Saha M, Nahar K, Hosen MMA, Khan MH, Saha SK, Shil BC, Rahman MH. Prevalence and Risk Factors of Asymptomatic Gallstone Disease in North-East Part of Bangladesh. Euroasian J Hepato-Gastroenterol 2015;5(1):1-3.

A high risk critical mitral valve stenosis with emergency management at Apollo Hospitals Dhaka

Heart valve surgery in high-risk patients with severe jaundice, congestive hepatomegaly and renal impairment is associated with considerable morbidity and mortality. Without operation the consequences are invariably grave. A 35 years old gentleman with congestive cardiac failure was initially treated in coronary care unit (CCU). Mitral valve area was 0.5cm², pulmonary arterial systolic pressure (PASP) was 110mmHg, serum bilirubin was 20mg/dl, SGPT & SGOT were 1024iu/l and 1027iu/l respectively. Serum creatinine was 3.35mmol/l. Serum bilirubin gradually diminished to 3.1mg/dl after 12 days treatment in Coronary Care Unit but next day it increased to 3.6mg/dl. Mitral valve was replaced on an emergency basis. Echocardiogram on the 5th post operative day showed well functioning prosthetic mitral valve in situ. Serum bilirubin decreased to 2.2mg/dl, SGPT, SGOT and serum creatinine to 43iu/l, 40iu/l and 1.34mmol/l respectively. After 8 weeks of postoperative follow up his serum bilirubin decreased to 0.8mg/dl.

Immediate outcome of chronic total occlusion opening in post-angioplasty patients

The study sought to compare procedural outcomes for patients undergoing percutaneous coronary intervention (PCI) of a chronic total coronary artery occlusion (CTO) with a matched non-CTO cohort. Percutaneous coronary intervention of a CTO is a common occurrence, and the outcome for patients with successful PCI of a CTO has not been clearly defined. Between November 2006 and December 2010, a total of 2,000 consecutive patients consecutively underwent PCI for a CTO. Utilizing propensity scoring methods, a matched non-CTO cohort of 2,000 patients was identified and compared to the CTO group. The cohorts were stratified as successful and failed procedures in United Hospital Limited Dhaka. The in-hospital major adverse cardiac event (MACE) rate was 3.8% in the CTO cohort. Technical success has improved over the last 10 years (overall 74.4%, slope 1.0%/year, p=0.02, R²=49.9%) as did procedural success (overall 69.9%, slope 1.2%/year, p=0.02, R²=51.5%) without a concomitant increase in in-hospital MACE rates (slope 0.1%/year, p=0.7). There was a distinct advantage for successful CTO treatment compared with failed CTO treatment (73.5% vs. 65.1%, p=0.001). The CTO versus non-CTO survival was the same (71.2% vs. 71.4%, p=0.9). Diabetics in the CTO cohort had a lower survival compared with non-diabetics (58.3% vs. 74.3%, p=0.0001). These data represent outcome of PCI for a CTO. The 10-year survival rates for matched non-CTO and the CTO cohorts were similar. Success rates have continued to improve without an accompanying increase in MACE rates. A successfully revascularized CTO confers a significant survival advantage compared with failed revascularization.

Correlation between microalbuminuria with complexity of coronary artery disease in diabetic patients

The present studies found that microalbuminuria is predictive, independent of classical risk factor of cardiovascular diseases and all causes of mortality in diabetes or hypertension patient groups and in the general population. Coronary angiograms for extent of severe CAD (luminal narrowing 50%) in patients with Diabetes Mellitus (DM) and general population were examined. The study comprised 150 patients undergoing coronary angiography at United Hospital Limited, Dhaka, Bangladesh, (M/F 80/70, mean age 57±11 years). Urine albumin excretion was measured in 24 hours urine samples employing immune precipitation technique. Age-gender distribution of coronary risk factors and microalbuminuria were compared between patient with and without coronary artery disease. As many as 70.5% (106) of patient had coronary artery disease and 29.4%(44) had no coronary lesion. Microalbuminuria was detected at 62.9% in patients with CAD and 8.8% in those without coronary artery lesion (p<0.001). The presence of 1 or 2 vessel CAD showed a linear increase between the groups without microalbuminuria. Patients with microalbuminuria have more severe angiographically detected coronary artery disease than those without microalbuminuria, thus a link can be established independent of other risk factors.

Emotional and behavioral disorders in children with epilepsy

This cross sectional study was done to observe the prevalence of emotional and behavioral disorders in children with epilepsy, in the Department of Psychiatry, Pediatrics and Neurology, of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2007 to June 2008. In this study, information about psychiatric disorders of 50 epileptic children, age ranging from 5-17 years with mean±SD (11.1±1.43) years, and 50 age, sex and socio-demographic status matched controls children (age ranging from 5-18 years with mean±SD (11.6±1.82) years were enrolled by parent, teacher and self version of Development And Well-Being Assessment (DAWBA) (Validated Bangla Version). Emotional disorders are more prevalent than behavioral disorders among epileptic children. Forty four percent (44%) of children with epilepsy had psychiatric disorder and this rate was significantly higher than that of healthy control (p>0.05). Disorders include major depressive disorder (20%), obsessive compulsive disorder (25%), other anxiety disorders (25%), specific phobia (15%), separation anxiety disorder (10%) and panic disorder with agoraphobia (5%).

Association of serum uric acid with ischemic stroke

The present study has examined the association between ischemic stroke and hyperuricemia in Bangladeshi population. This age and sex matched case control study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of January 2007 to December 2008. A total of 120 subjects were included in this study, among them 60 were cases and another 60 were controls. Data were collected purposively. Multiple logistic regressions were done to identify the risk factors for ischemic stroke. In this study 68.3% were male and 31.7% were female in both the groups. Male and female ratio of stroke patients was 2.16:1. Mean±SD of serum uric acid level of case and control group was 4.94±1.76 and 3.72±1.09 respectively. Among the case group 76.7% had normal and 23.3% had abnormal serum uric acid level. On the other hand, 93.3% respondents of control group had normal and 6.7% had abnormal serum uric acid (SUA) level. Significant differences was found between case and control group in term of SUA level (p<0.05). Since SUA level is a quantitative numerical variable, an increase in 1mg/dl has a 47.0% (95% CI 1.0% to 2.16%) increase in odds ratio (OR) of having ischemic stroke. This 47.0% is obtained by taking OR for uric acid-1. Elevated serum uric acid level is not significant for ischemic stroke among the Bangladeshi population.

Day case Laparoscopic Cholecystectomy: experience at the Bangabandhu Sheikh Mujib Medical University

Day case surgery offers convenience to the patients and cost saving to the healthcare institutes. In this prospective study, the authors reviewed their experience with day case Laparoscopic Cholecystectomy (LC) to determine its outcome in the government healthcare settings of Bangladesh. Selection criteria's for the day case LC were patients with symptomatic cholelithiasis with ASA (American Society of anesthesiologists) grade I or II, the availability of a responsible carer, absence of morbid obesity, low risk for concomitant presence of bile duct stones and domicile within Dhaka and around. Patients were admitted in the post operative ward as day case (DC) in the morning and were discharged on the next morning with a standard analgesia. Two hundred ten patients were admitted for LC as day cases over the last 7 years from October 2003 to October 2010 on the morning operation theatre lists. Five patients later required admission to the inpatient department for conversion to the open procedure. None of the patients was readmitted after discharge. Majority patients were followed up after 1st and 6th week. Two hundred seven patients attended for the follow up at the 1st week and 158 patients were reported for the 6th week. One hundred ninety six patients resumed their normal job or activities after one week. Patient's satisfaction was assessed by questionnaires. Two hundred five patients were either satisfied or very satisfied with the day-case procedure. It appears that for selected groups of patients, day-case LC can be safely done in government healthcare settings of Bangladesh with good patient satisfaction.

Maxillary sinusitis and fungal infection

This cross sectional study was done to identify the fungal etiology of maxillary sinusitis. This study was done in the department of Otolaryngology & Head-Neck Surgery, Shahid Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The study period was 5 years (January 2003 to December 2007). Total 63 patients who were diagnosed clinically and radiologically as a maxillary sinusitis were enrolled in this study. All the patients were included randomly. Among 63 patients 8(12.69%) patients had laboratory proved fungal maxillary sinusitis. Collection of the laboratory specimen was done from antral wash out and biopsy for histopathology was taken by endoscopic surgery. By histopathological and fungal stain revealed noninvasive type of fungal infection in all cases. Post nasal drip (100%), Headache (100%), Nasal obstruction (65% cases) were the main presenting symptoms in case of fungal maxillary sinusitis. Anti fungal treatment along with systemic antibiotic was given in case of proven maxillary sinusitis and 100% cure rate was observed after treatment.

Oral squamous cell carcinoma in a 10 year old boy

Squamous cell carcinoma of the oral cavity a type of Oral Cancer in young patients is a very rare occurrence particularly during the first decade of life. Oral cancer is predominantly an aggressive neoplasm of middle-aged people where 96% of the patients are more than 40 years of age and it occurs mainly due to the excessive consumption of tobacco and alcohol. In South-East Asia it has a higher rate of occurrence than the rest of the world, partly due to increased consumption of chewing tobacco and various harmful spices, areca nuts and betel quids. These rare varieties of aggressive neoplasm commonly affect tongue and lip. This report describes a case of squamous cell carcinoma in a 10 year old boy who had an exophytic type of granulomatous lesion with some indurated borders which diffusely involved the left side of the hard palate, alveolar mucosa, left maxillary antrum and aggressively emerged within the left orbit by engulfing the left inferior rectus muscle. The purpose of this case report is to provide information that younger group can suffer from oral squamous cell carcinoma though it is very rare and this younger group would appear to have a biologically more aggressive tumor and they require more complex treatment. The role of more aggressive initial therapy must be considered.

Oral rehabilitation in ectodermal dysplasia

Ectodermal dysplasia (ED) is an inherited heterogenous group of disorders causing mal formation of all tissues originating from ectoderm, like defect in hair, teeth, nail and sweat gland function. Numerous types have been described. Hypohydrotic ectodermal dysplasia (HED) is one of the common type; characterized by hypohidrosis, hypotrichosis (abnormal hair), onychodysplasia (abnormal nail) and hypodontia or anodontia (abnormal dentition). The significance of this disease lies in severe hypodontia. Dental clinicians can be the first to diagnose such cases. The dental team should be aware of its sign and symptoms in order to provide the correct therapies for the functional and psychologic needs of these patients. Here we have discussed oral rehabilitation of a 10 year old boy with ectodermal dysplasia. The objective of this case report is to make aware the people about such rare genetic disease and different methods of oral Rehabilitation of these patients for better social living, self esteem oral function.

Upper lip swelling caused by a large dentigerous cyst with mesiodens

Swelling of upper lip can results from various diseases such as salivary tumors, infections and inflammatory diseases and cyst, typically involving unerrupted teeth, are sometimes associated with supernumerary teeth in the maxillary anterior incisor region called the mesiodens. Mesiodens with dentigerous cyst is actually a rare case in the world and of course in Bangladesh. The overall prevalence of this type of cyst is only 0.15-1.9% of the total population. Recently we have experienced this kind of case like dentigerous cyst with mesiodens in the department of dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital. The patient was 24 years old male young complaining of slow growing painless swelling on the upper lip region for the last several years. Clinical examination revealed a soft intra oral swelling in the labial surface of maxillary incisor region and there was also extra orally upper lip swelling. Radiographic examination demonstrated a large radiolucent area with a mesiodens extending to the root of both lateral incisors. The patient was treated surgically by enucleation of total cysts and surgical extraction of mesiodens under local anesthesia.

Experience with the spanner prostatic stent in patients unfit for surgery: an observational study

BACKGROUND

Prostatic stents offer a third clinical option for patients with bladder-outlet obstruction who are unfit for surgical relief and wish to avoid long-term catheterization. We report our experience with the Abbey-Moor Spanner temporary prostatic stent in patients with acute and chronic symptoms of bladder-outlet obstruction secondary to benign or malignant disease who were unfit for surgery because of age or cardiorespiratory disease.

PATIENTS AND METHODS

A series of 43 consecutive patients stented March 2004 through November 2005 were reviewed retrospectively. Stents were removed and replaced every 3 months if tolerated.

RESULTS

More than half of the patients (63%) had an unsatisfactory outcome, namely, immediate or delayed retention or elective removal because of unbearable symptoms. The remaining 37% of patients had a satisfactory outcome and either continue to have the stent in situ after a mean of five changes or are stent free after a successful voiding trial.

CONCLUSION

Only 21% of the patients in whom stenting was indicated continued to have a stent in situ at the end of the study. We suggest that in such patients, a temporary stent such as the AbbeyMoor Spanner should be used for only 3 months as a trial of stenting followed by a trial of stent-free voiding, with the patient converted to permanent prostatic stenting if voiding is unsuccessful.

Mechanism of Phosphodiesterase 5 inhibitor relief of prostatitis symptoms

BACKGROUND

Chronic prostatitis is a common urological complaint without clearly defined causation or definitive treatment.

HYPOTHESIS

Phosphodiesterase 5 (PDE5) Inhibitor mediated relaxation of prostatic duct smooth muscle increases washout of prostatic reflux products reducing prostatic inflammation and consequent prostatitis symptoms. RATIONALE OF HYPOTHESIS: The presence of both Nitric Oxide Synthase and Phosphodiesterase 5 in human prostatic tissue and the effect of nitric oxide donors and PDE5 inhibitors in vitro indicate PDE5 inhibitors relax prostatic smooth muscle. Significant retrograde urinary flux into prostatic ducts has been described and suggested as the mechanism of chronic prostatitis. We postulate PDE5 inhibitors alter prostatic reflux hence prostatitis symptoms.

CONCLUSION

PDE5 inhibitors may represent a simple, effective treatment for chronic prostatitis.

Congenital subglotic haemingiomas

Congenital subglottic haemingomas are rare however they are important treatable cause of infantile stridor and can be fatal unless treated. They present in a range of ways most noticeably with stridor in infancy period and as they enlarge they can threaten the airway. Thus they require urgent assessment and treatment. We present three cases of subglottic haemingiomas all of which represented different clinical management strategies. We review this interesting topic with discussion on presentation, treatment options and outcome.

Pattern of local relapse of maxillary sinus carcinoma

Maxillary sinus carcinoma (MSC) is a rare disease with a variety of treatment options. The present study was undertaken to review the outcome of patients with treated MSC in order to clarify the factors related to local recurrence by analyzing CT findings. The study group comprised of 47 cases, 40 males and 7 females with a median age of 61 years (range, 40- 84 years) treated between 1988 to 1996 at the department of radiotherapy. CT was taken with a slice thickness of 5 mm and contrast material was routinely used. The mean follow-up period for the group was 45.0 months (range, 3-125 months). The treatment policy was either preoperative radiotherapy of 40Gy/16fr followed by maxillectomy or radical radiotherapy of 65Gy/26fr with partial maxillectomy during the course of radiotherapy. By using CT-simulation, wedge pair techniques were used in most patients with Cobalt or 6MV X-ray machines as treatment sources. Tumor extension was categorized into the following anatomical sites: orbital contents, other paranasal sinuses, posterior wall of the maxillary sinus, pterygoid plate/muscle, nasopharynx, infra-temporal fossa, base of the skull, anterior wall of the maxillary sinus, subcutaneous tissue, cheek mucosa, hard palate and alveolar bone. Local control was computed by using the Kaplan-Meier method and p value was measured by using Chi-squared test. The 5-year overall local control rates for all patients were 56%. The local recurrence was found in 19 of 47 patients (40.4%). Tumors extending to pterygoid plates (n=13) and pterygoid muscles (n=10) showed higher rate of local recurrences as compared to those without extensions (9/13 [69%] vs 10/34 [29%], p<0.02 and 7/10 [70%] vs 12/37 [32%], p<0.05, respectively). Extensions to nasopharynx (6/9, 66%) and base of skull (4/6, 66%) also showed higher rates of recurrence; however, those were not statistically significant. More than 80% of the relapse became manifest within 12 months of diagnosis and isolated local failure was the most common pattern. This analysis indicates that tumor extension to pterygoid plate/muscles, results in higher rates of recurrences. This may due to the difficult surgical accessibility of the tumor. During radiotherapy planning, special emphasis should be given to this sites of tumor extension to avoid possible local recurrence.

Muscle reflex control of sympathetic nerve activity in heart failure: the role of exercise conditioning

Muscle reflex control of sympathetic nerve activity has been an area of considerable investigation. During exercise, the capacity of the peripheral vasculature to dilate far exceeds the maximal attainable levels of cardiac output. The activation of sympathetic nervous system and engagement of the myogenic reflex serve as the controlling influence between the heart and the muscle vasculature to maintain blood pressure (BP). Two basic theories of neural control have evolved. The first termed "central command", suggests that a volitional signal emanating from central motor areas leads to increased sympathetic activation during exercise. According to the second theory the stimulation of mechanical and chemical afferents in exercising muscle lead to engagement of the "exercise pressor reflex". Some earlier studies suggested that group III muscle afferent fibers are predominantly mechanically sensitive whereas unmyelinated group IV muscle afferents respond to chemical stimuli. In recent years new evidence is emerging which challenges the concept of functional differentiation of muscle afferents as well as the classic description of muscle "mechano" and "metabo" receptors. Studies measuring concentrations of interstitial substances during exercise suggest that K(+) and phosphate, but not H(+) and lactate, may be important muscle afferent stimulants. The role of adenosine as a muscle afferent stimulant remains an area of debate. There is strong evidence that sympathetic vasoconstriction due to muscle reflex engagement plays an important role in restricting blood flow to the exercising muscle. In heart failure (HF), exercise leads to premature fatigue and accumulation of muscle metabolites resulting in a greater degree of muscle reflex engagement and in the process further decreasing the muscle blood flow. Conditioning leads to an increased ability of the muscle to maintain aerobic metabolism, lower interstitial accumulation of metabolites, less muscle reflex engagement and a smaller sympathetic response. Beneficial effects of physical conditioning may be mediated by a direct reduction of muscle metaboreflex activity or via reduction of metabolic signals activating these receptors. In this review, we will discuss concepts of flow and reflex engagement in normal human subjects and then contrast these findings with those seen in heart failure (HF). We will then examine the effects of exercise conditioning on these parameters in normal subjects and those with congestive heart failure (CHF).