Endodontic management of symptomatic pulpal pathosis by single -visit root canal therapy

Single-visit root canal therapy is one of the reality in modern endodontics globally, both for vital and non-vital teeth, despite many research efforts and much controversy, specially when post-operative pain is concerned. There are increased post-operative complications as pain, swelling, discomfort in managing teeth having symptomatic pulpal pathosis. To clinically verify the possibility to treat symptomatic vital and non-vital teeth in one visit technique, 126 patiens were selected and advised to undergone single visit endodontic treatment at the Department of Conservative Dentistry and Endodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka. Endodontically involved symptomatic vital and symptomatic non-vital teeth were enrolled in two groups and advised to undergone single visit endodontic treatment. Both groups were assessed at 24 hours, 48 hours, 72 hours and long term post operative evaluation up to 10 months. The main outcome measure was post operative pain. The result of our study indicates that single visit root canal treatment is a safe, effective and practical method of treatment of an endodontically involved tooth both in vital and non vital cases when applied in appropriate situation. Significantly fewer patients of symptomatic vital cases reported pain in immediate follow up i.e. 24 hours, 48 hours and 72 hours in comparison to non vital cases (12.69% vs. 22.2%, 4.16% vs. 11.11%, 1.58% vs. 7.93%). At 10 months of long term follow up the recall rate was 74.35% and 90(71%) of patients were comfortable after receiving treatment. Post operative pain incidence in single visit was equivalent to that of multi visit endodontics, provided one had an accurate diagnosis, proper case selection and skilled technique.

Cardiovascular complications in patients with end stage renal disease on maintenance haemodialysis

This cross-sectional study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), National Institute of Kidney Diseases & Urology (NIKDU) and Kidney Foundation from July 2005 to June 2007 to find the cardiovascular complications in end stage renal disease (ESRD) patients on maintenance haemodialysis. Patients of both sexes with age ranging from 18-59 years and getting at least 8 hours of haemodialysis per week for the last 3 months were enrolled in the study. A total of 126 such patients were included in the study. Among 126 patients 77(61.1%) developed some types of cardiovascular complications. In terms of type of complications 63.6% of the patients had LVH, 23.4% had ischemic heart disease (IHD) and 10.4% had congestive heart failure (CCF) and 2.6% cardiomyopathy. Over 96% patients were hypertensive, followed by 46.8% diabetics and 42.1% smokers. Presence of hypertension, diabetes, family history of diabetes and hypertension were observed to be significantly higher in patients who developed cardiovascular complications (p<0.05). It is deserved that cardiovascular complications (CVC) are very common in ESRD patients on maintenance haemodialysis (MHD). Poor control of blood pressure, low Haemoglobin level and poor glycaemic control are higher in ESRD patients on MHD and are possibly related to the development of cardiovascular complications.

A Study of Autoimmune Polyglandular Syndrome (APS) in Patients with Type1 Diabetes Mellitus (T1DM) Followed Up at a Teritiary Care Hospital

BACKGROUND

Type1 diabetes mellitus (T1DM) results from auto- immune destruction of insulin-producing β cells and is characterized by the presence of insulitis and β-cell autoantibodies. Up to one third of patients develop an autoimmune polyglandular syndrome (APS). Presence of other autoimmune disorders in patients with T1DM has been associated with increased morbidity and mortality. Hypoglycemia resulting from concurrent hypothyroidism or adrenal crisis can be dangerous; starting replacement therapy for hypothyroidism may result in adrenal crisis if background hypocortisolism is not recognized. Early detection of antibodies and latent organ-specific dysfunction is advocated to alert physicians to take appropriate action in order to prevent full-blown disease.

AIMS

The objectives of this study were to assess the concurrence of various autoimmune disorders in patients with T1DM, to review the concept and detect the overt forms of Autoimmune Thyroid Disease (AITD), Addison's Disease (AD), Vitamin B 12, vitiligo in T1DM and to find their correlation according to age and sex of the patients.

METHODS

It is a retrospective study where medical records between January 2007-June 2010 of all the patients diagnosed with T1DM, followed up at Department of Endocrinology were reviewed to find out the presence of (AD), AITD, vitiligo, Vitamin B12 deficiency and Primary Gonadal Failure, which were diagnosed clinically with available investigational procedures.

RESULTS

A total of 100 cases of T1DM were evaluated during the present study. The age group of patients ranged from 8 to 40 years, with the average being 21.56 years. 64% of the patients were males and the rest were females. 29 % of T1DM subjects had AITD (Hashimoto's or Graves'disease), 5% were diagnosed with Vitamin B12 deficiency, 4% had AD, and 6% showed Vitiligo. 28 % had family history of autoimmune endocrinopathy.

CONCLUSION

The commonest autoimmune disorder associated with T1DM found in our study was AITD. Because genetic/ autoantibodies testing is not a feasible option, it is important to screen them with best available laboratory facilities and clinical assessment in view of high prevalence of associated autoimmune conditions.

Chlamydia trachomatis IgM seropositivity during pregnancy and assessment of its risk factors

The study was undertaken to determine socio-demographic and reproductive risk factors associated with Chlamydia trachomaties IgM seropositivity during pregnancy. This cross sectional comparative study was carried out in the obstetrics outdoor of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in collaboration with the department of Virology between the periods from July 2007 to December 2008. Pregnant women at their first visit to the hospital were approached consecutively and asked to complete a questionnaire and 2cc blood was collected from each subject for Chlamydia trachomatis IgM antibody testing using ELISA method. The study population was divided into two groups according to the presence and absence of serum Chlamydia trachomatis IgM antibody. Finally socio-demographic and reproductive risk factors were compared between the groups. Among 172 women the sero-prevalence of Chlamydia IgM was 41%. The multiple logistic regression model (step wise) finally extracted for characteristics correlated with seropositivity. Ten years or less (≤SSC) education (OR 2.6 95% CI 1.1to 5.9), history of adverse pregnancy outcome (OR 2.8 95% CI 1.2 to 6.5) and multiple sex partner of husband (OR 4.1 95% CI 1.2 to 14.8) were associated with chlamydia infection. The use of condom (OR 0.28 95% CI 0.12 to 0.63) was associated with decreased risk of infection. Chlamydia trachomatis infection during pregnancy is associated with risk factors on the basis of which selective screening can be done.

Therapy-related myelodysplastic syndrome and acute myeloid leukemia following chemotherapy (paclitaxel and carboplatin) and radiation therapy in ovarian cancer: a case report

In recent years, the incidence of therapy-related myelodysplastic syndrome (t-MDS) and therapy-related acute myeloid leukemia (t-AML) that occur during chemotherapy for ovarian cancer has increased. While alkylating agents and topoisomerase II inhibitors are particularly mutagenic and have strong leukemogenic potential, paclitaxel and combination chemotherapy/radiation therapy also appear to induce t-MDS. The present authors report a case of t-MDS that developed during chemotherapy and radiation therapy for ovarian cancer. The patient was a 75-year-old woman who received six courses of cyclophosphamide/doxorubicin/cisplatin (CAP) therapy after initial surgery for Stage IIIc grade ovarian cancer in 1995. Beginning in February 2005, the patient experienced multiple recurrences due to sternal metastasis. Chemotherapy, including paclitaxel and carboplatin (TC), was administered intermittently and was combined with radiation therapy to a sternal metastatic lesion. Pancytopenia was observed in December 2008, and she was diagnosed with t-MDS (WHO subtype, refractory cytopenias with multilineage dysplasia [RCMD]): the time from first chemotherapy to t-MDS onset was 106 months. Without evidence of blast crisis, the recurrent lesions continued to grow and caused multiple cerebral infarctions, from which she eventually died. The cumulative doses of paclitaxel and carboplatin administered to this patient were 1,968 mg and 6,480 mg, respectively.

Auto-analyzer based screening of microcytic hypochromic ratio to differentiate thalassaemia and non thalassemic microcytosis

DOI: http://dx.doi.org/10.3329/bmrcb.v39i3.20317 Bangladesh Med Res Counc Bull 2013; 39: 146-147

Role of the p63-FoxN1 regulatory axis in thymic epithelial cell homeostasis during aging

The p63 gene regulates thymic epithelial cell (TEC) proliferation, whereas FoxN1 regulates their differentiation. However, their collaborative role in the regulation of TEC homeostasis during thymic aging is largely unknown. In murine models, the proportion of TAp63(+), but not ΔNp63(+), TECs was increased with age, which was associated with an age-related increase in senescent cell clusters, characterized by SA-β-Gal(+) and p21(+) cells. Intrathymic infusion of exogenous TAp63 cDNA into young wild-type (WT) mice led to an increase in senescent cell clusters. Blockade of TEC differentiation via conditional FoxN1 gene knockout accelerated the appearance of this phenotype to early middle age, whereas intrathymic infusion of exogenous FoxN1 cDNA into aged WT mice brought only a modest reduction in the proportion of TAp63(+) TECs, but an increase in ΔNp63(+) TECs in the partially rejuvenated thymus. Meanwhile, we found that the increased TAp63(+) population contained a high proportion of phosphorylated-p53 TECs, which may be involved in the induction of cellular senescence. Thus, TAp63 levels are positively correlated with TEC senescence but inversely correlated with expression of FoxN1 and FoxN1-regulated TEC differentiation. Thereby, the p63-FoxN1 regulatory axis in regulation of postnatal TEC homeostasis has been revealed.

Present scenario of landing and distribution of fish in Bangladesh

The present study was designed to know the landing and distribution pathways of fish and types and nature of stakeholders involved in fish distribution chain in Bangladesh. A total of 237 fish landing centers and 5440 markets were detected. The number of landing center and market were highest in Chittagong and Dhaka division respectively. Stakeholders in fish distribution, viz., arotdars, paikers and retailers were found to be 6219, 39506 and 122922, respectively. A 84.71% of the landing centers were found to be operated year round while 15.29% were seasonal. The major fish production zones and major gateways of the country where inland capture and culture and marine capture fish landed were identified. In any locality 62.83% of the landed fish were transported within 100 km area and 5.73% of fish were transported beyond 500 km. The quantity of fish harvested from river, beel, Kaptai lake floodplain, pond, baor, coastal area/sea and shrimp/prawn farm were 5.25, 4.41, 0.13, 35.03, 38.22, 0.23, 10.93 and 5.80%, respectively. The common constraints identified were lack of adequate infrastructure facilities in the landing center and market, unhygienic environment, influence of middlemen, money lending at high rate etc. For the betterment of fish landing and distribution, appropriate authority should pay proper attention so that both quality and fair price are ensured.

Micropropagation of Centella asiatica L. An Important Medicinal Herb

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

Evaluation of the results of operative management of lumbar spinal canal stenosis

Lumber spinal canal stenosis is an important cause of low back pain and it frequently presents with low backache with neurogenic claudication. Operative management of lumbar spinal canal stenosis by decompression surgery is an effective method. This prospective interventional (quasi experimental) study was performed in patient having history of characteristic clinical features like low backache with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in the department of Orthopaedic Surgery and Neurosurgery, Dhaka Medical College Hospital and NITOR. Dhaka, from July 2008 to June 2010. Thirty patients were evaluated among those 18(60%) were 50 years and above. Male to female ratio was roughly 9:1. About 87% of the patients had sensory deficit and 50% had neurogenic claudication. Majority (83.3%) of the patients at presentation had a suffering of 12 or >12 months. Diagnosis shows that 3.5% of patients had L4 lesion, 60% L5, 6.5% patients had L4 & L5 and 30% S1. Laminectomy was done in 43.3% of patients, laminectomy and disectomy in 30% and laminectomy, discectomy & foraminal decompression in 26.7% of patients. Relief of symptoms occurred in 25(83.5%) of patients. Over three-quarter (76.7%) of patients exhibited minimal disability and 23.3% moderate disability based on Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

A comparison of GFR by modified gates method with measured creatinine clearance rate (CCR) & MDRD formula based estimation in type 2 diabetic subjects with nephropathy

Accurate estimation of the glomerular filtration rate (GFR) is essential for the evaluation of patient with chronic kidney disease (CKD). The present study was a comparison between modified gates GFR with laboratory measured CCR & MDRD formula based estimated GFR method. Pre-diagnosed 180 diabetic nephropathy patients were selected. All the time of evaluation the blood glucose of the patients were controlled and serum creatinine was stable. Then CCR was done and GFR was estimated by Modified Gates method & MDRD method. All the patients were categorized in 5 stages of CKD. They were matched for age, BMI, blood pressure, duration of diabetes, the blood sugar and HbA1C levels. The Gates GFR in stage-2 (70±13) & stage-3 (48±12) was closer with MDRD in stage-2 (77±8) and stage 3 (43±7). The CCR is closer in stage-1 (110±52) & stage-4 (30±10) with MDRD in stage-1 (112±13) and stage-4 (21±4). Association study showed MDRD GFR had highest correlation with Gates GFR (r=0.86; p<0.05). The estimation of glomerular filtration rate (GFR) in different methods varied significantly between each other at different stages of chronic kidney disease (CKD) in type 2 diabetic nephropathy subjects.

Factors responsible for increased percent recirculation in arterio-venous fistula among the haemodialysis patients

Recirculation is an important issue in haemodialysis (HD) patients as increased percent recirculation causes decreased dialysis delivery of the patients. The purpose of the study was to determine the amount and factors of recirculation in those patients. The study was a cross sectional one carried in the Department of Nephrology, Dhaka Medical College and Hospital during October 2010 to September 2011. A total of 118 end stage renal disease patients with arterio-venous fistula who were on HD for more than 3 months were purposively selected. The degree of recirculation was measured with urea based two needle technique method. For each patient distances between arterial and venous and distances of needles from fistula and its directions were recorded. Echocardiography and A-V fistula Colour Doppler Ultrasound were also performed. The mean A-V fistula recirculation was 8.1 +/- 5.5% with a range 0-66%. The most common factors were close proximity and improper arterial and venous needles placement. No difference was observed between diabetic and non diabetic also between hypertensive and normotensive. A-V fistula recirculation is common occurrence in HD patients and the most common factors of recirculation are misplacement and close proximity of needles therefore emphasis should be given on education and training of HD staffs.

Platelet shedding of CD40L is regulated by matrix metalloproteinase-9 in abdominal sepsis

BACKGROUND AND OBJECTIVES

Platelet-derived CD40L is known to regulate neutrophil recruitment and lung damage in sepsis. However, the mechanism regulating shedding of CD40L from activated platelets is not known. We hypothesized that matrix metalloproteinase (MMP)-9 might cleave surface-expressed CD40L and regulate pulmonary accumulation of neutrophils in sepsis.

METHODS

Abdominal sepsis was induced by cecal ligation and puncture (CLP) in wild-type and MMP-9-deficient mice. Edema formation, CXC chemokine levels, myeloperoxidase levels, neutrophils in the lung and plasma levels of CD40L and MMP-9 were quantified.

RESULTS

CLP increased plasma levels of MMP-9 but not MMP-2. The CLP-induced decrease in platelet surface CD40L and increase in soluble CD40L levels were significantly attenuated in MMP-9 gene-deficient mice. Moreover, pulmonary myeloperoxidase (MPO) activity and neutrophil infiltration in the alveolar space, as well as edema formation and lung injury, were markedly decreased in septic mice lacking MMP-9. In vitro studies revealed that inhibition of MMP-9 decreased platelet shedding of CD40L. Moreover, recombinant MMP-9 was capable of cleaving surface-expressed CD40L on activated platelets. In human studies, plasma levels of MMP-9 were significantly increased in patients with septic shock as compared with healthy controls, although MMP-9 levels did not correlate with organ injury score.

CONCLUSIONS

Our novel data propose a role of MMP-9 in regulating platelet-dependent infiltration of neutrophils and tissue damage in septic lung injury by controlling CD40L shedding from platelets. We conclude that targeting MMP-9 may be a useful strategy to limit acute lung injury in abdominal sepsis.

HbA(1c) as a diagnostic tool for diabetes and pre-diabetes: the Bangladesh experience

AIMS

To evaluate HbA(1c) as a tool for the diagnosis of diabetes and pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) and to identify the optimal cut-off values suitable for a Bangladeshi population.

METHODS

In this cross-sectional survey in a rural community, 2293 randomly selected individuals aged ≥ 20 years without prior history of diabetes were included. HbA(1c) and other clinical covariates necessary for the diagnosis of diabetes were recorded. Diabetes and pre-diabetes were defined according to the World Health Organization 1999 criteria. The receiver operating characteristic curve was used to determine the performance of HbA(1c).

RESULTS

The prevalences of diabetes and pre-diabetes were 7.9 and 8.6%, respectively. Based on receiver operating characteristic curve analysis, an HbA(1c) cut-off value of ≥ 42 mmol/mol (≥ 6.0%) gave an optimal sensitivity of 86.2% and specificity of 93.3%, with an area under the curve of 0.949 to predict diabetes using the oral glucose tolerance test as the gold standard; a cut-off value of ≥ 38 mmol/mol (≥ 5.6%) gave an optimal sensitivity of 68.0% and specificity of 66.4%, with an area under the curve of 0.714 to predict pre-diabetes. In subjects at high risk of diabetes, HbA(1c) ≥ 42 mmol/mol (≥ 6.0%) showed higher sensitivity than fasting plasma glucose ≥ 7.0 mmol/l, 2-h plasma glucose ≥ 11.1 mmol/l and HbA(1c) ≥ 48 mmol/mol (≥ 6.5%).

CONCLUSIONS

An HbA(1c) cut-off value of ≥ 42 mmol/mol (≥ 6.0%) was highly sensitive and specific in diagnosing diabetes mellitus. This optimal cut-off level may be suitable as a diagnostic criterion for diabetes in a Bangladeshi population.

Testing urine samples with rK39 strip as the simplest non-invasive field diagnosis for visceral leishmaniasis: an early report from eastern India

BACKGROUND

Diagnosis of visceral leishmaniasis (VL) is a major obstacle in the control of this disease. The rK39 strip-test using patient's blood is a breakthrough; however, it still requires a blood sample, which is a concern for safety in the field. We tried to simplify the test using the patient's urine instead of blood.

AIMS

To observe the sensitivity and specificity of the urine test in comparison with the blood test.

MATERIALS AND METHODS

We tested active and post-treatment VL patients, Post Kala azar dermal leishmaniasis (PKDL), VL/HIV and control subjects (healthy, disease suspects and diseased other than VL) with the rK39 strip-test using blood and urine samples.

STATISTICAL ANALYSIS

The level of agreement between the urine and blood testing was calculated by inter-rater agreement (kappa) statistics.

RESULTS

Forty-two active VL, 40 treated VL, six PKDL, three VL/HIV and 139 controls (54 healthy, 21 disease suspects and 64 diseased other than VL) were tested. All VL-related cases showed positive results with urine as well as blood samples (100%). The urine testing was found to have 100% sensitivity and 86.33% specificity for the diagnosis of VL. Kappa statistic between the two methods was 0.916 (P<0.001). Urine testing had more false-positive results in comparison with blood testing (13.67% vs. 9.45%), but the test subjects were from VL-endemic areas and they might be exposed to Leishmania donovani infection.

CONCLUSIONS

The present study has the potentiality of providing a new, yet simplest non-invasive screening tool for VL in remote rural areas.

Post-transfusion increment of platelet count in thrombocytopenic patients treated with platelet concentrates

The Platelet (PLT) Transfusion Therapy plays an important role in the support of surgical, haematological, oncological and transplant patients. The present study was assigned to find out the post transfusion increment of platelet count among the thrombocytopenic patients in Bangladeshi population. This descriptive study was conducted at the Departments of Haematology and Transfusion Medicine, BSMMU, Dhaka. Total 42 thrmbocytopenic patients were randomly assigned to receive a transfusion when their platelet counts below 10000 per cubic millimeter or with active bleeding. Pre transfusion and post transfusion platelet count were measured in all patients. Out of 42 patients, 26(61.90%) were male and 16(38.10%) were female. Leukemia was the most common cause of thrombocytopenia (47.62%). Most of the patients (71.34%) required transfusion of multiple units of platelet and 12(28.57%) patients required double units. Before transfusion of platelet concentrate <30×10⁸/L, 30-80×10⁸/L and >80×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. After transfusion of platelet concentrate <50×10⁸/L, 50-100×10⁸/L and >100×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. In all patients post transfusion platelet count increases but 2 or multiple units of transfusion were needed.

Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh

A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.

A subunit vaccine against hydropericardium syndrome using adenovirus penton capsid protein

Hydropericardium syndrome (HPS) is a disease of poultry that is caused by fowl adenovirus-4. Inactivated liver homogenate from diseased birds is still the choice of vaccine in some countries which disseminates numerous pathogens along with inactivated virus. Moreover incomplete attenuation or inactivation, reversion to virulence and the oncogenic potential/genetic instability of the adenoviruses have prevented their use in routine vaccines. To address this problem an effort is made to develop a subunit vaccine. For this purpose penton base protein of HPS virus was expressed in Escherichia coli and used as subunit vaccine in broilers. Immunogenicity of the recombinant penton base protein and challenge protection test against pathogenic virus demonstrated the ability of recombinant penton base protein to confer (90%) protection. Results suggest that the recombinant penton base protein is a candidate for subunit vaccine against HPS.

Design, synthesis and antiinflammatory activity of some 1,3,4-oxadiazole derivatives

A series of substituted 1,3,4-oxadiazole derivatives 19-34 were synthesized as antiinflammatory agents. The target compounds were obtained by cyclodesulfurization of the corresponding thiosemicarbazides 3-18 using either dicyclohexylcarbodiimide DCC, or I(2)/NaOH. Intermediates 3-18 are readily accessible through conversion of the carboxylic acids 1a-d to the respective hydrazides 2a-d followed by treatment with appropriate isothiocyanate derivatives. The structures of the synthesized compounds were confirmed by elemental as well as spectroscopic analyses. The antiinflammatory activity was investigated by determination of the inhibitory effects of the oxadiazole derivatives 19-34 on histamine-induced edema in rat abdomen. Compounds 19a, 21a, 23b, 28c and 32d proved to be more potent antiinflammatory agents at 200 mg/kg po than ibuprofen, the standard reference drug. Other compounds such as 20a, 25b, 27c, 29c, and 33d showed significant antiinflammatory activity but less than ibuprofen at the same dose level. The low toxicity of the most potent compounds was reflected by their higher LD(50) value, ranging from ~1000 to 1500 mg/kg, as well as the lower ulcerogenic liability at 200 mg/kg po. Furthermore, some of the newly synthesized derivatives were better analgesics than the reference drug as observed from the percentage writhing inhibition in the p-benzoquinone (PBQ)-induced writhing test in mice.

Depression and its association with socio-demographic characteristics among type 2 diabetes mellitus patients of Bangladesh

Diabetes mellitus is being increasingly recognized as a serious global health problem and is frequently associated with co-morbid depression. A cross sectional study was conducted among 178 adult type 2 diabetes mellitus patients attending Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh to find out influence of socio-demographic characteristics for occurrence of depression among them. Data were collected through face-to-face interview. Depressive symptoms were measured using Centre for Epidemiological Studies Depression Scale. Proportion of depression was found 34.8% which included 20.2% with severe depression and 14.6% with mild to moderate depression. Both mild to moderate and severe depression were significantly more common in female, odds ratios were 2.72 (95% CI=1.13-6.53) and 5.94 (95% CI=2.49-14.20), respectively. Currently not married respondents were also suffered from higher depressive symptoms. For mild to moderate depression odds ratio was 4.38 (95% CI=1.46-13.18) and for severe depression odds ratio was 9.51 (95% CI=3.69-24.50). Among socio-demographic characteristics marital status was identified as the best predictor of depression, which was followed by education upto secondary level, female sex and primary education. Depression was identified as a significant health problem among adult type 2 diabetes mellitus patients. Its association with socio-demographic characteristics should be considered while planning therapeutic approaches for diabetic patients.

Effect of screening for Type 2 diabetes on population-level self-rated health outcomes and measures of cardiovascular risk: 13-year follow-up of the Ely cohort

AIMS

There is continuing uncertainty regarding the overall net benefits of population-based screening for Type 2 diabetes. We compared clinical measures, prescribed medication, cardiovascular morbidity and self-rated health in individuals without diabetes in a screened vs. an unscreened population.

METHODS

A parallel-group, cohort study of people aged 40-65 years, free of known diabetes, identified from the population register of a general practice in Ely, Cambridgeshire (n = 4936). In 1990-1992, one third (n = 1705), selected randomly, received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals (screened population). From the remainder of the sampling frame, 1705 randomly selected individuals were invited to diabetes screening 10 years later (unscreened population). Patients without known diabetes from both populations were invited for a health assessment.

RESULTS

Of 3390 eligible individuals without diabetes, 1442 (43%) attended for health assessment, with no significant difference in attendance between groups. Thirteen years after the commencement of screening, self-rated functional health status and health utility were identical between the screened and unscreened populations. Clinical measures, self-reported medication and cardiovascular morbidity were similar between the two groups.

CONCLUSIONS

Screening for diabetes is not associated with long-term harms at the population level. However, screening has limited long-term impact on those testing negative; benefits may largely be restricted to those whose diabetes is detected early through screening.

Spectrum of skin lesions of post-kala-azar dermal leishmaniasis in kala-azar endemic areas of Bangladesh

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) and serves as a potential reservoir for Leishmania parasite. The study was aimed to evaluate the spectrum of skin lesions of PKDL in kala-azar endemic areas in Bangladesh. This cross sectional study was carried out to observe the characteristics of skin lesions among 250 PKDL cases. The suspected PKDL patients in highly endemic villages of Fulbaria Upazilla of Mymensingh district.were subjected to a dipstick test (rK39) for kala azar. The median time interval between diagnosing kala-azar and PKDL was 23 month (m-21, r- 0-60 months). The most common skin lesions were multiple symmetrical hypopigmented macules with irregular margins in 179(71.6%) cases followed by erythematous facial induration in 74(29.6%), papular in 33(13.2%), nodular in 28(11.2%) cases, combination of macules, papules, nodules and plaques in 88(35.2%) cases, annular in 7(2.8%) cases and Papillomatous mucosal growth in 2(0.8%) cases. Sites of involvement were mostly in face (92.4%), Trunk (84.8%), extremities (33.2%), oral mucosa and tongue (0.8%) and Genitalia (1.2%). Suspicion of PKDL on the basis of skin lesions will lead to early diagnosis and prompt treatment will impart an important role in prevention and eradication of Leishmaniasis in Bangladesh.

Synthetic Brassica napus L.: development and studies on morphological characters, yield attributes, and yield

Brassica napus was synthesized by hybridization between its diploid progenitor species B. rapa and B. oleracea followed by chromosome doubling. Cross with B. rapa as a female parent was only successful. Among three colchicine treatments (0.10, 0.15, and 0.20%), 0.15% gave the highest success (86%) of chromosome doubling in the hybrids (AC; 2n = 19). Synthetic B. napus (AACC, 2n = 38) was identified with bigger petals, fertile pollens and seed setting. Synthetic B. napus had increased growth over parents and exhibited wider ranges with higher coefficients of variations than parents for morphological and yield contributing characters, and yield per plant. Siliqua length as well as beak length in synthetic B. napus was longer than those of the parents. Number of seeds per siliqua, 1000-seed weight and seed yield per plant in synthetic B. napus were higher than those of the parents. Although flowering time in synthetic B. napus was earlier than both parents, however the days to maturity was little higher over early maturing B. rapa parent. The synthesized B. napus has great potential to produce higher seed yield. Further screening and evaluation is needed for selection of desirable genotypes having improved yield contributing characters and higher seed yield.

Evaluation of microwave plasma sintering for the fabrication of dye sensitized solar cell (DSSC) electrodes

Dye-sensitized solar cells (DSSCs) have demonstrated considerable potential due to their solar energy conversion efficiency and their fabrication from relatively low cost materials. Titanium dioxide (TiO2) nanoparticles are widely used in the fabrication of the DSSC electrodes. There is a considerable energy requirement however required for the sintering of the TiO2 particles during the fabrication of the mesoporous electrodes. This study investigates the use of microwave (MW) plasma treatments as a rapid, energy efficient processing technique for the sintering of the metal oxide particles. A comparison is made with conventional furnace treatments for the sintering of TiO2 nanoparticles (Degussa P25), deposited onto fluorine doped tin oxide (FTO) coated glass substrates. Subsequent to the TiO2 sintering, ruthenium based dye (N719) adsorption studies were carried out for coatings heated using both sintering techniques. Based on UV/Vis absorption spectra measurements of 5 mins plasma and 30 mins furnace sintering, it was observed that both sintering techniques exhibited similar levels of dye adsorption. A decrease in the level of dye adsorption was observed for the TiO2 coatings sintered for longer periods (up to 10 mins in this study). This change with longer plasma treatment times was associated with rutile grain growth and a decrease in surface roughness, possibly due to a densification of the mesoporous structure. The effect of TiO2 coating plasma treatment times on the conversion efficiency of the dye sensitised electrodes was also evaluated. Plasma treatments of 5 mins were found to yield the highest conversion efficiency of 6.4%.

How much does screening bring forward the diagnosis of type 2 diabetes and reduce complications? Twelve year follow-up of the Ely cohort

AIMS

There are continuing uncertainties about how much screening for type 2 diabetes brings forward the clinical diagnosis and the impact that earlier diagnosis has on health outcomes. We compared the duration of diabetes and health outcomes in a population invited for diabetes screening at 5-yearly intervals from 1990 (screened population) with those in a similar population not invited for screening (unscreened population).

METHODS

This was a parallel-group, cohort study of people aged 40-65 years, free of known diabetes, identified from the population register of a general practice in Ely, Cambridgeshire, UK (n = 4,936). In 1990-1992, one-third (n = 1,705), selected randomly, received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals (screened population). From the remainder of the sampling frame, 1,705 randomly selected individuals were invited to diabetes screening 10 years later (unscreened population). Patients with diabetes from both populations were invited for a health assessment, including biochemical, anthropometric and questionnaire measures, and testing for the presence of diabetic complications

RESULTS

Of the 199 eligible individuals with diabetes diagnosed during follow-up, 152 (76%) attended for health assessment. The median duration of clinically recognised diabetes was significantly longer in cases arising in the screened (5.0 years) compared with the unscreened population (1.7 years; p = 0.006). Clinical measures, prescribed medication and functional status were similar between screened and unscreened populations.

CONCLUSIONS

Diabetes screening resulted in cases being identified on average 3.3 years earlier, a difference significantly shorter than previous estimates. Earlier diagnosis did not appear to impact on health outcomes. Further evidence is needed to justify the introduction of population-based screening.

Reverse-mode NCX current in mouse airway smooth muscle: Na(+) and voltage dependence, contributions to Ca(2+) influx and contraction, and altered expression in a model of allergen-induced hyperresponsiveness

AIM

We examined the electrophysiological properties of reverse-mode Na(+) /Ca(2+) exchange (NCX) in mouse airway smooth muscle (ASM), assessing its contributions to regulation of [Ca(2+) ], and its expression in acute and chronic airway hyperresponsiveness (AHR).

METHODS

Membrane currents were studied in single murine ASM cells under voltage clamp at -60 mV using ramp depolarizing commands to +80 mV. Confocal fluorimetric and RT-PCR techniques were used to monitor changes in cytosolic [Ca(2+) ] and NCX expression, respectively.

RESULTS

With standard KCl-containing electrode, 30 μm KB-R7943 (an inhibitor of reverse-mode NCX activity) exhibited variable effects on membrane current, indicating modulation of more than one conductance. KB-R7943 activated outwardly rectifying current that was inhibited by 100 μm iberiotoxin (blocker of large-conductance Ca(2+) -dependent K(+) channels), indicating a direct enhancing effect of KB-R7943 on those K(+) channels. After obviating K(+) currents, we found that a current sensitive to 4-4'-diisothiocyanostilbene-2,2'-disulfonic acid (blocker of Ca(2+) -dependent Cl- channels) was markedly increased by elevating [Na(+) ] in the electrode solution to 13, 15.5 and 18 mm and suppressed by KB-R7943, indicating Ca(2+) influx via reverse-mode NCX activity. With conditions preventing Ca(2+) influx through voltage-dependent Ca(2+) channels but promoting that through NCX, we found that introduction of Ca(2+) led to marked but transient KB-R7943-sensitive elevation of [Ca(2+) ]. Additionally, KB-R7943 suppressed cholinergically evoked Ca(2+) waves. Finally, NCX1 expression was not significantly changed in allergen-induced AHR acute model but increased approx. 2.5-fold in a chronic model.

CONCLUSION

Reverse-mode NCX activity leads to a physiologically relevant increase in [Ca(2+) ] even under control conditions, and this may be exaggerated in allergen-induced AHR and asthma.

Effect of doping (C or N) and co-doping (C+N) on the photoactive properties of magnetron sputtered titania coatings for the application of solar water-splitting

The photocatalytic splitting of water into hydrogen and oxygen using a photoelectrochemical (PEC) cell containing titanium dioxide (TiO2) photoanode is a potentially renewable source of chemical fuels. However, the size of the band gap (-3.2 eV) of the TiO2 photocatalyst leads to its relatively low photoactivity toward visible light in a PEC cell. The development of materials with smaller band gaps of approximately 2.4 eV is therefore necessary to operate PEC cells efficiently. This study investigates the effect of dopant (C or N) and co-dopant (C+N) on the physical, structural and photoactivity of TiO2 nano thick coating. TiO2 nano-thick coatings were deposited using a closed field DC reactive magnetron sputtering technique, from titanium target in argon plasma with trace addition of oxygen. In order to study the influence of doping such as C, N and C+N inclusions in the TiO2 coatings, trace levels of CO2 or N2 or CO2+N2 gas were introduced into the deposition chamber respectively. The properties of the deposited nano-coatings were determined using Spectroscopic Ellipsometry, SEM, AFM, Optical profilometry, XPS, Raman, X-ray diffraction UV-Vis spectroscopy and tri-electrode potentiostat measurements. Coating growth rate, structure, surface morphology and roughness were found to be significantly influenced by the types and amount of doping. Substitutional type of doping in all doped sample were confirmed by XPS. UV-vis measurement confirmed that doping (especially for C doped sample) facilitate photoactivity of sputtered deposited titania coating toward visible light by reducing bandgap. The photocurrent density (indirect indication of water splitting performance) of the C-doped photoanode was approximately 26% higher in comparison with un-doped photoanode. However, coating doped with nitrogen (N or N+C) does not exhibit good performance in the photoelectrochemical cell due to their higher charge recombination properties.

Epidemic plasmids in Neisseria gonorrhoeae isolated from high-risk population in Bangladesh

Gonorrhoea still remains as one of the most common venereal diseases, causing a wide range of morbidity among the sexually active people. Characterization of the circulating strains of gonococcus containing epidemic plasmids is important to formulate control strategy. Keeping in mind the above consideration, a total of 495 Neisseria gonorrhoeae isolates with known minimum inhibitory concentration (MIC) values and antimicrobial susceptibility to penicillin and tetracycline were investigated for plasmid content of either PPNG (penicillinase producing N. gonorrhoeae) or TRNG (tetracycline resistant N. gonorrhoeae) or both. Isolates of N. gonorrhoeae showing resistance to penicillin (penicillin MIC ≥ 2 μg/ml, n=255) and high-level tetracycline resistance (tetracycline MIC ≥ 8 μg/ml, n=396) were tested by polymerase chain reaction. The oligonucleotide primers developed to differentiate between three related, epidemic PPNG plasmids (Asia type, Africa type or Toronto/New Zealand type) were used to identify PPNG plasmids and the primers developed to distinguish between American and Dutch variants of Tet-M gene were used to identify TRNG plasmids. A total 169 (34.1%) of the N. gonorrhoeae isolates were found to carry PPNG plasmids and all of them were Africa type showing the amplified products of 3.1 kb. A total 382(77.2%) of the isolates were found positive for TRNG plasmids and almost all were Dutch type (377, 98.7%) with a few American type (5, 1.3%). Although the rate of plasmid infection of either PPNG or TRNG types were very high, because of the presence of only one variant, they are supposed to be endogenously acquired. Therefore, a control strategy, considering the sexual behaviour of the local high risk populations as well as the susceptibility pattern of the circulating N. gonorrhoeae-derived treatment regimen might suffice to control the disease in Bangladesh.

Clinical and angiographic profile of congenital anomalous origin of coronary arteries

Coronary artery anomalies were found in 24(0.6%) patients undergoing coronary arteriography at University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka from 2004 to 2007. Of the 24 patient, 21(87.5%) had anomalies of origin and distribution and 3(12.5%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms or complications and usually were discovered as an incidental finding at the time of catheterization. Most of them were benign anomalies: i) separate origin of left anterior descending and circumflex from sinus of valsalva; ii) ectopic origin of circumflex from right sinus of valsalva; iii) Anomalous origin of left main coronary artery from right coronary artery; iv) anomalous coronary origin from ascending aorta; v) absent left circumflex; vi) double right coronary artery; vii) small coronary artery fistula. These anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. In this study large coronary artery fistula was found as potentially serious anomaly. So coronary artery anomalies require accurate recognition for the appropriate management of the patients.

Regression equations for spirometry in children aged 6 to 17 years in Delhi region

BACKGROUND

Most of the studies carried out in India to develop regression equations for spirometry in children are now several years-to-decades old and had used equipment and measurement protocols that have since changed. Prediction equations using the current standardisation protocols for spirometry are not available. The lung health of the population may have changed too.

OBJECTIVE

To develop regression equations for spirometry for children aged 6 to 17 years of north Indian origin in Delhi region.

METHODS

School children of north Indian origin, as determined by mother tongue and parentage, aged 6 to 17 years were screened by a health questionnaire and physical examination and those found "normal" underwent spirometry according to the standardised procedure recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) task force in 2005. Pearson's correlation analysis was carried out to identify the predictor variables for spirometric parameters. Prediction equations were developed using the multiple linear regression procedure. The independent variables were entered in sequence of height, age and weight. R2, adjusted R2 and R2 change, standard errors of the estimate (SEE), and estimates of regression coefficients were obtained and the goodness of fit was examined.

RESULTS

Data was obtained in 365 boys and 305 girls. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) peak expiratory flow rate (PEFR), forced expiratory flow rate at 50% and 75% exhalation of vial capacity (F50 and F75) and mean forced expiratory flow rate over the middle 50% of the vital capacity (F25-75) showed moderate to strong correlations with age, height and weight in both boys and girls. In both genders, the equations explained very high variability of FVC, FEV1 and PEFR as shown by the R2 values. The explained variability for flow rates was lesser, with that for F75 being the least.

CONCLUSIONS

Regression equations for spirometry variables for children of north Indian origin in Delhi region have been developed. These represent the first such effort from India after the publication of the ATS/ERS task force 2005 guidelines on standardisation of spirometry.

Hepatitis B among pregnant women attending health care facilities in rural Bangladesh

This study assessed hepatitis B prevalence among pregnant women attending health care facilities in rural Bangladesh. Blood samples were collected from 480 participants. HBsAg was positive in 0.4% of subjects, anti-HBc was positive in 21.5% and anti-HBs was positive in 8.5% of subjects. HBsAg was more prevalent among the older age group. Hepatitis B has a low prevalence among pregnant women in rural Bangladesh. Existing hepatitis B vaccination schedule in the Expanded Program on Immunization (EPI) to vaccinate the children in rural Bangladesh is appropriate.