Pattern of Glomerular Disease in a Tertiary Care Hospital of Bangladesh

Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.

Impact of Myocardial Blush Grade on In-Hospital Outcome after Primary Percutaneous Coronary Intervention

Primary percutaneous coronary intervention (PPCI) is the optimal reperfusion strategy in patients with ST elevation Myocardial Infarction (STEMI). However, despite achieving TIMI 3 flow after PPCI, some patients have less optimal perfusion at the myocardial tissue level, as assessed by Myocardial Blush Grade (MBG) and consequently show adverse outcome. This prospective observational study was performed in the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from March 2016 to February 2017. Total 74 patients with STEMI who underwent primary PCI and achieved TIMI 3 flow were included among them 37 patients were taken with low MBG (grade 0 or 1) in Group I and other 37 patients with high MBG (grade II or III) were taken in Group II. Mean age of Group I and Group II were 53.70±9.17 and 51.49±9.41 years respectively (p=0.536). Male to female ratio was 5.7:1. Smoking (59.5% versus 35.1%, p=0.036) and diabetes mellitus (43.2% versus 18.9%, p=0.024) were significantly higher in low MBG group than high MBG group. Multi vessel involvement (24.3% versus 5.4%, p=0.022) and anterior MI (72.9% versus 51.4%, p=0.047) were significantly higher in low MBG group. LVEF was significantly lower in low MBG group than high MBG group (49.92?6.60% versus 58.84?4.55%, p=0.003). Among the complications acute heart failure was found significantly higher in low MBG group than high MBG group (8.1% versus 0.0%, p=0.048) along with total adverse in hospital outcome (24.3% versus 5.4%, p=0.041). In study population total mortality was 2.7% and all were in low MBG group (5.4%). Multivariate logistic regression analysis showed MBG was an independent predictor of adverse in hospital outcome after PPCI (OR 6.553, 95% CI 1.984-21.643, p=0.002). Low MBG is associated with more adverse in hospital outcome after PPCI. So, along with TIMI 3 flow following PPCI we have to assess MBG for evaluation of complete reperfusion and further outcome.

Functional Outcome of Bilateral Total Knee Replacement in Advanced Osteoarthritis in Simultaneous Versus Staged Procedure

Osteoarthritis (OA) is a chronic, progressive disease involving the degeneration of cartilage and joint tissue, resulting in pain and disability. Bilateral total knee arthroplasty (TKA) is is an effective intervention that improves quality of life, reduces pain and increases functional capability. This study was performed to compare the functional outcomes between staged and simultaneous total knee arthroplasty. This prospective interventional study was carried out in Arthroscopic and Arthroplasty unit of BSMMU, Dhaka from January 2017 to December 2018. A total of 60 OA patients underwent TKA were included in this study. Thirty patients underwent simultaneous TKA procedure and 30 patients underwent staged TKA procedures performed with 1-6 months between stages were included. Pre-operative and post operative data were collected. Data were analyzed using SPSS 12.0. Numerical data were analyzed using unpaired t test and categorical data were analyzed using Chi-Square test. A value of p<0.05 was considered statistically significant. Mean age of the study subjects was 60.47±10.13 years in staged group and 59.30±9.90 years in simultaneous group. Male to female ratio was 1:1.5 in staged group and 1:2 in simultaneous group. Mean BMI of the study subjects was 30.70±4.91kg/m² in staged group and 30.06±4.79kg/m² in simultaneous group (p>0.05). In both groups, maximum study subjects were housewife (33.3% vs. 33.3%). In staged group 13.3% and 16.7% in simultaneous group were heavy worker; 20.0% in staged group and 16.7% in simultaneous group were medium worker (p>0.05). Pain, motion, stability and function were significantly changed after surgery comparing before surgery.Infection was observed in 10.0% cases in both groups. Stiffness was observed in 10.0% cases in staged group but in 6.7% cases in simultaneous group. Even final outcome showed better in simultaneous procedure, there was no significant difference between two procedures. The outcome of both simultaneous andstaged procedure of bilateral total knee replacement in Advanced Osteoarthritis is similar.

Measurement of the Cross Sections of Ξ_{c}^{0} and Ξ_{c}^{+} Baryons and of the Branching-Fraction Ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+}) in pp Collisions at sqrt[s]=13 TeV

The p_{T}-differential cross sections of prompt charm-strange baryons Ξ_{c}^{0} and Ξ_{c}^{+} were measured at midrapidity (|y|<0.5) in proton-proton (pp) collisions at a center-of-mass energy sqrt[s]=13  TeV with the ALICE detector at the LHC. The Ξ_{c}^{0} baryon was reconstructed via both the semileptonic decay (Ξ^{-}e^{+}ν_{e}) and the hadronic decay (Ξ^{-}π^{+}) channels. The Ξ_{c}^{+} baryon was reconstructed via the hadronic decay (Ξ^{-}π^{+}π^{+}) channel. The branching-fraction ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+})=1.38±0.14(stat)±0.22(syst) was measured with a total uncertainty reduced by a factor of about 3 with respect to the current world average reported by the Particle Data Group. The transverse momentum (p_{T}) dependence of the Ξ_{c}^{0}- and Ξ_{c}^{+}-baryon production relative to the D^{0} meson and to the Σ_{c}^{0,+,++}- and Λ_{c}^{+}-baryon production are reported. The baryon-to-meson ratio increases toward low p_{T} up to a value of approximately 0.3. The measurements are compared with various models that take different hadronization mechanisms into consideration. The results provide stringent constraints to these theoretical calculations and additional evidence that different processes are involved in charm hadronization in electron-positron (e^{+}e^{-}) and hadronic collisions.

Expression analysis of transcription factors in sugarcane during cold stress

Transcription factors (TF) are a wide class of genes in plants, and these can regulate the expression of other genes in response to various environmental stresses (biotic and abiotic). In the current study, transcription factor activity in sugarcane was examined during cold stress. Initially, RNA transcript reads of two sugarcane cultivars (ROC22 and GT08-1108) under cold stress were downloaded from SRA NCBI database. The reads were aligned into a reference genome and the differential expression analyses were performed with the R/Bioconductor edgeR package. Based on our analyses in the ROC22 cultivar, 963 TF genes were significantly upregulated under cold stress among a total of 5649 upregulated genes, while 293 TF genes were downregulated among a total of 3,289 downregulated genes. In the GT08-1108 cultivar, 974 TF genes were identified among 5,649 upregulated genes and 283 TF genes were found among 3,289 downregulated genes. Most transcription factors were annotated with GO categories related to protein binding, transcription factor binding, DNA-sequence-specific binding, transcription factor complex, transcription factor activity in RNA polymerase II, the activity of nucleic acid binding transcription factor, transcription corepressor activity, sequence-specific regulatory region, the activity of transcription factor of RNA polymerase II, transcription factor cofactor activity, transcription factor activity from plastid promoter, transcription factor activity from RNA polymerase I promoter, polymerase II and RNA polymerase III. The findings of above results will help to identify differentially expressed transcription factors during cold stress. It also provides a comprehensive analysis of the regulation of the transcription activity of many genes. Therefore, this study provides the molecular basis for improving cold tolerance in sugarcane and other economically important grasses.

Λ_{c}^{+} Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV at the LHC

The prompt production of the charm baryon Λ_{c}^{+} and the Λ_{c}^{+}/D^{0} production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. These new measurements show a clear decrease of the Λ_{c}^{+}/D^{0} ratio with increasing transverse momentum (p_{T}) in both collision systems in the range 2<p_{T}<12  GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/π and Λ/K_{S}^{0}. At low p_{T}, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e^{+}e^{-} and e^{-}p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies.

Experimental Evidence for an Attractive p-ϕ Interaction

This Letter presents the first experimental evidence of the attractive strong interaction between a proton and a ϕ meson. The result is obtained from two-particle correlations of combined p-ϕ⊕ p[over ¯]-ϕ pairs measured in high-multiplicity pp collisions at sqrt[s]=13  TeV by the ALICE Collaboration. The spin-averaged scattering length and effective range of the p-ϕ interaction are extracted from the fully corrected correlation function employing the Lednický-Lyuboshits approach. In particular, the imaginary part of the scattering length vanishes within uncertainties, indicating that inelastic processes do not play a prominent role for the p-ϕ interaction. These data demonstrate that the interaction is dominated by elastic p-ϕ scattering. Furthermore, an analysis employing phenomenological Gaussian- and Yukawa-type potentials is conducted. Under the assumption of the latter, the N-ϕ coupling constant is found to be g_{N-ϕ}=0.14±0.03(stat)±0.02(syst). This work provides valuable experimental input to accomplish a self-consistent description of the N-ϕ interaction, which is particularly relevant for the more fundamental studies on partial restoration of chiral symmetry in nuclear medium.

Depression, Anxiety and Stress among the Students and Their Academic Performance in Selected Medical Colleges of Bangladesh

Medical education is associated with a great psychological distress that affects many aspects of students' lives, including their academic performance and professional development. The objective of the study was to determine the level of depression, anxiety and stress and their academic performance among fifth year medical students. This was a cross-sectional descriptive study conducted in Dhaka Medical College, Mymensingh Medical College, Anwar Khan Modern Medical College and Community Based Medical College of Bangladesh. For this purpose, 359 students were taken as sample and self-administered semi-structured questionnaire was used to collect data. Depression, anxiety and stress were assessed by using short form DASS-21 BV score. The results showed that, the mean age of students was 22.74 years with female predominance 230(64.0%). Majority 319(88.9%) of the respondents' parents monthly income was ≤100000 taka and one third 126(35.1%) respondents' monthly study expenditure was in between 5001 to 10000 taka. Four fifth 317(88.0%) of the respondents came from nuclear type of family and two third 245(68.2%) lived in hostel. Half 178(50.0%) of the respondents were eldest in birth order. Majority 221(61.6%) of the students were admitted to medical college by their own motivation and interest. Symptoms of depression, anxiety and stress were present in 179(49.9%), 215(59.9%) and 161(44.8%) respectively. No significant association was found between academic performance with depression or anxiety or stress, except class attendance of Gynaecology and Obstetrics which was significantly associated with stress (p=0.016); the students who suffered from more stress, their class attendance were very poor. Students who reappeared in MBBS professional examination were significantly associated with depression (p=0.032) and stress (p=0.036). There was significant difference between students of public and private medical colleges in terms of anxiety (p=0.031) that is students of public medical colleges more suffered from depression, anxiety and stress in comparison to private medical colleges. Depression (p=0.001) and anxiety (p=0.010) were significantly associated with motivation to study MBBS. No significant difference of depression, anxiety or stress was found with sex difference. This study revealed that fifth year MBBS students suffered more from depression, anxiety and stress. The causes of depression, anxiety and stress should be identified and resolved to improve their mental health and academic performance.

Characterization of wheat-Thinopyrum bessarabicum genetic stock for stripe rust and Karnal bunt resistance

Utilization of modern breeding techniques for developing high yielding and uniform plant types ultimately narrowing the genetic makeup of most crops. Narrowed genetic makeup of these crops has made them vulnerable towards disease and insect epidemics. For sustainable crop production, genetic variability of these crops must be broadened against various biotic and abiotic stresses. One of the ways to widen genetic configuration of these crops is to identify novel additional sources of durable resistance. In this regard crops wild relatives are providing valuable sources of allelic diversity towards various biotic, abiotic stress tolerance and quality components. For incorporating novel variability from wild relative's wide hybridization technique has become a promising breeding method. For this purpose, wheat-Th. bessarabicum amphiploid, addition and translocation lines have been screened in field and screen house conditions to get novel sources of yellow rust and Karnal bunt resistant. Stripe rust screening under field conditions has revealed addition lines 4JJ and 6JJ as resistant to moderately resistant while addition lines 3JJ, 5JJ, 7JJ and translocation lines Tr-3, Tr-6 as moderately resistant wheat-Thinopyrum-bessarabicum genetic stock. Karnal bunt screening depicted addition lines 5JJ and 4JJ as highly resistant genetic stock. These genetic stocks may be used to introgression novel stripe rust and Karnal bunt resistance from the tertiary gene pool into susceptible wheat backgrounds.

Multiharmonic Correlations of Different Flow Amplitudes in Pb-Pb Collisions at sqrt[s_{NN}]=2.76 TeV

The event-by-event correlations between three flow amplitudes are measured for the first time in Pb-Pb collisions, using higher-order symmetric cumulants. We find that different three-harmonic correlations develop during the collective evolution of the medium when compared to correlations that exist in the initial state. These new results cannot be interpreted in terms of previous lower-order flow measurements since contributions from two-harmonic correlations are explicitly removed in the new observables. A comparison to Monte Carlo simulations provides new and independent constraints for the initial conditions and system properties of nuclear matter created in heavy-ion collisions.

Soft-Dielectron Excess in Proton-Proton Collisions at sqrt[s]=13 TeV

A measurement of dielectron production in proton-proton (pp) collisions at sqrt[s]=13  TeV, recorded with the ALICE detector at the CERN LHC, is presented in this Letter. The data set was recorded with a reduced magnetic solenoid field. This enables the investigation of a kinematic domain at low dielectron (ee) invariant mass m_{ee} and pair transverse momentum p_{T,ee} that was previously inaccessible at the LHC. The cross section for dielectron production is studied as a function of m_{ee}, p_{T,ee}, and event multiplicity dN_{ch}/dη. The expected dielectron rate from hadron decays, called hadronic cocktail, utilizes a parametrization of the measured η/π^{0} ratio in pp and proton-nucleus collisions, assuming that this ratio shows no strong dependence on collision energy at low transverse momentum. Comparison of the measured dielectron yield to the hadronic cocktail at 0.15<m_{ee}<0.6  GeV/c^{2} and for p_{T,ee}<0.4  GeV/c indicates an enhancement of soft dielectrons, reminiscent of the "anomalous" soft-photon and soft-dilepton excess in hadron-hadron collisions reported by several experiments under different experimental conditions. The enhancement factor over the hadronic cocktail amounts to 1.61±0.13(stat)±0.17(syst,data)±0.34(syst,cocktail) in the ALICE acceptance. Acceptance-corrected excess spectra in m_{ee} and p_{T,ee} are extracted and compared with calculations of dielectron production from hadronic bremsstrahlung and thermal radiation within a hadronic many-body approach.

Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study

Eosinophilic esophagitis (EoE) is a disease of modern era. It was first described 40 years back. Since then it has drawn an immense interest among the clinicians. It is diagnosed by the presence of eosinophils count ≥15/HPF on esophageal biopsied mucosa in patients with symptoms of esopohageal dysfunction. It is more prevalent among patients with gastroesophageal reflux disease. As its symptoms overlap with that of gastroesophageal reflux disease (GERD), it is frequently overlooked & misdiagnosed which increases patients' sufferings. No data is available in Bangladesh. The objective of the study was to find out the frequency of eosinophilic esophagitis among patients with gastroesophageal reflux symptoms. The study was conducted at the Outpatient department of the department of Gastroenterology of Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2018 to April 2019. One hundred and thirty three (133) consecutive patients with symptoms suggestive of gastroesophageal reflux disease based on validated questionnaire underwent upper GI endoscopy. Biopsies were taken from proximal and distal esophagus as well as any other endoscopically abnormal esophageal mucosal lesion. Among 133 patients with gastroesophageal reflux symptoms, 7 patients (5.3%) were found to be positive for eosinophilic esophagitis. Mean age at diagnosis was 37.28±13.38 years. It was more common in younger age group. Female patients (56%) were more than male patients (44%). Heart burn was the major symptom followed by acid regurgitation. Nocturnal cough showed statistically significant relationship with eosinophilic esophagitis. Although the frequency is low, it may be considered as a differential diagnosis among patients with GERD.

Outcome of Danis-Weber Type-B ankle fracture treated by Pre-contoured Distal Fibular Locking Plate

Danis-Weber type-B ankle fracture is one of the most common injuries in young and active individual. This fracture offers a considerable challenge to orthopedic surgeon. Though there are several options for treating such type of fracture, ORIF by Pre-contoured Distal Fibular Locking Plate is the preferred option in the recent years. This descriptive type of observational study was performed from July 2017 to June 2019 in NITOR. Thirty (30) patients, 22 male and 8 female with an average age of 39 years with Danis-Weber type-B ankle fracture underwent ORIF by Pre-contoured Distal Fibular Locking Plate for fractured fibula and ORIF by 4.0mm cannulated cancellous screw for fractured medial malleolus. All the patients were initially managed by analgesic and short leg posterior slab. Average follow up was 24 weeks. Final outcome was assessed by AOFAS score. The main cause of injury was RTA (56.67%). Mean operation time was 1.2 hours. Mean duration of Hospital stay was 16.43±1.73 days. Superficial infection was in 3.33% and skin necrosis in 3.33% patient. Mean duration of radiological healing was 12.73±0.39 weeks. At final follow up, mean dorsi flexion was 10.93°±0.357° and plantar flexion was 50.93°±0.357°. Ninety percent (90%) patient had no difficulties in walking on any surface; 96.67% patient had stable ankle hind foot; 86.67% patient had good. Ten percent (10%) had fair and 3.33% patient had poor alignment of foot. The mean score in this study was 88.67±2.31. Satisfactory outcome was observed in 86.67% patients and 13.33% had unsatisfactory results. On the basis of results in the present study, it can be concluded that treatment of Danis-Weber type-B ankle fracture by Pre-contoured Distal Fibular Locking Plate is an effective and reliable method.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Effect of different protein based feed on the growth of mahseer

For the proper growth of fish, it is necessary to feed the fish with a proper and balanced diet. A study was conducted to find out the effect of different protein-based diets on fingerlings of Tor putitora (mahseer). A feed with dietary protein levels of 35%, 40%, 45%, and 50% were prepared. The effect of different protein-based feed on weight gain, standard growth rate (SGR), food conversion ratio (FCR), percent weight gain, food conversion efficiency (FCE), and protein efficiency ratio (PER) was studied. An increase was observed in the growth rate with an increase in protein concentration up to 45%. The fingerlings fed a 45% protein diet shown the highest growth, followed by 50%, 40%, and 35%. The SGR value was greatest for 45% protein diet (8.56) followed by 50% and 40%, while the least values were observed for 35% protein feed (1.57). The same trend was observed for FCE. The highest PER values was observed in fishes fed 45% protein-based feed (0.65) followed by 50% (0.56), 40% (0.38) and35% (0.17). The food conversion ratio was lowest for 45% protein diet (3.41), while the greatest for 35% protein feed (16.85). It was concluded that a 45% protein-based diet was the best feed formulation for higher production of Tor putitora. However, research on the same percentage of protein diet is recommended for yearlings.

Elliptic Flow of Electrons from Beauty-Hadron Decays in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The elliptic flow of electrons from beauty hadron decays at midrapidity (|y|<0.8) is measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The azimuthal distribution of the particles produced in the collisions can be parametrized with a Fourier expansion, in which the second harmonic coefficient represents the elliptic flow, v_{2}. The v_{2} coefficient of electrons from beauty hadron decays is measured for the first time in the transverse momentum (p_{T}) range 1.3-6  GeV/c in the centrality class 30%-50%. The measurement of electrons from beauty-hadron decays exploits their larger mean proper decay length cτ≈500  μm compared to that of charm hadrons and most of the other background sources. The v_{2} of electrons from beauty hadron decays at midrapidity is found to be positive with a significance of 3.75  σ. The results provide insights into the degree of thermalization of beauty quarks in the medium. A model assuming full thermalization of beauty quarks is strongly disfavored by the measurement at high p_{T}, but is in agreement with the results at low p_{T}. Transport models including substantial interactions of beauty quarks with an expanding strongly interacting medium describe the measurement within uncertainties.

Trend of Carcinoma of the Stomach in Relation to Site, Age and Aetiology: Study of 112 Cases in a Tertiary Level Hospital

Stomach cancer is the fourth most common cancer worldwide, but due to its poor prognosis, it is the second most common cause of cancer deaths worldwide. The incidence of carcinoma of gastric cardia is found to be increasing, while that of the antrum is seen to be decreasing. Data from Bangladesh is lacking on this aspect. The objective of this study was to understand the trends of frequency and localization of gastric cancers arising from the gastric cardia, body and antrum of the stomach in population of Bangladesh, which may enable us to identify important high risk populations, prevention strategies, and ultimately best treatment strategies. This cross sectional descriptive hospital record based study was conducted in Mymensingh Medical College Hospital during the period of June 2010 to January 2011. Data were collected from hospital records of 112 cases with carcinoma of stomach, confirmed by histopathology, admitted in Mymensingh Medical College Hospital during January 2007 to June 2010. Data collection, compilation, statistical analyses were performed manually. In this study 54.46% cases are in the age group of 50-60 year, mean age was 57.23 year and standard deviation was 57.37 and the second highest (31.25%) was in the age group of 61-70 year. Incidence of gastric carcinoma predominates in male. In this study 81(72.32%) patients were male and 31(27.68%) patients were female. Male to female ratio is 2.61:1. Majority 80(71.43%) of patients were smoker and 32(28.57%) patients were nonsmoker. Majority of the patients 90(80.36%) came from lower socioeconomic group, 19(16.96%) patients were from middle socioeconomic group and 3(2.68%) patients were from high socio-economic group. There is a link between diet and carcinoma stomach, suggested in various study. Here, 112(100%) took carbohydrate as the staple food. Salt preserved dried fish also was present in a significant number of patients 100(89.29%). Vegetables and fresh fruits were taken by 80(71.42%) patients. Antral region was involved in 65(58.03%) cases. In 28(25%) cases the lesion was in the body of the stomach. Cardiac end of the stomach was involved in only 19(16.97%) cases. Following histopathology, poorly differentiated carcinoma was found in 68(60.71%) patients well differentiated carcinoma in 24(21.43%) and moderately differentiated carcinoma in 20(17.86%) patients. This study found that stomach cancer in Bangladesh showed characteristics which are similar to other nations. As carcinoma stomach is one of the important causes of cancer mortality, and as there is no population based study in our country, further study needed and therefore it remains a major public health concern in need of prevention strategies.

Evaluation of Pre-peritoneal (Sublay) Mesh Repair for Treatment of Ventral Hernia

Ventral hernia after abdominal surgery is a common complication. Several techniques for the repair of ventral hernia have been described from time to time and it is a great challenge for a surgeon. The mesh placement by sublay technique authorized by Rives and Stoppa in Europe has been reported to be effective with low recurrence rate. The objective of this study was to evaluate the efficacy of sublay technique of mesh placement in ventral hernia. This prospective study was carried out in the Department of Surgery, Dhaka Dental College, Bangladesh from January 2017 to December 2018. A total of 21 patients with ventral hernia were included in this study. Data collected in data collection sheet regarding demographic data, severity of symptoms and post operative complains of patients which were then analyzed. Age ranged from 21-60 years. Male were 5(23.80%) and female were 16(76.20%). Dragging pain were 7(33.33%), irreducibility were 4(19.05%) but swelling were 100%. Incisional hernia was 18(85.71%) and para-umbilical hernia was 3(14.29%). Post-operative complication were seroma1 (4.76%), major wound infection 1(4.76%), minor infection 1(4.76%) but no recurrence. Sublay mesh repair in ventral hernia was found to be a better and effective technique with minimal complication rate.

Relation between Serum Magnesium Level and Migraine

Migraine is one of the most disabling types of headache. It affects 4-6% of men and 13-18% of women; more than 80% of them are under 30 years. Many theories to explain mechanism of migraine are present; role of serum magnesium is one of them. This Cross-sectional analytical study was designed to see serum magnesium level status of migraine patients in Bangladesh and to find out any relation. The study was carried out in Outpatient Department of Neurology of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2017 to September 2018. Seventy (70) patients between 18-60 years of both sexes with headache fulfilling the criteria for migraine were enrolled as migraine group. Patients with headache who did not fulfill the criteria of migraine enrolled as non migraine group. Patients were included in both groups after exclusion of structural lesions, magnesium containing drug intake, pregnancy, menstruation, alcoholism, renal or GIT problems. Serum magnesium levels were studied in both groups and compared with each other. All related factors such as age, sex, family history of migraine, occupation were assessed. Fifty one (51) of 70 patients (72.85%) was female and 19(27.15%) were male in migraine group. Thirty eight (54.28%) of cases were between 18 and 30 years old. Thirty nine (55.71%) of migraine patients had history of similar headache in their family. Severe headache in 51.43% of migraine patients and 30% had more than three attacks per month. Mean serum magnesium level was 1.70 mg/dl in migraine group and 1.85 mg/dl in non migraine group (p=0.001). Serum magnesium level was also lower in severe migraine headache in comparison to mild to moderate headache (p=0.01). No significant difference was found in serum magnesium level compared according to age, sex, frequency of attack and presence or absence of aura. The study concludes that serum magnesium in migraine patients was significantly lower than non migraine group. It was also lower in migraine patient having severe headache in comparison with mild to moderate headache, though in both conditions they were within normal range.

Diversity of Vibrio parahaemolyticus in marine fishes of Bangladesh

AIMS

To determine the occurrence, diversity, antibiotic resistance and biofilm formation of Vibrio parahaemolyticus isolated from marine fishes in Bangladesh.

METHODS AND RESULTS

A total of 80 marine fishes were obtained from the local markets and examined for the presence of V. parahaemolyticus. All the isolated V. parahaemolyticus were characterized for the presence of virulence markers, thermostable direct hemolysin (TDH) or thermostable direct hemolysin related hemolysin (TRH). Isolates were serotyped and further characterized by enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) typing to analyse the genetic diversity. Moreover, biofilm formation and antibiotic resistance patterns were also determined. About 63·75% (51/80) of the tested marine fishes were contaminated with V. parahaemolyticus. From the contaminated fishes, 71 representatives V. parahaemolyticus were isolated and none of them harboured tdh and trh virulence genes. Nine different O-groups and seven different K-types were found by serological analysis and the dominant serotype was O5:KUT. In ERIC-PCR analysis, eight clusters (A-H) were found and the most common pattern was A (46·5%). All of the isolates were resistant to ampicillin and 78·9% of isolates were resistant to streptomycin. The highest biofilm formation was found at 37°C compared to 25°C and 4°C.

CONCLUSION

Diverse V. parahaemolyticus are present in marine fishes in the local market of Bangladesh with antibiotic-resistant properties and biofilm formation capacity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The widespread prevalence of diverse V. parahaemolyticus in marine fishes is an issue of serious concern, and it entails careful monitoring to ascertain the safety of seafood consumers.

Evaluation of microbial contamination level and the drug susceptible pattern of the isolates cultivated from famous dessert food

Present study endeavored to evaluate the microbial contamination level along with their drug resistant pattern in some popular desert food items collected from different food shops in Dhaka city, Bangladesh. The microbial evaluation was conducted through conventional cultural methods and drug susceptibility test was executed through disc diffusion method. All the samples were found to be contaminated with heterotrophic bacteria as well as fungi within the range of 103 to 105 CFU/g. In case of specific microflora, the growth of Staphylococcus spp. was very high in sweet, faluda, milk cake and ice cream as estimated up to 105 CFU/g, halua and sweet yogurt showed 104 CFU/g while rest of the samples revealed 103 CFU/g. E. coli was found only in faluda and ice cream up to 103 CFU/g whereas Klebsiella spp. was estimated in all the samples within the range of 102 CFU/g to 105 CFU/g. Salmonella spp., Pseudomonas spp. and Bacillus spp. were totally absent in all the samples. Most of the isolates were found to be resistant against most of the antibiotics. Meanwhile, streptomycin (10 µg), gentamicin (10 µg), azithromycin (15 µg), and nalidixic acid (5 µg) were effective drug against both E. coli and Staphylococcus spp.

Anorectal Malformations and Associated Anomalies in Children

Anorectal malformations (ARM) incorporate a broad spectrum of diseases, can affect both sexes, and involve the distal anus and rectum as well as the uro-genital tracts. Defects range from the minor which can be treated easily with an excellent outcome, to those are complex and often associated with other anomalies are difficult to manage with poor functional prognosis. This study was done to observe the hospital incidence of Anorectal malformations, frequency of types, sex distribution and spectrum of associations with ARM. The effects of presence of associated anomalies on morbidity and mortality also observed. Detailed history, clinical examinations and relevant investigations were performed for the primary and as well as the associated anomalies. A total of 80 patients were admitted in the department of pediatric surgery in Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Age of the patients was ranging from 1-180 days with the mean age of 0.49±1.002 months. Male: Female ratio was 1.6: 1. Among them 48(60%) were high and 32(40%) were low variety of ARM. In male 37(46.2%) had high and 13(13.7%) were low variety whereas in female 11(13.7%) were high and 19(23.7%) had low ARM. Associated anomalies were seen in 25(31.2%) patient -18 in males and 7 in females; 20 in high and 5 in low ARM. Associated anomalies were uro-genital 11(13.8%), cardiovascular 10(12.5%), vertebral 4(5%), limb defects 3(3.5%) and others 2(2.5%). Four patients have more than one anomaly. Anorectal malformations occur more in boys than girls. Males were more likely to have high lesions and without fistula was the common defect. Low variety ARM were found more in females with Anovestibular fistula is the commonest defect. The most common associated anomalies were recto urinary fistula (13.8%). Associations were more in high than low ARM but not significant (p>0.05). Post operative complications were more in high ARM in both sexes with associated anomalies. The effects of types and associations on morbidity and mortality were significantly different (p<0.05).

Prediction of Esophageal Varices in Chronic Liver Disease by Liver Stiffness-Spleen Size-to-Plalelet Ratio Risk Score

Non-invasive tools are needed to rule out the presence of esophageal varices (EV) in patients with chronic liver disease. The aim of this study was to evaluate diagnostic accuracy of Liver stiffness-spleen size-to-platelet ratio (LSPS) for EV detection and identification of high risk EV in patients with CLD. A total of 70 patients with CLD irrespective of the etiology attending at OPD and admitted in Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD) of BIRDEM General Hospital, Dhaka, Bangladesh from January 2016 to October 2017 were enrolled in this observational cross-sectional study. All patients underwent routine laboratory tests, liver function tests, ultrasonography, liver stiffness (LS) measurement and esophagogastroduodenoscopy. Clinical value of LSPS was compared with platelet count, spleen size and LS for detection of esophageal varices. Diagnostic accuracy was assessed by the Area under the receiver operating characteristic (AUROC) curve. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ROC curve. LSPS has better diagnostic accuracy for detection of EV in terms of AUROC, showing superiority over each factor alone. LSPS also detect high risk EV but accuracy was lower than detection of EV. The optimal cutoff values of LSPS for EV and high risk EV were 0.879 and 4.132 respectively, at which AUROC, negative predictive value, and accuracy were 0.910 [95% confidence interval (CI) 0.832-0.988], 90.9% and 90.0% and 0.695 (95% CI 0.520-0.870), 62.5% and 69.4% respectively. LSPS represents a useful, noninvasive method to detect EV and a high risk EV in patients with CLD. Clinicians should recommend those patients with CLD who show higher values of LSPS to undergo further endoscopic examination.

Outcome of Stapled Hemorrhoidopexy: Experience of 90 Cases

Hemorrhoidal disease is one of the commonest anorectal problems in worldwide. Stapled hemorrhoidopexy is the treatment choice due to less post-operative pain and early recovery. The aim of this study was to assess outcomes after Stapled hemorrhoidopexy (SH). This cross-sectional prospective study was performed in Shaheed Suhrawardy Medical College Hospital, Dhaka from January 2016 to December 2017. Ninety patients with symptomatic hemorrhoidal diseases were included in this study. Data collected in data collection sheet regarding demographic data, severity of symptoms, post-operative complains of patient and outcome of patients which were then analyzed. Total 90 patients were included in this study. Age ranged from 18-50 years. Male were 59(65.56%) and female were 31(34.44%). 2° hemorrhoids were 11(12.22%), 3° hemorrhoids were 63(70%), 4° hemorrhoids were 16(17.78%). Post-operative complications were mild pain 73(81.11%), moderate pain 13(14.45%), severe pain 4(4.44%), early bleeding 23(25.56%), retention of urine 16(17.78%), early urgency 15(16.67%), infection 4(4.44%), constipation 9(10%), late recurrence 4(4.44%). Outcomes of stapled hemorrhoidopexy were satisfactory in most patients. Early recovery, low complication rate, minimal post-operative pain was encountered in treatment of symptomatic hemorrhoids by stapled hemorrhoidopexy.