Initial Six Month's Study of Neonatal Covid-19 in a Tertiary Care Hospital of Bangladesh

The pandemic Covid-19 affects mainly adult causing fatal illness specially who have co-morbidities. But as days pass by with increasing surveillances it's gradually obvious that this devastating disease also affects the children as well as neonates with greater number. The aim of study was to determine the Covid-19 in neonates. So, we can give proper emphasis on neonatal Covid-19. This cross-sectional study was conducted from April 2020 to September 2020 at Dhaka Shishu (Children) Hospital in Bangladesh. Neonates with suspected Covid-19 were tested for SARS-CoV-2 by RT- PCR. Newborn who had suspected or confirmed COVID-19 mother, exposed to relatives infected with Covid-19, related with cluster outbreak or with abnormal clinical courses such as respiratory distress, not responded to conventional treatment and also abnormal chest x-ray was selected for Covid-19 test. Data regarding gestational age, birth weight, gender, positive cases and other findings were collected and analyzed. Statistics analysis was done by SPSS version 26.0. Forty three cases were Covid-19 positive. Among them 28(65.1%) cases were male and 15(34.9%) female. Term was 39(90.6%) cases and preterm 4(9.4%). Twenty nine (67.5%) cases were belonged to medicine and 14(32.6%) surgical cases. Fourteen (32.5%) cases with Covid-19 lived in Dhaka and 29(67.5%) cases in outside of Dhaka. Eleven (25.5%) cases were positive for SARS -CoV-2 by RT- PCR within 3 days, among them 5 (11.6%) cases were within 24 hours of age. Nine (20.9%) and 23(53.5%) cases were test positive at day 4-7 and 8-28 days respectively. The main symptoms at admission were respiratory difficulty (12/43, 27.9%), fever (8/43, 18.6%), convulsion (8/43, 18.6%) and reluctance to feed (7/43, 16.6%). In neonate two or more diseases coexist in same cases. Sepsis was present in 20 (46.5%) cases with COVID-19. Perinatal asphyxia was present in 10(23.3%) and pneumonia in 8 (18.6%) cases. In laboratory findings low Hb% was present in 2/43(4.7%) cases, leukopenia in 4/43(9.3%), leukocytosis in 2/43(4.7%) and thrombocytopenia in 5/43(11.6%). Elevated CRP was present in 14/29 (32.6%) cases, hypernatremia in 10/33 (30.3%), hyponatremia in 1/33(3%), increased serum creatinine in 10/18(55.6%), and prolonged PT, aPTT in 2/2(100%). Hyperglycaemia was found in 1/15(6.7%) cases and hypoglycaemia in 2/15(13.3%). No organism was found in blood C/S. In chest X-ray, one showed patchy opacities in right lower lobe, another showed bilateral ground-glass opacity and third one revealed few patchy opacities in the right perihilar region. Among 43 cases 21(48.9%) were discharged with advice, 12(27.9%) cases referred to Covid-19 designated hospital, 2(4.7%) cases LAMA (Leave against medical advice) and 8(18.6%) cases died including one surgical case. A good number (43) of Covid-19 cases were found in this study. In neonates the clinical features could not be differentiated properly between Covid-19 or associated diseases unlike children and adult. The neonate may be a source of transmission of this disease. So, we should give proper emphasis on test, tracing and management of neonatal Covid-19.

Effectiveness of "Physician Prompt Clinical Decision Criteria" in Weaning Outcome Prediction for Neurocritical Patients

Endotracheal intubation and invasive mechanical ventilation are fundamental components for the resuscitation of neurocritically ill patients to achieve various goals which include ensuring the protection of the airway, participating in tissue oxygen delivery and indirectly modulating cerebral vascular reactivity. The neurocritical patients demand special attention to their systemic involvement regarding weaning. Physician prompt clinical decision criteria (PPC) can play a better role in weaning of such patients. The aim of this study was to evaluate the effectiveness of 'Physician prompt clinical decision criteria' for successful weaning in neurocritical patients. This prospective observational study was conducted in the ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from March 2018 to April 2020. In total 100 neurocritical patients who fulfilled the inclusion criteria were taken as samples by informed written consent. The outcome was observed as successful weaning or as failed weaning. Finally, the existence of Standard extubation criteria (SEC) was compared with Physician prompt clinical decision criteria (PPC). Weaning was succeeded in 80.0% of patients and failed in 20.0% according to the Standard extubation criteria (SEC) while weaning was succeeded in 85.7% of patients and failed in 14.28% according to the Physician prompt clinical decision criteria (PPC). There were some differences in results but no significant differences were observed statistically between the groups in predicting the weaning outcome. Physician prompt clinical decision criteria were found to be 75.0% sensitive and specificity was 50.0%. Positive predictive value for Physician prompt clinical decision criteria was 85.70% with a Positive likelihood ratio for these criteria was 1.5 times. So, according to the study findings, accuracy of Physician prompt clinical decision criteria was 70.0%. According to the findings of this current study we can conclude that Physician prompt clinical decision criteria are an effective weaning readiness predictor in neurocritical patients.

Determinants of early sexual initiation among female adolescents in Bangladesh: evidence from a countrywide cross-sectional survey

OBJECTIVES

Early sexual initiation (ESI), defined as sexual activity that begins before 15 or 18 years of age, is one of the risky sexual behaviours that has been linked to increased likelihood of adverse consequences, such as sexually transmitted diseases, unintended pregnancies and unsafe abortions. However, to date, there are no studies investigating the prevalence and factors influencing ESI among adolescent females (aged 10-19 years) in Bangladesh. Thus, this study aimed to identify the potential determinants of ESI among adolescent females in Bangladesh based on data that are representative of the country.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Based on the availability of the data, the analysis included a weighted sample of 2051 adolescent females aged 15-19 years from the Bangladesh Demographic and Health Survey 2017/18. Initial selection of predictor variables was based on the bivariate analysis using the Chi-squared test. Univariate and multivariable logistic regression modelling were performed to measure the crude and adjusted effect of the selected predictor variables on ESI using the odds ratio (OR). The elasticity of the effects was calculated by their 95% confidence intervals (CIs).

RESULTS

Approximately 22% and 85% of female adolescents experienced ESI before the age of 15 and 18 years, respectively. Findings revealed that illiteracy (adjusted OR [AOR]: 3.61, 95% CI: 1.82-7.18), primary education (AOR: 2.08, 95% CI: 1.60-2.69), working status (AOR: 1.25, 95% CI: 0.98-1.60), living in Chittagong (AOR: 0.46, 95% CI: 0.27-0.79), living in Sylhet (AOR: 0.21, 95% CI: 0.08-0.56), reading newspapers (AOR: 0.63, 95% CI: 0.40-1.01), earlier marriage preference (AOR: 3.30, 95% CI: 2.31-4.71) and later marriage preference (AOR: 4.10, 95% CI: 3.01-5.59) were significantly linked with ESI before the age of 15 years. ESI before the age of 18 years was significantly association with primary education (AOR: 1.47, 95% CI: 1.01-2.13), religion (AOR: 0.55, 95% CI: 0.32-0.94), female household head (AOR: 1.93, 95% CI: 1.17-3.19), living in Rajshahi (AOR: 1.97, 95% CI: 0.95-4.08), being in the 'poorest' wealth category (AOR: 2.43, 95% CI: 1.45-4.07), being in the 'poorer' wealth category (AOR: 1.70, 95% CI: 1.06-2.72), being in the 'middle' wealth category (AOR: 1.76, 95% CI: 1.12-2.77), being in the 'richer' wealth category (AOR: 1.58, 95% CI: 1.02-2.44), earlier marriage preference (AOR: 15.71, 95% CI: 9.09-27.14), later marriage preference (AOR: 12.62, 95% CI: 8.82-18.06) and heard about family planning (AOR: 0.70, 95% CI: 0.47-1.04).

CONCLUSIONS

In Bangladesh, the prevalence of ESI among female adolescents is a public health concern. Due to the detrimental impact of ESI on the well-being of adolescents, it is crucial that policymakers consider the factors influencing ESI that have been identified in this study when designing health strategies. The findings from this study will help the development of evidence-based effective initiatives by policymakers in collaboration with governmental and non-governmental organisations.

Outcomes of Varus Derotation Femoral Osteotomy By Angle Blade Plate in Legg-Calve-Perthes Disease for Patient Above Eight Years of Age in The Lateral Pillar B or B/C Group

Legg-Calve-Perthes disease (LCPD) that starts after 8 years (late onset) usually follow more aggressive course and the long-term outcome is also poor. Treatment method of LCPD that will produce best results is controversial particularly if the patients are with late-onset presentation. This prospective study was conducted from January 2015 to January 2019 at Dhaka Medical College Hospital and Health N Hope Hospital, Dhaka, Bangladesh. We evaluated the radiographic outcomes for patients who had varus derotation femoral osteotomy (VDRO). We followed up 16 patients who had femoral varus osteotomy. All patients were above 8 years of age at clinical onset. The involvement of femoral epiphysis was in either in B or B/C in lateral pillar classification. All patients had MRI done to confirm radiological diagnosis and classification. The mean age was 9.5 years (range, 8 to 12 years). Final outcome was evaluated by using the Stulberg classification which was radiological. Important exclusion criteria were patient with bilateral involvement and requirement of femoral varus >30 degree. We had 81.25% of our patient with satisfactory outcomes. Among them there were Stulberg grade I, 0 cases; Stulberg grade II, 13 cases (81.25%); Stulberg III, 3 cases (18.75%), Stulberg IV and V both 0 case each. The surgical outcomes for varus derotation femoral osteotomy in late onset LCPD patients over 8 years old were showing the good results than other modalities of non surgical and surgical methods.

Construction of copy number variation landscape and characterization of associated genes in a Bangladeshi cohort of neurodevelopmental disorders

Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh. Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., "Critical-Exon Genes (CEGs)"] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package. Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients' pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (<1 MB) focal CNVs in our NDD cohort and we identified PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients.

Exploration of the physical properties of the newly synthesized kagome superconductor LaIr3Ga2 using different exchange-correlation functionals

LaIr₃Ga₂ is a kagome superconductor with a superconducting temperature (T_c) of 5.16 K. Here, we present the physical properties of the LaIr₃Ga₂ kagome superconductor computed via the DFT method wherein six different exchange-correlation functionals were used. The lattice parameters obtained using different functionals are reasonable, with a slight variation compared to experimental values. The bonding nature was explored. The elastic constants (C_ij), moduli (B, G, Y), and Vickers hardness (H_v) were computed to disclose the mechanical behavior. The H_v values were estimated to be 2.56-3.16 GPa using various exchange-correlation functionals, indicating the softness of the kagome material. The Pugh ratio, Poisson's ratio, and Cauchy pressure revealed the ductile nature. In addition, mechanical stability was ensured based on the estimated elastic constants. The anisotropic mechanical behavior was confirmed via different anisotropic indices. The Debye temperature (Θ_D), melting temperature (T_m), and minimum thermal conductivity (k_min) were calculated to characterize the thermal properties and predict the potential of LaIr₃Ga₂ as a thermal barrier coating material. The electronic density of states was investigated in detail. The McMillan equation was used to estimate T_c, and the electron-phonon coupling constant (λ) was calculated to explore the superconducting nature. The important optical constants were also calculated to explore its possible optoelectronic applications. The values of reflectivity in the IR-visible region are about 62% to 80%, indicating that the compound under study is suitable as a coating to reduce solar heating. The obtained parameters were compared with previously reported parameters, where available.

Does knowledge and attitude of healthcare professionals working in critical care areas affect their willingness to offer the option of organ donation? results of a tertiary hospital survey

INTRODUCTION

Organ donation (OD) rates in Malaysia have remained suboptimal for decades. Healthcare professionals (HCPs) working in critical care areas are responsible for diagnosing brain death (BD) and initiating the OD process. Impact of their knowledge and attitudes on willingness to offer the option of OD to families of potential donors is unknown.

METHODS

Knowledge and attitudes about BD, OD, and organ transplantation (OT) of critical care HCPs in a Malaysian transplant centre were studied using a validated questionnaire. Responses were analysed using multivariable analysis with willingness to offer the option of OD to families of potential donors as dependent variable.

RESULTS

Age (p = 0.04), profession (doctors > nurses, p < 0.001), religion (Buddhists > others, p = 0.013) [but not ethnicity], higher knowledge scores for Brain Death Test, Brain Death Knowledge, Organ Donation and Transplantation, and overall knowledge score (p < 0.001) were associated with greater odds of offering OD to families. Belief in the reliable diagnosis of BD, confidence in explaining BD, and belief that OD will not affect religious services were significantly associated with willingness to offer OD, while HCPs who were willing to personally donate organs had greatest odds (p < 0.001). Other factors that significantly influenced HCPs' willingness to offer included their perception about families' willingness to donate, body disfigurement, and confidence in OT.

CONCLUSIONS

Overall, HCPs had highly positive attitudes. However, potential barriers in offering OD to families were identified. Proven interventions from international experience could help address these issues and likely improve OD rates in Malaysia.

Routine Exposure Versus Non-Exposure of Recurrent Laryngeal Nerve during Thyroid Surgery: Our Experience of 300 Cases

The technique of thyroidectomy has been in evolution for many years. It is a basic rule of surgery that an important structure of a human body must be recognized certainly during the surgical procedure in order to prevent its damage. The purpose of this study was to evaluate our routine identification and without identification of recurrent laryngeal nerve during thyroidectomy aiming to lessen the inadvertent injury of the recurrent laryngeal nerve. This retrospective clinical controlled study was performed in the Department of ENT and Head-Neck Surgery, BIRDEM General Hospital and the Department of General Surgery, BIRDEM General Hospital, Dhaka, Bangladesh from January 2014 to December 2018. Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cords were included in this study. Patients were excluded like containing hoarseness voice, abnormal movements of vocal cord. The total number of patients was 300 and these patients were randomly divided into two groups of 150 each using random number tables. In Group A the recurrent laryngeal nerves were identified by exposing the inferior thyroid artery and markedly seen in its entire course. Where as, in Group B, nerves were not identified during the operation. Immediate post operative direct laryngoscopy was performed by a surgeon with the help of an Anesthesiologist for the assessment of vocal cords. Patients with either persistent hoarseness of voice or not were followed up with indirect laryngoscopy or fiber optic laryngoscopy (FOL) at three and six months. In Group A, out of 150 patients, 6(4%) patients developed transient unilateral paralysis, resulting in slight hoarseness of voice postoperatively. The voice improved within 6 weeks. While 2(1.3%) patients developed permanent unilateral paralysis of recurrent laryngeal nerve. The voice and cord movement did not return to normal even after 6 months in one case while other one improved within the period of 6 months. In Group B, out of 150 patients, 14(9.3%) patients developed transient paralysis. Out of 14 transient paralysis 11 were unilateral and 3 were bilateral nerve paralysis. The voice was improved within 6 months in all of unilateral and bilateral transient paralyzed cases. While 6(4%) patients developed permanent paralysis of recurrent laryngeal nerve. Out of 6 permanent paralysis 2 cases were of bilateral recurrent laryngeal nerve paralysis required immediate tracheostomy. Rest 4 cases of unilateral permanent nerve paralysis, hoarseness of voice occurred but improved in 2 cases during the period varying from 2 to 6 months while in other 2 cases, it persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in Group A as compared to Group B. This difference remained statistically significant (p=0.046) between the two groups in terms of type of thyroid diseases, type of surgeries and number of surgeries. For essentially eliminating the risk of nerve injury during surgery, recurrent laryngeal nerve should be exposed and identified routinely in its entire course.

Pulse Methylprednisolone with Oral Prednisolone versus Adrenocorticotropic Hormone in Children with West Syndrome: a Randomized Controlled Trial

BACKGROUND AND PURPOSE

West syndrome is an epileptic encephalopathy of infancy. According to guidelines, adrenocorticotrophic hormone (ACTH) is probably effective for the short-term management of infantile spasm, but there is little uniformity in treatment due to variable response. This study has been done to evaluate the efficacy of pulse methylprednisolone as compared to ACTH in children with West syndrome.

METHODS

Children between 3 months to 24 months with the diagnosis of West syndrome were included and ACTH and pulse methyl prednisolone followed by oral prednisolone were given after randomization. Total duration of treatment was 6 weeks in both groups.

RESULTS

Total 87 children were enrolled; 12 patients lost in follow up. Finally, 43 received ACTH and 32 received pulse methylprednisolone. In pulse methylprednisolone group, 28.13% showed 50-80% response, 28.13% showed 80-99% response and 21.87% patients showed 100% response. In ACTH group, 41.86% showed 50-80% response, 25.58% showed 80-99% response and only 3 (6.97%) patients showed 100% response. Methylprednisolone treatment regimen did not cause significant or persistent adverse effects.

CONCLUSIONS

Pulse methylprednisolone followed by oral prednisolone for 6 weeks is as effective as ACTH. Thus, methylprednisolone therapy can be an important alternative to ACTH.

Ongoing efforts to improve the management of patients with diabetes in Bangladesh and the implications

BACKGROUND

Prevalence rates of patients with diabetes are growing across countries, and Bangladesh is no exception. Associated costs are also increasing, driven by costs associated with the complications of diabetes including hypoglycemia. Long-acting insulin analogues were developed to reduce hypoglycemia as well as improve patient comfort and adherence. However, they have been appreciably more expensive, reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is a need to document current prescribing and dispensing rates for long-acting insulin analogues across Bangladesh, including current prices and differences, as a result of affordability and other issues.

METHODS

Mixed method approach including surveying prescribing practices in hospitals coupled with dispensing practices and prices among community pharmacies and drug stores across Bangladesh. This method was adopted since public hospitals only dispense insulins such as soluble insulins free-of-charge until funds run out and all long-acting insulin analogues have to be purchased from community stores.

RESULTS

There has been growing prescribing and dispensing of long-acting insulins in Bangladesh in recent years, now accounting for over 80% of all insulins dispensed in a minority of stores. This increase has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs than the originator, with this trend likely to continue with envisaged growth in the number of patients. Consequently, Bangladesh can serve as an exemplar to other low- and middle-income countries struggling to fund long-acting insulin analogues for their patients.

CONCLUSIONS

It was encouraging to see continued growth in the prescribing and dispensing of long-acting insulin analogues in Bangladesh via the increasing availability of biosimilars. This is likely to continue benefitting all key stakeholder groups.

Evaluation of Surgical Correction of Adolescent Idiopathic Scoliosis by Transpedicular Screws and Rods

Transpedicular screw fixation is a challenging procedure for the correction of deformity of Adolescent Idiopathic Scoliosis (AIS) in the dorso-lumbar spine. The inadvertently misplaced screws have a high risk of complications. The exactness of the pedicle screws is normally distinct as the screws axis being fully enclosed within the cortices of the pedicle. Evaluation of the surgical correction of adolescent idiopathic scoliosis by transpedicular screws and rods was done in single posterior dynamic approach. This prospective observational study was conducted in the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka and different Hospitals in Dhaka, Bangladesh from July 2015 to March 2017. Ten patients at the age >9 years and <19 years who were admitted with a diagnosis of AIS during the period of study. The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods in single posterior approach. In every case fusion was done in selected segments. In this study out of 10 patients 7(70.0%) were 10 to 14 years of age and 3(30.0%) were 15 to 18 years. Mean age 9.51±2.13 years. Minimum 10 years and maximum 18 years. Majority 7(70.0%) of the patients were female and the rest 3(30.0%) male. Five (50.0%) presented with level of involvement, 3(30.0%) patients thoracic and 2(20.0%) patients had lumbar. Maximum 7(70.0%) presented right sided involvement and rest 3(30.0%) left sided involvement. Before surgical intervention 100% patients had rib hump and positive Adams forward bending test, 70.0% patients had asymmetry of shoulder and uneven hip and also 50% patients had pain. After surgical treatment with transpedicular screws and rods through posterior approach, 70% of patients improved in terms of deformity. The average major curve deformity as defined by Cobb angle measurements was measured to be 54.9°±9.9° (40°-68°) in pre-surgery. After surgery this deformity corrected to 16.0°±4.9° (10°-24°) on average as measured in erect posture posterior anterior and lateral view. This represents significant improvement average of 71.4±4.3% (64.6-75.09) (p<0.001). This correction was maintained at 24 months after surgery. Functional results assessed by Modified Macnab criteria, significant number of 7(70.0%) patients had excellent outcome, 2(20.0%) patients had good outcome, 1(10.0%) patients had fair outcome and no poor outcome. Ninety percent (90%) patients had satisfactory results. No patient deteriorates neurologically after surgery. It is concluded that satisfactory curve correction and maintenance thereof is possible in adolescent idiopathic scoliosis, with posterior instrumentation by transpedicular screw and rods with effective reduction of cost and associated risks.

Pattern of Neonatal Danger Signs and its Related Factors in a Tertiary Level Hospital

Considering very limited information in the pattern of neonatal danger signs with associated risk factors in our perspective, the aim of the study was to understand the country-context pattern of neonatal danger signs and its related factors in a tertiary level hospital. This cross-sectional study was conducted among 259 mothers and their neonates in Dhaka Medical College Hospital, Dhaka, Bangladesh from 01 January 2015 to 31 December 2015. Data were collected by face to face interview from mother by pre-tested semi structure questionnaire which was adopted from WHO-UNICEF list of newborn danger signs. Measurement of weight was taken from hospital record. Observation of danger signs were done by following check list. Data analysis was done by SPSS 20.0. Of all, majority (41.6%) was in the age group of 20-24 years & was educated up to secondary level (42.47%). More than half of the participants (54.1%) had family income >10,000 BDT. Sixty percentage of mother took ANC visit <3 times during their pregnancy period. About 42.1% had ≥1 co-morbidities. Hospital was the predominate place of birth with 48.3% caesarean delivery. At least one neonatal danger sign was present in 20.1% while 39.4% had at least 2 danger signs. Rest of the child had ≥2 danger signs at a time. The distribution of danger signs were not feeding since birth or stop feeding 206(79.5%), severe chest in drawing 145(56.1%) respiratory rates 60 or more 126(48.6%), convulsion 72(27.8%), yellow soles 68(26.3%). Factors like 'fail to identify with an expert health assistant', trial of delivery at home, delivery at home, older neonatal age (8-28 days), presence of injury at birth, and cutting of umbilical cord by blade during delivery were associated with higher number of danger signs (p<0.05 in all cases). About 80% neonate in our setting had ≥1 sign and had association with fail to identify with an expert health assistant', trial of delivery at home, delivery at home, older neonatal age, presence of injury at birth, and cutting of umbilical cord by blade during delivery.

Measurement of Placental Index in Different Gestational Age Groups in Bangladeshi Women

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complications in pregnancy of mother. The growth and survival of the fetus in utero is directly related to formation, development and maturation of the placenta. Placental index was correlated to poor pregnancy outcomes. Placental index can help to identify fetal growth restriction which is result of placental insufficiency and is characterized by insufficient trasnsplacental transport of nutrients and oxygen. This cross sectional descriptive study would provide information about the ratio of placental index in different gestational age group in Bangladeshi women. To achieve this aim the study was performed on 60 human placenta and corresponding fetuses and gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), Group C (38-40). These sample and information were collected from normal pregnancy in Gynecology and Obstetrics Department of Mymensingh Medical College Hospital from July 2009 to June 2010. After preservation in 10% formal saline, study was done in Department of Anatomy in Mymensingh Medical College. In this study, the mean±SD placental index was in Group A (0.187±0.113), Group B (0.153±0.025) and Group C (0.166±0.025) and also observed that mean placental index decreased with age up to certain level then increase in Group C. The mean placental index was maximum in Group A (0.187±0.113) and was minimum in Group B (0.153±0.025). The mean difference of placental index between Groups A&B, A&C and B&C was statistically not significant. Observed findings of this study were compared with those of Western and Bangladeshi researches.

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications

Objective: There are concerns with increased prices and drug shortages for pertinent medicines and personal protective equipment (PPE) to prevent and treat COVID-19 enhanced by misinformation. Community pharmacists and drug stores play a significant role in disease management in Bangladesh due to high co-payments. Consequently, a need to review prices and availability in the pandemic. Materials and Methods: Multiple approach involving a review and questionnaire among pharmacies and stores early March to end May 2020. Results and Discussion: 170 pharmacies and drug stores took part, giving a response rate of 63.9%. Encouragingly, no change in utilization of antimalarial medicines in 51.2% of stores despite global endorsements. However, increased utilisation of antibiotics (70.6%), analgesics (97.6%), vitamins (90.6%) and PPE (over 95%). Encouragingly, increases in purchasing of PPE. No increase in prices among 50% of the stores for antimalarials, with a similar situation for antibiotics (65.3%), analgesics (54.7%), and vitamins (51.8%). However, price increases typically for PPE (over 90% of stores). Shortages also seen for medicines and PPE, again greater for PPE. Conclusions: The pandemic has impacted on the supply and prices of medicines and PPE in Bangladesh. Key stakeholder groups can play a role addressing misinformation, with enhanced local production helping address future shortages and prices. Bangladesh Journal of Medical Science Vol.19(0) 2020 p. S 36-S 50

0953 The Maintenance of Wakefulness Test (MWT) in Pediatric Hypersomnia

Introduction

The Maintenance of Wakefulness Test (MWT) is a recommended procedure to evaluate the efficacy of treatment for hypersomnia. Limited data have been published on the use of the MWT in children and adolescents. This study aims to describe the clinical characteristics, MWT findings and their implication in the management of children with hypersomnia.

Methods

This study reviewed the charts of children with hypersomnia who had MWT performed at Cincinnati Children’s Hospital Medical Center (CCHMC) between January 1, 2007 and January 31, 2018. Demographics, clinical characteristics, MWT findings, diagnoses and managements of children with hypersomnia were obtained.

Results

Fifty-three patients with hypersomnia who had MWT were included (mean age 17.29 years, range 12.5-22.75 years), 32 (60%) were male, and 40 (75%) were Caucasian. The diagnosis included narcolepsy (41, 77%), idiopathic hypersomnia (7, 13.2%), narcolepsy with OSA (11, 20%) and OSA (4, 7.5%). A mean sleep latency for all studies was 23.24 minutes (range 1.25-40 minutes). Twenty seven (50.9%) patients had mean sleep latency &gt;20 minutes (passed MWT) which indicate adequate control of treatment, while 26 (49.1%) had mean sleep latency &lt;20 minutes (failed MWT) including 5 (9.4%) with mean sleep latency &lt;8 minutes. There was no difference between patients who had passed MWT and failed MWT in the mean of Epworth sleepiness scale (12 vs 11), age (16.8 vs 17.6 years), or BMI (29.2 vs 26.3). Higher percentage of narcolepsy with cataplexy was found in patients who failed MWT (46.2% vs 22.2%, P 0.06). Findings from the MWT caused the changes of management in 25/26 (96.1%) who failed MWT, and 8/27 (29.6%) who passed MWT (P&lt;0.001).

Conclusion

Our result suggests that the MWT has clinical usefulness in evaluating responses to treatment for conditions associated with hypersomnia in children. Changes in management occurred in almost all patient who failed MWT. Interesting, there was no difference in subjective sleepiness between adolescents who passed and failed MWT, indicating the need to obtain objective data in this population. Future study is required to explore normative MWT data in pediatric population and to compare MWT with other tools such as driving simulation test.

Support

None

Optimization of bio-cement production from cement kiln dust using microalgae

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CKD with microalgae sp. Chlorella kessleri is investigated for maximum bio-cement yields.

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A predictive quadratic model was developed for CaCO₃ yield with R² value of c.a. 92%.

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Low temperature and high pH were found to be important parameters in RSM study.

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Under optimal set, a maximum of 96% Ca was extracted experimentally from CKD.

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FTIR, XRD and EDS analysis confirmed the produced bio-cement compound.

The main aim of this study was to maximize bio-cement (CaCO₃) production through a waste feedstock of cement kiln dust (CKD) as a source of calcium by deployment of microalgae sp. Chlorella kessleri. The effect of process parameters such as temperature, pH and time-intervals of microalgae cultivation, were set as criteria that ultimately subscribe to a process of optimization. In this regard, a single factor experiments integrated with response surface methodology (RSM) via central composite design (CCD) was considered. A quadratic model was developed to predict the maximum CaCO₃ yield. A ceiling of 25.18 g CaCO₃ yield was obtained at an optimal set of 23 °C, pH of 10.63 and day-9 of microalgae culture. Under these optimized conditions, maximum 96% calcium was extracted from CKD. FTIR, XRD and EDS analyses were conducted to characterize the CaCO₃ precipitates. Compressive modes of mechanical testing seemed to hold conventional cement complimented by CaCO₃ co-presence markedly superior to mere cement performance as far as compressive strength is concerned. The latter criterion exhibited further increase in correspondence with rise in cement to bio-cement ratio. This investigative endeavour at hand offers a simple pivotal platform on the basis of which a scale-up of microalgae-infested bio-cement production might be facilitated in conjunction with the added benefit of alleviation in environmental pollution through cement waste utilization.

Demographics of healthcare professionals' knowledge and attitude toward deceased organ donation: Survey of critical care areas in a tertiary hospital

INTRODUCTION

Organ donation rate in Malaysia is amongst the lowest in the World. Healthcare professionals (HCPs) working in critical care areas play an important role in the deceased organ donation (DOD) process. This study seeks to identify the demographics of HCPs working in the critical care areas and their knowledge and attitudes toward the DOD process.

METHOD

A cross-sectional survey on the demographics, knowledge and attitudes of the doctors and nurses working in critical care areas was undertaken by the random sampling method, using a validated, structured questionnaire. HCP's knowledge and attitudes towards brain death (BD), DOD, organ transplantation (OT), and possession of organ donor card were compared against their demographics.

RESULTS

Four hundred and twelve (72.9%) out of the total 565 HCPs in critical care areas responded of whom 163 (39.6%) were doctors and 249 (60.4%) were nurses. After adjusting for other factors, department of work and profession were highly correlated with the overall knowledge score (p<0.001 and p=0.003 respectively) and knowledge about BD (p<0.001 and p=0.013 respectively). HCPs from the neurosurgical intensive care unit (p<0.001) and doctors (p<0.001) had higher mean knowledge scores compared to their counterparts. Profession was most significantly correlated with having a positive attitude towards BD (p<0.001) and OT (p<0.001).

CONCLUSION

Department, profession and ethnicity were the demographic characteristics that correlated with knowledge and attitudes of HCPs on organ donation. Efforts to improve DOD rates in Malaysia should include targeted interventions to address the knowledge and attitudes of HCPs working in critical care areas.

Efficacy of Palonosetron as Antiemetic Prophylaxis for Post Operative Patients

Palonosetron is a new, potent and long-acting 5HT3-receptorsantagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. The objective of this study was to investigate and compare the prophylactic effects of intravenously administered palonosetron, ondansetron and granisetron on prevention of postoperative nausea and vomiting after general anesthesia. This randomized double blind prospective clinical study was carried out in the Department of Anaesthesia, DMCH, Dhaka, Bangladesh from January 2014 to December 2015. A total of 102 patients who underwent laparoscopic cholecystectomy under general anesthesia, out of which patients who received Palonosetron were in Group A (n=34), patients who received Ondansetron were in group B (n=34) and patients who received Granisetron were in group C (n=34) and also the patients were selected randomly by lottery method. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Nausea was found 3(8.8%) in group A, 8(23.5%) in group B and 6(17.6%) in group C. Vomiting was found 3(8.8%) in group A, 10(29.4%) in group B and 7(20.6%) in group C. Vomiting was significantly higher in group B compare with group A. For group B rescue anti-emetic injection motilon (metoclopramide hydrochloride) 5mg IV slowly was given. Palonosetron is effective prophylaxis against post operative nausea and vomiting.

Implementation of Q learning and deep Q network for controlling a self balancing robot model

In this paper, the implementations of two reinforcement learnings namely, Q learning and deep Q network (DQN) on the Gazebo model of a self balancing robot have been discussed. The goal of the experiments is to make the robot model learn the best actions for staying balanced in an environment. The more time it can remain within a specified limit, the more reward it accumulates and hence more balanced it is. We did various tests with many hyperparameters and demonstrated the performance curves.

Halotolerant bacteria belonging to operational group Bacillus amyloliquefaciens in biocontrol of the rice brown stripe pathogen Acidovorax oryzae

AIMS

The aim of this study was to evaluate the antagonistic activity of halotolerant bacteria against rice brown stripe pathogen Acidovorax oryzae.

METHODS AND RESULTS

Fifteen of 136 isolates of halotolerant bacteria exhibited strong in vitro and in vivo antagonistic activity against both strains of A. oryzae. The 15 antagonistic isolates were identified as 'operational group Bacillus amyloliquefaciens' based on physiological and biochemical features, fatty acid profiles as well as sequence analysis of 16S rRNA, gyrA and rpoB genes. Furthermore, this result indicated that the most effective antagonistic isolates K5-3 and PPB6 could produce siderophore in iron-limiting medium, and four kinds of secondary metabolites based on MALDI-TOF analysis. In addition, the culture filtrates of isolates K5-3 and PPB6 caused the damage of cell membrane evidenced by the TEM images, and resulted in 73-80% reduction in cell numbers, 55-65% reduction in biofilm formation, and 42-50% reduction in swimming ability of both strains of A. oryzae.

CONCLUSIONS

These isolates in particular K5-3 and PPB6 of halotolerant bacteria markedly inhibited the growth of A. oryzae.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first report on biological control of halotolerant bacteria against bacterial brown stripe of rice.

Improvement of the nutritional value of high-protein sunflower meal for broiler chickens using multi-enzyme mixtures

Two experiments were conducted to determine the effect of replacing soybean meal (SBM) with a high-protein sunflower meal (HiSFM) without or with multi-enzyme mixtures on growth performance, nutrient utilization, jejunal digesta viscosity, and excreta moisture in broiler chickens. In experiment 1, 400 chicks were divided into 40 replicates of 10 birds and fed for 35 d a corn-soybean meal (CSBM) control diet or CSBM with 25 (HiSFM25), 50 (HiSFM50), 75 (HiSFM75), or 100% (HiSFM100) of total SBM replaced by HiSFM. During d 0 to 35, increasing HiSFM content in diets linearly reduced (P < 0.0001) BW, FI, and BW gain (BWG). Feeding HiSFM25 or HiSFM50 resulted in similar growth performance as CSBM (P > 0.05). In experiment 2, 120 chicks were divided into 24 replicates of 5 birds and fed CSBM or HiSFM75 diet without or with enzyme A (supplying 4,000, 500, and 8,000 U/kg of xylanase, alpha-amylase, and protease, respectively) or enzyme B (supplying 1,700, 1,100, 240, 30, 1,200, 360, 1,500, and 120 U/kg of cellulase, pectinase, mannanase, galactanase, xylanase, glucanase, amylase, and protease, respectively) for 21 days. Excreta moisture content was determined weekly, and birds were euthanized on d 22 to collect jejunal and ileal digesta for viscosity and apparent ileal digestibility (AID) measurements, respectively. Compared with CSBM, feeding HiSFM75 reduced (P < 0.05) BWG and G: F, enzymes A and D alleviated BWG and G: F reduction (P < 0.05), and enzyme A reduced (P = 0.037) the excreta moisture content, whereas the treatments did not influence AID or jejunal digesta viscosity measurements. In conclusion, experiment 1 results show that HiSFM can replace up to 50% of SBM without depressing growth performance in either the starter or finisher phase, whereas experiment 2 shows that enzymes A and B supplementation can alleviate the growth depression associated with feeding HiSFM75. These results suggest that enzyme supplementation can enhance HiSFM inclusion in broiler diets without affecting productivity or barn hygiene management.

Zinc deficiency tolerance in maize is associated with the up-regulation of Zn transporter genes and antioxidant activities

Zinc (Zn) is an essential micronutrient for the growth and development of plants. However, Zn deficiency is a common abiotic stress causing yield loss in crop plants. This study elucidates the mechanisms of Zn deficiency tolerance in maize through physiological and molecular techniques. Maize lines tolerant (PAC) and sensitive (DAC) to Zn deficiency were examined physiologically and by atomic absorption spectrometry (AAS). Proteins, H₂ O₂ , SOD, POD, membrane permeability and gene expression (using real-time PCR) of roots and shoots of both maize lines were assessed. Zn deficiency had no significant effect on root parameters compared with control plants in PAC and DAC but showed a substantial reduction in shoot parameters in DAC. AAS showed a significant decrease in Zn concentrations in both roots and shoots of DAC but not PAC under Zn deficiency, implying that Zn deficiency tolerance mechanisms exist in PAC. Consistently, total protein and membrane permeability were significantly reduced in DAC but not PAC in both roots and shoots under Zn deficiency in comparison with Zn-sufficient plants. Real-time PCR showed that expression of ZmZIP1, ZmZIP4 and ZmIRT1 transporter genes significantly increased in roots of PAC, but not in DAC due to Zn deficiency compared with controls. The H₂ O₂ concentration dramatically increased in roots of DAC but not PAC. Moreover, tolerant PAC showed a significant increase in POD and SOD activity due to Zn deficiency, suggesting that POD- and SOD-mediated antioxidant defence might provide tolerance, at least in part, under Zn deficiency in PAC. This study provides an essential background for improving Zn biofortification of maize.

Measurement of Length of Umbilical Cord in Different Gestational Age Groups in Bangladesh

The umbilical cord and placental have been considered to significantly contribute to the perinatal outcome. Long or short cord can lead to intrauterine fetal demise. So this type of study in placenta and umbilical cord can yield information for immediate and later management of newborn. This information may also be essential for protecting the attending physician in the event of a fetal outcome. This Cross sectional descriptive study would provide information about the length of umbilical cord in different gestational age groups in Bangladesh. To fulfill this aim the study was performed on 60 human placentas and umbilical cords and Gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), and Group C 38 weeks and above. These samples were collected from normal pregnancy in Gynecology and Obstetrics Department of Mymensingh Medical College Hospital from July 2009 to June 2010. After preservation in 10% normal saline, study was done in the department of Anatomy of Mymensingh Medical College. In this present study the mean±SD length of umbilical cord was found in different gestational age groups in Group A 63.00±5.40, Group B 63.69±8.80 and Group C 67.03±10.64cm and also observed that the mean length of umbilical cord increased with gestational age. The mean length of umbilical cord was maximum in Group C (67.03cm) and was minimum in Group A (63.00cm). The mean difference of length of umbilical cord among different groups was statistically not significant. Observed findings of this study were compared with those of western and Bangladeshi researches.

Abstract P5-07-14: miR-17-92 cluster, an oncogenic microRNA cluster acts as a context dependent tumour suppressor in breast cancer

Background: The miR-17-92 is an oncogenic miRNA cluster that generate six mature miRNAs: miR-17, miR-18a, miR-19a, miR-20a, miR-19b-1, and miR-92-1. Accumulating evidences indicate the oncogenic role of the miR-17-92 cluster in human cancers. Amplification of 13q31-q32, which is the locus of the miR-17-92 cluster, have been reported in haematopoietic malignancies, such as B cell lymphoma. In contrast, MIR17HG was deleted in 21.9% of breast cancers and loss of heterozygosity at 13q12-q13 was associated with poor prognosis in breast cancer. This oncogenic miRNA cluster is deferentially expressed in various cancer. Since, miR-17-92 cluster shows differential expression among the cancers types, it is hypothesized that biological function may also vary depending on the context. Indeed, this cluster has been shown to act a tumour suppressor in some cancers. However, the functional role of this cluster in the subtypes of breast cancer remains largely unknown.

Methods: The oncomine datasets were analysed for expression of MIR17HG in breast cancer at parameters p-value threshold of 0.01 with minimum 2-fold change. We generated stable sub-clones of MCF7, T47D, SKBR3 and MDA-MB231 cells overexpressing miR-17-92 cluster by transducing with lentivirus expressing miR-17-92. Proliferation was assessed by MTS assay and colony forming assay. Cell migration was tested using scratch method. Invasion potentiality was monitored by using matrigel Boyden chamber invasion assay. For drug response analysis, control and microRNA overexpressing sub-clones were exposed to different chemotherapeutic agents at different concentrations followed by MTS assay at different time intervals. Association of miRNAs belonging to miR-17-92 with outcome in breast cancer was determined by Kaplan-Meier analysis on METABRIC dataset.

Results: We observed that expression of MIR17HG was increased in tissues and cell lines from triple negative breast cancer (TNBC) but decreased in the tissues and cell lines from the estrogen receptor (ER)-positive breast cancer. Our results showed that ectopic expression of miR-17-92 cluster significantly suppressed cell proliferation, colony formation, migration and invasion of ER-positive (MCF7, T47D) and HER2-enriched (SKBR3) cells whereas it enhanced cell proliferation, colony formation, migration and invasion in (TNBC) MDA-MB 231 cells. Further, we found that expression of miR-17-92 cluster sensitized MCF7 cells whereas it rendered SKBR3 cells resistant to chemotherapeutic compounds. Higher expression of five miRNAs of this cluster was associated with better relapse free survival (RFS) in (miR-17, miR-19a, miR-20a, miR-19b and miR-92) Luminal A subtype whereas three miRNAs of this cluster were associated with poor RFS in (miR-17, miR-18a and miR-92) HER2-enriched and (miR-17, miR-19b and miR-92) TNBC subtypes.

Conclusions: Taken together our results suggest that miR-17-92 cluster acts as a tumour suppressor in ER-positive and HER2-enriched breast cancer cells but shows oncogenic role in TNBC. Our observations underscore the functional complexity of miR-17-92 in a context-dependent and cell type-dependent manner, and more investigations are warranted to fully explore the functional complexity of miR-17-92 in subtypes of breast cancer.

Citation Format: Hossain MM, Arabkari V, Barua D, Gupta A, Islam MN, Gupta S. miR-17-92 cluster, an oncogenic microRNA cluster acts as a context dependent tumour suppressor in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-07-14.

Short hairpin RNA-mediated gene silencing of ADAM17 inhibits the growth of breast cancer MCF‑7 cells in vitro and in vivo and its mechanism of action

A disintegrin and metalloprotease 17 (ADAM17) is highly expressed in many malignant tumors and is closely related to their development. We showed in a previous study that silencing of ADAM17 by siRNA inhibited the growth of MCF-7 breast cancer cells in vitro and in vivo. In the present study, we investigated the effects of ADAM17-short hairpin RNA (ADAM17-shRNA) on MCF-7 breast cancer cells and explored the potential action pathway. In vitro, transfection of shRNAs was performed using a lentivirus, and the effects of ADAM17-shRNA on invasion, proliferation and cell cycle distribution of MCF-7 cells were assessed by Boyden chamber method, real-time cell analysis and flow cytometry, respectively. In vivo, MCF-7 cells with different administrations were transplanted subcutaneously into nude mice, and the effect of ADAM17-shRNA on the growth of transplanted tumors was assessed. In addition, the morphological structures were observed by H&E staining, and the expression of ADAM17 and Ki-67 was assessed by immunohistochemistry; expression of ADAM17, EGFR, p-EGFR, AKT, p-AKT, ERK and p-ERK proteins was assessed by western blotting, respectively. Our data showed that ADAM17-shRNA successfully inhibited ADAM17 mRNA expression, invasion and proliferation of MCF-7 cells resulting in G0/G1 phase arrest, and significantly inhibited the growth of transplanted tumors with larger areas of necrosis, low expression of ADAM17 and Ki-67 and reduced protein expression of ADAM17, EGFR, p-EGFR, AKT, p-AKT, ERK, and p-ERK in the tumor tissues. The present research suggests that ADAM17-shRNA can inhibit MCF-7 cell invasion and proliferation in vitro and inhibit MCF-7 xenograft growth in vivo through the EGFR/PI3K/AKT and EGFR/MEK/ERK signaling pathways.

Double Heterozygous For Haemoglobin S and Haemoglobin E

Here we present a Bangladeshi family where out of four family members two (mother and son) inherited both haemoglobin (HbS) S and haemoglobin (HbE) E gene confirming the diagnosis of double heterozygous state for HbS and HbE, presented in the Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh on the month of July 2016. Among other two members, one (daughter) inherited HbS and other (father) HbE. Double heterozygous state for HbS and HbE is a rare condition in this subcontinent especially in Bangladesh. HbS is rare but HbE is prevalent in Bangladesh. Co-inheritance of both HbS and HbE is therefore uncommon in this country in comparison to HbE/β - thalassaemia. Though the double heterozygous state for HbS and HbE is rare and the patients are usually asymptomatic but their documentation is important for genetic counseling and to determine the reproductive risk of the family.

Impact of Magnetic Resonance Imaging in the Diagnosis of Pituitary Adenoma

Pituitary adenoma is the third most common primary intracranial neoplasm involving the adult population with clinical features due to excess or deficient hormone secretion or due to its mass effect. Debate about the diagnostic accuracy, sensitivity and specificity of MRI imaging in detecting pituitary adenoma has been continuing. The study was aimed to evaluate the accuracy, sensitivity and specificity of MR imaging in detecting pituitary adenoma. This cross sectional study was conducted in the Department of Radiology and imaging, Bangabandhu Sheikh Mujib medical University (BSMMU) from July 2013 to August 2015. It was carried out in 50 pituitary adenoma cases of which, 28 male and 22 female to see the impact of MRI in the diagnosis of pituitary of adenoma. Out of 50 cases 43 cases were diagnosed by MRI, 3 were normal and 2 were pituitary apoplexy, one was immature teratoma as confirmed through histopathology. So, MRI has got major impact in the diagnosis of pituitary adenoma.

Effects of diet complexity and multicarbohydrase supplementation on growth performance, nutrient digestibility, blood profile, intestinal morphology, and fecal score in newly weaned pigs

To study the effects of diet complexity and multicarbohydrase (MC) supplementation, 144 piglets (6.70 ± 0.81 kg of BW) weaned at 21 ± 2 d of age (1:1 male to female ratio) were assigned to 1 of 6 dietary treatments in a 3 × 2 factorial arrangement based on diet complexity (complex1, complex2, and simple) and MC addition (0 vs. 0.1% of MC). Diets were provided in a 2-phase feeding program with phase I (d 1 to 14) and phase II diets (d 15 to 28). Complex1 was formulated to mimic a conventional weaner diet with blood plasma, fish meal, dried whey, and skim milk powder, whereas complex2 partially or totally replaced these ingredients with various plant-based ingredients. The simple diet primarily comprised corn, wheat, and soybean meal. No interactions were found between diet complexity and MC supplementation ( > 0.10), except for apparent total tract digestibility (ATTD) of ash and globulin concentration on d 28 ( < 0.05). Pigs fed the complex1 diet had greater ( < 0.01) ADG, ADFI, and G:F than those fed the other diets during the first week after weaning. However, no differences in ADG or ADFI were observed for pigs fed the complex1 and simple diets throughout the 28-d experimental period ( > 0.10), whereas the complex2 diet led to lower ADG and ADFI compared with the complex1 diet ( < 0.05). Overall, G:F was greater for pigs fed the simple diet compared with those fed the complex1 diet ( < 0.01). Pigs fed the simple diet showed ATTD of DM, OM, GE, and ash comparable to those fed the complex1 diet on d 14 ( > 0.10). In contrast, greater ATTD of DM, OM, NDF, GE, and ash was observed ( < 0.05) in pigs fed the complex1 diet than in those fed the complex2 diet or the simple diet on d 28. The simple diet increased the lymphocyte proportion in serum compared with the complex1 diet ( < 0.01) on d 14. Pigs fed the complex1 diet had a greater ( < 0.05) ratio of villus height (VH) to crypt depth (CD) in the ileum compared with the other diets. The complex2 diet decreased ( < 0.05) the fecal score during 3 wk of the postweaning period compared with the complex1 diet. Dietary MC supplementation increased ( < 0.05) G:F during the overall experimental period, VH in the ileum, VH:CD ratio in the duodenum, and ATTD of DM and GE but it reduced fecal score ( < 0.05). In conclusion, feeding a simple diet resulted in BW comparable to feeding the complex1 diet, but it led to inferior intestinal morphology and ATTD of nutrients on d 28. Also, MC supplementation could be beneficial regardless of diet complexity.

Bone Age Determination by Radiology & Imaging in Bangladesh Perspective

Determination of age is one of the most important and vital demand in legal affairs, court and young sports, especially from 7-21 years. There is no established age determination table in our county. So we are dependent upon Galstaun, Bashu & Bashu and other European tables, which sometimes provide misinterpretation and variation of opinion. We should have our own table suitable for our nation. So, this prospective study was carried out in the Department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2010 to June 2014 (five years) to assess the general skeletal maturity. Three hundred boys and girls of known date of birth were selected on random basis from Dhaka. Ages were limited within 7 to 21 year. Every 20 person for each age group, of them 10 were male and 10 were female. To observe the bony maturity, radiographs were taken at the end of their age belongs to. Thus a growth table is to be prepared for further evaluation.

Incidence of Diabetes Insipidus in Postoperative Period among the Patients Undergoing Pituitary Tumour Surgery

Post operative complications after pituitary tumour surgery vary according to procedure. There are several surgical procedures being done such as transcranial, transsphenoidal microsurgical and transsphenoidal endoscopic approaches. One of the commonest complications is diabetes insipidus (DI). Our main objective was to find out the incidence of diabetes insipidus in post operative period among patients undergoing surgical intervention for pituitary tumour in our institute. The presence of diabetes insipidus in the postoperative period was established by measuring serum Na+ concentration, hourly urine output and urinary specific gravity to find out the incidence of diabetes insipidus in postoperative period in relation to age, gender, tumour diameter, function of tumour (i.e., either hormone secreting or not) and operative procedure used for surgical resection of pituitary tumor. As it is the most common postoperative complication so, in this study we tried to find out how many of the patients develop diabetes insipidus in postoperative period following surgical resection of pituitary tumour. This cross sectional type of observational study was carried out in the department of Neurosurgery, BSMMU from May 2014 to October 2015 on 33 consecutive patients who underwent surgical intervention for pituitary tumour for the first time. Data was collected by using a data collection sheet. The incidence of diabetes insipidus was found 23.1% of patients in <30 year age group, 38.5% of patients in 31-40 year age group and 38.5% of patients in ≥40 year age group (p=0.764). In case of distribution of patients according to gender 38.5% of male and 61.5% of female developed diabetes insipidus (p=0.073). Regarding tumour size 30.8% and 69.2% of patients developed diabetes insipidus having tumour diameter <30mm and ≥30mm respectively (p=0.590). In case of operative procedure 69.2% of patients developed diabetes insipidus who was operated by transsphenoidal endoscopic approach, 23.1% and 7.7% of patients developed diabetes insipidus who underwent pituitary tumour resection through transsphenoidal microscopic approach and transcranial microscopic approach respectively (p=0.432). 17.6% of patients develop DI having functioning pituitary macroadenoma and 62.5% of patients develop DI having nonfunctioning pituitary macroadenoma. This observational study has been performed to find out the incidence of diabetes insipidus. Incidence of postoperative DI is more at or around the age of 40 years. It is slightly predominant in female. Most of the patients manifest DI in the first 24 hours of surgical intervention. Incidence of DI is low among patients having functioning pituitary macroadenoma.

Ultrasonographic Evaluation of Palpable Breast Mass and Correlation with Histopathology

Breast cancer is the most common malignancy in women and the second most common cause of cancer-related mortality. The distinction by physical examination of physiologic nodularity from abnormal masses can be difficult, while the clinical differentiation of a malignant mass from a benign one is difficult; the medical as well as potential legal consequences of missing a palpable carcinoma are high. There are significant number of reported cases of false-negative findings on mammography and the great desire not to miss a malignant lesion in the early stage of disease lead to aggressive biopsy, but the biopsy rate for cancer is only 10.0% to 30.0%. This means that 70.0% to 90.0% of breast biopsies are performed for benign diseases, which induce unnecessary patients discomfort and anxiety in addition to increasing costs to the patient. Clearly, there is a great need for development of additional reliable methods to complement the existing diagnostic procedures to avoid unnecessary biopsy. This cross sectional study was carried out on 43 patients having palpable breast mass, attended in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st January 2012 to 31st December 2013 for the period of two year. These patients were evaluated by USG at the Department of Radiology and Imaging and histopathological examination at the Department of Pathology of the same College to confirm the diagnosis. In diagnosis of malignant mass by USG, 9(20.9%) cases were diagnosed as malignant and 34(79.1%) cases as other than malignant. Eight out of 9 were sonographically diagnosed as malignant lesions also proved as malignant lesion by histopathology and 1 other than malignant. Out of 34 sonographically diagnosed cases of other than malignant lesions 32 were proved histopathologically and 2 did not match with sonographic findings. USG, in diagnosis of malignant lesion, sensitivity was 80.0%, specificity 96.97%, positive predictive value (PPV) (88.89%), negative predictive value 94.12% and accuracy was 93.02% and comparable to other study. In diagnosis of benign lesion by USG, sensitivity was 96.97%, specificity 80.0%, positive predictive value (PPV) (94.12%), negative predictive value 88.89% and accuracy was 93.02%. So, USG is an appropriate imaging method for diagnosis & differential diagnosis of palpable breast mass.

Identification and Characterization of microRNAs Associated With Human β-Cell Loss in a Mouse Model

Currently there is no effective approach for monitoring early β-cell loss during islet graft rejection following human islet transplantation (HIT). Due to ethical and technical constraints, it is difficult to directly study biomarkers of islet destruction in humans. Here, we established a humanized mouse model with induced human β-cell death using adoptive lymphocyte transfer (ALT). Human islet grafts of ALT-treated mice had perigraft lymphocyte infiltration, fewer insulin⁺ β cells, and increased β-cell apoptosis. Islet-specific miR-375 was used to validate our model, and expression of miR-375 was significantly decreased in the grafts and increased in the circulation of ALT-treated mice before hyperglycemia. A NanoString expression assay was further used to profile 800 human miRNAs in the human islet grafts, and the results were validated using quantitative real-time polymerase chain reaction. We found that miR-4454 and miR-199a-5p were decreased in the human islet grafts following ALT and increased in the circulation prior to hyperglycemia. These data demonstrate that our in vivo model of induced human β-cell destruction is a robust method for identifying and characterizing circulating biomarkers, and suggest that miR-4454 and miR-199a-5p can serve as novel biomarkers associated with early human β-cell loss following HIT.

Association between Metabolic Syndrome and Acute Myocardial Infarction (AMI)

To evaluate the biochemical parameters of metabolic syndrome in case of acute myocardial infarction (AMI) patients this case control study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013. To assess of serum total cholesterol, triacylglycerol, HDL-cholesterol, LDL-cholesterol, to estimate of serum glucose and to establish the association of age, sex, BMI, waist circumference, waist hip ratio and blood pressure of myocardial infarction patients. A total of 120 subjects were included in the study. Among them 60 were subjects of AMI cases and another 60 subjects of non AMI patients as controls. Serum total cholesterol, serum triacylglycerol, serum LDL-Cholesterol & serum HDL-Cholesterol were estimated in each sample. All values were expressed as Mean±SD. Statistical significance of difference between case and control were evaluated by using student's unpaired 't' test. All statistical analysis was done by using SPSS windows package. Past history of diabetes Mellitus and hypertension were more common in cases compared to those in control (p<0.001) which was statistically highly significant. There was no significant difference in the history of smoking between case and control. Statistical mean values of serum triacylglycerol, serum FBS, serum total cholesterol were highly significant in AMI patients in comparison to control (p<0.001). Statistical mean value of HDL-C was significantly decreased in AMI patients in contrast to control (p<0.001). In this study systolic blood pressure and diastolic blood pressure were significantly increased in AMI patients in comparison to control (p<0.05). Waist circumference was highly significant in AMI patients in comparison to control (p<0.001). Analyzing the findings of the present study there were significant alteration in lipid profile, blood pressure, fasting blood sugar & WC. These findings reaffirm the clinical importance of the metabolic syndrome as a significant risk factor for AMI. So it may be recommended that estimation of these parameters may help pivotal for better management of AMI.

Prevalence of depression in patients of type 2 diabetes mellitus: A cross sectional study in a tertiary care centre

AIMS

The present study aims to study the prevalence of depression in patients with uncomplicated type II diabetes mellitus and to find its association with various socio-demographic factors in the same.

MATERIALS AND METHODS

A cross-sectional, single interview study was performed in an outpatient department of an endocrinology institute. Total 80 type II DM patients without any associated complications of diabetes were included in this study. To diagnose Depressive Episode, structured clinical interview for DSM V was applied. Severity of depression was assessed by Hamilton Rating Scale for Depression (HAM-D). To assess socio-demographic characteristics of the patients, all of them were evaluated with a semi-structured socio-demographic performa.

RESULTS

38.75% patients (N=31) were found to be suffering from depression. Among them 48.38% were moderately depressed and none were suffering from very severe depression. Significant association was not found between depression and socio-demographic factors of age (p=0.920), gender (p=0.251), economic profile (p=0.583), local background of the patient (p=0.646), educational qualification (p=0.935) and marital status (p=0.644). Similarly no association was found with duration of diabetes, HbA1c and BMI.

CONCLUSION

Exclusion of complicated cases didn't seem to influence overall prevalence of depression, although reduction in severity was apparent. Thus even in those diabetic patients who are leading a complication free life, a detailed psychiatric analysis to rule out depression is mandatory.

Serum Copper Status among Acute Myocardial Infarction Male Patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2015 to December 2015. The aim of the study was to explore the serum copper status among acute myocardial infarction (AMI) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed AMI patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum copper determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 20. Among the study groups the mean serum copper levels were 150.30±26.16 and 103.65±9.38 in case and control group respectively. Analysis showed that the mean serum copper level was significantly (p<0.01) increased in AMI patients in comparison to that of control group.

Doppler Assessment of Hepatic Venous Waves for Evaluation of Large Varices in Cirrhotic Patient

This cross sectional study was conducted to evaluate the role of doppler ultrasonography of hepatic venous waves for evaluation of large varices in cirrhotic patients from July 2013 to June 2015 in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Patients getting admitted in the ward with a diagnosis of cirrhosis were enrolled in the study and purposive sampling technique was adopted. The sample size was 43. Data were collected by face to face interview and some data were gathered by records review and analyzed with the help of SPSS windows version - 12 software programs. Statistical significance was set at P<0.05 and confidence interval set at 95%. The research protocol was approved by the local ethical committee. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although and it can certainly demonstrate the presence of varices. In 60.47% of patient's monophasic wave pattern was seen and in 39.53% of cases biphasic & triphasic wave pattern were detected. Endoscopic examination was performed in all selected patients. In this study, 67.44% is large varices, 32.66% is small varices. Chi Square test was done for hypothesis testing and it was found significant (<0.05) and it indicates monophasic wave in Doppler USG signifies large varices. This test was also done to find out whether any significant difference of hepatic venous waveform in between male and female but it was not significant (>0.05). Diagnostic performance of USG for evaluation of varices showed, Sensitivity: 86.2%, Specificity: 92.85%, PPV: 96%, NPV: 76.47%, Accuracy 88%. Correlation co-efficient was 0.0064 which indicates moderately positive correlation in between monophasic hepatic venous waveform pattern by Doppler USG and large varices in oesophagogastroduodenoscopic findings Normal hepatic wave form shows triphasic pattern. Loss of this pattern in cirrhosis is mainly due to loss of compliance of liver. In conclusion, the loss of triphasic pattern of hepatic wave form is highly sensitive in predicting the presence of large varices in cirrhotic patients and this doppler parameter may be used as a non-invasive test for cirrhotic patients, who wish to avoid upper GI endoscopy. Further studies using a combination of various doppler parameters are needed to create indices with a better predictive value.

Rice Vision for Bangladesh: 2050 and Beyond

CORRECTION: Due to a number of formatting and layout issues, the PDF of this paper was replaced on 10th October 2016.Combined efforts of farmers, rice scientists, extension personnel and Government of Bangladesh have yielded clean rice growth rate of 0.34 million ton (MT) year-1 during 2009-10 to 2013-14 in the country. In 2014-15, the country acquired a rice surplus of about 2 MT. However, maintaining the current surplus of rice in the coming decades is a great challenge. Authentic estimation of future rice requirement and future resource availability would guide to way forward. This paper presents rice vision for Bangladesh leading to 2050 and beyond. In this study, secondary data from different government-owned statistics and research institutes were collected, analyzed and synthesized to develop models and/or model parameters to generate outputs such as future population, rice production and rice requirement. Population of Bangladesh will reach 215.4 million in 2050, when 44.6 MT of clean rice will be required. With the pace of rice-production-increase in the last five years, production can reach 47.2 MT, having a surplus of 2.6 MT in 2050. The study sets 2.6 MT as the target for clean rice surplus every year leading to 2050 and beyond. Several hurdles, such as increasing population, decreasing resources and increasing climate vulnerability, can hinder achieving the target. Three major interventions?accelerating genetic gain, minimizing yield gap and curtailing adoption lag?are proposed to break the barriers to achieve the target. Major challenges to implement the interventions include shrinking net cropped area, decreasing availability of irrigation water and increasing pressure on soil fertility. Smart technology such as, location specific variety, profitable cropping sequences, innovative cultural management, and mechanization coupled with smart dissemination using multiple means would ease production barriers. We recommend a number of measures, such as, guaranteeing a minimum cropped area, accelerating the rate of genetic gain in varietal development and intensifying collaboration among the stakeholders to reduce adoption lag of newly released promising rice varieties, to achieve the rice vision of Bangladesh leading to 2050 and beyond.Bangladesh Rice j. 2015, 19(2): 1-18

Correlation between Umbilical Cord Diameter and Cross Sectional Area with Gestational Age and Foetal Anthropometric Parameters

The objective of the study was to find out correlation between umbilical cord diameter, cross sectional area with gestational age and foetal anthropometric parameters. This cross sectional study was conducted among healthy women between the 24(th) and 40(th) completed weeks of a normal pregnancy in the Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh during the study period, from July 2009 to June 2011. A total of 230 consecutive normal pregnancy patients were included in the study. The diameter & cross-sectional area of the umbilical cord were measured on a plane adjacent to the junction of the umbilical cord and the fetal abdomen, in cross-section, with maximum magnification of the image. The cord was manually circled, and it's cross sectional areas was automatically calculated by the ultrasonograph. The mean±SD age was 24.3±4.7 years with range from 19 to 36 years. The mean gestational age was 32.1±4.5 weeks and more than a half (56.4%) of the pregnant women were nulliparas. A positive significant (p<0.001) correlation were found between umbilical cord diameter with bi-parietal diameter (r=0.548); head circumference (r=0.411); abdominal circumference (r=0.444); femur length (r=0.366) and gestational age gestation age (r=0.643). Similarly, a significant (p<0.001) positive week correlation were found between umbilical cross sectional area with bi-parietal diameter (r=0.3303); head circumference (r=0.3202); abdominal circumference (r=0.2651); femur length (r=0.3307) and gestation age (r=0.4051). A positive significant better correlation was found with umbilical cord diameter than cross sectional area with foetal anthropometric parameters.

Serum Glucose Level in First and Third Trimester of Pregnancy

In the present study serum glucose were estimated in pregnant women during the first trimester of pregnancy and third trimester of pregnancy to observe the frequency of hyperglycemia during pregnancy and to assess the incidence of gestational diabetes mellitus. This study was a cross sectional study, carried out in the Department of Physiology of Mymensingh Medical College, Mymensingh from July 2014 to June 2015. For this purpose, total 300 women with age ranged from 18 to 35 years were selected and divided into 100 healthy non pregnant women as control group and 200 normal pregnant women as study group. Study group was further divided into 100 pregnant women in first trimester of pregnancy and 100 pregnant women in third trimester of pregnancy. Diagnosed case of type I and type II diabetes, hypothyroidism, cushing's syndrome, polycystic ovary, antipsychotic drug users, regular steroid users were excluded from this study. Serum glucose was evaluated by the glucose-oxidase principle by GOD-PAP method in women with 1st trimester of pregnancy, 3rd trimester of pregnancy and in non pregnant women. Statistical analysis of data was done by unpaired student's t test. The results showed that the serum glucose levels increased significantly in third trimester and the value is not significant in first trimester. The increasing frequency of serum glucose level in third trimester may predispose the women to hyperglycemia of pregnancy or gestational diabetes mellitus.

Effects of fenugreek seed extract supplementation on growth performance, nutrient digestibility, diarrhoea scores, blood profiles, faecal microflora and faecal noxious gas emission in weanling piglets

This study was conducted to evaluate the effect of dietary fenugreek seed extract (FSE) on growth performance, apparent total tract digestibility (ATTD), diarrhoea scores, blood profiles, faecal microflora and faecal gas emission in weanling pigs. A total of 135 weanling pigs [(Yorkshire × Landrace)  × Duroc] with an average BW of (7.96 ± 1.03 kg; 28 days of age) were used in a 42-day study. Piglets were randomly allotted to three experimental diets with nine replicate pens and five pigs per pen. Dietary treatments were as follows: CON, basal diet; FSE1, basal diet + 0.1% FSE; FSE2, basal diet + 0.2% FSE. Pigs were fed with phase 1 (0-14 days) and phase 2 (14-42 days) diets in the form of mash. Average daily gain (ADG) was linearly increased (p = 0.031) by FSE supplementation compared with CON diet during days 0-14. From days 14-42, FSE2 diet had increased ADG and growth efficiency (G/F) compared with the CON diet (p = 0.014 and 0.026 respectively). Moreover, ADG and G/F were increased by FSE supplementation during days 0-42 (linear, p = 0.037 and 0.014 respectively). Energy digestibility was higher (linear, p = 0.030) by FSE supplementation at 6 weeks. On day 42, dietary supplementation of FSE linearly increased red blood cells (RBC) and immunoglobulin G (IgG) concentration (p = 0.042 and 0.038 respectively). Piglets fed FSE2 diet had higher (linear, p = 0.025) serum high-density lipoprotein cholesterol (HDL-C) concentration compared with those fed CON diet. However, piglets fed FSE2 diet had linearly reduced faecal ammonia (NH₃ ) and hydrogen sulphide (H₂ S) gas emission compared with those fed the CON diet (p = 0.018 and 0.010 respectively). In conclusion, FSE supplementation increased the performance and reduced faecal gas emission in weanling pigs.

Evaluation of Physicochemical Deterioration and Lipid Oxidation of Beef Muscle Affected by Freeze-thaw Cycles

This study was performed to explore the deterioration of physicochemical quality of beef hind limb during frozen storage at -20℃, affected by repeated freeze-thaw cycles. The effects of three successive freeze-thaw cycles on beef hind limb were investigated comparing with unfrozen beef muscle for 80 d by keeping at -20±1℃. The freeze-thaw cycles were subjected to three thawing methods and carried out to select the best one on the basis of deterioration of physicochemical properties of beef. As the number of repeated freeze-thaw cycles increased, drip loss decreased and water holding capacity (WHC) increased (p<0.05) till two cycles and then decreased. Cooking loss increased in cycle one and three but decreased in cycle two. Moreover, drip loss, WHC and cooking loss affected (p<0.05) by thawing methods within the cycles. However, pH value decreased (p<0.05), but peroxide value (p<0.05), free fatty acids value (p<0.05) and TBARS value increased (p<0.05) significantly as the number of repeated freeze-thaw cycles increased. Moreover, significant (p<0.05) interactive effects were found among the thawing methods and repeated cycles. As a result, freeze-thaw cycles affected the physicochemical quality of beef muscle, causing the degradation of its quality.

Lesser-known bunyavirus infections

This paper reviews less well-known or less widely distributed viruses of the Bunyaviridae family that are nonetheless of significant veterinary and public health concern. These include: Cache Valley fever, Main Drain, Ingwavuma, Bhanja and Heartland viruses. A description of the agents, clinical signs of infection, epidemiology, and insect transmission is provided for each, and the authors discuss current diagnostic strategies plus the lack of control measures.

Facile, room-temperature pre-treatment of rice husks with tetrabutylphosphonium hydroxide: Enhanced enzymatic and acid hydrolysis yields

Aqueous solutions of tetrabutylphosphonium hydroxide have been evaluated as pretreatment media for rice husks, prior to sulphuric acid hydrolysis or cellulase enzymatic hydrolysis. Varying the water:tetrabutylphosphonium hydroxide ratio varied the rate of delignification, as well as silica, lignin and cellulose solubility. Pre-treatment with 60wt% hydroxide dissolved the rice husk and the regenerated material was thus heavily disrupted. Sulphuric acid hydrolysis of 60wt%-treated samples yielded the highest amount of glucose per gram of rice husk. Solutions with good lignin and silica solubility but only moderate to negligible cellulose solubility (10-40wt% hydroxide) were equally effective as pre-treatment media for both acid and enzymatic hydrolysis. However, pre-treatment with 60wt% hydroxide solutions was incompatible with downstream enzymatic hydrolysis. This was due to significant incorporation of phosphonium species in the regenerated biomass, which significantly inhibited the activity of the cellulase enzymes.