Prevalence and Symptom Correlation of Lactose Intolerance in the North East Part of Bangladesh

This study was designed to see the prevalence of lactose intolerance and symptom correlation following oral lactose challenge in healthy volunteers in the north east part of Bangladesh. Symptoms of abdominal pain, nausea, borborygmi, flatulence, diarrhea and others were noted for 24 hours and blood glucose was estimated at 0 hour and 30 minutes after 50 gm oral lactose load to healthy volunteers. Failure to rise blood glucose level ≥1.1 mmol/l at 30 minutes after lactose intake from fasting level was taken as lactose malabsorption (LM) i.e., lactose intolerance. Sensitivity and specificity of different symptoms were then found out. A total of 171 volunteers (male 123, female 48) with a mean age 34.08 years participated in this study. Lactose intolerance was found among 82.5% (n=141, M=100, F=41) subjects. Symptoms mostly experience by the lactose malabsorbers were diarrhea 93(66.0%), borborygmi 80(56.7%), abdominal pain 31(22.0%) and flatulence 32(22.7%). LM prevalence was found to increase with increasing number of symptoms up to 3 symptoms. A week positive correlation (r=0.205, P=0.007) was found between the number of symptoms and proportion of subjects having positive lactose tolerance test. Lactose intolerance among healthy adults of North East part of our country is as common as in other Asian countries including China and Malaysia. But LM is higher than that of Europeans and south Indians. Diarrhea and borborygmi were mostly associated with LM.

Chronic Gastritis and its Association with H. Pylori Infection

This cross sectional study was designed to see association of chronic gastritis including its type with H. pylori infection. Consecutive patients undergoing endoscopic examination having histopathological evidence of chronic gastritis were enrolled in the study and was done in Sylhet MAG Osmani Medical College from July 2011 to June 2012. Biopsies were taken from antrum, body and fundus in all patients. Histopathological examinations were done using H-E stain and for detection of H. pylori, rapid urease test, anti-H.pylori antibody test and histopathological test with modified Giemsa stain were done. Patients having results positive in at least two methods were considered infected by H. pylori. Total 80 dyspeptic patients having chronic gastritis were evaluated. Out of them 67(83.8%) had H. pylori infection and 13(16.2%) were H. pylori negative. Among all patients 57(71.2%) had pangastritis and 23(28.8%) had antral gastritis with female and male predominance respectively. H. pylori infection was present in 49(86.0%) cases of pangastritis and 18(78.3%) cases of antral gastritis. H. pylori infection was a little higher among males (34, 50.7%) females (33, 49.3%). H. pylori infection is the predominant cause of chronic gastritis and pangastritis is the major type.

Leiomyoma of broad ligament mimicking ovarian malignancy- report of a unique case

Tumors of the broad ligament are uncommon. Leiomyoma, which is the commonest female genital neoplasm, is also the most common solid tumor of the broad ligament. Leiomyomas affect 30% of all women of reproductive age but the incidence of broad-ligament leiomyoma is <1%. These benign tumors are usually asymptomatic. A case is being described where a 52 year old presented with gradual abdominal swelling which was clinically and radiologically diagnosed as ovarian malignancy. On abdominal and bimanual palpation a soft cystic mass was noted in the right pelvic region. CA 125 was mildly raised. CEA, CA 19.9 levels were within normal limit. The radiological diagnosis was ovarian cyst with possibility of malignant changes. Staging laparotomy and histopathological examination of the resected specimen revealed a right sided broad ligament leiomyoma with cystic changes. The degenerative changes in the leiomyoma lead to the clinical and radiological diagnostic confusion. Thus, though uncommon, broad ligament leiomyoma should be considered during evaluation of adnexal masses for optimal patient management. The above description of leiomyoma in the broad ligament is a highly unique case and thus deserves appropriate attention.

Functional constipation - prevalence and life style factors in a district of bangladesh

Constipation is a common problem throughout the world and is particularly prevalent in women, children and older adults producing considerable health care expenditure. Data on functional constipation is limited especially in Asian countries. This cross-sectional survey assessed prevalence and association of functional constipation or chronic constipation (FC) with a number of socio-demographic and lifestyle factors. Data were collected from 3000 apparently healthy subjects by personal interview in a home setting with a questionnaire based on Rome III criteria for FC. Persons were selected by cluster sampling method from the population of Sylhet district. Among the 3000 subjects 148 subjects fulfilled the criteria for FC (Male=67, Female=81) giving a prevalence of 4.9%. Functional constipation was more prevalent in elderly (50-60 years, 10.1%, p=0.000), married persons (and widow/widowers, separated) (5.6-9.1%, p=0.000), city dwellers (6.2%), farmers (10.5%, p=0.000), house wives 6.1%, subjects taking vegetable (7.35%) and spices (6.0%) less frequently. The highest prevalent symptoms were feeling of incomplete evacuation (96.6%) and sensation of ano-rectal blockage (93.9%). No significant difference was found in the symptom pattern of FC among men and women. Older age (OR 2.755), female sex (OR 1.249), low intake of vegetable (OR 2.350) and spice (OR 2.050) appeared as important associated factor for FC. BMI and smoking had no significant association with FC. Functional constipation is a less prevalent disorder than IBS in our community. Female gender, old age and low intake of vegetable and spice were important associated factors for FC.

A study on plasma homocysteine level in age-related macular degeneration

INTRODUCTION

Age-related macular degeneration (AMD) related to adverse vascular changes is the most frequent cause of irreversible visual impairment in the elderly. Elevated plasma concentrations of serum homocysteine have been shown to increase the risk of vascular disease.

OBJECTIVE

To assess the relationship between plasma homocysteine level and age related macular degeneration.

MATERIALS AND METHODS

A case control study was conducted in a tertiary eye care hospital with 32 diagnosed AMD patients. The patients were compared for plasma homocysteine levels with a control group of 32 patients without AMD. A 1.5 ml of fasting venous blood sample was obtained from each participant. Plasma homocysteine level was measured by high performance liquid chromatography. The main outcome measure was hyperhomocysteinemia, defined as a plasma homocysteine level above 15 μmol/l.

RESULTS

Hyperhomocysteinemia was found in 10 blood samples (83.3 %) of patients in the wet AMD group, in 16 (80 %) blood samples in the dry AMD group, and in 12 blood samples (37%) of controls. The mean ± SD homocysteine level in the AMD group was 16.86 ± 3.52 μmol/L, while in the non-AMD control group it was 14.53 ± 4.08 μmol/L. This difference was statistically significant (p-value = 0.0186). In the individual analysis, it was also found out that the homocysteine level differed significantly between cases and controls in only the wet variety of AMD.

CONCLUSION

Hyperhomocysteinemia was significantly associated with the wet AMD variety but not with the dry AMD. Thus, homocysteine by oxidative stress and vascular dysfunction can be an important risk factor in the pathogenesis of AMD.

Prognostic factors in pemphigus vulgaris and pemphigus foliaceus

BACKGROUND

Pemphigus typically has a chronic course, although there is great variability in disease duration (DD) and time taken to disease remission (DR) between individuals with the disease. The reasons for this are unclear.

OBJECTIVES

To explore the prognostic influence of epidemiological, clinical, immunological and genetic factors on disease course and remission in pemphigus vulgaris (PV) and pemphigus foliaceus (PF).

METHODS

This was a retrospective study of patients with PV and PF, recruited from a single UK centre. Direct and indirect immunofluorescence and enzyme-linked immunosorbent assay studies for antidesmoglein (Dsg) antibodies were used to assess immunological factors. Polymerase chain reaction with sequence specific primers (PCR-SSP) was used to assess the Class II human leukocyte antigen status of patients. Prognostic endpoints investigated were time to initial first DR and total DD.

RESULTS

Ninety-five patients were recruited (79 PV and 16 PF). Patients of Indo-Asian origin were significantly associated with longer DD than White-British patients (P = 0.029). In addition, younger age at onset was associated with a worse prognosis in terms of DD: the mean age at presentation of patients with DD of < 5 years was 49 years (SEM = 3.4) compared with 40 years (SEM = 1.9) in those with DD > 5 years (P = 0.039). A higher initial intercellular antibody titre on normal human skin substrate was associated with a greater time to initial DR (P = 0.007) and high anti-Dsg 3 levels at baseline were associated with a longer total DD (P = 0.03).

CONCLUSIONS

Ethnic group, age at presentation, initial intercellular antibody titre and initial Dsg 3 antibody levels all had a significant impact on prognosis of pemphigus.

Efficacy of adefovir dipivoxil therapy in patients with chronic hepatitis B viral infection

Hepatitis B virus (HBV) infection is a major public health problem in the world. About 30% of world population has serological evidence of HBV infection. The prevalence of chronic hepatitis B in Bangladesh is reported to be 7.8%. Several potentially effective agents with different mechanisms of action have entered clinical practice and adefovir dipivoxil is one of them. Studies on the efficacy of adefovir dipivoxil in Bangladeshi patients are lacking. This was a prospective study to find out the effect of one year adefovir therapy in patients with chronic hepatitis B virus infection who were HBeAg positive. Total number of patients included in this study was 68. Among them 53(77.94%) patients continued the therapy and completed follow up. At the end of one year of therapy, intention to treat analysis showed that the rate of response (HBeAg seroconversion and HBV DNA negative) was 37.73% which was comparable to the results obtained in other studies. There was major difference in the pre treatment serum ALT level between the responders and non-responders. Comparison of reduction of serum ALT level before treatment and after treatment showed that ALT level to be lower in both responder group and non responder group. Adefovir was effective in replicative HBV infection in Bangladeshi population. So we suggest that treatment can be started and subsequent follow up can be done in chronic HBV patients who are HBeAg positive without liver biopsy.

Loss of GluN2A-containing NMDA receptors impairs extra-dimensional set-shifting

Glutamate neurotransmission via the N-methyl-D-aspartate receptor (NMDAR) is thought to mediate the synaptic plasticity underlying learning and memory formation. There is increasing evidence that deficits in NMDAR function are involved in the pathophysiology of cognitive dysfunction seen in neuropsychiatric disorders and addiction. NMDAR subunits confer different physiological properties to the receptor, interact with distinct intracellular postsynaptic scaffolding and signaling molecules, and are differentially expressed during development. Despite these known differences, the relative contribution of individual subunit composition to synaptic plasticity and learning is not fully elucidated. We have previously shown that constitutive deletion of GluN2A subunit in the mouse impairs discrimination and re-learning phase of reversal when exemplars are complex picture stimuli, but spares acquisition and extinction of non-discriminative visually cued instrumental response. To investigate the role of GluN2A containing NMDARs in executive control, we tested GluN2A knockout (GluN2A(KO) ), heterozygous (GluN2A(HET) ) and wild-type (WT) littermates on an attentional set-shifting task using species-specific stimulus dimensions. To further explore the nature of deficits in this model, mice were tested on a visual discrimination reversal paradigm using simplified rotational stimuli. GluN2A(KO) were not impaired on discrimination or reversal problems when tactile or olfactory stimuli were used, or when visual stimuli were sufficiently easy to discriminate. GluN2A(KO) showed a specific and significant impairment in ventromedial prefrontal cortex-mediated set-shifting. Together these results support a role for GluN2A containing NMDAR in modulating executive control that can be masked by overlapping deficits in attentional processes during high task demands.

Role of crush smear cytology in the diagnosis of gastrointestinal malignancy

Crush smear cytology, commonly used for central nervous system lesions was reported to be useful in the diagnosis of GI malignancies. This study was designed to see the accuracy of crush smear cytology in detection of gastrointestinal malignancy in relation to histopathological examination. First 4 or 5 bits of pinch biopsy specimens from each of the consecutive patients having endoscopic findings suggestive of carcinoma of gastro-intestinal tract were examined by conventional paraffin embedding and H-E staining by a cytologist. Crush smears stained with Papanicolaou's stain were prepared with the last bit of specimen and were examined by another cytologist. The diagnostic accuracy was examined by correlating with clinical and histological data. Out of 100 cases of suspected oesophageal malignancies, 99 were diagnosed as carcinoma by histopathology and 84 (sensitivity 83.83%, accuracy 83%, K - 0.14) cases were positive for malignancy by crush smear cytology. Out of 60 cases of gastric lesion, 54 and 44 cases were proved to be malignant by histopathology (sensitivity 76%, accuracy 73.3%, K - 0.2) and crush smear cytology respectively. Fifty four of the 57 cases of colonic lesions were proved to be malignant by histopathology and 50 (sensitivity 91%, accuracy 89.5%, K - 0.34) were malignant by crush smear cytology. Combining two methods the accuracy was 100%, 95% and 96.5% in detecting oesophageal, gastric and colonic malignancies respectively. Concordance rate of both the methods in diagnosing oesophageal, gastric and colonic lesions were 883.83%, 73.3% and 89.5% respectively. Crush smear cytology is a cheap, easy and rapidly performing technique. The diagnostic yield is very high when the technique is combined with histopathology. It may be used as a useful adjunct to conventional histopathology.

Tubercular breast abscess--a diagnostic dilemma

Tuberculosis affects many organs, however isolated tubercular breast lesion is rare. Clinically as well as radiologically it may mimic both pyogenic abscess and malignancy. One such case is being reported where a middle aged woman presented with painful, gradually increasing breast lump and was diagnosed clinically, radiologically, cytologically and even histologically as pyogenic abscess. Poor response to antibiotics raised the suspicion of malignancy for which repeat fine needle aspiration cytology was done. Well formed granulomas, necrosis and finally demonstration of acid fast bacilli established the diagnosis of tubercular abscess. No other organs were involved by tuberculosis in this case. Patient responded well to antitubercular drugs. Thus diagnostic challenge lies in the demonstration of acid fast bacilli in cases of equivocal morphology in routine cytology as well as histology. High clinical suspicion, poor response to antibiotics, suggestive radiological findings, cytology, histology and demonstration of acid fast bacilli -all contributes to the diagnosis of breast tuberculosis.

Calcium carbide related ocular burn injuries during mango ripening season of West Bengal, eastern India

Introduction: Calcium carbide used in fruit ripening industry as a cheap alternative to natural plant hormone ethylene produces highly inflammable acetylene gas. Inadvertent ignition of this gas can cause severe ocular burn injury with unilateral or bilateral blindness. Objective: To determine the characteristics and visual outcome of ocular burn injuries from calcium carbide during mango ripening season of West Bengal, eastern India. Materials and methods: A prospective study of all cases of calcium carbide related ocular burn injury attending a tertiary care hospital during mango ripening season was carried out. The demographic features, characteristics of the injury, management and outcomes were recorded. Results: Fifty five eyes of 33 patients were studied. Males were more commonly affected (20 patients, 60.6%) than females. The injury was bilateral in 22 patients (66.66%). Seventeen patients (51.51%) were below 20 years of age. Ten eyes had open globe injuries and 45 eyes had closed globe injuries. One eye of a patient had to be enucleated (3%). Children below 14 years of age were mainly injured while playing with indigenous fireworks of shooting carbide. Middle aged women were affected particularly during ignition of evening lamps. Carbide lamp was another source of injury. Conclusion: Males are more commonly affected by calcium carbide related ocular injuries. Children and young adults are the common victims. Such injuries can involve both the eyes and cause a permanent visual disability. Nepal J Ophthalmol 2013; 5(10): 242-245 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8736

Amebic Liver abscess Complicated by Inferior Vena Cava Thrombosis: A Case Report

Amebic liver abscess is the most common extraintestinal manifestation of infection with Entamoeba histolytica. It is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. The authors describe a case of amebic liver abscess in a patient who developed a rare vascular complication of inferior vena cava thrombosis. The case responded to conservative treatment and radiological intervention.

"On-water" catalyst-free ecofriendly synthesis of the hantzsch dihydropyridines

An eco-friendly “on-water” protocol for efficient catalyst-free synthesis of the Hantzsch dihydropyridines from aryl, heteroaryl, alkyl, and vinylogous aldehydes has been developed with minimum auxiliary substances, toxic reagents, organic solvents, and disposal problems.

Isolated tubercular splenic abscess: can we defer splenectomy? Our single experience with anti-tuberculous therapy alone

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Chronic kidney disease specific cardiovascular risk factors among non dialytic patients with chronic kidney disease stage-V--an experience of a specialized hospital

The study was carried out to see prevalence of Chronic Kidney Disease (CKD) specific cardiovascular risk factors and cardiovascular events among patients with Chronic Kidney Disease stage-V (CKD-V) before starting dialysis therapy in the department of Nephrology of National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh. Among CKD specific cardiovascular risk factors, anemia showed the highest prevalence (96.7%) in study population. More than fifty percent of CKD-V patients had both hypocalcaemia and hyperphosphataemia. Calcium-Phosphate Product (CaXP) was elevated among 23 percent of the population. C-reactive protein, an acute phase protein was positive in 78% of CKD-V patients. Besides, among traditional risk factors, Hypertension and Diabetes Mellitus were present in 83.3% and 23% of the study population respectively. The prevalence of cardiovascular events among CKD-V patients showed that 18.3% had ischemic heart disease, 38% heart failure, 4.7% arrhythmia and 9% left ventricular hypertrophy. Females were significantly prone to develop cardiovascular events than their male counterpart (p=0.028). Diabetes was significantly higher in patients with cardiovascular complications than in patients without cardiovascular complications (p=0.021).

Long-range interactions between adjacent and distant bases in a DNA and their impact on the ribonucleic acid polymerase-DNA dynamics

When an inhomogeneous RNA-polymerase (RNAP) binds to an inhomogeneous DNA at the physiological temperature, we propose a spin-like model of DNA nonlinear dynamics with long-range interactions (LRI) between adjacent and distant base pairs to study RNAP-DNA dynamics. Using Holstein-Primakoff's representation and Glauber's coherent state representation, we show that the model equation is a completely integrable nonlinear Schrödinger equation whose dispersive coefficient depends on LRI's parameter. Inhomogeneities have introduced perturbation terms in the equation of motion of RNAP-DNA dynamics. Considering the homogeneous part of that equation, a detailed study of the solution shows that the number of base pairs which form the bubble, the height, and the width of that bubble depend on the long-range parameter. The results of the perturbation analysis show that the inhomogeneities due to the DNA and RNAP structures do not alter the velocity and amplitude of the soliton, but introduce some fluctuations in the localized region of the soliton. The events that happen in the present study may represent binding of an RNAP to a promoter site in the DNA during the transcription process.

Dimethylsulphopropionate (DMSP) and proline from the surface of the brown alga Fucus vesiculosus inhibit bacterial attachment

It was demonstrated previously that polar and non-polar surface extracts of the brown alga Fucus vesiculosus collected during winter from the Kiel Bight (Germany) inhibited bacterial attachment at natural concentrations. The present study describes the bioassay-guided identification of the active metabolites from the polar fraction. Chromatographic separation on a size-exclusion liquid chromatography column and bioassays identified an active fraction that was further investigated using nuclear magnetic resonance spectroscopy and mass spectrometry. This fraction contained the metabolites dimethylsulphopropionate (DMSP), proline and alanine. DMSP and proline caused the anti-attachment activity. The metabolites were further quantified on the algal surface together with its associated boundary layer. DMSP and proline were detected in the range 0.12-1.08 ng cm(-2) and 0.09-0.59 ng cm(-2), respectively. These metabolites were tested in the concentration range from 0.1 to 1000 ng cm(-2) against the attachment of five bacterial strains isolated from algae and sediment co-occurring with F. vesiculosus. The surface concentrations for 50% inhibition of attachment of these strains were always <0.38 ng cm(-2) for DMSP and in four cases <0.1 ng cm(-2) for proline, while one strain required 1.66 ng cm(-2) of proline for 50% inhibition. Two further bacterial strains that had been directly isolated from F. vesiculosus were also tested, but proved to be the least sensitive. This study shows that DMSP and proline have an ecologically relevant role as surface inhibitors against bacterial attachment on F. vesiculosus.