Management of Neglected Rupture of Tendoachilles with Long Gap by Flexor Hallucis Longus Tendon Transfer

The tendo achilles is one of most important tendon in human body which often injured through direct trauma or indirect stress on a weakened tendon. Longer the duration after injury the injured parts likely to move apart, fibrosis and degeneration leading to difficulty in repair or reconstruction. Usually a phase of 4 weeks or more without specific treatment is regarded as chronic or neglected rupture. Different authors described many management protocols about the tendo achilles rupture but there is no procedure of choice for neglected rupture with long gap. Prospective case series of 21 patients of neglected tendo achilles rupture with long gap treated with flexor hallucis longus tendon (FHLT) transfer was taken for study from January 2019 to December 2020 in Mymensingh Medical College Hospital, Bangladesh. Average age of patients was 39.47 years with range 22-65 years. Fifteen (15) cases of traumatic rupture in this study with average age 32.66 years and pathologic 6 cases with average age 56.5 years were recorded. We grafted FHLT from channel by incising Henry's knot. Krackow et al.'s technique was followed for tendon mobilization and bone fixation. We made procedure simpler and cheaper; instead of using interference screw the sutured tendon pulled through the heel and anchored over rubber tube or button by Cole method. Post-operative complications were less with one patient with superficial infection which eventually recovered 3 cases of mild pain and 2 cases of numbness. Questionnaire for surgical outcome measure are satisfactory in 19 patients (90.47%). Final follow up AOFAS score at 6 month (91.61±5.41) was highly significant (p<0.001) in comparison to preoperative score (38.71±9.78). These are comparable to other study. Above mentioned scores indicate the reliability of the surgical system. But our study is a prospective case series with minimum cases. To establish the best procedure for neglected tendo achilles rupture with long gap we recommend further study with larger group and Randomized Controlled Trial (RCT) study among different procedure.

Clinical Outcome on Comminuted Femoral Shaft Fractures in Adults Treated by Minimally Invasive Plate Osteosynthesis (MIPO) with Locking Plate

Intramedullary nailing is a pillar in the treatment of femoral shaft fractures. But it is not possible in all cases especially in comminuted fractures. This study has been designed to explain the importance of Minimally Invasive Plate Osteosynthesis (MIPO) with the locking plate in the treatment of comminuted Femoral Shaft Fracture. Twenty (20) such patients were treated by MIPO and analysis has been done in this study to get fruitful result and to find out the effectiveness of this procedure who were admitted at Mymensingh Medical College Hospital, Mymensingh, a tertiary level hospital of Bangladesh from February 2018 to January 2019. Mean age of the patients were 49.20±14.41 years. Based on AO classification, there were 4, 8 and 8 patients belong to type A, B and C respectively. The union period for all the patients was in between 12 to 14 weeks. The mean union period was 12.90±1.997 weeks. Mean follow up period was 19.70±2.77 weeks. Mean full weight bearing period was 16.50±1.10 weeks. In Thoresen scoring system excellent result was 9(45%), good result was 10(20%) and fair result was 01(5%). Mal-alignment happened in two cases. However, delayed union and broken screws were found in two cases each of which was treated accordingly. Comminuted Femoral shaft fracture with MIPO procedure is more effective treatment than intramedullary nailing. Furthermore, mal-alignment is the basic complexity that must be taken away intraoperatively.

Clinical Outcome in Intra Articular Distal Humerus Fractures in Adults Treated with Different Hardware in a Tertiary Level Hospital of Bangladesh

In adults, distal humerus fractures are infrequent and frequently intra-articular. Customarily encompass both medial and lateral columns. Operative management gives constructive outcomes. The aim of this study was to evaluate clinical outcome in intra articular distal humerus fractures in adults treated by different hardware. This prospective study consists of 20 purposively selected patients with intra articular distal humerus fractures treated by surgical intervention with different hardware who were admitted to Mymensingh Medical College and Hospital, Bangladesh in between November 2016 to October 2018. Surgical approaches were standard dorsal with or without olecranon osteotomy. The mean age of the patients was 32.3 years, range between 18-55 years. The maximum patients i.e. 85% were between 18-45 years. Seventy percent (70%) of the cases admitted were due to Road traffic accident (RTA). Most of the patients were males 14(70%) with right upper limb was involved in 13(65%) cases. Mean Mayo Elbow Performance Score was 81.5 post-operatively. According to Mayo Elbow Performance (MEP) score clinical outcome was excellent in 20%, good in 50%, fair in 25% and poor in 10% of patients. Distal humerus fractures are censorious in nature. Proper anatomical articular reconstruction and stable fixation by surgical intervention helps in fruitful results.

Meeting Needs of Newly-Married Youth: The Bangladesh Case

In Bangladesh more than 1.15 million couples get married every year and approximately 90 percent of female spouses are below nineteen years of age. It is widely reported that newly married couples (those who are married within the last 12 months) were less likely to have been visited by field workers and have had limited access to family planning including reproductive health services. Findings from 1996–97 Demographic and Health Survey (BDHS) suggest that little change has occurred in the age specific fertility rates among the females belonging to age groups fifteen to nineteen and twenty to twenty-four in the last five years [1]. It is also observed that the current contraceptive use rate in age group fifteen to nineteen was 32.9 percent and approximately 10 percent of women in age group fifteen to nineteen do not want any children. The male methods use rate among the newlywed couples was double the national rate. It suggests that males from the younger generation are more likely to practice male contraceptive methods compared to the older generation. Married youths and those soon-to-be-married are critical demographic segments of the population. Achieving early population stabilization depends on how adequately and effectively the national reproductive health program serves them and how other development programs simultaneously compliments to health efforts. Using 1996–97 BDHS data, this article examines fertility and contraceptive behavior of the married youths in Bangladesh.

TGF-β1 induces EMT reprogramming of porcine bladder urothelial cells into collagen producing fibroblasts-like cells in a Smad2/Smad3-dependent manner

Activation of fibroblasts and their differentiation into myofibroblasts, excessive collagen production and fibrosis occurs in a number of bladder diseases. Similarly, conversion of epithelial cells into mesenchymal cells (EMT) has been shown to increase fibroblasts like cells. TGF-β1 can induce the EMT and the role of TGF-β1-induced EMT during bladder injury leading to fibrosis and possible organ failure is gaining increasing interest. Here we show that EMT and fibrosis in porcine bladder urothelial (UC) cells are Smad dependent. Fresh normal porcine bladder urothelial cells were grown in culture with or without TGF-β1 and EMT markers were assessed. TGF-β1 treatment induced changes in cellular morphology as depicted by a significant decrease in the expression of E-cadherin and corresponding increase in N-cadherin and α-SMA. We knocked down Smad2 and Smad3 by Smad specific siRNA. Downregulation of E-cadherin expression by TGF-β1 was Smad3-dependent, whereas N-cadherin and α-SMA were dependent on both Smad2 and Smad3. Connective tissue growth factor (CTGF/CCN2), matrix metalloproteinase-2 and -9 (MMP-2, MMP-9) has been shown to play important roles in the pathogenesis of fibrosis. Induction of these genes by TGF-β1 was found to be time dependent. Upregulation of CTGF/CCN2 by TGF-β1 was Smad3 dependent; whereas MMP-2 was Smad2 dependent. Smad2 and Smad3 both participated in MMP-9 expression. TGF-β1 reprogrammed mesenchymal fibroblast like cells robustly expressed collagen I and III and these was inhibited by SB-431542, a TGF-β receptor inhibitor. Our results indicate that EMT of porcine bladder UC cells is TGF-β1 dependent and is mediated through Smad2 and Smad3. TGF-β1 may be an important factor in the development of bladder fibrosis via an EMT mechanism. This identifies a potential amenable therapeutic target.

Electrochemical measurement and speciation of inorganic arsenic in groundwater of Bangladesh

The presence of arsenic in groundwater above the maximum permissible limit of 50 mug l(-1) has threatened the health of more than 50 million people in Bangladesh and neighboring India. We report here the development of an inexpensive anodic stripping voltammetric (ASV) technique for routine measurement and speciation of arsenic in groundwater. The measurements are validated by more expensive atomic absorption, atomic emission and other techniques. To understand the present situation in Bangladesh, we measured As(III) in 960 water samples collected from 18 districts. A random distribution of 238 samples was used to measure both As(III) and As(V). The results from the present study indicate that most toxic form of inorganic arsenic, As(III), has the broad range of 30-98%. It shows 60% of the samples have 10 mug l(-1) and 44% of the samples have 50 mug l(-1) or more As(III). The fractional distribution pattern shows significant skew towards high percent occurrence which may indicate a progressive reduction process with a single source or a single mechanism for the formation of As(III). For direct consumption, this is possibly one of the most toxic groundwater known today. Speciation distribution at groundwater pH value shows H(3)AsO(3) is the predominant species including H(2)AsO(4)(-) and H(2)AsO(4)(2-) whose distribution is significantly pH dependent. This is also supported by E(h)-pH measurements. The depth distribution for Kushtia shows most of the As(III) is located within 100-200 ft deep aquifers. Similar fractional distribution of As(III) is found in deeper aquifers and may indicate contamination by leakage from upper aquifer. This study clearly demonstrates the aquifer environment is reductive and conducive to the formation of As(III) species.

Antihyperglycemic effect of Trigonella foenum-graecum (fenugreek) seed extract in alloxan-induced diabetic rats and its use in diabetes mellitus: a brief qualitative phytochemical and acute toxicity test on the extract

The effects of ethanol extract of Trigonella foenum-graecum (Fenugreek) seeds on the blood glucose levels in alloxan-induced diabetic rats at different doses (2 g/kg, 1 g/kg, 0.5 g/kg and 0.1 g/kg) were studied. The hypoglycemic effect of extract was compared with that of the standard antidiabetic drug (glimepiride, 4 mg/kg) single dose. The extract showed significant activity against the diabetic state induced by alloxan but the intensity of hypoglycemic effect varied from dose to dose. The most effective dose recognized was 1 g/kg but that is still lower than the standard antidiabetic drug. No acute toxicity was observed for ethanol extract of T. foenum-graecum seed when it was administered orally at high dose level (3 g/kg body weight), which is higher than effective antihyperglycemic dose, and closely observed for 24 hrs for any mortality and next 10 days for any delayed toxic effects on gross behavioral activities. Phytochemical group tests were also accomplished and presence of alkaloids, steroids and carbohydrates were recognized in the extract.

Hearing status of elderly people: study in a tertiary level hospital

A study was carried out from April 2003 to March 2004 at the Department of Otolaryngology and Head-Neck Surgery, BSMMU, with the aim to evaluate the prevalence of hearing loss and to find out the pattern and extent of hearing loss among the elderly people. The study included 100 people aged over 50 years. Out of 100 cases 59% were found with normal hearing and 41% had variable degree of hearing impairment. The highest prevalence of hearing impairment was found 100% in 9th decade with gradually decreasing tendency and lowest was 29.50% in 6th decade. Most of the cases were found to be bilateral (65.85%). Majority (65.85%) of the hearing impaired people had sensorineural type of loss with a significant number (21.95%) of conductive loss. Irrespective of type of impairment. Most of the people (73%) had no complaint of ear problem during presentation. Only 27% had some sorts of otological symptoms like hearing loss, tinnitus and vertigo and among them about 96.29% complained of hearing loss. About 44.44% of the hearing impaired person of 6th decade, showed mild hearing loss. In the 7th decade maximum (50%) had moderate to severe hearing loss. About 31% of persons of 8th decade and 50% of 9th decade had severe degree of hearing loss.

Intranasal meningoencephalocoele-a rare childhood condition

Congenital or acquired intranasal meningocoele or meningoencephalocoele is a rare condition ever reported in world literature. We report a case of intranasal meningoencephalocoele in which a 10 month old male child presented with left sided progressive nasal obstruction, nasal mass and reluctant to feed. On examination slight broadening of the bridge of the nose with obliteration of left nasomaxillary fold, mucoid discharge and a pinkish, polypoidal, non tender, non pulsatile mass with prominent blood vessels on the surface occupying almost 3/4(th) of the nasal cavity was observed. On probing it appeared to be attached to roof of left nasal cavity. Computed tomography revealed a hypodense area in the nasal cavity but there was no bony defect in the skull base. Peroperatively on aspiration of nasal cystic mass revealed free flow of clear fluid which was biochemically CSF. A one stage, Lynch Howarth approach, correctional procedure was performed. We present here a discussion of findings and surgical treatment. Early diagnosis and referral are of paramount importance, because failure to identify this leads to fatal outcome if surgery performed.

Outcome of management of differentiated thyroid carcinoma

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

Genital fistula--our experience

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.

Head and neck squamous cell carcinoma (HNSCC) 5 year study at BSMMU

Head and Neck Squamous Cell Carcinoma (HNSCC) are generally similar in their clinical features, epidemiology and etiology although their natural and clinical history and treatment differ. Despite lot of improvement in diagnostic and management technique, there is little improvement in survival rate over the last few decades. This study was carried-out in a multidisciplinary tertiary level hospital (BSMMU), with a country-wide catchment area to see the burden of HNSCC existing in our country and their clinical pattern. The overall incidence rate of HNSCC in this study was (0.15%) i.e. 150 person in 1,00,000 population. Male incidence (0.19%) was higher than female (0.12%). This study revealed that carcinoma of the larynx (25.22%) and pyriform fossae (20.57%) were the main culprit, whereas buccal carcinoma was the main component (37.70%) in the female series. Highest incidence was found in the 6th decade in both sexes. As the treatment of HNSCC may be time consuming, requires multidisciplinary approach, demands lot of clinical, social and financial consideration, therefore, the best treatment can be offered through a combined board consisting of Surgical, Radiation, Medical oncologists, Histopathologist and Speech therapist as required.

Management of thyroid carcinoma-an experience in Bangladesh

All patients (n=154) of thyroid malignancy admitted in the Otoluryngology Department of Bangabandhu Sheikh Mujib Medical University (former IPGMR) between 1986 and 2000 were retrospectively analyzed to find out the extent and result of surgery used for thyroid carcinoma. The other objectives were to find out the incidence of differentiated thyroid carcinoma among the thyroid malignancy and also to find out the age, sex and clinical presentation of papillary and follicular carcinoma. Among all the thyroid malignancy (n-154), Differentiated Thyroid Carcinoma (DTC) was seen in 130 (84.41%) cases, where as papillary carcinoma occurred in 98(63.64%), and follicular carcinoma in 32(20.77%)cases. On the basis of risk factors, the DTC were designated as low and high risk. The year-wise incidence of DTC revealed increasing trend from 1986 (3 cases) to 2000 (23 cases).Among the 98 papillary thyroid carcinoma highest number of cases (35.71%) were seen in 31-40 year age group. The male to female ratio was 1: 1.64. In follicular carcinoma, highest number (35.25%) of cases were also seen in 31-40 year age group. The male to female ratio was 1:1.66. The commonest presentation in papillary carcinoma was thyroid swelling (96.93%). The other presentations were occult thyroid (3.06%), Cervical lymph node metastasis (38.77%) and distant metastasis (2.04%). In Follicular carcinoma, the presentations were thyroid swelling (100%), Cervical lymph node metastasis (6.25%) and Distant metastasis (21.87%).In this series, low risk DTC were treated by Lobectomy & Isthmusectomy plus Thyroxin. In low risk group the rate of recurrence was 6.89% and the mortality was nil in five years follow-up. Except two inoperable cases, all high risk patients were managed by Total thyroidectomy (with or without neck dissection, plus removal of metastatic lesion when required) with Radioiodine ablation plus Thyroxin. . The rate of recurrence was 7.81% and mortality was 1.56% in high risk group in similar period of time.Vocal cord palsy were noted in 5 (3.84%) unilateral, and inane (0.76%) bilateral cases. Hypoparathyroidism was found in 4.61%.

Chemical fate of arsenic and other metals in groundwater of Bangladesh: experimental measurement and chemical equilibrium model

The presence of toxic level of inorganic arsenic in groundwater used for drinking in Bangladesh and neighboring India is unfolding as one of the worst natural disaster in the region. The purpose of this work is to ascertain the chemical fate of arsenic and other metals in groundwater of Bangladesh. A combination of techniques was used to measure 24 metals, 6 anions, Eh, pH, dissolved oxygen, conductivity, and temperature to understand the distribution of components which were then used in computational chemical equilibrium model, MINEQL+, for detailed speciation. It was found that the fate of arsenic and its speciation were inextricably linked to the formation of hydrous ferric oxide (HFO) and its kinetic. The HFO induced natural attenuation removes 50-75% of total arsenic in first 24 h through a first order kinetics. Adsorption on HFO is the predominant mode of removal of arsenic, iron, manganese, and most trace metals. The equilibrium model points to the presence of excess active sites for the removal of arsenic. MINEQL+ shows that significantly higher concentration of HFO forming iron is required to remove arsenic below maximum contamination level (MCL) of 50 microg/L than predicted by stoichiometry. The practical implication of this work is the prediction of water quality based on models.

Solid phase microextraction: measurement of volatile organic compounds (VOCs) in Dhaka City air pollution

A solid phase microextraction (SPME) technique was applied for the sampling of volatile organic compounds (VOCs) in ambient air polluted by two stroke autorickshaw engines and automobile exhausts in Dhaka city, Bangladesh. Analysis was carried out by capillary gas chromatography (GC) and GC-mass spectrometry (MS). The methodology was tested by insitu sampling of an aromatic hydrocarbon mixture gas standard with a precision of +/-5% and an average accuracy of 1-20%. The accuracy for total VOCs concentration measurement was about 7%. VOC's in ambient air were collected by exposing the SPME fiber at four locations in Dhaka city. The chromatograms showed signature similar to that of unburned gasoline (petrol) and weathered diesel containing more than 200 organic compounds; some of these compounds were positively identified. These are normal hydrocarbons pentane (n-C5H2) through nonacosane (n-C29H60), aromatic hydrocarbons: benzene, toluene, ethylbenzene, n-propylbenzene, n-butylbenzene, 1,3,5-trimethylbenzene, xylenes, and 1-isocyanato-3-methoxybenzene. Two samples collected near an autorickshaw station contained 783000 and 1479000 microg/m3 of VOCs. In particular, the concentration of toluene was 50-100 times higher than the threshold limiting value of 2000 microg/m3. Two other samples collected on street median showed 135000 microg/m3 and 180000 microg/m3 of total VOCs. The method detection limit of the technique for most semi-volatile organic compounds was 1 microg/m3.

Comparative study between tubotympanic and atticoantral types of chronic suppurative otitis media

This prospective study was done to compare the different aspects of tubotympanic (group I) and atticoantral types (group II) of chronic suppurative otitis media. The study included 200 patients of chronic suppurative otitis media, of them 100 were of tubotympanic type and 100 were with atticoantral disease. The age (mean +/- SD) of group I and II were 17 +/- 2.7 years and 12 +/- 2.3 years respectively (P < 0.05). The majority of the patients having poor socio-economic condition 69% in group I and 87% in-group II. In both groups, slum dwellers with bathing habit in pond or river and illiterate were more sufferer (P < 0.05). There was central perforation in all patients in-group I, and in-group II, 67% were with attic and 33% were with marginal perforations. In group I, aural discharge was mucoid or mucopurulent in majority of cases 80% and in-group II foul smelling scanty ear discharge was from 88% of subjects. In atticoantral type, hearing impairment was more than tubotympanic disease. Complications were more in atticoantral type of disease. In-group II, post auricular sinus 25% was the commonest extracranial complication followed by subperiosteal abscess 18%, and meningitis 10% was the commonest intracranial complication followed by brain abscess 8%. In tubotympanic type conservative treatment with reconstructive surgery were the treatment of choice, whereas radical or some modifications of radical surgery (with or without reconstruction) were the treatment plan for atticoantral disease. Among the groups the mortality rate was only 4% in-group II and was due to intracranial complications. The study recommends early detection and effective surgical treatment of the disease to improve the situation.

Carcinoma larynx--topographical distribution

One hundred and sixty subjects were included in our study, collected from four hospitals in Dhaka City. The mean age (+/- SD) of study subjects were 54.67 +/- 11.27 years. Out of 160 subjects 155 was males and 5 were females, and male to female ratio was 31:1. The highest number of study subjects was related to cultivation (40.62%). The majority of study subjects were from the low socio-economic status (68.72%). Carcinoma larynx is a multifactorial disease. Smoking and chewing habit are the most important factors associated with carcinoma larynx. Most of the male (93.12%) subjects were smoker. One hundred and fifteen (71.87%) subjects were found chewing habit of betel leaves with other ingredients. Hoarseness of voice was the commonest symptom 65.62%. Regional distribution of tumour showed supraglottic carcinoma topping the list (69.38%) followed by glottic carcinoma (30.62%) and there was no subglottic carcinoma. Site involvement in supraglottic carcinoma was found in combined location topping the list (89.20%). In glottic carcinoma majority was found glottic with supraglottic extension (65.31%). In majority cases growth were exophytic 52.50%. Palpable lymph mode was found in 48.75% of cases. All the carcinoma of larynx was found histologically of squamous cell type.

Synthesis and in vitro activity of 3 beta-substituted-3 alpha-hydroxypregnan-20-ones: allosteric modulators of the GABAA receptor

Two naturally occurring metabolites of progesterone, 3 alpha-hydroxy-5 alpha- and 5 beta-pregnan-20-one (1 and 2), are potent allosteric modulators of the GABAA receptor. Their therapeutic potential as anxiolytics, anticonvulsants, and sedative/hypnotics is limited by rapid metabolism. To avoid these shortcomings, a series of 3 beta-substituted derivatives of 1 and 2 was prepared. Small lipophilic groups generally maintain potency in both the 5 alpha- and 5 beta-series as determined by inhibition of [35S]TBPS binding. In the 5 alpha-series, 3 beta-ethyl, -propyl, -trifluoromethyl and -(benzyloxy)methyl, as well as substituents of the form 3 beta-XCH2, where X is Cl, Br, or I or contains unsaturation, show limited efficacy in inhibiting [35S]TBPS binding. In the 5 beta-series, the unsubstituted parent 2 is a two-component inhibitor, whereas all of the 3 beta-substituted derivatives of 2 inhibit TBPS via a single class of binding sites. In addition, all of the 3-substituted 5 beta-sterols tested are full inhibitors of [35S]TBPS binding. Electrophysiological measurements using alpha 1 beta 2 gamma 2L receptors expressed in oocytes show that 3 beta-methyl- and 3 beta-(azidomethyl)-3 alpha-hydroxy-5 alpha-pregnan-20-one (6 and 22, respectively) are potent full efficacy modulators and that 3 alpha-hydroxy-3 beta-(trifluoromethyl)-5 alpha-pregnan -20-one (24) is a low-efficacy modulator, confirming the results obtained from [35S]TBPS binding. These results indicate that modification of the 3 beta-position in 1 and 2 maintains activity at the neuroactive steroid site on the GABAA receptor. In animal studies, compound 6 (CCD 1042) is an orally active anticonvulsant, while the naturally occurring progesterone metabolites 1 and 2 are inactive when administered orally, suggesting that 3 beta-substitution slows metabolism of the 3-hydroxyl, resulting in orally bioavailable steroid modulators of the GABAA receptor.

Enhanced tumor uptake of macromolecules induced by a novel vasoactive interleukin 2 immunoconjugate

Low uptake of monoclonal antibodies (MAbs) in cancer lesions is a significant problem in cancer therapy. Recent studies have shown that antibody uptake in tumor is controlled in large part by the tumor blood flow and the vascular permeability of the tumor endothelium. We have hypothesized that these physiological properties of tumor vessels may be altered by pretreatment with vasoactive drugs or peptides linked to tumor-specific MAbs. To test this hypothesis, two MAbs, Lym-1 directed against human malignant lymphomas and B72.3 reactive with the TAG-72 antigen expressed in solid tumors, were chemically conjugated with human recombinant interleukin 2 (IL-2). IL-2 has been used in humans to activate lymphokine-activated killer cells for the treatment of cancer but is also known to produce a generalized vascular permeability by an unknown mechanism when used systemically. Chemical conjugation of IL-2 to MAbs appears to destroy its cytokine function as shown by T-cell proliferation studies in vitro. Despite this finding, MAb/IL-2 immunoconjugates retain their ability to produce an enhanced vascular permeability when injected i.v. into nude mice bearing relevant tumor models only. Biodistribution studies using 125I-labeled tracer Lym-1 have demonstrated that the Lym-1/IL-2 immunoconjugate can increase antibody uptake in tumor by a factor of 4 in a time (2.5-h pretreatment)- and dose (30 micrograms/mouse)-dependent manner. In contrast, treatment of mice with free IL-2 and antibody showed this effect in all organs of the mouse including the tumor. Bidirectional crossover imaging studies in individual tumor-bearing nude mice showed improved uptake and decreased blood pool when the MAb/IL-2 immunoconjugates were used compared to controls. Finally, tumor blood flow and vascular permeability studies demonstrate that the physiological effect of the MAb/IL-2 is due to a reversible and specific vascular leakage at the tumor site. These studies indicate that pretreatment with this novel immunoconjugate may enhance the diagnostic and therapeutic potential of MAbs, drugs, and other macromolecules for the treatment of cancer.

Maternal mortality in rural Bangladesh: the Tangail District

A study was conducted from September 1982 to August 1983 in the Tangail district of Bangladesh to estimate the maternal mortality level there and identify its causes and correlates. A rate of 56.6 per 10,000 live births was found, with abortion-related deaths contributing nearly 10 deaths per 10,000 live births. The major causes of maternal mortality were found to be obstructed labor and sepsis caused by improperly performed abortion. Those at high risk were mothers below age 20 and above age 30 and those above parity four. No inverse relationship was found between maternal mortality and socioeconomic status, as might be expected. Community-level pregnancy monitoring programs, increased attention on the part of family planning workers toward teenaged, older, and high parity mothers, and nutrition supplement programs for anemic mothers are recommended.

Brain trace element concentrations in aging

Trace element concentrations were determined in various human brain regions over the complete life span using instrumental neutron activation analysis. Several different patterns of trace element alteration were observed with age. Brain Al, Cl and Na concentrations increase with advancing age, while K, P and Rb decline. Ag, Co, Fe, Sb and Sc concentrations increase up to the 40 to 79 age range then decline. Br, Se and Zn remain relatively constant throughout adult life. Hg, Mn and Cs show no consistent trend with age. In infant brains Br and Cl increase and Al, Cr, Cs, Fe, Mn, P, Rb, Sc, Se and Zn decrease compared to adults. The essential elements that remain within narrow concentration limits throughout adult life suggest the presence of an efficient homeostatic mechanism for their regulation in the brain, while those that are altered with age suggest modifications in control mechanisms or altered relationships with other elements. Increased concentrations of non-essential elements may reflect accumulation from our environment, impaired removal or altered balance with other elements.

Brain trace elements in Pick's disease

The trace element content of the brain of two patients with Pick's disease examined postmortem was studied using instrumental neutron activation analysis. Results showed significant increases in chlorine, iron, manganese, sodium, and phosphorus and significant decreases in chromium, cesium, rubidium, and selenium and in the mean freeze-dried to wet-weight ratio for patients with Pick's disease compared with control patients. Brain zinc content was not elevated in the two patients, a finding that fails to support the hypothesis that elevated zinc levels play a role in the pathogenesis of Pick's disease.

Instrumental neutron activation analysis of brain aluminum in Alzheimer disease and aging

Instrumental neutron activation analysis procedures were used to determine the aluminum content of various brain regions in histologically verified Alzheimer disease (AD) and in controls. The grand mean aluminum level for 74 AD specimens was 0.372 +/- 0.058 microgram/gm and for 137 adult controls, 0.467 +/- 0.033 microgram/gm, both on a wet weight basis. No difference was found at the bulk sample level between AD and adult controls, corrected for age and sex, or when frontal, temporal, and hippocampal specimens were compared. Control specimens (infancy to 85 years) showed an increase in brain aluminum concentration with age. Comparison of freeze-dried to wet weight ratios of AD and controls revealed a small increase in water content in AD brains.

Bisquaternary ammonium salts derived from 3α,12α-Diamino-5β-cholane and 3α,12α-Diamino-24-nor-5β-cholane

The preparation of 3α,12α-bisdimethylamino-5β-cholane dimethiodide, 3α,12α-bisdimethylamino-5β-cholane dimethiodide, 3α,12α- bisdimethylamino-24-nor-5β-cholanedimethiodide, and 3α,12α- bisdimethylamino-24-nor-5β-cholanediethiodide, from deoxycholic acid are described. During this work it was found that attempted copper- quinoline decarboxylation of dehydrocholic acid gives rise to lactol formation, and that what had previously been considered to be 3α,12α- dihydroxy-5β-cholane is a mixture of this compound and 12α,24- dihydroxy-5β-cholane. Comparable selectivity of attack by methanesulphonyl chloride and toluene-p-sulphonyl chloride occurs with various polyhydric alcohols derived from bile acids, as evidenced from the products of reduction of the sulphonates with lithium aluminium hydride. With both 5α- and 5β-cholane derivatives, a C 3 equatorial hydroxyl group exhibits comparable reactivity to the terminal primary hydroxyl group, generated from the bile acid carboxylic group, towards both sulphonyl chlorides. With axial hydroxyl groups at C 7 and C 12, toluene-p-sulphonate formation is much more difficult than methane- sulphonate formation. Reduction by means of lithium aluminium hydride of equatorial sulphonate esters at C 7 and C 12 gives rise to a methylene group, but the axial sulphonates under the same conditions give the axial alcohol. The same clear distinction between equatorial and axial sulphonate esters is not observed at C 3 and C 6, but 17α- methanesulphonyloxy-5α-androstane gives 5α-androstane and the 17β- ester gives 17β-hydroxy-5α-androstane. Reduction of 12-oximino groups in both 5α- and 5β-cholanes with sodium and ethanol, hydrogen in the presence of a catalyst, or lithium aluminium hydride gives solely the 12α-amino compound.

Neonatal hearing screening

DOI: 10.3329/bjo.v16i1.5782Bangladesh J Otorhinolaryngol 2010; 16(1): 54-59

Techniques and results of stapedial surgery

Objective: To evaluate the improvement of hearing after stapedial surgery, to record the problems during surgery and to assess the complications of the same. Study design: Retrospective review. Setting: Department of Otolaryngology & Head and Neck Surgery, Bangabandhu Shiekh Mujib Medical University. Materials and Methods: This study included thirty two patients of otosclerosis that were surgically treated in the department of otolaryngology and Head-Neck surgery at BSMMU from January, 2003 to June, 2005. The data of each patient included age, sex, educational & socio-economic status, mode of admission, types of dwelling, occupation, presenting symptoms and signs, preoperative investigations like PTA, tympanometric compliance, stapedial reflex, speech discrimination, HRCT temporal bone(in suspected cases of obliterated otosclerosis), operation notes, complications of surgery and state at follow up. Results: Most common age group was 21-30 years (50%) and 68.75% patients were male. Most of the patients were primarily educated (31.25%) and middle class people was maximum (62.5%). Most patients came to hospital referred by outside doctor (62.5%) and most of them were from rural area of Bangladesh(62.5%). Main presenting symptoms were progressive deafness and duration of hearing loss for 2-5 years was 31.25%. Most of the tympanic membranes (86.75%) were normal. Rinne was negative in all cases and Weber lateralized to affected ear or more deaf ear in 93.75% cases. Patients mainly presented with 50-60 dB hearing loss. There was slightly reduced compliance in 29 cases (90%) and stapedial reflex were absent in 75% cases. Speech discrimination test was 100% in 90% of the patients. HRCT temporal bone was done in 3 cases and 2 showed thickening of foot plate of stapes. Stapedotomy was done in most of the patients (78.1%). Common problems encountered during operation was perilymph flooding (6.28%) and obliterated otosclerosis (6.28%). Most common complication was injury to Chorda tympani nerve (9.37%). Improvement of hearing was in 28 patients (87.50%) and after surgery Air-Bone gap closure more than 10 dB was in 87% of patients. Most common prosthesis used was Teflon prosthesis. Conclusion: In general the stapedotomy/stapedectomy is very successful with over 90% of people experiencing a good improvement in hearing. Sometimes the hearing remains unchanged and there is a small (approx 1-2%) chance of hearing loss. Rarely there is chance of dead ear also. Hearing results vary from surgeon to surgeon. As with all operations the best results tend to be achieved by those who do the procedure most frequently. Key Words: Otosclerosis, Stapedectomy, StapedotomyDOI: 10.3329/bjo.v15i1.4305 Bangladesh J of Otorhinolaryngology 2009; 15(1): 10-16

Pattern of metastasis in differentiated thyroid carcinoma

Total 60 patients were selected as per described criteria from the department of Otolaryngology and head neck surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2005 to October 2006. In this study of 60 patients of differentiated thyroid carcinoma (DTC), majority of the patients are within 31-50 yrs age group with female predominance. Papillary carcinoma was more common in 31-40 yrs age group and follicular carcinoma was more common in 41-50 years. Thyroid swelling was the most common presenting symptom of DTC (91.66%), followed by cervical lymphadenopathy (33.33%). Among the 60 DTC patients, papillary carcinoma was commoner (73.33%) than follicular carcinoma (26.67%). Overall female-male ratio for these 60 patients of DTC was 1.72: 1, but in papillary type the ratio was 1.44:1. and for follicular carcinoma was 3:1. Out of 44 papillary carcinoma patients 18 patients had cervical lymph node metastasis (40.90%), and out of 16 follicular carcinoma patients 2 had cervical lymph node metastasis (12.50%); P < 0.05. Among the 44 papillary carcinoma patients only 1 had distant metastasis (2.27%), and among the 16 follicular carcinoma patients 4 had distant metastasis (25%); P <0.05. 85% of the patients were presented with unilateral and 15% were presented with bilateral lymph node metastasis. In this series, distant metastasis was found in bone and lung, Maximum lymph node metastasis was found in level II (42.10%), level III (57.89%) and level IV (42.10%). Finally the Chi-square (x2) significance test was performed according to above described findings and it was found that there is significant difference in the pattern of lymph node metastasis and of distant metastasis between papillary and follicular type of DTC (P<0.05). Key words: Thyroid carcinoma; Metastasis. DOI: 10.3329/bjo.v15i2.5059 Bangladesh J Otorhinolaryngol 2009; 15(2): 60-68

Volumetric studies of alcohols in water and aqueous micelle solutions of cetyltrimethylammonium bromide

The volumetric properties of 1-propanol, cyclohexanol and butoxyethanol in water and CTAB water mixtures have been studied. The apparent molar volumes of 1-propanol, cyclohexanol and butoxyethanol in water and in aqueous solutions of CTAB were determined from density data. The partial molar volumes of the alcohols in water and aqueous micelle solutions at infinite dilution, V20(mic) were obtained from apparent molar volume data and compared with the corresponding values. The standard partial molar expansibilities, E20(mic) of the solubilizates were evaluated from V20(mic) data at various temperatures. The volumetric studies of alcohols in CTAB micelles indicate that alcohols on the average are preferentially solubilized in the palisade layer of the micelle and increasing amount of each is transferred more deep into the palisade layer of the micelle with increasing surfactant concentration and temperature. The results of standard partial molar volume, V20 and standard partial molar expansibilities, E20 are reported and discussed. DOI: http://dx.doi.org/10.3329/jbcs.v24i2.9703 Journal of Bangladesh Chemical Society, Vol. 24(2), 143-157, 2011

Hypopharyngeal carcinoma: a clinical study

A prospective study was carried out from 2001 to 2002 at Department of Otolaryngology and Head- Neck Surgery, BSMMU, DMCH, SSMC & Mitford Hospital, Dhaka. Data were collected from 45 patients with histologically diagnosed hypopharyngeal carcinoma on the following variables 1) sociodemographics, 2) clinical manifestations, 3) sub-sites of carcinoma, 4) clinical staging, 5) time of diagnosis, 6) associated risk factors, and 8) patients general performance status at presentation was determined by the Karnofsky scoring system. Results of this study showed that hypopharyngeal carcinoma affects fourth (60%) and fifth (26.7%) decade of life. It was found that male was highly predominant to develop hypopharyngeal carcinoma and ratio was 6:1. People with lower educational level and lower income group were found to be affected more by hypopharyngeal carcinoma. In this study the mean time elapsed from the appearance of the first symptom to the diagnosis of hypopharyngeal carcinoma was 4.11 months. This study found that the key symptom of hypopharyngeal carcinoma was dysphagia, pain, hoarseness and neck mass. 80 percent patient presented with palpable lymph node and all of them were in level II. Pyriform fossa was found to be the commonest site (80%) affected by carcinoma. In this series 75 percent patient presented in stage III and stage IV. There is strong relation between staging and diagnostic delay (p<0.05). In this study 86.7 percent patients had history of smoking. Smoking was found significantly associated with hypopharyngeal carcinoma (p<0.05). Betel nut chewing and tobacco chewing was found to be significant factors to develop hypopharyngeal carcinoma (p<0.05). This study showed that there was no patient with good oral health. Bad and average orodental hygiene was found in 44.4 and 55.6 percent respectively. Statistically bad oral hygiene was significantly related to hypopharyngeal carcinoma (p<0.05). Performance status of the patients at presentation was good and 77.8 percent of patients with hypopharyngeal carcinoma at diagnosis were capable of self-care.  DOI: 10.3329/bjo.v14i1.3276 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 23-29

Pain management of peritonsillar abscess

One year cross sectional study was undertaken in 50 patients with peritonsillar abscess to determine the treatment that was most effective in relieving the excruciating pain associated with the condition. The patients were divided into two treatment groups: intravenous antibiotic, and incision and drainage. The effect of treatment over was objectively assessed by serially measuring the distence between upper & lower incisor and by giving the patient water to drink at regular intervals to determine the point at which swallowing was pain-free. The improvement of the mean upper to lower incisor distance 15 minutes after the initial treatment was five per cent in the intravenous antibiotic group and 100 per cent in the incision and drainage group. None of the patients in the intravenous antibiotic group was able to swallow water two hours after the initial treatment. In the same time interval 23 patients (92 per cent) in the incision and drainage group were able to swallow water. The conclusion derived from this study is that incision and drainage is superior to intravenous antibiotic in relieving the pain associated with peritonsillar abscess. Key words: Peritonsillar Abscess, Pain.  DOI: 10.3329/bjo.v14i1.3273 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 6-8

Prevalence of otitis media with effusion among school going children in Bangladesh

A Prospective study was carried out from Jan 2000 Jan 2003, to find out the prevalence of OME among School children The study was done in Dhaka City and adjacent areas of Dhaka City in Savar, Munshigonj and Keranigonj, Altogether 280 Students aged 4-9 years were interviewed and examined. Nineteen percent children were found to have OME. In the urban community it was 17%, but in rural areas it was 21%. In our study children with OME were more in poorer people, smoker parents and bottle fed babies. Key words: Otitis media with effusion (OME), school children.DOI: 10.3329/bjo.v15i1.4308 Bangladesh J of Otorhinolaryngology 2009; 15(1): 31-34

Clinicopathological study of sinonasal malignancy

This cross sectional study was done in the Otolaryngology and Head-Neck Surgery Department of Banghabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Sir Salimullah Medical College Hospital during the period of September 2003 to February 2004. In this study 30 patients of sinonasal malignancy were studied and to observe the clinicopathological pattern of sinonasal malignancy. The diagnosis was made by detailed history, clinical, radiological and histopathological examinations. In this study majority of the patients were within 40 to 70 years of age (77%). Male to female ratio was 2.33:1. Majority of the malignancy came from maxillary sinuses 15(50.00%); ethmoidal sinuses were involved in 8(26.66%) cases, multiple sinuses were involved in 5(16.66%). Neck node metastases was found in 4(14%) cases. Squamous cell carcinoma was the most common histological type (70.00%); the other less common histological types were adenoid cystic carcinoma (06.66%), adenocarcinoma (06.66%), Non-Hodgkin's lymphoma (06.66%), least frequent types were malignant fibrous histocytoma, transitional cell carcinoma, olfactory neuroblastoma. Key words: Sinonasal malignancy; clinicopathological study. DOI: 10.3329/bjo.v15i2.5058 Bangladesh J Otorhinolaryngol 2009; 15(2): 55-59