Effect of Meconium Staining Amniotic Fluid on Fetal Outcome

Meconium-stained amniotic fluid is the passage of meconium by a fetus in utero during the antenatal period or in labour. It has for long been considered to be a bad predictor of fetal distress and meconium aspiration syndrome (MAS). The objective of this study was to find out the fetal outcome of MSAF and clear amniotic fluid. This cross- sectional comparative study was carried out in Upazilla Health Complex, Palash, Narshingdi from July 2016 to June 2017. A total of 100 pregnant women among them 50 women with MSAF and 50 women with clear liquor were studied to see the record of ANC, mode of delivery and fetal outcome by APGAR score. Study showed that among MSAF group 76.0% (n=38) had irregular ANC and 24.0% (n=12) had regular ANC whereas in clear liquor 86.0% (n=43) had regular ANC 14.0% had irregular ANC. Among MSAF (50 cases) thick meconium was in 20 cases (40.0%) and thin meconium was in 30 cases (60.0%). Regarding mode of delivery 52.0% (n=26) MSAF cases had instrumental delivery and Caesarean section compared to 24.0% (n=12) in clear liquor group. Regarding thick MSAF among 40.0% (n=20), (n=14) had low APGAR score and (n=6) had normal score at one minute and (n=9) low APGAR score and (n=11) normal score at five minutes. In clear liquor, among 100.0% (n=50), 20.0% (n=10) had low APGAR score and 80.0% (n=40) had normal score at one-minute and at five minutes 8.0% (n=4) had low APGAR score and 92.0% (n=46) had normal score. Among MSAF 26.0% (n=13) were admitted to SCBU compare to 12.0% (n=6) in clear liquor group. The mean SCBU stay was 3.1 days in MSAF whereas 1.2 days in clear liquor. Among MSAF babies 4.0% (n=2) had MAS compared to no MAS in clear liquor group. Regarding Survivalist 92.0% (n=46) were alive in MSAF whereas 100.0% all (n=50) were alive in clear liquor group.

Comparison of Serum Phosphorus Level among Women with Preeclampsia and Normal Pregnancy

Pregnancy is a physiological state. During pregnancy increased physiological changes may lead to many biochemical and anatomical alterations. The biochemical changes that seen in blood of the pregnant mother are exaggerated in various complications of pregnancy like preeclampsia. Preeclampsia is a dangerous complication that may leads to maternal and neonatal mortality. Globally it affects 3.0-5.0% of pregnant women. The study was done to analyze the changes in serum phosphorus level in pre-eclamsia compared with normal pregnancy. The study was cross sectional and was performed from July 2016 to June 2017 in the department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh. Total 100 subjects were included in this study. Among them 50 preeclamptic patients were taken as case and another 50 normal pregnant women were taken as control. Statistical difference was calculated by Student's unpaired 't' test. Biochemical values were expressed as mean±SD. The mean±SD of serum phosphorus levels in case and control group were 2.81±0.79 and 3.40±0.87mg/dl respectively. The difference in mean±SD of serum phosphorus were highly significant (p<0.001) when compared between case and control.

Association of Dyslipidemia with Endometriosis: A Case Control Study

Endometriosis is a chronic multi-factorial disease characterized by the presence of functioning uterine glands and stroma in any site outside the uterus. Despite the major public health impact of this condition, little is known about their etiologies. Some studies focused on the similarities between the common biological mechanisms underlying the development of endometriosis and atherosclerotic plaques. So, it is possible to hypothesize that same atherogenic risk factors, such as dyslipidemia may play a role in endometriosis pathogenesis. This case-control study was carried out in the department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2018 to August 2019 to investigate the lipid profile in patients with endometriosis and to analyze the association of dyslipidemia with endometriosis. A total of 140 participants ranged between 18 and 35 years of age attending BSMMU were enrolled in the study. The study population was divided into case and control group; the case group consisting of patients with endometriosis and control group comprising of healthy women without endometriosis. Fasting lipid profile of all participants was measured in the department of Biochemistry and Molecular Biology of BSMMU, Bangladesh. Doing student's t-test and Chi square test compared results of both groups. Logistic regression analysis was done to see association of dyslipidemia with endometriosis. Women with endometriosis were found to have significantly higher levels of serum total cholesterol (TC), low density lipoprotein (LDL-C), triglyceride (TG) and significantly lower level of high density lipoprotein (HDL-C) compared to the controls (p<0.05). The mean atherogenic index was significantly higher in case group (p<0.05). This study found an association between dyslipidemia and endometriosis.Women with endometriosis have higher atherogenic index compared to women without endometriosis.

Serum Magnesium Level and It's Relation in Predicting Adverse In-Hospital Outcome in Patients with First Attack of Myocardial Infarction

Acute myocardial infarction (AMI) patients characterize a large proportion of admissions in coronary care unit and their management and risk stratification is of immense importance. Hypomagnesemia is a long-term risk factor for incident of both myocardial infarction and arrhythmia. We assessed whether serum magnesium levels at admission is associated with arrhythmias and in-hospital mortality in patients with acute myocardial infarction (AMI). The aim of the study was to evaluate the prognostic implications of serum magnesium level in patients with acute myocardial infarction. This cross-sectional observational study was conducted in the department of cardiology in Mymensingh Medical College Hospital from October 2017 to March 2019. Total 259 acute myocardial infarction patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with acute myocardial infarction with serum magnesium ≥1.82mg/dl. Group-II: Patients with acute myocardial infarction with serum magnesium <1.82mg/dl. Serum magnesium level was measured on admission, and the incidence of in-hospital major cardiac events was assessed. In this study mean serum magnesium level of Group-I, Group-II were 2.21±0.14mg/dl, 1.60±0.15mg/dl respectively. It was statistically significant (p<0.05). In-hospital outcomes of the study group revealed that low risk group patients were uneventful outcome during hospitalization period, they had no any complication. In Group-I patient, 9(4.8%) were developed arrhythmias, 26(13.9%) were developed heart failure, 9(4.8%) were developed cardiogenic shock and 3(1.6%) were died and in Group-II patient, 44(61.10%) developed arrhythmias, 9(12.50%) were developed heart failure, 7(9.7%) were developed cardiogenic shock and 12(16.7%) were died out of them which was statistically significant (p<0.05). Mean duration of hospital stay of the study population according serum magnesium level was in Group-I, 4.27±0.68 days, in Group-II, 5.84±1.05 days which was statistically significant (p<0.05). In conclusion patient with serum magnesium level less than 1.82mg/dl increased the risk of in-hospital arrhythmia and death.

Changes in Serum Uric Acid Level in Acute Myocardial Infarction Patients

Myocardial infarction (MI) is one of the dangerous manifestations of coronary artery disease and one of the commonest causes of mortality. This cross-sectional study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with the department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period of January 2018 to December 2018. A total of 120 subjects were included in this study. Among them 60 were diagnosed AMI patients denoted as case group and 60 were apparently normal healthy individuals denoted as control group. Biochemical values were expressed as Mean±SD (Standard deviation). Statistical analysis was done by using SPSS (Statistical package for social science) version 21.0 windows package. Serum uric acid determined by enzymatic colorimetric method using the test kit. Among the study groups the mean±SD values of uric acid were 6.61±2.62 and 5.38±1.16mg/dl in case and control group respectively. The analysis showed that, serum uric acid was statistically increased in case group compared with control group. The level of significance was 0.001. Statistical significance of difference between two groups were evaluated by using Student's unpaired 't' test.

Clinico-pathological Evaluation of Residual Ovary Syndrome: A Cross Sectional Study

The residual ovary syndrome (ROS) occurs in patients where one or both ovaries are conserved at the time of hysterectomy. It occurs mostly within 10 years of hysterectomy. Residual ovary syndrome usually requires surgery and histology varies from some physiological cysts to benign or even malignant neoplasms. The objectives of the study were to analyze the etiopathology of re-operation for ROS and to find out their clinical presentations. This cross-sectional observational study was conducted in the department of Obstetrics and Gynaecology, BSMMU during a period of 5 years from January 2014 to December 2018. All consecutive patients admitted with residual ovary syndrome (ROS) at the department of Obstetrics and Gynaecology and also in Gynae-oncology department at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Total 40 cases were enrolled according to selection criteria and sampling technique was purposive. The mean age of the study populations was 42.20±7.13 years. All of the study populations were parous except one who was nulliparous. The mean age of hysterectomy was 37.25±6.44 years. The indication of primary surgery by hysterectomy was fibroid in 50% of cases; others were abnormal uterine bleeding, pelvic inflammatory disease etc. After primary surgery majority (77.5%) of the study populations presented with chronic pain with or without dyspareunia and 20% presented with lump in abdomen either symptomatic or asymptomatic. Around half (57.5%) of the patients were presented within 5 years and 82.5% within 10 years of hysterectomy. Per-operative findings of secondary surgery for ROS were mainly extensive peri-ovarian and peritoneal adhesions involving surrounding structures. Among them majority (77.5%) of the cases were presented with various types of cystic and complex masses in the ovaries. Histopathological reports of residual ovary were functional cysts 35.0% (n=14), Corpus luteal cyst 12.5% (n=5), endometriotic cyst 12.5% (n=5), benign ovarian tumours 37.5% (n=15) and malignant ovarian tumour 2.5% (n=1). ROS, usually requires surgery which in most of the cases becomes troublesome due to presence of extensive adhesions with surrounding structures. So, decision is crucial whether to remove or conserve apparently healthy ovaries found at hysterectomy in pre-menopausal women. Moreover decision of hysterectomy in premenopausal women should be taken very judiciously as several medicines are available for conservative management. Usually indications of hysterectomy are benign.

Coumarin improves tomato plant tolerance to salinity by enhancing antioxidant defence, glyoxalase system and ion homeostasis

Salinity is a severe threat to crop growth, development and even to world food sustainability. Plant possess natural antioxidant defense tactics to mitigate salinity-induced oxidative stress. Phenolic compounds are non-enzymatic antioxidants with specific roles in protecting plant cells against stress-mediated reactive oxygen species (ROS) generation. Coumarin (COU) is one of these compounds, however, to date, little is known about antioxidative roles of exogenous COU in enhancing plant tolerance mechanisms under salt stress. The involvement of COU in increasing tomato salt tolerance was examined in the present study using COU as a pre-treatment at 20 or 30 µM for 2 days against salt stress (100 or 160  NaCl; 5 days). The COU-mediated stimulation of plant antioxidant defence and glyoxalase systems to suppress salt-induced ROS and methylglyoxal (MG) toxicity, respectively, were the main hypotheses examined in the present study. Addition of COU suppressed salt-induced excess accumulation of ROS and MG, and significantly reduced membrane damage, lipid peroxidation and Na⁺ toxicity. These results demonstrate COU-improved plant growth, biomass content, photosynthetic pigment content, water retention and mineral homeostasis upon imposition of salinity. Finally, this present study suggests that COU has potential roles as a phytoprotectant in stimulating plant antioxidative mechanisms and improving glyoxalase enzyme activity under salinity stress.

Mucosal-associated invariant T (MAIT) cells are activated in the gastrointestinal tissue of patients with combination ipilimumab and nivolumab therapy-related colitis in a pathology distinct from ulcerative colitis

The aim of this study was to investigate the pathogenesis of combination ipilimumab and nivolumab-associated colitis (IN-COL) by measuring gut-derived and peripheral blood mononuclear cell (GMNC; PBMC) profiles. We studied GMNC and PBMC from patients with IN-COL, IN-treated with no adverse-events (IN-NAE), ulcerative colitis (UC) and healthy volunteers using flow cytometry. In the gastrointestinal-derived cells we found high levels of activated CD8⁺ T cells and mucosal-associated invariant T (MAIT) cells in IN-COL, changes that were not evident in IN-NAE or UC. UC, but not IN-C, was associated with a high proportion of regulatory T cells (T_reg ). We sought to determine if local tissue responses could be measured in peripheral blood. Peripherally, checkpoint inhibition instigated a rise in activated memory CD4⁺ and CD8⁺ T cells, regardless of colitis. Low circulating MAIT cells at baseline was associated with IN-COL patients compared with IN-NAE in one of two cohorts. UC, but not IN-COL, was associated with high levels of circulating plasmablasts. In summary, the alterations in T cell subsets measured in IN-COL-affected tissue, characterized by high levels of activated CD8⁺ T cells and MAIT cells and a low proportion of T_reg , reflected a pathology distinct from UC. These tissue changes differed from the periphery, where T cell activation was a widespread on-treatment effect, and circulating MAIT cell count was low but not reliably predictive of colitis.

In Vitro Antibacterial Activity of Ethanol Extracts of Cinnamomum zeylanicum against Pseudomonas aeruginosa

Cinnamomum zeylanicum as medicinal plants are measured as new resources for preparing elements in the treatment of antibiotic-resistant microbes as alternatives to antibiotics. This study was aimed to evaluate the antibacterial activity of ethanol extracts of Cinnamomum zeylanicum against a Gram-negative bacteria Pseudomonas aeruginosa. This experimental study was carried out in the department of Pharmacology & Therapeutics and department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2017 to July 2018. Evaluation of the in vitro antibacterial activity of ethanol extracts of Cinnamomum zeylanicum against Pseudomonas aeruginosa was performed by disc diffusion method. And also in this study we used broth dilution method to determine the minimum inhibitory concentration (MIC). Ethanol cinnamon extract (ECE) was found active against P. aeruginosa. Zone of inhibition (ZOI) ranged between 6-25mm at different concentration of extracts. The MIC was 0.3g/ml. Cinnamomum zeylanicum showed strong antibacterial activity against a Gram-negative bacteria Pseudomonas aeruginosa. The results may contribute to the development of potential antimicrobial agents for inclusion in antipseudomonal regimens.

Prevalence of Gall Bladder Carcinoma in Patients with Cholelithiasis

The objective of the study was to find out the prevalence of gallbladder carcinoma in patients having cholelithiasis. For this purpose a prospective study was carried out on 15 patients of both sexes in Shaheed Ziaur Rahman Medical College Hospital, Bogura. Their mean age was 56 ±8 years (range 30 to 70 years) having gall bladder mass. Gall bladder mass and stone were detected by history, Physical examination, ultrasonography and computed tomography of the abdomen. Carcinoma was confirmed by histopathological examination of specimens removed by operation. All gallbladder masses removed by operation showed malignat tumor on histopathological examination. Among them adenocarcinoma and squamous cell carcinoma were present in 94 and 6 percent respectively. Stones were present within gallbladder mass in 94 percent of cases. In 80 percent of cases the disease was in advanced stage. The results of the present study suggested that the patient having cholelithiasis are prone to develop malignancy in the gallbladder. However as the sample size is small further studies are needed by taking large number of sample to validate this statement Journal of Surgical Sciences (2012) Vol. 16 (2) : 68-70

Knowledge, Attitude and Practice of Bangladeshi Women towards Breast Cancer: A Cross Sectional Study

In Bangladesh incidence rate of breast cancer was about 22.5 per 100000 females. Breast cancer has been reported as the highest prevalence rate (19.3 per 100,000) among Bangladeshi women between 15 and 44 years of age. For this prevailing situation a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Bangladesh towards breast cancer at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2013 to June 2014. All female participants attending at outpatient department of BSMMU having age more than 20 years and education at least JSC, purposively selected until the sample size achieved 500. Only applying simple cost free method like self breast examination (SBE) and clinical breast examination (CBE) one can asses her breast. Thereby awareness develops regarding her breast so any mass newly appear can be assessed by the lady herself. Early diagnosis of the breast cancer will reduce the burden of treatment cost, mortality & morbidity. Research and development strategy of the project is to enhance the awareness of the community people about breast cancer prevention. Mean age of the study population was 36.16 years. Regarding education nearly 30% (n=150) of them studied up to Junior School, 16% (n=80) respondents completed masters and above remaining in between. Regarding occupation, almost 60% (n=300) were house wife, 32% (n=160) were service holder and only 8% (n=40) of them were students. Knowledge about common female cancer 60% (n=300) were aware about the cervical cancer, 24% (n=120) mentioned breast cancer, 4% (n=20) mentioned ovarian cancer, and 12% (n=60) don't know anything regarding common women cancer. Knowledge about early symptoms of breast cancer, majority of the respondents 66% (n=330) were aware that mass in the breast is the main symptom, 2% (n=10) mentioned pain in breast, 32% (n=160) mentioned that they don't know anything regarding the early symptoms. About the cause of breast cancer 60% (n=300) mentioned that, they don't know anything regarding the cause of breast cancer, 36% (n=180) were aware that non lactation is a cause of breast cancer. About 4% (n=20) of the study population mentioned others, like due to some ones bad did cancer occur as punishment. Knowledge about risk factor of breast cancer, 65% (n=325) have no idea about the risk of breast cancer, 32% (n=160) mentioned few risk factors which have relation with breast cancer and 3% (n=15) did not mention anything. Regarding diagnosis of cancer breast 72% (n=360) mentioned they don't know anything, 16% (n=80) by doing ultra sonogram of breast, 6% (n=30) mentioned about Mammography and 6% (n=30) MRI & others. Regarding screening for prevention of breast cancer 60% (n=300) mentioned that they don't know anything regarding screening. Thirty percent (n=150) were aware that there is screening method but they are not aware specifically regarding this method and they also not aware that breast cancer is a preventable disease. 10% (n=50) were fully aware about screening method like CBE & SBE. About the cause of not seeking medical advice for prevention of Breast cancer, majority of the respondents 40% (n=200) mentioned expenditure problems, 32% (n=160) they don't have any knowledge about this type of medical advice, 8% (n=40) mentioned communication problems and 20% (n=100) others. Regarding Practice of CBE & SBE 68% (n=340) never practice CBE & SBE, 30% (n=150) occasionally practiced CBE & SBE. Only 2% (n=10) mentioned that they were regularly practicing CBE & SBE.

Extra Skeletal Ewing's Sarcoma Involving Perineum of a Young Male Patient

Ewing's Sarcoma is the second most common primary malignant bone tumor in children and young adults after osteosarcoma but exceptionally it can arise from extra skeletal sites also. Extra skeletal Ewing's sarcoma is of neuroectodermal origin and usually involves extremities, retroperitoneum and paravertebral regions. No case of extra skeletal Ewing's sarcoma involving perineum is yet reported. A 16 years old male patient admitted to colorectal surgery department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in July 2015 having swellings in perineum as well as both inguinal regions. The swelling was near to anal verge. FNAC from perineal swelling and inguinal lymph node demonstrate small blue round cell tumor. After operation the tumor size was 5cm×4cm, cell type was malignant round cell arranged in sheet and perivascular forming rosette. Extra skeletal Ewing's sarcoma can be a differential diagnosis of soft tissue tumor arising in perineum.

Ovarian Endometrioid Adenocarcinoma Arising in Endometriosis: A Case Report

Malignant transformation of ovarian endometriosis was first described in 1925 by Sampson; later on it has been described in extragonadal regions by few authors also. Ovarian endometrioid and clear cell carcinoma are highly associated with endometriosis. Here we present a case of malignant transformation of ovarian endometrioma into endometrioid adenocarcinoma and review the clinical and pathological features of these tumors. A 45-years old infertile woman diagnosed as a case of bilateral chocolate cyst with pelvic endometriosis underwent total hysterectomy with bilateral salpingo-oophorectomy. A solid portion was also identified in the right sided cyst, histology of which revealed a well-differentiated endometrioid adenocarcinoma grade-II with foci of squamous morules and keratin pearls. Her pre-operative CA-125 level was within normal range. Women with endometriosis should be considered at an increased risk for the development of ovarian cancer even with normal CA-125 level.

Interaction of sulfur with phytohormones and signaling molecules in conferring abiotic stress tolerance to plants

Sulfur (S) is a macronutrient for the plant, which has an immense role in basic plant processes and regulation of several metabolic pathways. It has also a major role in providing protection against adverse conditions. Sulfur-containing amino acids and metabolites maintain plant cell mechanisms to improve stress tolerance. It interacts with several biomolecules such as phytohormones, polyamines, nitric oxide (NO), and even with other plant nutrients, which can produce some derivatives those are essential for abiotic stress tolerance. Different S derivatives stimulate signaling cascades, for the upregulation of different cellular messengers such as abscisic acid, Ca²⁺, and NO. Sulfur is also known to interact with some essential plant nutrients by influencing their uptake and transport, hence, confers nutrient homeostasis efficiencies. This review focuses on how S is interacted with several signaling molecules like NO, glutathiones, phytohormones, hydrogen sulfide, polyamines, etc. This is a concise summary aimed at guiding the researchers to study S-related plant processes in the light of abiotic stress tolerance.

Response & Side Effects of Injectable Labetalol in Pregnancy Induced Severe Hypertension

The study was performed to assess the response & side effects of injectable Labetalol in the treatment of pregnancy induced severe hypertension. This interventional study was carried out on 72 patients having pregnancy induced severe hypertension attended in the Department of Obstetrics & Gynaecology, Mymensingh Medical College & Hospital (MMCH), Mymensingh, Bangladesh from November 2009 to October 2010. All patients were treated with intravenous Labetalol 20mg & the dose was repeated at sequential escalating dosages every 15 minutes until a therapeutic goal of systolic blood pressure <160mm of Hg & diastolic blood pressure <105mm of Hg were achieved. Among 72 respondents highest number were observed having systolic blood pressure 160-169 and 180 & above mm of Hg. The mean systolic & the diastolic blood pressure at the initiation of the study were observed 198±13.17mm of Hg & 119±8.6mm of Hg respectively. After use of injection Labetalol mean systolic blood pressure were 138.61±15.43mm of Hg, which is statistically significant (p value <0.001) & mean diastolic blood pressure were 96.18±9.7mm of Hg, which is also statistically significant (p value <0.001). It was observed that majority patients' blood pressure was controlled by 1-2 doses. It was noticed that injection Labetalol controls blood pressure in 80% antenatal cases & 86% postnatal cases. Out of 72 patients 4 cases (5.5%) experienced nausea & vomiting and only 1 case (1.1%) experienced headache. Regarding fetal outcome 48% patients delivered healthy baby, about 31% patients delivered asphyxiated baby & neonatal death were noticed in 4% cases. This study assessing the response & side effects of intravenous antihypertensive drug in the treatment of pregnancy induced severe hypertension shows that Labetalol fulfils the criteria of an antihypertensive drug for this purpose.

Sonographically Detected Non Alcoholic Fatty Liver Disease in Apparently Healthy Adults and Associated Factors

This hospital-based study was done to see the prevalence of sonologically detected non alcoholic fatty liver disease and associated factors in the apparently healthy adults. Apparently healthy and non alcoholic companions of the patients visiting the Centre of Nuclear Medicine and Ultrasound, Sylhet were subjected to abdominal ultrasonography to see the presence of fatty liver. Demographic features and other relevant data were collected in a semi structured questionnaire to find out the associated factors for non alcoholic fatty liver disease (NAFLD). Total 1019 persons with mean age of 37.23 years were included in the study. Among them 703 (69%) were female and 316 (31%) were male. Out of them 189 (18.5%) persons had sonologically detectable nonalcoholic fatty liver disease. NAFLD was more prevalent in male than female (25.6% vs. 15.4%, p=0.000). In univariate analysis NAFLD were more in male (25.6%) 41-50 years age group (29.3%, p=0.000), over weight (32.3%)/obese subjects (51.4%), businessmen (24.0%), service holders (28.7%), high income group, diabetics (27.0% vs. 18.0%, p=0.000) and hypertensive subjects (43.3% vs. 15.24%, p=0.000). In multivariate analysis, BMI over 23kg/m² (OR 6.683, p=0.000), age >30 years (OR 1.787, p=0.006) and higher income (OR 1.788, 95% CI 0.970-3.293) were independent factors associated with NAFLD. Sonologically detected nonalcoholic fatty liver disease (18.5%) is common in our apparently healthy adults. BMI over 23kg/m² was the most important predictor for NAFLD.

Huge Perineal Tumour: A Rare Presentation of Gastrointestinal Stromal Tumour of Rectum

Gastrointestinal stromal tumour (GIST) is a relatively rare neoplasm of gastrointestinal tract of which Rectal GIST is uncommon. It produces symptoms of per rectal bleeding or change in bowel habit. Recurrences following curative resection are predominantly intraabdominal, hepatic metastasis occurring at a median 20-25 months following the primary surgery. A 42 years old male presented a huge mass in hypogastrium, the size of which was reduced ofter neoadjuvant therapy for period of 1.5 years. He underwent abdominoperineal resection. He developed recurrences in perineum three times and in thigh at short intervals after primary resection. He also developed liver metastasis. He died two and half years after primary diagnosis. Rectal GIST should be included in differential diagnosis of intraabdominal mass and preoperative diagnosis based on histopathological as well as the immunohistochemical feature of the CD(117) and CD(34). Although complete surgical resection with negative tumour margin is the principal curative procedure for primary and non metastatic tumours, further studies are still needed for the determination of the most effective treatment strategy for patients of rectal GIST.

Role of Serum Follicle Stimulating Hormone, Luteinizing Hormone, Testosterone and Prolactin Levels in Azoospermic Male Partner of Subfertile Couple

This cross sectional study was carried out in the Infertility Unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2011 and June 2013. Eighty one (81) consecutive azoospermic male partner of married couple, aged 20-50 years with at least two years of subfertility and no known endocrinopathy and ejaculatory dysfunction were included in this study to find out their abnormal hormonal pattern. None of them had received any form of treatment within the last 3 months prior to hormonal evaluation. Men with hypertension, recent fever, chemo or radiation exposure were excluded from the study. Eight weeks interval two semen analyses were done in the Andrology Laboratory of above department following standard WHO guideline, 2004. Using standard ELISA technique, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and prolactin were measured/assayed/estimated. The results of this study demonstrated that 40 (49.4%) men had normal endocrine pattern against 51 (50.6%) with endocrinopathy. The former may be related to obstructive azoospermia, which needs further analyses. Both the increased FSH (>11.1mIU/ml) and LH (>7.6mIU/ml) were observed in 25 (30.9%) men, only elevated FSH (>11.1mIU/ml) in 9(11.1%), and only elevated LH (>7.6mIU/ml) in 7(8.6%). Low testosterone level (<270ng/dl) was observed in 11(13.6%), low TSH (<0.4μIU/ml) in 1(1.2%) and low prolactin (<2.5ng/dl) in 5(6.2%).

Estimation of Thyroid Hormone in Early Pregnancy and it's Clinical Correlation

This descriptive cross sectional study was done for the estimation of thyroid hormone in early pregnancy and it's clinical correlation. It was conducted at the Antenatal Clinic of Mymensingh Medical College Hospital, Mymensingh from December 2010 to November 2011. Total 185 cases in early pregnancy were taken purposively and randomly. Among the pregnant women, age ranged from 18-42 years with the Mean±SD age 25.77±4.96 years, the gestational weeks ranged 6±1 to 13±1weeks having Mean±SD 9.06± 2.49 weeks. The gravida ranged from primi to 8th gravida Mean±SD 1.89±1.10. Haemoglobin level ranged from 9.0 to 13.2gm/dl; Mean±SD 10.90±0.99gm/dl. Mean±SD of serum FT4 was 17.77±7.25 and Mean±SD of TSH was 3.95±2.94mIU/L. In present study, 5.40% (n=10) of the respondents had hypothyroidism and 0.54% (n=1) showed hyperthyroidism. The present study showed that, the incidence of hypothyroidism had relatively increased then the reference ranges but not statistically significant. But hyperthyroidism was within the reference range. This study showed slightly higher percentage of hypothyroidism in both ≤30 (4.52%) and ≥30 (10%) years of age groups especially a bit higher percentage in the elderly group. In present study, hypothyroidism was common among women of lower income group. Present study showed a higher percentage of stillbirth &miscarriage among study population. This study showed a relatively higher prevalence of abnormal thyroid function (especially hypothyroidism) in the study population and suggests the routine screening of thyroid hormone in early pregnancy in addition to routine antenatal care.

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.

Engineering of plasminogen activators for targeting to thrombus and heightening thrombolytic efficacy

Thrombotic occlusion of the coronary artery, which triggers acute myocardial infarction, is one of the major causes of death in the USA. Currently, arterial occlusions are treated with intravenous plasminogen activators (PAs), which dissolve the clot by activating plasminogen. However, PAs indiscriminately generate plasmin, which depletes critical clotting factors (fibrinogen, factor V, and factor VIII), precipitates a lytic state in the blood, and produces bleeding complications in a large patient population. PAs have been extensively investigated to achieve thrombus specificity, to attenuate the bleeding risk, and to widen their clinical applications. In this review, we discuss various strategies that have been pursued since the beginning of thrombolytic therapy. We review the biotechnological approaches that have been used to develop mutant and chimeric PAs for thrombus selectivity, including the use of specific antibodies for targeting thrombi. We discuss particulate carrier-based systems and triggered-release concepts. We propose new hypotheses and strategies to spur future studies in this research arena. Overall, we describe the approaches and accomplishments in the development of patient-friendly and workable delivery systems for thrombolytic drugs.

Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region

BACKGROUND

At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South-East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time.

METHODS

This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste during 2006-2013. GYTS is a nationally representative survey of 13-15-year-old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software.

RESULTS

According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011.

CONCLUSION

The findings call for countries to implement corrective measures through strengthened policy and enforcement.

A 7 years old girl with abdominal lump and per-vaginal bleeding of hypothyroidism

Hypothyroidism is a common endocrine disorder resulting from decreased secretion of thyroid hormone. The diagnosis of hypothyroidism is suggested from the clinical and laboratory findings. Here we present a case report on this disease with rare presentation of abdominal lump and pervaginal bleeding in childhood. A 7 years old girl admitted in a tertiary level hospital with abdominal lump and irregular per vaginal bleeding. Abdominal swelling was gradually increasing in size & associated with lower abdominal pain for last 5 months. On examination the girl was moderately anaemic, mildly oedematous, distended lower abdomen and a mass in left iliac region. Her thyroid function test, serum FSH, serum LH, serum Prolactin was done and high FSH, LH, Prolactin levels were found. Ultrasonography of lower abdomen revealed bulky uterus and bilateral ovarian cysts. MRI of Brain showed feature of pituitary microadenoma. Finally the patient was diagnosed as primary hypothyroidism and bilateral follicular ovarian cyst with pituitary adenoma developed as its consequence. The case is reported for clinical awareness & to share our experience.

Placental changes in pregnancy induced hypertension and its impacts on fetal outcome

A descriptive cross sectional study was carried out in the Gynae and Obstetrics & Pathology department of Mymensingh Medical College & Hospital (MMCH) to see the placental changes in normal & pregnancy induced hypertension (PIH) and its impacts on fetus for one year period. Total 80 placentas were collected, 40 from normal pregnant mothers having no hypertension and 40 from PIH group (one from gestational hypertension, 17 from pre-eclampsia and 22 from eclampsia. Macroscopic study of the placenta revealed placental weight, surface area and number of cotyledons were less in study group. Mean placental weight in study group was 419.50gm and in control group was 477.50 (p<0.001). Mean surface area in study group & control group were 232.29cm² and 304.80cm² respectively (p<0.001). Mean number of cotyledons were 15.39 and 17.40 in study & control group respectively (P<0.001) and lower diameter of umbilical cord (p<0.04667). But in the present study placental thickness was not significant (p<0.539). There was a single umbilical artery present in one patient in PIH group .In PIH group syncytial knots (95%), fibrinoid necrosis (80%), VSM (vasculosyncytial membrane) formation, sclerosis, chorangiosis and calcification were more marked. Infarction was present in placenta of PIH 34(85%) and in control group 8(20%). There was a tendency of lowering the weight of neonate 2.47kg in study group and 3.06kg in control group (p<0.001), number of asphyxiated babies and perinatal morbidity and mortality( still birth was 7.5 and neonatal death was 15%) were more marked in PIH group. In PIH group placental changes were related with fetal outcome. Common placental changes were significant in this study.

Role of D-dimer in determining coagulability status in pre-eclamptic and normotensive pregnant women

A cross sectional study was carried out from January 2007 to December 2008 in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka in collaboration with Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Pregnant women with pre-eclampsia attending at Out-patient Department (OPD) and admitted in In-patient Department of Obstetrics and Gynaecology Dhaka Medical College Hospital, Dhaka were selected as cases. Healthy and uncomplicated pregnant women admitted in the same hospital were taken as controls. The study showed that 26-30 years and 21-25 years age category was higher in the case and control groups and the mean age was significantly higher in case group compared to control group (p=0.025). The study showed that 44% of case group had a significantly high level of plasma D-dimer (>0.5μg/ml) as opposed to control group (8%) (p<0.001). Estimation of odds ratio demonstrates that pre-eclamptic women (case) had 9 times (95% of CI = 2.8 - 28.9) more risk of having plasma D-dimer >0.5μg/ml than that of normal pregnant women (control). The mean systolic and diastolic blood pressures in patients with plasma D-dimer >0.5μg/ml were considerably higher than those who had plasma D-dimer ≤0.5μg/ml (p<0.001). The study showed that majority (81.8%) of pre-eclamptic women with plasma D-dimer >0.5μg/ml had systolic blood pressure ≥ 160 mm Hg compared to 46.4% of those who had plasma D-dimer ≤0.5μg/ml (p=0.010). And ninety percent of pre-eclamptic women with plasma D-dimer >0.5μg/ml had exhibited severe proteinuria as opposed to 53.6% of those who had plasma D-dimer ≤0.5μg/ml (p=0.017). The study concludes that plasma D-dimer level can easily be used in screening for the hypercoagulable state in pre-eclamptic patients which have preventive and therapeutic implications.

Augmented post-induction therapy for children with high-risk acute lymphoblastic leukemia and a slow response to initial therapy

BACKGROUND

Children with high-risk acute lymphoblastic leukemia (ALL) who have a slow response to initial chemotherapy (more than 25 percent blasts in the bone marrow on day 7) have a poor outcome despite intensive therapy. We conducted a randomized trial in which such patients were treated with either an augmented intensive regimen of post-induction chemotherapy or a standard regimen of intensive post-induction chemotherapy.

OBJECTIVE

To compare the effect of augmented therapy with standard intensive post induction therapy in children with high-risk ALL who entered remission after a slow response to initial therapy.

METHODS

Between January 2005 and December 2011, 311 children with newly diagnosed ALL who were either 1 to 9 years of age with white cell counts of at least 50,000 per cubic millimeter or 10 years of age or older, had a slow response to initial therapy, and entered remission at the end of induction chemotherapy were randomly assigned to receive standard therapy (156 children) or augmented therapy (155). Those with lymphomatous features were excluded. Event-free survival and overall survival were assessed from the end of induction treatment.

RESULTS

The outcome at five years was significantly better in the augmented-therapy group than in the standard-therapy group. The difference between treatments was most pronounced among patients one to nine years of age, all of whom had white-cell counts of at least 50,000 per cubic millimeter (P<0.001). Risk factors for an adverse event in the entire cohort included a white-cell count of 200,000 per cubic millimeter or higher (P=0.004). The toxic effects of augmented therapy were considerable but manageable.

CONCLUSION

Augmented post-induction chemotherapy results in an excellent outcome for most patients with high-risk ALL and a slow response to initial therapy.

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.

Gastrointestinal stromal tumor of the rectum: An analysis of six cases

DOI: http://dx.doi.org/10.3329/bmrcb.v40i1.20336 Bangladesh Med Res Counc Bull 2014; 40: 42-46

Placental changes in pregnancy induced hypertension

A descriptive cross sectional study was carried out in Gynae and Obstetrics & Pathology department of Mymensingh Medical College Hospital (MMCH) to see the placental changes in normal pregnant & pregnancy induced hypertensive (PIH) mother. Total 80 placentas were collected, 40 from normal pregnant mothers having no hypertension and 40 from PIH group (one from gestational hypertension, 17 from pre-eclampsia and 22 from eclamptic mother). Macroscopic study of the placenta revealed placental weight, surface area and number of cotyledons were less in study group. Mean placental weight in study group was 419.50gm and in control group was 477.50gm (p<0.001). Mean surface area in study group & control group were 232.29cm² and 304.80cm² respectively (p<0.001). Mean number of cotyledons were 15.39 and 17.40 in study & control group respectively (p<0.001) and lower diameter of umbilical cord p<0.04667. But in the present study placental thickness was not significant p<0.539. In PIH group, macroscopic infractions were more marked. There was a single umbilical artery present in one patient in PIH group. In PIH group syncytial knots (95%), fibrinoid necrosis (80%), VSM formation, sclerosis, chorangiosis and calcification were more marked. Infarction was present in placenta of PIH 34(85%) and in control group 8(20%). Common placental changes were significant in this study. So, early intervention in PIH is rational to get the good perinatal morbidity and mortality.

Labor outcome of primigravidae in Mymensingh Medical College Hospital

This cross sectional study was done in the department of Obstetrics and Gynae, Mymensingh Medical College Hospital, during the period 1st January to 30th June 2000 to evaluate the labor outcome in primigrvidae women. Total 1250 cases were delivered in this period. Among all 500(40%) were primigravidae. All the primigravidae were included and labor was monitored and managed by close observation. Condition of the baby was determined by applying APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score. Maximum (66.6%) of patients were belonged to 21-29 years age group. Only few 28.2% had regular antenatal check-up. Risk factors were present in 32% cases. Common risk factors were PET (Pre-eclamptic toxemia) and eclampsia. Mode of deliveries were normal vaginal delivery (NVD) in (51.6%) cases, Lower Uterine Caesarean section (LUCS) in 43.8% cases, Ventouse in 2.8% cases, Forceps in 9(1.8%) cases and craniotomy was required in 2(0.4%) cases. Complications during labor were prolonged labor, postpartum hemorrhage, obstructed labor and perineal tear. PET was common (29.62%) in age group 30-36 years and eclampsia was more common (15%) in age group 16-20 years. NVD were more (55.85%) in 21-29 years group than other age group. The duration of labor pain was short in the age group of 21-29 years and was prolonged in the age group 30-36 years. Maternal mortality was 1.6% (8) cases. Causes of death were septic shock, renal failure and Cerebrovascullar accident. Morbidities after delivery were hypertension, wound infection, puerperal psychosis, acute renal failure, vesicovaginal fistula, hypertensive retinopathy, chronic ill health and retention of urine. Among 500 cases 92.6% were live born and 7.4% were still born. Among total cases 81.6% babies were healthy, 6.8% were asphyxiated, 71.2% had normal birth weight 21.4% had low birth weight, 18% were premature and 7.4% were IUGR. This study shows the safest and easiest delivery age group of primigravidae is between 21-29 years. Maternal mortality and early neonatal death are still holding high rate.

Total proctocolectomy with ileal pouch-anal anastomosis by stapling technique

An ileal pouch-anal anastomosis (IPAA) has become the gold standard procedure for ulcerative colitis and familial adenomatous polyposis coli. Construction of an ileal pouch reservoir is now standard, usually in the form of J pouch. The aim of this study was to assess the outcome of ileal pouch-anal anastomosis by stapling technique after total proctocolectomy. This prospective observational study of six patients who underwent proctocolectomy followed by an ileal pouch-anal anastomosis by stapling technique. Whole colon and rectum was mobilized and resected; J pouch created by GIA device and pouch-anal anastomosis done by staplers. All patients were continent. Patients with familial adenomatous polyposis (FAP) and ulcerative colitis showed excellent outcome regarding their disease after proctocolectomy. The ileal pouch-anal anastomosis has become a feasible alternative to the conventional permanent ileostomy after total proctocolectomy. Satisfactory results have been reported, although the procedure is associated with considerable morbidity. Excision of all the affected mucosa is an essential part of the procedure. Our experience with the ileal pouch-anal anastomosis using stapling devices without mucosectomy.

Maternal serum zinc level and its relation with neonatal birth weight

The present study was conducted in the Department of Obstetrics & Gynaecology, Mymensingh Medical College Hospital, Mymensingh and Molecular Microbiology & Central Laboratory of Bangladesh Institute of Nuclear Agriculture (BINA) from 15th November 2007 to 31st May 2009 to find out the relation between maternal serum zinc level with neonatal birth weight. Hundred pregnant women who were advised to take 61.8 mg zinc daily throughout pregnancy were assigned to study group while the pregnant woman did not take zinc orally were allocated into control group. Serum zinc levels were measured between 37-42 weeks gestation and birth weight were measured just after delivery. Data were processed and analyzed using SPSS version 11.5. The test used to analyze the data was descriptive statistics, Chi-square probability test, Pearson correlation, unpaired t-test and odds ratio. A probability value of <0.05 was considered significant. Majority (97%) of the cases who received zinc during their antenatal period had normal serum zinc (≥ 700μg/L) level compared to only 22% of the control group woman who did not receive zinc. Normal birth weight of babies in pregnant woman who received zinc is 5.7 times higher than the pregnant woman who did not receive zinc. As the present study was a cross-sectional one, further study with large sample size and prospective design is recommended.

Successful pregnancy in a woman after repair of bladder exstrophy

Exstrophy of bladder is a rare congenital anomaly. Pregnancy following surgical correction of bladder exstrophy occurred in this woman. Improved techniques in urinary diversion operation have enabled a large number of patients with bladder exstrophy to achieve urinary control. They can live fairly normal lives and some have achieved pregnancy. Case reports of such exist in the literature. The present case is based on the experience of a 28 years old lady who had successful pregnancy and delivery following curative repair of this defect one and a half year ago. A living healthy male baby was delivered by elective cesarean section.

Comparison between ICT and PCR for diagnosis of Chlamydia trachomatis

Chlamydia trachomatis is an obligate intracellular gram-negative bacterium which is the most prevalent cause of bacterial sexually transmitted infections (STI). The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Immunochromatographic test (ICT) and Polymerase chain reaction (PCR). A total of 70 females were included in this study. Out of 70 cases 56 were symptomatic and 14 asymptomatic. Endocervical swabs were collected from each of the cases and examined by Immunochromatographic test (ICT) for antigen detection and Polymerase chain reaction (PCR) for detection of endogenous plasmid-based nucleic acid. A total 29(41.4%) of the cases were found positive for C. trachomatis either by ICT or PCR. Of the 56 symptomatic cases, 19(33.9%) were found ICT positive and 17(30.4%) were PCR positive. Among 14 asymptomatic females, 2(14.3%) were ICT positive and none were PCR positive. Though PCR is highly sensitive but a total of twelve cases were found ICT positive but PCR negative. It may be due to presence of plasmid deficient strain of C trachomatis which could be amplified by ompA based (Chromosomal gene) multiplex PCR.

Comparing systemic defence-related gene expression changes upon migratory and sedentary nematode attack in rice

Complex defence signalling pathways, controlled by different hormones, are known to be involved in the reaction of plants to a wide range of biotic and abiotic stress factors. Here, we studied the differential expression of genes involved in stress and defence responses in systemic tissue of rice infected with the root knot nematode (RKN) Meloidogyne graminicola and the migratory root rot nematode Hirschmanniella oryzae, two agronomically important rice pathogens with very different lifestyles. qRT-PCR revealed that all investigated systemic tissues had significantly lower expression of isochorismate synthase, a key enzyme for salicylic acid production involved in basal defence and systemic acquired resistance. The systemic defence response upon migratory nematode infection was remarkably similar to fungal rice blast infection. Almost all investigated defence-related genes were up-regulated in rice shoots 3 days after root rot nematode attack, including the phenylpropanoid pathway, ethylene pathway and PR genes, but many of which were suppressed at 7 dpi. Systemic shoot tissue of RKN-infected plants showed similar attenuation of expression of almost all studied genes already at 3 dpi, with clear attenuation of the ethylene pathway and methyl jasmonate biosynthesis. These results provide an interesting starting point for further studies to elucidate how nematodes are able to suppress systemic plant defence mechanisms and the effect in multitrophic interactions.

Non-culture diagnosis of Chlamydia trachomatis genital infection in sexually active women

Infections caused by Chlamydia trachomatis (CT) are one of the most prevalent of all sexually transmitted diseases (STD). This cross sectional study was carried out to diagnose genital CT infection on 108 (59 pregnant and 49 non-pregnant) women attending at Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009. This non- culture technique was based on detection of CT major outer membrane protein (MOMP) by Direct Fluorescence Antibody Test (DFAT) from endocervical swab. Chlamydial inclusion bodies (IB) were looked for using Iodine stain. CT antigens were detected in 45.3% (49/108) cases by DFAT; IBs were detected in 5.5% cases (06/108) by Iodine staining technique. Majority of CT positive cases (65%) were found in the younger age group (15 to 25 years). The CT infection was found 47.2 % (35/74) in symptomatic cases, 41.1% (14/34) in asymptomatic cases and 47.4% in pregnant group, 42.8% in non-pregnant group. Although high incidence of genital chlamydia infection is common both in pregnant, non-pregnant, symptomatic and asymptomatic women in Bangladesh an early and reliable diagnostic method for genital chlamydia infection in Bangladesh should be further explored.

Intra-vaginal use of misoprostol for induction of labour in intrauterine death

This prospective study was done in the Department of Obstetric & Gynaecology in Mymensingh Medical College & Hospital during the period of February 2006 to January 2007, to assess the efficacy of vaginal misoprostol for induction of labour in intrauterine foetal death cases and to detect any intrapartum or postpartum complications. For this study, 50 cases of IUD were selected among admitted patients who were diagnosed by detailed history, clinical examination and by USG. Fifty microgram of misoprostol was given per vaginally, which was repeated 4 hours interval upto effective uterine contraction to a maximum six doses. All the informations were recorded in a predesigned structured data collection sheet and data had been interpreted through appropriate statistical analysis. In this study, 46% patients were within 18-25 years of age and gestational age between 28-37 weeks was 80%. Regarding causes of IUD, commonest was idiopathic (52%), next was gestational hypertension, pre-eclampsia, impending eclampsia (28%). Most of the patients (80%) had no history of antenatal checkup and belongs to below average socioeconomic status. Most case (64%) had less Bishop's score (<3) & all cases had unfavourable cervix, score <6. Vaginal delivery was 98% and 2% needed caesarean section. Mean induction delivery interval was 11.8 hours. Induction delivery interval was within 6-23 hours and 66% cases needed 2-3 doses of vaginal misoprostol. Complications were found in a minor group of patients. Nausea, vomiting, occurred in 12% of cases. Others were fever (2%), shivering (6%), PPH (4%), chorioamniotitis (2%) etc. Vaginal misoprostol for cervical ripening and labour induction is very effective and shorten the time of induction delivery interval. On the other hand, misoprostol is quite cheap, easy to administer, well tolerability and less side effects.

Molecular diagnosis of genital Chlamydia trachomatis infection by polymerase chain reaction

The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Polymerase chain reaction (PCR). A total of 70 females were investigated including 56 symptomatic and 14 asymptomatic cases. Endocervical swabs were collected and dipped in 500μl Tris buffer. Polymerase chain reaction (PCR) amplification was done for detection of endogenous plasmid-based nucleic acid. A total 17 out of 56 of the symptomatic cases (30.4%) were positive for C. trachomatis and none were found positive among the 14 asymptomatic cases. These findings suggest high prevalence of C. trachomatis infection among this group of population.

Seroprevalence of genital Chlamydia trachomatis infection in women of reproductive age

The genital chlamydial infection is the most common sexually transmitted diseases (STD) and major cause of infertility and ectopic pregnancy for millions of women in the world particularly in developing countries. This study was performed to find out the seroprevalence of Chlamydia trachomatis (CT) genital infection in women of reproductive age attending the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009 through a cross sectional study. A total of 108 serum samples from symptomatic and asymptomatic pregnant and non-pregnant women were tested for CT specific IgG antibody by Enzyme Linked Immunosorbent Assay (ELISA). A total of 31(28.7%) patients were found to have antibody of which 44% (26/59) were from pregnant group and 10.2% (5/49) from non-pregnant group. The seropositivity was 21.6% (16/74) in symptomatic cases and 44.1% (15/34) in asymptomatic cases. The study shows high prevalence of Chlamydial antibody which is common in pregnant and non-pregnant, symptomatic and asymptomatic adult women in Bangladesh. So, screening for chlamydial infection should be done routinely by suitable tests in sexually active symptomatic and asymptomatic women including pregnant women to prevent serious complications.

Phytoestrogen intake and cardiovascular risk markers in Bangladeshi postmenopausal women

Menopause is the transitional event of female life creating a considerable degree of clinical and psychological as well as social problem and it is known to affect the risk markers of cardiovascular diseases. Hormone replacement therapy (HRT) was though to be a cornerstone in the management of menopause, but evidences accumulated in the recent past have raised serious questions regarding its safety and usability. In this context, phytoestrogens are getting increasingly more attention for therapeutic (as an alternate of HRT) and dietary interventions. Menopause is a special problem for women in developing countries and intake of phytoestrogens can be highly useful also from the economic point of views. The nutraceuticals of specific vitamins, minerals and especially phytoestrogens supplementations are a vital component of the strategy to reduce health problem. The present study was aimed to assess the association of phytoestrogens and risk markers of cardiovascular diseases in postmenopausal women. A total of 111 postmenopausal subjects [age, (years, M±SD) 52±5.35] were studied. The dietary intake of phytoestrogens by study subjects was calculated by a specific food frequency questionnaire (FFQ). Serum fasting homocysteine was measured by AxSYM system. Serum glucose was estimated by glucose-oxidase method. Serum total cholesterol, triglyceride and HDL-C were estimated by enzymatic-colorimetric method LDL-C was estimated by the Friedewald's formula. The intake of total phytoestrogens, isoflavones and lignans (mean±SD, mg/day) were 7.65±3.33, 0.32±0.16, 7.32±3.28 respectively in postmenopausal women. The intake of diadzein, genistein, formononetin, biochanin A (mean±SD, mg/day) were 0.085±0.035, 0.168±0.101, 0.074±0.052 and 0.001±0.0008 respectively. The intake of matairesinol and secoisolaiciresinol (SILR) (mean±SD, mg/day) were 0.022±0.006 and 7.30±3.28 respectively. The total phytoestrogens (r=-0.19, p=0.03) and SILR, one specific type of lignans (r=-0.19, p=0.04) consumption in this study were inversely significantly associated with serum glucose level. The dietary formononetin, one specific type of isoflavones was negatively significantly associated with LDL-cholesterol (r=-0.18, p=0.04). There was no significant relationship found between phytoestrogen intake and serum homocysteine level (r=-0.11, p=0.23). Phytoestrogens containing food intake should be encouraged for reducing risk markers of cardiovascular disease in postmenopausal women.

Platelet count in 100 cases of pregnancy induced hypertension

Hypertensive disorders are most common medical complication of pregnancy and the major causes of maternal & perinatal disease and death worldwide. The aim of the study was to see the platelet count in pregnancy induced hypertension (PIH). It was a prospective study. The study was done on 100 cases of PIH patients in Gynae & Obstetrics department of Mymensingh Medical College Hospital (MMCH) during the period of January to July 2006. Among the 100 cases 60 were eclamptic, 34 were pre eclamptic (PE) and 06 were gestational hypertensive (GH) patients. All the necessary informations and data were collected by interviewing the patients or their attendants on a pre-designed data collection sheet. Blood sample were collected from the patients and required investigations were done. Most of the eclampsia cases were from below average socioeconomic status of family, and other two groups were from average socioeconomic status of family. Among eclamptic patients 76.60% were primigravida. In eclamptic group 93.33% did not get any antenatal care but 83.33% GH cases had regular antenatal care. Among the eclamptic group mean maternal age was 23.12 years. In our study 47.00% had low platelet count (<1,50,000/cmm). Among eclampsia group 60.00% had low platelet count (<1,50,000/cmm). In our study 12% cases developed postpartum haemorrhage (PPH) and among them 66.67% had low platelet count (<1,50,000/cmm). Although there is chance of development of disseminated intravascular coagulation (DIC) and Liver Failure in patients with low platelet count, but in our study there is no such incidence. In our study mortality was 3% and all were in eclamptic group. Those patients had low platelet count 74.28% had low birth weight (LBW) babies. Platelet count is a very important investigation for antenatal mother having PIH, as it is directly related to maternal and perinatal outcome.

Preliminary report on anaerobic culture at Mymensingh Medical College Hospital in Bangladesh

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. This study was undertaken to isolate and identify the anaerobic bacterial agents of puerperal sepsis among the patients admitted in Mymensingh Medical College Hospital (MMCH) during the period from July 2006 to June 2007. Endocervical swabs/secretions were collected from 50 cases of puerperal sepsis and were cultured anaerobically. Anaerobiasis was done by using gas pack (BD GAS PAK TM EZ) in anaerobic jar. Out of 50 samples, 42(84%) yielded growth in cultures. Among 42 culture positive cases, 20(40%) were Aerobic organisms and 22(44%) were mixed, i.e., Aerobic and Anaerobic bacteria. The isolated Anaerobic organisms were Peptostreptococcus 14(63.63%), Bacteroides fragilis 3(13.64%), Prevotella melaninogenica 3(13.64%) and Clostridium perfringens 2(9.09%). As a preliminary study, it was observed that anaerobic culture could be carried out with available logistic arrangement. So, it was recommended to design further study on anaerobic bacterial isolation with particular emphasis on their antimicrobial susceptibility.

In vitro antibacterial and cytotoxic activities of different parts of plant Swietenia mahagony

Crude extracts from different parts (leaf, bark and seed) of Swietenia mahagony (Family: Meliaceae) were screened for their antibacterial activity against 4 Gram positive and 8 Gram negative bacteria. Disc diffusion technique was used for in vitro screening. Among the crude extracts, chloroform and ethyl acetate extracts of leaf and bark showed good activity against all the tested organisms. The chloroform and ethyl acetate extracts of seed exhibited little or positive effect against most of the tested bacteria. The activities were compared to a standard antibiotic-kanamycin. Cytotoxic activity of crude extracts were determined using brine shrimp lethality bioassay and standard vincristine sulphate was used as positive control. The chloroform extract of seed and ethyl acetate extract of bark showed good cytotoxic activities and the LC50 values were found 13.75 and 11.64 microg mL(-1), respectively.