Evaluation of Serum CA 19-9 as a Diagnostic Marker for Pancreatic Malignancy

In biliary-pancreatic malignancy, the serum CA 19-9 is considered as a tumor marker. Its high level may indicate the presence of a malignant disorder, but it can also be raised in benign conditions and also in malignancies from other organs. The value may be normal even in malignant condition. This comparative study was conducted in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from 1st June 2016 to 31st May 2017 to determine the sensitivity and specificity of CA 19-9 as a tumor marker in pancreatic malignancy in our perspective and to establish a cut-off value of CA 19-9 which might prove as a definitive indication of pancreatic malignancy. We found that when the cut off value of CA 19-9 is 38 U/ml (according to ROC curve), the sensitivity, specificity, PPV and NPV were 77.8%, 77.8%, 77.8%, 77.8% respectively. And if the serum CA 19-9 threshold was raised to 100 and 120 to diagnose pancreatic cancer, sensitivity became 72.2% and 66.7% and NPV 76.2% and 73.9% respectively. However, the specificity increased to 88.9% and 94.4% and the PPV increased to 86.7% and 92.3% respectively.

Structural, thermodynamic, and magnetic properties of SrFe12O19 hexaferrite modified by co-substitution of Cu and Gd

A hard magnetic system of SrFe12O19 nanomaterial was modified according to the composition of Sr0.95Gd0.05Fe12-xCuxO19 with x = 0.0, 0.30, and 0.60 using the sol-gel technique. The structures of the samples were evaluated using X-ray diffraction (XRD) along with Rietveld refinement, and an M-type hexaferrite with a hexagonal structure was confirmed with a trace amount of the α-Fe2O3 phase. In addition, transmission electron microscopy (TEM) analysis revealed polycrystalline nanoplates in all samples. Furthermore, the bond structures of the octahedral and tetrahedral sites along with the thermodynamic properties of these ferrites were extracted from the FTIR spectra at room temperature. The Debye temperature (θD) decreased from 755.9 K to 749.3 K due to the co-substitution of Gd3+ at Sr2+ and Cu2+ at Fe3+. The magnetic hysteresis (M-H) measurements revealed that the coercivity decreased from 5.3 kOe to 1.5 kOe along with the highest magnetization saturation (Ms) of 65.2 emu g-1 for the composition Sr0.95Gd0.05Fe11.7Cu0.3O19, which is suitable for industrial application. The effect of local crystalline anisotropy in magnetization was explored using the law of approach to saturation (LAS). Finally, thermo-magnetization was recorded in the range from 400 K to 5 K for cooling under zero field and in the presence of a 100 Oe field, and magnetic transitions were tracked due to the introduction of the foreign atoms of Gd and Cu into SrFe12O19.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Bacteriological Profile of Hospital Acquired Infection and Their Antimicrobial Susceptibility Patterns in a Tertiary Care Hospital

A hospital-acquired infection (HAI) is acquired in a hospital or other health care facilities. This is an extra burden in every unit of hospital as it increases the morbidity, mortality, cost of treatment and also duration of the hospital stays for the patients. This study aimed to find out the causative bacterial agents of HAI from different clinical samples and their antimicrobial susceptibility patterns. This was a cross-sectional descriptive study conducted in the Department of Microbiology and Virology, Sylhet MAG Osmani Medical College, in collaboration with in-patient departments of Sylhet MAG Osmani Medical College Hospital from January 2019 to December 2019. A total of 123 patients of different ages, sex were enrolled in this study. Samples were collected from postoperative wounds, post catheterized urinary tract infections, diabetic wounds and intravenous cannula from Surgery ward, Medicine ward and Obstetrics & Gynecology ward. Standard laboratory procedures were applied to isolate and identify the bacteria. The identified organisms were then tested for anti biogram. Among 123 patients 46 (37.4%) were affected by hospital acquired infections. Higher prevalence (n=28, 60.87%) of HAI was found in Surgery ward and the lower prevalence (n=9, 19.56%) was found in Medicine ward and Obstetrics & Gynecology ward. The most common type of infection was surgical wound infection (20, 43.48%). Out of all the HAIs irrespective of source and site, highest number were done by Staphylococcus aureus (15, 30.61%) followed by Pseudomonas aeruginosa (08, 16.33%), Escherichia coli (07, 14.29%), Serratia spp. (05, 6.12%), Aeromonas spp. (05, 6.12%), Acinetobacter spp. (02, 4.08%), Proteus spp. (02, 4.08%), Citrobacter spp. (02, 4.08%), Klebsiella spp. (02, 4.08%), CoNS (02, 4.08%), Enterobacter spp. (01, 2.04%) and Morganella morganii (01, 2.04%). The antimicrobial susceptibility data suggested that Gram positive bacteria are more susceptible to doxycycline, vancomycin and linezolid; while Gram negative bacteria were more susceptible to imipenem, levofloxacin and meropenem.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Predicting Difficult Intubation by using Modified Mallampati (MMT) with or without Thyromental Height Test (TMHT)

Failed Tracheal Intubation with Subsequent inability to maintain an open airway and adequate oxygenation is the most frequent cause of brain damage or death during anesthesia. Recognizing before anesthesia the potential for difficult intubation allows time for optimal preparation. Proper Selection of equipment and techniques is needed to avoid unwanted situation. To find out difficulties associated with endotracheal intubation using Modified Mallampati Test (MMT) combined with Thyromental Height Test (TMHT) and MMT without TMHT. This prospective observational study was conducted at the Department of Anesthesia in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2018 to September 2018. Two hundred two patients with different surgical procedures under general anaesthesia in different operation theaters of BSMMU, Dhaka were selected as study population. After taking written consents from each patient or his/her attendant elaborate history of illness, meticulous clinical examinations were performed and relevant laboratory investigations were done. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS-22.0. Mean age ±SD of the study subjects was 42.49±14.29 years in MMT with TMHT group and 43.40±15.39 years in MMT without TMHT group. Females were enrolled more than males in both the groups. BMI was 28.75±3.59kg/m² in MMT with TMHT group and 29.44±8.64kg/m² in MMT without TMHT group. There were no significant differences in age, gender and BMI between the groups. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT with TMHT in predicting intubation difficulty. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT only in predicting intubation difficulty. MMT combined with TMHT is a better predictor of intubation difficulty than MMT alone.

Role of Rotaviral Antigen Detection by ICT in Acute Diarrhoeic Children below 5 Years in a Tertiary Care Hospital of Bangladesh

Rotavirus is responsible for acute severe watery diarrhoea in young children. Early and rapid detection of Rotavirus infection can help to reduce inappropriate administration of antibiotics and has future positive impact on prevention of drug resistance. This cross-sectional study was designed to determine the role of Rotaviral antigen detection by ICT from stool sample of acute diarrhoeal children below five years admitted in Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology in collaboration with the Department of Paediatrics during the period from 1st January 2018 to 31st December 2018. Total 184 children of under five years of age with acute watery diarrhoea were enrolled in this study. Rotaviral antigen was detected by ELISA (Enzyme Linked Immunosorbent Assay) and ICT (Immunochromatographic test) from stool samples. Out of 184 stool samples, Rotaviral antigen was found positive in 84 and 86 cases by ICT and ELISA methods, respectively. ICT showed sensitivity of 90.70% and specificity of 93.88% when compared with ELISA. The Rotavirus infection was found highest in male children (61.90%) and in age group of 7 to 12 months (51.89%). Considering the importance of Rotaviral diarrhoea, rapid detection of Rotavirus infection by ICT is essentially needed and might be practiced routinely as it is relatively reliable, easy to perform and cost-effective. It is particularly important in Bangladesh, where diarrhoea is still contributing a significant proportion of morbidity and mortality in under five children.

A Comparative Study Between 20% Mannitol and 3% Hypertonic Saline for Brain Oedema Reduction during Elective Brain Tumour Surgery

Cerebral oedema is an important manifestation of brain tumour. The significant reduction of cerebral oedema can show rapid improvement of the patients. Hypertonic saline solution and mannitol both are commonly used for this action. It is now time to choose the better one. This was a prospective randomized comparative study designed to evaluate the efficacy of 3% hypertonic saline (NaCl) in reduction of brain oedema during brain tumour surgery and compare it with that of 20% Mannitol. The study was conducted in the department of Anaesthesiology, Combined Military Hospital, Dhaka, Bangladesh from July 2016 to December 2016. A total number of 47 patients for brain tumour surgery were selected. After screening 40 patients were finalized. Then the patients were divided into 2 equal groups 20 patients in each. Patients of Group A received 3% hypertonic saline and Group B 20% mannitol. Uniform anaesthetic technique applied for all patients, fixed surgeon/group of surgeons carried out the surgery. Heart rate and noninvasive blood pressure were monitored and kept with in ±20% baseline values different means. ETCO2 were kept in between 28-32mm of Hg by adjusting ventilator setting. Reduction of brain oedema was monitored by subjective assessment of surgeons using a 3 point scale of brain relaxation. The data were recorded in preformed data sheet. The results were tested by chi-square test to see their level of significance i.e. p value <0.05 was considered as significant. At the opening of dura, the number of brain conditions classified as soft, adequate and tight were statistically non-significant between groups. After 0.5 hour and 1.0 hour 10% patient's brain was tight in Group A whereas it was 35% and 40% in Group B respectively. Reduction of brain oedema or brain relaxation was significantly better in Group A compared to Group B (p<0.05). Urine output was higher with mannitol than hypertonic saline (p<0.05). Duration of ICU and hospital stay in both Group A and Group B were statistically similar (p>0.05). Compared to mannitol, hypertonic saline caused an increase in serum sodium concentration over time (p<0.05). From the available data, use of 20% mannitol and 3% hypertonic saline for brain oedema reduction, it is suggested that hypertonic saline significantly reduces the risk of tight brain and produce the brain more soft than mannitol during brain tumour surgery.

Outcome of Open Reduction and Internal Fixation of Posterior Wall Fracture of Acetabulum

Acetabular fracture usually occurs as a result of high velocity injury and often affects the young and economically productive population. Previously, treatment of acetabular fracture was grossly inadequate and many patients were left with incapacitating pain, limitation of movement. Proper management should be given in our set-up to save lives and to minimize long term complications and related disabilities. This study was done to evaluate the outcome of open reduction and internal fixation of posterior wall fracture of acetabulum. This prospective observational study was carried out in Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2016 to June 2018. Total twenty five cases were selected. Radiological and functional outcome were evaluated six months after surgery according to Matta radiographic criteria and Merle d Aubigne and Postel criteria respectively. Effect of age, gender, hip dislocation, displacement of fracture fragment, associated injury, reduction quality, trauma to surgery time, complication of operation on the functional outcome was evaluated. Age range was 18-60 years. The mean age was 38±11 years. Male 23 and female 2, male and female ratio was 11.5:1. Mean follow up 8.5±1.7 months, range 6-12 months. According to Matta radiographic criteria, 6 months after surgery, 10 patients had excellent, 10 patients had good, 3 patients had fair and 2 patients had poor radiological outcome. According to Merle d Aubigne and Postel criteria, 6 months after surgery, 11 patients had excellent, 10 patients had good, 3 patients had fair and 1 patient had poor functional outcome. Overall functional outcome of the study population revealed that 21 patients (84%) belonged to satisfactory (Excellent + Good) and 4 patients (16%) belonged to unsatisfactory (Fair + Poor) outcome. AVN (avascular necrosis) of femoral head had been occurred in two patients, post-operative wound infection had been occurred in two patients and myositis ossificans around hip joint had been occurred in two patients. Twenty (20) patients were achieved anatomic (0, 1mm) reduction, 3 patients were achieved imperfect (2, 3mm) reduction and 2 patients were achieved poor (>3mm) reduction. This study concludes that open reduction and internal fixation of posterior wall fracture of acetabulum is a satisfactory method of treatment.

MEASUREMENT OF EXTREMITY DOSES OF NUCLEAR ENERGY WORKER BY USING RING DOSIMETER

Finger doses can serve as a guide to suggest any needed modification in work practice to minimise radiation doses to the extremities. In the present study, radiation doses at the base of the middle finger of both hands of 20 nuclear energy workers handling 99mTc-labelled compounds,125I and131I during various diagnostic and therapeutic procedures in nuclear medicine were measured. The laboratory assessments were carried out by means of thermoluminescence ring dosimetry in Health Physics Division, Atomic Energy Center, Dhaka. The recorded extremity doses were then compared to their routinely monitored whole-body doses. The average annual finger doses recorded in this study were found to be 10.7 ± 8.2 and 12.7 ± 12.9 mSv, respectively, for the left- and right-hand fingers, which are at least 12-fold higher than the average whole-body dose. There was, however, no extreme case found of health hazard to the workers' hand, which exceeds maximum dose limit 500 mSv/year given by the International Commission on Radiological Protection. On comparing the average annual finger doses at different labs, significantly higher average dose was recorded at isotope-dispensing lab (19.6 ± 12.6 mSv/year) and then followed by gamma camera lab (13.2 ± 12.1 mSv/year) and radioimmunoassay lab (7.0 ± 5.5 mSv/year). These observations are fairly in good agreement with the reported results. The observations of the present study, therefore, may be implemented for the betterment of safety for the occupational workers in nuclear medicine facilities.

Serum Albumin Level and In-Hospital Outcome of Patients with First Attack Acute Myocardial Infarction

Acute myocardial infarction (AMI) patients constitute a large proportion of admissions in coronary care unit and their management and risk stratification is of immense importance. A decrease in serum albumin concentration might be associated with an increased risk in the incident of both cardiovascular diseases and worse hospital outcome. We assessed whether serum albumin levels at admission was associated with in-hospital adverse outcome in patients with first attack of acute myocardial infarction (AMI). The aim of the study was to evaluate association of serum albumin level with in-hospital outcome in patients with first attack of acute myocardial infarction. This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2017 to February 2018. Total 374 patients of first attack of acute myocardial infarction included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I (Patients with acute myocardial infarction with serum albumin <3.5gm/dl) and. Group II (Patients with acute myocardial infarction with serum albumin ≥3.5gm/dl). Serum albumin level was measured within 24 hours of admission and the incidence of in-hospital major cardiac outcomes was observed. In this study mean±SD serum albumin level of Group I, Group II were 3.02±0.12gm/dl, 4.48±0.50gm/dl respectively. In Group I patient, 52(59.80%), 7(8.00%), 10(11.50%), developed heart failure, cardiogenic shock, arrhythmias respectively and 8(9.20%) died and in Group II patient 20(7.90%), 7(2.80%), 8(3.20%) developed heart failure, cardiogenic shock, arrhythmias respectively and 4(1.60%) died out of them and all of these outcome were statistically significant. Mean±SD duration of hospital stay of the study population according serum albumin level, in Group I, 5.76±1.83 days, in Group II, 4.40±1.22 days which was statistically significant (p<0.05). In conclusion, patient with first attack of acute myocardial infarction serum albumin level below 3.50gm/dl increased the risk of worse in-hospital outcome.

Electrosurgery Dissection versus Sharp Dissection: Effect on Early Postoperative Wound Complications in Modified Radical Mastectomy

Modified radical mastectomy (MRM) is still the most commonly performed operation for breast cancer, despite the trends toward breast-conserving treatment. Since 1970s, electrosurgery (also known as electrocautery, diathermy) has been a widespread surgical tool to raise flaps and excise the breast specimen in order to perform a bloodless mastectomy. Use of diathermy has been well blamed for wound complications. To prevent undue delay in the adjuvant treatment, it is important to minimize the surgical complications. This quasi experimental study was conducted in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to evaluate the effects of electrosurgery and sharp dissection on early postoperative wound complications in MRM. 46 patients were included in the study (23 in each group). Data analysis done in SPSS version 23.0 and 'p' value <0.05 considered significant at 95% confidence interval. In Electrosurgery Dissection (ED) group mean duration of drainage was 7.8±1.2 days and in Sharp Dissection (SD) group 6.4±1.0 days (p value 0.000). Mean total drainage in ED group found 1082±287ml and in SD group 693±194ml (p value 0.000). Seroma formation found 7(30.4%) in ED group and 3(13.0%) in SD group (p value 0.004). Wound dehiscence found 5(21.7%) in ED group and 2(8.7%) in SD group (p value 0.013). Flap necrosis rate was 4(17.4%) and 1(4.4%) in ED and SD group respectively (p=0.003). Demographic and clinical variables were similar or differences were not statistically significant in two groups. No difference found in operating time and wound infection rate in two groups. The result of the study showed that, electrocautery dissection caused early postoperative wound complications more than the sharp dissection.

Porcelain Gallbladder: A Case Report

"Porcelain gallbladder" term has been used to highlight the blue staining and fragile consistency of the gallbladder wall at surgery. Some authorities avoid these terms and alternately call all calcified gallbladders "porcelain gallbladders". It is a morphological deviation of chronic cholecystitis. Inflammatory scarring of the wall combined with dystrophic calcification inside the wall transforms the gallbladder into a porcelain-like container. In porcelain gallbladder patients are usually asymptomatic and the condition is usually noted incidentally on plain abdominal radiographs, sonograms, or computed tomography (CT) images. Porcelain gallbladder is a rare condition; recognizing the clinical and imaging characteristics of the disease is important because of the high frequency (22%) of adenocarcinoma in porcelain gallbladder. Operation should not be delayed even if the patient is asymptomatic, because the incidence of carcinoma in porcelain gallbladder is extremely high. Here we present a case of 45 years old lady with porcelain gallbladder who was initially diagnosed as a case of carcinoma gallbladder at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 5th August 2017. But she was found to have a benign gallbladder after cholecystectomy.

Upper GIT Endoscopic Evaluation and Psychological State Assessment of Patients with Globus Sensation

Globus sensation is a subjective feeling of a lump or foreign body in the throat without interfering swallowing of food. It is a persistent and distressing sensation in throat. It affects about 6% of population. But cause of globus is still unknown. Exact aetiology of globus is considered to be multifactorial. Some other studies also show association between globus and psychological distress including anxiety and depression. As there is no established pharmacological treatment, adequate investigations with negative result could reassure patients and improve their symptoms. In this prospective study consecutive patients with globus symptoms examined by upper GIT endoscopy with attention to larynx, epiglottis, base of tongue, both pyriform fossa and hypo-pharynx using Olympus forward viewing video Gastroscope (GIF Q-150 & GIF Q-170) to exclude organic lesion and was conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and North East Medical College, Sylhet from 1st July 2014 to 31 December 2016. Their psychological status and epidemiological information including personal and family history were noted in a pre-designed data sheet. Total 104 patients were examined, among them definite anxiety was found in 36(34.95%) and borderline feature of anxiety was found in 19(18.44%) and 48(46.60%) were free of anxiety. Incidence of anxiety was significantly higher among females and was more prevalent among housewife, married people and people from rural community. In this series, 13(12.5%) patients had definite depression and 29(27.9%) patients had borderline depression, while 61(59.2%) patients had no feature of depression. Incidence of depression was significantly higher among females, housewife and married people. Organic lesion is rare in patients with globus symptoms. Globus sensation is more common among females. Psychological factors like anxiety and depression are frequently associated with globus sensation.

Variability Assessment of Aromatic Rice Germplasm by Pheno-Genomic traits and Population Structure Analysis

While the pleasant scent of aromatic rice is making it more popular, with demand for aromatic rice expected to rise in future, varieties of this have low yield potential. Genetic diversity and population structure of aromatic germplasm provide valuable information for yield improvement which has potential market value and farm profit. Here, we show diversity and population structure of 113 rice germplasm based on phenotypic and genotypic traits. Phenotypic traits showed that considerable variation existed across the germplasm. Based on Shannon-Weaver index, the most variable phenotypic trait was lemma-palea color. Detecting 140 alleles, 11 were unique and suitable as a germplasm diagnostic tool. Phylogenetic cluster analysis using genotypic traits classified germplasm into three major groups. Moreover, model-based population structure analysis divided all germplasm into three groups, confirmed by principal component and neighbors joining tree analyses. An analysis of molecular variance (AMOVA) and pairwise FST test showed significant differentiation among all population pairs, ranging from 0.023 to 0.068, suggesting that all three groups differed. Significant correlation coefficient was detected between phenotypic and genotypic traits which could be valuable to select further improvement of germplasm. Findings from this study have the potential for future use in aromatic rice molecular breeding programs.

Metal-Adapted Bacteria Isolated From Wastewaters Produce Biofilms by Expressing Proteinaceous Curli Fimbriae and Cellulose Nanofibers

Bacterial biofilm plays a pivotal role in bioremediation of heavy metals from wastewaters. In this study, we isolated and identified different biofilm producing bacteria from wastewaters. We also characterized the biofilm matrix [i.e., extracellular polymeric substances (EPS)] produced by different bacteria. Out of 40 isolates from different wastewaters, only 11 (27.5%) isolates (static condition at 28°C) and 9 (22.5%) isolates (agitate and static conditions at 28 and 37°C) produced air–liquid (AL) and solid–air–liquid (SAL) biofilms, respectively, only on salt-optimized broth plus 2% glycerol (SOBG) but not in other media tested. Biomass biofilms and bacteria coupled with AL biofilms were significantly (P ≤ 0.001) varied in these isolates. Escherichia coli (isolate ENSD101 and ENST501), Enterobacter asburiae (ENSD102), Enterobacter ludwigii (ENSH201), Pseudomonas fluorescens (ENSH202 and ENSG304), uncultured Vitreoscilla sp. (ENSG301 and ENSG305), Acinetobacter lwoffii (ENSG302), Klebsiella pneumoniae (ENSG303), and Bacillus thuringiensis (ENSW401) were identified based on 16S rRNA gene sequencing. Scanning electron microscope (SEM) images revealed that biofilm matrix produced by E. asburiae ENSD102, uncultured Vitreoscilla sp. ENSG301, A. lwoffii ENSG302, and K. pneumoniae ENSG303 are highly fibrous, compact, and nicely interlinked as compared to the biofilm developed by E. ludwigii ENSH201 and B. thuringiensis ENSW401. X-ray diffraction (XRD) results indicated that biofilm matrix produced by E. asburiae ENSD102, uncultured Vitreoscilla sp. ENSG301, and A. lwoffii ENSG302 are non-crystalline amorphous nature. Fourier transform infrared (FTIR) spectroscopy showed that proteins and polysaccharides are the main components of the biofilms. Congo red binding results suggested that all these bacteria produced proteinaceous curli fimbriae and cellulose-rich polysaccharide. Production of cellulose was also confirmed by Calcofluor binding- and spectrophotometric assays. E. asburiae ENSD102, Vitreoscilla sp. ENSG301, and A. lwoffii ENSG302 were tested for their abilities to form the biofilms exposure to 0 to 2000 mg/L of copper sulfate (for Cu), zinc sulfate (for Zn), lead nitrate (for Pb), nickel chloride (for Ni), and potassium dichromate (for Cr), several concentrations of these metals activated the biofilm formation. The polysaccharides is known to sequester the heavy metals thus, these bacteria might be applied to remove the heavy metals from wastewater.

Efficacy of 0.5% Hyperbaric Bupivacaine with Dexamethasone versus 0.5% Hyperbaric Bupivacaine alone in Spinal Anaesthesia for Patient Undergoing Lower Abdominal Urological and Lower Limb Orthopedic Surgeries

Spinal anaesthesia with local anaesthetics has limited duration. Different additives have been used to prolong spinal anaesthesia. The aim of this study was to determine the efficacy of adding dexamethasone to bupivacaine in spinal anaesthesia specially whether it would prolong the duration of sensory block/ surgical analgesia and post-operative analgesia/pain free period or not. This randomized, prospective, double-blind, clinical study was conducted in the Department of Anaesthesia, Analgesia and Critical Care of Combined Military Hospital, Chittagong from October 2016 to August 2017. Seventy two (72) adult patients scheduled for lower abdominal urological and lower limb orthopedic surgery under spinal anaesthesia were included. They were divided in two groups; each group comprised 36 patients to receive 20mg 0.5% hyperbaric bupivacaine (Bupivacaine group) or 15mg 0.5% hyperbaric bupivacaine plus 5mg dexamethasone (Bupivacaine-Dexamethasone/case group) intrathecally. The patients were evaluated for quality, quantity and duration of sensory block/surgical analgesia, post-operative analgesia/pain free period, blood pressure, heart rate, nausea, and vomiting or other complications. There were no significant differences in demographic data, sensory level and onset time of the sensory block between two groups. Duration of sensory block/Surgical analgesia in the bupivacaine group was 92.32±8.34 minutes and in the bupivacaine- dexamethasone/case group was 122.11±10.59 minutes which was statistically highly significant (p<0.001). The duration of post-operative analgesia/pain free period was 208.78±41.57 minutes in the bupivacaine group; whereas it was 412.82±71.51 minutes in the bupivacaine-dexamethasone/case group which was also statistically highly significant (p<0.001). The frequency of complications was not different between two groups. This study has shown that the addition of dexamethasone to bupivacaine in spinal anaesthesia significantly improved the duration of sensory block/surgical analgesia as well as post-operative analgesia/pain free period without any complications.

Experimental study of radiation dose rate at different strategic points of the BAEC TRIGA Research Reactor

The 3MW TRIGA Mark-II Research Reactor of Bangladesh Atomic Energy Commission (BAEC) has been under operation for about thirty years since its commissioning at 1986. In accordance with the demand of fundamental nuclear research works, the reactor has to operate at different power levels by utilizing a number of experimental facilities. Regarding the enquiry for safety of reactor operating personnel and radiation workers, it is necessary to know the radiation level at different strategic points of the reactor where they are often worked. In the present study, neutron, beta and gamma radiation dose rate at different strategic points of the reactor facility with reactor power level of 2.4MW was measured to estimate the rising level of radiation due to its operational activities. From the obtained results high radiation dose is observed at the measurement position of the piercing beam port which is caused by neutron leakage and accordingly, dose rate at the stated position with different reactor power levels was measured. This study also deals with the gamma dose rate measurements at a fixed position of the reactor pool top surface for different reactor power levels under both Natural Convection Cooling Mode (NCCM) and Forced Convection Cooling Mode (FCCM). Results show that, radiation dose rate is higher for NCCM in compared with FCCM and increasing with the increase of reactor power. Thus, concerning the radiological safety issues for working personnel and the general public, the radiation dose level monitoring and the experimental analysis performed within this paper is so much effective and the result of this work can be utilized for base line data and code verification of the nuclear reactor.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

Acinar Cell Carcinoma of the Pancreas: A Case Report

Acinar cell carcinoma (ACC) of the pancreas is a very rare neoplasm. We report a case of pancreatic acinar cell carcinoma involving the uncinate process of the pancreas. A 45 year old man presented with a painful upper abdominal mass without any jaundice or weight loss. Computed Tomography (CT) and Magnetic Resonance Cholangio-Pancreatography (MRCP) indicated a mass lesion in the uncinate process of the pancreas. He underwent Whipple's procedure (Pancreaticoduodenectomy). Histological slides revealed features of Acinar cell carcinoma (ACC) in the uncinate process of the pancreas and a lymph node.

CytR Homolog of Pectobacterium carotovorum subsp. carotovorum Controls Air-Liquid Biofilm Formation by Regulating Multiple Genes Involved in Cellulose Production, c-di-GMP Signaling, Motility, and Type III Secretion System in Response to Nutritional and Environmental Signals

Pectobacterium carotovorum subsp. carotovorum [Pcc (formerly Erwinia carotovora subsp. carotovora)] PC1 causes soft-rot disease in a wide variety of plant species by secreting multiple pathogenicity-related traits. In this study, regulatory mechanism of air-liquid (AL) biofilm formation was studied using a cytR homolog gene deletion mutant (ΔcytR) of Pcc PC1. Compared to the wild type (Pcc PC1), the ΔcytR mutant produced fragile and significantly (P < 0.001) lower amounts of AL biofilm on salt-optimized broth plus 2% glycerol (SOBG), yeast peptone dextrose adenine, and also on King’s B at 27°C after 72 h incubation in static condition. The wild type also produced significantly higher quantities of AL biofilm on SOBGMg^– (magnesium deprived) containing Cupper (Cu²⁺), Zinc (Zn²⁺), Manganese (Mn²⁺), Magnesium (Mg²⁺), and Calcium (Ca²⁺) compared to the ΔcytR mutant. Moreover, the wild type was produced higher amounts of biofilms compared to the mutant while responding to pH and osmotic stresses. The ΔfliC (encoding flagellin), flhD::Tn5 (encoding a master regulator) and ΔmotA (a membrane protein essential for flagellar rotation) mutants produced a lighter and more fragile AL biofilm on SOBG compared to their wild counterpart. All these mutants resulted in having weak bonds with the cellulose specific dye (Calcofluor) producing lower quantities of cellulose compared to the wild type. Gene expression analysis using mRNA collected from the AL biofilms showed that ΔcytR mutant significantly (P < 0.001) reduced the expressions of multiple genes responsible for cellulose production (bcsA, bcsE, and adrA), motility (flhD, fliA, fliC, and motA) and type III secretion system (hrpX, hrpL, hrpA, and hrpN) compared to the wild type. The CytR homolog was therefore, argued to be able to regulate the AL biofilm formation by controlling cellulose production, motility and T3SS in Pcc PC1. In addition, all the mutants exhibited poorer attachment to radish sprouts and AL biofilm cells of the wild type was resistant than stationary-phase and planktonic cells to acidity and oxidative stress compared to the same cells of the ΔcytR mutant. The results of this study therefore suggest that CytR homolog is a major determinant of Pcc PC1’s virulence, attachment and its survival mechanism.

Epigenetic programming alterations in alligators from environmentally contaminated lakes

Previous studies examining the reproductive health of alligators in Florida lakes indicate that a variety of developmental and health impacts can be attributed to a combination of environmental quality and exposures to environmental contaminants. The majority of these environmental contaminants have been shown to disrupt normal endocrine signaling. The potential that these environmental conditions and contaminants may influence epigenetic status and correlate to the health abnormalities was investigated in the current study. The red blood cell (RBC) (erythrocyte) in the alligator is nucleated so was used as an easily purified marker cell to investigate epigenetic programming. RBCs were collected from adult male alligators captured at three sites in Florida, each characterized by varying degrees of contamination. While Lake Woodruff (WO) has remained relatively pristine, Lake Apopka (AP) and Merritt Island (MI) convey exposures to different suites of contaminants. DNA was isolated and methylated DNA immunoprecipitation (MeDIP) was used to isolate methylated DNA that was then analyzed in a competitive hybridization using a genome-wide alligator tiling array for a MeDIP-Chip analysis. Pairwise comparisons of alligators from AP and MI to WO revealed alterations in the DNA methylome. The AP vs. WO comparison identified 85 differential DNA methylation regions (DMRs) with ⩾3 adjacent oligonucleotide tiling array probes and 15,451 DMRs with a single oligo probe analysis. The MI vs. WO comparison identified 75 DMRs with the ⩾3 oligo probe and 17,411 DMRs with the single oligo probe analysis. There was negligible overlap between the DMRs identified in AP vs. WO and MI vs. WO comparisons. In both comparisons DMRs were primarily associated with CpG deserts which are regions of low CpG density (1-2CpG/100bp). Although the alligator genome is not fully annotated, gene associations were identified and correlated to major gene class functional categories and pathways of endocrine relevance. Observations demonstrate that environmental quality may be associated with epigenetic programming and health status in the alligator. The epigenetic alterations may provide biomarkers to assess the environmental exposures and health impacts on these populations of alligators.

A regulatory approach on serum bilirubin level in subjects with impaired glucose tolerance

The present study was undertaken to find the role of dietary intervention and physical exercise on serum bilirubin level in IGT subjects. Thirty three newly detected otherwise healthy subjects with IGT, aged 35-63 years, were randomly selected to participate in a 12 weeks diet and exercise program. Nine participants were within 35-40 years while majority fifteen participants aged 41-50 years and rest six participants were above 50 (51-63) years. A male preponderance was observed among the study participants where 53.3% of the total participants were male (n=16) and 46.7% were female (n=14). Mean bilirubin (mg/dl) level was recorded 0.68 ± 0.29 at base line and with follow-up, the value was 0.66 ± 0.26 mg/dl. For men (n=16), serum bilirubin were 0.77 ± 0.39 and 0.75 ± 0.36 mg/dl at base line and follow-up while for women (n=14), the values were 0.67 ± 0.33 and 0.59 ± 0.28 mg respectively. The 35-40 years group (n=9) showed bilirubin from 0.66 ± 0.23 at base line to 0.73 ± 0.19 mg/dl at follow-up while 41-50 years group (n=15) had 0.70 ± 0.34 and 0.58 ± 0.26 mg/dl and for 51-63 years group (n=6), the values were 0.65 ± 0.29 and 0.73 ± 0.33 mg/dl respectively. Participants with BMI 20-25 had bilirubin 0.62 ± 0.29 mg/dl at base line and 0.71 ± 0.21 mg/dl at follow-up while with BMI >25 (n=20) had 0.71 ± 0.30 and 0.63 ± 0.2 8 mg/dl respectively. No significant changes in serum bilirubin were observed among the groups and therefore, the dietary intervention and physical exercise during the period did not have a significant role in this respect.

Surgical Decompression of Resistant Cases of DeQuervain's Disease

DeQuervain's disease of the first dorsal compartment of the wrist, is a common wrist pathology, pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendon in the fibroosseous canal. Management of resistant cases of DeQuervain's disease with failed conservative treatment treated by surgical decompression yield satisfactory outcomes. A large number of patients being dissatisfied with the medical treatment, still present with persistent pain and positive clinical finding. Surgical decompression is an effective method for the treatment of resistant cases of DeQuervain's disease. Outcome variables were measured by Scheller, Forget and Macey evaluation criteria. Most of our patients were female 28(93.3%), housewife 17(56.7%) with mean age of 41.57 years, ranging from 25-60 years. Right sided involvement was 20(66.7%) and Left sided involvement was 10(33.3%). Restricted movement of thumb in 30(100%) were the predominant symptoms. One (3.3%) patient develop chronic tenosynovitis, 1(3.3%) patient develop hypertrophic scar. There was no wound infection in the follow-up period of 3-18 months. Satisfactory results were found in 29(96.7%).

First Report of Phytophthora plurivora Causing Collar Rot on Common Alder in Spain

Phytophthora decline of riparian alder (Alnus spp.) has been reported in several European countries (2). Death of common alder (Alnus glutinosa) due to Phytophthora alni has also been reported in Spain (4). During several surveys of alder trees in September 2012, typical dieback symptoms, including sparse small yellowish foliage and the presence of rusty exudates on the bark at the collar and lower stem were observed in A. glutinosa growing on the banks of the river Tera (Langa de Duero, Soria, 41°36'34″ N, 3°25'10″ W, elevation 851 m) and the river Tormes (La Maya, Salamanca, 40°41'42″ N, 5°35'36″ W, elevation 833 m). Bark samples plus cambium were taken from the active lesions at collar region, cut into small pieces, dried on filter paper, and plated on V8-PARPH agar (2). The samples were incubated for 4 days at 20°C in the dark before obtaining the Phytophthora isolates. Colonies developed on V8 juice agar (V8A) had limited aerial mycelium at the center and displayed radiate and slightly chrysanthemum-like growth pattern. Mycelial growth was optimal at 25°C (radial growth rate, 8.2 mm d^-1), whereas no growth was observed at 32°C. Isolates were homothallic with paragynous antheridia, smooth-walled spherical (very rarely elongated) oogonia (22.8 to 30.6 μm diam.) and both plerotic and aplerotic golden brown oospores (21.3 to 28.5 μm diam.). In non-sterile soil extracts, the isolates produced abundant sporangia (31.5 to 57.2 × 21.3 to 38.4 μm; length:breadth ratio 1.2 to 1.6) borne terminally on unbranched or sympodial sporagiophores, occasionally attached laterally to the sporangiophores. Sporagia were non-caducous, semipapillate, mainly ovoid and obpyriform, obovoid to limoniform but sometimes distorted with two apices. On the basis of the morpho-physiological features, the isolates resembled P. plurivora (formerly identified as P. citricola) (3). To confirm this, genomic DNA was extracted and subjected to PCR. The internal transcribed spacer (ITS) region of the rDNA was amplified using the ITS-6 (5' GAAGGTGAAGTCGTAACAAGG 3') and ITS-4 (5' TCCTCCGCTTATTGATATGC 3') primers before sequencing (Secugen, Madrid, Spain). The sequences were deposited in the EMBL/GenBank database (Accession Nos. KF413074 and KF413075). In order to perform the pathogenicity test, 10 A. glutinosa seedlings (2 years old) per isolate were inoculated by using the under-bark inoculation technique (1) and 10 control seedlings were inoculated with V8A. Seedlings were incubated in a growth chamber at 22.5°C with a 14-h photoperiod. Three months after inoculation, all inoculated plants wilted and died, whereas the control plants showed no disease symptoms. To fulfill Koch's postulates, the pathogen was re-isolated from the necrotic lesions developed around inoculation points, thus confirming its pathogenicity. P. plurivora has been found to be present in rhizosphere soil beneath Alnus spp. and to cause aerial canker and collar rot on alder trees in Austria, Germany, and Romania (2,3). Further studies and surveys are essential to determine the distribution, extent of damage, and potential interactions with other alder pathogens (e.g., P. alni). To our knowledge, this is the first record of P. plurivora affecting A. glutinosa in Spain. References: (1) T. Jung et al. Eur. J. For. Pathol. 26:253, 1996. (2) T. Jung and M. Blaschke. Plant Pathol. 53:197, 2004. (3) T. Jung and T. I. Burgess. Persoonia 22:95, 2009. (4) A. Solla et al. Plant Pathol. 59:798, 2010.

Photocatalytic degradation of herbicide bentazone in aqueous suspension of TiO2: mineralization, identification of intermediates and reaction pathways

Semiconductor-mediated hydrogen peroxide-assisted photocatalytic degradation of a selected herbicide, Bentazone (1) has been investigated in aqueous suspensions of TiO2 under a variety of conditions. The degradation was studied by monitoring the depletion in total organic carbon content as a function of irradiation time. The degradation kinetics was investigated under different conditions such as type of TiO2 (Anatase/Anatase-Rutile mixture), reaction pH, catalyst dosage and hydrogen peroxide (H202) concentration. The degradation rates were found to be strongly influenced by all the above parameters. Titanium dioxide Degussa P25 was found to be more efficient as compared with other two commercially available TiO2 powders like Hombikat UV100 and PC500 from Millennium Inorganic Chemicals. Gas Chromatography-Mass Spectrometry (GC-MS) analysis of the irradiated mixture of Bentazone (1) indicates the formation of several intermediate products which have been characterized on the basis of molecular ion/mass fragmentation pattern and also on comparison with the National Institute of Standards and Technology (NIST) library. Plausible mechanism for the formation of different products during photocatalytic treatment of Bentazone in the presence of TiO2 has been proposed. The use of H202 substantially increased the efficiency of TiO2 photocatalytic degradation.

Effect Of Ga3 And Row Ratio On Floral Traits Of Component Lines Of BRRI Hybrid Dhan2

Component lines (A and R lines) of BRRI hybrid dhan2 were assessed under treatment of GA3 application and row ratio on days to 5% and 50% flowering, duration of opening of floret, angle of open floret, filament length, anther length, stigma length, panicle exsertion rate, stigma exsertion rate and outcrossing rate. The CMS line viz; BRRI 10A have been found to be usable female parents for hybrid rice seed production due to their stigma length, stigma exsertion rate, duration of blooming, anther length and filament length. The different between genotypic and phenotypic variation was not remarkable for most of the characters studied indicating negligible environmental influence on the traits. The maximum duration of opening of floret (158.10 min) and angle of floret opening (28.870) were obtained with the application of 350 g GA3 ha-1. The improvement in the floral traits with increased GA3 level might be due to increased availability of GA3 which enhanced floral traits. The CMS line can be used as potential female parent in hybrid rice seed production of BRRI hybrid dhan2. Bangladesh J. Agril. Res. 38(1): 155-163, March 2013 DOI: http://dx.doi.org/10.3329/bjar.v38i1.15202

Sphincter saving surgery is the standard procedure for treatment of low rectal cancer

Carcinoma rectum is a challenging problem both for the developed and underdeveloped countries. Colorectal cancer accounts for 9% of all cancer deaths (49,920) in 2009 in USA. Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. To observe the objective, subjective and functional outcome of the patients suffering from cancer of the lower third of the rectum managed by surgical intervention with preservation of sphincter. A comparative study was carried out on 54 patients with low rectal cancer who underwent ultra-low anterior resection in the department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2009 to December 2010. Patients were divided into two groups depending on the tumor distance from anal verge. Thirty one (57%) patients were in Group A (Experimental) where tumor distance was 5cm from anal verge and upper 1cm of anal sphincter was sacrificed during surgical intervention. Twenty three (43%) patients were in Group B (Control) where tumor distance was 6cm from anal verge and whole length (4cm) of anal sphincter was preserved during surgical intervention. Functional integrity of anal sphincter was assessed between these two groups of patients following surgery. The mean age of the patients was 45.96±14.41 years. During surgery, ultra low anterior resection was performed to remove the tumor in all patients and for anastomosis double stapling technique was performed in 52(96%) patients and hand sewn technique was performed in 2(4%) patients irrespective of tumor distance from anal verge. Covering ileostomy was fashioned in all but one patient. During post-operative follow up anal sphincter muscle tone, anal sphincter function (Anal continence, p = 0.54), Quality of life (Social life, p = 0.54; Professional life, p = 0.23; House work and Need a diaper, p = 0.54) were not significantly impaired in both groups. Functional outcome of anal sphincter muscle and quality of life was not impaired in comparison to general population after low rectal cancer surgery.

Metastatic squamous cell carcinoma of spleen: a case report

Metastatic squamous cell carcinoma of spleen is a very rare occurrence and a very small number of cases have been reported so far, mostly in autopsy series. More commonly observed metastasis to the spleen are from breast, lungs, colorectal organs and ovaries. Interestingly enough the spleen is very unusual site of metastasis from an esophageal malignancy, only very few cases (four cases up to 2005) being reported in the literature. A case of splenic metastasis from carcinoma of the esophagus in a 60 years old woman is presented in this report. Extraordinary merit of this case is that carcinoma of the esophagus was diagnosed after the patient had been operated for splenic abscess and was histologically diagnosed as metastatic squamous cell carcinoma of spleen. The patient underwent splenectomy and recovered well. Only during post operative period endoscopic examination of upper GIT with biopsy revealed carcinoma of the esophagus. Further investigations failed to delineate any other organ involvement. So, this case is being reported as metastatic squamous cell carcinoma of spleen from carcinoma of esophagus.

Melioidosis in an adult male

Infection with Burkholderia pseudomallei has been described, albeit rarely, patients in Bangladesh. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, which is present in soil and surface water in the endemic region. A 35-year-young male farmer presented with prolonged fever and significant weight loss. Patient gradually deteriorated despite getting different antibiotics including intravenous ceftriaxone and metronidazole. Panels of investigations were done which revealed no diagnostic confirmation except uncontrolled diabetes and multiple abscesses in different organs. Melioidosis was suspected and serum samples were positive for Burkholderia pseudomallei antibody. The case illustrates the importance of non-specific nature of the clinical presentation and high index of suspicion of uncommon diseases like melioidosis where the disease has not been considered as an endemic.

Pattern of mental illness on substance abusers

The aim of this study was to investigate mental illnesses among the substance abuse dependent populations. A total of 1076 substance abusers were recruited from the Outpatient Department of the Central Drug Addiction Treatment Center, Tejgaon, Dhaka from July 2008 to June 2009. They sought detoxification therapy voluntarily at this centre. The research participants were selected consecutively following the defined selection criteria. Research instruments were interviewer-administered questionnaire and standard mental state examination scales. Of the 1076 substance abusers, 82.6% had been using heroin currently and rest of them used phensedyl followed by injection drugs and cannabis with a period ranged 2-30 years. Results showed that 91.3% of the substance abusers had been suffering from insomnia and 75.0% had altered food habit. About 49.0% showed disturbed behaviors and 45.2% had been suffering from sexual dysfunctions. Around 32.0% of the substance abusers had been suffering from nonspecific generalized anxieties and 72.7% were found in abnormal mood/affects. A striking finding was that 7.3% of the substance abusers had been suffering from perceptual and/or thought disturbances. In conclusion, 7.3%-92.5% of the substance abusers had been suffering from mental illnesses. Insomnias, decreased intake of food and taste preference, irritable mood/affects, loss of interest in sex and non-specific anxieties were highly prevalent among them. Medical management and altering lifestyle are still the only applicable way to control this human catastrophe.

Evaluation of transurethral ethanol ablation of prostate for symptomatic benign prostatic hyperplasia

Evaluating short-term (03 months) efficacy and safety of transurethral intraprostatic injection of absolute ethanol to treat benign prostatic hyperplasia (BPH). This intervention study was conducted to evaluate 30 patients with benign prostatic hyperplasia treated by transurethral injection of dehydrated ethanol. Mean age was 69.96 years. Endoscopic injection of 6-13.5 ml ethanol was carried out at 4-8 sites in the prostate. International Prostate Symptom Score (IPSS), maximum flow rate, prostate volume, postvoid residual and side effects or complications were measured postoperatively. Mean IPSS (SD) improved significantly from 18.43 ± 2.38 preoperatively to 6.80 ± 1.34 at 03 months of follow-up, mean peak urinary flow rate increased from 7.33 ± 1.19 ml/s to 16.31 ± 1.69 ml/s after 3 months, mean residual urine volume had decreased from 54.16 ± 30.93 ml to 17.01 ± 9.59 ml after 3 months (p<0.05). The prostate volume decreased from 44.66 ± 9.52 gm preoperatively to 32.46 ± 7.78 gm after 3 months (statistically significant at 5% level). There were no intra-operative complications but post-operative haematuria occurred in two patients, urinary retention occurred in two patients after removal of the catheter. Urinary tract infection developed in one patient. Transurethral ethanol ablation of prostate appears to be safe and cost effective. No occurrence of retrograde ejaculation was detected. The short-term effects of ethanol injection at prostate were satisfactory and acceptable as a minimally invasive therapeutic modality in selected patients.

Lifestyle pattern in selected slums in Mymensingh Municipal area

Lifestyle is composed of cultural and behavioural patterns and lifelong personal habits that developed through processes of socialization. Lifestyle may be health promotive or detrimental to health. Health requires the promotion of healthy lifestyle. Many current day health problems are associated with lifestyle changes. Because of rising urban population, the number of slum dwellers is rising. The mobility of people from rural to urban areas is the main reason of the growing slum population in cities. This Descriptive, cross-sectional study was directed to assess lifestyle pattern in four purposively selected slums in Mymensingh Municipal area. Non-Probability purposive type of sampling technique was used for selecting the study unit. Sample size was one hundred and twenty-three (123) families. Data were collected by interview with one of the adult family members, preferably with the head of the family, with mixed type of interviewer administered questionnaire. There were 494 family members with an average family size of 4.02, while mean age was 24.58 years with a standard deviation (SD) of 17.79 years. Male-female ratio was 103:100. Of 409 members over 5 years, 174(42.54%) did not have schooling and were illiterate. At least 105(33.02%) members were house-wives, and 99(81.15%) members were smokers. An overwhelming majority (79, 64.23%) families had monthly income between 2000 to 4999 taka. As many as 55(44.72%) families lived in kaccha house, while 40(32.52%) had to live in "Jhupree". In cent per cent families, tube well was the source of water for drinking and other household purposes. A highest majority 121(98.37%) of the families had latrine, while the remaining 2(1.63%) did not have any latrine, and defecate in open air. Of 121 families, 78(64.46%) families had sanitary latrine, while 43(37.54%) did not have sanitary latrine. It was revealed that 86(69.92%) families had cell-phone, while 65(52.85%) families had television, 10(8.13%) families had radio, and 5(4.06%) families had DVD/VCR for recreational facilities. As many as 75(60.98%) respondents had correct knowledge, while the rest 48(39.02%) had incorrect knowledge on hand washing. Of 75, at least 66(88.00%) respondents practiced hand washing, while 9(12.00%) respondents did not practice it. As many as 110(89.43%) members sought medical help for major and minor illness of their family members, whereas the rest 13(10.57%) families did not. Of 110, 62(56.36%) families paid visit to government Hospital, while 22(20.00%) visited to private clinic, 12(10.90%) to pharmacy, 10(9.10%) to qualified doctors and 4(3.64%) to the traditional healers. As many as 58(52.71%) respondents mentioned that they preferred as the facilities cater service free of cost, while 32(29.10%) preferred for better and effective treatment, 16(14.55%) for close to their residence and 4(7.27%) for their belief. Living condition of slum dwellers is considerably low due to low income and inadequate education. Moreover, poor physical environment with unsanitary excreta disposal method is commonplace in slum areas. Existing lifestyle of slum dwellers is unacceptable, and should be improved so that they can contribute to the national development.

Different doses of atropine on heart rate fluctuations during reversal of neuromuscular blockade

It was a prospective comparative clinical study carried out in the Department of Anaesthesia, Combined Military Hospital (CMH), Dhaka, to evaluate the heart rate changes during reversal of neuromuscular blockade by using 3 different doses of atropine (in a mixture with neostigmine) and thereby detect comparatively safer dose. Sixty patients of ASA (American Society of Anesthesiologists) grade I and II physical status were divided equally into 3 groups. Neostigmine 0.05 mg/kg body weight mixed with atropine 0.02, 0.015 and 0.01 mg/kg body weight given intravenously in group A, B and C respectively during reversal. The 3 groups were compared in age, sex, body weight, and ASA grades, but there was no significant difference (p>0.05) between 3 groups. It is revealed that in Group C (atropine at a dose of 0.01 mg/kg with neostigmine), heart rate affected very little but salivary and tracheobronchial secretions were more. One of them had laryngospasm which was managed conservatively. In Group B (who received atropine 0.015 mg/kg) incidence of tachycardia observed was less than Group A (who received atropine 0.02 mg/kg). The patients of this group also had some salivary secretions but less than group C. Tachycardia was most marked in Group A but had minimum salivary secretions. Statistical analysis of heart rate changes in different times among the 3 Groups was significant (p<0.05). It was highly significant (p<0.01) in 1 minute after reversal. So relatively lower dose (0.015 mg/kg) of atropine with neostigmine than the conventional dose (0.02mg/kg) can be used to decrease tachycardia during reversal of neuromuscular blockade especially in haemodynamically unstable patients.

Penile agenesis in adult

Penile agenesis (PA) is an extremely rare congenital anomaly with profound surgical and psychosocial consequences. Only seventy five cases have been reported in the literature, the highest age of presentation known seven years. We present a twenty six years old otherwise normal aphallic male with attraction to female sex and night emission through anus. The patient did not agree to the female gender assignment and functioning phallic reconstruction is practically unavailable. Early female gender assignment and feminizing perineal reconstruction (Vaginoplasty) in neonatal cases is the technically easier goal of treatment. Late presenting cases add difficulty to debated decision making of gender assignment.

Iron chelation therapy and thalassemia - an overview

New developments in the epidemiology, treatment and prognosis of thalassemia have dramatically altered the approach to the care of affected patients. In the last 30 years, conventional treatment of β-thalassemia major, based primarily on regular blood transfusions and iron chelation therapy with desferrioxamine (DFO) has markedly improved the prognosis of the disease. Adequate administration of parenteral DFO reduces or prevents iron accumulation. The unavailability of DFO (dysferol) for most patients with thalassemia major and the failure of prescribed therapy to prevent complications in other patients have led to a search for alternative iron chelators; one of them, deferiprone (DFP) has been commercially available. Patients may ultimately benefit from having a choice between several chelators, including orally active drugs. Combination therapy and organ-targeted chelation, may soon have a considerable impact on the therapeutic outcome and quality of life of patients with thalassemia.

Primary tuberculosis of breast

Primary tuberculosis of breast is not uncommon in developing countries. Initial presentations may be confused with benign or malignant lesions of breast. Diagnosis in endemic areas is suggested on clinical consideration. FNAC and/or biopsy confirm the diagnosis. The adequate anti-tubercular chemotherapy is essential for sustained resolution of mammary tuberculosis. We have a case of primary tuberculosis of breast in a young female with complete follow up to be reported. We treated a 22-year-old married female patient who was admitted with an ulcerated lump over the right breast. Initially ultrasonographic scanning and FNAC from the lump suggested a breast abscess. She was treated surgically as breast abscess which failed to resolve in due course. Provisional diagnosis was breast abscess. Breast malignancy or granulomatous inflammation could not be excluded. On elective lumpectomy and subsequent histopathological examination of the lump could confirm the diagnosis of tuberculosis of breast. We failed to discover any tuberculous lesion over other sites of the body. The patient was treated postoperatively with anti-tubercular chemotherapy. On follow up after six months, she was reasonably healthy. Chemotherapy is continued for another two months. Follow up is being continued for next two years.

Wilms tumor in adult

Wilms Tumor (WT) is a very rare malignancy in adults representing 1% of all renal neoplasms. It is however the most common renal tumor of children and adult patients are treated like pediatric cases. Bilateral tumors occur in 5% of adult cases. The typical presenting features are asymptomatic abdominal mass (most common), hematuria, pain, fever, and hypertension. As clinical presentation of WT is similar to that of renal cell carcinoma (RCC), it tends to be an unsuspected pathological diagnosis in most cases. The diagnosis of the tumor needs positive sonographic and computed tomography (CT) findings with histopathological confirmation. Prognosis of adult WT is relatively poor and resistant to chemotherapy. We present a case of wilms tumor in a 68 years old male patient with right sided non tender abdominal mass and occasional flank pain. The patient was normotensive but hematuric and radiological findings suggested right renal mass with enlarged lymph node and histopathological analysis revealed nephroblastoma associated with lymph node metastases.

Photocatalytic degradation of disperse blue 1 using UV/TiO2/H2O2 process

The photocatalytic degradation of a dye derivative, C.I. disperse blue 1 (1), has been investigated under UV light irradiation in the presence of TiO2 and H2O2 under a variety of conditions. The degradation was studied by monitoring the change in substrate concentration employing UV spectroscopic technique as a function of irradiation time. The degradation was studied under different conditions such as different types of TiO2, reaction pH, catalyst and substrate concentration containing hydrogen peroxide (H2O2), besides molecular oxygen in the presence of TiO2. The degradation of dye was also investigated under sunlight and the efficiency of degradation was compared with that of the artificial light source. The degradation rates were found to be strongly influenced by all the above parameters. The photocatalyst Degussa P25 was found to be more efficient for the degradation of the dye.

Anesthesia for emergency cesarean section

Caesarean Section is one of the most common of all surgical procedures. Common indications for caesarean section may include foetal distress, Cephalopelvic disproportion and failure of labour to progress. Both regional and general anesthesia may be employed for caesarean section. Each is relatively safe and they have their own advantages and disadvantages. Actual decision to adopt one technique over another depends on maternal and foetal status and skill and ability of the anesthesiologist to tackle the situation with the aim of patient and baby safely. Among these, many of the cases come to the hospital as emergency basis. The Anesthesiologists have to face the challenge in providing anesthesia for emergency caesarean section, being the last member in the perinatal team. The challenge faces the risks in involvement of maternal changes in pregnancy, presence of foetal distress and various anesthetic complications arising in perioperative period. Still now anesthetic mishaps are considered as the sixth most frequent cause of maternal mortality. The use of regional Anesthesia reduced the number of deaths at about 80% but deaths involving general anesthesia has not decreased and the incidence is 17 times more than the regional anesthesia. Most of the deaths or complications are related to the airway management (also failed intubation). Better skill and knowledge in physiology, pharmacology and use of modern Anesthetic technique is essential to face the problems.

Epidemiological study of risk factors of stroke and its immediate consequence

The study was a cross sectional study conducted among 48 stroke patients in Medicine & Neuromedicine department of Mymensingh Medical College & Hospital. The objective of the study was to reveal the risk factors and other relevant information & immediate outcome of stroke patients. The sample size was 48 who were selected purposively and study area was selected for easy access. Study period was from 15th May 2007 to 15th July 2007. Forty eight (48) respondents and their reliable attendants were interviewed by pre tested structured questionnaire. Among 48 stroke patients 60% were male& 40% were female. Occupations of the patients were 21% desk job, 15% laborious work, 37% housewife, 6% businessman &21% in other profession. Age group of respondents were 13% below 45 years of age, 25% were 45-55 years of age, 29% were 55-65 years of age & 33% were over 65 years of age. Among 48 stroke patients 62.5% had 1st attack & others had multiple attacks. Among all the stroke patients 37.5% performed physical exercise. Forty six percent (46%) patients have family history of Hypertension. 27% have no family history of Hypertension & 27% have no idea. Sixty six percent (66%) patients have suffering from Hypertension, 23% have no history of Hypertension & 10% have no idea. Sixty percent (60%) patients had habit of Smoking, 40% had no habit of Smoking. 21% patients have family history of Diabetes, 48% have no family history of Diabetes & 31% have no idea about family history of Diabetes. Complications among stroke patients are 51% have Hemiplegia, 10% have Paraplegia, 23% have Paresis, 10% have Aphasia & 6% have others complications.

Photodegradation of norfloxacin in aqueous suspensions of titanium dioxide

The photocatalytic degradation of an antibiotic norfloxacin [1-ethyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinoline-carboxylic acid, 1], has been investigated in aqueous suspensions of titanium dioxide (TiO(2)) under a variety of conditions. The degradation was studied by monitoring the change in substrate concentration employing UV spectroscopic analysis technique and depletion in total organic carbon (TOC) content as a function of irradiation time. The degradation kinetics were investigated under different conditions such as different types of TiO(2), pH (ranging from 4 to 11), catalyst concentration (0.5-3gL(-1)), substrate concentration (0.15-0.5mM) and in the presence of electron acceptor such as hydrogen peroxide (H(2)O(2), 10mM) besides molecular oxygen. Semiconductor titanium dioxide (Degussa P25) was found to be more efficient as compared with other photocatalysts.

Heterogeneous photocatalyzed degradation of uracil and 5-bromouracil in aqueous suspensions of titanium dioxide

Photocatalyzed degradation of uracil (1) and 5-bromouracil (2) has been investigated in aqueous suspensions of titanium dioxide under a variety of conditions. The degradation was studied by monitoring the change in substrate concentration employing UV spectroscopic analysis technique and depletion in total organic carbon (TOC) content as a function of irradiation time. The degradation of the compounds under investigation was studied using various parameters such as, different types of TiO2 powders, pH, catalyst concentration, substrate concentrations, and in the presence of electron acceptors like hydrogen peroxide (H(2)O(2)) and potassium bromate (KBrO(3)) besides molecular oxygen. Photocatalyst Degussa P25 was found to be more efficient for the degradation of both compounds as compared with other TiO2 powders such as UV100, PC500 and TTP.

Heterogeneous photocatalysed degradation of 4-chlorophenoxyacetic acid in aqueous suspensions

The photocatalysed degradation of 4-chlorophenoxyacetic acid (4-CPA, 1) has been investigated in aqueous suspensions of titanium dioxide under a variety of conditions. The degradation was studied by monitoring the change in substrate concentration employing UV spectroscopic analysis technique and depletion in total organic carbon (TOC) content as a function of irradiation time. The influence of various parameters such as, different types of titanium dioxide (TiO2) powders, pH, catalyst and substrate concentrations, and in the presence of electron acceptor such as hydrogen peroxide (H(2)O(2)) besides molecular oxygen has been investigated. The effects of these parameters on the degradation rates were found to be significant. The volatile degradation product 4-chlorophenol was analyzed by GC-MS technique and probable pathways for the formation of product has been proposed.

Visible fluorescence chemosensor for saxitoxin

Absorption spectra of a number of shellfish extracts have been obtained and reveal prominent absorptions in all samples at 210 and 260 nm and at 325 nm in some of them. These absorptions preclude the use of chromophores with similar absorptions in testing of shellfish samples for paralytic shellfish toxins. Two crown ether chemosensors featuring a boron azadipyrrin chromophore have been synthesized; both have absorption maxima at 650 nm, where all the shellfish extracts are transparent. The synthetic sensors feature either 18- or 27-membered crown ether rings and have been evaluated as visible sensors for the paralytic shellfish toxin saxitoxin. The binding constant for one of them is in the range of 3-9x10(5) M-1 and exhibits a fluorescence enhancement of over 100% at 680 nm in the presence of 40 microM saxitoxin.

Contraceptive prevalence: experience from rural areas of Mymensingh

Contraceptive prevalence although increased over the last decade but has not yet achieved the desired level. The present descriptive type of cross-sectional study aimed at exploring the status of Contraceptive prevalence rate (CPR) along with relevant issues in two rural areas in Mymensingh. A total 223 respondent was interviewed. Majority respondents were females and young aged 36 years or below. Around a half of the respondents were illiterate while more than half was earning less than 3000 taka a month. Majority women were married earlier than the legal age of marriage with 15.92 years. Around two third (63%) respondents were found using any contraceptives while female partners' shyness and male partners' disliking were reported as reasons for non-use. Increase in female literacy and involvement of family planning worker in motivational programme at individual level could help in improving the situation.

Style of lecturing of medical teacher--an evaluation by medical students of Mymensingh Medical College

It was a cross sectional descriptive type of study carried out among the 3rd year, 4th year and 5th year medical students of Mymensingh Medical College (MMC) with the objective of finding out the various lecture style followed by medical teachers of MMC and other relevant information regarding teaching tools used related to lecturing. The sample size was 134 who were selected purposively. The study was conducted in the month of June 2004. One thirty four (134) respondents were interviewed by pre tested questionnaire. From the study it was revealed that majority (66%) of these respondents were male and 34% were female and 57%, 28.5% and 14.5% were 3rd, 4th and 5th year students respectively. A good number of students (82.5%) expressed their opinion that lecture time was sufficient for their learning. Among the medical teachers the lecture methods followed were VIG (81%) OP (54%) EP (47.2%) EL (25.5%) AT (23%). Eighty Seven percent of the students gave their opinion that the best style of lecture was EP. Seventy and half percent students disliked the AT style followed by OP, which was 85.5%. Seventy two percent of the students were not satisfied with the teaching aids used by the teachers. OHP (90%) was the most commonly used teaching material. Most of the respondents (97.5%) expressed their opinion that SGT was the most suitable way for imparting information.

Pregnancy outcome in adolescent and adult - a case comparison study

This study outlined the consequences of adolescent pregnancy with comparison to adults in Mymensingh Medical College Hospital, Mymensingh. It was a case-comparison study. The study population was the mothers who admitted and delivered at the Obstetrics and Gynaecology ward of hospital during April-June 2003. Sample size was 220 mothers, out of which 110 were primigravidae adolescent mothers and 110 were adults. The study finding showed that adolescents were 2.105 times and 3.679 times more at risk than adults to suffer from anaemia and UTI during pregnancy. Among adolescents 74(67.3%) and in adults 39(35.5%) had obstetric complications during pregnancy and the adolescents were 3.742 times more at risk than the adults. PET and Eclampsia were more common in adolescent than adult mothers. 86(78.2%) adolescents and 36(32.7%) adult mothers had complications before delivery. Pre term labour, Premature rupture of membrane (PROM) and Intra-uterine foetal death (IUD) were more common in adolescents than adult mothers. Stillbirths were more in adolescent mothers 23(20.9%) and adults 11(10.0%). There was more low birth weight (LBW) newborns in adolescents 42(38.2%) than adults 18(16.4%). As a result the adolescents were 3.157 times more likely to give birth to low birth weight babies . The newborns of the adolescent mothers were nearly 2 times more at risk to develop asphyxia neonatorum (p< 0.030, odds ratio=1.806).

Attitude of the parents seeking service from the paediatricians

The overuse of antibiotics and other medicines have been standing a dangerous proposition and researchers are coming in fore front analyzing and assessing the aftermath of years of misperceptions and inappropriate usage of drugs prescribed by the pediatricians. Two hundred and two parents from the community as well as from the outpatient department of medical college hospitals were interviewed, to study their attitude while seeking for the health service for their children. Data were collected through a face-to-face interview using a structured questionnaire. One hundred and ninety nine (82.7%) of the parents interviewed were mothers and only 3 (1.5%) were fathers. One hundred and sixty-seven (82.7%) parents were from the urban population and the rest 35 (17.3%) were from rural areas. The mothers mean stay in the educational institution was 11.8 years and that of the father's was 13.1 years. About 34.7% parents had to seek for doctor's advice at least once or twice a month and around 43% had to visit doctor's clinic. Most (66.8%) of the parents were from the family earning tk.6000 to tk.20000 a month, 19.8% and 13.4 % were from the families earning below tk.6000 and above tk.20000 respectively. A vast majority of the parents expressed their preference for advice to medicines. Among the medicines they like antibiotics more than vitamins. Majority of the parents showed their interest to spend more time and to have less medicine. For anorexic children parents preferred advice to medicines. An overwhelming majority (98%) of the parents was interested to get advice and ORS for diarrhea. For ARI also a larger number (56.1%) of parents opted for advice only and no medicine at all but 37.1% kept their option for both. A large majority of the parents were preferring more frequent visit and having fewer medicines than the conditions of more medicines with less frequented visits.