The Tulip GT® airway versus the facemask and Guedel airway: a randomised, controlled, cross-over study by Basic Life Support-trained airway providers in anaesthetised patients

We performed a randomised, controlled, cross-over study of lung ventilation by Basic Life Support-trained providers using either the Tulip GT® airway or a facemask with a Guedel airway in 60 anaesthetised patients. Successful ventilation was achieved if the provider produced an end-tidal CO2 > 3.5 kPa and a tidal volume > 250 ml in two of the first three breaths, within 60 sec and within two attempts. Fifty-seven (95%) providers achieved successful ventilation using the Tulip GT compared with 35 (58%) using the facemask (p < 0.0001). Comparing the Tulip GT and facemask, the mean (SD) end-tidal CO2 was 5.0 (0.7) kPa vs 2.5 (1.5) kPa, tidal volume was 494 (175) ml vs 286 (186) ml and peak inspiratory pressure was 18.3 (3.4) cmH2 O vs 13.6 (7) cmH2 O respectively (all p < 0.0001). Forty-seven (78%) users favoured the Tulip GT airway. These results are similar to a previous manikin study using the same protocol, suggesting a close correlation between human and manikin studies for this airway device. We conclude that the Tulip GT should be considered as an adjunct to airway management both within and outside hospitals when ventilation is being undertaken by Basic Life Support-trained airway providers.

Identification of bacterial isolates in neonatal sepsis and their antimicrobial susceptibility

A cross-sectional descriptive study was conducted in the Neonatal Intensive Care Unit (NICU) of Ad-din Medical College Hospital during the period of January to December 2011 to determine the pattern of bacterial agents causing neonatal sepsis and their susceptibility pattern to various antimicrobial agents. Blood cultures were performed on admitted newborn babies (0-28 days) to rule out sepsis. Antimicrobial susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Out of 1000 screened blood cultures, 87(8.7%) reported as positive and the gram positive and gram negative bacteria accounted for 21(24.1%) and 66(75.9%) respectively. The most common gram positive organisms were Coagulase Negative Staphylococcus Aureus (CONS) (18.4%) and Staphylococcus Aureus (4.6%) and gram negative organisms were Acinetobacter (34.4%), Pseudomonas (21.8%) and Klebsiella spp. (6.9%). The susceptibilities were remarkably low to Ampicillin (20%) and Cefotaxim (29.6%) for both gram positive & gram negative isolates. Gram positive group had susceptibilities of 71.1% to Gentamicin, 85.7% to Imipenem & 100% to Amikacin & Vancomycin. Gram negative isolates showed higher sensitivities to Colistin (96.9%), Piperacillin-Tazobactum (78.7%), Imipenem (74.2%), Levofloxacillin (71.2%), respectively. Gram-negative bacteria showed high level of resistance to commonly used antibiotics (Ampicillin, Ceftazidim and Cefotaxim). Gentamicin, Amikacin, Imipenem and Levofloxacin were the most effective drugs compared to others. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care.

A pilot study to examine the effect of the Tulip oropharyngeal airway on ventilation immediately after mask ventilation following the induction of anaesthesia

The Tulip airway is an adult, disposable, single-sized oropharyngeal airway, that is connectable to an anaesthetic circuit. After a standardised induction of anaesthesia in 75 patients, the ease of insertion, intracuff pressure and intracuff volume were measured, as were the end-tidal carbon dioxide levels, airway pressures and tidal volumes over three breaths. Successful first-time insertion was achieved in 72 patients (96%, CI 88.8-99.2%) and after two attempts in 74 patients (99%, CI 92.8-100%). There was outright failure only in one patient. In 60 patients (80%, CI 72.2-90.4%), the Tulip airway provided a patent airway without additional manoeuvres, but in 14 patients, jaw thrust or head extension was necessary for airway patency. The main need for these adjuncts appeared to be an initial under-inflation of the cuff. These promising results are consistent with recent manikin studies using this device.

Liposome encapsulation of curcumin: physico-chemical characterizations and effects on MCF7 cancer cell proliferation

The role of curcumin (diferuloylmethane), for cancer treatment has been an area of growing interest. However, due to its low absorption, the poor bioavailability of curcumin limits its clinical use. In this study, we reported an approach of encapsulation a curcumin by nanoliposome to achieve an improved bioavailability of a poorly absorbed hydrophobic compound. We demonstrated that liposomal preparations to deliver curcumin increase its bioavailability. Liposomes composed of salmon's lecithin also improved curcumin bioavailability compared to those constituted of rapeseed and soya lecithins. A real-time label-free cell analysis system based on real-time cell impedance monitoring was used to investigate the in vitro cytotoxicity of liposomal preparations.

Bioavailability and plasma concentration of omeprazole in healthy bangladeshi population after ingestion

This cross-sectional observational study was conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Plasma concentration of omeprazole was assayed in the quality control laboratory of Novartis (Bangladesh) Limited, Tongi, Gazipur, Bangladesh. The study was conducted from January 2006 to April 2007 and was designed to find out the bioavailability of omeprazole in capsule form in healthy Bangladeshi population and to compare this with that of the other population in the world. Twelve healthy volunteers were included in this study. The subjects were divided into two groups; six of them were randomly selected in each. One group received 40mg omeprazole intact capsule of one trade and other group received 40mg omeprazole intact capsule of another trade once daily for consecutive 8 days at 8.00 hours on each day. On the first and eight days of dosing, 10ml of blood sample was collected from each subject at 0.0, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 and 6.0 hours after dosing. Blood samples were centrifuged at 2500rpm for 15 minutes and plasma was stored at 20°C. Omeprazole concentration in plasma was determined using a reverse phase high performance liquid chromatography (HPLC). From the concentration, the area under the curve (AUC) of omeprazole was determined for each subject by the trapezoidal rule. From the result it was observed that the plasma concentration of omeprazole was increased up to 6 hours in both trade-A and trade-B in day 1 and 8. Thus the AUC of omeprazole was also increased. But most of the studies in western population showed that the maximum plasma concentration was within 0.5 to 2.0hours indicating a difference from that of western studies. In this study all the subjects exhibited increased plasma concentration and AUC which may be due to genetic variation of omeprazole metabolism as an Asian which may be due to slow or "Poor metabolizers" (PMs), of the study population, who are deficient in CYP2C19. It is revealed that the plasma concentration and AUCs of both the products after single and repeated doses of omeprazole capsule were higher in comparison to other studies in western population.

A simplified technique to determine random coincidence summing of gamma rays and dead time count loss corrections

The loss in counts rate under the peak in gamma spectrum was studied using two techniques (complex spectrum and high active single isotope). The results showed that the loss was occurred when the integrated counting rate was more than 400 counts per second (CPS) up to 10(4)cps, for energy range 20-2,500 keV. This was mainly due to the random summing effect in the detector's volume. It was found that the probability of random summing has increased with the increase of the volume of detector's crystal. The correction factor F(Ct) for the counts rate under the peak was determined experimentally.

Mass attenuation coefficients of soil and sediment samples using gamma energies from 46.5 to 1332 keV

Mass attenuation coefficients of various soil and sediment samples (density range between 1.0 and 1.7 g cm(-3)) collected from 60 sites distributed in Syrian land have been determined for gamma lines of 46.5, 59.5, 88, 122, 165, 392, 661, 1173, and 1332 keV using gamma spectrometry and simulation software program X-com. The average mass attenuation coefficients for the studied samples were found to be 0.513, 0.316, 0.195, 0.155, 0.134, 0.096, 0.077, 0.058, and 0.055 cm(2) g(-1) at previous energies, respectively. The results have shown that Ca and Fe contents of the samples have strong effect on the mass attenuation coefficient at lower energies. In addition, self-attenuation correction factors determined using mass attenuation coefficient was in good agreement with addition spiked reference material method provided that the sample thickness is 2.7 cm. However, mass attenuation coefficients determined in this study can be used for determination of gamma emitters at energy ranges from 46.5 to 1332 keV in any soil and sediment samples having density of 1.0-1.7 g cm(-3).

Renal function impairment in Hypothyroidism

Background: Hypothyroidism is an important public health problem in Bangladesh. It is associated with increased risk for atherosclerosis and other complications. The frank development of hypothyroidism is associated with metabolic derangements including dyslipidemia- which is an etiopathologic factor for development of renal impairment. This study was to evaluate whether hypothyroidism is associated with impaired renal function. Methods: Using a cross sectional analytical study design, a total of 111 subjects attending Out Patient Department, Center for Nuclear Medicine and Ultrasound, Bogra Medical College during January 2007 to December 2007 were included purposively. Eighty newly diagnosed hypothyroid patients (Group I) and 31 healthy adults (Group II) were enrolled in this study. Serum thyroid stimulating hormone and serum free thyroxine were assayed by radioimmunoassay. Serum fasting lipid profile, serum creatinine and serum uric acid were estimated by enzymatic colorimetric method. Estimated GFR was calculated using MDRD equation. Results: The mean (±SD) age of in Group I and Group II were 35.59 (±6.91) and 37.35 (±2.78) years and were comparable. In Group I, there were 66 females and 14 males. In Group II, there were 16 females and 15 males. The mean BMI was 25.49 ±2.17 kg/m2 in Group I and 24.24 ±1.99 kg/m2 in Group II. The mean (±SD) Serum total-cholesterol, LDL- cholesterol and tryacylglycerol in Group I were significantly higher than that in Group II. Serum HDL cholesterol in Group I was significantly lower than that in Group II (p<0.001). The mean (±SD) serum creatinine was significantly higher in Group I than Group II (P<0.001). The estimated glomerular filtration rate (eGFR) was lower in Group I compared to Group II (p=0.011). In Group I (Hypothyroid), there were significant correlations of BMI, S Total-Cholesterol, S HDLCholesterol, S LDL-Cholesterol, S triglycerides and S creatinine with serum TSH level. In Group I (Hypothyroid), there were significant positive correlations of BMI and TSH with serum creatinine. Conclusions: Hypothyroidism is associated with dyslipidemia, hyperuricemia and impaired renal function. Therefore, patients presenting with these biochemical abnormalities are recommended to be investigated for hypothyroidism and vice versa. DOI: http://dx.doi.org/10.3329/bjmb.v6i1.13283 Bangladesh J Med Biochem 2013; 6(1): 19-25

Problems leading to conversion in laparoscopic cholecystectomy

In prospective study, the various reasons for conversion in laparoscopic cholecystectomy were shown and recommended various measures to decrease the incidence of conversion and associated complications with this procedure. Fifty cases of conversion in laparoscopic cholecystectomy were studied in Dhaka Medical College Hospital & Bangabandhu Sheikh Mujib Medical University from July 2002 to July 2004. The commonest cause of conversion was dense pericholecystic adhesion or unclear anatomy (24%). Next common cause was accidental injury to surrounding structures (18%) and uncontrolled bleeding (14%) and thick fibrosed gall bladder (14%). Other causes were gall bladder wall perforation (6%), carcinoma gall bladder (6%) and choledocholithiasis (6%), anatomic variation (4%), equipment failure (4%), cholecystoduodenal fistula (2%) and choledochal cyst (2%). Proper case selection, good laparoscopic skill and adequate experience of the surgeon are the prerequisites for safe laparoscopic cholecystectomy and thereby reducing conversion rate.

Serum lipid profile in patients with acute myocardial infarction

Serum lipids and lipoproteins were estimated in 29 patients with acute myocardial infarction during acute phase (day 1,2,3), predischarge and after three months. Serum total lipids, total cholesterol (TC) and LDL-cholesterol (LDLc) showed no significant change during the hospital stay and three months followup. HDL-cholesterol (HDLc), however, started falling from day 2 onwards with statistically significant reduction at pre-discharge and remained so at 3 months. The ratios of TC/HDLc and LDLc/HDLc showed significant increase on predischarge day as compared to day 1. Serum triglycerides also showed an increasing trend after myocardial infarction with a significant increase on day 3 and predischarge as compared to day 1. it is concluded that the optimum time for assessment of serum lipid profile in patients with myocardial infarction seems to be within 24 hours of the acute episode.

Clinicopathological profile of patients with abdominal tuberculosis

BACKGROUND

Tuberculosis (TB) is not a uncommon problem throughout the world particularly in the developing countries like Nepal, India and Bangladesh. Abdominal Tuberculosis accounts for nearly 2% of tuberculosis worldwide. The aim of this study was to evaluate the clinicopathological profile with the help of other investigations in the diagnosis of patients with abdominal TB and their response to anti-tubercular therapy. This was a prospective cross-sectional study conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of October 2002 to June 2009.

METHODS

Total 53 patients with abdominal TB diagnosed on the basis of clinical profile and supported investigation data like gross morphological findings at endoscopy, colonoscopy, diagnostic laparoscopy , laparotomy or histologically proven caseating granulomas were selected for this study. Detailed demographic, clinical profile, investigations and treatment response were recorded properly in a predesigned data collection sheet which were analyzed and compared with other studies.

RESULTS

Out of the 53 patients, 33 were males and 20 females with age ranging 16-70 (Mean 30.01±11.7) years. Abdominal pain was the most common presenting symptom in 47 (88.68%), fever in 45 (84.9%) and weight loss in 37 (69.81%) cases. Anemia was found in 41 (77.36%), cachexia 40 (75.47%), ascites 20 (37.74%), palpable abdominal mass in 14 (26.42%) and features of intestinal obstruction in 5 (9.43%) cases. Five patients had positive family history of TB and five had past history of pulmonary TB. The diagnosis of abdominal TB was confirmed microscopically in 5 (9.43%), histopathologically in 31 (58.49%) and the remaining 17 (32.07%) cases were diagnosed by a positive response to anti-TB therapy. According to site of involvement, 31 (58.51%), patients had intestinal TB, 9 (16.98%) had peritoneal TB and disseminated TB in 20 (37.74%) of the case. Twenty seven patients were given 3 drugs regimen for 12 months and 26 patients received 4 drugs regimen for 9 months under close supervision. By 9 months of therapy 51 patients become symptom free and no pathological findings were observed thereafter at follow up visits after 6 months. Response was not satisfactory in two patients and subsequent follow up investigation revealed to have crohn's disease rather than TB and none of them died.

CONCLUSIONS

Abdominal TB is an important clinical entity having varied mode of clinical presentation. So the diagnosis of abdominal TB is difficult and careful approach to the patients and supportive investigation data are necessary to make the final diagnosis. Neither clinical features, laboratory, radiological and Endoscopic methods nor bacteriological and histopathological findings by themselves provide a gold standard in the diagnosis of abdominal TB. In this series of abdominal TB, intestinal TB was the most frequent clinical type and the common presenting symptoms were abdominal pain, fever and weight loss. If diagnosed early, it can be treated successfully with anti-TB drugs.