Integrating High-Resolution Mass Spectral Data, Bioassays and Computational Models to Annotate Bioactives in Botanical Extracts: Case Study Analysis of C. asiatica Extract Associates Dicaffeoylquinic Acids with Protection against Amyloid-β Toxicity

Rapid screening of botanical extracts for the discovery of bioactive natural products was performed using a fractionation approach in conjunction with flow-injection high-resolution mass spectrometry for obtaining chemical fingerprints of each fraction, enabling the correlation of the relative abundance of molecular features (representing individual phytochemicals) with the read-outs of bioassays. We applied this strategy for discovering and identifying constituents of Centella asiatica (C. asiatica) that protect against Aβ cytotoxicity in vitro. C. asiatica has been associated with improving mental health and cognitive function, with potential use in Alzheimer's disease. Human neuroblastoma MC65 cells were exposed to subfractions of an aqueous extract of C. asiatica to evaluate the protective benefit derived from these subfractions against amyloid β-cytotoxicity. The % viability score of the cells exposed to each subfraction was used in conjunction with the intensity of the molecular features in two computational models, namely Elastic Net and selectivity ratio, to determine the relationship of the peak intensity of molecular features with % viability. Finally, the correlation of mass spectral features with MC65 protection and their abundance in different sub-fractions were visualized using GNPS molecular networking. Both computational methods unequivocally identified dicaffeoylquinic acids as providing strong protection against Aβ-toxicity in MC65 cells, in agreement with the protective effects observed for these compounds in previous preclinical model studies.

Prevalence of Diarrhea and its Relation with Severity of the Disease among Covid-19 Positive Patient in a Selected Covid Dedicated Hospital

Covid-19 has become a pandemic since its emergence in Wuhan, China. It involves Gastro intestinal (GI) system and diarrhea is recognized as an important symptom. Diarrhea is also associated with disease severity. This study was conducted to see the prevalence of diarrhea in Covid-19 positive patient and its relation with disease severity. Prospective observational study done among consecutive Covid-19 positive patient of both sex admitted in Mugda Medical College Hospital in Dhaka from February 2021 to April 2021. Informations were collected by face to face interview and severity was assessed on bedside. Among 166 Covid-19 positive patient 40.0% developed diarrhea. Mean age of the diarrheal patients was 44.21±14.40. Women affected more than men (51.0% versus 49.0%). In majority patient (62.0%) diarrhea persist for 3-7 days and majority had frequency of bowel movement 3-5 times per day. Regarding Bristol stool type 47.0% had stool type 6 followed by stool type 7(43.0%) and stool type 5(10.0%). Half of the diarrheal patient (48.0%) had severe pneumonia. Severe pneumonia is significantly more common in non-diarrheal patients (65.0%) than in diarrheal patient (35.0%) (p=0.007). This study reflects that a large number of Covid-19 positive patients developed diarrhea. Half of the diarrheal patients had severe pneumonia. But severe pneumonia is significantly common in non-diarrheal patient than diarrheal patients.

Glasgow Coma Score Predicting the Poor Outcome of the Patients Presenting Fever with Altered Sensorium

To assess the role of the Glasgow Comma Score (GCS) for predicting the outcome of the patient with fever and altered sensorium was the objective of the study. This prospective observational study was conducted for six months following ethical approval. Informed consent was obtained prior enrollment. A total of 50 patients with complaints of fever for <2 weeks duration with altered sensorium with or without seizure were included in the study. GCS was calculated for all patients just after admission and before starting interventions. All patients were investigated and managed according to the hospital protocol. The outcome of the patients (living or dead within the hospital) was evaluated against the admission GCS score. The study was performed in accordance with the current Declaration of Helsinki. Of all, 42.0% (n=21) of the patients had bacterial meningitis, followed by viral encephalitis, cerebral malaria and coma vigil. Complete recovery occurred in 60.0% of cases, while recovery with disability occurred in 28.0% of cases. Death occurred in 12.0% of cases (n=6) due to cerebral malaria, viral encephalitis and bacterial meningitis (n=2 each cause). A higher number of deaths occurred in the lower GCS group (n=5 in GCS group 3-5) and this difference was statistically significant (p<0.05). Moreover, considering death as an outcome, multivariate logistic regression showed that GCS (OR 70.598, 95% CI-1.243-4009.41; p=0.039) was an independent predictor of the outcome. GCS seemed to be a predictor of the short-term outcome of the patient presenting with fever and altered sensorium in our setting. However, further exploration in larger setting with appropriate study design is recommended.

Diseases Pattern and Outcome among the Neonates in A Newly Established Special Care Newborn Unit (SCANU) At Secondary Level District Hospital in Bangladesh

Although huge improvement in neonatal mortality reduction in last two decades in Bangladesh but it is still very high compare with many other countries. High neonatal mortality also significantly contribute deaths among the under five children. Neonatal mortality reflects a nation's socio-economic status, efficiency and effectiveness of health care services. This was cross sectional study. The objective of this study was to analyse the diseases pattern and outcome of the neonates admitted in the newly established SCANU (Special care neonatal unit) of 250 bedded General Hospital of Tangail district, Bangladesh. Study period was one year from January 2017 to December 2017. Information from medical records of the SCANU was analysed. During the study period 1,379 neonates were admitted in the SCANU. The ratio between male and female was 1.5:1, 61% of the neonates admitted at first day of life. The reasons for admissions in SCANU were 31% of preterm and low birth weight, 23%birth asphyxia, 13% neonatal sepsis, 9% transient tachypnea of newborn, 5% congenital anomalies and 4% neonatal jaundice. Out of all neonates survival rate was 56% (779), while 25% (349) ended with fatality, 9% (122) were referred to tertiary level hospital and 10% (129) were left the hospital against medical advice. Among the fatal cases 63% died in first 24 hours and 88% in first week of life. Data shows that 47% deaths were due to preterm and low birth weight with its complication, other significant causes were birth asphyxia (30%), septicemia (16%) and congenital anomalies were (6%). Preterm and low birth weight, neonatal sepsis, birth asphyxia, transient tachypnea of newborn; congenital anomalies were the main reasons for admission in SCANU. Prematurity and its complication, birth asphyxia and neonatal sepsis as the major contributors to the neonatal mortality. The study findings will help researchers and policy makers to initiate further research and interventions to reduce fatality among the neonates in the SCANU.

Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study

Eosinophilic esophagitis (EoE) is a disease of modern era. It was first described 40 years back. Since then it has drawn an immense interest among the clinicians. It is diagnosed by the presence of eosinophils count ≥15/HPF on esophageal biopsied mucosa in patients with symptoms of esopohageal dysfunction. It is more prevalent among patients with gastroesophageal reflux disease. As its symptoms overlap with that of gastroesophageal reflux disease (GERD), it is frequently overlooked & misdiagnosed which increases patients' sufferings. No data is available in Bangladesh. The objective of the study was to find out the frequency of eosinophilic esophagitis among patients with gastroesophageal reflux symptoms. The study was conducted at the Outpatient department of the department of Gastroenterology of Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2018 to April 2019. One hundred and thirty three (133) consecutive patients with symptoms suggestive of gastroesophageal reflux disease based on validated questionnaire underwent upper GI endoscopy. Biopsies were taken from proximal and distal esophagus as well as any other endoscopically abnormal esophageal mucosal lesion. Among 133 patients with gastroesophageal reflux symptoms, 7 patients (5.3%) were found to be positive for eosinophilic esophagitis. Mean age at diagnosis was 37.28±13.38 years. It was more common in younger age group. Female patients (56%) were more than male patients (44%). Heart burn was the major symptom followed by acid regurgitation. Nocturnal cough showed statistically significant relationship with eosinophilic esophagitis. Although the frequency is low, it may be considered as a differential diagnosis among patients with GERD.

Measuring Sensitivity, Specificity and Accuracy of HRCT of Chest and Comparison with Biomarkers in COVID-19 Suspected Patients: A Cross Sectional Study

COVID-19 is a declared pandemic by World Health Organization. The diagnostic tests are not of high specificity and sensitivity, so far. Pro-inflammatory biomarkers and High Resolution Computed Tomography (HRCT) of chest are the common investigations performed to evaluate the diagnosis and prognosis of COVID-19. The objective of this study was to estimate the sensitivity, specificity and accuracy of HRCT and to find out the relationship between the biomarkers and HRCT findings. This was a cross-sectional descriptive study carried out in the COVID-19 suspected isolation unit of a tertiary hospital from July 2020 to November of 2020. Data were collected from electronic medical record (EMR). Relationship test were done by t-test and one-way-ANOVA test. Total 123 cases were enrolled after matching with selection criterion. Mean age of male was 62.5 years and female 57.7 years. Highest frequency of participants was observed in the 60-69 year age group. According to HRCT% findings 4 groups were made. They are below 25%, 25%-50%, 51%-75% and 76%-100%. The distribution of case among these groups was 15%, 44%, 35% and 6% respectively. The relationship between biomarkers (NLR, D-dimer, Ferritin and CRP) and HRCT% was found significant (p<0.05). In HRCT 92.5% lesion were peripherally placed and 99.2% cases were affected by both lungs. The sensitivity and specificity of HRCT were found 46% and 72.6% respectively with 62% accuracy. Raised biomarkers are significantly related to the more lung involvement in case of COVID-19 suspected pneumonia patients. These biomarkers will be helpful as diagnostic and prognostic markers for this disease. HRCT percentage can play an important role as diagnostic and prognostic tool in case of COVID-19 suspected cases.

Vas Deferens Calcification in a Diabetic CKD: An Incidental Finding

Vas deferens calcification is a very rare condition. The causes can be categorized as inflammatory and non-inflammatory type. We are presenting such a non inflammatory type of bilateral vas calcification in a diabetic chronic kidney diseases (CKD) patient. Presented patient a 50 years old man admitted in Samorita Hospital Ltd., Dhaka, Bangladesh on 03 August 2014 in cabin - 537 with registration number 1904/14. He was labeled as Diabetes mellitus (DM), Hypertension (HTN), CKD & Urinary tract infection (UTI). Vas deferens calcification was diagnosed incidentally by X-ray KUB. Subsequently we have discussed all possible causes in this report. The purpose of presenting this rare imaging finding is to emphasize the under diagnosis of the disease and causes. It can also be diagnosed by simple, easily available and cheap investigations like Plain X ray KUB.

Helicobacter Pylori Infection and Vitamin B12 Deficiency During Early Pregnancy in an Urban Slum in Bangladesh (P24-035-19)

Objectives

Helicobacter pylori (H. pylori), an inflammatory gastric bacterial infection is prevalent worldwide and may impair the absorption of many micronutrients, particularly iron and vitamin B12. We measured H. pylori infection status in the extracted stool sample in pregnant women and examined its associations with biomarkers of vitamin B12 (B12) status.

Methods

In a blinded-placebo controlled trial, Bangladeshi women (n = 160, 18–35 years, gestational weeks 9–14, Hb > 70 g/L) were randomized to receive either B12 (100 μg/day) fortified or control milk throughout pregnancy up to 6-mo postpartum. Baseline data of the trial were used to conduct this analysis. Blood and stool samples were collected from all participants at enrollment. Folate, B12 and total homocysteine (tHcy) in plasma were measured by electrochemiluminescence immunoassay. Plasma active-B12 was determined by enzyme linked immunosorbent assay and H. pylori antigen in feces was measured by enzyme immunoassay.

Results

The mean hemoglobin concentration of women was 116.5 ± 10.2 g/L and 25.6% had anemia (Hb < 110 g/L). About 6.25% of the women were B12 deficient (150 pmol/L) and 29.38% had marginal status (150–220 pmol/L). The mean active B12 concentration was 43.3 ± 22.4 pmol/L and 39.38% (<35 pmol/L) were at risk of B12 deficiency. Elevated tHcy was found in 34.1% of the women (>8 μmol/L) and 3.8% had low plasma folate (<3.1 ng/mL). The majority of the participants (65%) had fecal H. pylori antigen, indicating asymptomatic carriage state. Presence of H. pylori antigen was accompanied by B12 deficiency in ̴23% of the women. Logistic regression analysis revealed that the odds of having H. pylori antigen was lower in women with increasing age [OR: 0.89 (95% CI: 0.81, 0.96); p-value = 0.005]. However, the results showed no significant association between B12 markers and H. pylori infection.

Conclusions

The high prevalence of H. pylori infection co-exists with micronutrient deficiencies during early pregnancy in an urban slum in Bangladesh, meriting more comprehensive approaches for their evaluation and prevention.

Funding Sources

Nestle Foundation.

Study on Neurological Consequence of Eclampsia

The present study was carried out in the Department of Obstetrics and Gynecology at Mymensingh Medical College Hospital, Mymensingh, Bangladesh for a period of one year from 1st June 2009 to 30th June 2010 to see the Neurological Consequence of Eclampsia. A total number of 37 patients were enrolled in this study. Among 37 patients majority are in the age group of 21-30 years which is 19(51.4%) cases followed by less than or equal to 20 years and more than 30 years which are 13(35.1%) cases and 5(13.5%) cases respectively. Knee jerk is present in 28(75.7%) cases and absent in 8(21.6%) cases. The exaggerated knee jerk is present in only in 1(2.7%) case. The rate of Glasgow coma scale is less than 5 in 21(56.8%) cases, 14(37.8%) cases in 5-10 and 2(5.4%) cases is in more than 10. Focal sign is absent in 22(59.5%) cases and present in 15(40.5%) cases. Majority of the patients is presented with absence of neck stiffness which is 35(94.6%) cases and the rest 2(5.4%) cases are presented with neck stiffness. Flexor planter response is found in 20(54.1%) cases which is the highest in number followed by extensor which is 15(40.5%) cases. In only 2(5.4%) cases the planter reflex is not elicitable. Presence of infarct is found in 15(40.5%) cases which is the highest number. Cerebral edema and Presence of haemorrhage is found in 3(8.1%) cases in each. Leuko-encephalopathy is found in 2(5.4%) cases. Encephalopathy and Both infarct & haemorrhage is found in 1(2.7%) case of each. Normal CT scan findings of brain are found in 12(32.4%) cases.

Impact of livestock rearing practices on public health and environmental issues in selected municipality areas of Bangladesh

Livestock keeping at urbanized areas is increasing folds in rate now-a-days in Bangladesh. To characterize the urban livestock keeping practices and its implications on public health and environmental issues in Mymensingh, Gazipur and Shariatpur municipality, Bangladesh, a questionnaire survey was carried out. Ninety livestock keepers were freely characterized and data were obtained through interview. Data were analyzed using percentage and mean. Age does not have any role in keeping livestock at municipal areas. Majority (73%) of the respondents have at least primary education. Male dominates in keeping livestock than female. Local political leader kept the highest number of animals then self-employer or trader takes the second position. Dairy cattle share a lion number (67%) over other species. Ninety five per cent (95%) available breeds in municipal areas are crossbred and the rest is indigenous. More than 75% livestock holders keep their animals over 3 years and only 6% keepers sell their animals within 6 months. Most of the livestock keepers (56%) use their calf as replacement stock. The majority (66%) of the livestock depends on grazing and scavenging for feed from government and municipal lands, unfenced open land, roadsides, rubbish dumps. Most of the livestock owner (66%) does not supplement to their animals with feeds other than free scavenging throughout the rearing time. Most of the farmers (85%) have temporal shed for sheltering their animals during night time. Almost 78% flying herds available in municipal areas drink water from drainage line. Disease outbreaks are 21%, 18%, 17%, 16%, 13%, and 10% of ecto-parasite, mastitis, helminthosis, lumpy skin disease, wounds, and diarrhoea. 14% livestock owner follow vaccination program to keep better their animals from viral or bacterial infections. All the respondents (100%) are aware that livestock keeping could have a negative effect on urban health and environment. More than 50% of the respondents choose dung and urine disposal, malodor and blocked roads are the major damages caused by livestock. Strategies for controlling the damages were as follows: awareness through broadcasting documentary via mass media (4.33), regular health check via veterinary services (3.96), keeping database and regular updated of livestock keepers (3.82), proper disposal of waste (3.69), strengthening rules and policy development for local authority (3.61), reducing numbers of animal (3.48), provision of extension services (3.47), cleaning vicinity daily (3.32). There were some measures taken from public interviewing which need to amend for keeping health and environment free from diseases and pollution.Bang. J. Anim. Sci. 2016. 45 (1): 44-51

Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus

Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups.

Prevalence of Gastrointestinal Helminth Infections in Indigenous Chickens of Selected Areas of Barisal District, Bangladesh

The prevalence of gastrointestinal helminth infections and the gross pathological lesions produced by them were studied from February 2012 to January 2013 in the Department of Pharmacology of Bangladesh Agricultural University, Mymensingh. In this study, a total of 320 indigenous chickens aged ranging from 2 to 4 months were examined to identify the different types of gastrointestinal helminth infections in indigenous chickens. During routine examination, six species of helminth parasites were recorded, of which five species of nematodes such as Ascaridia galli, Heterakis gallinarum, Capillaria spp, Acuaria hamulosa and Dispharynx spiralis; and one species was cestode called Raillietina tetragona. The highest prevalence was observed for Ascaridia galli (41.56%) followed in descending order by Raillietina tetragona (19.68%), Heterakis gallinarum (15.62%), Acuaria hamulosa (8.75%), Capillaria spp. (4.68% ) and Disopharinx spiralis (1.56%). The gross pathological lesions were observed in case of Acuaria hamulosa and Heterakis gallinarum infection. In case of Acuaria hamulosa infection keratinization of gizzard mucosa and cross section of adult Acuaria hamulosa were seen along with marked infiltration of neutrophils. The results of this study suggest that both nematodes and cestodes are highly prevalent in indigenous chickens in the studied area.DOI: http://dx.doi.org/10.3329/bjvm.v12i2.21275 Bangl. J. Vet. Med. (2014). 12 (2): 135-139 

Wandering biliary ascariasis with hepatic abscess in a postmenopausal woman

Hepatobiliary ascariasis is common in developing countries where there is a low standard of public health and hygiene. We are reporting a rare case of ascariasis which induced multiple liver abscesses in a post menopausal woman who presented with fever, anorexia, nausea, vomiting and mild hepatomegaly. Ultrasonography revealed biliary ascariasis with multiple hepatic abscesses. Laparoscopic drainage of hepatic abscesses was done and microscopic examination of drainage materials showed decorticated eggs of Ascaris Lumbricoides. The post operative recovery of the patient was uneventful. Ultrasonography is a reliable modality to diagnose and follow up of such cases.

The Ameliorating Effects of Garlic (Allium sativum) against Lead (Pb) Intoxication on Body Weight, Dressing Percentages, Feed Consumption and Feed Conversion Ratio in Lead Induced Broiler Chickens

Lead (Pb) has extensive commercial and industrial use despite of its recognized as health hazard. The therapeutic application of garlic (Allium sativum) was investigated for preventing the toxic effect of lead (Pd) in lead exposed chickens. 350 commercial broiler chickens were grouped into five such as T0, T1, T2, T3 and T4consisting of 70 birds each where T0 served as control. T1 was provided with lead acetate at 100mg/kg body weight, T2 had 100mg/kg lead acetate + 1% garlic supplement, T3 was fed with 100mg/kg lead acetate + 2% garlic supplement and T4 had 100mg/kg lead acetate + 4% garlic supplement for 42 days. Garlic was found to be capable of elimination of lead (Pb). Analysis of variance statistically revealed that significant (P<0.01) lower level of live weight (g), carcass weight (g) and eviscerated fresh carcass weight (%) were 2015.26±49.73, 1124.45±11.67 and 60.63±3.18, respectively in the chickens in group T1 at 42nd day of treatment in comparison to other groups. All garlic treatment groups satisfactorily increased live weight and carcass weight. Following the application of dietary garlic, mean values of live weight (g), carcass weight (g) and eviscerated fresh carcass weight (%) were significantly (P<0.01) increased at 2156.63±74.52, 1455.85±9.21 and 63.96±2.18 in group T3. Feed conversion ratio showed non-significant differences between different groups, but the most significant (P<0.01) FCR values were recorded in T3 among the treatment groups. It can be recommended from the present study that garlic might be played an active role to antagonize lead (Pb) toxicity.DOI: http://dx.doi.org/10.3329/bjvm.v12i1.20453 Bangl. J. Vet. Med. (2014). 12 (1): 1-7 

Color Doppler sonography and resistivity index in the differential diagnosis of hepatic neoplasm

The purpose of this study was to determine the usefulness of color doppler sonography and resistivity index (RI) in differentiating liver tumors. The study was carried out in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, and Institute of Nuclear Medicine and Allied Sciences (INMAS), Mymensingh, Bangladesh, during the period of July 2009 to June 2011. Total 50 consecutive cases were studied. Among them 27 were hepatocellular carcinomas, 19 were metastatic tumors, 03 were hemangiomas and 01 was hepatic adenoma. Doppler sonographic findings were then correlated, case by case, with final diagnosis- either pathologically by USG guided Fine-needle aspiration or by other imaging modalities (e.g., CT scan and RBC liver scan for hepatic hemangioma). The RI value of hepatocellular carcinoma was 0.69±0.096 and in metastatic tumors 0.73±0.079. The results showed no significant difference between the RI of hepatocellular carcinomas and metastatic liver tumors but it was significantly higher than benign lesions (p<0.05). RI of hemangiomas was 0.49±0.64 and in one hepatic adenoma was 0.65. When RI was <0.6 for benign liver tumors and ≥0.6 for malignant tumors we calculated a sensitivity of 89.14%, specificity of 66.7%, accuracy of 85.71% positive predictive value of 97.62% and negative predictive value of 28.57% in differentiating benign and malignant tumors. Thirty four of 46(73.9%) malignant lesions had intratumoral flow and 25% of benign lesions also showed intratumoral flow. The difference of intratumoral flow between malignant and benign lesions was significant (p<0.01). Two of 4 benign lesions (50%) had peritumoral vascularity where 6% of the malignant tumors showed peritumoral vascularity. In conclusion, combined studies of the type of intra-and peri-tumoral flow signals in CDFI and the parameter of RI would be more helpful in the differential diagnosis of benign and malignant liver tumors.

Association of other Autoimmune Diseases in Vitiligo Patients

A cross sectional study of thirty eight vitiligo patients attending at the outpatients was conducted. The result revealed generalized presentation in 53.6% cases followed by focal presentation, acro-facial and segmented presentation which were 26.3% cases, 15.8%cases and 5.3% cases. Progressive type was found in majority of cases which were 71.1% cases followed by stable case which was 39.9% cases and positive family history was found in 36.8% cases in our study. Among 38 vitiligo patients highest number of associated autoimmune disease was the thyroid abnormalities of which hypothyroidism was 15.8% and hyperthyroidism was 7.9% cases respectively. Diabetes mellitus was found in 2.6% cases, Addison’s disease and SLE were found in 2.6%case each. No autoimmune disease was found in the rest 68.5% cases. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16700 Community Based Medical Journal 2013 July: Vol.02 No 02: 57-61

Evaluation of the results of operative management of lumbar spinal canal stenosis

Lumber spinal canal stenosis is an important cause of low back pain and it frequently presents with low backache with neurogenic claudication. Operative management of lumbar spinal canal stenosis by decompression surgery is an effective method. This prospective interventional (quasi experimental) study was performed in patient having history of characteristic clinical features like low backache with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in the department of Orthopaedic Surgery and Neurosurgery, Dhaka Medical College Hospital and NITOR. Dhaka, from July 2008 to June 2010. Thirty patients were evaluated among those 18(60%) were 50 years and above. Male to female ratio was roughly 9:1. About 87% of the patients had sensory deficit and 50% had neurogenic claudication. Majority (83.3%) of the patients at presentation had a suffering of 12 or >12 months. Diagnosis shows that 3.5% of patients had L4 lesion, 60% L5, 6.5% patients had L4 & L5 and 30% S1. Laminectomy was done in 43.3% of patients, laminectomy and disectomy in 30% and laminectomy, discectomy & foraminal decompression in 26.7% of patients. Relief of symptoms occurred in 25(83.5%) of patients. Over three-quarter (76.7%) of patients exhibited minimal disability and 23.3% moderate disability based on Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

Effectiveness of radioiodine therapy in treatment of hyperthyroidism

The present non randomized clinical trial was conducted in the Center for Nuclear Medicine and Ultrasound, Mymensingh, Bangladesh for duration of one year. Total 30 patients with hyperthyroidism diagnosed by clinical and biochemical profile were included in the study. All patients received radioiodine treatment and regular follow up at 1st month, 3rd month, 6th month & 9th month were done to evaluate clinical and biochemical status and complications. Data were analyzed by computer with SPSS programme using 't' test and chi-square test. In the present study, out of 30 respondents more than three fourth of the respondents (76.6%) were in the age group of 31-50 years followed by less than 30 years are group (16.7%) and rest of respondents were in the age group of more than 50 years (06.7%). Mean±SD and range of age of the respondents were 39.80±10.02 years and 17-65 years respectively. Among the 30 respondents 11(36.7%) were male and 19(63.3%) were female. Male to female ratio was 1:1.73. Out of 30 patients 26(86.7%) presented with goiter and among them 21(80.8%) has diffused goiter and five (19.2%) had nodular goiter. Baseline mean±SD, median, range of serum T₃ level were 5.24±3.62, 4.34, 1.48-14.65nmol/L respectively. Base line mean±SD, median range of serum T₄ level were 192.25±99.17, 201.77, 1.75-336.25nmol/L respectively. Baseline mean±SD, median range of serum TSH level were 6.33±23.93, 0.15-0.07, 130.46nmol/L respectively. In the present study serum T₃, T₄ level among the respondents sharply decrease from baseline to 2nd follow up then gradually decrease from 2nd to 4th follow up. Serum TSH level gradually increases from baseline to 3rd follow up and then gradually decreases from 3rd to 4th follow up. The result showed radioiodine is an effective option for the treatment of thyrotoxicosis.

Sleep-wake and diurnal modulation of nitric oxide in the perifornical-lateral hypothalamic area: real-time detection in freely behaving rats

Nitric oxide (NO) has been implicated in the regulation of sleep. The perifornical-lateral hypothalamic area (PF-LHA) is a key wake-promoting region and contains neurons that are active during behavioral or cortical activation. Recently, we found higher levels of NO metabolites (NOx), an indirect measure of NO levels, in the PF-LHA during prolonged waking (SD). However, NO is highly reactive and diffuses rapidly and the NOx assay is not sensitive enough to detect rapid-changes in NO levels across spontaneous sleep-waking states. We used a novel Nafion®-modified Platinum (NF-PT) electrode for real-time detection of NO levels in the PF-LHA across sleep-wake cycles, dark-light phases, and during SD. Sprague-Dawley male rats were surgically prepared for chronic sleep-wake recording and implantation of NF-PT electrode into the PF-LHA. Electroencephalogram (EEG), electromyogram (EMG), and electrochemical current generated by NF-PT electrode were continuously acquired for 5-7days including one day with 3h of SD. In the PF-LHA, NO levels exhibited a waking>rapid eye movement (REM)>non-rapid eye movement (nonREM) sleep pattern (0.56±0.03μM>0.47±0.02μM>0.42±0.02μM; p<0.01). NO levels were also higher during the dark- as compared to the light-phase (0.53±0.03μM vs. 0.44±0.02μM; p<0.01). NO levels increased during 3h of SD as compared to undisturbed control (0.58±0.04μM vs. 0.47±0.01μM; p<0.05). The findings indicate that in the PF-LHA, NO is produced during behavioral or cortical activation. Since elevated levels of NO inhibits most of the PF-LHA neurons that are active during cortical activation, these findings support a hypothesis that NO produced in conjunction with the activation of PF-LHA neurons during waking/SD, inhibits the same neuronal population to promote sleep.

Melioidosis in an adult male

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

MOLECULAR EPIDEMIOLOGICAL STUDIES ON ROTAVIRUS INFECTION CAUSING SEVERE DIARRHEA IN HUMAN, ANIMALS AND POULTRY

The epidemiology of rotavirus infection in human, calves, sheep, goats and poultry were studied. Among total  of 800 collected fecal samples , 320 samples from human, 125 samples from calves, 82 samples from sheep, 7 samples from goats, 267 samples from poultry were collected from July 2010 to May 2011 and examined by Polyacrylamide Gel Electrophoresis and Silver Staining (PAGE-SS) technique for the detection of presence of rotavirus dsRNA. Human rotavirus was detected 10.94 % (35/320) in diarrhoeic fecal samples. The highest prevalence was recorded in September 33.33% and the lowest in May 4.54%. The prevalence of rotavirus infections was 33.33% in autumn (September), 11.69% in late autumn (October-November), 9.6% in winter (December-January), 9.72% in spring (February- March), 6.12% in summer (April-May) season in diarrhoeic samples indicated the presence of rotavirus in human round the year in Bangladesh and as such no marked seasonal variation in rotavirus infection in human. No calves, sheep and goat fecal sample was found positive for rotavirus on PAGE-SS technique. During the study period, 267 faecal samples (diarrhoeic and nondiarrhoeic) of chicken (from one day to one month of age) were tested and only one was found positive on PAGE-SS technique for rotavirus infection (0.38%; 1/267). The positive cases were found in samples collected in winter season from layer chicks aged 10 days. The migration patterns of detected positive strains were not similar on polyacrylamide gel electrophoresis and their migration speed was different types. Five electropherotypes were determined among 35 human rotavirus positive samples. All the electropherotypes were under group A and long pattern. The genome migration of avian rotavirus was distinct from human types and under group D and long pattern. In the present study, it was not investigated that bacteria, parasite or any other viruses which might be responsible for development of diarrhoea.DOI: http://dx.doi.org/10.3329/bjvm.v9i2.13473

Efficacy of amitriptyline, pizotifen and propranolol in the prevention of migraine

This intervention study conducted in the Neurology outpatient Department of Mymensingh Medical College Hospital (MMCH) from January 2006 to December 2007 to compare efficacy of amitriptyline, pizotifen and propranolol in the prophylaxis of migraine. Ninety cases were selected following certain inclusion and exclusion criteria. Result showed that the differences in duration, frequency and severity of attack were reduced in all groups but the differences among the groups were not significant (p>0.05). However, compared with amitriptyline and pizotifen, the propranolol group needed tablet paracetamol as abortive therapy less frequently which was statistically significant (p<0.05). All the drugs were well tolerated with minimum adverse effects.

Electrolyte changes in stroke

The present study was carried out in the department of Neurology and Medicine, Mymensingh Medical College Hospital, Bangladesh during the period of January 2009 to December 2010 to see the electrolyte changes in stroke. The serum concentration of Na⁺, K⁺, and Cl⁻ were measured in 110 cases during acute period of stroke (55 ischemic and 55 haemorrhagic strokes). Data were analyzed by computer with SPSS programme using 't' test and chi square test. In haemorrhagic stroke, out of 55 patients 29(52.72%) had abnormal sodium level, of them 23(41.8%) had hyponatremia, 6(10.9%) had hypernatremia. In contrast in ischemic stroke 23(41.80%) out of 55 had abnormal sodium level, of them 21(38%) had hyponatremia. The result showed that hyponatremia is almost equally common in both haemorrhagic and ischaemic group without significant difference (p>0.05). The study also revealed that hyponatremia is more common than hypernatremia in both groups. Mean ± SD of age of the haemorrhagic group was 60.80 ± 15.97 while the age of ischaemic group was 59.89 ± 15.84 years. Male, female ratio in haemorrhagic and ischaemic group 1:0.62 and 1:0.89 respectively. Mean ± SD of serum Na⁺, K⁺, Cl⁻ in haemorrhagic group were 136.18 ± 10.5, 3.83 ± 0.65, 97.96 ± 16.74 mmol/L, in ischaemic group 135.08 ± 9.08, 4.00 ± 0.75, 100.27 ± 8.39 mmol/L. The result showed no significant difference in haemorrhagic and ischemic stroke. Hyponatremia, hypokalamia and hyperchloredemia were more common than hypernatremia, hyperkalamia and hyperchloredemia. In haemorrhagic stroke, out of 55 patients, 21(38.18%) had abnormal potassium level, of them 19(34.55%) had hypokalemia, 2(3.63%) had hyperkalemia. In contrasts, in ischemic stroke, 15 out of 55(27.22%) had abnormal potassium level. Of them 12(21.81%) had hypokalemia and 3(5.45%) had hyperkalemia. The finding showed that hypokalemia is almost equally common in both haemorrhagic and ischaemic group without significant difference. The study also revealed that hypokalemia is more common than hyperkalemia in both groups. In haemorrhagic stroke, out of 55 patients 33(60%) had abnormal chloride level. Of them 20(36.4%) had hypochrloridemia, 13(23%) had hyperchrloridemia, in contrast, in ischemic stroke, 40 out of 55(60%) had abnormal chloride level, of them 22(40%) had hypochrloridemia and 18(32.7%) had hyperchrloridemia. The result showed that changes in chloride level after haemorrhagic and ischemic stroke are similar. The result showed hypochrloridemia is more common than hyperchrloridemia in both groups.

Demographic and clinical profile of myelopathy patients

This descriptive type of cross sectional study was aimed to identify the demographic profile, clinical presentations of myelopathy and to find out the etiological factors associated with myelopathy. Total 65 patients having clinical features of myelopathy, admitted in Neurology and Medicine ward of Mymensingh Medical College Hospital from February 2009 to December 2010 were purposively studied. Patients underwent a detailed clinical evaluation followed by laboratory investigations and neuro-imaging studies. Out of 65 cases, 80.0% were male and 20.0% were female with mean age 39.15 ± 16.8 years. Highest number of cases (41.6%) was farmers. Most of the cases (72.3%) hailed from rural area. Mean duration of illness was 7.74 ± 15.8 months. 41.54% patients presented with paraplegia/paraparesis and 58.46% with quadriparesis/quadriplegia. 63.1% patients had sensory disturbance. It is observed that 58.5% had urinary sphincter disturbance and 21.5% had bowel sphincter disturbance. Among the causes of myelopathy found in this study, 29.23% patients had spondylotic myelopathy and 24.62% had transverse myelitis (ATM). In 12.31% patients the cause of myelopathy could not be identified. Myelopathy is more common in males and most of the patients are farmers. Spondylotic and Transverse myelopathy is the main etiology of compressive and non-compressive myelopathy respectively.

Melphalan plus prednisolone in the treatment of multiple myeloma

Various chemotherapies are used for better remission of symptoms of multiple myeloma as it is not a curable disease. This study was carried out to evaluate the response of melphalan plus prednisolone therapy for the treatment of Multiple myeloma. The study was conducted in the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January to December 2009. A total of 21 patients were included in this study. Combinations of melphalan plus prednisolone were given. Data were analyzed by paired 't' test to evaluate the response after treatment. Most of the patients were within 40-60 years with a male predominance. Haemoglobin level significantly raised after therapy (p<0.001) and ESR was found significantly reduced of these patients after treatment (p<0.001). On the other hand no significant change seen in calcium level before & after therapy (p=0.713). Significantly raised albumin and B2 microglubulin level were also found after treatment (p<0.001). After therapy with malphalan plus prednisolone, 11(52.38%) patient's M Protein reduction was >75%, 7(33.33%) patients M Protein reduction was 50-75%, 1(9.5%) patient's M Protein reduction was >25-50% and 1(12.50%) patient's M Protein reduction was <25%. Mean±SD M protein values before & after therapy were 50.23±19.49 gm/l and 21.01±16.11 gm/1 respectively. M protein level significantly reduced after treatment (p<0.001).

Postoperative pain relief following inguinal hernia repair in children by wound infiltration with levobupivacaine

The present study has been designed to compare the postoperative pain relief for inguinal hernia repair in children through wound infiltration with levobupivacaine with that provided by paracetamol administration per rectaly. This interventional study was carried out in the Department of Paediatric surgery, Mymensingh Medical College Hospital, Mymensingh and Dhaka Medical College Hospital, Dhaka, during the period from January 2009 to September 2010. A total of 120 patients were included in this study. Among them 60 patients in Group-A (study group) where post incisional wound infiltration with levobupivacain after inguinal herniotomy and before skin closure was done and 60 patients in Group-B (control group) where paracetamol was given per rectally after anesthesia induction. Both groups were followed up post operatively for 23 hours. In Group A maximum analgesic period was 8.30 hours and minimum analgesic period was 5.30 hours. On the other hand in Group B maximum analgesic period was 6.50 hours and minimum analgesic period was 4.50 hours. Duration of post operative analgesia between two groups of the patients were significant [p<0.01]. Post incisional wound infiltration with levobupivacain has significantly better efficacy to rectal administration of paracetamol with respect to providing pain relief following inguinal hernia repair in children. Longer duration of analgesic action is more achieved in the Levobupivacaine group.

Central nervous system sites of the sleep promoting effects of eszopiclone in rats

We examined the effects of eszopiclone (ESZ), a GABA-A receptor agonist in current clinical use as a hypnotic medication, on the activity of subcortical wake- and sleep-active neuronal populations in the rat brain. Sleep-wake states were quantified after i.p. injections of ESZ (3 and 10 mg/kg) or vehicle administered early in the dark phase, when rats are spontaneously awake. Rats were euthanized 2 h post-injection and brain tissue was processed for c-Fos protein immunoreactivity (IR) and for neurotransmitter markers. ESZ at 3 and 10 mg/kg increased time spent in non-rapid-eye-movement (nonREM) sleep, but had no significant effect on Fos-IR in GABAergic neurons in the preoptic hypothalamus that normally express c-Fos during sleep. Among wake-active cell types examined, Fos-IR in hypocretin (HCRT) neurons in the perifornical lateral hypothalamus (LH) was reduced following 3 and 10 mg/kg ESZ. At 10 mg/kg, ESZ suppressed Fos-IR in cholinergic and noncholinergic neurons in the basal forebrain and in serotonergic and nonserotonegic neurons in the dorsal raphe. Having determined that HCRT neurons were responsive to the low dose of systemic ESZ, we unilaterally perfused ESZ directly into the LH of awake rats, using reverse microdialysis. Perfusion of ESZ at 50 μM into the LH for 2 h suppressed waking-related Fos-IR in HCRT neurons, but not in nonHCRT neurons ipsilateral to the dialysis probe. Bilateral LH perfusion of ESZ at 50 μM for 2 h early in the dark phase significantly increased sleep. These findings demonstrate that sleep induction by ESZ does not require activation of GABAergic sleep-regulatory neurons in the preoptic hypothalamus, and identify suppression of HCRT neurons in the LH and suppression of basal forebrain and dorsal raphe neurons as potential mechanisms underlying the sleep-promoting effects of ESZ.

Testing blood glucose may be useful in the management of dengue

Recently dengue viral fever is observed each year in Bangladesh. Overall skills for diagnosis and management have improved owing to national awareness for the disease. We have observed and investigated the frequency of glucose intolerance in the early phase of dengue fever. A two-sampled challenge test by 75 gm oral glucose (OGTT) was done in 133 patients [age (mean+/-SD):33+/-13 years, sex (male/female): 97/36] suffering from dengue fever during their illness. Diagnosis of dengue was based on serologic test for anti-dengue antibodies after the first week. Other investigations were done as part of the management. Among 133 studied dengue patients, 100 were found to have glucose intolerance by OGTT (75.2%). In regards to intensity of intolerance, 21.1%(28/133) had diabetes while 54.1%(72/133) had impaired glucose tolerance (IGT). Among the patients who agreed for a second OGTT (n=40) during discharge, 11(28%) had normal OGTT at both events, 22(55%) revert to normal on second OGTT while 7(17.5%) persisted abnormal glucose intolerance. On regression analysis, glucose intolerance was independently related to increased age (p=0.001) and higher titre of IgG antibody (p=0.006). The study demonstrated that glucose intolerance is frequently associated with dengue fever in its early course. These findings may help for the early diagnosis of dengue fever; and warrants for avoidance of dextrose infusions as fluid replacement in dengue fever. Moreover, patients suffering from dengue fever should be cautioned for development of diabetes in future.

GABAergic regulation of the perifornical-lateral hypothalamic neurons during non-rapid eye movement sleep in rats

The perifornical-lateral hypothalamic area (PF-LHA) has been implicated in the regulation of behavioral arousal. The PF-LHA predominantly contains neurons that are active during behavioral and cortical activation and quiescent during non-rapid eye movement (nonREM) sleep, that is, are nonREM-off neurons. Some in vitro and in vivo studies indicate that PF-LHA neurons, including hypocretin-expressing neurons, are under GABAergic control. However, a role of GABA in suppressing the discharge of PF-LHA neurons during spontaneous nonREM sleep has not been confirmed. We recorded the sleep-wake discharge profiles of PF-LHA neurons and simultaneously assessed the contributions of local GABA(A) receptor activation and blockade on their wake- and nonREM sleep-related discharge activities by delivering GABA(A) receptor agonist, muscimol (500 nm, 5 microM, and 10 microM) and its antagonist, bicuculline (5 microM, 10 microM, and 20 microM), adjacent to the recorded neurons via reverse microdialysis. Muscimol dose-dependently decreased the discharge of PF-LHA neurons including nonREM-off neurons. Muscimol-induced suppression of discharge during nonREM sleep was significantly weaker than the suppression produced during waking. In the presence of bicuculline, PF-LHA neurons, including nonREM-off neurons, exhibited elevated discharge, which was dose-dependent and was significantly higher during nonREM sleep, compared to waking. These results suggest that GABA(A) receptor mediated increased GABAergic tone contributes to the suppression of PF-LHA neurons, including nonREM-off neurons, during spontaneous nonREM sleep.

Kikuchi-Fujimoto disease

A 14 year-old Bangladeshi girl presented with high fever, painful swellings in the neck, anorexia, weight loss and night sweating. On examination she had multiple enlarged and tender cervical lymph nodes. Other systems were normal. Laboratory investigations for sepsis and autoimmune diseases were negative. Initial fine needle aspiration and cytology of affected lymph node was suggestive of tubercular lymphdenitis. But she did not respond to anti-tubercular treatment. Kikuchi-Fujimoto disease was diagnosed from the histopathological appearance of excised lymph node. She completely recovered with symptomatic treatment. Kikuchi-Fujimoto disease, also called Kikuchi's disease or histiocytic necrotizing lymphadenitis is a rare, benign but enigmatic disease of unknown aetiology. The disease is self-limited and has an excellent prognosis. Its recognition is crucial because it can be mistaken for systemic lupus erythematosus, malignant lymphoma, tubercular lymphadenitis or even, for metastatic adenocarcinoma. Clinicians' and pathologists' awareness of this disease may help prevent misdiagnosis and inappropriate treatment.

Administration of the protein synthesis inhibitor, anisomycin, has distinct sleep-promoting effects in lateral preoptic and perifornical hypothalamic sites in rats

Although a robust relationship between sleep and increased brain protein synthesis is well-documented, there have been few reports of the effects of local application of a protein synthesis inhibitor (PSI) on sleep. In this study, we compared the effects of local microdialytic administration of the protein synthesis inhibitor, anisomycin (ANI) into the lateral preoptic area (LPOA), a sleep promoting area vs. the perifornical/lateral hypothalamus (PF/LH), a wake and rapid eye movement (REM) sleep-promoting area. ANI administered to the LPOA at night resulted in an increase in stage 2 of rat non-REM sleep, whereas ANI delivered into the PF/LH during the daytime increased REM sleep. ANI microdialysis into hippocampus did not affect sleep or waking. These differential effects of local protein synthesis inhibition on sleep support a hypothesis that mechanisms controlling protein synthesis are critically involved in the regulation of both NREM sleep and REM sleep.

Distribution of naturally occurring radionuclides in soils of the southern districts of Bangladesh

The activity concentrations of naturally occurring radioactive materials in soil samples of an elevated radiation background area of nine southern districts of Bangladesh were determined using gamma-ray spectrometry with an aim of evaluating the environmental radioactivity. The outdoor and indoor external effective dose rates and the radiation hazard indices from the soil activity were evaluated with an aim of minimising the harmful effects of ionising radiation to the population of the area concerned. The activity of (137)Cs was measured and observed in some of the locations.

Urinary iodine status and thyroid dysfunction: a Bangladesh perspective

Iodine deficiency is endemic in Bangladesh. Compulsory iodization of table salt was introduced since 1993 to prevent and improve thyroid disorders in the country. Urinary iodine status, thyroid function and antithyroid antibodies were studied in 397 newly diagnosed thyroid patients and 94 age-sex matched controls. Among thyroid patients, 96 were hyperthyroid, 185 euthyroid and 116 hypothyroid. Mean and median urinary iodine were higher (p=0.075) in thyroid patients (26.13+/-0.91 and 23.03) than controls (22.65+/-1.47 and 18.59); in hyperthyroid and euthyroid than hypothyroid (p=0.020); in multinodular (28.08+/-2.80 and 26.94) and diffuse (27.35+/-1.19 and 26.71) goitre than uninodular (23.91+/-2.37 and 19.14) and nongoitrous (NG, 21.5+/-2.05 and 18.27) (p=0.098) patients but no sex difference (p=0.466). Antimicrosomal (26.7%) and antithyroglobulin (34%) antibodies were more frequently positive among thyroid patients than controls (6.4% and 12.8% respectively) (p=0.00002 and p=0.00005 respectively). Antibody positivity was higher in diffuse (82/228) and multinodular (20/47) goitre than nongoitrous (20/56) and uninodular (13/66) goitre (p=0.046) as well as in hypothyroid (55.2%) and hyperthyroid (36.5%) than euthyroid (19.5%) patients (P<0.001). Urinary iodine correlated neither with antimicrosomal (thyroid patients: p=0.597 and control: p=0.112) nor with antithyroglobulin (thyroid patients: p=0.388 and control: p=0.195) antibody. Thyroid autoimmunity and dysfunction seems common; and interaction of salt iodization with iodine status and thyroid disorders may be important in Bangladesh.

Predominance of the DEN-3 genotype during the recent dengue outbreak in Bangladesh

A recent outbreak of dengue in Bangladesh was marked by many fatal complications. As clinical virulence varies among the genotypes of dengue virus, a study was conducted to investigate the molecular genotypes of dengue in Bangladesh. Reverse transcription polymerase chain reaction was used to determine viral genotypes using oligonucleotide generic primers that produce a 511 bp product. The resulting product was typed by nested PCR with strain-specific primers, yielding 482 (DEN-1), 119 (DEN-2), 290 (DEN-3) and 392 (DEN-4), visualized on UV transilluminator after electrophoresis on 2% agarose gel stained with ethidium bromide. Of 45 clinically diagnosed dengue patients (mean age 28 years; male/female 30/15), 19 (42.2%) had detectable viral RNA in their blood. However, during the first 5 days of fever in 30 patients, the frequency was 60% (18/30), implying that the sooner serum is drawn after the fever, the greater the chances of detecting viral RNA. DEN-3 was detected in all except 2 patients who were infected with DEN-2. DEN-2 (two cases) and DEN-4 (one case) were present as co-infections with DEN-3. All of the patients presented with fever, anorexia and vomiting; many had headache and general body ache; a few had a rash. About a quarter had suffered episodes of bleeding, while ascites, pleural effusion and CNS symptoms were found in a few patients Patients positive for viral RNA were also positive for anti-dengue IgM (p=0.007) in subsequent sampling. The study suggests the predominance of DEN-3 infection with occasional co-infection with other types, during the recent outbreak of dengue in Bangladesh.

Study of natural radionuclide concentrations in an area of elevated radiation background in the northern districts of Bangladesh

The activity concentrations of naturally occurring radioactive materials in soil samples from an elevated radiation background area of three northern districts of Bangladesh were determined using gamma ray spectrometry. The outdoor and indoor external effective dose rates and the radiation hazard indices from these soil activities were evaluated. The dose rates were found to be about four times higher than the reported world average value. The concentration of natural radionuclides, derived radium equivalent activities and the representative level indices were also found to be higher. Recommendations on radiological and dosimetric measures have been suggested with an aim of minimising the harmful effects of ionising radiation to the population of the area concerned.

Attenuation coefficients of soils and some building materials of Bangladesh in the energy range 276-1332 keV

The linear and mass attenuation coefficients of different types of soil, sand, building materials and heavy beach mineral samples from the Chittagong and Cox's Bazar area of Bangladesh were measured using a high-resolution HPGe detector and the gamma-ray energies 276.1, 302.8, 356.0, 383.8, 661.6 and 1173.2 and 1332.5 keV emitted from point sources of 133Ba, 137Cs and 60Co, respectively. The linear attenuation coefficients show a linear relationship with the corresponding densities of the samples studied. The variations of the mass attenuation coefficient with gamma-ray energy were exponential in nature. The measured mass attenuation coefficient values were compared with measurements made in other countries for similar kinds of materials. The values are in good agreement with each other in most cases.

Cell-specific and developmental regulation of rabbit surfactant protein B promoter in transgenic mice

Surfactant protein B (SP-B) is expressed tissue specifically in the lung and is developmentally regulated. To identify genomic regions that control SP-B expression, we analyzed SP-B promoter activity in transgenic mice containing rabbit SP-B 5'-flanking DNA fragments linked to the chloramphenicol acetyltransferase (CAT) reporter gene. Results showed that whereas the -2,176/+39-bp fragment failed to express CAT, shorter fragments of -730/+39 and -236/+39 bp expressed CAT tissue specifically in the lung. Further deletion of 5'-flanking DNA to -136 bp resulted in no expression of CAT. Immunostaining demonstrated that both -730/+39- and -236/+39-bp regions expressed CAT specifically in alveolar type II and Clara cells. The -236/+39-bp region expressed CAT at a significantly lower level than the -730/+39-bp region. CAT expression in mice containing the -730/+39-bp region was detected in embryonic day 14 lung and attained maximum levels in day 18 lung, indicating that the developmental expression of CAT was similar to that of SP-B. These data show that the DNA elements necessary for cell type-specific expression are located within -236/+39 bp of the SP-B gene. Additionally, these data suggest that the -2,176/-730- and -730/-236-bp regions contain the DNA elements that repress and enhance SP-B gene transcription, respectively.

Subcutaneous administration of nicotine changes dorsal raphe serotonergic neurons discharge rate during REM sleep

In the present study nicotine (0.1 mg/kg, s.c.) increased discharge rate of putative dorsal raphe (DRN) serotonergic neurons of behaving rats during REM sleep (362.61%), without any significant change during waking and non-REM sleep. Since serotonergic DRN neurons gate PGO onset, these results suggest that nicotine-induced suppression of PGO spikes during REM sleep previously reported is achieved through stimulation of dorsal raphe serotonergic cells.

Effects of lateral preoptic area application of orexin-A on sleep-wakefulness

Deficiency of orexin, a newly discovered hypothalamic peptide, is thought to lead to abnormal sleepiness and cataplexy in both human narcolepsy and animal models of the disease. As the POA contains extensive orexin terminals and is established as a sleep/arousal regulatory site, we evaluated a hypothesis that this site is a target for the arousal-inducing effects of orexin. Orexin-A was microinjected into lateral preoptic area (IPOA) and the effects on sleep-wakefulness and brain temperature were studied. Compared to saline vehicle control, orexin-A induced an increase in wakefulness for 70 min and suppressed all sleep stages, especially SWS2 and REM for 80 and 90 min, respectively. Brain temperature was not differentially affected by orexin-A compared to saline control. The orexin-induced arousal and REM suppression are consistent with the orexin-deficiency model of narcolepsy. Our results suggest that the IPOA orexin terminal field or adjacent structures may be a locus of arousal regulation by this peptide and a substrate of sleep-wake regulatory deficits in narcolepsy.

Discharge modulation of rat dorsal raphe neurons during sleep and waking: effects of preoptic/basal forebrain warming

In cats, putative serotonergic neurons (PSNs) recorded from the dorsal raphe nucleus (DRN) across the sleep-wake cycle exhibit the so-called rapid eye movement sleep-off (REM-off) discharge pattern. Since, the sleep-wake discharge patterns of DRN neurons in behaving rats is poorly known, the present study examined this neuronal populations. The PSNs recorded in this study exhibited: (1) progressive decrease in discharge rate from waking to NREM to REM sleep; (2) long action potential duration, and (3) reduction of discharge rate after systemic administration of a selective 5-HT(1A) agonist, (+/-)-8-hydroxy-2-(di-n-propylamino) tetralin hydrobromide (8-OH-DPAT). Evidence supports the hypothesis that NREM sleep is modulated by thermoregulatory mechanisms localized in the preoptic area and adjacent basal forebrain (POA/BF). We previously reported that POA/BF warming suppresses the discharge of wake-promoting neurons in the posterior hypothalamus and the basal forebrain. Since the DRN is one component of the brainstem arousal system and receives projections from POA/BF, we examined the effects of local POA/BF warming by 1.5-2.0 degrees C during waking on the discharge of DRN neurons. POA/BF warming reduced the discharge in 14 of 19 PSNs and in 12 of 17 other wake-related neurons in the DRN. DRN neuronal discharge reduction occurred without accompanying EEG frequency or behavioral changes. These results suggest that PSNs recorded in DRN in unrestrained and unanesthetized rats exhibit a "wake-active REM-off" discharge pattern and further support the hypothesis that the POA/BF warm-sensitive hypnogenic system induces sleep by a coordinated inhibition of multiple arousal systems including that modulated by the DRN.

Vegetarian diet in the treatment of fibromyalgia

Brain tryptophan is low in fibromyalgia. Intake of protein rich in large neutral amino acids is reported to lower brain tryptophan. This study was undertaken to assess whether any reduction of such proteins by exclusion of animal protein from the diet reduced pain and morbidity in fibromyalgia patients. It was an open, randomized controlled trial. 37 subjects with fibromyalgia were enrolled in the vegetarian diet and 41 in the amitriptyline groups. The outcome was assessed with the help of frequencies of fatigue, insomnia & non-restorative sleep, pain score on a 10-point VAS and tender point count. Fatigue, insomnia and non-restorative sleep were present in 41, 26 and 32 subjects before and in 3, 0 and 0 subjects respectively at six weeks of treatment in the amitriptyline group. The pain score and tender point count were 6.2 +/- 1.9 & 16.1 +/- 2.3 before and 2.3 +/- 1.3 & 6.4 +/- 3.0 after treatment. All these differences were significant (P < 0.001). In the vegetarian diet group, fatigue, insomnia and non-restorative sleep were present in 36, 24 and 27 subjects before and in 34, 29 and 29 subjects at six weeks of treatment. The pain score and tender point count were 5.7 +/- 1.8 and 15.7 +/- 2.4 before and 5.0 +/- 1.8 & 14.7 +/- 3.6 after treatment. All these differences were insignificant except that in the pain score. The decrease in the pain score, though significant, was much smaller than that in the amitriptyline group. So, it may be concluded that vegetarian diet is a poor option in the treatment of fibromyalgia.

Status of antithyroid antibodies in Bangladesh

To study autoimmunity among thyroid diseases, 397 thyroid patients (age 30 (13) years; M/F 75/322) from two referral centres in Bangladesh and 94 healthy controls (age 30 (13) years; M/F 24/70) were studied for antimicrosomal and antithyroglobulin antibodies. Thyroid patients were clinically grouped as suspected autoimmune thyroid disease (AITD), non-autoimmune, or indeterminate groups (where no decision could be reached). Antimicrosomal antibody was strongly positive in 19.4% and weakly positive in 7.3% of patients but only 4.3% and 2.1% respectively in the controls (chi(2) = 17.852; p = 0.000) whereas strong and weak positivity were 27.2% and 6. 8% in patients compared with 8.5% and 4.3% respectively in the controls (chi(2) = 16.916; p = 0.000) for antithyroglobulin antibody. Antibodies were positive in 63.0% with Hashimoto's thyroiditis, 36.4% with Graves' disease, and 44.7% with atrophic thyroiditis among the autoimmune group. In the non-autoimmune group antibodies were positive in 100% with multinodular hypothyroidism, 46.7% with subacute thyroiditis, 40.0% with suspected iodine deficiency goitre, 31.3% with toxic multinodular goitre, 30.8% with non-toxic solitary nodules, and 19.4% with simple diffuse goitre. None was positive for antimicrosomal antibody without being positive for antithyroglobulin antibody. The two antibodies strongly correlated in both patients (r = 0.977, p = 0.000) and controls (r = 0.986, p = 0.000). About 9% (36/397) of patients were mismatched with the final diagnosis on antibody measurement; most of them had Hashimoto's thyroiditis (33/36). Prevalence of AITD among thyroid patients was 48.36%. Specificity of antimicrosomal and antithyroglobulin antibodies were 93% and 87%. It was concluded that AITD is not uncommon in Bangladesh; antimicrosomal antibody is a useful marker for AITD and unless antibodies are checked, an appreciable number of patients with AITDs will remain undetected.

Two new quinones from Iris bungei

Two new benzoquinone derivatives, bungeiquinone (1) and dihydrobungeiquinone (2), and two known derivatives, 3-hydroxyirisquinone (3) and 3-hydroxydihydroirisquinone (4), were isolated from the roots of Iris bungei. The structures of the new compounds were established on the basis of spectroscopic methods.

Efficacy of sulphasalazine plus methotrexate in rheumatoid arthritis

Early intervention with slow acting anti-rheumatic drugs (SAARDs) has led to improvement in substantial proportion of rheumatoid arthritis (RA) patients. The present open, controlled study was designed to assess whether a combination of SAARDs offer any added benefit. Fifty-four adult RA patients were randomly allocated to methotrexate (MTX) (n = 27) and MTX plus sulphasalazine (SSZ) (n = 27) groups. The subjects were followed-up fortnightly for four weeks then monthly for six months. The disease activity was assessed with the help of 10 clinical and four laboratory indices. The improvement was graded as: minor, mild decreases in indices, non-steroidal anti-inflammatory drugs (NSAIDs) continued, physician's global assessment (PGA) decreased by one; marked, acceptable decreases in indices, NSAIDs being taken sparingly, PGA decreased by at least 2, and complete, all indices normalised and patients discontinued NSAIDs completely. The improvement was considered clinically important when marked or complete improvement occurred. Adverse drug reactions resulted in withdrawal of 4 subjects from the MTX + SSZ group and 1 from the control groups. Four and three subjects in the combined and MTX groups respectively were lost to follow-up. Subjects in both groups showed significant decline in all indices except hemoglobin and neutrophil count. The differences between the two groups in the pre-treatment and post-treatment values were insignificant. Complete, marked, minor and no improvement occurred in 4 (21%), 12 (63%), 3 (16%) & 0 in the MTX and in 11 (48%), 7 (30%), 4 (17%) & 1 (4%) in MTX + SSZ groups respectively. The differences in the rates of complete and clinically important improvement between the two groups were insignificant (P 0.1398 and 0.7092). The incidence of side effects was insignificantly higher in the MTX + SSZ group. Most of them were mild and transient. The combination of SAARDs offered little added advantage in RA. However, the higher rate of complete improvement in the combination group justifies trials including larger samples.

Identification of functional TTF-1 and Sp1/Sp3 sites in the upstream promoter region of rabbit SP-B gene

Surfactant protein B (SP-B) is essential for the maintenance of biophysical properties and physiological function of pulmonary surfactant. SP-B mRNA is expressed in a cell type-restricted manner in alveolar type II and bronchiolar (Clara) epithelial cells of the lung and is developmentally induced. In NCI-H441 cells, a lung cell line with characteristics of Clara cells, a minimal promoter region comprising -236 to +39 nucleotides supports high-level expression of chloramphenicol acetyltransferase reporter activity. In the present investigation, we characterized the upstream promoter region, -236 to -140 nucleotides, that is essential for promoter activity. Deletion mapping identified two segments, -236 to -170 and -170 to -140 nucleotides, that are important for promoter activity. Mutational analysis and gel mobility shift experiments identified thyroid transcription factor-1, Sp1, and Sp3 as important trans-acting factors that bind to sequences in the upstream promoter region. Our data suggest that SP-B promoter activity is dependent on interactions between factors bound to upstream and downstream regions of the promoter.

Adenosinergic modulation of rat basal forebrain neurons during sleep and waking: neuronal recording with microdialysis

1. The cholinergic system of the basal forebrain (BF) is hypothesized to play an important role in behavioural and electrocortical arousal. Adenosine has been proposed as a sleep-promoting substance that induces sleep by inhibiting cholinergic neurons of the BF and brainstem. However, adenosinergic influences on the activity of BF neurons in naturally awake and sleeping animals have not been demonstrated. 2. We recorded the sleep-wake discharge profile of BF neurons and simultaneously assessed adenosinergic influences on wake- and sleep-related activity of these neurons by delivering adenosinergic agents adjacent to the recorded neurons with a microdialysis probe. Discharge rates of BF neurons were recorded through two to three sleep-wake episodes during baseline (artificial cerebrospinal fluid perfusion), and after delivering an adenosine transport inhibitor (s-(p-nitrobenzyl)-6-thioinosine; NBTI), or exogenous adenosine, or a selective adenosine A1 receptor antagonist (8-cyclopentyl-1, 3-dimethylxanthine; CPDX). 3. NBTI and adenosine decreased the discharge rate of BF neurons during both waking and non-rapid eye movement (NREM) sleep. In contrast, CPDX increased the discharge rate of BF neurons during both waking and NREM sleep. These results suggest that in naturally awake and sleeping animals, adenosine exerts tonic inhibitory influences on BF neurons, supporting the hypothesized role of adenosine in sleep regulation. 4. However, in the presence of exogenous adenosine, NBTI or CPDX, BF neurons retained their wake- and sleep-related discharge patterns, i.e. still exhibited changes in discharge rate during transitions between waking and NREM sleep. This suggests that other neurotransmitters/neuromodulators also contribute to the sleep-wake discharge modulation of BF neurons.

Sleep-waking discharge of neurons in the posterior lateral hypothalamus of the albino rat

The sleep-waking discharge patterns of neurons in the posterior lateral hypothalamus (PLH) were investigated in the rat. Previous studies in the cat demonstrated that this region contained neurons that fired tonically at low rates (2-4 Hz) during waking, decreased firing in non-rapid eye-movement (NREM) sleep and nearly ceased firing during rapid eye-movement (REM) sleep. These "REM-off" neurons were proposed to be histaminergic neurons of the tuberomammillary nucleus (TM). Since many anatomical and physiological studies are performed in the rat, we sought to examine the sleep-waking discharge of these neurons in this animal. We found three main types of discharge patterns among PLH neurons. Waking-related neurons decreased their discharge in NREM sleep, and remained at low rates during REM sleep. A subpopulation of these neurons discharged very little during REM sleep (<0.2 Hz) (REM-off neurons). Waking/REM-related neurons decreased their discharge in NREM sleep and returned to waking rates in REM sleep. REM-related neurons decreased their discharge in NREM sleep and increased their discharge during REM sleep higher than waking rates. No NREM-related discharge patterns were recorded. Waking-related and waking/REM-related neurons were similar in location within the PLH and action potential duration. Some REM-off and other waking-related neurons were recorded within the boundaries of the histaminergic TM, however, not all waking-related and REM-off neurons were found within this region. Furthermore, neurons with waking/REM-related and state-indifferent discharge patterns were localized within the TM. These results suggest that waking-related and/or REM-off neurons may not be exclusively histaminergic in rats.

Assessment of occupational and patient dose from diagnostic and therapeutic radiation exposure using thermoluminescent dosimetry

Radiation doses of occupational personnel exposed from diagnostic x rays, therapeutic installations, and patients were measured using thermoluminescent dosimeters. The monthly occupational doses from diagnostic x ray ranged from 0.1076 mSv to 0.5774 mSv, and those from therapeutic treatment ranged from 0.365 mSv to 0.657 mSv, which is within the dose limit recommended by ICRP 60. The patient organ doses were evaluated and found to range from 0.0615 mSv s(-1) to 2.8823 mSv s(-1) for gonad, 0.3676 mSv s(-1) to 2.1088 mSv s(-1) for thyroid, and 0.00972 mSv s(-1) to 4.01 mSv s(-1) for eyes.