Initial Six Month's Study of Neonatal Covid-19 in a Tertiary Care Hospital of Bangladesh

The pandemic Covid-19 affects mainly adult causing fatal illness specially who have co-morbidities. But as days pass by with increasing surveillances it's gradually obvious that this devastating disease also affects the children as well as neonates with greater number. The aim of study was to determine the Covid-19 in neonates. So, we can give proper emphasis on neonatal Covid-19. This cross-sectional study was conducted from April 2020 to September 2020 at Dhaka Shishu (Children) Hospital in Bangladesh. Neonates with suspected Covid-19 were tested for SARS-CoV-2 by RT- PCR. Newborn who had suspected or confirmed COVID-19 mother, exposed to relatives infected with Covid-19, related with cluster outbreak or with abnormal clinical courses such as respiratory distress, not responded to conventional treatment and also abnormal chest x-ray was selected for Covid-19 test. Data regarding gestational age, birth weight, gender, positive cases and other findings were collected and analyzed. Statistics analysis was done by SPSS version 26.0. Forty three cases were Covid-19 positive. Among them 28(65.1%) cases were male and 15(34.9%) female. Term was 39(90.6%) cases and preterm 4(9.4%). Twenty nine (67.5%) cases were belonged to medicine and 14(32.6%) surgical cases. Fourteen (32.5%) cases with Covid-19 lived in Dhaka and 29(67.5%) cases in outside of Dhaka. Eleven (25.5%) cases were positive for SARS -CoV-2 by RT- PCR within 3 days, among them 5 (11.6%) cases were within 24 hours of age. Nine (20.9%) and 23(53.5%) cases were test positive at day 4-7 and 8-28 days respectively. The main symptoms at admission were respiratory difficulty (12/43, 27.9%), fever (8/43, 18.6%), convulsion (8/43, 18.6%) and reluctance to feed (7/43, 16.6%). In neonate two or more diseases coexist in same cases. Sepsis was present in 20 (46.5%) cases with COVID-19. Perinatal asphyxia was present in 10(23.3%) and pneumonia in 8 (18.6%) cases. In laboratory findings low Hb% was present in 2/43(4.7%) cases, leukopenia in 4/43(9.3%), leukocytosis in 2/43(4.7%) and thrombocytopenia in 5/43(11.6%). Elevated CRP was present in 14/29 (32.6%) cases, hypernatremia in 10/33 (30.3%), hyponatremia in 1/33(3%), increased serum creatinine in 10/18(55.6%), and prolonged PT, aPTT in 2/2(100%). Hyperglycaemia was found in 1/15(6.7%) cases and hypoglycaemia in 2/15(13.3%). No organism was found in blood C/S. In chest X-ray, one showed patchy opacities in right lower lobe, another showed bilateral ground-glass opacity and third one revealed few patchy opacities in the right perihilar region. Among 43 cases 21(48.9%) were discharged with advice, 12(27.9%) cases referred to Covid-19 designated hospital, 2(4.7%) cases LAMA (Leave against medical advice) and 8(18.6%) cases died including one surgical case. A good number (43) of Covid-19 cases were found in this study. In neonates the clinical features could not be differentiated properly between Covid-19 or associated diseases unlike children and adult. The neonate may be a source of transmission of this disease. So, we should give proper emphasis on test, tracing and management of neonatal Covid-19.

Increased iron utilization and oxidative stress tolerance in a Vibrio cholerae flrA mutant confers resistance to amoeba predation

IMPORTANCE

Persistence of V. cholerae in the aquatic environment contributes to the fatal diarrheal disease cholera, which remains a global health burden. In the environment, bacteria face predation pressure by heterotrophic protists such as the free-living amoeba A. castellanii. This study explores how a mutant of V. cholerae adapts to acquire essential nutrients and survive predation. Here, we observed that up-regulation of iron acquisition genes and genes regulating resistance to oxidative stress enhances pathogen fitness. Our data show that V. cholerae can defend predation to overcome nutrient limitation and oxidative stress, resulting in an enhanced survival inside the protozoan hosts.

Protozoan predation as a driver of diversity and virulence in bacterial biofilms

Protozoa are eukaryotic organisms that play a crucial role in nutrient cycling and maintaining balance in the food web. Predation, symbiosis and parasitism are three types of interactions between protozoa and bacteria. However, not all bacterial species are equally susceptible to protozoan predation as many are capable of defending against predation in numerous ways and may even establish either a symbiotic or parasitic life-style. Biofilm formation is one such mechanism by which bacteria can survive predation. Structural and chemical components of biofilms enhance resistance to predation compared to their planktonic counterparts. Predation on biofilms gives rise to phenotypic and genetic heterogeneity in prey that leads to trade-offs in virulence in other eukaryotes. Recent advances, using molecular and genomics techniques, allow us to generate new information about the interactions of protozoa and biofilms of prey bacteria. This review presents the current state of the field on impacts of protozoan predation on biofilms. We provide an overview of newly gathered insights into (i) molecular mechanisms of predation resistance in biofilms, (ii) phenotypic and genetic diversification of prey bacteria, and (iii) evolution of virulence as a consequence of protozoan predation on biofilms.

Physical, Psychological and Social Impact of COVID-19 Pandemic on Healthcare Workers at a COVID Designated Bangladeshi Public Hospital

The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are directly involved in the diagnosis, treatment and care of patients with COVID-19, are taking significant personal risks on their own health and those of their family members. Objectives of the study include establishing the physical, psychological and social impact experience by the healthcare workers serving in public hospitals of Bangladesh. This prospective cross-sectional observational study was carried out at Kuwait Bangladesh Friendship Government Hospital, the first Covid-19 designated hospital of Bangladesh between the 1st June and the 31st August, 2020. A total of 294 doctors, nurses, ward boys and ailed healthcare workers were included in this study via purposive sampling. The study found statistically significant (p value 0.024) difference of medical co-morbidities between Covid-19 positive and Covid-19 negative groups of health care professionals. Significant association was found between duration of work and presence during aerosol generating procedure with COVID infectivity of the study subjects. 72.8% respondents experienced public fear of contracting the virus from them and 69.0% noticed negative attitude of the society towards them. Eighty five percent (85.0%) did not get any community support during this pandemic crisis. The health care professionals engaged in COVID-19 treatment have been taking significant personal risk on their life in terms of physical, psychological and social perspective. Providing safeguard to the health care workers are integral components of public health measures for addressing the COVID-19 pandemic. Special interventions to promote their physical wellbeing and arrangement of adequate psychological training need to be immediately implemented to cope up this critical situation.

Characterization of Shigella flexneri Serotype 6 Strains Isolated from Bangladesh and Identification of a New Phylogenetic Cluster

A significant cause of shigellosis in Bangladesh and other developing countries is Shigella flexneri serotype 6. This serotype has been subtyped, on the basis of the absence or presence of a group-specific antigen, E1037, into S. flexneri 6a and 6b, respectively. Here, we provided rationales for the subclassification, using several phenotypic and molecular tools. A set of S. flexneri 6a and 6b strains isolated between 1997 and 2015 were characterized by analyzing their biochemical properties, plasmid profiles, virulence markers, pulsed-field gel electrophoresis (PFGE) results, and ribotype. Additionally, the genomic relatedness of these subserotypes was investigated with global isolates of serotype 6 using publicly available genomes. Both subserotypes of S. flexneri 6 agglutinated with monoclonal antiserum against S. flexneri (MASF) B and type VI-specific antiserum (MASF VI) and were PCR positive for O-antigen flippase-specific genes and virulence markers (ipaH, ial, sen, and sigA). Unlike S. flexneri 6a strains, S. flexneri 6b strains seroagglutinated with anti-E1037 antibodies, MASF IV-I. Notably, these two antigenically distinct subserotypes were clonally diverse, showing two distinct PFGE patterns following the digestion of chromosomal DNA with either XbaI or IceuI. In addition, hybridization of a 16S rRNA gene probe with HindIII-digested genomic DNA yielded two distinguishing ribotypes. Genomic comparison of S. flexneri subserotype 6a and 6b strains from Bangladesh indicated that, although these strains were in genomic synteny, the majority of them formed a unique phylogroup (PG-4) that was missing for the global isolates. This study supports the subserotyping and emphasizes the need for global monitoring of the S. flexneri subserotypes 6a and 6b. IMPORTANCE Shigella flexneri serotype 6 is one of the predominant serotypes among shigellosis cases in Bangladesh. Characterization of a novel subserotype of S. flexneri 6 (VI:E1037), agglutinated with type 6-specific antibody and anti-E1037, indicates a unique evolutionary ancestry. PFGE genotyping supports the finding that these two antigenically distinct subserotypes are clonally diverse. A phylogenetic study based on single-nucleotide polymorphism (SNP) data revealed that these two subserotypes were in genomic synteny, although their genomes were reduced. Interestingly, a majority of the S. flexneri 6 strains isolated from Bangladesh form a novel phylogenetic cluster. Therefore, this report underpins the global monitoring and tracking of the novel subserotype.

Effect of telephone-monitored home-based cardiac rehabilitation exercise on functional capacity and quality of life in heart failure patients in a lower-middle-income country

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic heart failure (CHF) prevails as one of the major cardiovascular diseases in lower-middle-income countries (LMICs) like Bangladesh. Home-Based Cardiac Rehabilitation (HBCR) is a cost-effective method of secondary prevention of chronic heart failure which, if provided, might not only improve the health status of the patients but might also reduce the financial and hospitalization burden on the health care system of these countries. The study aims to assess the scope and benefits of HBCR in such low resource settings.

Purpose

The study evaluates the effect of telephone-monitored HBCR exercise programme in improving the functional capacity and quality of life (QoL) in patients of CHF with reduced ejection fraction due to ischemic heart disease (IHD).

Method

This self-controlled interventional study was conducted from August 2019 to July 2020 at a heart failure clinic, a tertiary healthcare centre in Bangladesh. A total of 115 patients of CHF with ejection fraction <40% and in NYHA class II and III were included in the study according to selection criteria. The functional capacity of the patients was evaluated by NYHA classification and 6-minute walk test. The quality of life of the patients was evaluated by Minnesota Living with Heart Failure Questionnaire (MLHFQ). All patients were advised to perform HBCR exercise as per recommended guideline and were telephone-monitored 2-weekly. After the 3-months study period, the participants were divided into compliant and partial compliant groups based on their adherence to the guideline. Repeat evaluation of patients' condition was carried out. Results were then compared within the groups and data was analyzed through appropriate statistical methods.

Results

Significant improvement of NYHA class (p<0.05), and 6-minute walk test distance (6MWTD) (1102.01±215.90 feet vs 1243.30±217.86 feet; p<0.001) were noticed after the rehabilitation programme. Improvement of total MLHFQ score was also observed (35.53±14 vs 28.22±12.84; p<0.001) at 3-months follow up. The functional capacity and quality of life of the patients in both the compliant and partially compliant groups showed significant improvement after the rehabilitation programme (p<0.001); though no difference was found in the indicators when compared between compliant vs partially compliant groups after rehabilitation except for 6MWTD (1302.86±219.61 feet vs 1230.71±212.284 feet, p<0.001).

Conclusion

From the results, it can be concluded that any amount of routine exercise tends to improve quality of life and symptoms in patients of chronic heart failure with reduced ejection fraction. However, to achieve the best effect in functional capacity and overall health status, the addition of a structured exercise programme like HBCR can be beneficial for proper rehabilitation in low resource settings. Further validation of the results is recommended through randomized control trials in larger study groups.

Adaptation to an amoeba host drives selection of virulence-associated traits in Vibrio cholerae

Predation by heterotrophic protists drives the emergence of adaptive traits in bacteria, and often these traits lead to altered interactions with hosts and persistence in the environment. Here we studied adaptation of the cholera pathogen, Vibrio cholerae during long-term co-incubation with the protist host, Acanthamoeba castellanii. We determined phenotypic and genotypic changes associated with long-term intra-amoebal host adaptation and how this impacts pathogen survival and fitness. We showed that adaptation to the amoeba host leads to temporal changes in multiple phenotypic traits in V. cholerae that facilitate increased survival and competitive fitness in amoeba. Genome sequencing and mutational analysis revealed that these altered lifestyles were linked to non-synonymous mutations in conserved regions of the flagellar transcriptional regulator, flrA. Additionally, the mutations resulted in enhanced colonisation in zebrafish, establishing a link between adaptation of V. cholerae to amoeba predation and enhanced environmental persistence. Our results show that pressure imposed by amoeba on V. cholerae selects for flrA mutations that serves as a key driver for adaptation. Importantly, this study provides evidence that adaptive traits that evolve in pathogens in response to environmental predatory pressure impact the colonisation of eukaryotic organisms by these pathogens.

Isolation of the Au145(SR)60X compound (R = n-butyl, n-pentyl; X = Br, Cl): novel gold nanoclusters that exhibit properties subtly distinct from the ubiquitous icosahedral Au144(SR)60 compound

We report the identification and quantitative isolation of Au₁₄₅(SR)₆₀X (R = n-butyl, n-pentyl; X = halide) along with elucidation of key properties as compared to the corresponding ubiquitous chiral-icosahedral Au₁₄₄(SR)₆₀ cluster known to have a central vacancy. The stoichiometries were assessed by electrospray mass spectrometry (ESI-MS) at isotopic resolution, and induced dissociation patterns indicate the 'extra' (Au,Br) atoms are strongly bound components of these structures. Voltammetric and spectroscopic characterization reveals Au₁₄₅(SR)₆₀X behaviors that are qualitatively similar to yet fascinatingly distinct from those of Au₁₄₄(SR)₆₀. (¹H,¹³C)-NMR spectra clearly show how both Au₁₄₅(SR)₆₀X and Au₁₄₄(SR)₆₀ are capped by 12 distinct ligand types of 5-fold equivalence, as was recently established for Au₁₄₄(SR)₆₀ capped by shorter ligands, demonstrating that this novel cluster shares the same chiral-icosahedral motif. Intriguingly, Au₁₄₅(SR)₆₀X is strongly near-IR luminescent, whereas under comparable conditions Au₁₄₄(SR)₆₀ barely emits. The photoluminescence pattern of Au₁₄₅(SR)₆₀X is very similar to that observed for Au₂₅(SR)₁₈, which contains the Au₁₃ core. The combined results are interpreted as consistent with neutral Au₁₄₅(SR)₆₀X as a diamagnetic species, electronically and structurally similar to the corresponding Au₁₄₄(SR)₆₀ compounds.

Environmental prevalence of toxigenic Vibrio cholerae O1 in Bangladesh coincides with V. cholerae non-O1 non-O139 genetic variants which overproduce autoinducer-2

Prevalence of toxigenic Vibrio cholerae O1 in aquatic reservoirs in Bangladesh apparently increases coinciding with the occurrence of seasonal cholera epidemics. In between epidemics, these bacteria persist in water mostly as dormant cells, known as viable but non-culturable cells (VBNC), or conditionally viable environmental cells (CVEC), that fail to grow in routine culture. CVEC resuscitate to active cells when enriched in culture medium supplemented with quorum sensing autoinducers CAI-1 or AI-2 which are signal molecules that regulate gene expression dependent on cell density. V. cholerae O1 mutant strains with inactivated cqsS gene encoding the CAI-1 receptor has been shown to overproduce AI-2 that enhance CVEC resuscitation in water samples. Since V. cholerae non-O1 non-O139 (non-cholera-vibrios) are abundant in aquatic ecosystems, we identified and characterized naturally occurring variant strains of V. cholerae non-O1 non-O139 which overproduce AI-2, and monitored their co-occurrence with V. cholerae O1 in water samples. The nucleotide sequence and predicted protein products of the cqsS gene carried by AI-2 overproducing variant strains showed divergence from that of typical V. cholerae O1 or non-O1 strains, and their culture supernatants enhanced resuscitation of CVEC in water samples. Furthermore, prevalence of V. cholerae O1 in the aquatic environment was found to coincide with an increase in AI-2 overproducing non-O1 non-O139 strains. These results suggest a possible role of non-cholera vibrios in the environmental biology of the cholera pathogen, in which non-O1 non-O139 variant strains overproducing AI-2 presumably contribute in resuscitation of the latent pathogen, leading to seasonal cholera epidemics. Importance. Toxigenic Vibrio cholerae which causes seasonal epidemics of cholera persists in aquatic reservoirs in endemic areas. The bacteria mostly exist in a dormant state during inter-epidemic periods, but periodically resuscitate to the active form. The resuscitation is enhanced by signal molecules called autoinducers (AIs). Toxigenic V. cholerae can be recovered from water samples that normally test negative for the organism in conventional culture, by supplementing the culture medium with exogenous AIs. V. cholerae belonging to the non-O1 non-O139 serogroups which do not cause cholera are also abundant in natural waters, and they are capable of producing AIs. In this study we characterized V. cholerae non-O1 non-O139 variant strains which overproduce an autoinducer called AI-2, and found that the abundance of the cholera pathogen in aquatic reservoirs correlates with an increase in the AI-2 overproducing strains. Our results suggest a probable role of these variant strains in the environmental biology and epidemiology of toxigenic V. cholerae, and may lead to novel means for surveillance, prevention and control of cholera.

Association of Low Serum Free Testosterone with Carotid Atherosclerosis in Male

The cross sectional descriptive type of observational study was aimed to evaluate the association of serum free testosterone in 59 patients of carotid atherosclerotic male {<50% stenosis (n=26); >50% stenosis (n=33) } from March 2015 to February 2016 in the Department of Radiology & Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU) & National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Twenty seven patients who had normal carotid doppler findings were taken as control. Serum total testosterone and sex hormone binding globulin was measured by chemiluminescence micro particle immunoassay and free testosterone was done by using Vermeulen formula. Concentration of free testosterone differed significantly among groups (p=0.004) and it was significantly lower in <50% stenosed group. Logistic regression analysis revealed that low free testosterone (free testosterone ≤0.24 nmol/L) was independently associated with development of carotid atherosclerosis (p=0.04, OR 3.07, 95% CI 1.14-9.30). In conclusion low serum free testosterone was associated with carotid atherosclerosis in male.

The Impact of Protozoan Predation on the Pathogenicity of Vibrio cholerae

In the aquatic environment, Vibrio spp. interact with many living organisms that can serve as a replication niche, including heterotrophic protists, or protozoa. Protozoa engulf bacteria and package them into phagosomes where the cells are exposed to low pH, antimicrobial peptides, reactive oxygen/nitrogen species, proteolytic enzymes, and low concentrations of essential metal ions such as iron. However, some bacteria can resist these digestive processes. For example, Vibrio cholerae and Vibrio harveyi can resist intracellular digestion. In order to survive intracellularly, bacteria have acquired and/or developed specific factors that help them to resist the unfavorable conditions encountered inside of the phagosomes. Many of these intra-phagosomal factors used to kill and digest bacteria are highly conserved between eukaryotic cells and thus are also expressed by the innate immune system in the gastrointestinal tract as the first line of defense against bacterial pathogens. Since pathogenic bacteria have been shown to be hypervirulent after they have passed through protozoa, the resistance to digestion by protist hosts in their natural environment plays a key role in enhancing the infectious potential of pathogenic Vibrio spp. This review will investigate the current knowledge in interactions of bacteria with protozoa and human host to better understand the mechanisms used by both protozoa and human hosts to kill bacteria and the bacterial response to them.

Comparison of High Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh, Bangladesh

Pregnancy is accompanied by changes in the maternal lipoprotein metabolism that may serve to satisfy the nutritional demands of the fetus in addition to the energy requirements of the mother. Early pregnancy is considered the anabolic phase, characterized by increased hepatic production of triglycerides and enhanced removal of triglycerides from the circulation, resulting in an increased deposition of fat in maternal adipose tissue. Late pregnancy is referred to as the catabolic phase, the release of free fatty acids from adipocytes is enhanced due to both relative insulin resistance and stimulation of hormones. Although it is known that cholesterol rises in pregnancy, at present it is not routinely measured or treated. However, a growing body of evidence from animal and human studies suggests adverse consequences of high cholesterol levels in pregnancy. High lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh from July 2011 to December 2012 to compare the changes in high density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hours. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has been found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum High Density Lipoprotein (HDL) cholesterol increases in second trimester (48.71±7.61mg/dl) than third trimester (47.01±7.45mg/dl) of Pregnancy. So, Lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

Detection of Retinopathy of Prematurity (ROP) in very Low Birth Weight Babies and Outcome of Management

The purpose of the present study was to early detection and management of retinopathy of prematurity (ROP). This observational descriptive/ interventional study was carried out to evaluate 96 babies brought by their parents to BIRDEM General Hospital during the period of January 2016 to June 2016 who fulfilled the inclusion and exclusion criteria. Screening of ROP was performed in all 96 babies after taking informed written consent. After screening of ROP, the babies who had ROP, staging was done and treatment was given as per requirement. Descriptive data in the study were shown by cross table and compared by student paired 't' test and Chi-square test. The study included total 96 babies of preterm low birth weight. Among them 64(66.66%) babies had no ROP, where 32(33.33%) babies had different stages of ROP. In these 32 babies, 18 babies didn't need any treatment, only 14 babies needed treatment according to their requirement (14 babies had 28 eyes, where 16 eyes needed Inj. Anti VEGF and laser and 11 eyes needed only laser and one eye had Stage V ROP, so observed that eye). Early detection of ROP and proper management not only restore the anatomical and functional outcome of the retina, but also restore the vision, prevent childhood blindness and decrease morbidity.

Vibrio cholerae strains with inactivated cqsS gene overproduce autoinducer-2 which enhances resuscitation of dormant environmental V. cholerae

BACKGROUND

Toxigenic Vibrio cholerae resides in aquatic reservoirs of cholera-endemic areas mostly in a dormant form known as conditionally viable environmental cells (CVEC) in which the bacteria remain embedded in an exopolysaccharide matrix, and fail to grow in routine bacteriological culture. The CVEC can be resuscitated by supplementing culture media with either of two autoinducers CAI-1 and AI-2, which are signal molecules controlling quorum sensing, a regulatory network of bacterial gene expression dependent on cell density. This study investigated possible existence of variant strains that overproduce AIs, sufficient to resuscitate CVEC in environmental waters.

METHODS

Environmental V. cholerae isolates and Tn insertion mutants of a V. cholerae strain C6706 were screened for production of AIs using bioluminescent reporter strains. Relevant mutations in environmental strains which overproduced AI-2 were characterized by nucleotide sequencing and genetic complementation studies. Effect of AIs produced in culture supernatants of relevant strains on reactivation of CVEC in water was determined by resuscitation assays.

RESULTS

Two of 54 environmental V. cholerae isolates were found to overproduce AI-2. Screening of a Tn-insertion library of V. cholerae strain C6706, identified a mutant which overproduced AI-2, and carried Tn insertion in the cqsS gene. Nucleotide sequencing also revealed mutations inactivating the cqsS gene in environmental isolates which overproduced AI-2, and this property was reversed when complemented with a wild type cqsS gene. Culture of river water samples supplemented with spent medium of these mutants resuscitated dormant V. cholerae cells in water.

SIGNIFICANCE

V. cholerae strains with inactivated cqsS gene may offer a convenient source of AI-2 in enhanced assays for monitoring bacteriological quality of water. The results also suggest a potential role of naturally occurring cqsS mutants in the environmental biology of V. cholerae. Furthermore, similar phenomenon may have relevance in the ecology of other waterborne bacterial pathogens beyond V. cholerae.

New Evidence of the Bidentate Binding Mode in 3-MBA Protected Gold Clusters: Analysis of Aqueous 13-18 kDa Gold-Thiolate Clusters by HPLC-ESI-MS Reveals Special Compositions Aun(3-MBA)p, (n = 48-67, p = 26-30)

Gold clusters protected by 3-MBA ligands (MBA = mercaptobenzoic acid, -SPhCO2H) have attracted recent interest due to their unusual structures and their advantageous ligand-exchange and bioconjugation properties. Azubel et al. first determined the core structure of an Au68-complex, which was estimated to have 32 ligands (3-MBA groups). To explain the exceptional structure-composition and reaction properties of this complex, and its larger homologs, Tero et al. proposed a "dynamic stabilization" via carboxyl O-H--Au interactions. Herein, we report the first results of an integrated liquid chromatography/mass spectrometer (LC/MS) analysis of unfractionated samples of gold/3-MBA clusters, spanning a narrow size range 13.4 to 18.1 kDa. Using high-throughput procedures adapted from bio-macromolecule analyses, we show that integrated capillary high performance liquid chromatography electrospray ionization mass spectrometer (HPLC-ESI-MS), based on aqueous-methanol mobile phases and ion-pairing reverse-phase chromatography, can separate several major components from the nanoclusters mixture that may be difficult to resolve by standard native gel electrophoresis due to their similar size and charge. For each component, one obtains a well-resolved mass spectrum, nearly free of adducts or signs of fragmentation. A consistent set of molecular mass determinations is calculated from detected charge-states tunable from 3- (or lower), to 2+ (or higher). One thus arrives at a series of new compositions (n, p) specific to the Au/3-MBA system. The smallest major component is assigned to the previously unknown (48, 26); the largest one is evidently (67, 30), vs. the anticipated (68, 32). Various explanations for this discrepancy are considered. A prospective is given for the various members of this novel series, along with a summary of the advantages and present limitations of the micro-scale integrated LC/MS approach in characterizing such metallic-core macro-molecules, and their derivatives.

Toward Smaller Aqueous-Phase Plasmonic Gold Nanoparticles: High-Stability Thiolate-Protected ∼4.5 nm Cores

Most applications of aqueous plasmonic gold nanoparticles benefit from control of the core size and shape, control of the nature of the ligand shell, and a simple and widely applicable preparation method. Surface functionalization of such nanoparticles is readily achievable but is restricted to water-soluble ligands. Here we have obtained highly monodisperse and stable smaller aqueous gold nanoparticles (core diameter ∼4.5 nm), prepared from citrate-tannate precursors via ligand exchange with each of three distinct thiolates: 11-mercaptoundecanoic acid, α-R-lipoic acid, and para-mercaptobenzoic acid. These are characterized by UV-vis spectroscopy for plasmonic properties; Fourier transform infrared (FTIR) spectroscopy for ligand-exchange confirmation; X-ray diffractometry for structural analysis; and high-resolution transmission electron microscopy for structure and size determination. Chemical reduction induces a blueshift, maximally +0.02 eV, in the localized surface plasmon resonance band; this is interpreted as an electronic (-) charging of the monolayer-protected cluster (MPC) gold core, corresponding to a -0.5 V change in electrochemical potential.

Base Side of Noble Metal Clusters: Efficient Route to Captamino-Gold, Au n(-S(CH2)2N(CH3)2) p, n = 25-144

Monolayer-protected clusters (MPCs), typified by the (Au, Ag)-thiolates, share dimensions and masses with aqueous globular proteins (enzymes), yet efficient bioanalytical methods have not proved applicable to MPC analytics. Here we demonstrate that direct facile ESI(+)MS analysis of MPCs succeeds, at the few-picomol level, for aqueous basic amino-terminated thiolates. Specifically, captamino-gold clusters, Au _n(SR) _p, wherein -R = -(CH₂)₂N(CH₃)₂, are prepared quantitatively via a direct one-phase (aq/EtOH) method and are sprayed under weakly acidic conditions to yield intact 6.8 kDa complexes, ( n, p) = (25, 18), with up to 5 H+ adducts, or 34.6 kDa MPCs (144, 60) at charge state z = 8+. These exceed all prior reports of positive charging of MPCs except for those bearing per-cationized (quat) ligands. pH-mediated reversible phase transfer (aqueous to/from DCM-rich phases) are consistent with peripheral exposure of all tertiary amino groups to solutions. This surprising development opens the way to all manner of modifications or extensions, as well as to advanced analyses inspired by those applied to intact biomolecules.

Isolation of a 300 kDa, Au∼1400 Gold Compound, the Standard 3.6 nm Capstone to a Series of Plasmonic Nanocrystals Protected by Aliphatic-like Thiolates

Disclosed herein is a method to obtain the ∼300 kDa gold-hexanethiolate compound, extracted from the Faradaurate series of smaller (3) and larger (1) homologues, thereby permitting the first measurement of its distinctive properties by methods including mass spectrometry, optical spectroscopy, electron microscopy, X-ray scattering, and diffraction. The results suggest a monocrystalline metallic core (free of twinning planes) of ∼3.1 nm minimum dimension, which supports a clear plasmonic optical response, along with a diffuse exterior shell. An idealized model to account for this (and smaller) members of the series is proposed based on the completion of a convex core of regular truncated-octahedral (TO) morphology, that is, the TO (5,5) crystallite comprising 1289 sites. The diffuse layer may comprise the 240 S sites (thiolate sulfur headgroups) and 96 Au-adatom sites, giving a total composition (1385,240) and a molar mass of ∼301.0 kDa (90.7% Au). The ∼300 and ∼400 kDa gold compounds contain Au_∼1400 and Au_∼2000 atoms, respectively.

Outcome of Surgery in Chronic Inactive Mucosal Otitis Media

Chronic otitis media is a common condition seen in patients attending the otorhinolaryngology Department. The discharging ear presents the otologists with the dilemma of operating on it or not. The aim of the this cross-sectional observational study was to find out the outcome of surgery in chronic inactive mucosal otitis media and was conducted on 62 patients of either sex in the age group of 15-60 years in the Department of ENT and Head Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh From July 2015 to January 2016. Pre and post operative hearing assessment was done with pure tone audiometry (PTA). Post operative graft status also noted. All the information's were recorded in the fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19. Among 62 cases the mean age were 36.79±10.33 in chronic inactive mucosal otitis media. Majority of the study population were in age group of between 15-25 in this group of which was 16(51.6%). Male were 36(58.06) and 26(41.94) were female. All patients presented with history of otorrhoea in this group, 52(83.87%) had hearing impairment in chronic inactive mucosal otitis media, 30(48.39%) involved in right ear and 26(41.94%) involved in left ear and 06(9.68%) in both ear in chronic inactive mucosal otitis media. Majority of perforation were medium in size in this group of which was 30(48.39%). anterior perforation was 24(38.71%), posterior perforation 28(45.16%) and subtotal 10(16.13%) in chronic inactive mucosal otitis media. Sixty two (100%) cases underwent myringoplasty. Post-auricular approach used in most of operation in this group of which was 60(96.77%). Preoperative air conduction threshold 32(51.61%) were in between 31-45 dB in myringoplasty group (p<0.05) that was statistically significant. Postoperative air conduction threshold 30(48.39%) were between 16-30 dB in myringoplasty group (p<0.05) that was statistically significant. Difference between preoperative and postoperative air conduction threshold mean difference was 11.38 dB and 36.75±5.84 and 25.37±7.46 respectively (p<0.001) in myringoplasty group. Hearing gain was 42(67.74%) in myringoplasty (p>0.05) that was not statistically significant. Graft uptake in myringoplasty was 52(83.9%). Graft failure in myringoplasty was 10(16.1%). post operative complication was tinnitus in 12(19.35%) cases in myringoplasty. Success rate was more in case of posterior perforation than anterior and subtotal perforation in both chronic inactive mucosal otitis media which was 92.86%. Success rate was more in case of medium size perforation than subtotal perforation in chronic inactive mucosal otitis media which was 86.67%. Success rate was (100%) in small perforation in this group. From this study it can be concluded that myringoplasty is a valid treatment modality for chronic inactive mucosal otitis media to achieve an intact tympanic membrane and to gain hearing.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Obesity phenotypes and their adipocyte dysfunction among the attendants at outpatient department

<p>The present study was aimed to find out the frequency of obesity phenotypes and to correlate adipocyte dysfunction with different obesity phenotypes. A total of 1,507 apparently healthy adults attending the outpatient department were grouped into three based on body mass index which were then further categorized into six groups according to metabolically unhealthy or healthy phenotypes by the presence or absence of metabolic syndrome. Of them, metabolically obese normal weight, overweight, healthy obese and unhealthy obese groups were included as obesity phenotypes. Then by purposive sampling, leptin and adiponectin concentration of 184 subjects with different phenotypes were measured to find out the adipocyte dysfunction. Metabolically obese overweight followed by metabolically unhealthy obese were more prevalent i,e.,  24.9% and 19.5%. All obesity phenotypes except metabolically obese normal weight were significantly documented with adipocyte dysfunction (p&lt;0.05).</p>

Effect of administration of vitamin E, selenium and antimicrobial therapy on incidence of mastitis, productive and reproductive performances in dairy cows

Administration of vitamin, mineral and antimicrobials at the end of lactation plays potential role in preventing mastitis in dairy cows. A total of 255 cows dividing into five groups (A = 50, B = 50, C = 50, D = 50 and E = 55) at their late gestation period were selected to explore the effect of vitamin E, selenium and antimicrobial therapy on mastitis incidence, their productive and reproductive performances. Each cow of group A received α-tocopherol + sodium selenite orally daily for last 30 days before calving, while each cow of group B, C and D was treated with α-tocopherol + sodium selenite intramuscular injection, procaine penicillin + neomycin sulfate, and dicloxacillin sodium intramammary infusions at Day 30-20 before calving, respectively. Group E cows served as untreated control. California mastitis test (CMT) revealed that 70.0%, 76.0%, 84.0% and 100.0% cows in group A, B, C and D, respectively were free from new intramammary infections (IMIs) during early lactation period. The bacteriological results showed highest IMIs rates (76.3%) in group E and lowest IMIs (2.0%) in group D (P < 0.05). Staphylococcus aureus and Escherichia coli were the most predominant udder pathogens in all groups except group D (only CNS). The mean IMIs incidence (20.5%) was significantly lower in treated cows (P < 0.001). The treated cows had higher cure rates (81.9%) than control cows (23.1%) and overall efficacy of treatments on cure rates was 71.8% for all mastitis pathogens (P < 0.0001). The productive and reproductive performances of the treated cows at postpartum and early lactation period remained always higher than their non-treated counterparts (P < 0.001). A number of cow and herd related factors were identified to be significantly associated with mastitis (P < 0.001). The results concluded that antimicrobial therapy had more beneficial effect in preventing mastitis over vitamin-mineral administration and intramammary infusion with dicloxacillin sodium remained as the best effective preventive strategies for mastitis in dairy cows.

Quorum Regulated Resistance of Vibrio cholerae against Environmental Bacteriophages

Predation by bacteriophages can significantly influence the population structure of bacterial communities. Vibrio cholerae the causative agent of cholera epidemics interacts with numerous phages in the aquatic ecosystem, and in the intestine of cholera patients. Seasonal epidemics of cholera reportedly collapse due to predation of the pathogen by phages. However, it is not clear how sufficient number of the bacteria survive to seed the environment in the subsequent epidemic season. We found that bacterial cell density-dependent gene expression termed "quorum sensing" which is regulated by signal molecules called autoinducers (AIs) can protect V. cholerae against predatory phages. V. cholerae mutant strains carrying inactivated AI synthase genes were significantly more susceptible to multiple phages compared to the parent bacteria. Likewise when mixed cultures of phage and bacteria were supplemented with exogenous autoinducers CAI-1 or AI-2 produced by recombinant strains carrying cloned AI synthase genes, increased survival of V. cholerae and a decrease in phage titer was observed. Mutational analyses suggested that the observed effects of autoinducers are mediated in part through the quorum sensing-dependent production of haemaglutinin protease, and partly through downregulation of phage receptors. These results have implication in developing strategies for phage mediated control of cholera.

Evaluation of Iron Store by Serum Ferritin in Healthy Blood Donors of Bangladesh

Iron stores in the body exist primarily in the form of ferritin. Small amounts of ferritin secreted into the plasma and plasma ferritin is positively correlated with the size of the total body iron stores. The present study conducted to determine the iron status using the serum ferritin level among healthy Bangladeshi blood donors. The present cross sectional study was conducted in the Department of Transfusion Medicine, Dhaka Medical College, Dhaka, Bangladesh from July 2011 to June 2012. Blood donor signed informed consent and has satisfactory pre-donation health assessment and satisfactory post-donation blood test results were included in the study. Full blood counts were performed within 4 hours of collection using an automated haematology analyzer. Serum ferritin was measured using a validated enzyme immunoassay. Data were analyzed using SPSS version 16 (SPPS Incorporation, Chicago, IL, USA). P value <0.05 was considered as statistically significant. Total 100 blood donors were included in the study, among them 88 were male and 12 were female. Mean±SD of the age of the respondents was 26.8±5.9 years with a range of 19 to 45 years. Mean±SD of heamoglobin level (gm/dl) and total count of Red Blood Cell (million/cmm) were 14.1±1.4 and 5.1±0.4 respectively. Mean±SD of serum ferritin level (ng/ml) was 96.4±69.0ng/ml with a range of 4.1ng/ml to 298.7ng/ml. Among the respondents 9.0% had depleted iron store, 7.0 reduced iron store and 84.0% had normal iron store. Among the respondents 5.0% had iron deficiency anaemia in term of serum ferritin level. Statistically significant difference of serum ferritin level observed between male and female and donors with and without history of previous blood donation. Among the healthy blood donors of Bangladesh abnormal serum ferritin is highly prevalent among blood donors specially among female. Monitoring of iron stores by serum ferritin seems justified in order to identify those with depleted iron stores who will benefit from iron supplementation.

Relationship between Serum Iron Profile and Blood Groups among the Voluntary Blood Donors of Bangladesh

Blood donation results in a substantial iron loss and subsequent mobilization from body stores. Chronic iron deficiency is a well-recognized complication of regular blood donation. The present study conducted to compare the level of serum ferritin, serum iron, total iron binding capacity (TIBC) and percentage transferrin saturation in different ABO and Rhesus type blood groups among the voluntary blood donors of Bangladesh. The present prospective study included 100 healthy voluntary donors attending at Department of Blood Transfusion, Dhaka Medical College, Dhaka between the periods of July 2013 to Jun 2014. From each donor 10mL venous blood sample was taken and divided into heparinized and non-heparinized tubes for determination of hemoglobin (Hb), hematocrit (Hct), serum iron (SI), total iron binding capacity (TIBC) and serum ferritin by standard laboratory methods. Percentage of transferrin saturation (TS) calculated from serum iron and TIBC. Data were analyzed with SPSS (version 16) software and comparisons between groups were made using student's t-test and one way ANOVA. In the present study mean±SD of age of the respondents was 27.2±6.5 years with a range of 18 to 49 years and 81.0% were male and 19.0% were female. Among the donors 18.0% had blood group A, 35.0% had blood group B, 14.0% had blood group AB and 33.0% had blood group O. Among the donors 91.0% had rhesus positive and 9.0% had rhesus negative. Donors with blood group O had lowest haemoglobin, serum iron and transferring saturation levels. Donors with blood group A had highest TIBC level. Donors with blood group B had lowest serum ferritin level. An independent samples 't' test showed statistically significant difference in serum ferritin and percentage transferrin saturation between blood group AB and blood group O and in percentage transferrin saturation between blood group B and blood group O. One way ANOVA showed that there is no significant difference in haemoglobin, serum iron, serum ferritin and percentage transferring saturation in different ABO and Rh blood grouping categories. Blood donors with blood group O had lowest haemoglobin, serum iron and transferring saturation levels and donors with blood group A had highest TIBC level. Blood donors with blood group B had lowest serum ferritin level. The understanding of the different blood groups ability to retain iron in their system can give an insight into their ability to handle the disease iron deficiency anaemia.

Investigation of Effluent Quality from an Effluent Treatment Plant of a Textile Industry, Fakir Knitwear Ltd. Narayangonj, Bangladesh

Textile industries are the major contributor to environmental pollution and health hazards by generating huge amount of effluents that contain several pollutants and coloring agents. The concentration of these pollutants can be reduced to the permissible limit with the help of an Effluent Treatment Plant (ETP). The study was conducted to observe the textile effluent management techniques of an Effluent Treatment Plant (ETP) of Fakir Knitwear Limited (FKL), Narayanganj, Bangladesh. FKL set up a biological treatment plant to treat the effluent generated by the industry. Different effluent quality parameters were investigated at different stages in ETP. The effluent of the outlet was dark colored probably because of soluble coloring materials of the effluent but it is comparatively better than that of raw wastewater. There were found higher EC values than the standards which indicated that the greater amount of salts in the water due to dumping of solid wastes and discharging of industrial effluents. The highest TDS value 2054 ppm was observed at the screening pit unit than the other parts of the ETP. The highest DO was found 4.58 ppm in clarification tank which was within the standard value of aquaculture. The study also showed that the lowest BOD (24 ppm) and COD (145 ppm) was found at the outlet which was comparatively better than others. Although the effluent from the outlet contained pollutants, these effluent quality was comparatively good than the untreated waste water discharged from the industry. After treatment, the effluent of outlet moderately ensures the standard quality for aquaculture and irrigation. The results suggested that it is obvious to run the ETP regularly to improve the quality of effluents to save our native environment from the harmful effects of wastewater.J. Environ. Sci. & Natural Resources, 8(2): 25-31 2015

Prevalence and Risk Factors of Iron Deficiency Anaemia in Children admitted in a Tertiary Care Hospital of Bangladesh

Introduction: Anaemia is a common problem in childhood. In Bangladesh, overall 68% of children aged 6-59 months are anaemic. Anaemia impairs normal growth and development, decreases physical exercise tolerance and intellectual performance in children. The objective of this study was to find out the prevalence and risk factors for iron deficiency anaemia in hospitalized children aged 6 to 36 months.Materials and Methods: Eligible children admitted in Dhaka Shishu (Children’s) Hospital due to any acute illness, were enrolled from 1st June 2010 to 30th August 2010. Anaemia (Hb <11gm/dl) was classified as microcytic, normocytic or macrocytic. Peripheral blood film, serum ferritin, haemoglobin electrophoresis, serum C-reactive protein and stool microscopy were done. Risk factors were looked for in cases of iron deficiency anaemia.Results: Among 331 enrolled children, 201 (61%) had anaemia, among them 63 (31%) had iron deficiency anaemia. Lower the socioeconomic status, higher was the rate of anaemia. Prematurity and low birth weight was significantly associated with anaemia. Poor feeding practices including colostrum rejection, non-exclusive breastfeeding, early/late weaning and inappropriate weaning diet were important risk factors. Gender was not found as a risk factor.Conclusion: A large proportion of hospitalized children under three years of age were found anaemic, among them iron deficiency anaemia was most common. The study result emphasizes the importance of identifying the risk factors of anaemia in this age group. Raising awareness of the problem and providing health and nutrition education will be the key interventions to prevent and control this huge public health problem in Bangladesh.J Nepal Paediatr Soc 2015;35(1):38-43

Prediction of Risk Factors of Frequent Relapse Idiopathic Nephrotic Syndrome

This case control study was aimed to identify the predictive risk factors for frequent relapse idiopathic nephrotic syndrome (INS) and conducted in Sir Salimullah Medical College & Mitford Hospital, Dhaka and at Renal and Dialysis Unit of Dhaka Shishu Hospital and Bangladesh Institute of Child Health (BICH), Dhaka, from January 2006 to December 2006. We examined retrospectively the clinical course of fifty cases of frequent relapse nephrotic syndrome (FRNS) as cases and fifty cases of infrequent relapse nephrotic syndrome (IRNS) as control who met the predefined enrollment criteria, followed for at least one year after initial onset of disease. After enrollment following parameters were studied as predictors of frequent relapse: i) Socio-demographic variables: age, sex, socio-economic condition, number of living room ii) Disease related variables i.e. age of onset, duration of illness, frequency of relapse within the 1st year, regimen of initial steroid therapy, total cumulative dose of steroid for remission, day of remission after starting steroid, association with atopy and infection, concomitant upper respiratory illness iii) Biochemical and pathological variables (at the time of initial attack) i.e. Serum albumin, serum cholesterol, blood urea, 24 hours urinary protein, serum creatinine, complete blood count, urine RBC, urine pus cell, urine culture. The test statistics used to analyses the data were descriptive statistics, Chi-square probability test, Student's t-test and Binary logistic regression analysis for Odds ratio. Both univariate and multivariate logistic regression analysis revealed that age of onset (P<0.001, OR=0.9, 95% CI=0.85-0.95), poor socioeconomic status (P<0.034, OR=0.5.8, 95% CI=1.14-29.5) and low serum albumin level at the time of initial presentation (P<0.022, OR=0.8, 95% CI=0.65-0.97) were independent predictors of frequent relapse nephrotic syndrome. In conclusion, we demonstrated that age at onset, poor socioeconomic condition and low serum albumin level at the time of initial attack is independent risk factors for frequent relapse idiopathic nephrotic children. This information can be used as a predictor of FRNS.

Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.

Traumatic gut injury: a study of 100 cases in Mymensingh Medical College Hospital

This study was done to find out the mode of presentations, management options and the factors which dictate the out-come of the patients with traumatic gut injury. It has been carried out in the department of Surgery, Mymensingh Medical College Hospital in 100 patients with traumatic gut injury from January 2009 to December 2010. Most of the patients were within 21-30 years (47%) and male patients were the predominant group (90%). In this study penetrating injury was more common (57%) than non-penetrating (43%) injury as a cause of gut injury. Stab (64.91%) was the main mechanism of penetrating abdominal trauma; while road traffic (58.14%) was the main mechanism of non-penetrating abdominal trauma. Diagnosis was made on clinical presentation, physical examination and some investigations. Abdominal pain (98%) was the chief complain and chief sign was abdominal tenderness (98%) and absent bowel sound (91%). Small gut injury was present in 71% patients, 20% patients had large gut injury and 9% had both gut injury. In small gut, jejunum (49.29%) was the most vulnerable portion and right sided colon (55%) was the most affected portion in large gut trauma. Spectrum of injury in small gut included single perforation (63%), multiple perforations (23%), laceration (11%) and devascularization (3%) injury. Primary repair in 60.87%, resection & anastomosis in 27.54% and resection anastomosis with proximal diversion in 11.59% patients were done in small gut injury. Injuries in the large gut were classified into three categories according to Flint Colon Injury Severity Scoring. Highest incidence was in Grade I (60%) category, second in Grade II (35%) and Grade III (5%) was the third one. Simple primary repair in 40%, primary repair or resection anastomosis with proximal diversion in 30%, loop ileostomy in 20% and Hartman's procedure in 10% were done in patients of large gut injury. Resection anastomosis with proximal diversion was performed in patients of both small and large gut injury. Outcome of management was quiet acceptable with 47% of patients having uneventful recovery. Delayed presentation, delayed definitive management, haemodynamically unstable patient, site and number of injuries in the gut were the crucial factor for the overall 44% morbidities of this series. Morbidity rate was 9%. More than half of the patients (56.04%) discharged from the hospital within 10 days. Only a few patients could be followed up for a few months after surgery, who reported to have a satisfactory outcome with no morbidity.

Sexual and urinary outcome after surgical treatment for low rectal cancer

Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. This study was designed to observe the sexual and urinary dysfunction in both sexes 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. The mean±SD 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 Sexual activity in both groups of male patients (Potency, P=0.17; ejaculation; satisfaction and loss of libido, P=0.15) and in female patients (Satisfaction and loss of libido, P=0.15) was not significantly hampered following surgery. Urinary function was assessed by incontinence, increased frequency (P=0.54) and retention (n=0) which were not impaired significantly following surgery. Sexual and urinary function was not significantly impaired in both sexes after low rectal cancer surgery. Sphincter saving surgery can be performed in a very low rectal cancer with preservation of anal sphincter.

Effect of short-term recombinant human erythropoietin therapy in the prevention of anemia of prematurity in very low birth weight neonates

Premature infants especially those with birth weight < 1500 g suffer from Anaemia of prematurity (AOP) and associated problems. Erythropoietin therapy is a safe effective way to prevent and to treat anaemia of prematurity. To evaluate the effect of short-term administration of recombinant human erythropoietin (rHuEPO) with iron and folic acid in very low birth weight (VLBW) neonates in the prevention of anaemia of prematurity. A randomized controlled trial was carried out at Dhaka Shishu Hospital. Sixty preterm very low birth weight (PTVLBW) babies were enrolled in this study. Thirty were assigned to rHuEPO group and 30 as control. Baseline haematologic values were estimated before administration of rHuEPO. From day 7 of life rHuEPO-200 IU/kg/dose subcutaneously every alternate day for 2 weeks was administered to rHuEPO group. All infants in both groups have received oral iron, folic acid from day 14. Clinical and haematological assessment was done at 6 and 10 weeks of life. Baseline clinical characteristics and haematologic values were almost similar in both groups. This study has shown increase in haematological values (haemoglobin and haematocrit) and reduction in the number of blood transfusions during both the 1st and 2nd follow up in rHuEPO group in comparison to control group (p < 0.01). Short-term rHuEPO appears to be very effective in prevention of Anaemia of prematurity.

Fasciolopsiasis in a five year old girl

A 5 year old girl hailing from Keraniganj, presented with the complaints of fever, periumbilical pain and vomiting. In vomitus, Fasciolopsis buski worm in adult form was identified by naked eye examination. In stool, ova of Fasciolopsis buski were also observed under microscope. Clinically she was pale and had hepatomegaly. Microcytic hypochromic anaemia with normal liver function test was found on lab investigation. She was diagnosed as a case of Fasciolopsiasis and treated with Praziquantel and on follow up visit she was found to be free of symptom.

Seroprevalence of TORCH antibody in pregnant women

DOI: http://dx.doi.org/10.3329/jafmc.v8i1.13537 JAFMC Vol.8(1) 2012 pp.35-39

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

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

Physicochemical and Functional Properties of Brown Rice (Oryza sativa) and Wheat (Triticum aestivum) Flour and Quality of Composite Biscuit Made Thereof

The consumer demand is increasing for composite flour based bakery products like biscuits. The incorporation of brown rice flour can be justified in composite flour based biscuits as it has beneficial nutraceutical properties and its gluten-free nature can play important role in preventing celiac problem. The physicochemical and functional properties of brown rice and wheat flour were studied and biscuits were prepared with the incorporation of brown rice flour in 0, 5, 10, 15 and 20 % with the wheat flour to assess the quality and acceptability of the biscuits. The water absorption capacity of brown rice flour was lower than that of wheat flour (p?0.05), whereas oil absorption and foaming capacity of brown rice flour were significantly higher than that of wheat flour (p ?0.05). The brown rice flour had higher least gelation concentration (30.66%) as compared with wheat flour (20.33%). As the concentration of brown rice flour was increased, spread ratio of biscuits decreased. The biscuits containing 5, 10 and 15% brown rice flour indicated that addition of increasing level of brown rice flour had higher ash, fat, moisture and crude fiber contents, while protein and total carbohydrate contents found lower in the biscuits. Statistical analysis of biscuits containing various amount of brown rice flour (0, 5, 10, 15 and 20% brown rice flour) showed that control biscuits (0% brown rice flour) secured the highest score for color, flavor, texture and overall acceptability, which is followed by biscuits containing 10, 5,15 and 20% brown rice flour. DOI: http://dx.doi.org/10.3329/agric.v10i2.13135 The Agriculturists 2012; 10(2) 20-28

Pathogenicity of SspI-positive infectious bursal disease virus and molecular characterization of the VP2 hypervariable region

The pathogenicity of four isolates of infectious bursal disease virus (IBDV) that have restriction fragment length polymorphism patterns of very virulent IBDV (vvIBDV), based on the presence of SspI and TaqI sites in the VP2 hypervariable region, was studied in specific pathogen free chickens. Chickens inoculated with isolates 92/04, 94/B551 and 97/61 developed severe clinical signs with a high mortality ranging from 70 to 80%, whereas the 94/273 isolate caused 10% mortality. Regardless of the isolates, significant differences were noted in the bursal lesion scores and bursa:body weight ratio index in the infected groups in comparison with the control groups. However, the presence of lesions in non-bursal tissues, muscles, thymus and at the junction of the proventriculus and gizzard were found only in the 92/04, 97/61 and 94/B551 isolates. Restriction fragment length polymorphism and sequence analysis of the VP2 hypervariable region indicated that all the isolates can be classified as vvIBDV based on the presence of SspI and TaqI sites at nucleotide positions 1011 and 833, respectively. In addition, all the isolates had amino acid substitutions at P222A, V256I and L294I, which are characteristic for vvIBDV isolated from different parts of the world. All the isolates except 94/273 also had a StyI site at nucleotide position 888. The absence of a StyI site in this isolate was associated with amino acid substitution at 254 from G to S. The 94/273 also had an amino acid substitution at position 270 from A to E, which is variable in the STC, Cu1 and OH strains. The presence of amino acid substitutions from G254S andA270E in SspI- and TaqI-positive vvIBDV strains is very uncommon and has not been reported previously. These amino acid variations might have caused the 94/273 to become less virulent in specific pathogen free chickens and resemble a classical virulent IBDV strain.

Cardiovascular complications of chronic renal failure - an updated review

Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

Experience of early breast milk feeding in preterm very low birth weight infants

Although human milk is generally accepted as the gold standard for the feeding of term infants, its use in the preterm and very low birth weight (VLBW) infants particularly in the initial period of birth has been more controversial. Little is known about the risks and benefits of early introduction of breast feeding on preterm VLBW infants. The primary object of this study was to evaluate the safety and benefit of early breast milk feeding in preterm VLBW newborns during their initial hospitalization periods. Therefore a prospective observational study was conducted among 37 preterm VLBW infants who were admitted to the Neonatal ward of Sir Salimullah Medical College and Mitford Hospital during the period of February 15th to July 25th, 2003. Oral feeding with breast milk was started within one hour of birth, and weight gain, feeding tolerance, nosocomial infection rate as well as other associated problems of pre-maturity, and postnatal growth curve were recorded upto 16th postnatal day. Seventy three percent of the newborns tolerate breast milk well from the very beginning, and the rest did not tolerate initially but all of them tolerate within 24 hours of birth. Infants had less initial weight loss (20 ± 10 gm) and faster recovery of birth weight. They regained their birth weight at 12th postnatal day. Hyper-bilirubinaemia was found in only 22% cases, and was observed in the group who initially didn't tolerate breast milk and was on intravenous fluid. Nobody developed symptomatic hypoglycemia or necrotizing enterocolitis (NEC). Two cases of sepsis and another two cases of minor infection like conjunctivitis and oral thrush have occurred. In conclusion it can be said that early breast milk feeding is safe in preterm VLBW infants and it helps to promote growth and reduce the need for intravenous line.

Breastfeeding and cognitive development of children: assessment at one year of age

Breastfeeding is the fundamental component of child survival strategy. It significantly influences neurological development of children. The study was conducted to assess whether exclusive and prolonged breastfeeding improves children's cognitive development, including low birth weight (LBW) babies, in a developing country setting like Bangladesh. This observational study was done on a cohort of newborn infants who were discharged from the special care baby unit of Dhaka Shishu Hospital during January 2006 to December 2008 with proper counseling about exclusive and prolonged breastfeeding. Their neuro-developmental follow-up was started at 4 weeks postnatal age and continued at 3-monthly intervals up to 1 year of age. At each visit, cognitive development was assessed using the Bayley Scales of Infant Development (BSID II). Cognitive development was compared between the babies of exclusive vs. non exclusive breastfeeding, normal weight vs. low birth weight and male vs. female babies. A total of 105 cases were successfully followed-up during this period. Out of these 47(44.8%) babies were exclusively breastfed up to 6 month of age and 58(55.2%) were in nonexclusive group. Overall Psychomotor Development Index (PDI) was slightly more (108.40 ± 23.06 vs. 103.23 ± 19.87) in the exclusive breast fed babies in comparison to nonexclusive breast fed babies, but was significantly more in babies having birth weight >2.5 kg in comparison to those having birth weight of <2.5 kg. Other parameters of cognitive development were more or less same in both normal and LBW groups. Mental and motor development was same in both boys and girls. In behavior ratings, cooperation was significantly high (5.89 ± 2.54 vs. 4.71 ± 3.13, p=0.05) and vocalization (5.89 ± 1.07 vs. 4.58 ± 1.16) was also high, though not significant, in girls than boys.

Clinicopathological stages of carcinoma breast patient

Carcinoma of breast is the second most common cancer among women next to uterine cervical cancer in Bangladesh. It was well established that 5 years survival rates greatly vary among the different stages of carcinoma of breast disease. The study was carried out to see the stages of presentation of carcinoma of breast patient to a tertiary level hospital attended first time for medical help as well as to find out the factors responsible for the late (advanced) stage presentation. This descriptive type of cross sectional study was carried out in the department of surgery, Mymensingh Medical College and Hospital (MMCH) during the period of May 2010 to April 2011. A total of 110 cases admitted with carcinoma breast diagnosed by means of FNAC positive or suspicious findings were selected purposively during the study period. Patients were staged initially according to the TNM staging system by through clinical examination as well as final clinicopathological stages were done after histopathological examination of the resected specimen (breast with or without axillary lymphnode) in resectable cases. Among the advanced stage presentation, attempts were made to find out the factors responsible for advanced stage of the disease. The results showed that carcinoma of breast predominantly a disease of female and comparatively younger age group 40-49 years affected mostly in 40.9% cases with a mean age of 44.02 ± 10.32 years. Premenopausal lady mostly affected in 63.6% cases. Majority of patients presented in advanced stage of the disease in 62.8% cases. Multiple factors were observed responsible for the advanced stage of the disease - among them delay in hospital presentation, poor socioeconomic condition and illiteracy have found to be associated which were statistically significant (p<0.001). It was needed for mass awareness program against the breast cancer in our society. Necessary steps should be taken for the initiation of breast self examination (BSE) to patients and clinical breast examination (CBE) to health care providers.

Morbidities of preterm VLBW neonates and the bacteriological profile of sepsis cases

Background: Preterm very low birth weight babies are at increased risk of perinatal, neonatal and postnatal mortality and morbidity, mainly due to infections and complications of prematurity. Mortality of VLBW neonates is 30 times more than that of normal weight. Outcomes of such infants have been reported extensively from developed countries, but less is known from developing countries like Bangladesh though prematurity is very common.Objective: To determine the morbidities associated with preterm VLBW neonates with particular emphasis on sepsis. Methods: A prospective cohort study was done in Special Care Baby Unit of a tertiary care teaching hospital from July 2009 to December 2009. Preterm VLBW neonates admitted within 7 days of age comprised the cohort for the study. Detailed physical findings and information on pregnancy, delivery and immediate postnatal period were recorded on enrolment. Sepsis workup was done whenever sepsis was suspected clinically. Daily follow-up was given till discharge/death and relevant clinical findings recorded. Data were analyzed using SPSS 12.    Results: A total of 738 neonates were admitted during study period, 92 were preterm VLBW and enrolled in the cohort. Fifty-two (56.5%) of the enrolled cases were male and 40 (43.5%) female, male female ratio of 1.3:1. Mean gestational age was 30.8±2.4 weeks and mean birth weight 1,320±133 grams. Eight cases (8.7%) had features of septicaemia on admission and 49 (53.2%) neonates subsequently developed nosocomial infections. Other morbidities were jaundice (34.8%), RDS (8.7%), NEC (4.3%), TTN (3.3%), IVH (2.2%) and PDA (1.1%). Blood culture was positive in 29.8% among 57 suspected sepsis cases; Acinetobacter (41.2%) was the most common organism, followed by Klebsiella pneumoniae (23.5%), Escherichia coli (23.5%) and Pseudomonas sp. (11.8%). Sixty (62.5%) preterm VLBW neonates were improved and discharged, 3 (3.3%) cases were discharged on risk bond and 29 (31.5%) died.Conclusions: Preterm VLBW neonates are at increased risk of morbidity and mortality. Septicemia is the most common and devastating morbidity, most infections are hospital acquired. Therefore strict protocol for asepsis in neonatal units must be adhered to when handling these high risk infants. Key words: Preterm; very low birth weight; septicaemia; morbidity; mortalityDOI: http://dx.doi.org/10.3329/pulse.v4i1.6955Pulse Vol.4 January 2010 p.5-9

Update of pathogen reduction technology for therapeutic plasma

In the developed world, blood products are tested for the presence of some of pathogens prior to administration. There exists a small, but definite risk of transmission of infectious agents. The risk of transmission of viral infection is due to the "window period": the period of time between the infection of a donor and the development of detectable level of antibodies. Nucleic acid amplification testing (NAT) was introduced for HIV and HCV in the United States in 1998 and has shortened the window period and further decreased the incidence of pathogens in transfused units of blood products. The development of increasingly sensitive laboratory screening methods and restrictive donor criteria has greatly decreased the risk of transmission of many pathogens through blood transfusion; however, transfusion is still not risk free. Blood is currently not tested for many potentially dangerous known pathogens. The emergence of new agents such as West Nile Virus (WNV) demonstrates that potential threats to the blood supply continue to emerge world wide. The testing and donor rejection methods currently used to screen the blood supply may not offer complete protection against all of these emerging infectious agents. This overview aims to provide an update on the continual improvements in blood component safety in particular using methods that target pathogen's nucleic acid.

Swine flu: a new emerging disease

Swine flu is an important zoonotic disease that has been recognized as an important global health problem by any one of several types of swine influenza virus or swine-origin influenza virus. Due to its increasing incidence in many countries of the world and occurrence of several large outbreaks in present year, it is a burning issue nowadays. It is thought to be a mutation--more specifically, a reassortment of four known strains of influenza A virus subtype H1N1. Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza, often resulting only in the production of antibodies in the blood. Due to variability of clinical features and limited availability of laboratory facilities, the disease remains largely under-reported. Early and specific diagnosis is important to ensure a favourable outcome. In this paper we attempted to explore history, classification, transmission, sign symptoms, diagnosis and prevention of swine flu as a critical review to provide some new upgrade regarding this devastating pandemic disease.

Role of homocysteine in cerebrovascular disease

Cerebrovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide and places a huge burden on the health care system. The most common forms of CVD are ischemic cerebrovascular disease (ICVD) and hemorrhagic cerebrovascular disease (HCVD). Since, the treatment, prognosis and rehabilitation of CVD is frustrating, prevention of CVD by properly addressing its modifiable risk factors might be the spearhead to combat the burden. There are several established risk factors associated with CVD, but a newer modifiable risk factor, hyperhomocysteinemia has created a new window for limiting the occurrence of CVD. Homocysteine is potentially vasculotoxic because of its association with endothelial dysfunction and impairment of fibrinolytic system. A total of 248 subjects were included in this case control study. Among them 104 were diagnosed CVD cases (ICVD-59, HCVD- 45) and 144 were age and sex matched healthy controls. Serum total homocysteine was measured in all the study subjects. Mean total homocysteine was found 12.95+/-6.20 micromol/L, 15.55+/-7.35 micromol/L in controls and cases respectively and 15.70+/-7.82 micromol/L, 15.34+/-6.78 micromol/L in ICVD and HCVD respectively. Homocysteine found to be significantly raised in CVD cases compared to controls but sub groups of CVD (ICVD & HCVD) did not differ between themselves with respect to serum homocysteine.

Study of oral itraconazole and terbinafine pulse therapy in onychomycosis

In this open, randomized and comparative study, the safety and efficacy of systemic intermittent itraconazole and terbinafine was examined in 30 patients with onychomycosis. The patient with positive mycological culture and also the patients with positive microscopy and negative culture were investigated. Patients were randomly assigned: 15 patients in each group received either 200mg itraconazole or 250 mg terbinafine twice daily during the first week of a 4 weeks cycle. The treatment duration was 16 weeks and was followed-up for 36 weeks. Both the treatment regimen showed significant reduction in onychomycosis affected areas after 8 weeks and maximum reduction was observed at the end of 36 weeks. At the end point of the follow-up period, the clinical cure rates (no residual deformity or with some deformity) were 86.7% in the itraconazole group and 100% in the terbinafine group. The mycological cure rates were 86.7% and 100% respectively. However, no statistically significant differences between the treatment groups were seen in clinical, mycological (P= 0.864) and severity assessment (P= 0.220). Nausea, abdominal cramp, headache, back pain and flu like syndrome are the adverse effects more frequently reported. At least one adverse effect was reported by 17 patients, of them 12 belonged to itraconazole group and 5 to terbinafine group and the difference was statistically significant (P= 0.027). The overall therapeutic effectiveness, safety and cost affectivity were in favor of Terbinafine pulse therapy.

Lipoprotein -- an independent risk factor for CVD

A case control study done to evaluate the Lipoprotein(a) [LP(a)] as a risk factor for CVD (cerebrovascular disease). 150 non-smokers, non-alcoholic subjects free from DM, renal disease, thyroid disease and liver disease were included in the study. Among them 120 were CVD cases and 30 were age and sex matched healthy control. Subjects were grouped as group-I (30, healthy control), Group-II (60, Hemorrhagic CVD) and group-III (60, Ischemic CVD). Fasting (12 hr) blood samples were collected from all subjects and in CVD cases samples were collected after 24 hr of attack. Lipid profile and LP(a) conc. were measured in all samples. Mean serum LP(a) conc. in Group-I, Group-II and Group-III were found to be 17.6 7.4 mg/dl, 31.9 15.6 mg/dl and 44.8 24.0 mg/dl respectively. Both the groups of CVD cases showed significantly higher level of serum LP(a) conc. compared to healthy control. CVD cases did not differ statistically in respect of their lipid profile when compared with control. Moreover the serum LP (a) conc. of CVD cases found to show no correlation with their lipid profile, suggesting the serum LP(a) conc. a possible independent risk factor for CVD.

Lipoprotein-a: a laboratory tool for clinical categorization of CVD

A case-control study was done to evaluate the association of Lipoprotein(a)[LP(a)] with CVD (Cerebrovascular disease) and also to assess the implication of serum LP(a) concentration as a differentiating marker between ICVD (Ischemic CVD) & HCVD (Hemorrhagic CVD). 150 non-smokers, non-alcoholic subjects free from DM, renal disease, thyroid disease and liver disease were studied. Among them 120 were CVD cases and 30 were age & sex matched healthy control. Fasting (12 hr.) blood samples were collected from all subjects and in CVD cases samples were collected after 24 hr. of attack. Serum LP(a) concentration were measured in all samples. Mean serum LP(a) concentration in control, HCVD & ICVD were found to be 17.6 +/- 7.4 mg/dl, 31.9 +/- 15.6 mg/dl and 44.8 +/- 24.0 mg/dl respectively. Both HCVD & ICVD cases showed significantly higher level of serum LP(a) concentration compared to control. Moreover ICVD cases showed significantly higher level of serum LP(a) concentration compared to HCVD cases. The exquisite athero-thrombo-embolic potential of LP(a) explain its involvement with CVD but more with ICVD in comparison to HCVD; This finding apparently suggest the prospect of serum LP(a) concentration to be used as a promising laboratory maker to differentiate clinically the ICVD from HCVD following determination of cut-off value between ICVD & HCVD by broad based comprehensive study.

Demand-based water options for arsenic mitigation: an experience from rural Bangladesh

A supply of safe drinking water is a recognized global concern. The arsenic contamination of groundwater in Bangladesh and other countries has furthered this concern. Lack of appropriate water options is one of the main barriers to the supply of safe drinking water for 30-60 million people who are exposed to the risk of drinking arsenic-contaminated water in Bangladesh. This paper describes the experience from a water supply programme for arsenic mitigation based on demand and participation of 30,000 rural people in Srinagar, a subdistrict of Bangladesh. About 85% of the 912 tubewell water samples tested had an arsenic content higher than 0.05 mg/l. The project promoted 11 options including groundwater, surface-water and rainwater-harvesting household-based options as well as community managed technologies. Most people, particularly women, wanted piped water, and hand-operated deep tubewells were also requested. Four cluster-based motorized piped water systems, 20 home-based arsenic-removal options (two types) and an arsenic-removal filter plant were installed. The public contributed about 49, 25 and 20% of the installation costs of piped water, home-based options and filter options, respectively, and 100% of all operation and maintenance costs. The household options and filter plant were abandoned within a few weeks. Reportedly, those options required too much attention, discharged small volumes of water at low rates, were difficult to maintain, and discharged poor-quality water. The proportion of families (54%) that drank arsenic-contaminated water during the final survey was significantly lower than in the baseline survey (87%). For arsenic-affected areas, it is recommended that a cluster-based piped water system be given proper consideration when selecting appropriate water options rather than household-based options or the development of new low-cost options.