Emergence of multidrug-resistant Bacillus spp. derived from animal feed, food and human diarrhea in South-Eastern Bangladesh

BACKGROUND

Antimicrobial resistance poses a huge risk to human health worldwide, while Bangladesh is confronting the most severe challenge between the food supply and the huge consumption of antibiotics annually. More importantly, probiotics containing Bacillus spp. are claimed to be an alternative to antimicrobial stewardship programs. However, their antibiotic resistance remains elusive. Thus, we employed the antimicrobial susceptibility test and PCR to assess the prevalence of resistance, including multidrug resistance (MDR) and resito-genotyping of isolated Bacillus spp.

RESULTS

The phenotypic profile showed that Bacillus spp. were 100% sensitive to gentamicin (2 µg/mL), whereas lowered sensitivity to levofloxacin (67.8%, 0.5-1 µg/mL), ciprofloxacin (62.3%, 0.5-1 µg/mL), clindamycin (52.2%, 0.25-0.5 µg/mL), amoxicillin-clavulanic acid (37.6%, 0.06 µg/mL), azithromycin (33.4%, 1-2 µg/mL), tetracycline (25.6%, 2-4 µg/mL), nitrofurantoin (21.1%, 16-32 µg/mL), co-trimoxazole (19.2%, 2 µg/mL), and erythromycin (18.8%, 0.25-0.5 µg/mL). The strains were completely resistant to penicillin, amoxicillin-clavulanic acid, cefixime, ceftriaxone, vancomycin, and co-trimoxazole, and a species-specific trend was seen in both phenotypic and genotypic resistance patterns. Genotypic resistance indicated prevalence of the bla1 (71.5%), tetA (33%), erm1 (27%), blaTEM (13.1%), blaCTX-M-1/blaCTX-M-2 /sul1 (10.1%), blaSHV (9.6%), and qnrS (4.1%) genes. The β-lactamase resistance gene bla1 was found in all penicillin-resistant (MIC ≥ 32 µg/mL) Bacillus spp. One hundred ninety-one isolates (89.6%) were MDR, with 100% from diarrhea, 90.3% from food, and 88.7% from animal feed.

CONCLUSION

Based on the MIC value and profile analysis of antibiotic resistance genes, this is the first study that Bacillus spp. antimicrobial susceptibilities have been identified in Bangladesh, and our study will shed light on the adverse effects of feed-borne Bacillus spp. emerging from animal feed to the food chain. A comprehensive investigation is urgently needed by policymakers on tolerance limits and harmful effects in the animal industry.

Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

Characterization of lignin and hemicellulose degrading bacteria isolated from cow rumen and forest soil: Unveiling a novel enzymatic model for rice straw deconstruction

Application of greener pretreatment technology using robust ligninolytic bacteria for short duration to deconstruct rice straw and enhance bioethanol production is currently lacking. The objective of this study is to characterize three bacterial strains isolated from the milieux of cow rumen and forest soil and explore their capabilities of breaking down lignocellulose - an essential process in bioethanol production. Using biochemical and genomic analyses these strains were identified as Bacillus sp. HSTU-bmb18, Bacillus sp. HSTU-bmb19, and Citrobacter sp. HSTU-bmb20. Genomic analysis of the strains unveiled validated model hemicellulases, multicopper oxidases, and pectate lyases. These enzymes exhibited interactions with distinct lignocellulose substrates, further affirmed by their stability in molecular dynamic simulations. A comprehensive expression of ligninolytic pathways, including β-ketoadipate, phenyl acetate, and benzoate, was observed within the HSTU-bmb20 genome. The strains secreted approximately 75-82 U/mL of cellulase, xylase, pectinase, and lignin peroxidase. FT-IR analysis of the bacterial treated rice straw fibers revealed that the intensity of lignin-related peaks decreased, while cellulose-related peaks sharpened. The values of crystallinity index for the untreated control and the treated rice straw with either HSTU-bmb18, or HSTU-bmb19, or HSTU-bmb20 were recorded to be 34.48, 28.49, 29.36, 31.75, respectively, which are much higher than that of 13.53 noted for those treated with the bacterial consortium. The ratio of fermentable cellulose in rice straw increased by 1.25-, 1.79-, 1.93- and 2.17-fold following treatments with HSTU-bmb18, HSTU-bmb20, HSTU-bmb19, and a mixed consortium of these three strains, respectively. These aggregative results suggested a novel model for rice straw deconstruction utilizing hydrolytic enzymes of the consortium, revealing superior efficacy compared to individual strains, and advancing cost-effective, affordable, and sustainable green technology.

Monkeypox virus (MPXV): A Brief account of global spread, epidemiology, virology, clinical features, pathogenesis, and therapeutic interventions

The largest monkeypox virus (MPXV) outbreak of the 21st century occurred in 2022, which caused epidemics in many countries. According to WHO, physical contact with infected persons, contaminated surfaces, or affected animals might be a source of this virus transmission. A febrile sickness including few symptoms found in MPX disease. Skin rash, lesions, fever, headache, fatigue, and muscle aches symptoms were observed commonly for this disease. Animal and in vitro, studies have shown that the antiviral medications cidofovir and brincidofovir are effective against MPXV. The first-generation vaccinia virus vaccine was developed in 1960, and it helped to protect against MPXV with its side effects. A second-generation vaccination with limitations was launched in 2000. However, the CDC advised vaccinations for risk groups in endemic countries, including positive patients and hospital employees. The JYNNEOS vaccine, administered in 2 doses, also provides protection from MPX. This article presents concisely the most recent findings regarding epidemiology, genomic transmission, signs and symptoms, pathogenesis, diagnosis, and therapeutic interventions for MPXV, which may be helpful to researchers and practitioners. WHO declared that MPX was no longer a global health emergency due to its declining case rate, and a number of countries have reported new incidences. Further research-based investigations must be carried out based on the 2022 outbreak.

Association of transcription factor 7-like 2 rs12255372 polymorphism with susceptibility of type 2 diabetes mellitus in Bangladeshi population

Polymorphism of transcription factor 7-like 2 (TCF7L2) has a link with type 2 diabetes mellitus (T2DM) through β cell dysfunction that causes defect in blood glucose homeostasis. This case-control study recruited 67 T2DM as cases and 65 age-matched healthy individuals as controls to determine whether the polymorphism rs12255372 (G > T) in the TCF7L2 gene have an association with T2DM in Bangladeshi population. Genomic DNA was purified from peripheral whole blood sample and direct Sanger sequencing was done for genotyping of SNP. Bivariate logistic regression was done to find out the association between genetic variant and T2DM. In our study, the minor T allele frequency was significantly more frequent in T2DM group than healthy controls (29.1% vs. 16.9%). After adjusting with confounding factors, heterozygous-genotype GT had higher odds of developing T2DM (OR 2.4; 95% CI: 1.0-5.5; p value = 0.04) and in dominant model, having SNP in TCF7L2 increased the risk of T2DM 2.3 times (95% CI: 1.0-5.2; p value = 0.04). In interaction model, genetic susceptible SNP cases interacted significantly with increasing age and BMI, female gender, and having family history of diabetes mellitus to develop T2DM (pinteraction < 0.001). Having minor T allele either in heterozygous or homozygous variant form of rs12255372 (G > T) TCF7L2 had significant association with T2DM. In conclusion, TCF7L2 gene variant increases risk of developing T2DM among the Bangladeshi population.

Enhanced rice plant (BRRI-28) growth at lower doses of urea caused by diazinon mineralizing endophytic bacterial consortia and explorations of relevant regulatory genes in a Klebsiella sp. strain HSTU-F2D4R

Endophytic biostimulant with pesticide bioremediation activities may reduce agrochemicals application in rice cultivation. The present study evaluates diazinon-degrading endophytic bacteria, isolated from rice plants grown in the fields with pesticide amalgamation, leading to increased productivity in high-yielding rice plants. These endophytes showed capabilities of decomposing diazinon, confirmed by FT-IR spectra analysis. Growth promoting activities of these endophytes can be attributed to their abilities to produce an increased level of IAA content and to demonstrate high level ACC-deaminase activities. Furthermore, these endophytes demonstrated enhanced level of extracellular cellulase, xylanase, amylase, protease and lignin degrading activities. Five genera including Enterobacter, Pantoea, Shigella, Acinetobacter, and Serratia, are represented only by the leaves, while four genera such as Enterobacter, Escherichia, Kosakonia, and Pseudomonas are represented only by the shoots. Five genera including, Klebsiella, Enterobacter, Pseudomonas, Burkholderia, and Bacillus are represented only by the roots of rice plants. All these strains demonstrated cell wall hydrolytic enzyme activities, except pectinase. All treatments, either individual strains or consortia of strains, enhanced rice plant growth at germination, seedling, vegetative and reproductive stages. Among four (I-IV) consortia, consortium-III generated the maximum rice yield under 70% lower doses of urea compared to that of control (treated with only fertilizer). The decoded genome of Klebsiella sp. HSTU-F2D4R revealed nif-cluster, chemotaxis, phosphates, biofilm formation, and organophosphorus insecticide-degrading genes. Sufficient insecticide-degrading proteins belonging to strain HSTU-F2D4R had interacted with diazinon, confirmed in molecular docking and formed potential catalytic triads, suggesting the strains have bioremediation potential with biofertilizer applications in rice cultivation.

Insight into vaccination and meteorological factors on daily COVID-19 cases and mortality in Bangladesh

The ongoing COVID-19 contagious disease caused by SARS-CoV-2 has disrupted global public health, businesses, and economies due to widespread infection, with 676.41 million confirmed cases and 6.77 million deaths in 231 countries as of February 07, 2023. To control the rapid spread of SARS-CoV-2, it is crucial to determine the potential determinants such as meteorological factors and their roles. This study examines how COVID-19 cases and deaths changed over time while assessing meteorological characteristics that could impact these disparities from the onset of the pandemic. We used data spanning two years across all eight administrative divisions, this is the first of its kind--showing a connection between meteorological conditions, vaccination, and COVID-19 incidences in Bangladesh. We further employed several techniques including Simple Exponential Smoothing (SES), Auto-Regressive Integrated Moving Average (ARIMA), Auto-Regressive Integrated Moving Average with explanatory variables (ARIMAX), and Automatic forecasting time-series model (Prophet). We further analyzed the effects of COVID-19 vaccination on daily cases and deaths. Data on COVID-19 cases collected include eight administrative divisions of Bangladesh spanning March 8, 2020, to January 31, 2023, from available online servers. The meteorological data include rainfall (mm), relative humidity (%), average temperature (°C), surface pressure (kPa), dew point (°C), and maximum wind speed (m/s). The observed wind speed and surface pressure show a significant negative impact on COVID-19 cases (-0.89, 95% confidence interval (CI): 1.62 to -0.21) and (-1.31, 95%CI: 2.32 to -0.29), respectively. Similarly, the observed wind speed and surface pressure show a significant negative impact on COVID-19 deaths (-0.87, 95% CI: 1.54 to -0.21) and (-3.11, 95%CI: 4.44 to -1.25), respectively. The impact of meteorological factors is almost similar when vaccination information is included in the model. However, the impact of vaccination in both cases and deaths model is significantly negative (for cases: 1.19, 95%CI: 2.35 to -0.38 and for deaths: 1.55, 95%CI: 2.88 to -0.43). Accordingly, vaccination effectively reduces the number of new COVID-19 cases and fatalities in Bangladesh. Thus, these results could assist future researchers and policymakers in the assessment of pandemics, by making thorough efforts that account for COVID-19 vaccinations and meteorological conditions.

A 30-day follow-up study on the prevalence of SARS-COV-2 genetic markers in wastewater from the residence of COVID-19 patient and comparison with clinical positivity

Wastewater based epidemiology (WBE) is an important tool to fight against COVID-19 as it provides insights into the health status of the targeted population from a small single house to a large municipality in a cost-effective, rapid, and non-invasive way. The implementation of wastewater based surveillance (WBS) could reduce the burden on the public health system, management of pandemics, help to make informed decisions, and protect public health. In this study, a house with COVID-19 patients was targeted for monitoring the prevalence of SARS-CoV-2 genetic markers in wastewater samples (WS) with clinical specimens (CS) for a period of 30 days. RT-qPCR technique was employed to target nonstructural (ORF1ab) and structural-nucleocapsid (N) protein genes of SARS-CoV-2, according to a validated experimental protocol. Physiological, environmental, and biological parameters were also measured following the American Public Health Association (APHA) standard protocols. SARS-CoV-2 viral shedding in wastewater peaked when the highest number of COVID-19 cases were clinically diagnosed. Throughout the study period, 7450 to 23,000 gene copies/1000 mL were detected, where we identified 47 % (57/120) positive samples from WS and 35 % (128/360) from CS. When the COVID-19 patient number was the lowest (2), the highest CT value (39.4; i.e., lowest copy number) was identified from WS. On the other hand, when the COVID-19 patients were the highest (6), the lowest CT value (25.2 i.e., highest copy numbers) was obtained from WS. An advance signal of increased SARS-CoV-2 viral load from the COVID-19 patient was found in WS earlier than in the CS. Using customized primer sets in a traditional PCR approach, we confirmed that all SARS-CoV-2 variants identified in both CS and WS were Delta variants (B.1.617.2). To our knowledge, this is the first follow-up study to determine a temporal relationship between COVID-19 patients and their discharge of SARS-CoV-2 RNA genetic markers in wastewater from a single house including all family members for clinical sampling from a developing country (Bangladesh), where a proper sewage system is lacking. The salient findings of the study indicate that monitoring the genetic markers of the SARS-CoV-2 virus in wastewater could identify COVID-19 cases, which reduces the burden on the public health system during COVID-19 pandemics.

Prevalence of chronic obstructive pulmonary disease (COPD) among rural population: A national survey in Bangladesh

Background

In Bangladesh, there is a scarcity of nationally representative data on the burden of chronic obstructive pulmonary disease (COPD).

Methods

To estimate the COPD prevalence in rural settings, this cross-sectional, population-based study was conducted in all eight administrative divisions of Bangladesh, and involved adults aged 40 years and above. By using multi-stage random sampling, 2,458 individuals were enrolled. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were used to diagnose COPD based on post-bronchodilator lung function, while additional participant data was gathered through computer-assisted personal interviews.

Results

A 2% COPD prevalence (95% CI: 1.45, 2.55) was found in the study sample with a statistically significant difference between males (2.7%; 95% CI: 1.8, 3.6) and females (1.2%; 95% CI: 0.59, 1.81). Increasing age significantly inflated the odds of having COPD irrespective of sex (OR: 1.03; 95% CI: 1.00, 1.05; P value < 0.05). Furthermore, prevalence of COPD was higher among manual workers, cigarette smokers, and those that used the indoor kitchen and did not have a primary education. Sex-based analysis showed that smokeless tobacco consumption was significantly associated with COPD occurrence among males (OR: 2.14; 95% CI: 1.05, 4.37; P value < 0.05), but not females. Further, using an indoor kitchen increased the odds of developing COPD by 400% among female participants (OR: 4.39; 95% CI: 1.37, 14.10; P value < 0.05).

Conclusion

This study provides a comprehensive sex-based estimation of COPD prevalence among rural population and imparts significant contribution to the growing database on COPD prevalence in Bangladesh.

Correlation between Antero-posterior Diameter and Vertical Diameter of Both Ends of Fully Ossified Dry Human Clavicle

Clavicle is an upper limb locomotory bone which helps in formation of pectoral girdle and connected the upper limb with axial skeleton. There is no baseline data of clavicle in contrast to demographic variation in our country, so the study was designed to obtain baseline data on clavicle for anthropological, forensic and clinical use. This descriptive cross-sectional study was done among 150 (65 right and 85 left) fully ossified dry human clavicle in Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. Sample was collected by the help of nonrandom purposive sampling technique from Department of Anatomy of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. The parameters were the antero-posterior diameter and vertical diameter of sternal and acromial ends of clavicle, measured with the help of digital vernier slide caliper and expressed in millimeter. In the current study the mean±SD antero-posterior diameter of sternal end of 65 clavicles of right side was 21.97±2.889mm and 85 clavicles of left side were 20.30±3.459mm. The mean±SD antero-posterior diameter of acromial end of 65 right sided clavicles was 21.96±5.161mm and 85 clavicles of left side were 21.00±4.002mm. Correlation was done in between antero-posterior diameter and vertical diameter of sternal end of clavicle and the differences were highly significant on both sides. Similarly, when correlation was done for the acromial end of clavicle the difference was found non-significant on right side and highly significant on left side.

Protocatechuic acid: A novel detoxication agent of fumonisin B1 for poultry industry

Fumonisin B1 (FB1) is a major fusarium mycotoxin that largely contaminates feedstuffs and foods, posing a health risk to both animals and humans. This mycotoxin can enter the human body directly through contaminated food consumption or indirectly by toxins and their metabolites. In a prior study, feed-borne FB1 is one of the leading mycotoxins in breeder eggs, leading to reduced hatchability and gizzard ulceration in chicken progenies. Currently, no effective way is available to remove FB1 from feeds and human-contaminated foods. We hypothesize that FB1 can be reduced to low risk by protocatechuic acid (PCA). To assess the ability of FB1 to be degraded in vivo, 1 ppm of FB1 was treated with PCA, or D-glucose, or silymarin, or anti-FB1 monoclonal antibody. Our study revealed that both D-glucose and PCA exhibited 53.4 and 71.43% degradation, respectively, at 80°C for 2 h, while 35.15% of FB1 detoxification was determined in the silymarin group at 60°C for 0.5 h. A dose-dependent manner was found after treatment with D-glucose or PCA at 80°C for 2 h. As for detoxification of anti-FB1 monoclonal antibody, the 1:3,000 dilution induced significant FB1 detoxification, accounting for 25.9% degradation at 25°C for 2 h. Furthermore, 50 SPF 11-day-old embryonated eggs were divided into 10 groups, with five eggs per group. Post treatment with PCA or D-glucose, or silymarin or anti-FB1 monoclonal antibody, the treated samples were inoculated into albumens and monitored daily until the hatching day. Consequently, 100% of the chickens survived in the D-glucose group and other control groups, except for the FB1 control group, while 80, 80, and 60% hatching rates were found in the PCA-treated group, the anti-FB1 monoclonal antibody-treated group, and the silymarin-treated group. Additionally, both the FB1 group and the silymarin-treated group yielded lower embryo growth than other groups did. Postmortem, lower gizzard ulceration index was determined in the PCA-treated group and the anti-FB1 monoclonal antibody-treated group compared to those of the silymarin-treated group and D-glucose-treated group. Based on the above evidence, PCA is a promising detoxification to reduce FB1 contamination in the poultry industry, contributing to the eradication of mycotoxin residuals in the food chain and maintaining food security for human beings.

A Review on Measures to Rejuvenate Immune System: Natural Mode of Protection Against Coronavirus Infection

SARS-CoV-2, a novel Corona virus strain, was first detected in Wuhan, China, in December 2019. As of December 16, 2021, almost 4,822,472 people had died and over 236,132,082 were infected with this lethal viral infection. It is believed that the human immune system is thought to play a critical role in the initial phase of infection when the viruses invade the host cells. Although some effective vaccines have already been on the market, researchers and many bio-pharmaceuticals are still working hard to develop a fully functional vaccine or more effective therapeutic agent against the COVID-19. Other efforts, in addition to functional vaccines, can help strengthen the immune system to defeat the corona virus infection. Herein, we have reviewed some of those proven measures, following which a more efficient immune system can be better prepared to fight viral infection. Among these, dietary supplements like- fresh vegetables and fruits offer a plentiful of vitamins and antioxidants, enabling to build of a healthy immune system. While the pharmacologically active components of medicinal plants directly aid in fighting against viral infection, supplementary supplements combined with a healthy diet will assist to regulate the immune system and will prevent viral infection. In addition, some personal habits, like- regular physical exercise, intermittent fasting, and adequate sleep, had also been proven to aid the immune system in becoming an efficient one. Maintaining each of these will strengthen the immune system, allowing innate immunity to become a more defensive and active antagonistic mechanism against corona-virus infection. However, because dietary treatments take longer to produce beneficial effects in adaptive maturation, personalized nutrition cannot be expected to have an immediate impact on the global outbreak.

Bacillus spp. Contamination: A Novel Risk Originated From Animal Feed to Human Food Chains in South-Eastern Bangladesh

The current study provides information on Bacillus spp. contamination along with present status in commercially available poultry and animal feeds as well as animal-derived products in Bangladesh. The research has been conducted to determine if animal feed and its components are a source of Bacillus spp. contamination in feed and food chain. Out of 180 different feeds, milk, egg, and human stool samples, 218 Bacillus spp. were isolated and identified by cultural morphology, microscopic, biochemical, and molecular characteristics where B. cereus, B. subtilis, B. amyloliquefaciens, B. licheniformis, B. thuringiensis, B. megaterium, and B. coagulans accounted for 51, 22, 9.1, 5.9, 5, 3.6, and 2.2%, respectively. Regarding the enumeration of total viable count and total Bacillus count, correspondingly 67 and 39% samples were found to be contaminated with above 10,000 CFU/g, while highest contamination was 85 and 75% in broiler feed, respectively. The total number of bacteria above the regulatory limits in commercially available feeds indicates a poor compliance with regulation and abuse administration in the Bangladeshi market. Moreover, a hospital-based survey showed that food-borne Bacillus spp. contributed to 4.5% human diarrhea cases and 25% food contamination associated with vegetables, rice, RTE food, milk, and egg, accounting for 46, 34, 14, 4, and 2%, respectively. B. cereus was the dominant isolate correspondingly accounting for 56 and 51% egg and milk contamination followed by B. amyloliquefaciens (32%) and B. thuringiensis (12%) in egg and B. subtilis (25%), B. amyloliquefaciens (12%), B. thuringiensis (6.4%), and B. coagulans (3.2%) in milk, respectively. Toxin gene profiling of Bacillus spp. revealed that B. cereus constituted a principal part of virulence, while B. thuringiensis, B. licheniformis, B. megaterium, B. coagulans, and B. subtilis showed genetic diversity and B. amyloliquefaciens had not carried any toxin gene. Detection rate of enterotoxin genes (nheA, nheB, nheC, cytK, hblA, hblC, hblD, and entFM) showed that 55% isolates carried nheABC genes, 80% entFM, and 71% cytK, whereas only 33% of the isolates contained hblACD gene clusters. These virulence genes were posing a threat to human health due to spread across the food and feed chain. Finally, our findings support the hypothesis that B. cereus might contribute to clinical diarrhea, gizzard erosion, and lung infection in duck and poultry, and that it contaminates animal-derived foods resulting in toxicity and antibacterial resistance to humans. Therefore, maximal tolerance limits of Bacillus spp. and their potential risks to the animal industry are urgently needed to clarify. Moreover, Bacillus spp.–induced toxin residual must be altered for human health via food chain transmission.

Noonan Syndrome Presenting with Stunted Growth: A Case Report

Noonan syndrome is a genetic disorder of autosomal dominant inheritance that prevents normal development in various parts of the body. A spontaneous mutation without any family history may also result in the condition. Noonan syndrome can affect normal growth. Birth weight may be normal, but growth slows over time. The growth spurt usually seen during the teenage years may be delayed, and bone maturity also is delayed. In this case A 13 year's male admitted inpatient Department of Endocrinology, Mymensingh Medical College Hospital in April 2021 with not attaining appropriate height and delayed development of secondary sexual characteristics. His birth weight was normal; gestational and neonatal history was uneventful. He was diagnosed with severe pulmonary stenosis at four years and underwent cardiac surgery at his four and eleven years. He was noted to have growth failure from the age of 9 years onward. He had no family history of such type of disease. On examination, he was short statured, underweight, having an upper: lower segment ratio of 1.05 with an arm span of 126cm. He had craniosynostosis, high arched palate, the thick helix of ears (outer rim), small, upturned nose, depressed broad nose, deeply grooved philtrum, keratosis pilaris of the face and upper arm, slant eyes with proptosis, keloid scar over mid-chest, widely spaced nipple, shield chest, pectus excavatum and cubitus valgus. His sexual maturation score was A1, P1, B1. He had pulmonary stenosis with pulmonary hypertension. He had mild microcytic anemia with normal liver, renal, blood glucose, and calcium profile. His bone age was delayed (9 years), thyroid function was normal. The growth hormone dynamic test after clonidine stimulation was normal. His karyotype was 46XY. We have considered giving recombinant growth hormone therapy to accelerate his height.

Prevalence of Hepatitis B Virus Infection among Children with Liver Disease Admitted In Mymensingh Medical College Hospital

Hepatitis B virus infection is an important cause of liver disease. Hepatitis B Virus may present with varying degree of severity. In older children, 5-10% cases leading to chronic liver disease, cirrhosis and hepatocellular carcinoma. This descriptive cross sectional study was done to assess the prevalence of Hepatitis B Virus infection among hospitalized children with liver disease in pediatric department of Mymensingh Medical College Hospital, Bangladesh from December 2015 to October 2016. All the children of both sexes having age between six months to twelve years admitted in the pediatric ward with acute or chronic liver disease were included in this study by purposive sampling. A written consent was obtained from legal guardian of children before inclusion. Ethical clearance was obtained from competent authority. A detailed history was taken from parents in each case according to pre-designed questionnaire about demography of the patients and the risk factors of the liver disease. A thorough clinical examination and available relevant investigations like serological testing for HBV infection was done in all patients. We had figure out the seropositivity of HBV among patients having liver disease by doing HBsAg and Anti-HBc IgM. Progress of the patient was monitored by daily clinical examinations and by investigating HBsAg and Anti-HBc IgM. Finally data analysis was done by SPSS version 21.0. Among total 100 patients most (44%) patients were in 7-10 years old and most (62%) of the participants were male. Acute liver disease was 58% cases and chronic liver disease was 42% cases. HBsAg was positive in 1 case among acute liver disease and 5 cases among chronic cases. Total 6 (six) patients were found positive for HBsAg. Anti HBc IgM was positive in 4 patients among acute liver disease. Among these Anti HBc IgM positive (4) patients only one had both HBsAg and Anti HBc IgM positive. So, four patients were confirming suffered from acute viral hepatitis because they had anti HBc IgM positive. On the contrary 5 patients suffered from chronic hepatitis by hepatitis B because they were only HBsAg positive. So, in this study 9 patients (9%) were confirming suffered from HBV infection. Possible transmission factors of hepatitis B were history of (H/O) blood transfusion/trauma/parenteral injection, H/O umbilical sepsis, H/O maternal illness/infection during pregnancy. HBV still is a major cause of morbidity. All the children with liver disease should be routinely tested for HBV.

A Prospective Study of Deep Vein Thrombosis after Major Abdominal Surgery in a Tertiary Level Hospital

This prospective study was conducted to find the rate of deep and risk factors associated with vein thrombosis following major abdominal surgery in Sylhet MAG Osmani Medical College Hospital from 1st November 2017 to 30th April 2018. Total 103 patients aged above 20 years both male and female who got admitted in Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet for their disease requiring routine and emergency major abdominal operation during the study period and fulfilling the inclusion and exclusion criteria were selected in this study. Informed written consent was obtained from the patients after full explanation of the purpose of the study. After full investigations and proper preparation of each patient for operative procedure major abdominal surgery were done. Peroperative findings were noted and post-operative period were followed up routinely. Duplex scanning was done on 3rd POD in all cases. The age of the patients ranged from 25 to 74 years with the mean age of 49.5±13.8 years. There were 60(58.3%) male and 43(41.7%) female. Deep vein thrombosis (DVT) developed in 5(4.9%) of cases and not developed in 98(95.1%) cases. All the five cases were confirmed by color duplex scan. DVT was detected in 2(3.3%) of the 60 males and 3(7.0%) of the 43 females undergoing major general surgical procedures. Among 63 patients in whom the duration of surgery was up to 2 hours, none developed DVT, while among the 40 patients in whom the duration of surgery lasted more than 2 hours, 5(12.5%) developed DVT. Among 23 patients in whom the surgery for malignancy was done, 4(17.4%) developed DVT, while among the 80 patients in whom surgery for non-malignancy, 1(1.2%) developed DVT. The Incidence of DVT in patients undergoing major abdominal surgery is 4.9%. Patients undergoing major abdominal surgery for malignancy and duration of operation greater than 2 hours have higher risk of developing DVT. But there is no significant increase in risk of development of DVT relation to age and sex; and also in patients on oral contraceptives, diabetes mellitus, obesity and smoking. Clinical findings alone cannot be relied upon for the diagnosis of DVT. The study has to be continued with larger sample size to get statistically significant results.

Salinity Influences Plant-Pest-Predator Tritrophic Interactions

Climate change-induced salinity intrusion into agricultural soils is known to negatively impact crop production and food security. However, the effects of salinity increase on plant-herbivore-natural enemy systems and repercussions for pest suppression services are largely unknown. Here, we examine the effects of increased salinity on communities of rice (Oryza sativa), brown planthopper (BPH), Nilaparvata lugens, and green mirid bug (GMB), Cyrtorhinus lividipennis, under greenhouse conditions. We found that elevated salinity significantly suppressed the growth of two rice cultivars. Meanwhile, BPH population size also generally decreased due to poor host plant quality induced by elevated salinity. The highest BPH density occurred at 2.0 dS/m salinity and declined thereafter with increasing salinity, irrespective of rice cultivar. The highest population density of GMB also occurred under control conditions and decreased significantly with increasing salinity. Higher salinity directly affected the rice crop by reducing plant quality measured with reference to biomass production and plant height, whereas inducing population developmental asynchrony between BPH and GMB observed at 2 dS/m salinity and potentially uncoupling prey-predator dynamics. Our results suggest that increased salinity has harmful effects on plants, herbivores, natural enemies, as well as plant-pest-predator interactions. The effects measured here suggest that the bottom-up effects of predatory insects on rice pests will likely decline in rice produced in coastal areas where salinity intrusion is common. Our findings indicate that elevated salinity influences tritrophic interactions in rice production landscapes, and further research should address resilient rice insect pest management combining multipests and predators in a changing environment.

Contamination With Fumonisin B and Deoxynivalenol Is a Threat to Egg Safety and Contributes to Gizzard Ulcerations of Newborn Chickens

Fumonisin B (FB) and other fumonisins, deoxynivalenol (DON), and zearalenone (ZEN) are mycotoxins (secondary metabolites of fungi) present at high levels of contamination in poultry diets and threatening the sustainability of the poultry industry and egg safety for consumers. However, residual mycotoxins in breeder eggs and their effects on chicken progeny and gizzard ulcerations remain unclear. To unveil mycotoxin contaminations from daily diets to breeder eggs, 293 poultry feed samples were collected from three large-scale poultry provinces across Northern China to Southern China. Average levels of 1,628 ± 4.36 μg/kg of FB₁, 593 ± 11.16 μg/kg of DON, 69 ± 9.21 μg/kg of ZEN, 52 ± 7.33 μg/kg of OTA, and 24 ± 5.85 μg/kg of AFB₁ were found in feedstuffs and poultry diets using commercial ELISA kits. In terms of residual mycotoxins in breeder eggs, FB₁ and DON contaminations dominated residues in egg albumen and yolk samples. Out of 221 breeder eggs, the average residual of FB₁ in albumen were 320.6 ± 10.12 μg/kg (Hebei), 420.2 ± 10.98 μg/kg (Guangdong), and 549.4 ± 10.27 (Guangxi). Moreover, higher residual of DONs were determined in Guangdong and Guangxi provinces compared to Hebei province. ZEN, ochratoxins A (OTA), and aflatoxin B₁ (AFB₁) contamination at low levels were found in the above samples collected from afronmentioned three provinces. Based on residual mycotoxins in breeder eggs, SPF embryonated eggs aged 11 days were inoculated into albumen with different doses of FB₁, FB₂ or DON, or a combination of FB₁ and DON, or a combination of FB₁ with FB₂ and FB₃. A lower hatching rate was observed in the chicken progenies with the combination of 24 μg of FB₁ and 0.1 μg of DON compared to other treatments. Moreover, typical gizzard ulcerations with hemorrhagic lungs were observed in the progeny of breeder eggs post-inoculation of 24 μg of FB₁ and synergetic inoculation of FB₁ and DON. Finally, residual FB mycotoxins were detected in the gizzards and in the lungs of the progenies. Based on the above evidence, feed-borne FB₁ and DON are dominant mycotoxins in breeder eggs and threatening food security using breeder eggs as a Trojan horse. More importantly, the residual of FB₁ alone and in combination with of DON contamination are associated with low hatching rate and gizzard ulcerations in chicken progenies, hampering sustainable development perspectives of the poultry industry.

Comparison of Nutritional Status of Children with Congenital Heart Diseases with Minor Illness of Other Children in a Tertiary Level Hospital

This cross sectional comparative analytical study was undertaken with the objectives to find out the nutritional status of children with congenital heart disease by anthropometric measurement and was compared it with those of children having minor illness and without any congenital heart disease in indoor and outdoor Department of Paediatrics of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from December 2015 to November 2016. Purposive sampling was done. One hundred children aged 6 to 60 months with congenital heart disease confirmed by echocardiogram were taken as Group A and one hundred children of same age and sex matched having minor illness and without any congenital heart disease were taken as Group B. Age of the patients ranged from 6 to 60 months. There was no obvious difference of socio-demographic status between two groups. Most of the patient (64.0%) had acyanotic congenital heart disease among them VSD was commonest (68.8%). Thirty-six percent (36.0%) patient had cyanotic congenital heart disease and among them Tetralogy of Fallots (83.3%) was commonest. There were significant differences regarding weight, height and MUAC values in between two Groups. Underweight (51%), Stunting (50%) and Wasting (29%) all were higher in congenital heart disease than that of Group B where they were 28%, 31% and 13% respectively and the differences were statistically significant (p<0.05). The findings of this study imply that malnutrition is very common among children with congenital heart disease. So, anthropometric measurement should be done in each and every child with congenital heart disease.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822)

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin's niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Study on Alanine Aminotransferase in Patients of Type 2 Diabetes Mellitus

Type 2 Diabetes mellitus (DM) is associated with various types of liver disorders including elevated liver enzymes. This study was carried out to observe hepatocellular injury in type 2 Diabetes mellitus as evidenced by raised Alanine aminotransferase (ALT) among the type 2 Diabetes mellitus patients and to find out association between elevated ALT and glycaemic control. This was a descriptive cross-sectional comparative study carried out in Department of Medicine, Rajshahi Medical College Hospital and Rajshahi Diabetic Association Hospital, Rajshahi, Bangladesh from July 2009 to June 2010. One hundred (100) diagnosed type 2 diabetic patients according to WHO criteria and 30 apparently healthy people of both sexes were included. Age of the study people were >40 years. All of those study population were free from taking any hepatotoxic drugs, inj. Insulin, alcohol and preexisting liver disease. Detailed History, thorough clinical examination and relevant investigations were done for exclusion. The frequency of abnormal ALT, Serum bilirubin, Aspartate aminotransferase (AST), Alkaline phosphatase, Prothrombin time and Serum albumin were 30%, 6%, 7%, 6%, 54% and 12% respectively in type 2 diabetic patients and 3.3%, 00%, 00%, 6.7%, 10% and 3.3% respectively in normal people. Serum ALT (U/L) level (mean±SD) of the type 2 diabetic patients and normal people were (39.00±24.21) and (28.26±6.67) respectively. This difference is highly significant (p<0.001). Elevated serum ALT level of type 2 diabetic patients showed positive association with increased Body mass index (BMI) (p<0.05) and poor glycaemic control (p<0.05) and fatty liver (p=0.055). So, a high proportion of patients with type 2 diabetes mellitus have raised serum Alanine aminotransferase level. Elevated serum ALT level was also associated with high BMI, poor glycaemic control and fatty liver which may be a marker of NAFLD and insulin resistance.

Bacillus spp. Contamination: A Novel Risk Originated From Animal Feed to Human Food Chains in South-Eastern Bangladesh

The current study provides information on Bacillus spp. contamination along with present status in commercially available poultry and animal feeds as well as animal-derived products in Bangladesh. The research has been conducted to determine if animal feed and its components are a source of Bacillus spp. contamination in feed and food chain. Out of 180 different feeds, milk, egg, and human stool samples, 218 Bacillus spp. were isolated and identified by cultural morphology, microscopic, biochemical, and molecular characteristics where B. cereus, B. subtilis, B. amyloliquefaciens, B. licheniformis, B. thuringiensis, B. megaterium, and B. coagulans accounted for 51, 22, 9.1, 5.9, 5, 3.6, and 2.2%, respectively. Regarding the enumeration of total viable count and total Bacillus count, correspondingly 67 and 39% samples were found to be contaminated with above 10,000 CFU/g, while highest contamination was 85 and 75% in broiler feed, respectively. The total number of bacteria above the regulatory limits in commercially available feeds indicates a poor compliance with regulation and abuse administration in the Bangladeshi market. Moreover, a hospital-based survey showed that food-borne Bacillus spp. contributed to 4.5% human diarrhea cases and 25% food contamination associated with vegetables, rice, RTE food, milk, and egg, accounting for 46, 34, 14, 4, and 2%, respectively. B. cereus was the dominant isolate correspondingly accounting for 56 and 51% egg and milk contamination followed by B. amyloliquefaciens (32%) and B. thuringiensis (12%) in egg and B. subtilis (25%), B. amyloliquefaciens (12%), B. thuringiensis (6.4%), and B. coagulans (3.2%) in milk, respectively. Toxin gene profiling of Bacillus spp. revealed that B. cereus constituted a principal part of virulence, while B. thuringiensis, B. licheniformis, B. megaterium, B. coagulans, and B. subtilis showed genetic diversity and B. amyloliquefaciens had not carried any toxin gene. Detection rate of enterotoxin genes (nheA, nheB, nheC, cytK, hblA, hblC, hblD, and entFM) showed that 55% isolates carried nheABC genes, 80% entFM, and 71% cytK, whereas only 33% of the isolates contained hblACD gene clusters. These virulence genes were posing a threat to human health due to spread across the food and feed chain. Finally, our findings support the hypothesis that B. cereus might contribute to clinical diarrhea, gizzard erosion, and lung infection in duck and poultry, and that it contaminates animal-derived foods resulting in toxicity and antibacterial resistance to humans. Therefore, maximal tolerance limits of Bacillus spp. and their potential risks to the animal industry are urgently needed to clarify. Moreover, Bacillus spp.-induced toxin residual must be altered for human health via food chain transmission.

Children's exposure to psychological abuse and neglect: A population-based study in rural Bangladesh

AIM

We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh.

METHODS

Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect.

RESULTS

The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse.

CONCLUSION

The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.

Mycotoxin contamination and control strategy in human, domestic animal and poultry: A review

Mycotoxins are secondary metabolites produced mainly by fungi belonging to the genera Aspergillus, Fusarium, Penicillium, Claviceps, and Alternaria that contaminate basic food products throughout the world, where developing countries are becoming predominantly affected. Currently, more than 500 mycotoxins are reported in which the most important concern to public health and agriculture include AFB1, OTA, TCTs (especially DON, T-2, HT-2), FB1, ZEN, PAT, CT, and EAs. The presence of mycotoxin in significant quantities poses health risks varying from allergic reactions to death on both humans and animals. This review brings attention to the present status of mycotoxin contamination of food products and recommended control strategies for mycotoxin mitigation. Humans are exposed to mycotoxins directly through the consumption of contaminated foods while, indirectly through carryover of toxins and their metabolites into animal tissues, milk, meat and eggs after ingestion of contaminated feeds. Pre-harvest (field) control of mycotoxin production and post-harvest (storage) mitigation of contamination represent the most effective approach to limit mycotoxins in food and feed. Compared with chemical and physical approaches, biological detoxification methods regarding biotransformation of mycotoxins into less toxic metabolites, are generally more unique, productive and eco-friendly. Along with the biological detoxification method, genetic improvement and application of nanotechnology show tremendous potential in reducing mycotoxin production thereby improving food safety and food quality for extended shelf life. This review will primarily describe the latest developments in the formation and detoxification of the most important mycotoxins by biological degradation and other alternative approaches, thereby reducing the potential adverse effects of mycotoxins.

Towards reducing behavioral risk factors of non-communicable diseases among adolescents: protocol for a school-based health education program in Bangladesh

BACKGROUND

Developing strategies aimed at reducing behavioral risk factors and hence the prevalence of non-communicable diseases (NCDs) is a major challenge to the policy makers today. Like the same age group worldwide, the prevalence of obesity, unhealthy dietary habit, physical inactivity, smoking and alcohol intake is high among the adolescents of Bangladesh. Studies showed promising results of an early intervention at adolescent age in reducing the likelihood of NCDs at adult age. So, this study is designed to implement a behavior change intervention and evaluate the effectiveness of the intervention in reducing the behavioral risk factors of NCDs among the adolescents of Bangladesh.

METHODS

A before-after designed intervention study will be conducted in two randomly selected secondary schools- one will be selected randomly as intervention school and the another as control school. A baseline survey will be conducted among the students of both schools by a pre-tested questionnaire to attain their current status of knowledge, attitude and practices related to NCDs. Afterward, students will be enrolled in the intervention group who will meet the eligibility criteria from the intervention school. The intervention will be given through a health promotion session to a group of students, not more than 25 at a time, by trained facilitators. A post-intervention end line survey will be conducted among all the participants from both schools using the same questionnaire 3 months after the baseline survey.

DISCUSSION

An intervention has been developed based on some principals of two psychosocial theory- Motivational Interview and Social Cognitive Theory. Emphasis will be given on motivating the adolescents towards a healthy lifestyle, supporting self-efficacy to be changed, guiding self-regulatory ways along with facilitating desired changing process by empowering them with choices about the preventive measures of NCDs. This intervention is expected to increase awareness by equipping the adolescents with specific knowledge and skills and thus, facilitate an eventual change in their practiced risk behaviors. Besides, this intervention will address multiple behaviors at a time, and will be delivered to a group of adolescents, to attain the cost-effectiveness and thereby making it more realistic in the resource-poor context of Bangladesh.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03975335, registered on 01.06.2019. Retrospectively registered.

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.

Psychiatric Disorders in Drop out from Educational Attainment Attending Mental Health Facilities: A Descriptive Cross Sectional Study

Studies of the impact of mental disorders on educational attainment are rare. Mental disorders, those beginning in childhood or adolescence may increase the risk of early drop out from education. The latter has been shown to have adverse life-course consequences on individuals such as greater demand on social welfare entitlements. A descriptive cross sectional study was carried out at the department of Psychiatry, Comilla Medical College, Comilla, Bangladesh. All cases were selected from patients attending at Comilla Medical College Hospital and Private Mental Health Facilities in Comilla City from March 2015 to February 2016. We found out the psychiatric disorders and socio-demographic status of patients with educational drop out over the early life course. A total of 50 dropout patients aged 10 to 30 years who fullfiled the enrolment criteria included in the study. Sociodemographic questionnaires, diagnostic information (DSM-5 and ICD-10) as well as an account of a various level of education were used as research instruments. The Frequency tables, summary tables and appropriate graphs were prepared to describe the population characteristics and study finding. The most of the psychiatric morbidity presents in male (62%) and age group of 18-24 years (54%). In this study, anxiety disorders was 8%, behaviour/ impulse control disorders was 8%, mood disorders was 16%, substance use disorders was 24%, schizophrenia spectrum disorders was 12% and composite psychiatric disorders was 32%. Among drop out patient's non- completion of primary education was 14%, non-completion of secondary education was 20%, non- completion of higher secondary education was 24%, not entry to tertiary education was 12% and non-completion of tertiary education was 30%. Among behaviour/impulse control disorders non-completion of primary education was 6%, substance use disorders non-completion of higher secondary education was 10%, mood disorder both non-completion of higher secondary education and non-completion of tertiary education were 6%. Among composite psychiatric disorders non-completion of secondary education, non-completion of higher secondary education and non-completion of tertiary education were 8%, 6% and 12% respectively. Onset of mental disorders and subsequent drop out from education was found in this study. Further multi-centered prospective and population-based studies should be designed to find out the exact situation.

Anti-HBc Screening of Blood Donors in Bangladesh: Relevance to Containment of HBV Propagation

OBJECTIVES

To avoid further transmission of hepatitis B virus (HBV) infection, blood is tested for hepatitis B surface antigen (HBsAg) before transfusion. However, post-transfusion hepatitis B has been detected in clinics after transfusion of HBsAg-negative blood. The study presented here was undertaken to assess if HBsAg-negative blood is free from HBV or not.

METHODS

Sera were collected from 398 blood donors who were negative for HBsAg. Out of 398 blood samples, antibody to hepatitis B core antigen (ant-HBc) was detected in 82 sera samples. HBV DNA was evaluated in HBsAg-negative, anti-HBc-positive sera. HBsAg, hepatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe), and anti-HBc in the sera were measured by an enzyme-linked immunosorbent assay (ELISA). HBV DNA was quantified by a real time polymerase chain reaction (PCR).

RESULTS

Out of 82 HBsAg-negative, anti-HBc-positive sera samples, HBV DNA were detected in the sera of 7 voluntary blood donors. Out of these 7 subjects, all were negative for HBeAg. The levels of ALT were more than 30 IU/L in 6 of 7 HBVDNA-positive subjects and it was above upper limit of normal (>42 IU/ml) in one subject.

CONCLUSIONS

The present recommendation about blood transfusion of HBsAg-negative blood system is not capable of blocking HBV transmission to blood recipients. Although advanced countries have adopted nucleic acid testing (NAT) for preventing HBV transmission, developing countries may apply anti-HBc testing and ALT estimation before blood transmission.

Niemann-Pick Disease Type B in a 21 Year Old Male

Niemann-pick disease is a group of autosomal recessive disorder of lipid storage with progressive accumulation of sphingomyelin and other lipids in the lysosomes of various tissues. We are reporting a 21 year old male who had hepatosplenomegaly, cherry red macula and normal cognitive function. Bone marrow biopsy showed plenty of foam cells and sphingomyelinase level was low, thus conforming our diagnosis. Survival into adulthood and absence of gross neurological involvement suggests Niemann-Pick disease type B.

Status of Serum Zinc in Multidrug Resistant Tuberculosis

Zinc plays a vital role in the immune status. Its deficiency affects host defense by reducing the number of circulating T cells and phagocytosis activity of other cells which ultimately impair cell mediated immunity. The cell-mediated immunity plays a major role in the causation of pulmonary tuberculosis. The present study was carried out to estimate serum zinc level in newly detected multidrug resistant tuberculosis (MDR-TB) in adult population. In this study total fifty (50) MDR-TB patients were enrolled conveniently from the in-patients departments of National Institute of Diseases of the Chest Hospital (NIDCH), Bangladesh. Serum zinc was estimated by atomic absorption spectrophotometry method from early morning fasting blood sample. Serum zinc level was assessed according to normal cut-off value 70-120 μgm/dl and 76% studied population were found lower than this value. The mean±SD serum zinc level was observed 60.40±8.91 μgm/dl. No associations were found between serum zinc level with age (p=0.11) and with sex (p=0.085) of the study population respectively. The low level of serum zinc in MDR-TB patients suggested impaired immune status of our study population.

Biomass Fuel Smoke and Tuberculosis: A Case-Control Study

This case control study was done to ascertain the association between exposures to biomass cooking fuel smoke and pulmonary tuberculosis. Cases were all newly diagnosed pulmonary tuberculosis patients, randomly collected from the Hospital (DOTS centers) Registry from January 2012 to June 2012 from two Upazillas of Sirajganj district, Bangladesh. A home visitation program was done subsequently. Healthy controls were recruited from the neighbourhood of each case through a predefined procedure. Total 276 new pulmonary tuberculosis cases and 276 neighbourhood controls were enrolled. A semi-structured questionnaire containing demographic information, smoking habits, cooking place, kitchen condition, use of biomass fuel for cooking was used for interview. Crude (unadjusted) odd ratios and their corresponding 95% confidence limits for independent variables were determined by binary logistic regression. All significant variables were entered into a multivariate conditional logistic regression model and a final fitted model was determined by backward elimination methods. In univariate analysis, member of a nuclear family {Unadjusted odd ratio (Unadj. OR) 1.570, 95% CI 1.008-2.44)}, having non-formal education (Unadj. OR 2.739, 95% CI 1.219, 6.153) or primary (Unadj. OR 3.407, 95% CI 1.492, 7.782) to secondary level (Unadj. OR 2.392, 95% CI 1.032, 5.544) education, using cow dung (Unadj. OR 3.961, 95% CI 1.267, 12.376) and biomass fuel i.e. plant origin (Unadj. OR 3.382, 95% CI 1.087, 10.518) for cooking, past smoker (Unadj. OR 2.504, 95% CI 1.061, 5.910), using open oven (Unadj. OR 3.109, 95% CI 0.995, 9.716), having small kitchen area (Unadj. OR 0.99, 95% CI 0.989, 0.999) all were significantly associated with tuberculosis. When all significant variables were entered into a multivariate conditional logistic regression model nuclear family {Adjusted odd ratio (Adj OR) 1.808, 95% CI 1.127, 2.9)}, primary level education (Adj OR 2.86, 95% CI 1.23, 6.647) and non formal education (Adj OR 2.312, 95% CI 1.013, 5.276), biomass fuel (plant origin, Adj OR 3.497, 95% CI 1.059, 11.55), and cow dung (Adj OR 4.368, 95% CI 1.319, 14.464)) used in cooking and irregular smoker (who stop smoking at least 6 month back) (Adj OR 2.806, 95% CI 1.141, 6.901) were significantly associated with tuberculosis cases. From this study significant association have been found between exposure to combustion of biomass cooking fuel and tuberculosis.

Gender Variation in the Risk Factors with Ischemic Stroke: Bangladesh Perspective

It is suggested in different studies that gender has a great impact on the distribution of risk factors of stroke. This study aims at determining the gender differences in risk factors of acute ischemic stroke among male and female patients. Data extracted for this study were taken from a case control study which was carried out in the departments of Neurology and Medicine of Dhaka Medical College Hospital (DMCH) and Shaheed Suhrawardy Medical College Hospital (ShSMCH) Dhaka from July 2009 to June 2011. We collected data of 125 patients with ischemic stroke and 129 healthy controls from the primary source. All secondary data were divided on the basis of gender. Among all male respondents 70 stroke patients were considered as case and 72 healthy respondents were considered as control and in female group 55 were stroke patients (case) and 57 were healthy control. Risk factors of stroke for male and female were evaluated separately. After multivariate analysis ever smoking (both present and ex smoker) (adj. OR 3.799, 95% CI 1.416, 10.19), diabetes mellitus (adj. OR 5.687, 95% CI 1.99, 16.26), hypertension (adj. OR 18.53, 95% CI 6.43, 53.4) and total cholesterol (adj. OR 1.017, 95% CI 1.01, 1.03) were found significant predictors for stroke in male whereas diabetes mellitus (adj. OR 6.989, 95% CI 1.54, 31.64), hypertension (adj. OR 17.85, 95% CI 5.1, 62.38), serum low density lipoprotein (LDL) (adj. OR 1.04, 95% CI 1.013, 1.07) and serum triglyceride (TG) (adj. OR 1.012, 95% CI 1.004, 1.02) were found significant in female. Besides taking the controlling measure for hypertension and diabetes mellitus, life style modification is an important factor to prevent stroke in both sexes.

In situ degradation studies of two-dimensional WSe₂-graphene heterostructures

Heterostructures of two-dimensional materials can be vulnerable to thermal degradation due to structural and interfacial defects as well as thermal expansion mismatch, yet a systematic study does not exist in the literature. In this study, we investigate the degradation of freestanding WSe2-graphene heterostructures due to heat and charge flow by performing in situ experiments inside a transmission electron microscope. Experimental results show that purely thermal loading requires higher temperatures (>850 °C), about 150 °C higher than that under combined electrical and thermal loading. In both cases, selenium is the first element to decompose and migration of silicon atoms from the test structure to the freestanding specimen initiates rapid degradation through the formation of tungsten disilicide and silicon carbide. The role of the current flow is to enhance the migration of silicon from the sample holder and to knock-out the selenium atoms. The findings of this study provide fundamental insights into the degradation of WSe2-graphene heterostructures and inspire their application in electronics for use in harsh environments.

Pylorus Preserving Pancreaticoduodenectomy vs. Standard Whipple's Procedure in Case of Carcinoma head of the Pancreas and Periampullary Carcinoma

Pancreatic carcinoma is a life threatening condition. Surgical resection is the only hope of cure. Advances in surgical technique have reduced the mortality rate. Nevertheless, operative complications related with morbidity still remains high. Two operation techniques in the treatment of periampullary and pancreatic head cancer: the Standard Whipple operation (SW) and Pylorus Preserving Pancreaticoduodenectomy (PPPD) are performed predominantly. This study was performed to compare the results of Pylorus Preserving Pancreaticoduodenectomy (PPPD) with that of the Standard Whipple's (SW) procedure. This prospective study was carried out in the Department of General Surgery, BSMMU in two years duration. All admitted patient's with periampullary carcinoma and carcinoma of the head of the pancreas were included and randomized for a SW or a PPPD resection. Data regarding patients demographics, preoperative assessment, intraoperative and postoperative findings were collected and analyzed. Less blood loss (2.67±0.65 units in Group I and 2.88±0.64 units in Group II), fewer need of blood transfusions and shorter hospital stay in the PPPD group were observed. Gastrointestinal leakage was similar in both groups of patients (1:1). One pancreatic fistula (8.3% in Group I) was observed in PPPD group and one intra-abdominal abscess developed in Standard Whipple's procedure (00.0% in Group I and 12.5% in Group II). Bile leakage was higher in standard Whipple procedure (8.3% in Group I and 37.5% in Group II). Morbidity was more or less similar in both groups (58.0% in Group I and 50.0% in Group II) but one patient (12.5% in Group II) died in standard Whipple's resection. PPPD procedure is more effective treatment for periampullary carcinoma and cancer of the pancreatic head region than the standard Whipple's operation.

Association of hypoglycemia, hypocalcemia and hypomagnesemia in neonates with perinatal asphyxia

The clinical evidence of neurological menifestations associated with asphyxia is described as hypoxic ischaemic encephalopathy (HIE). A variety of metabolic problems are present in asphyxiated newborns including hypoglycemia, hypocalcemia, hypomagnesemia and others metabolic abnormalities. Some of these biochemical disturbances may trigger seizure or potentiate further brain damage. This cross sectional case-control study was done in Mymensingh Medical College Hospital, to identify the association of hypoglycemia, hypocalcemia, hypomagnesemia in neonates with perinatal asphyxia. Study period was six months. Sample size was 60. Among total sample 30 term asphyxiated newborns of <24 hours age were case and equal number term healthy newborns <24 hours age were control. The main clinical presentations were delayed cry after birth along with respiratory distress, convulsion and absence of cry in asphyxiated newborns. Major physical findings were cyanosis, convulsion and tachypnoea in asphyxiated group. The mean value of serum calcium level was significantly lower in asphyxiated newborns (7.37 ± 0.10mg/dl) than control value (8.04±0.09mg/dl). Hypocalcemia was found among 23.33% babies in case group. On the contrary, hypocalcemia was found in single baby among control group. The mean value of serum magnesium was significantly lower in asphyxiated newborns (1.83 ± 0.04mg/dl) than control value (1.96 ± 0.05mg/dl). Hypomagnesemia was found among 3(10%) newborns but none was found among control group. Hypoglycemia was found in 7(23.33%) cases though the mean value of blood glucose was higher in case group (5.72 ± 0.62mmol/l) than control group (4.87 ± 0.15mmol/l) difference was not statistically significant. Combined hypoglycemia, hypocalcemia and hypomagnesemia were found in 1(3.33%) case; combined hypoglycemia and hypocalcemia were found in 2(6.67%) cases; and combined hypocalcemia and hypomagnesemia were found in 1(3.33%) case. During the study period, 3(10.0%) cases were expired but no death occurred among control group. This study shows isolated or combined hypoglycemia, hypocalcemia, hypomagnesemia are frequently found in newborns with perinatal asphyxia. So, it is necessary to monitor blood glucose, serum calcium and also serum magnesium among asphyxiated newborns for proper management.

Morphometric study of dentate nucleus of cerebellum in Bangladeshi cadaver

This cross sectional descriptive study was done by using nonprobability sampling technique and performed by examining 63 (sixty three) cerebellum. Out of them 40 postmortem human cerebellum collected from Bangladeshi cadavers of both sexes (male 25 and female 15) age ranging from 5 to 60 years and 23 cerebellums from caesarian section of intrauterine death cases of both sexes (male 14 and female 9) age ranging from 34 to 41 weeks of gestation. Specimens were collected from dead bodies autopsied on different dates from April' 2009 to September' 2009 at the autopsy laboratory of department of Forensic Medicine and prenatal cases from Gynaecology and Obstetrics Department of Mymensingh Medical College, Mymensingh. The collected specimens were grouped into three age groups like Group A (28 to 42 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years) and, two sex groups (male and female) and two sides (right and left). A transverse section was made at the level of horizontal fissure, and length and breadth of dentate nucleus were measured by divider and scale. The mean (±SD) length and breadth of dentate nucleus was 8.619±2.995mm and 14.770±3.604mm respectively and it was observed that length and breadth of dentate nucleus increased with age upto certain level then slightly decreased in the late age Group C. In this study, differences of the mean length of dentate nucleus on both right and left sides were statistically moderately significant between age Groups A&B. The differences of mean breadth of dentate nucleus on both right and left side were statistically highly significant between age Groups A&B and moderately significant between age Groups A&C on right side and only significant on left side. The differences between male & female were statistically insignificant in length and breadth of dentate nucleus.

Case report on carotid body tumor

A 40 years old lady presented to us with the complaints of repeated attack of syncope with left sided neck swelling. Ultrasonography, Color Doppler study and arteriography were done which revealed a solid vascular mass in the carotid bifurcation. Mass was resected and histopathology was done. Histopathologic findings were typical of a carotid body tumour. As carotid body tumour is a rare disease. So, we are going to present this in this article.

Pattern of dyslipidaemia among the Bangladeshi type 2 diabetic patients presented with acute coronary syndrome

Increasing prevalence of diabetes and its complications in the developing communities would pose a threat in respect to their existing health care service. An increased incidence of atherosclerosis in insulin-dependent diabetic patients has long been recognized. Hyperlipidaemia, a common finding in these patients, may be one of the contributing factors. The objective of our study is to find out the patterns of dyslipidaemia among the Bangladeshi patients with type-2 diabetes mellitus presented with acute coronary syndrome. This study was conducted in the department of cardiology of BIRDEM and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period of January 2009 to December 2009. A total of 100 patients were included in this study, according to the inclusion and exclusion criteria. Diabetes Mellitus and Acute Coronary Syndrome was diagnosed according to the guideline of American Diabetic Association and American College of Cardiology respectively. Among the respondents Mean±SD of fasting blood sugar and 2 hours ABF were 9.23±3.6mmol/L and 12.61±8.52mmol/L respectively. Mean±SD of HbA1C of the respondents was 7.23±2.12. Total cholesterol level <150mg/dl, 150-200mg/dl and >200mg/dl were 27.0%, 42.0% and 31.0% respectively. HDL cholesterol <40mg/dl and >40mg/dl were 76.0% and 24.0% respectively. LDL cholesterol <150mg/dl and >150mg/dl were 43.0% and 57.0% respectively. TG within 40 to 160mg/dl and >160mg/dl were 73.0% and 27.0% respectively, Mean±SD of Total Cholesterol, HDL Cholesterol, LDL Cholesterol and Triglyceride were 162.43±38.62, 37.41±8.59, 137.43±22.73 and 156.43±41.92mg/dl respectively.

The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.

Intermittent prophylaxis of recurrent febrile seizures with clobazam versus diazepam

Febrile seizures are the most common type of seizure among children that can be prevented by using prophylactic drugs like Clobazam and Diazepam. The present prospective study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh over a period of 1 year from July 2012 to June 2013 to compare the effectiveness of intermittent Clobazam versus Diazepam therapy in preventing the recurrence of febrile seizures and assessed adverse effects of each drug. A total of 65 patients (32 children administered Clobazam and rest 33 children received Diazepam) of simple and complex febrile seizures aged 6 months to 5 years of both sexes were the study population. Data were collected by interview of the patients, clinical examination and laboratory investigations using the research instrument. Data were analyzed by using Chi-square (χ2) Test, Student's 't' Test and Fisher's Exact Test. For all analytical tests, the level of significance was set at 0.05 and p<0.05 was considered significant. The proportion of patients was higher between age 12-36 months and male was predominant in the both Clobazam and Diazepam groups. Over 31% of patients in Clobazam group who experienced episode of fever within 3 months, 40.6% within 6 months and 9.4% within 9 months compared to 36.4% in Diazepam group within 3 months, 45.5% within 6 months & 12.1% within 9 months after discharge from the hospital. Three (9.4%) patients in Clobazam group and 7(21.3%) in Diazepam group who experienced febrile convulsion during the follow up period. From the data adverse effects within 3 and 6 months experienced by the patient's drowsiness, sedation and ataxia were higher in Diazepam group than those in Clobazam group. However, within 9 months lethargy and irritability were somewhat higher in Clobazam group than those in Diazepam group. The mean duration of hospitalization was significantly higher in Diazepam group compared to Clobazam group (6.0±1.0 vs. 4.6±0.08 days, P<0.001). Seven (21.2%) out of 33 children with febrile seizures in Diazepam group had a history of recurrent seizures, whereas 3(9.4%) of 32 children in the Clobazam group. The risks of recurrent febrile seizure in the Diazepam group was 2.6 times greater compared to those in the Clobazam group (P=0.186). The result indicates that Clobazam is safe, efficacious, requires less frequent dosing and has less adverse effects such as drowsiness, sedation, ataxia and irritability as compared to Diazepam. So, Clobazam may be an alternative to Diazepam given intermittently for prevention of recurrent febrile seizures.

Comparison between azithromycin and cefixime in the treatment of typhoid fever in children

An intervention study was carried out in the department of paediatrics of Mymensingh Medical College Hospital, Mymensingh to compare the clinical efficacy of Azithromycin in the treatment of childhood typhoid fever with that of cefixime for a period of one year from January 2011 to December 2011. A total of 60 cases of typhoid fever were enrolled in to a randomized clinical trial and was divided into two groups. The inclusion criteria of the cases were: Documented fever for more than 4 days plus two or more of the following clinical features: toxic physical appearance, intestinal complaints, coated tongue, ceacal gurgling, hepatomegaly and splenomegaly, diarrhoea and constipation plus positive Widal test and/or blood culture positivity. Patients who had complication like GIT heamorrhage; intestinal perforaion and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg/day for a period of 07 days Cefixime was given at a dose of 20mg/kg/day in two divided dose for 14 days. The mean time of defervesence was 4.05+1.14 days with azithromycin and 3.41+0.95 with cefixime respectively. The minimum defervesence time was 02 days and maximum defervesence time was 07 days. Clinical cure rate was 87% in azithromycin group and 93% in cefixime group. No serious adverse effect was noted related to azithromycin and cefixime therapy except nausea, vomiting, diarrhoea and jaundice. It was found that azithromycin is almost as effective as cefixime in the treatment of typhoid fever.

Vaginal rhinosporidiosis: a case report

The female genital tract is an extremely rare site for Rhinosporidiosis. Here we described a 13 year old girl who presented with a slow growing polypoid fleshy mass in the posterior vaginal wall near the orifice for 6 months with scanty bleeding from the mass. The girl was admitted to hospital with profuse watery vaginal discharge. Excision of the mass was followed by histopathological examination which confirmed the diagnosis Rhinosporidiosis.

Comparison of coronary CT angiography with conventional coronary angiography in the diagnosis of coronary artery disease

Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ≤ 50%, stenosis > 50%, and stenosis > 75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis.

Duodenal carcinoid tumor - a case report

Carcinoid tumors are well differentiated neuroendochrine tumors which most frequently involve the gastrointestinal tract; however duodenal carcinoid tumors are rare. They can present with various clinical symptoms and are difficult to diagnose. A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. Polyp was removed by endoscopic resection and tissue was taken for biopsy. Histological findings of biopsy specimen shows carcinoid tumor. As duodenal carcinoid tumor is a rare presentation so we are going to present this case in this article.

Dieulafoy's lesion: an overview

Dieulafoy's lesion accounts for 1-5.8% of cases of acute upper GI bleeding. The two largest retrospective series, both from North America, found Dieulafoy's lesion as the source of hemorrhage in 1.9% and 1.2% of all endoscopies performed for acute GI bleeding. In the prospective study of Chung et al., Dieulafoy's Lesion was found in 3.4% of all patients with acute GI bleeding referred to their unit. The Dieulafoy's Lesion accounted for up to 40% of all causes of nonvariceal upper GI bleeding not caused by gastric or duodenal ulceration or esophageal varices in the prospective study of Matsui et al. In the study of Schmulewitz and Bailli, colonic Dieulafoy's Lesion were only found in 0.09% of all colonoscopies performed for lower GI bleeding. The actual incidence of both upper and lower GI bleeding from Dieulafoy's Lesion is likely higher than estimated because the diagnosis remains difficult. Recent advances in endoscopy have led to an increased detection of Dieulafoy's lesions. Initial GI endoscopy is effective in diagnosing up to 70% of patients. Several endoscopies may be required with 6% of patients, requiring three or more to establish the diagnosis. Angiography and/or red cell scanning can be used when endoscopy fails to diagnose a doubtful case. There is no definite unique policy for the treatment of Dieulafoy's lesions. Therapeutic endoscopy remains the first line of treatment option for controlling the bleeding while angiography is considered as a valuable alternative. Surgical intervention is kept for failure cases where it should be guided by preoperative localization. The mortality rate has decreased dramatically from 80% to 8.6% in recent times due to advancement in both diagnostic and therapeutic tools.

A high risk critical mitral valve stenosis with emergency management at Apollo Hospitals Dhaka

Heart valve surgery in high-risk patients with severe jaundice, congestive hepatomegaly and renal impairment is associated with considerable morbidity and mortality. Without operation the consequences are invariably grave. A 35 years old gentleman with congestive cardiac failure was initially treated in coronary care unit (CCU). Mitral valve area was 0.5cm², pulmonary arterial systolic pressure (PASP) was 110mmHg, serum bilirubin was 20mg/dl, SGPT & SGOT were 1024iu/l and 1027iu/l respectively. Serum creatinine was 3.35mmol/l. Serum bilirubin gradually diminished to 3.1mg/dl after 12 days treatment in Coronary Care Unit but next day it increased to 3.6mg/dl. Mitral valve was replaced on an emergency basis. Echocardiogram on the 5th post operative day showed well functioning prosthetic mitral valve in situ. Serum bilirubin decreased to 2.2mg/dl, SGPT, SGOT and serum creatinine to 43iu/l, 40iu/l and 1.34mmol/l respectively. After 8 weeks of postoperative follow up his serum bilirubin decreased to 0.8mg/dl.

Morphometric study of thyroid angle in different age and sex in Bangladeshi cadaver

This cross sectional descriptive study was to measure the thyroid angle and to establish the difference between sexes of different age groups in Bangladeshi cadaver. A total 60 human larynges were collected by purposive sampling from October 2008 to March 2009. Among them 45(male 23 and female 22) were collected from Bangladeshi cadavers (9 to 60 years) at the autopsy laboratory of Department of Forensic Medicine and 15 (male 6 and female 9) from stillborn infants of viable age (28 to 40 weeks of gestation) from Gynaecology and Obstetrics Department of Mymensingh Medical College, Mymensingh. The thyroid angle was measured and significant differences of the dimensions between different age and sex groups were observed. In the present study observed findings was compared with those of other researchers. The mean±SD thyroid angle was found as 65.00±11.65 degree in age Group A (28 to 40 weeks of gestation), 73.69±6.56 degree in age Group B (9 to 16 years) and 77.76±7.76 degree in age Group C (17 to 60 years). The mean thyroid angle was higher in female (83.1667±5.78220 degree) than that in male (73.9412±7.09460 degree) and statistically moderately significant in Group C, where t = 3.853 and p = 0.001. In statistical analysis, differences between age and sex groups were calculated by using Students (unpaired) 't' test. The present study revealed that the value was significantly greater in adult female than male and the value increased with age.

Characterizing microscale biological samples under tensile loading: stress-strain behavior of cell wall fragment of onion outer epidermis

PREMISE OF THE STUDY

The results of published studies investigating the tissue-scale mechanical properties of plant cell walls are confounded by the unknown contributions of the middle lamella and the shape and size of each cell. However, due to their microscale size, cell walls have not yet been characterized at the wall fragment level under tensile loading. It is imperative to understand the stress-strain behavior of cell wall fragments to relate the wall's mechanical properties to its architecture. •

METHODS

This study reports a novel method used to characterize wall fragments under tensile loading. Cell wall fragments from onion outer epidermal peels were cut to the desired size (15 × 5 µm) using the focused ion beam milling technique, and these fragments were manipulated onto a microelectromechanical system (MEMS) tensile testing device. The stress-strain behavior of the wall fragments both in the major and minor growth directions were characterized in vacuo. •

KEY RESULTS

The measured mean modulus, fracture strength, and fracture strain in the major growth direction were 3.7 ± 0.8 GPa, 95.5 ± 24.1 MPa, and 3.0 ± 0.5%, respectively. The corresponding properties along the minor growth direction were 4.9 ± 1.2 GPa, 159 ± 48.4 MPa, and 3.8 ± 0.5%, respectively. •

CONCLUSIONS

The fracture strength and fracture strain were significantly different along the major and minor growth directions, the wall fragment level modulus of elasticity anisotropy for a dehydrated cell wall was 1.23, suggesting a limited anisotropy of the cell wall itself compared with tissue-scale results.