Study on Neurological Manifestations of Eclampsia & Findings of CT scan of Brain

This cross sectional study was carried out in the Department of Obstetrics & Gynaecology in Mymensingh Medical College Hospital during the period of January 2011 to December 2012 to evaluate neurological manifestations in eclampsia by CT scan of brain. A total 35 patients with eclampsia were studied, who underwent CT scan of brain in Radiology & Imaging Department of Mymensingh Medical College Hospital. The study patients were divided into two groups, those who had changes in brain on CT scan (Group A) & those who had no changes in brain on CT scan (Group B). Finally the study variables were compared between these two groups. Each selected patient fulfilling the criteria was sent to the department of Radiology & Imaging for CT scanning of brain. In antepartum cases of eclampsia CT scan of brain were done after delivery/ termination of pregnancy. In all cases, CT scan of brain was done within 72 hours of admission. Out of 35 patients total 85.72% had changes in brain on CT scan & 14.28% had no changes in brain on CT scan. Among them 45.72% patients had cerebral oedema, 37.14% had cerebral infarct & 2.86% patients had intracerebral haemorrhage. Comparison of neurological parameters were done & showed that there were statistically significant difference between the two groups regarding headache, visual disturbance, hypereflexia & depression of consciousness. There was no statistically significant difference regarding aphasia & hemiplegia between the two groups. So the CT scan of brain has been useful in demonstrating the lesion of brain in patients with eclampsia & also helpful to evaluate the neurological manifestations in eclampsia.

Characteristics and Management of Children with Continuous Spikes and Waves during Slow Sleep

This study was done to describe the clinical spectrum, EEG characteristics and treatment modalities in children with continuous spike and slow wave in sleep (CSWS). Ten patients with CSWS had been treated between 2012 and 2013. Mean age of the patients was 6.9 years; male female ratio was 3:2. The main etiologic group in this study was epilepsy (10), cerebral palsy (3) and brain lesion (arachnoid cyst). All the patients had prior seizure. Presenting features were abnormal behavior (4), agitation (4), aggression (4), eye blinking (2) and involuntary movement (2). Three patients had speech regression and 1 had motor regression. Regarding EEG finding, 7 out 10 cases had SWI>85% whereas, rest of them had SWI 50 to 80%. Most of the patients were resistant to two or more oral AED. The AED found to be efficacious were Midazolam drip, pulse methyl prednisolone and valproate. Eighty percent (80%) patient responded to midazolam drip. Methyl prednisolone caused 50% improvement in one patient but failed in 2 cases. In contrast to the previous studies where high dose valproic acid, levetiracetam, Injection ACTH was more efficacious, this study demonstrates significant positive result with midazolam drip.

Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC.

Particle emissions from microalgae biodiesel combustion and their relative oxidative potential

Microalgae are considered to be one of the most viable biodiesel feedstocks for the future due to their potential for providing economical, sustainable and cleaner alternatives to petroleum diesel. This study investigated the particle emissions from a commercially cultured microalgae and higher plant biodiesels at different blending ratios. With a high amount of long carbon chain lengths fatty acid methyl esters (C20 to C22), the microalgal biodiesel used had a vastly different average carbon chain length and level of unsaturation to conventional biodiesel, which significantly influenced particle emissions. Smaller blend percentages showed a larger reduction in particle emission than blend percentages of over 20%. This was due to the formation of a significant nucleation mode for the higher blends. In addition measurements of reactive oxygen species (ROS), showed that the oxidative potential of particles emitted from the microalgal biodiesel combustion were lower than that of regular diesel. Biodiesel oxygen content was less effective in suppressing particle emissions for biodiesels containing a high amount of polyunsaturated C20-C22 fatty acid methyl esters and generated significantly increased nucleation mode particle emissions. The observed increase in nucleation mode particle emission is postulated to be caused by very low volatility, high boiling point and high density, viscosity and surface tension of the microalgal biodiesel tested here. Therefore, in order to achieve similar PM (particulate matter) emission benefits for microalgal biodiesel likewise to conventional biodiesel, fatty acid methyl esters (FAMEs) with high amounts of polyunsaturated long-chain fatty acids (≥C20) may not be desirable in microalgal biodiesel composition.

Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis of population-based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low- and middle-income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty-two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27), low birthweight (OR, 1.66; 95% CI, 1.50-1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69-2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, caesarean delivery and post-partum haemorrhage. The population-attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre-pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre-eclampsia or pregnancy-induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries.

Moving Beyond Cancer: Immediate Impact on-the Health-Related Quality of Life of Breast Cancer Patients After Mastectomy

During the last decade, survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy. Limited data exist on the post mastectomy quality of life in the process of transition from health to cancer in its different phases of treatment. The aim of current study was to evaluate the changes of health-related quality of life (HRQoL) after mastectomy and to measure their impression about future perspectives in Bangladeshi Breasts cancer patients. A group of 250 women with a diagnosis of primary breast cancer who was admitted in the department of surgical oncology in National Institute of Cancer Research and Hospital, Dhaka were enrolled in this study from January 2012 to March 2013. Two-point interview like pre(MI) and post mastectomy(M2) was taken using the structured questionnaire made by European Organization for Research and Treatment of Cancer (EORTC)- EORTC Q30 and BR23. The mean age of the patients was 44.7?9.87 years, 52.6% were locally advanced. HRQoL scores of breast cancer patients deteriorated after mastectomy, general features like presence of fatigability, nausea, apatite loss, sleeplessness and pain has got tremendous effect on the quality of life(p<.005). Financial difficulties and sleep disorders did not affect much. Four of the Global Health status/QOL parameters like physical functioning, role functioning, emotional functioning, cognitive functioning deteriorated but only physical functioning status affected significantly(p<0.005). Breast symptoms like body image problem, general breast symptoms like pain, arm swelling and sexual feeling affected their (HRQOL) after mastectomy. A diagnosis of cancer and associated treatments affects multiple domains of life. The complicated transitions between health, illness and living with cancer can often be challenged with a preoperative information for the patient confronted with breast cancer should include possible psychological effects of cancer diagnosis, surgery, and other treatment. Breast conservation particularly in the young group may give a better outcome in the treatment protocol of breast cancer patients.

Candida isolates from pregnant women and their antifungal susceptibility in a Malaysian tertiary-care hospital

Objective:

Pregnant women are susceptible to vaginal colonization and infection by yeast. The purpose of the study was to determine the prevalence of Candida spp in high vaginal swabs of pregnant women and their antifungal susceptibility.

Methods:

High vaginal swab samples received from Serdang Hospital, Selangor, Malaysia during 2011 initially had microscopic examination, Gram-staining and fungal culture. These were finally confirmed by growth in chromogenic medium (CHROMagarCandida; Difco BBL, USA) and commercial biochemical identification kit (API 20C AUX; bioMérieux, Lyon, France). Antifungal susceptibility was performed by E-test method.

Results:

Out of 1163 specimens 200 (17.2%) candida spp were confirmed from high vaginal swabs of pregnant women. Candida albicans (83.5%) is the most common species detected followed by Candida glabrata (16%) and Candida famata (0.05%). All C. albicans and C.famata isolates were susceptible to fluconazole while C.glabrata isolates were dose dependent susceptibility. First and second trimester, and diabetes were considered significant factors in patients for the vaginal candidiasis (p < 0.001).

Conclusions:

In pregnant women, C. albicans was the frequently isolated yeast from high vaginal swabs. Routine screening and treatment are important of pregnant women regardless of symptoms.

Parathyroid Carcinoma in a 10 Years Old Female Child

Parathyroid carcinoma (PC) is a rare cause of hypercalcaemia in children. Only 7 cases of PC have been reported so far in the world journal. The authors report the 8th case of parathyroid carcinoma in children less than 16 years of age. A 10 year old girl presented with difficulty in walking, dorsiflexion and ulnar deviation of both wrist joints and occasional pain in the central abdomen of about two years duration. Biochemical investigations revealed serum calcium 12.2 mg/dL (normal 9-11 mg/dL), serum alkaline phosphate 4992 U/L (normal 50-136 U/L), PTH (parathyroid hormone) 2217 pg/ml (normal 9-80 pg/ml). Parathyroid scintigraphy localized the lesion in the left parathyroid gland. X-ray showed bilateral coxa vera, genu valgus deformity and multiple stress fractures in both wrist joints. Histopathology confirmed PC with capsular and vascular invasion.

Scleredema Diabeticorum - A Case Report

Buschke Scleredema is a rare connective tissue disorder of unknown aetiology and characterized by thickening of the dermis. It resembles systemic sclerosis, eosinophilic fasciitis and cutaneous amyloidosis. Scleredema may be associated with a history of an antecedent febrile illness, diabetes mellitus, or blood dyscrasia. It may be classified into three clinical groups, each has a different history, course, and prognosis. Histology of skin is characterized by thickened dermis and increased spaces between large collagen bundles due to increased deposition of mucopolysaccharide in the dermis. Differential diagnosis can be made considering the typical clinical features and the histological peculiarity. No therapy is effective. In this communication we have presented a 54 year old man with scleredema successfully treated by PUVA and methotrexate. We reviewed associated diseases, clinical and histopathological characteristics, evolution and response to treatment.

Giant Retroperitoneal Fibrolipoma - A Case Report

Lipomas are common benign adipose tumours generally located at superficial locations but deep seated lipomas are rather infrequent out of which retroperitoneal location of giant lipoma is rare. Fibrolipoma is one of the uncommon variant of lipoma. There is no different evidence in clinical profile, management, and prognosis of fibro lipoma from other variants of lipomas. Complete surgical excision is the treatment of choice. Here we present a case of 13 year old lady with giant retroperitoneal fibrolipoma which was completely excised through laparotomy. And the patient remains well one year after surgery without recurrence of the disease.

Bickerstaff's Brainstem Encephalitis - A Case Report

A 11 years male child was presented with fever, headache, vertigo, repeated seizure for 8 days. He had also complains of hemiperesis of right side and impaired vision. On examination patient was drowsy and somnolent. Paralysis of circular muscles of eye ball, exaggerated deep reflexes, extensor planter reflexes and right sided ataxia were present. All routine investigations revealed normal findings except CSF showed slight pleocytosis. MRI of brain revealed hyper intensity of midbrain in left side. The diagnosis of Bickerstaff's brainstem encephalitis (BBE) was strongly suggested from the medical history, clinical examination, biochemical and radiological (MRI) findings of brain. The purpose of our report is to highlight this very rare disease to all.

Multivariate analysis of PRISMA optimized TLC image for predicting antioxidant activity and identification of contributing compounds from Pereskia bleo

Multivariate analysis of thin-layer chromatography (TLC) images was modeled to predict antioxidant activity of Pereskia bleo leaves and to identify the contributing compounds of the activity. TLC was developed in optimized mobile phase using the 'PRISMA' optimization method and the image was then converted to wavelet signals and imported for multivariate analysis. An orthogonal partial least square (OPLS) model was developed consisting of a wavelet-converted TLC image and 2,2-diphynyl-picrylhydrazyl free radical scavenging activity of 24 different preparations of P. bleo as the x- and y-variables, respectively. The quality of the constructed OPLS model (1 + 1 + 0) with one predictive and one orthogonal component was evaluated by internal and external validity tests. The validated model was then used to identify the contributing spot from the TLC plate that was then analyzed by GC-MS after trimethylsilyl derivatization. Glycerol and amine compounds were mainly found to contribute to the antioxidant activity of the sample. An alternative method to predict the antioxidant activity of a new sample of P. bleo leaves has been developed.

Testing the interactive effects of carotenoids and polyunsaturated fatty acids on ejaculate traits in the guppy Poecilia reticulata (Pisces: Poeciliidae)

Using the polyandrous livebearing guppy Poecilia reticulata, this study revealed no main effects of carotenoids in the diet on ejaculate traits, but significant main effects of polyunsaturated fatty acids (PUFAs) on sperm viability and weak but significant interacting effects of both nutrients on sperm length. Collectively, these findings not only add evidence that PUFAs are critical determinants of sperm quality, but also provide tentative evidence that for some traits these effects may be moderated by carotenoid intake.

Changes in oxalate and some mineral concentrations of Setaria sphacelata under cutting and uncutting conditions

Oxalate concentration in forage plants is important, because it results mineral deficiency in ruminants. Data on oxalate concentration in forage plants in conjunction with cutting and uncutting conditions throughout the growing period are limited. This study was aimed to investigate the changes in oxalate and some mineral concentrations of setaria (Setaria sphacelata). The plants were harvested at different stages (vegetative, boot, pre-flowering, flowering and seed) of maturity and at about 50 cm in length of regrowth (second to sixth cuttings) for evaluation of soluble oxalate, insoluble oxalate and some mineral concentrations. Soluble oxalate and total oxalate concentrations, as well as mineral concentrations, decreased with advancing maturity. Both oxalate concentrations (soluble or insoluble) were higher in leaf compared to stem. Soluble oxalate and total oxalate concentrations of regrowth were the highest at third cutting and lowest at sixth cutting. Insoluble oxalate concentration of regrowth was almost similar in all cuttings, except for the sixth cutting. The highest concentrations of potassium, sodium and magnesium of regrowth were observed at third cutting, while the highest concentration of calcium was observed at sixth cutting. A relationship between oxalate and mineral concentrations was partially observed. Results suggest that cutting materials of setaria from June to October could achieve oxalate levels that are toxic to ruminants.

Effects of organic extracts and their different fractions of five Bangladeshi plants on in vitro thrombolysis

Background

The increasingly high incidence of ischemic stroke caused by thrombosis of the arterial vessels is one of the major factors that threaten people’s health and lives in the world. The present treatments for thrombosis are still unsatisfactory. Herbal preparations have been used since ancient times for the treatment of several diseases. The aim of this study was to investigate whether herbal preparations possess thrombolytic activity or not.

Methods

An in vitro thrombolytic model was used to check the clot lysis effect of the crude extracts and fractions of five Bangladeshi plant viz., Trema orientalis L., Bacopa monnieri L., Capsicum frutescens L., Brassica oleracea L. and Urena sinuata L. using streptokinase as a positive control and water as a negative control. Briefly, venous blood drawn from twenty healthy volunteers was allowed to form clots which were weighed and treated with the test plant materials to disrupt the clots. Weight of clot after and before treatment provided a percentage of clot lysis.

Results

Using an in vitro thrombolytic model, different fractions of five Bangladeshi medicinal plants namely T. orientalis, B. monnieri, C. frutescens, B. oleracea and U. sinuata showed various range of clot lysis activity. Chloroform fractions of T. orientalis, B. monnieri, C. frutescens, B. oleracea and U. sinuata showed highest significant (P < 0.05 and P < 0.001) clot lysis activity viz., 46.44 ± 2.44%, 48.39 ± 10.12%, 36.87 ± 1.27%, 30.24 ± 0.95% and 47.89 ± 6.83% respectively compared with positive control standard streptokinase (80.77 ± 1.12%) and negative control sterile distilled water (5.69 ± 3.09%). Other fractions showed moderate to low clot lysis activity. Order of clot lysis activity was found to be: Streptokinase > Chloroform fractions > Methanol (crude) extract > Hydro-methanol fractions > Ethyl acetate fractions > n-hexane fractions > Water.

Conclusions

Our study suggests that thrombolytic activity of T. orientalis, B. monnieri and U. sinuata could be considered as very promising and beneficial for the Bangladeshi traditional medicine. Lower effects of other extracts might suggest the lack of bio-active components and/or insufficient quantities in the extract. In vivo clot dissolving property and active component(s) of T. orientalis and B. monnieri for clot lysis could lead the plants for their therapeutic uses. However, further work will establish whether or not, chloroform soluble phytochemicals from these plants could be incorporated as a thrombolytic agent for the improvement of the patients suffering from atherothrombotic diseases.

Syphilis in pregnancy

Syphilis in pregnancy remains an important medical condition due to its consequences. We present two cases of young pregnant women who were diagnosed syphilis during their antenatal visit. The first case was a 29-year-old Malay lady diagnosed with syphilis during the first trimester of pregnancy, while the second case was a 21-year-old Chinese lady diagnosed with syphilis during the third trimester of pregnancy. The diagnosis and management of the syphilis in pregnancy are discussed.

Association of heart rate response with scan and left ventricular function on adenosine stress myocardial perfusion imaging

To evaluate the association of heart rate (HR) response with abnormal scan and/or left ventricular (LV) function in patients undergoing adenosine myocardial perfusion imaging, we prospectively studied 164 consecutive patients who underwent a standard adenosine stress test (without exercise) and myocardial perfusion imaging (MPI) using technetium-99m sestamibi radioisotope. Change in HR was calculated by subtracting HR at rest from peak HR. The percentage change in HR was calculated. All patients underwent stress and resting single photon emission computed tomography (SPECT) imaging. Left ventricular ejection fraction (EF) was calculated using gated SPECT. Mean age was 54 ± 11.7 years and 126 of the patients (72%) were men. We divided the patients into 2 groups: group 1(42 patients, 25%) had normal scans and group 2(122 patients, 74.3%) had abnormal scans; abnormal scans were defined as presence of either fixed defects, reversible defects, or both. Average HR increased by 35 beats/min in the normal scan group compared with 23 beats/min in the abnormal scan group (p=0.002). Sixty four (64) patients (39%) had reduced EF (<45%). This group had an average HR and percentage HR increase of 23 beats/min (27%) compared with an increase of 35 beats/min (38%) in patients with normal EF (p=0.002 and p=0.02, respectively). Thus, a diminished HR response had a significant association with both an abnormal scan and reduced EF on adenosine MPI.

Measurement of Apolipoprotein B May Predict Acute Coronary Syndrome in Hyper-triglyceridemic Young Population

The purpose of this study is to measure apolipoprotein B (ApoB) in hyper-triglyceridemic (HTG) young people of Bangladesh for predicting risk of acute coronary syndrome. This case-control study was carried out in Department of Cardiology, of Mymensingh Medical College Hospital within the period from June 2009 to May 2010. A total 50 case of 18-45 years of age with first attack of acute coronary syndrome admitted in coronary care unit and 50 healthy controls of same age and sex distribution were studied. Twenty (40%) of the studied case and 21(42%) of controls had hyper hyper-triglyceridemia, of those 18(90%) of HTG cases and 12(57.1%) of HTG controls had hyper-ApoB condition. The present study shows significant association of apolipoprotein B as an independent determinant and estimation of ApoB may be an alternative tool for predicting risk of development of acute coronary syndrome in hyper-triglyceridemic young people.

Correlation between Clinical Diagnosis and Colonoscopic Findings of Patients Presented with Lower Gastrointestinal Bleeding

Lower gastrointestinal bleeding is a frequently encountered problem in general medical practice. This bleeding comes from a site distal to ligament of Treitz. But it may also come from upper gastrointestinal tract when it is massive and pass through the stool. This study was intended to explore the causes of lower gastrointestinal bleeding and correlating them with their colonoscopic findings. This study was cross-sectional prospective. Sample was taken purposively. Out of 200 patients which were selected for the study, 122(61%) were male and 78(39%) were female with a male to female ratio of 5:3. The ages of the patients were ranging from 5 to 80 years with the mean age of 41.9±15.0 years; maximum 38(19%) patients were in 51 to 60 years. All patients were presented with per rectal bleeding & underwent colonoscopy & maximum 57(28.5%) patients were diagnosed as hemorrhoids, followed by colorectal cancer in 55(27.5%) cases. In 10(5%) cases of haemorrhoids 2nd pathology was found associated with it. In 32(16%) cases colonoscopic findings were normal. It was concluded that the most common cause of lower gastrointestinal bleeding was hemorrhoids followed by colorectal cancer. But several cases of colon cancer were misdiagnosed clinically as colitis. So clinical diagnosis should be correlated & confirmed by colonoscopy and biopsy.

Experience of Exchange Transfusion in a Newly Established SCANU at a Tertiary Care Hospital in Bangladesh

Hyperbilirubinemia is common in neonates. The value of exchange transfusion (ET) is recognized. The procedure has some risks and complications. This descriptive observational cross sectional study was done in the Neonatology department during the period of January 2013 to December 2013. Total 62 patients were studied. ET was done in 47 patients. Among 47 patients, 29(61.7%) were male and 18(38.3%) were female. The most common cause of ET was Rh incompatibility (46.8%). In order of frequency, major findings were ABO incompatibility (25.5%), unidentified (14.9%), Sepsis (6.4%), minor blood group incompatibility (4.3%) and others (2.1%) respectively. Mean Serum bilirubin level was 22±5.1mg/dl. Most common complications following ET were anemia (12.7%), Sepsis (10.6%), and omphalitis (6.4%). The overall mortality observed was 6.4%. The majority of the adverse events associated with ET were treatable.

Orthodontic management of a young girl with class I malocclusion and severe crowding: a case report

We describe the treatment of a young girl age, 16 years, with Class I malocclusion. Both upper and lower anterior segment of jaws were crowded with buccally placed canines. Treatment consisted mainly of premolars extractions, canine retraction, labeling and alignment with Edgewise fixed appliances by multiloop technique. The patient did not show good cooperation, hence treatment time was prolonged. However the treatment resulted in Class I molar occlusion with proper alignment of both upper and lower anterior segment, an ideal overjet, overbite and incisor angulation.

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.

Mycoplasma infection in Malaysian children: laboratory investigation and antimicrobial therapy

Background: Mycoplasma pneumonia (M. pneumoniae) is an important causative agent of childhood infection with variable clinical presentations. The objective of the study was to evaluate the laboratory investigation and antimicrobial therapy of M. pneumoniae infection in children admitted to paediatric ward. Materials & Methods: A total of 111 children, of which 59 (53.2%) boys and 52 (46.8%) girls, with median age of 2 years (inter quartile range 1-6 years) with suspected M. pneumoniae infection were tested for IgM by enzyme-linked immunosorbent assay (ELISA). The children were classified as seropositive and seronegative. Results: Of the 111 children, 45 (40.5%) had serological evidence of M. pneumoniae infection and the remaining 66 (59.5%) were seronegative. There was significant association (p < 0.001) between age and serology response. Seropositive children were more likely to be older (median age 5.0 [interquartile range 2- 7] years, p < 0.001). Children with M. pneumoniae infection were less likely to have cough (p = 0.023) in which 55 (65.5%) patients having cough were seronegative. There was no significant association between laboratory findings of full blood count and serology. Conclusion: In addition to clinical and laboratory features, other factors like age group and absence of cough might be helpful in predicting M. pneumoniae infection.DOI: http://dx.doi.org/10.3329/bjms.v14i1.21564 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.75-78

Public Health Safety in Relation to Microbiological Quality of Freshly Drawn Cow’s Milk in Bangladesh

The aim of the present study was to determine the microbial quality of freshly drawn cow’s milk belonging to the arsenic affected and non-affected areas. In the present work 25 milk sample were collected from five different arsenic affected and non-affected areas. The analysis comprised enumeration of total viable count (TVC), total coliform count (TCC) and total staphylococcal count (TSC) for the determination of sanitary quality. The highest total viable count, total coliform count and total staphylococcus count were log 5.894 ± 0.221, log 2.832± 0.129 and log 2.898 ± 0.162 respectively. Staphylococcus spp, Escherichia coli, Pseudomonas spp and Bacillus spp were isolated from the milk samples. Among them Escherichia coli were isolated from the maximum milk samples. It is found that the level of microbial quality in terms of TVC, TCC and TSC were high in arsenic affected areas than arsenic non-affected area. It also found that TVC and TCC were positively correlated with each other. This survey indicates that most of the raw milk samples were not satisfactory in course of public health standard as some pathogenic bacteria were detected from these samples and it is necessary to improve the hygienic practices required for the handling and processing of milk.DOI: http://dx.doi.org/10.3329/bjvm.v12i2.21297 Bangl. J. Vet. Med. (2014). 12 (2): 231-236 

Dual use of tobacco among Bangladeshi men

INTRODUCTION

Dual use of tobacco (using smoking and smokeless forms) in Bangladesh is uncommon in women but common in men. Dual users are at additional risk of cancers and heart diseases compared with a single form of tobacco use. Knowledge about their socioeconomic background is necessary for planning appropriate interventions. We report here socioeconomic background of the dual users of tobacco from a nationally representative survey.

METHODS

The study adopted a probability proportionate to size sampling technic of divisional population stratified into urban and rural areas to recruit men aged 25 years or older from their households. A total of 4312 men were recruited. Variables included questions on 20 household assets, tobacco use and other behavioral risk factors, and measurement of body weight and height.

RESULTS

The average age of dual users was 46.7 years old compared to 43.4 and 52.3 years for smokers and smokeless tobacco users. Prevalence of "smoking only," "smokeless only" and "dual use" of tobacco was 40.6%, 15.2%, and 14.2%, respectively. Among all tobacco users, dual users constituted 20%. These dual users had lower educational achievement, rural residence, lower intake of fruit, and higher intake of alcohol. They were more undernourished as indicated by a thin body mass index compared to nonusers and smokers. Dual users were of socioeconomically deprived as measured by wealth quartiles constructed out of household assets.

CONCLUSION

Dual use of tobacco is common in Bangladesh, and it is intimately linked with socioeconomic deprivation. Poverty reduction strategy and campaigns should address tobacco control not only tobacco in general, but its dual use in particular.

Influence of fuel molecular structure on the volatility and oxidative potential of biodiesel particulate matter

We have studied the effect of chemical composition of biodiesel fuel on the physical (volatility) and chemical (reactive oxygenated species concentration) properties of nano particles emitted from a modern common-rail diesel engine. Particle emissions from the combustion of four biodiesels with controlled chemical compositions and different varying unsaturation degrees and carbon-chain lengths, together with a commercial diesel, were tested and compared in terms of volatility of particles and the amount of reactive oxygenated species carried by particles. Different blends of biodiesel and petro diesel were tested at several engine loads and speeds. We have observed that more saturated fuels with shorter carbon chain lengths result in lower particle mass but produce particles that are more volatile and also have higher levels of Reactive Oxygen Species. This highlights the importance of taking into account metrics that are relevant from the health effects point of view when assessing emissions from new fuel types.

Rigorous analysis of the transverse acoustic modes in optical waveguides by exploiting their structural symmetry

A full-vectorial finite-element-based approach has been developed to find accurate modal solutions of acoustic modes in Ge-doped planar silica waveguides. The structural symmetry is exploited, and Aitken's extrapolation is also used to improve the accuracy of the solution. The spatial dependences of the dominant and nondominant displacement vectors are shown for the fundamental and higher-order transverse modes. The modal hybridness and modal birefringence between the two fundamental transverse modes are also presented.

Correlation of platelet count and acute ST-elevation myocardial infarction

The study was conducted in the Department of cardiology, NICVD Dhaka during the period January 2006 to December 2007 to assess the impact of platelet on ST-elevation myocardial infarction (STEMI). To perform this prospective study 200 patients with STEMI within 72 hours of chest pain of both sexes were randomly selected and were evaluated by clinical history, physical examination and with the help of ECG, Echocardiography and others cardiac risk factors analysis. Heparin therapy before admission, previously documented thrombocytopenia (<140,000/cmm), history of previous or current haemostatic disorder, renal impairment (Creatinine >1.6mg/dl) and history of PCI & CABG were excluded in this study. Patient of Platelet count (PC) ≤200000/cubic millimeter (cmm) in Group I and patient of Group II, platelet counts were PC >200000/cmm. Follow up period was 3 days to 7 days after hospital admission. Primary outcome heart failure (any Killip class) was significantly more in Group II than Group I (40.0% vs. 23.0%; p=0.009). Though the incidence of Killip class I and cardiogenic shock were not significant between these two groups but Killip class II (18.0% vs. 8.0%; p=0.036) and Killip class III (15.0% vs. 6.0%; p=0.037) heart failure were significantly more among the patient with higher platelet counts. In-hospital mortality, one of the primary outcomes of this study, was significantly higher in Group II (13.0%) than Group I (5.0 %) and p value was 0.048. Re-infarction was more in patient with higher platelet counts group (Group II) than patients with lower platelet count (Group I) but statistically was not significant (16.0% vs.11.0%; p=0.300).

The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.

The Ameliorating Effects of Garlic (Allium sativum) against Lead (Pb) Intoxication on Body Weight, Dressing Percentages, Feed Consumption and Feed Conversion Ratio in Lead Induced Broiler Chickens

Lead (Pb) has extensive commercial and industrial use despite of its recognized as health hazard. The therapeutic application of garlic (Allium sativum) was investigated for preventing the toxic effect of lead (Pd) in lead exposed chickens. 350 commercial broiler chickens were grouped into five such as T0, T1, T2, T3 and T4consisting of 70 birds each where T0 served as control. T1 was provided with lead acetate at 100mg/kg body weight, T2 had 100mg/kg lead acetate + 1% garlic supplement, T3 was fed with 100mg/kg lead acetate + 2% garlic supplement and T4 had 100mg/kg lead acetate + 4% garlic supplement for 42 days. Garlic was found to be capable of elimination of lead (Pb). Analysis of variance statistically revealed that significant (P<0.01) lower level of live weight (g), carcass weight (g) and eviscerated fresh carcass weight (%) were 2015.26±49.73, 1124.45±11.67 and 60.63±3.18, respectively in the chickens in group T1 at 42nd day of treatment in comparison to other groups. All garlic treatment groups satisfactorily increased live weight and carcass weight. Following the application of dietary garlic, mean values of live weight (g), carcass weight (g) and eviscerated fresh carcass weight (%) were significantly (P<0.01) increased at 2156.63±74.52, 1455.85±9.21 and 63.96±2.18 in group T3. Feed conversion ratio showed non-significant differences between different groups, but the most significant (P<0.01) FCR values were recorded in T3 among the treatment groups. It can be recommended from the present study that garlic might be played an active role to antagonize lead (Pb) toxicity.DOI: http://dx.doi.org/10.3329/bjvm.v12i1.20453 Bangl. J. Vet. Med. (2014). 12 (1): 1-7 

Follicle Stimulating Hormone (FSH) Dosage Based on Body Weight Enhances Ovulatory Responses and Subsequent Embryo Production in Goats

An experiment was conducted to evaluate the efficacy of porcine follicle stimulating hormone (pFSH) dosage based on body weight (BW) on ovarian responses of crossbred does. Thirty donor does were divided into 3 groups getting pFSH dosages of 3, 5, and 8 mg pFSH per kg BW, respectively, and were named as pFSH-3, pFSH-5 and pFSH-8, respectively. Estrus was synchronized by inserting a controlled internal drug release (CIDR) device and a single injection of prostaglandin F2α (PGF2α). The pFSH treatments were administered twice a day through 6 decreasing dosages (25, 25, 15, 15, 10, and 10% of total pFSH amount; decreasing daily). Ovarian responses were evaluated on Day 7 after CIDR removal. After CIDR removal, estrus was observed 3 times in a day and pFSH treatments were initiated at 2 days before the CIDR removal. All does in pFSH-5 and pFSH-8 showed estrus signs while half of the does in pFSH-3 showed estrus signs. No differences (p>0.05) were observed on the corpus luteum and total ovarian stimulation among the treatment groups, while total and transferable embryos were higher (p<0.05) in pFSH-5 (7.00 and 6.71) than pFSH-3 (3.00 and 2.80) and pFSH-8 (2.00 and 1.50), respectively. In conclusion, 5 mg pFSH per kg BW dosage gave a higher number of embryos than 3 and 8 mg pFSH per kg BW dosages. The results indicated that the dosage of pFSH based on BW is an important consideration for superovulation in goats.

Percutaneous Electrocauterization (Electrosclerotherapy) to Treat Cutaneous Hemangioma- our experience in Apollo Hospitals Dhaka

Introduction Percutaneous Electrosclerotherapy technique for the treatment of cutaneous hemangioma is introduced as an alternative and minimally invasive treatment mode. The aim of the study was to evaluate the response of percutaneous electrosclerotherapy on cutaneous hemangioma, as monotherapy or in adjunct to surgery. Materials and Methods Fourteen patients with 10 females and 04 males underwent percutaneous electrosclerotherapy for the treatment of cutaneous hemangioma mostly on head and neck in Plastic and Cosmetic Surgery department of Apollo Hospitals Dhaka from January 2009 to June 2010. Percutaneous Electrosclerotherapy was applied through a Colorado needle with an intention to cauterize the bulk of the lesion at the tip of the needle but not burning the skin. Pre and post operatively the size of the lesions were measured to see the percentage of regression. Results Percutaneous Electrosclerotherapy was done in all 14 cases. Most of the lesions (78%) were smaller in size (<5cm) and the site was mostly in head and neck (57%), more than half of the patients (57%) got significant benefit from this procedure. The regression of size is mostly in children <10 years which is noted in about 65%. The only complication found was overlying skin necrosis due to burn in 35% of patients which was managed usually by simple dressing and antibiotics with complete healing. Conclusion Percutaneous Electrosclerotherapy is effective monotherapy for smaller hemangioma and prior to surgery to reduce the volume, operation time, bleeding, as well as post operative scar. It can be done easily with minimal hospital stay, less cost and complication DOI: http://dx.doi.org/10.3329/pulse.v5i2.20262 Pulse Vol.5 July 2011 p.26-30

Correlation of ultrasonographically determined renal cortical thickness and renal length with estimated glomerular filtration rate in chronic kidney disease patients

DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19649Bangladesh Med Res Counc Bull 2013; 39: 91-92

Detection of Giardia lamblia and Cryptosporidium parvum by direct immunofluorescence assay in stool specimen

Giardia and Cryptosporidium are the pathogens which transmitted through contaminated soil and contaminated water are significant causes of diarrhea and nutritional disorders in institutional and community peoples. Children and immune compromise persons are more vulnerable for these infections. Both Giardiasis and Cryptosporidiosis were included in 2004 as WHO Neglected Disease. So this is a major public health problem in developing countries. The present study was carried out to detect the Giardia and Cryptosporidium from diarrheic or patient having loose stool by Direct Immunofluorescence assay. The study was conducted during July 20012 to February 2013 and the work was done in Mymensingh Medical College in the department of Microbiology and in Bangladesh Agricultural University in the department of Veterinary Medicine. A total of 100 loose stools were collected from school children of different area and hospital under sadar upazilla, Mymensingh. The detection of Giardia lamblia and Cryptosporidium parvum showed the individual prevalence 8% and 4% respectively. The highest cyst/oocyst count was 85,000 and 1,000/gm of stool and the lowest being 100 and 50/gm of stool for Giardiasis and Cryptosporidiosis respectively. The detection rate of Giardia and Cryptosporidium by Immunofluorescence assay was relatively higher than the previous study done in Bangladesh and this was the first report from Bangladesh over human stool specimen using Immunofluorescence assay. So, Immunofluorescence assay could be adapted for rapid and accurate detection of Giardia and Cryptosporidium.

Present status of rearing backyard poultry in selected areas of Mymensingh district

This study was conducted in Boyra and Sutiakhali villages under Sadar upazila of Mymensingh district to know the present status of backyard poultry production system. The survey data were collected from 40 randomly selected farmers having 20 from each village by interviewing them. The data were then analyzed statistically. All the selected farmers reared deshi chicken and about 54% of them reared deshi duck only. It was also found that highest proportion (75%) of farmers reared both chicken and duck together, followed by 17.5% reared only chicken and 7.5% reared chicken, duck and pigeon at a time. The average population per household of chicken, duck and pigeon were 10.4, 9.95 and 4.0, respectively, in both villages. All farmers reared poultry in semi-scavenging system. About 55% farmers kept poultry in their dwelling house. Farmers were used boiled rice, rice polish, paddy and broken rice to fed the birds. About 62% farmers were used rice and rice polish to make diet for chicken and ducks. Farmers provided around 49g and 108g supplemental diet to each chicken and duck per day, respectively and about 65% farmers provided this diet twice a day. Majority of farmers did not use feeder and waterer (about 75% and 87.5% respectively). Age at sexual maturity of Chicken and duck were around 189 days and 195 days, respectively. Adult weight of chicken and duck were 1192.5g and 1690g, respectively. The weights of chicken and duck eggs were 39.02 and 62.5g, respectively. The hatchability of chicken and duck eggs ranged between 69-80% and 76-90% with an average of 75.97 and 83%, respectively. Majority of the farmers mentioned that the most prevalent diseases of chicken and duck were New castle and cholera (about 51% and 49%, respectively). A large number of farmers (86%) did not vaccinate their poultry. Mortality of chicken and duck were calculated about 28% and 20%, respectively. Farmers collected chicks and ducklings from market and neighbor but most of the farmers (50% for chicks and 43% for ducks) incubate eggs under the broody hen. It was concluded that backyard poultry farmers are low producers and chicken and duck were found to be the most common poultry species reared by the farmers.DOI: http://dx.doi.org/10.3329/bjas.v43i1.19382 Bang. J. Anim. Sci. 2014. 43 (1): 30-37  

Protection Effect of Vaxxitek HVT + IBD Vaccine Against Infectious Bursal Disease in Broiler Chickens

The very virulent infectious bursal disease virus (vvIBDV) infection cause constant and frequent outbreaks of IBD. In order to prevent the disease caused by vvIBDV, moderate-virulent live vaccines are usually used in broilers, but these vaccine influence the immune system of chickens and cause the immunosuppression. VAXXITEK® HVT+IBD bivalent vaccine, a novel vaccine produced by Merial Company, is the recombinant vaccine generated by inserting IBDV VP2 gene into the HVT genome. The recombinant vaccine could prevent Marek’s disease and IBD of chickens at the same time after vaccinated by the subcutaneous route at 1-day-old. The objective of this study was to evaluate protection effect of this new vaccine against IBD in broilers. The results of the lab and field immunization trial showed that the vaccination of VAXXITEK® HVT+IBD vaccine did not damage the bursa of broilers; the level of IBD antibody of the VAXXITEK® HVT+IBD vaccination groups was higher than IBD-BLEN® vaccination groups at 21-day-old; the protection effect of the VAXXITEK® HVT + IBD vaccination groups was better than IBD-BLEN® vaccination groups, especially at 21-28 day. The results indicated that VAXXITEK® HVT + IBD vaccine could provide better protection to broiler chickens against IBD.DOI: http://dx.doi.org/10.3329/pa.v24i1-2.19102 Progress. Agric. 24(1&2): 69 - 78, 2013

Clinical and haemato-pathological characteristics of adult acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is a heterogeneous group of disorders. It varies with respect to the morphologic, cytogenetic, molecular and immunologic features of the neoplastic cells reflecting the variable clinical-pathologic presentations and outcome of the patients. The aim of the study was to observe the clinical and haemato-pathological characteristics in newly diagnosed adult ALL patients. A total number of 61 patients morphologically diagnosed as acute lymphoblastic leukaemia aged 15 and above assigned for this observational study. The study was carried out in the Department of Haematology, BSMMU from January 2007 to December 2008. Among 61 patients, aged 15 to 80 years with median age 25 years, 79% were male and 21% were female. Most of the patients presented with anaemia (67%), fever (66%), lymphadenopathy (64%) and splenomegaly (57%). Other common clinical findings were hepatomegaly (39%), bone tenderness (44%) and bleeding manifestations (34%). Among haemato-pathological findings 67% patients had Hb level ≤10gm/dl, 46% patients had WBC count ≥30×10⁹/L, 67% patients had platelet count ≤100×10⁹/L, 93% patients had blast in peripheral blood and 61% patients had ≥90 % blasts in the bone marrow at the time of diagnosis. In this study adult ALL patients were analyzed only for their clinical and haemato-pathological characteristics. But their biologic characteristics were not analyzed due to lack of availability of facility. A progressive understanding of the biologic and genetic characteristics of ALL will allow us to identify different prognostic subgroups with specific molecular and cellular features. All the necessary measures have to be developed in our country in order to identify prognostically distinct subgroups of patients.

Malignant paraganglioma: a case report

A paraganglioma is a rare tumour composed of chromaffin cells. The malignant paraganglioma is a very rare presentation, diagnosed by local recurrence after total resection of primary mass or findings of distant metastasis. Recurrent paraganglioma developed in a 60 years old lady 10 years after first surgical resection. This time the patient presented with neck swelling as well as with vertebral metastases. The patient underwent radiotherapy and symptomatic improvement was there. We present the case to emphasize the role of imaging in early diagnosis, avoidance of complications of advanced disease and to make awareness among the physicians.

Influenza and Respiratory Syncytial viral infections in Malaysia: Demographic and Clinical perspective

Objective: Respiratory infections represent a major public health problem worldwide. The study aimed to determine the prevalence of respiratory syncytial and influenza virus infections and analyzed in respect to demography and clinical perspective.

Methods: The specimens were processed by cell culture and immunofluorescent assay (IFA) and real-time reverse transcriptase-PCR (rRT-PCR) for detection of respiratory viruses.

Results: Out of 505 specimens 189 (37.8%) were positive, in which RSV was positive in 124(24.8%) cases and influenza A was positive in 65(13%) cases. Positive cases for influenza virus A and RSV were analyzed based on demography: age, gender, ethnicity and clinical symptoms. There were no significant differences among gender, ethnicity and clinical symptoms in both RSV and influenza A virus infections. It was observed that children below 3 years of ages were more prone to RSV infections. On the contrary, influenza virus A infected all age groups of humans.

Conclusion: RSV infects mostly child below 3 years of age and influenza virus infects all age group. No specificity of RSV and influenza infection in relation to demography.

Aspirin resistance in patients with acute coronary events: risk factors and prevalence as determined by whole blood multiple electrode aggregometry

Objectives: To determine the prevalence of aspirin resistance and associated risk factors based on biochemical parameters using whole blood multiple electrode aggregometry.

Methods:The study was conducted at the outpatients cardiology clinic of the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from August 2011 to February 2012.

Subjects on aspirin therapy were divided into two groups; first-ever coronary event and recurrent coronary event. Aspirin resistance was measured by a Multiplate^® platelet analyser.

Results: A total of 74 patients (63 male, 11 female), with a mean age of 57.93 ± 74.1years were enrolled in the study. The patients were divided into two groups –first-ever coronary event group (n=52) and recurrent coronary event group (n=22). Aspirin resistance was observed in 12 out of 74 (16%) of the study patients, which consisted of 11 patients from the first-ever coronary event group and one patient from the recurrent coronary event group. There were significant correlations between aspirin resistance and age (r = -0.627; p = 0.029), total cholesterol (r = 0.608; p = 0.036) and LDL (r = 0.694; p = 0.012). LDL was the main predictor for area under the curve (AUC) for aspirin resistance. However, there was no association between aspirin resistance and cardiovascular events in both groups in this study.

Conclusions: Aspirin resistance was observed in 16% of the study population. LDL was the major predictor of aspirin resistance. No association was found in the study between aspirin resistance with recurrent coronary events.

Current Status of Service Centers Serving Autism Spectrum Disorder in Dhaka City

DOI: http://dx.doi.org/10.3329/bjdre.v4i1.18011 Bangladesh Journal of Dental Research & Education Vol.4(1) 2014: 16-20

Comparative assessment on in vitro antioxidant activities of ethanol extracts of Averrhoa bilimbi, Gymnema sylvestre and Capsicum frutescens

Background:

Averrhoa bilimbi, Gymnema sylvestre and Capsicum frutescens are medicinal plants commonly used as traditional medicine for the treatment of various diseases. The present study was designed to investigate the antioxidant activities of Ethanolic extract of A. bilimbi, G. sylvestre and C. frutescens.

Materials and Methods:

The antioxidant activity of the extracts were evaluated using total phenolic and flavonoid contents, ferric reducing power and the free radical scavenging activity against 1,1-diphenyl-2-picrylhydrazyl (DPPH).

Results:

Total phenolic and flavonoid contents were higher in G. sylvestre (53.63636 ± 0.454545 mg/g gallic acid equivalent) and C. frutescens (26.66667 ± 2.081666 mg/g quercetin equivalent) respectively. Reducing power of the crude ethanol extracts increased with the concentrations of the extracts and all the extracts showed moderate free radical scavenging activity against DPPH. The plant extract displayed moderate phenolic and flavonoid contents compared to gallic acid and quercetin equivalent respectively, whereas also exhibited significant scavenging of DPPH radical and reducing power compared with ascorbic acid as standard.

Conclusion:

Our study suggests that G. sylvestre has significant antioxidant activity. The antioxidant compound of this plant might be a therapeutic candidate against oxidative stress related diseases. Different sub-fraction of A. bilimbi and C. frutescens should be studied further to assess the effect. Further study is necessary for isolation and characterization of the active antioxidant agents for better treatment.

Surgical management of rectourethral fistula in different situations

This study was done to see the outcome of repair of rectourethral fistula (RUF) in different situations between 2002 and 2009 in Chittagong and Dhaka Medical College Hospitals. We prospectively reviewed the records of all the patients who developed rectourethral fistula. Total 18 patients were included and in all cases faecal and urinary diversion was done preoperatively. In 4 patients fistulas size was <1cm where spontaneous closure of RUF occured after 6 months of diversion. In 8 patients repair of fistula was done through the perineal approach where excision of fistulas tract with anastomotic urethroplasty and repair of rectal wound was done. Out of these 8 patients tunica vaginalis flap was applied in 3 and dartos pedicle flap in 5 cases, in the remaining 6 patients transrectal York-Mason repair was done. Out of 6 patients of York-Mason repair, one developed recurrent fistula - which underwent repair with a graft through the perineal approach later on with good result. No patient developed urinary or faecal incontinence. In 2 patients leakage of urine was noted in post operative days in the perineal wound and catheter was kept for 3 weeks more. No one had erectile dysfunction. Both faecal & urinary diversion adds benefit to the outcome of the rectourethral fistula. Transrectal York-Mason repair is easier to do with less morbidity and complication while perineal approach with graft interposition may be done in cases where anastomotic urethroplasty is needed along with fistula repair.

Effect of levodopa and carbidopa on non-motor symptoms and signs of Parkinson's disease

Parkinson's disease (PD) patient presents with both motor and non-motor symptoms. This was descriptive type of interventional study carried out in the department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2009 to December 2010. Among the total 59 cases, 51 completed the proposed five months follow up. The rest eight cases attended Neurology department irregularly and were ultimately dropout from follow up. The case selection technique was purposive type of non probability sampling. Each patient was treated with levodopa+carbidopa. Then the effect of levodopa+carbidopa on non-motor symptoms and signs were evaluated in subsequent five visits at four week interval. All relevant information and follow-up were recorded in a pre-designed individual case record form. Chi square test was done and probability value <0.05 were considered as level of significance with 95% confidence limit. Among the non-motor symptoms (NMS), the most frequent symptoms at base line visit were fatigue 56.8%, excessive sweating 54.9%, insomnia 54.9%, akathisia 47.1%, anxiety 45.1%, constipation 17.6%. After five months of levodopa+carbidopa therapy, frequencies of most of the NMS decreased slightly in comparison to base line symptoms but there were no significant effect of levodopa+carbidopa on NMS of study subjects.

A giant hepatic cyst

Liver cysts occur in approximately 5% of the population. However, only about 5% of these patients ever develop symptoms. In general, cysts are thin-walled structures that contain fluid. Most cysts are single, although some patients may have several. Here we report a case of a giant hepatic cyst in a 50 year old female who was admitted in our Hospital for right upper quadrant pain and abdominal lump. She was thoroughly investigated with ultrasonography, and computerized tomography scan of the abdomen along with other supportive investigations, and was diagnosed as having a 30×25cm cyst in the right lobe of the liver. Exploratory laparotomy and partial cystectomy with drainage & marsupialization were performed in the patient.

Neurologic manifestations, diagnosis and management of Wilson's disease in children - an update

Wilson's disease (WD) is a genetic disorder of copper (Cu) metabolism. It is a progressive hepatolenticular degenerative disease due to toxic accumulation of copper in the various tissues particularly in the liver, brain and eyes. The neurologic manifestations of Wilson's disease are extremely varied like simple behavioral change such as irritability, depression, deterioration of school performance to severe form of neurologic presentations like dystonia, dysarthria, tremor and gait disturbance. Early diagnosis is possible by history of progressive neurologic dysfunction, clinical examination of Kayser Flescher rings (K-F rings) in eyes, along with some important investigations like low serum ceruloplasmin, high 24 hours urinary excretion of copper, presence of basal ganglia lesion in neuro imaging of the brain. Though hepatic copper estimation done by liver biopsy is the gold standard, is not available in Bangladesh. Most of the neurodegenerative diseases have no specific treatment and worse outcome. But it has a specific treatment with life long medication that reduces copper absorption or removes the excess copper from the body. Children on therapy must be monitored regularly for response, side effects and compliance. The aim of this article is to gather update information of neurologic manifestations of Wilson's disease and proper management as well to prevent the major neurological complications and better out come.

Changing trends in incidence and indications of caesarean section

Caesarean section is most frequently performed major operation in obstetrics. The rate of caesarean section has been increasing both in developed and developing countries in the past decade. This study was done to find out the change of sociodemographic condition of respondents, identify the different types & rate of caesarean section indications, the outcome of different indications, estimate the rate of caesarean section proportion of the elective & emergency indications and evaluate the complications of caesarean sections. This is a cross-sectional study of randomly selected 130 cases of lower caesarean section done at Sir Salimullah Medical College & Mitford Hospital, Dhaka from March 2006 to August 2006. In this study 80(61.5%) cases underwent emergency caesarean section and in 50(38.5%) cases elective caesarean section had done. Among indications of caesarean section repeat section scores the top of the list. No maternal mortality case recorded in this study. This study shows high incidence of caesarean section which does not reflect the picture of total population of Bangladesh.

Campylobacteriosis - an overview

Campylobacteriosis is a collective term, used for infectious, emerging foodborne disease caused by Campylobacter species comprising Gram negative, curved, and microaerophilic pathogens. The true incidence of human campylobacteriosis is unknown for most countries of the world including Bangladesh. But campylobacteriosis is not uncommon in our country. Due to its increasing incidence in many countries of the world, it is an important issue now a day. Animals such as birds are the main sources of infection. Farm animals such as cattle, poultry are commonly infected from such sources and raw milk, undercooked or poorly handled meat becomes contaminated. Transmission of campylobacteriosis to human occurs through consumption of infected, unpasteurized animal milk and milk products, undercooked poultry and through contaminated drinking water. Contact with contaminated poultry, livestock or household pets, especially puppies, can also cause disease. Due to variability of clinical features and limited availability of laboratory facilities, the disease remains largely under-reported. Early and specific diagnosis is important to ensure a favourable outcome regarding this food borne disease. Antibiotic treatment is controversial, and has only a benefit on the duration of symptoms. Campylobacter infections can be prevented by some simple hygienic food handling practices.

Role of adenosine deaminase in diagnosis of tubercular pleural effusion

The diagnosis of pleural tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. It is produced during the inflammatory process triggered by the M. tuberculosis. Usefulness of adenosine deaminase (ADA) estimation in pleural fluid has been shown as a reliable chemical bio-marker specially when there is suspicion of tuberculosis in endemic areas. ADA level was determined in the pleural fluid of 100 patients present with pleural effusion admitted at Mymensingh Medical College Hospital during the period of March 2012 to September 2012. ADA level was >40IU/L among the 52 tubercular pleural effusion patients with sensitivity & specificity is 100% and 66% respectively. Thus is evident that ADA level can be used along with conventional methods for diagnosis of pleural TB.

A case of mycotic aneurysm due to Burkholderia pseudomallei

Burkholderia pseudomallei is an free-living gram-negative bacterium causing melioidosis and is endemic in Southeast Asia. A 56-year-old diabetic construction worker with a 1-month history of abdominal pain and 1-day history of high-grade fever was found to have a left non-dissecting infrarenal mycotic aortic aneurysm by abdominal computerized tomography scan. Bacteriological examination of his blood yielded Burkholderia pseudomallei. The patient was treated with right axillo-bifemoral bypass with excision of aneurysm and high-dose intravenous ceftazidime for two weeks, followed by oral trimethoprim/sulfamethoxazole and oral doxycycline for a minimum of five months.