Association of Low Level of High Density Lipoprotein cholesterol with Acute Coronary syndrome

Incidence of coronary artery disease (CAD) is increasing in developing countries in Bangladesh with improvement of socioeconomic status, urbanization, changes of dietary habits and lifestyle. Dyslipidaemia is one of the major contributors increase CAD risk. This study was aimed to find out the association of low level HDL-C with acute coronary syndrome. This cross sectional study was conducted in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from August 2009 to May 2010. Sociodemographic characteristics, smoking, hypertension, FBS, serum total cholesterol level, HDL-C, LDL-C, Triglyceride level were important variable considered. A total number of 100 respondents consisted of 50 cases (patient) Group I and 50 healthy people (control) Group II. Investigations included ECG, Troponin-I, FBS and Fasting Lipid Profile. The data was analyzed by computer with the help of SPSS. Chi-square test, T-test, ANOVA test used as test of significance. The mean level in cases of HDL-C 39.3±5.1 and in control level HDL-C 34.2±3.4 statistically significant (p<0.0001). In both group low concentration HDL-C (<40mg/dl) risk for CAD. Un-adjusted odds ratio 95% CI determinants of ACS, HDL-C of OR was 0.2. So, HDL-C is not protective factor. In multivariate logistic regression analysis that adjusted for confounders of HDL-C level (age, sex, smoking, hypertension, TC, LDL-C, TG) associated with ACS. HDL-C was strong predictor of ACS (RR in the highest) compared with lowest quarantile = 0.02; (95% CI=0.003-0.173; P for trend <0.0001). The study reflected that low HDL-C level associated with ACS. Categorization of patients with ACS on the basis HDL-C level may be helpful for risk stratification and management.

Effect of dairy milk, eggs, meat, fish and fruits intake on academic performances of secondary school students in Bangladesh

Background: Contribution of dairy milk and other food items and schools to academic performances of students are the important factors to build a peaceful meritorious nation with sound mental and physical health.Objective: This experiment was designed to study the contribution of dairy milk and other food item intake pattern and schools to academic performances.Method: Students of class nine in Bangladesh were enumerated using a preprescribed questionnaire during March 2016 to June 2016 by direct interview method. Collected primary data were analyzed using the Statistical Package for the Social Sciences version 14.015.Results: Male (69.63%) students and students of schools in the town (84.97%) performed better. Majority of the students in towns (46.85%; 49.65%) and villages (45.51%; 50.90%) drank dairy milk and ate meat respectively, once or twice in a week. Many students in towns (30.77%) and villages (38.92%) ate eggs for 3 to 4 days in a week. Maximum students in town (53.50%) and in village (46.71%) took fish for 5 to 7 days and 3 to 4 days in a week, respectively. Many students in town (39.86%) and in village (59.88%) took fruits 1 to 2 days and 5 to 7 days in a week, respectively. Most (74.31%) of the students who took dairy milk, meat (73.68%), fruits (66.67%), fish (65.81%) and eggs (64.71%) everyday in a week obtained A grade.Conclusions: Schools, availability of dairy milk, meat, fruits, fish and eggs, Tiffin intake status and gender affected the academic performances but educational institutions had no effect on weekly dairy milk, eggs and meat intake of the students but weekly fish and fruits intake status were affected.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.355-359

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Biochemical Predictors in Patients with Type-2 Diabetes Mellitus

Non-alcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition in the Western world and it is commonly associated with type 2 diabetes mellitus (DM). The aim of this study to determine the prevalence of NAFLD and identify the predisposing factors in type 2 DM patients with NAFLD. Total of 258 patients of type 2 DM were included in this observational study in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 11th May 2013 to 11th November 2013. Patients with characteristic findings on ultrasonography were considered as having fatty liver. They were divided into fatty liver (Group I) and non-fatty liver group (Group II) and were further evaluated by measurement of body mass index, liver function tests and lipid profile. Out of 258 type 2 diabetic patients, 167 (64.7%) patients had fatty liver on ultrasonography. BMI, waist-hip ratio and triglyceride levels in the Group I was significantly higher than Group II. An increase in the levels of ALT, AST, total cholesterol, LDL and a decrease in HDL was observed in Group I as compared to Group II. The prevalence of NAFLD is common among in type 2 diabetic patients and it increases with the rising incidence of obesity. Obesity as well as elevated liver enzymes, triglyceride and cholesterol are significantly raised in NAFLD patients with type 2 DM. It highlights the importance of routine liver function test and lipid profile in subjects with type 2 DM and should be more closely observed for NAFLD and liver complications.

Relationship between Triglyceride and HDL-C ratio with Acute Coronary Syndrome

Cardiovascular diseases (CVD) is the leading cause of death worldwide, responsible for one third of death, coronary artery disease (CAD) is the most common cause. Dyslipidaemiais one of the major contributors increased of CAD risk. This study was aimed to find out the relationship between triglyceride and HDL cholesterol ratio with acute coronary syndrome. This cross sectional study was conducted in the department of Cardiology, Mymensingh Medical College Hospital from August 2009 to May 2010. Smoking, hypertension, serum total cholesterol level, serum HDL-C, LDL-C, triglyceride (TG) level were important variable considered. A total number of 100 respondents consisted of 50 cases (patient) and 50 healthy persons (control). Investigations included ECG, Troponin-I, FBS and lipid profile. The data was analyzed by computer with the help of SPSS; Chi-square test, 't' test, ANOVA test used as test of significance. The mean level in cases of TG 168.2±88.0 vs. HDL 41.3±5.1 in control level TG 141.2±45.3 and HDL 34.2±3.4. TG/HDL ratio cases 4.2±1.7 and control 4.1±1.3. This ratio >4 is atherogenic for CAD. Unadjusted odds ratio TG/HDL ratio level high (>1). In multivariable regression analysis, TG/HDL ratio was strong relation with ACS. The study reflected that high TG/HDL ratio is associated with ACS. Categorization of patient with ACS on the basis of high TG/HDL ratio will be helpful for risk stratification and management.

Forgotten, Encrusted Ureteral Stents: Removal - Multimodal Endourologic Approach

Ureteral stent placement is a common procedure in urologic practice. Forgotten, encrusted D/J stents represent a difficult problem for urologists. The major complications are infection, impaired renal function, migration, encrustation, stone formation and multiple fragmentation of stent. A consensus on the best therapeutic approach is still lacking. Here we present our experience with endoscopic management of this challenging problem and discuss the multimodal endourologic approaches for treating forgotten, encrusted ureteral stents. In this prospective observational study 29 patients (17 males and 12 females), age ranges from 19 to 57 years with 35 (23 unilateral and 6 bilateral) encrusted ureteral stents, indwelling for 5 to 78 months were treated in the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from January 2011 to December 2015. All patients were evaluated by urine culture and sensitivity, renal function. Stent encrustation and the associated stone burden were estimated by plain radiograph. Treatment decisions were made based on the clinical presentation, degree of encrustation, stone burden and image findings. Patients were followed up to 06 months. The main indications for stenting were pyelolithotomy, ureterolithotomy, ureteroneocystostomy, URS and pyeloplasty. In kidney, mild encrustation was common (48.3%) moderate encrustation (27.6%) was less common; where as in ureter and urinary bladder, moderate encrustation was common (72.4% and 44.8%). Over three-quarters 22(75.9%) of the patients underwent extracorporeal shockwave lithotripsy (ESWL) and 10(34.5%) percuteneousnephrostomy preoperatively. Retrograde ureteroscopy with intracorporeal lithotripsy (URS & ICPL) was done in 29 cases and cystolitholapaxy (CLL) in 16(55%) cases. Cystolithotomy & PCNL was rarely done. The mean number of procedures was 2.8 (range: 1-7). Using these multimodal approaches, all stents and associated stones were eventually removed with minor complications. Nine patients developed haematuria, 5 urosepsis and 4 both haematuria & urosepsis. Multimodal endourologic approaches can safely remove forgotten, encrusted D/J stents, if treatment is tailored to the volume of encrustation and associated stone. Imaging evaluation and documentation of negative urine culture are imperative prior to any attempt to remove the stent.

Dietary substitution of fishmeal by alternative protein with guanosine monophosphate supplementation influences growth, digestibility, blood chemistry profile, immunity, and stress resistance of red sea bream, Pagrus major

We determined the effects of complete fishmeal (FM) replacement by alternative protein (soy protein concentrate, SPC) with guanosine monophosphate (GMP) supplementation on growth, digestibility, immunity, blood chemistry profile, and stress resistance of juvenile red sea bream, Pagrus major. FM protein of a FM-based control diet (FM0) was replaced with 33.3 (FM33.3), 66.6 (FM66.7), and 100% (FM100) by SPC protein, and each replacement group was supplemented with 0.4% GMP to formulate four experimental diets. Each diet was randomly allocated to triplicate groups of fish (4.8 g) for 56 days. Results demonstrated that fish fed diet group FM33.3 had the significantly highest final weight, weight gain-specific growth rate, and feed intake. Meanwhile, in comparison to control, growth performance and feed utilization did not significantly differ with 66.7% FM replacement by SPC with GMP supplementation. Apparent digestibility coefficient of protein and lipid also followed a similar trend. All growth, feed utilization, and digestibility parameters were significantly lower in FM100 diet group. Blood urea nitrogen (BUN) and triglycerides (TG) increased (P < 0.05) with increasing FM replacement level by SPC. Interestingly, total cholesterol level reduces with the increasing level of FM replacement by SPC with GMP supplementation. Fish fed FM0 diet group showed the best condition of both oxidative and freshwater stress resistance. Meanwhile, FM33.3 and FM66.7 diet groups showed acceptable conditions. Innate immune responses enhanced with the increasing FM replacement level by SPC with GMP supplementation. In conclusion, FM could be replaced ≤66.7% by SPC with GMP supplementation in diets for red sea bream without any adverse effects on fish performances.

Management of Infected Sebaceous Cyst by Suture Closure: A New Approach

Incision and drainage is the management plan of any infected sebaceous cyst from old age. But in infected sebaceous cyst, we can treat it in a simple way.Under local or general anesthesia the infected tissue is excised along with a rim of healthy tissue and then closed by Prolene in the same sitting. Usually stitches are removed on 21st day in the back and 14th day in the limb. This cross sectional observational study was carried out in the Department of Surgery of 250 Bed District Hospital, Kishoreganj and local clinics of Kishoreganj, Bangladesh from January 2012 to March 2015. One hundred (100) cases were selected with clinical diagnosis of infected sebaceous cyst and the procedure was carefully explained to every patients. The overall results were analyzed and it was revealed that with this method patients got quick recovery and no need for frequent dressing which prevents cross infection. It is cost effective and saves time also.

Assessment of Difficulties Associated with Endotracheal Intubation using Modified Mallampati and Upper Lip Bite Test

This study was aimed at finding the parameters for prediction of difficulty in endotracheal intubation, that are easy to examine and that could better predict difficulty. The current observational prospective, cross sectional study was conducted in the department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2015 comprising 180 patient of both sexes requiring endotracheal intubation were arranged into two groups, Group A: Modified Mallampati test Group and Group B: Modified Mallampati & upper lip bite test group (combined) Assessment of difficulty in intubation was done by Cormack & Lehane direct Laryngoscopic grading. Outcome was measured as no difficulty or difficulty in intubation. In Group A 33 cases were true positive, 15 false negative, 26 false positive, 16 true negative. In Group B 53 cases were true positive, 1 false positive, 8 false negative, 28 true negative. The validity tests for Group A for evaluation of difficult intubation were indicated by sensitivity 55.9%, Specificity 51.6%, Accuracy 54.41%, Positive predictive value 68.8% and Negative predictive value 38.1%. The values for Group-B were 86.9%, 96.6%, 90.0%, 98.1% and 77.8% respectively. Combined modified Mallampati & Upper Lip Bite Test has definite value in the diagnosis of difficulty in intubation and can be regarded as sensitive & specific test for operative discrimination of the patient.

Serum Zinc 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 zinc 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 zinc was determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 20. Among the study groups the Mean±SD values of serum zinc were 64.98±18.86μmol/L and 97.14±7.97μmol/L in case and control group respectively. Analysis showed that the mean serum zinc level was significantly (p<0.01) decreased in AMI patients in comparison to that of control group.

Molecular-Characterization of Methicillin-Resistance Staphylococcus aureus (MRSA) from Different Tertiary Care Hospitals in Bangladesh

Infections caused by Staphylococcus aureus were treated by methicillin, but about 95% of S. aureus has been resistance to methicillin, both in the community and hospitals and are increasing day by day. MRSA produces altered penicillin binding protein, PBP2a, due to the expression of mecA gene. Some strains of both the MRSA and MSSA carry PVL gene. This cross sectional observational study was conducted to detect the molecular-characterization of methicillin resistant Staphylococcus aureus (MRSA) and carried out in the Department of Microbiology, Mymensingh Medical College from July 2014 to December 2015. Clinical samples for this study were wound swab, pus, exudates from diabetic ulcer and burn ulcer, aural swab, blood and urine which were collected from three tertiary care hospitals such as from MMCH, BIRDEM hospital and SSMCH. Standard microbiological procedure & biochemical tests were carried out to detect S. aureus. Oxacillin disk diffusion method (ODDM) was done by Kirby-Bauer disk diffusion method. Out of a total 109 culture positive samples 69 isolates of S. aureus were selected for the study. Among the 69 isolates 33, 27 and 09 were from MMCH, BIRDEM hospital and SSMCH respectively. Among the 69 isolates, 17(24.6%) and 52(75.3%) were distinguished as MRSA and MSSA respectively by ODDM. In contrast, detection of presence and absence of mecA gene by PCR identified 20(28.9%) and 49(71.01%) isolates as MRSA and MSSA respectively. Multiplex PCR was performed by standard protocol with specific primers for detection of 16S rRNA gene for Staphylococcus, nuc gene for Staphylococcus aureus, mecA gene for MRSA, PVL gene as a virulence factor and ACME-arc gene for worldwide spreading USA 300 MRSA clone. The PVL gene were detected in 3 out of 20 MRSA (15%) and 19 out of 49 MSSA (38.7%) and the ACME- arc gene was not found in any isolates. All of the S. aureus (MRSA and MSSA) isolates were sensitive to Vancomycin and Gentamicin. All MRSA isolates (100%) showed resistance to Penicillin and Oxacillin. Of the MRSA isolates about 88.2% were resistance to Ceftazidime, 64.7% were resistance to Erythromycin and Ciprofloxacin, 11.7% were resistance to Tetracycline. Among the MSSA isolates 94.2% were resistance to Penicillin and 9.6% resistance to Ciprofloxacin. The MSSA were less resistance for non-beta lactam drugs than MRSA.

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.

Effects of dietary administration of guanosine monophosphate on the growth, digestibility, innate immune responses and stress resistance of juvenile red sea bream, Pagrus major

The present study explored the dietary administration effects of guanosine monophosphate (GMP) on growth, digestibility, innate immune responses and stress resistance of juvenile red sea bream, Pagrus major. A semi-purified basal diet supplemented with 0% (Control), 0.1% (GMP-0.1), 0.2% (GMP-0.2), 0.4% (GMP-0.4) and 0.8% (GMP-0.8) purified GMP to formulate five experimental diets. Each diet was randomly allocated to triplicate groups of fish (mean initial weight 3.4 g) for 56 days. The obtained results clearly indicated that, growth performance of red sea bream enhanced by dietary GMP supplementation compared to control and significantly higher final weight was found in fish fed diet group GMP-0.4. Specific growth rate (SGR) and percent weight gain (%WG) also significantly higher in diet group GMP-0.4 in compared to control and it was not differed (P > 0.05) with diet group GMP-0.8. Feed intake significantly increased with the supplementation of GMP. Feed conversion efficiency (FCE) and protein efficiency ratio (PER) also improved (P < 0.05) when fish fed the diets containing GMP and diet group GMP-0.4 showed the significantly higher value in compared to control. The Apparent digestibility coefficients (dry matter, protein and lipid) also improved by GMP supplementation and the significantly higher protein digestibility was observed in fish fed diet groups GMP-0.2, GMP-0.4 and GMP-0.8. Among the measured non specific immune parameters peroxidase activity (PA), respiratory burst activity (NBT), Bactericidal activity (BA) were significantly affected by dietary supplementation and highest value obtained in diet group GMP-0.4. Total serum protein, lysozyme activity (LA), and agglutination antibody titer also increased (P > 0.05) by GMP supplementation. In contrast, catalase activity decreased with GMP supplementation. In terms of oxidative stress GMP-0.2 showed best condition with low oxidative stress and high antioxidant level. Moreover, the fish fed GMP supplemented diets had better improvement (P < 0.05) in body protein contents, hepatosomatic index, hematocrit content and glutamyl oxaloacetic transaminase (GOT) and glutamic-pyruvate transaminase (GPT) level than the control group. Supplementation also improved (P < 0.05) freshwater stress resistances. Quadratic regression analysis of WG and LA revealed that, the optimal levels of dietary GMP were 0.45 and 0.48%, respectively, for juvenile red sea bream, which is also in line with the most of the growth performance and health parameters of the fish.

Dietary effects of adenosine monophosphate to enhance growth, digestibility, innate immune responses and stress resistance of juvenile red sea bream, Pagrus major

Our study explored the dietary effects of adenosine monophosphate (AMP) to enhance growth, digestibility, innate immune responses and stress resistance of juvenile red sea bream. A semi-purified basal diet supplemented with 0% (Control), 0.1% (AMP-0.1), 0.2% (AMP-0.2), 0.4% (AMP-0.4) and 0.8% (AMP-0.8) purified AMP to formulate five experimental diets. Each diet was randomly allocated to triplicate groups of fish (mean initial weight 3.4 g) for 56 days. The results indicated that dietary AMP supplements tended to improve growth performances. One of the best ones was found in diet group AMP-0.2, followed by diet groups AMP-0.1, AMP-0.4 and AMP-0.8. The Apparent digestibility coefficients (dry matter, protein and lipid) also improved by AMP supplementation and the significantly highest dry matter digestibility was observed in diet group AMP-0.2. Fish fed diet groups AMP-0.2 and AMP-0.4 had significantly higher peroxidase and bactericidal activities than fish fed the control diet. Nitro-blue-tetrazolium (NBT) activity was found to be significantly (P < 0.05) greater in fish fed diet groups AMP-0.4 and AMP-0.8. Total serum protein, lysozyme activity and agglutination antibody titer were also increased (P > 0.05) by dietary supplementation. In contrast, catalase activity decreased with AMP supplementation. Moreover, the fish fed AMP supplemented diets had better improvement (P < 0.05) in body lipid contents, condition factor, hematocrit content and glutamyl oxaloacetic transaminase (GOT) level than the control group. Supplementation also improved both freshwater and oxidative stress resistances. Interestingly, the fish fed diet groups AMP-0.2 and AMP-0.4 showed the least oxidative stress condition. Finally it is concluded that, dietary AMP supplementation enhanced the growth, digestibility, immune response and stress resistance of red sea bream. The regression analysis revealed that a dietary AMP supplementation between 0.2 and 0.4% supported weight gain and lysozyme activity as a marker of immune functions for red sea bream, which is also inline with the most of the growth and health performance parameters of fish under present experimental conditions.

Antimicrobial Susceptibility Pattern of Methicillin-Resistance Staphylococcus aureus from Different Tertiary Care Hospitals Including Mymensingh Medical College Hospital

The aim of this study was to detect antimicrobial susceptibilities and the presence of drug resistance genes of MRSA from tertiary care hospitals. This study was carried out in the Department of Microbiology, Mymensingh Medical College during the period from Jan, 2015 to Dec, 2015. Clinical samples, including wound swab, pus, exudates from diabetic ulcer and burn ulcer, aural swab, blood and urine were collected. Standard microbiological procedure & biochemical tests were carried out to detect S. aureus. Oxacillin disk diffusion test was done by Kirby-Bauer disk diffusion method. Total 69 isolates of S. aureus were selected for the study. The isolates were collected from three different tertiary care hospitals, of which 33, 27 and 9 were from Mymensingh Medical College Hospital (MMCH), BIRDEM hospital and Sir Salimullah Medical College Hospital (SSMCH) respectively. Among the 69 isolates, 17(24.6%) and 52(75.3%) were distinguished as MRSA and MSSA respectively by ODDM (Oxacillin disk diffusion method). In contrast, detection of presence and absence of mecA gene by PCR identified 20 (28.9%) and 49 (71.01%) isolates as MRSA and MSSA respectively. All of the S. aureus (MRSA and MSSA) isolates were sensitive to vancomycin and gentamicin. All MRSA isolates (100%) showed resistance to Penicillin and Oxacillin. Among the MRSA isolates about 88.2% were resistance to Ceftazidime, 64.7% were resistance to Erythromycin and Ciprofloxacin, 11.7% were resistance to Tetracycline. Among the MSSA isolates about 94.2% were resistance to Penicillin and 9.6% resistance to Ciprofloxacin. The MSSA were less resistance for non-beta lactam drugs than MRSA. Regarding drug resistance genes, the blaZ genes were present in 47 out of 49(95.8%) MSSA and in 18 out of 18 (100%) MRSA. The erythromycin resistance gene ermB was found in 8.69% isolates, of which highest 20% in MRSA and 4.08% in MSSA. The ermA was not found in any isolates. Among tetracycline resistance genes, tetK were detected in 10.1% and tetL were found in 2.8% of MRSA. The highest tetK genes were found in 20% of MRSA and in 6.1% of MSSA. Regarding, the gentamicin drug resistance, the aac(6')-Iaph(2'')-Ia gene was not found in any isolates. The relatively high proportion of MRSA and the associated antibiotic resistance seen in this study emphasizes the need for country based surveillance to characterize and monitor MRSA and to develop strategies that will improve MRSA treatment and control.

Study on the safety and efficacy of miltefosine for the treatment of children and adolescents with post-kala-azar dermal leishmaniasis in Bangladesh, and an association of serum vitamin E and exposure to arsenic with post-kala-azar dermal leishmaniasis: an open clinical trial and case-control study protocol

INTRODUCTION

Post-kala-azar dermal leishmaniasis (PKDL) is a dermatological complication that occurs primarily among treated visceral leishmaniasis (VL) patients, and sporadically in a few without a history of VL. It mostly affects children and adolescents but is also common in adults. The conventional treatment with 120 intramuscular injections of sodium stibogluconate (SSG) is phasing out. Miltefosine (MF) is the only eventual alternative to SSG; however, its efficacy and safety profiles for treatment of children and adolescents with PKDL are lacking. In addition, risk factors for PKDL are poorly investigated. Host genetic, nutritional and environmental factors could be potential risk factors. As such, here we propose to evaluate the efficacy and safety of MF for 12 weeks at an allometric dose for children and adolescents with PKDL, and also to explore potential risk factors for PKDL.

METHODS AND ANALYSIS

A cross-sectional survey will look for suspected participants with PKDL among treated VL children and adolescents, a subsequent open clinical trial with MF at allometric dose, with a follow-up at 12 months. A case-control study will be carried out for PKDL risk factors. Assuming 95% cure rate, 95% CI and α=0.05, a sample size of 73 children with PKDL is needed. Considering an attrition rate of 10%, the final sample size is 80 children in each group. Descriptive and analytical analyses will be performed. Primary outcome is safety and cure rate of 12 weeks of treatment with MF.

ETHICS AND DISSEMINATION

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) Ethical Review Committee (ERC) approved the protocol (PR#013045). Written informed consent will be taken from all participants and their guardians (in case of minor). A Data and Safety Monitoring Board (DSMB) of ICDDR,B ERC will monitor all study activities to ensure the safety of the participants.

TRIAL REGISTRATION NUMBER

NCT02193022; Pre-results.

Effects of dietary supplementation of Lactobacillus rhamnosus or/and Lactococcus lactis on the growth, gut microbiota and immune responses of red sea bream, Pagrus major

Pagrus major fingerlings (3·29 ± 0·02 g) were fed with basal diet (control) supplemented with Lactobacillus rhamnosus (LR), Lactococcus lactis (LL), and L. rhamnosus + L. lactis (LR + LL) at 10(6) cell g(-1) feed for 56 days. Feeding a mixture of LR and LL significantly increased feed utilization (FER and PER), intestine lactic acid bacteria (LAB) count, plasma total protein, alternative complement pathway (ACP), peroxidase, and mucus secretion compared with the other groups (P < 0.05). Serum lysozyme activity (LZY) significantly increased in LR + LL when compared with the control group. Additionally, fish fed the LR + LL diet showed a higher growth performance (Fn wt, WG, and SGR) and protein digestibility than the groups fed an individual LR or the control diet. Superoxide dismutase (SOD) significantly increased in LR and LR + LL groups when compared with the other groups. Moreover, the fish fed LR or LL had better improvement (P < 0.05) in growth, feed utilization, body protein and lipid contents, digestibility coefficients (dry matter, protein, and lipid), protease activity, total intestine and LAB counts, hematocrit, total plasma protein, biological antioxidant potential, ACP, serum and mucus LZY and bactericidal activities, peroxidase, SOD, and mucus secretion than the control group. Interestingly, fish fed diets with LR + LL showed significantly lower total cholesterol and triglycerides when compared with the other groups (P < 0.05). These data strongly suggest that a mixture of LR and LL probiotics may serve as a healthy immunostimulating feed additive in red sea bream aquaculture.

Two-year survival following discharge from hospital after spinal cord injury in Bangladesh

STUDY DESIGN

Mixed retrospective-prospective cohort study.

OBJECTIVES

To determine 2-year survival following discharge from hospital after spinal cord injury in Bangladesh.

SETTING

Bangladesh.

METHODS

Medical records were used to identify all patients admitted in 2011 with a recent spinal cord injury to the Centre for Rehabilitation of the Paralysed, a large Bangladeshi hospital that specialises in care of people with spinal cord injury. Patients or their families were subsequently visited or contacted by telephone in 2014. Vital status and, where relevant, date and cause of death were determined by verbal autopsy.

RESULTS

350 of 371 people admitted with a recent spinal cord injury in 2011 were discharged alive from hospital. All but eleven were accounted for two years after discharge (97% follow-up). Two-year survival was 87% (95% CI 83% to 90%). Two-year survival of those who were wheelchair-dependent was 81% (95% CI 76% to 86%). The most common cause of death was sepsis due to pressure ulcers.

CONCLUSION

In Bangladesh, approximately one in five people with spinal cord injury who are wheelchair-dependent die within two years of discharge from hospital. Most deaths are due to sepsis from potentially preventable pressure ulcers.

Effect of lemon grass (Cymbopogen citratus) extract on seed health of rice

Lemon grass extract was evaluated in different dilutions on rice seed health in laboratory and net house experiments. The objectives were to investigate the effect of lemon grass extract on seed-borne pathogen of rice and seedling vigour. Four treatments as 1:1, 1:2, 1:3 dilution of lemon grass extract including a control were studied. Lemon grass extract at 1:1 dilution showed highest germination and vigour index of rice seed and seedlings. It was also found most effective in controlling seed borne fungi of rice. The fungi Bipolaris oryzae, Alternaria padwickii, Curvularia lunata, Fusarium moniliforme, Aspergillus and Penicillium spp. were controlled effectively by soaking seeds in the extract of lemon grass at 1:1 dilution for 6 hours.DOI: http://dx.doi.org/10.3329/brj.v17i1-2.20904Bangladesh Rice j. 2013, 17(1&2): 105-108

Evaluation of serum lipid profile in patients with hypertension living in a coastal region of Bangladesh

Serum lipid levels are greatly controlled by genetic and environmental factors. When investigating the relationship between lipid disturbances and hypertension it is necessary to use local data on blood lipid profile in each region. Unfortunately, there is no literature reporting the lipid profile in hypertensive patients in coastal region of Bangladesh. The present study was conducted as a case-control study with 100 hypertensive patients as cases and equal number of normotensive individuals as controls. Socio-demographic, anthropometric and clinical data of both patients and controls were collected. Serum lipid parameters were analyzed biochemically. Independent sample t-test, Chi-Square test and Pearson's correlation test were done for the statistical analysis using the statistical software package SPSS. Our study found that serum total cholesterol (TC), triglyceride (TG), LDL, VLDL, TC/HDL, LDL/HDL were significantly higher (p<0.05) whereas the level of HDL cholesterol was significantly lower in hypertensive patients as compared to control subjects (p<0.05). Pearson's correlation analysis reveals that HDL cholesterol was inversely correlated with systolic and diastolic blood pressure in both patient and control groups. But serum TC, TG, LDL and HDL cholesterol were directly correlated with systolic and diastolic blood pressure in both groups. This study explored that hypertensive patients have higher level of TC, TG, LDL and VLDL cholesterol but lower level of HDL cholesterol than the normotensive subjects. Routine investigation of lipid profile in hypertensive patients may help to prevent further aggravation and risks of coronary artery diseases.

Micropropagation of Centella asiatica L. An Important Medicinal Herb

High frequencies of multiple shoot regeneration were achieved from shoot tip explants cultured on MS media fortified with 4.0 mgl-1 BAP + 0.1 mgl-1 NAA. On an average 10.2?0.38 shoots per explant were obtained. The regenerated shoots were rooted in MS medium supplemented with 1.0 mgl-1 IBA. The in vitro grown plantlets were acclimatized and successfully transferred to natural condition with 80% survival. A reproducible protocol was established for in vitro propagation through multiple shoot induction of Centella asiatica L. an important medicinal herb having high medicinal value.DOI: http://dx.doi.org/10.3329/pa.v19i2.16928 Progress. Agric. 19(2): 51 - 56, 2008

Isolation ofVibrio choleraefrom neonates admitted to an urban diarrhoeal diseases hospital in Bangladesh

BACKGROUND

Very little is known about Vibrio cholerae infection in neonates with diarrhoea.

AIM

The aim was to examine the frequency of enteropathogenic bacteria, especially Vibrio cholerae, in stool specimens from neonates with diarrhoea.

METHODS

We reviewed the hospital records of 240 neonates admitted with diarrhoea to the Dhaka Hospital of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh during January-December 2001. On admission, rectal swabs or stool specimens were plated directly onto taurocholate-tellurite-gelatin agar, Salmonella-Shigella agar and MacConkey's agar for culture of Vibrio cholerae, Shigella and Salmonella spp.

RESULTS

A single bacterial enteric pathogen was detected in 71 neonates, multiple pathogens in 12, and stool samples of 157 neonates revealed no pathogen. The identified enteropathogens were as follows: V. cholerae in 42 neonates, Shigella spp in 22, Salmonella spp in 8, Aeromonas spp in 9 and Hafnia alvei in 2.

CONCLUSION

V. cholerae is not uncommon in neonates presenting with diarrhoea in cholera-endemic countries.

Health Education Intervention on Hand Washing in a selected Primary School Children

DOI: http://dx.doi.org/10.3329/bjdre.v2i1.15571 Bangladesh Journal of Dental Research & Education Vol.2(1) 2012: 7-11

Comparison of trabeculectomy with mitomycin-C versus medical treatment in moderate stage of steroid induced glaucoma

This prospective, comparative and interventional study was done to compare the effects of Trabeculectomy with Mitomycin-C and medical treatment with Timolol maleate 0.5% by controlling IOP (intra ocular pressure) and assessing the visual acuity (VA) and mean sensitivity (MS) of visual field in moderate stage of steroid induced glaucoma and conducted in the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2004 to June 2009. Sixty eyes of thirty patients with glaucoma due to use of topical steroids for >1 year. IOP range was 22-30 mm of Hg, visual field with (MD) mean deviation >6 to 12 dB and (MS) mean sensitivity >12-21dB, C:D ratio 0.7-0.8 and visual acuity 6/9 to 6/6 were included in this study. At first, topical steroid was stopped. Sample was collected in lottery method. Patients were divided into two groups. In Group I, 30 eyes were treated with Timolol maleate 0.5%. In Group II, 30 eyes were treated surgically by Trabeculectomy with Mitomycin-C. Follow-up were done on 1st POD, after 7 days, 1 month, 3 months and 6 months. Successful IOP control (<15mm of Hg) were achieved in 23 eyes (77%) in Group I and 30 eyes (100%) in Group II and were highly significant (p<0.001). Visual acuity and mean sensitivity also improved more in Group II than the Group I. It was also highly significant (p<0.001). So, Trabeculectomy with mitomycin-C is effective procedure in comparison to medical treatment for steroid induced glaucoma.

Effects of Pleurotus ostreatus on Blood Pressure and Glycemic Status of Hypertensive Diabetic Male Volunteers

Different species of mushrooms are being used increasingly for their nutritional and medicinal values. They are used in traditional medical practice in the treatment and prevention of diabetes, obesity, heart diesaes, hyperacidity, cancer and hypertension. This study was designed to see the effects of Pleurotus ostreatus on blood pressure and glycemic status of hypertensive diabetic male volunteers. The study was carried out in the National Mushroom development and Extension Center (NAMDEC) laboratory, Savar, Dhaka in collaboration with the Department of Pharmacy along with the Department of Biochemistry and Molecular Biology, Jahangirnagar University. A total of 27 hypertensive male volunteers suffering from type 2 diabetes mellitus with age range of 32 to 68 years, who were free from renal impairment and other known acute or chronic diseases were included in the study. Blood pressure, fasting plasma glucose, HbA1c and serum creatinine were measured before and after 3 months of regular intake of 3 grams mushroom powder capsule daily in in 3 divided doses. However they were allowed to continue the drugs they were taking already. The study showed that after 3 months of regular intake of Pleurotus ostreatus mushroom, both systolic and diastolic blood pressure decreased significantly (p<0.001). It was also observed that, Pleurotus ostreatus decreased fasting plasma glucose level significantly (p<0.001). Reduction of HbA1c % observed after 3 months of mushroom intake was found to be significant (p<0.001). But there was no significant change of plasma creatinine level (p>0.05) indicating Pleurotus ostreatus has no detrimental effect on renal system. From the study, it can be said that, Pleurotus ostreatus mushroom intake improves glycemic status and blood pressure control in diabetic hypertensive subjects. DOI: http://dx.doi.org/10.3329/bjmb.v6i1.13280 Bangladesh J Med Biochem 2013; 6(1): 5-10

Scatter/Gather Clustering: Flexibly Incorporating User Feedback to Steer Clustering Results

Significant effort has been devoted to designing clustering algorithms that are responsive to user feedback or that incorporate prior domain knowledge in the form of constraints. However, users desire more expressive forms of interaction to influence clustering outcomes. In our experiences working with diverse application scientists, we have identified an interaction style scatter/gather clustering that helps users iteratively restructure clustering results to meet their expectations. As the names indicate, scatter and gather are dual primitives that describe whether clusters in a current segmentation should be broken up further or, alternatively, brought back together. By combining scatter and gather operations in a single step, we support very expressive dynamic restructurings of data. Scatter/gather clustering is implemented using a nonlinear optimization framework that achieves both locality of clusters and satisfaction of user-supplied constraints. We illustrate the use of our scatter/gather clustering approach in a visual analytic application to study baffle shapes in the bat biosonar (ears and nose) system. We demonstrate how domain experts are adept at supplying scatter/gather constraints, and how our framework incorporates these constraints effectively without requiring numerous instance-level constraints.

Total proctocolectomy with ileal pouch-anal anastomosis by stapling technique

An ileal pouch-anal anastomosis (IPAA) has become the gold standard procedure for ulcerative colitis and familial adenomatous polyposis coli. Construction of an ileal pouch reservoir is now standard, usually in the form of J pouch. The aim of this study was to assess the outcome of ileal pouch-anal anastomosis by stapling technique after total proctocolectomy. This prospective observational study of six patients who underwent proctocolectomy followed by an ileal pouch-anal anastomosis by stapling technique. Whole colon and rectum was mobilized and resected; J pouch created by GIA device and pouch-anal anastomosis done by staplers. All patients were continent. Patients with familial adenomatous polyposis (FAP) and ulcerative colitis showed excellent outcome regarding their disease after proctocolectomy. The ileal pouch-anal anastomosis has become a feasible alternative to the conventional permanent ileostomy after total proctocolectomy. Satisfactory results have been reported, although the procedure is associated with considerable morbidity. Excision of all the affected mucosa is an essential part of the procedure. Our experience with the ileal pouch-anal anastomosis using stapling devices without mucosectomy.

Effect of dietary karaya saponin on serum and egg yolk cholesterol in laying hens

1. The objective of the study was to investigate the effect of dietary karaya saponin on cholesterol deposition in laying hens. 2. A total of 40 Boris Brown hens were randomly assigned at 20 weeks of age to 4 treatment groups and fed on diets supplemented with 0 (control), 25, 50 or 75 mg/kg karaya saponin for an 8-week experimental period. 3. After 8 weeks of dietary supplementation, karaya-saponin-treated groups had significantly lower serum cholesterol (23·0%) and triglycerides but increased high density lipoproteins cholesterol concentration than controls, irrespective of karaya saponin content in the diet. Egg yolk cholesterol and triglycerides were also significantly reduced by dietary karaya saponin. Hepatic cholesterol and triglycerides were significantly reduced by karaya saponin but bile acids concentration in the faeces and liver were significantly increased by karaya saponin. The concentrations of oleic, linoleic and linolenic acids in the yolk were greater in hens receiving karaya saponin than in controls. Karaya saponin significantly increased egg production, feed efficiency and yolk colour compared with controls. Karaya saponin tended to increase egg weight, feed consumption, Haugh units, albumen weight and yolk index. 4. In conclusion, karaya saponin is a potential agent for reducing yolk cholesterol concentration together with an overall increase of production performance and improvement in egg quality.

Testicular tumour - a diagnostic dilemma

A 45 year-old man presented to us with upper abdominal lumps of different sizes with heaviness and mild pain. He underwent two surgeries previously one was right sided orchidectomy through scrolal incision and another one laparatomy which was done four months later of 1st one. But in both situations - no biopsy were taken & failed to establish a diagnosis. On the basis of clinical, bio-chemical and radiological examinations - it was a diagnostic dilemma. Then we performed laparotomy followed by debulking and biopsy was taken for histopathological examination. It revealed metastatic teratoma of testis.

Effects of karaya saponin and Rhodobacter capsulatus on yolk cholesterol in laying hens

1. It has been reported that karaya saponin and Rhodobacter capsulatus individually have hypocholesterolaemic activity in laying hens. This study focuses on the effect of adding karaya saponin with R. capsulatus to hen's diet with regard to serum and egg yolk cholesterol and triglycerides. 2. A total of 56 Boris Brown laying hens were divided into 7 groups at 20 weeks of age. Combinations of 25, 50, 75 mg kg(-1) karaya saponin and R. capsulatus 200 and 400 mg kg(-1) were used as treatment groups. 3. After 8 weeks of supplementation, the effects of all the combinations of karaya saponin and R. capsulatus on serum and egg yolk cholesterol, triglycerides, and high-density lipoprotein (HDL)-cholesterol were greater than either karaya saponin or R. capsulatus alone. The combination of karaya saponin 50 mg kg(-1)+ R. capsulatus 400 mg kg(-1) exhibited the greatest reduction of serum (325%) and yolk (225%) cholesterol and the greatest increase of faecal, liver bile acids and yolk fatty acid (oleic, linoleic and linolenic) concentrations. In addition, egg production and yolk colour were significantly improved by the combined use of karaya saponin and R. capsulatus supplementation. 4. Therefore, the dietary supplementation of karaya saponin and R. capsulatus may lead to the production of a low-cholesterol egg, with production performance maintained at a standard level.

Hypocholesterolemic effect of karaya saponin in Japanese laying quails (Coturnix coturnix japonica)

The effect of karaya saponin supplementation on the serum and egg yolk cholesterol and fatty acid composition in egg yolk were investigated in Japanese quails. A total of 80 Japanese quails aged 5 weeks were equally divided into four groups of 20. Four levels (0, 25, 50 and 75 mg/kg feed) of karaya saponin were included in the basal diet and experiment was lasted for 6 weeks. The cholesterol fractions in the egg yolk and serum were measured by enzymatic assay, and the fatty acid composition in egg yolk was determined by gas chromatography. The results revealed that the supplementation of 75 mg/kg karaya saponin significantly reduced (p < 0.05) cholesterol and triglycerides concentration in serum and egg yolk. High-density lipoprotein-cholesterol was increased, low-density lipoprotein-cholesterol and the atherogenic index were decreased (p < 0.05) by the dietary supplementations. Hepatic cholesterol was reduced (p < 0.05) by the 25 mg/kg karaya saponin. A higher degree of yolk colour was improved (p < 0.05) when 75 mg/kg saponin was supplemented in the diet. The concentration of polyunsaturated fatty acids (PUFA) in egg yolk was increased (p < 0.05) in a dose-dependent manner in quails fed the supplemented diet than the control diet. The ratio of PUFA to saturated fatty acids in egg yolk was improved (p < 0.05) by 75 mg/kg feed karaya saponin-supplemented diet. Therefore, the dietary supplementation of 75 mg/kg karaya saponin may be a feasible means of producing quail eggs with lower cholesterol and higher PUFA content for health conscious consumers.

Testosterone secreting adrenal adenoma in an adult female patient

Adrenal tumours that secrete testosterone are extremely rare and we describe such a case in a 35 years old female with virilization. She had steroid biochemical profile in normal limit, except increased serum testosterone level. She had left adrenal adenoma 7.5 X 6.4 cm in size, her ovaries were normal. After left adrenalectomy the serum testosterone level returns to normal and has remained in the normal range. Hirsutism decreasing gradually and menstruation restarts after 3 months. Histopathological examination confirmed the diagnosis of adrenal adenoma.

Diagnosis and management of solid pseudopapillary tumours of the pancreas

The finding of a solid or cystic mass in the pancreas is becoming more common secondary to the increasing use of cross-sectional imaging and the improved sensitivity of such studies for the detection of pancreatic abnormalities. Because of the aggressive natural history of pancreatic cancer, this has caused concern that all pancreatic abnormalities may be cancer as well as confusion over proper diagnostic and treatment algorithms. This review provides an overview of the natural history, diagnostic considerations, and treatment recommendations for the less common tumor of the pancreas which can be misinterpreted as pancreatic cancer: solid pseudopapillary tumors (SPT). A Medline search was conducted to identify studies investigating the clinicopath-ologic features, molecular genetics, pathogenesis, diagnosis, and treatment of SPT. It is often possible to obtain an accurate pretreatment diagnosis for this unusual pancreatic tumor and to successfully differentiate them from the more common pancreatic malignancies.

Sistrunk's operation for the treatment of thyroglossal cyst

Effective Treatment of thyroglossal cyst requires knowledge of its embryological background and anatomical disposition of the thyroglossal duct and its remnants. Equally important is the expertise of the surgeon to ensure total excision of the remnants of thyroglossal duct. We have operated 12 cases of both primary and recurrent thyroglossal cysts in the department of Surgery, BSMMU, Dhaka, Bangladesh from January 2001 to September 2008. We performed the Sistruk's operation on all the 12 cases. Under general anaesthesia the thyroglossal cyst, 10 mm of the central part of the body of the hyoid bone and a core of tissue in the suprahyoid region up to the foramen caecum were removed. There was no need for blood transfusion. There was neither mortality nor any significant morbidity. Average hospital stay after operation was three days. After mean follow up of 3 years there was no recurrence. We found that the Sistrunk operation is a safe and effective procedure.

Temporal variations in arsenic uptake by rice plants in Bangladesh: the role of iron plaque in paddy fields irrigated with groundwater

The transfer of arsenic to rice grains is a human health issue of growing relevance in regions of southern Asia where shallow groundwater used for irrigation of paddy fields is elevated in As. In the present study, As and Fe concentrations in soil water and in the roots of rice plants, primarily the Fe plaque surrounding the roots, were monitored during the 4-month growing season at two sites irrigated with groundwater containing approximately 130microgl(-1) As and two control sites irrigated with water containing <15microgl(-1) As. At both sites irrigated with contaminated water, As concentrations in soil water increased from <10microgl(-1) to >1000microgl(-1) during the first five weeks of the growth season and then gradually declined to <10microgl(-1) during the last five weeks. At the two control sites, concentrations of As in soil water never exceeded 40microgl(-1). At both contaminated sites, the As content of roots and Fe plaque rose to 1000-1500mgkg(-1) towards the middle of the growth season. It then declined to approximately 300mgkg(-1) towards the end, a level still well above As concentration of approximately 100mgkg(-1) in roots and plaque measured throughout the growing season at the two control sites. These time series, combined with simple mass balance considerations, demonstrate that the formation of Fe plaque on the roots of rice plants by micro-aeration significantly limits the uptake of As by rice plants grown in paddy fields. Large variations in the As and Fe content of plant stems at two of the sites irrigated with contaminated water and one of the control sites were also recorded. The origin of these variations, particularly during the last month of the growth season, needs to be better understood because they are likely to influence the uptake of As in rice grains.

The effect of shredding and test apparatus size on compressibility and strength parameters of degraded municipal solid waste

In many situations, MSW components are processed and shredded before use in laboratory experiments using conventional soil testing apparatus. However, shredding MSW material may affect the target property to be measured. The objective of this study is to contribute to the understanding of the effect of shredding of MSW on the measured compressibility and strength properties. It is hypothesized that measured properties can be correlated to an R-value, the ratio of waste particle size to apparatus size. Results from oedometer tests, conducted on 63.5 mm, 100 mm, 200 mm diameter apparatus, indicated the dependency of the compressibility parameters on R-value. The compressibility parameters are similar for the same R-value even though the apparatus size varies. The results using same apparatus size with variable R-values indicated that shredding of MSW mainly affects initial compression. Creep and biological strain rate of the tested MSW are not significantly affected by R-value. The shear strength is affected by shredding as the light-weight reinforcing materials are shredded into smaller pieces during specimen preparation. For example, the measured friction angles are 32 degrees and 27 degrees for maximum particle sizes of 50 mm and 25 mm, respectively. The larger MSW components in the specimen provide better reinforcing contribution. This conclusion is however dependent on comparing specimen at the same level of degradation since shear strength is also a function of extent of degradation.

Effect of relaxin on the decidual cell reaction in the Mongolian gerbil (Meriones unguiculatus)

Purpose

Differentiation of endometrial stromal cells into decidual cells occurs during embryo implantation and pregnancy. Recently, it has been reported that relaxin affects the decidualization of cultured human endometrial cells in vitro; however, there has been no study on the decidualization of the Mongolian gerbil (Meriones unguiculatus). The authors demonstrated artificially induced decidualization, and the effect of relaxin on decidualization in gerbils.

Methods

Ten-to-twelve-week-old female Mongolian gerbils were ovariectomized, treated with estradiol, progesterone, and relaxin, and the uterine horn was stimulated. On day 10, uterine horns were measured for weight, protein concentration, and the incorporation of ¹⁴C-methionine; tissue sections were examined. Interleukin-11 (IL-11) primers were used for RT-PCR to confirm decidualization.

Results

Decidualization can be induced artificially in gerbils. In general, the histological observations of gerbil decidual cells were very similar to those of rats. The uterine horn weight, protein content, and protein synthesis from ¹⁴C-methionine significantly increased in the relaxin-treated gerbils (P< 0.05). Mast cells in the relaxin-treated uterus had proliferated more than those of the non-relaxin-treated group, which was confirmed by IL-11 expression.

Conclusions

We conclude that decidualization can be induced artificially, and relaxin increased weight of uterine horn, protein concentration, protein synthesis and IL-11 expression in gerbils.

Fatty acid composition of lipids in day 7-13 blastocysts, serum and uterine fluid of rabbits

Purpose

The fatty acid composition of rabbit blastocysts, blood serum and uterine fluids were analyzed to study embryonic lipid metabolism.

Methods

Embryos were collected from Japanese white rabbits and fatty acids were analyzed by gas chromatograph.

Results

Total amount of fatty acids in blastocysts was higher than that in serum and uterine fluid. The amount of fatty acids in blastocysts markedly decreased during days 7-13 of pregnancy, and in serum had hovered, but in uterine fluid on day 13 was nine times higher than that on day 7 of pregnancy. Palmitic acid predominates in blastocysts, serum and uterine fluid during this period.

Conclusion

Palmitic acid is the most abundant fatty acid in the blastocysts, serum and uterine fluids of rabbit during days 7-13 of pregnancy.

Bacterial enteropathogens of neonates admitted to an urban diarrhoeal hospital in Bangladesh

Data on the aetiology of diarrhoea in neonates are scarce, especially from developing countries including Bangladesh. A retrospective review of the electronic database of the Microbiology Laboratory of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), was carried out to examine enteropathogens associated with diarrhoea in neonates. Stool specimens of the neonates on admission to the Dhaka Hospital of ICDDR,B were collected and sent to the laboratory for direct plating onto taurocholate tellurite gelatin agar, Salmonella-Shigella agar and MacConkey's agar. Stool specimens of 2511 neonates of either sex were examined. Bacterial pathogens were recovered from the stools of 699 (27.8%) of these neonates--a single bacterial pathogen from 670 neonates and more than one pathogen from 29 neonates. Vibrio cholerae, Shigella, Salmonella, Aeromonas spp. and Plesiomonas shigelloides were isolated from 294, 108, 52, 222 and 19, respectively, of the neonates. The year-wise isolation of these pathogens varied between 4.9-23.4%, 2.7-5.4%, 0-4.7%, 0-19.4% and 0-1.6%, respectively, of the neonates. The results of the study indicate that infection by V. cholerae, Shigella spp., Salmonella spp., Aeromonas and P. shigelloides is common in neonatal diarrhoea in Bangladesh.

Flushing history as a hydrogeological control on the regional distribution of arsenic in shallow groundwater of the Bengal Basin

Whereas serious health consequences of widespread consumption of groundwater elevated in As have been documented in several South Asian countries, the mechanisms responsible for As mobilization in reducing aquifers remain poorly understood. We document here a previously unrecognized and consistent relationship between dissolved As concentrations in reducing groundwater and the phosphate-mobilizable As content of aquifer sediment for a set of precisely depth-matched samples from across Bangladesh. The relationship holds across nearly 3 orders of magnitude in As concentrations and suggests that regional as well as local patterns of dissolved As in shallow groundwater are set by the solid phase according to a remarkably constant ratio of approximately 250 microg/L dissolved As per 1 mg/kg P-mobilizable As. We use this relationship in a simple model of groundwater recharge to propose that the distribution of groundwater As in shallow aquifers of the Bengal Basin could primarily reflect the different flushing histories of sand formations deposited in the region over the past several thousand years.

Retrograde jejunogastric intussusception (JGI) with strangulation following previous gastrojejunostomy

Jejunogastric intussusception is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. A young man presented with epigastric pain and bilous vomiting followed by haematemesis 15 years after vagotomy & gastrojejunostomy for chronic duodenal ulcer. At presentation the patient was in shock and an emergency laparotomy was done after resuscitation. At laparotomy a retrograde type II JGI was found and managed by resection of the affected segment and partial gastrectomy and jejuno - jejunostomy with closure of the duodenal stump. Postoperative recovery was uneventful. Retrograde JGI is a rare condition and only less than 200 cases have been reported since its first report. Clinical picture of acute intestinal obstruction with suspicion about the condition in patients having a past history of gastrojejunostomy makes the elusive diagnosis definite and demands early surgery to reduce the grave consequences of the disease.

Low osmolar oral rehydration salts solution in the treatment of acute watery diarrhoea in neonates and young infants: a randomized, controlled clinical trial

To compare the efficacy and safety of low osmolar oral rehydration salts solution (ORS-75) (mmol/L: Na+ 75, osmolarity 245) with that of World Health Organization-recommended ORS (ORS-90) (mmol/L: Na+ 90, osmolarity 311 ) in the treatment of acute watery diarrhoea in neonates and very young infants, a randomized double-blind, controlled clinical trial was carried out at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh, during January 1998-December 1999. Infants, aged < or = 2 months, presenting with a history of watery diarrhoea of < or = 72 hours, with no or some dehydration and without any systemic illness, were randomly assigned to receive either ORS-75 or ORS-90 for the correction and subsequent prevention of dehydration. Infants were studied for a maximum of five days. Total stool output, stool frequency, and requirement for ORS were outcome measures. Serum electrolytes were measured at 24 hours after admission to monitor serum sodium imbalance. Seventy-three infants received ORS-75, and 71 received ORS-90. Both the groups were comparable in their baseline characteristics. Diarrhoea resolved within five days in 53% and 66% of infants receiving ORS-75 and ORS-90 respectively (p = 0.3). Total stool volume [median (inter-quartile range) 132 (65-280) vs 139 (70-259) g/kg, p = 0.9], during the study period, was not significantly different between the two groups. Total stool frequency [31 (16-51) vs 35 (16-53), p = 0.9] and total ORS intake [192 (96-374) vs 209 (134-317) mL/kg, p = 0.7] were similar between the groups. No infants developed late evidence of hypernatraemia, irrespective of treatment. The results of the study indicate that ORS-75 is as safe as standard ORS-90 in the treatment of acute watery diarrhoea in neonates and very young infants and is effective in correcting and preventing dehydration.

Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study

Little is known about clinical and epidemiological features of Plesiomonas shigelloides-associated diarrhoea in children. We reviewed hospital-based surveillance records of 38 children with diarrhoea having P. shigelloides as the only pathogen isolated from their faecal specimen. Of those 38 children, 29 (76 per cent) were below 2 years of age and 28 (74 per cent) were male. Thirty-two (84 per cent) children presented with watery diarrhoea and six (16 per cent) had dysenteric stools. Vomiting was a feature in 27 (71 per cent) children and clinically significant dehydration was observed in nine (23 per cent) children. Fever was present in three (8 per cent) children and five (13 per cent) had diarrhoea 14 days. Thirty-three (87 per cent) children were successfully treated with ORS alone and only five (13 per cent) required intravenous fluid in addition to ORS. Plesiomonas shigelloides was isolated throughout the year. The findings may be of public health importance for creating awareness among physicians about the clinical profile and management strategy of P. shigelloides-associated diarrhoea in children.

Characterization of ORF89--a latency-related gene of white spot syndrome virus

Open reading frame 89 (ORF89) is one of the three genes that are believed to be involved in the latent infection of white spot syndrome virus (WSSV). Here, we report the structure and functional characterization of ORF89. cDNA sequencing, 5' RLM-RACE, and 3' RLM-RACE showed that ORF89 gene is transcribed into an unspliced mRNA of 4436 nucleotides, which is predicted to encode a protein of 1437 amino acids. ORF89 expressed an approximately 165-kDa protein in Sf9 cells that localized in the nucleus. Amino acids 678-683 were found to be essential for nuclear localization. Cotransfection assays demonstrated that ORF89 protein repressed its own promoter as well as those of a protein kinase and the thymidine-thymidylate kinase genes of WSSV. SYBR Green real-time PCR indicated that the repression occurred at the transcriptional level.

Non-invasive imaging in the diagnosis and management of Takayasu's arteritis

OBJECTIVES

Takayasu's arteritis (TA) is a rare disease, in which early diagnosis and assessment of treatment efficacy remain a problem. Signs and symptoms may be non-specific and conventional blood tests unreliable, with vascular inflammation often persisting in the face of a normal acute phase response. The current "gold standard" investigation, x ray angiography, is invasive and only identifies late, structural changes in vessels. Recently, non-invasive imaging methods have shown promise in the assessment of patients with TA.

METHODS

The invasive and non-invasive imaging performed on all patients in the rheumatology department at the Hammersmith Hospital between May 1996 and May 2002 who fulfilled the ACR criteria for TA were reviewed. All patients were clinically active at diagnosis and were treated with high dose oral prednisolone and additional oral or intravenous immunosuppression.

RESULTS

Non-invasive imaging methods ([(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) and magnetic resonance imaging (MRI)) provided important additional information about disease activity ([(18)F]FDG-PET) and progression of vessel wall thickening (MRI) when compared with x ray angiography.

CONCLUSIONS

Non-invasive imaging methods provide useful additional information towards the diagnosis and management of TA. Such techniques may allow earlier diagnosis and more accurate assessment of response to treatment than conventional clinical assessment and/or angiography. Non-invasive imaging is likely to be useful in the management of other large vessel vasculitides.

Demand-based water options for arsenic mitigation: an experience from rural Bangladesh

A supply of safe drinking water is a recognized global concern. The arsenic contamination of groundwater in Bangladesh and other countries has furthered this concern. Lack of appropriate water options is one of the main barriers to the supply of safe drinking water for 30-60 million people who are exposed to the risk of drinking arsenic-contaminated water in Bangladesh. This paper describes the experience from a water supply programme for arsenic mitigation based on demand and participation of 30,000 rural people in Srinagar, a subdistrict of Bangladesh. About 85% of the 912 tubewell water samples tested had an arsenic content higher than 0.05 mg/l. The project promoted 11 options including groundwater, surface-water and rainwater-harvesting household-based options as well as community managed technologies. Most people, particularly women, wanted piped water, and hand-operated deep tubewells were also requested. Four cluster-based motorized piped water systems, 20 home-based arsenic-removal options (two types) and an arsenic-removal filter plant were installed. The public contributed about 49, 25 and 20% of the installation costs of piped water, home-based options and filter options, respectively, and 100% of all operation and maintenance costs. The household options and filter plant were abandoned within a few weeks. Reportedly, those options required too much attention, discharged small volumes of water at low rates, were difficult to maintain, and discharged poor-quality water. The proportion of families (54%) that drank arsenic-contaminated water during the final survey was significantly lower than in the baseline survey (87%). For arsenic-affected areas, it is recommended that a cluster-based piped water system be given proper consideration when selecting appropriate water options rather than household-based options or the development of new low-cost options.