Symptom Analysis of Early Parkinson's Disease and its Correlation with High Sensitivity C-reactive Protein

Parkinson's disease is a debilitating neurodegenerative disease for which there is no cure. It is characterized by bradykinesia, resting tremor, rigidity and postural instability, due to impairment of function of the basal ganglia which is involved in the coordination of body movement. Neuro-inflammation is pathogenesis of development in early Parkinson's disease. High-sensitivity C-reactive protein level is a useful non-specific biochemical marker of inflammation. Objective of this study was to analyze the symptoms of Parkinson disease and it's correlation with high sensitive CRP. Seventy-six Parkinson's disease patients were enrolled in this Cross-sectional observational study that was attended in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from September 2014 to March 2016. Analysis of the symptoms of Parkinson disease and it's correlation with high sensitive CRP were done among these patients. This study was performed on 76 Parkinson disease patients with presented early with symptoms. a positive and highly significant correlation were seen in between duration of tremor and High sensitivity CRP (r=0.430, p<0.001) and between duration of bradykinesia and High sensitivity CRP (r=0.426, p<0.001) which indicate increase duration causes increase level of high-sensitivity C-reactive protein value. The neuro-inflammation plays a significant role in the pathogenesis of symptoms development in early Parkinson's disease.

Salinisation of drinking water ponds and groundwater in coastal Bangladesh linked to tropical cyclones

Salinity is a widespread problem along the Asian coast, mainly in reclaimed lands where most people live. These low-lying areas are vulnerable to impacts from tropical cyclone induced storm surges. The role of such surges on the long-term salinity of water resources, particularly the salinisation of drinking water ponds, a key water resource, requires further investigation. Here we show, using high-resolution measurements of pond hydrology and numerical modelling, that episodic inundation events cause the widespread salinisation of surface water and groundwater bodies in coastal areas. Sudden salt fluxes in ponds cause salinity build-up in the underlying sediments and become a source of salinity. Rapid clean-up of drinking ponds immediately after a surge event can significantly minimize these salinity impacts, which are likely to increase under climate change. Our study has implications for coastal land use and water resources management in tropical deltas.

Study on Blood Pressure Profile in School Children of Mymensingh City

High blood pressure and its related problems are progressively assuming public health dimensions in developing countries like Bangladesh. There was a suggestion that hypertensive process can be aborted in its early stages. But it is poorly understood in its early stages. So, early natural history of hypertension and its evolution from the youth needs to be investigated. Objective of this study was to determine blood pressure distribution in school children aged 6-15 years. This descriptive cross-sectional study was conducted in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015. The sample was collected by simple random sampling from five different schools of Mymensingh after applying inclusion and exclusion criteria. After taking proper history and doing relevant examination, both systolic and diastolic BP was recorded by auscultatory method. Out of 994 children, 480(48.29%) were boys and 514(51.71%) were girls. In boys, the mean±SD of systolic and diastolic blood pressure (BP) were 105.9±10.8 mm of Hg and 67.4±6.7 mm of Hg and in girls it was 106.1±11.8 and 67.5±6.9 mm of Hg respectively. Systolic BP was found higher in girls belongs to 10-13 years. The study has shown that BP rises linearly with age and both systolic and diastolic BP has a significant positive correlation with age, sex, height and BMI in both sexes. This study also showed, 46(4.6%) children were hypertensive and 89(8.9%) were pre-hypertensive. Hypertension was found more in girls but there was no significant difference between two sexes. Hypertension was found more in relation to overweight, obesity and family history of hypertension. Hypertension is not uncommon in children. Routine blood pressure measurement should be conducted in all children.

H9N2 avian influenza virus dispersal along Bangladeshi poultry trading networks

Avian influenza virus subtype H9N2 is endemic in Bangladesh's poultry population. The subtype affects poultry production and poses a potential zoonotic risk. Insufficient understanding of how the poultry trading network shapes the dissemination of avian influenza viruses has hindered the design of targeted interventions to reduce their spread. Here, we use phylodynamic analyses of haemagglutinin sequences to investigate the spatial spread and dispersal patterns of H9N2 viruses in Bangladesh's poultry population, focusing on its two largest cities (Dhaka and Chattogram) and their poultry production and distribution networks. Our analyses suggest that H9N2 subtype avian influenza virus lineage movement occurs relatively less frequently between Bangladesh's two largest cities than within each city. H9N2 viruses detected in single markets are often more closely related to viruses from other markets in the same city than to each other, consistent with close epidemiological connectivity between markets. Our analyses also suggest that H9N2 viruses may spread more frequently between chickens of the three most commonly sold types (sunali-a cross-bred of Fayoumi hen and Rhode Island Red cock, deshi-local indigenous, and exotic broiler) in Dhaka than in Chattogram. Overall, this study improves our understanding of how Bangladesh's poultry trading system impacts avian influenza virus spread and should contribute to the design of tailored surveillance that accommodates local heterogeneity in virus dispersal patterns.

Natural attenuation processes control groundwater contamination in the Chernobyl exclusion zone: evidence from 35 years of radiological monitoring

The Chernobyl Exclusion Zone (CEZ) contains the vast majority of radionuclides released by the accident in nuclear fuel particle form. We present and analyze groundwater measurements collected from the monitoring network in CEZ covering key aquifers over 35 years since the accident. These new data, together with a comprehensive analysis of historical data shows that ⁹⁰Sr remains mobile in the subsurface environment, while groundwater concentrations of ¹³⁷Cs, Pu isotopes and ²⁴¹Am are relatively low, and are not of radiological concern. During the last two decades, ⁹⁰Sr and ¹³⁷Cs levels have declined or remained stable over time in the majority of monitoring locations. This is due to natural attenuation driven by gradual exhaustion of the fuel particle source, geochemical evolution of groundwater downstream from waste dumps and radionuclide retention in surface soil due to absorption and bio-cycling. Decommissioning of the cooling pond and construction of the 'New safe confinement' over Unit 4 (damaged reactor) also favored better protection of groundwater close to the Chernobyl plant site. Data from confined and unconfined aquifers, as well as rivers, evidence low radiological risks from groundwater contamination both outside the CEZ and to onsite "self-settlers". Though several groundwater contamination "hot spots" remain in the vicinity of Unit 4, "Red Forest" waste trenches and surface water bodies with contaminated bottom sediments, the findings of this study support a monitored natural attenuation approach to groundwater management in the CEZ.

Comparison of Growth of School Children in Mymensingh City Area, Bangladesh Using the 2000 CDC Standards and 2007 WHO Standards

Growth assessment is an essential component of child health surveillance. The most influential tool in the growth assessment is the growth chart. Growth parameters of children are usually interpreted in relation to international standards like the NCHS/1977, CDC/2000 and WHO/2007 growth charts. This comparative study was carried out in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015 to compare the growth parameters of children using 2000 CDC standards and 2007 WHO standards. A total of five hundred healthy school children, aged 6 to 10 years were randomly selected proportionately from each class of five government primary schools from Mymensingh city area. Children with physical deformities and acutely ill and those with chronic debilitating diseases were excluded from the study. The mean and median weight, height and BMI were calculated for each age and sex. The median weight, height and BMI were then standardized by converting them to Z-scores (SD) for comparing against known reference values of 2000 CDC and 2007 WHO charts. Among 500 children, 252(50.4%) were boys and 248(49.6%) were girls. The mean age was found 8.0±1.42 years in boys and 8.04±1.42 years in girls. The mean weight was found 24.4±6.36kg in boys and 24.08±6.35kg in girls. The mean height was 125.90±10.16cm in boys and 125.38±10.74cm in girls. The mean weight, height and BMI of boys and girls were found to be lower in all age groups with compared to 2000 CDC standard and 2007 WHO standard but were closer to the WHO standards compared to the CDC standards. According to CDC and WHO in the study it was observed that underweight was found 16.3% and 14.7%, stunting 7.1% and 6.7%, overweight 6.7% and 8.7%, and obese 2.8% and 4.0% respectively in male subjects. On the other hand, in female subjects it was observed that according to CDC chart and WHO chart underweight was found 19.4% and 13.3%, stunting 6.0% and 4.8%, overweight 7.3% and 8.1% and obese 2.0% and 2.0% respectively. The findings in this study imply that growth pattern of Bangladeshi school children is closer with WHO standards and wider from CDC standards.

Clinical Profile of Parkinson's Disease Patients in a Tertiary Hospital

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. The pathogenesis of PD is yet unknown. Aim of this study was to analyze the clinical profile of patient with early Parkinson disease. A total of seventy-six early Parkinson's disease patients were enrolled in this cross-sectional observational study which was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2014 to March 2016. Analysis of the history and clinical findings were done among these patients. This study was performed with 76 early Parkinson disease patients. Among them, male and female were 69.7% and 30.3% respectively. The mean±SD age of patients was 53.25±11.53 years with an age range of 24 to 77 years. The patients were found in primary level accounted for 42.1% which was followed by secondary 19.7% and illiterate or non-formal education 17.1%. Only 5.3% study population was found in post-graduate. Occupant as 28.9% were service holder, 26.3% as a housewife, 1.3% as business and 43.5% other occupations. Regarding smoking, 28.9% was a current smoker, 59.2% non-smoker and 11.8% ex-smoker. Of them, 11.8% had a family history of Parkinson's disease. Of the total population, 30.3% had dyslipidemia, 21.1% had hypertension, and 7.9% had diabetes mellitus. Males are predominant in affecting this disease. Middle aged people are vulnerable to it. Parkinson's disease is common in nonsmoker and dyslipidaemia. Few patient had family history of Parkinson's disease.

Efficacy of Nebulized Hypertonic Saline (3%) Versus Normal Saline and Salbutamol in Treating Acute Bronchiolitis in A Tertiary Hospital: A Randomized Controlled Trial

Acute bronchiolitis is a viral respiratory illness of infants and young children that occurs in the first two years of life. It is a major cause of hospital admissions in Bangladesh. Management of bronchiolitis is a great challenge for the pediatrician both in the outpatient and inpatient department. Because mainstay of treatment options are usually supportive like cool humidified oxygen, fluids, bronchodilators, epinephrine and corticosteroids. A number of agents have been proposed as adjunctive therapies, but their effects are controversial. Nebulized hypertonic saline (3%) has been reported to have some benefit in recent studies. So the objective of this study was to compare the efficacy of nebulized 3% hypertonic saline (HS) with salbutamol and normal saline (0.9%) nebulization in children with acute bronchiolitis. A double-blind randomized controlled trial was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital, Bangladesh from November 2015 to October 2016. A total of 100 children aged one month to two years with acute bronchiolitis admitted in the Pediatric wards of MMCH were included in the study and were randomly assigned to either 3% nebulized hypertonic saline (n=50) or to 0.9% nebulized isotonic saline with salbutamol solution (n=50). The main outcome variables were clinical severity score, length of hospital stay, duration of oxygen therapy and oxygen saturation (SpO2). The therapy was repeated three times on every hospitalization day and the outcome was evaluated two times daily (12 hourly) for 60 hours. Mean duration of oxygen therapy in study group was 33.6±21.7 hours and in control group was 36.8±22.5 hours. But their difference was not statistically significant (p>0.05). The mean clinical severity score and mean oxygen saturation of the entire study patients in both groups decreased and increased respectively during hospital stay. There was significant difference of mean clinical severity score and oxygen saturation between admission and follow up-5 in each group (p<0.001). But their difference between two groups was not statistically significant (p>0.05). Mean duration of hospital stay was 2.91±1.54 days in study group and 3.09±1.85 days in control group. But their difference between two groups was not statistically significant (p>0.05). So in acute bronchiolitis nebulized hypertonic saline (3%) is as effective as normal saline (0.9%) and salbutamol nebulization.

Risk Factors of Malnutrition in Under-5 Children of Slum Area in Dhaka City

Malnutrition is a serious public health problem that has been linked to increase risk of morbidity and mortality in slums of Dhaka city and where the prevalence of malnutrition is very high. This study was conducted to evaluate the risk factors of malnutrition among under-5 children of selective slum area in Dhaka City. This cross sectional study was conducted from January 2016 to December 2019, among 500 under-5 children selected by random sampling technique from Agargaon and Beribadh slums of Dhaka city. Anthropometric measurements were taken using standard methods those were weight, height, MUAC and age. A questionnaire was ready for data collection containing episode of diseases, breast feeding status, complementary feeding, family size, family income, maternal education status, housing, source of drinking water etc in under-5 children. Data were analyzed by using SPSS version 21.0. Among 500 children from slums area, malnutrition was present in 220(44%) cases. Out of them 115(23%) children were wasted, 205(41%) children were stunted and 175(35%) children were underweight. Malnutrition was found significantly high among non-breast feed babies, who breast feed only for 6 months, in whom colostrum was not given and also when complimentary feeding was not given properly (p<0.05). Malnourished children were found significantly higher among illiterate mothers and those who used Kancha house (p<0.05). Wasting, stunting and underweight were more with increasing family size. There were a decreased number of malnutrition cases when family income rises. Diarrhoea and ARI was significantly associated with malnutrition (p<0.05). Large number of children in slum areas of Dhaka city was suffering from malnutrition. Malnutrition was significantly higher among children who did not get colostrum; non-breast fed and got improper complimentary feeding. Maternal illiteracy, living in Kancha house, large family size, family income and associated disease condition were also contributed to malnutrition.

A chemical and ecological assessment into elemental loading from ford crossings in Ashdown Forest, Sussex, United Kingdom

Numerous studies have identified the issue of road surface runoff as a source of contamination into waterways but the impact of vehicular wash-off is less well understood. A ford crossing provides a pathway for vehicle-derived contaminants emanating from both road surface runoff and vehicular wash-off into a river system. Twyford Lane Ford (Ford 1) and Birchgrove Lane Ford (Ford 2), located ca. 600 m apart on a tributary of the River Ouse in Sussex (UK), were the focus of this study. A combination of biomonitoring (assessment of benthic macroinvertebrates) and chemical assessments of water and sediments has been undertaken to determine any detrimental impacts, such as a lack in biodiversity, resulting from the ford crossings. Sediment concentrations of chromium (Cr³⁺), lead (Pb) and zinc (Zn) were generally elevated at Ford 1, attenuating at sampling points between the fords to then peak at Ford 2. However, sediment particle size was seen to have an influence on elemental concentrations. In general, an increase in elemental concentrations was associated with a higher percentage of fine-grained sediments (≤63 μm). Elevated concentrations of Zn and magnesium (Mg) were identified within water samples taken during a precipitation event following a prolonged dry period. The biomonitoring results found reduced BMWP (Biological Monitoring Working Party) scores at positions close to the ford crossings, and where the stream was in proximity to the roadside. Sensitive Ephemeroptera were largely absent at sampling points closest to the fords, which is likely to be associated with elevated Zn. The results suggest that careful consideration should be applied when selecting crossing points over sensitive waters.

Solid-liquid distribution coefficients (Kd-s) of geological deposits at the Chernobyl Nuclear Power Plant site with respect to Sr, Cs and Pu radionuclides: A short review

A review is presented of data on solid-liquid distribution coefficients (Kd-s) of the main radiologically important radionuclides of the Chernobyl release within geological deposits at the Chernobyl Nuclear Power Plant (ChNPP) Site. The Kd values for Sr, Cs and Pu for Quaternary sandy deposits that form sedimentary cover at Chernobyl fall within the range of parameters reported in international sorption databases. In agreement with general knowledge on radionuclide geochemical behavior and affinity to soils, Kd-s increase in the sequence: Sr < Cs < Pu. Alluvial and fluvioglacial sandy deposits are characterized by larger Kd values then deposits of eolian genesis due to higher content of clay minerals in fine fractions. For Sr, laboratory batch tests have given Kd values that are in a reasonable agreement with in situ measurements. At the same time, the ⁹⁰Sr Kd-s obtained from groundwater transport model calibrations were noticeably lower than experimentally determined values, thus showing potential limitations of the Kd-approach. Monitoring data on mobility of ⁹⁰Sr, ¹³⁷Cs and ^239,240Pu in groundwater in the Chernobyl zone on a whole are consistent with the radionuclide Kd-s summarized in this article. The highest concentrations in groundwater (based on data for 2012-2014) were observed for ⁹⁰Sr, while orders of magnitude lower concentrations were observed for ¹³⁷Cs and ^239,240Pu. At the same time, detection of ¹³⁷Cs and ^239,240Pu in groundwater at sites with a relatively deep groundwater table suggests the possibility of facilitated transport of small amounts of these radionuclides in the form of non-retarded colloids or complexes.

Impact of Climate Change and Land Use on Groundwater Salinization in Southern Bangladesh-Implications for Other Asian Deltas

Pervasive salinity in soil and water is affecting agricultural yield and the health of millions of delta dwellers in Asia. This is also being exacerbated by climate change through increases in sea level and tropical storm surges. One consequence of this has been a widespread introduction of salt water shrimp farming. Here, we show, using field data and modeling, how changes in climate and land use are likely to result in increased salinization of shallow groundwater in SE Asian mega-deltas. We also explore possible adaptation options. We find that possible future increase of episodic inundation events, combined with salt water shrimp farming, will cause rapid salinization of groundwater in the region making it less suitable for drinking water and irrigation. However, modified land use and water management practices can mitigate the impacts on groundwater, as well as the overlying soil, from future salinization. The study therefore provides guidance for adaptation planning to reduce future salinization in Asian deltas.

Clinical and Radiological Evaluation of Children Aged 2 Months to 5 Years with Severe Pneumonia According to WHO Guideline

Pneumonia is the leading cause of morbidity and mortality in children less than 5 years of age in developing countries like Bangladesh. Although WHO guideline classified severe pneumonia by symptoms and signs of the patients, radiological and laboratory investigations were not studied well. There was increasing number of cases of bronchiolitis which meet the criteria of WHO classified severe pneumonia are reported. The objective of the study was to assess the clinical and radiological parameters of severe pneumonia in 2 months to 59 months hospitalized children according to WHO guideline. This cross sectional study was conducted in pediatrics department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July, 2015 to December 2015. Total 150 patients were included in this cross sectional study according to their clinical symptoms. Firstly, the chest x-ray was done in all the patients and radiographs were reviewed by an expert radiologist who was blind about the cases. Then the patients were classified as pneumonia and bronchiolitis according to the clinical features and radiology findings. Majority of the patients 83(55.3%) were between 2-6 months of age and mean age was 7.52±8.87. Maximum 105(70%) patients were male and 45(30%) were female. Most of them 70(47%) came from low middle class family. Regarding clinical features, all patients 150 had cough and chest indrawing. Ronchi found in 135(90%) patients, difficult breathing and fast breathing found in 130(87%) patients, crepitation in 122(81%) patients, wheeze in 93(62%) patients, dull on percussion in 36(21%) patients, bronchial breath sound in 25(17%) patients. Regarding radiological features, lobar consolidation was found in 18(12%) patients, patchy opacities in 42(28%) patients, which were radiological findings of pneumonia, while hyperinflation of lung present in 90(60%) patients, increased translucency in 82(54.6%), increased interstitial marking in 88(58.6%) patients, which were radiological findings of bronchiolitis. A total of 60(40%) admitted cases were diagnosed as pneumonia and 90(60%) cases diagnosed as bronchiolitis radiologically, which were predominant in WHO classified severe pneumonia (p<0.05). Wheeze was present in case of hyperinflation of lung in 78(83.8%), increased translucency in 67(72%) and increased interstitial marking in 70(75.2%) patients among radiological bronchiolitis (n=90). From above results we can concluded that Bronchiolitis was predominant among WHO guideline classified severe pneumonia.

Extended investigation on road fatality in Brunei

Road fatality is one of the leading causes of death in Brunei with 79 deaths in 1993, the highest ever recorded. The Brunei government has been trying to reduce this by implementing new traffic measures and successfully reduced fatalities to 24 fatalities in 2014. Yearly road fatality has been fluctuating, but there has been a declining tendency overall. The aim of this study is to investigate road fatality in Brunei by extending the research. We developed a multiple regression model and carried out an analysis on road fatality in Brunei. Our analysis indicates that the road fatality appears to rise depending on the increase in the number of young drivers between 15 to 24 years and the number of unemployed people. Comparisons of Brunei road fatality rate per 10,000 vehicles are made with some other countries and we conclude that Brunei has approximately the same rate as Australia in 2014.

Drinking Water Salinity and Raised Blood Pressure: Evidence from a Cohort Study in Coastal Bangladesh

BACKGROUND

Millions of coastal inhabitants in Southeast Asia have been experiencing increasing sodium concentrations in their drinking-water sources, likely partially due to climate change. High (dietary) sodium intake has convincingly been proven to increase risk of hypertension; it remains unknown, however, whether consumption of sodium in drinking water could have similar effects on health.

OBJECTIVES

We present the results of a cohort study in which we assessed the effects of drinking-water sodium (DWS) on blood pressure (BP) in coastal populations in Bangladesh.

METHODS

DWS, BP, and information on personal, lifestyle, and environmental factors were collected from 581 participants. We used generalized linear latent and mixed methods to model the effects of DWS on BP and assessed the associations between changes in DWS and BP when participants experienced changing sodium levels in water, switched from "conventional" ponds or tube wells to alternatives [managed aquifer recharge (MAR) and rainwater harvesting] that aimed to reduce sodium levels, or experienced a combination of these changes.

RESULTS

DWS concentrations were highly associated with BP after adjustments for confounding factors. Furthermore, for each 100 mg/L reduction in sodium in drinking water, systolic/diastolic BP was lower on average by 0.95/0.57 mmHg, and odds of hypertension were lower by 14%. However, MAR did not consistently lower sodium levels.

CONCLUSIONS

DWS is an important source of daily sodium intake in salinity-affected areas and is a risk factor for hypertension. Considering the likely increasing trend in coastal salinity, prompt action is required. Because MAR showed variable effects, alternative technologies for providing reliable, safe, low-sodium fresh water should be developed alongside improvements in MAR and evaluated in "real-life" salinity-affected settings. https://doi.org/10.1289/EHP659.

Serum Zinc, Copper, Magnesium & Phosphorus Level in Children with Severe Acute Malnutrition (SAM)

Malnutrition is widely prevalent among hospitalized children in most developing countries including Bangladesh. Though malnutrition accounts for the high rate of under 5 mortality sometimes it is overlooked. Keeping in this in mind A comparative cross sectional study was done in Mymensingh Medical College Hospital from 1st October 2009 to 31st May 2011. Children aged 1-5 years with presence of one or more criteria WHM <70%, WHZ-score <-3SD, Bipedal edema & Mid upper arm circumference <110mm were taken as study group and children aged 1-5 years with normal growth allowable normal range of variation is between 3rd and 97th centile curve or median (50th centile) ±2SD of weight for age growth chart (CDC growth chart, USA, 2000) were taken as reference group. Persistent diarrhea, Patients taking medications containing zinc, copper, magnesium, phosphorus & calcium, PEM with shock were excluded from study group. Nutritional assessment was done according to WHO criteria of SAM. Serum Zinc, Copper Magnesium and Phosphorus level were determined by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer, model no. 969, Spain. Total 120 study populations were taken. Ninety Out of 120 were taken as a study group (SAM) & 30 were reference group. In reference group serum Zn, Cu, Mg, P value was 103.80±8.86μg/dl, 135.92±13.57μg/dl, 2.31±0.18mg/dl, 3.96±0.22mg/dl respectively. In study group serum Zn, Cu, Mg, P value was 60.33±11.08μg/dl, 80.60±15.46μg/dl, 1.47±0.22mg/dl, 2.00±0.52mg/dl respectively. All these results show that there is significant difference between study group & reference group. Considering the decreased level of these parameters, close biochemical monitoring and follow up should be emphasized for the children with SAM.

Incomplete Pentalogy of Cantrell--A Case Report

Cantrell's Pentalogy is a rare congenital malformation consists of supraumbilical abdominal wall defect, defect in the lower part of sternum, agenesis of anterior portion of diaphragm, an absence of the diaphragmatic part of the pericardium and intracardiac malformation. This case report presents a female neonate, who was born at 40 weeks of gestation weighing 2400 gm and was admitted 4 hours after delivery with the complaints of something coming out from chest. On physical examination her vital signs were within normal limit, she had a systolic murmur on heart at lower left sternal area and there was a vascular structure present on the upper part of abdomen which was pulsatile and pulsation was synchronized with cardiac pulsation. On investigation chest X-ray lateral view showed absence of lower part of sternum, echocardiography findings were different in different institutes. Echocardiography findings at Mymensingh medical college hospital (MMCH) were large VSD (Ventriculo septal defect), ASD (Atrial septal defect) and rotated heart. On colour Doppler ultrasonogram at MMCH showed there were VSD, ASD, and a small epigastric swelling which was vascular and appears to be attached to the apex of the heart. On the other hand echocardiography findings of LAB AID hospital in Dhaka were Dextrocardia, complete AV (atrio ventricular) canal defect, almost common atrium, almost single ventricle, common AV valve, double outlet right ventricle (DORV), Cortriatriatum, mild A-V valve regurgitation and severe pulmonary hypertension (PAH). Echocardiography was also done at national heart foundation hospital in Dhaka. Findings were situs solitus, mesocardia to dextrocardia, DORV, large VSD, mild mitral inflow, mild TR (triuspid regurgitation), good LV (left ventricle) and RV (right ventricle) systolic function. Cardiologists at Dhaka in Bangladesh were suggested for surgery. Then the patient was consulted at Naryan Institute of Cardiac Science, Chennai in India. Here echocardiography findings were dextroversion/dextrocardia, DILV (Double inlet left ventricle), large inlet VSD with bidirectional shunt, mild TR, severe PAH with good ventricular function. Cardiologists in India were given comment about this patient. This patient was highly risky for surgery. They advised medical treatment and requested to review after one year. By taking medical treatment patient condition is well except failure to thrive and cyanosis develops during feeding and crying according to the statement of guardian of the patient. This case has 3 criterias among the five criteria of Cantrell's Pentalogy. So, it is incomplete Pentalogy of Cantrell.

Medical Hydrogeology of Asian Deltas: Status of Groundwater Toxicants and Nutrients, and Implications for Human Health

Drinking water, a fluid primarily for human hydration, is also a source of mineral nutrients. Groundwater, a drinking water source for more than 70% of inhabitants living in Asian deltas, has received much attention because of its naturally occurring arsenic, but the linkage of arsenic toxicity with other water constituents has not been studied. In addition, although nutrients are generally provided by food, in under developed rural settings, where people subsist on low nutrient diets, drinking-water-nutrients may supply quantities critical to human health thereby preventing diseases. Here, we show, using augmented datasets from three Asian deltas (Bengal, Mekong, and Red River), that the chemical content of groundwater is so substantial that in some areas individuals obtain up to 50% or more of the recommended daily intake (RDI) of some nutrients (e.g., calcium, magnesium, iron) from just two litres of drinking water. We also show some indications of a spatial association of groundwater nutrients and health outcome using demographic health data from Bangladesh. We therefore suggest that an understanding of the association of non-communicable disease and poor nutrition cannot be developed, particularly in areas with high levels of dissolved solids in water sources, without considering the contribution of drinking water to nutrient and mineral supply.

Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial

This study was done to determine the effects and outcome of inhaled budesonide in addition to standard management of asthma exacerbations in pediatric age groups. A randomized, double-blind, placebo controlled trial was done in a tertiary care urban hospital. Sixty six children aged 5 to 15 years with moderate to severe asthma exacerbations were eligible. All patients received a single dose of prednisolone 1mg/kg orally as first dose of systemic corticosteroids and then salbutamol (0.15mg/kg) and ipratropium bromide (500mcg) was nebulized every 20 minutes for 3 doses and then hourly for 2 hours as a part of standard treatment of asthma exacerbations. The intervention was 2mg (4mL) of budesonide or 4mL of normal saline which was nebulized immediately after the 1st dose of nebulized salbutamol and ipratropium bromide. The baseline characteristics of the budesonide group (n=33) and placebo group (n=33) were similar, but at 1 hour, 2 hour and 3 hour PEFR, respiratory rate, pulse rate, SaO2 and asthma score were significantly improved in the budesonide group compared to placebo group (p<0.01). The positive immediate effect of nebulized budesonide added to standard treatment of asthma exacerbations is an encouraging finding for further investigations of its routine use in the treatment of asthma exacerbations in children.

Stroke in Bangladeshi patients and risk factor

To evaluate comprehensively the distribution of established risk factors of stroke among Bangladeshi patients. This is an observational study. It involved 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years. Common established risk factors of stroke e.g. age, sex, family history, hypertension, diabetes, ischemic heart disease, smoking, obesity, dyslipidaemia, alcoholism, use of oral contraceptive pill, lack of fresh fruit consumption etc. were evaluated in these patients through a preformed questionnaire and data were analyzed. Majority of the stroke events occurred after the age of forty (82.3%) and the ischemic stroke (72%) is the most common. Apart from non modifiable risk factors (advancing age, sex, Family history of stroke) hypertension was the most common modifiable risk factor found in stroke patients (57.6%) followed by smoking (44.6%), tobacco use (24.3%), OCP use in female (40% of female stroke), diabetes (23%), ischemic heart disease (17.1%), obesity (10.6%) and dyslipidaemia (5.3%). Lack of fresh fruit consumption and alcoholism were found in some of the patients. Stroke is common after the age of forty. Ischemic events are commonest type of stroke. Hypertension, smoking, tobacco use, diabetes and ischemic heart disease were five most common risk factors of stroke. Outlining the common stroke risk factors in our settings, may help the physicians and care givers in managing this disabling disease properly.

Peak expiratory flow rate of normal school going children in Mymensingh municipality

This cross sectional study was conducted to measure the PEFR values of normal school going children of Mymensingh, Bangladesh. Peak expiatory flow rate (PEFR) is a lung function test which is easily measurable and reproducible but the base line values of PEFR have not been studied in large scale among Bangladeshi children. In Mymensingh municipality out of 79 schools 4 schools were selected purposively. A total of 984 (499 boys and 485 girls, nearly equal in ratio) normal children (6-15 years), were selected randomly by using lottery technic in classroom. To obtain peak expiratory flow rate (PEFR) mini Wright peak flow meter was used. The highest of three readings was taken as the correct value. Anthropometric parameters including body weight and height were recorded by bathroom scale and stadiometer respectively and body surface area was calculated. According to age interval (10 months) in boys and girls the mean difference of PEFR values showed that among age categories of 6, 7 & 8 years had no significant (p were <0.18, <0.73 and <0.70 accordingly) and all other age categories the mean difference of PEFR between boys and girls had significant (p<0.01). The correlation coefficient (r values) and the level of significance between different anthropometric parameters and PEFR in case of boys and girls were significant (p<0.001). Correlation of height (boys r=0.961 & girls r=0.954) with PEFR was the highest in comparison to other anthropometric parameters (age, sex and body weight). Boys had significantly higher values of PEFR than the girls at any height.

Stable groundwater quality in deep aquifers of Southern Bangladesh: the case against sustainable abstraction

In forty six wells >150 m deep, from across the arsenic-polluted area of south-central Bangladesh, groundwater composition remained unchanged between 1998 and 2011. No evidence of deteriorating water quality was found in terms of arsenic, iron, manganese, boron, barium or salinity over this period of 13 years. These deep tubewells have achieved operating lives of more than 20 years with minimal institutional support. These findings confirm that tubewells tapping the deep aquifers in the Bengal Basin provide a safe, popular, and economic, means of arsenic mitigation and are likely to do so for decades to come. Nevertheless, concerns remain about the sustainability of a resource that could serve as a source of As-safe water to mitigate As-pollution in shallower aquifers in an area where tens of millions of people are exposed to dangerous levels of arsenic in well water. The conjunction of the stable composition in deep groundwater and the severe adverse health effects of arsenic in shallow groundwater lead us to challenge the notion that strong sustainability principles should be applied to the management of deep aquifer abstraction in Bangladesh is, the notion that the deep groundwater resource should be preserved for future generations by protecting it from adverse impacts, probably of a minor nature, that could occur after a long time and might not happen at all. Instead, we advocate an ethical approach to development of the deep aquifer, based on adaptive abstraction management, which allows possibly unsustainable exploitation now in order to alleviate crippling disease and death from arsenic today while also benefiting future generations by improving the health, education and economy of living children.

Iron status in children with febrile seizure

This hospital based cross sectional analytic study was carried out in department of Pediatrics Dhaka Medical College Hospital and Combined Military Hospital from July 2009 to June 2010 to find out the relationship of iron status with febrile seizure in children. Sixty children aged 6 months to 5 years having febrile seizure were enrolled as cases after taking proper consent by purposive sampling. Sixty age matched children with fever but no seizures were taken as control after taking proper consent. Children having a febrile seizure, developmental delay, hemorrhagic disorder, severe malnutrition or micronutrient deficiency and abnormal CSF findings were excluded from the study. In cases after control of seizure 2 ml of CSF was taken for cytology, biochemistry, Gram & AFB staining. Two milliliter of blood from cases as well as control was collected, released to EDTA bottle for Hb, MCV and MCHC. Again 2 ml of blood was taken in plain test tube for testing serum iron, TIBC and for serum ferritin. Serum iron, TIBC, serum ferritin was estimated by automated analyzer (PENTRA for serum iron, DADE BEHRING for TIBC, IMMULITE 1000 for serum ferritin). There was no significant difference between two groups regarding age (p>0.05), sex (p>0.05). High fever (p<0.001) and continuous fever (p<0.001) was significantly associated with febrile seizure. Seizure was generalized in all with positive family history in 83.3% cases. The Mean±SD of blood Hb (Case 9.8±1.6; Control 10.7±0.9), MCH (Case 22.1±2.3; Control 24.3±3.6) & serum ferritin (Case 55.1±29.3; Control 99.6±81.9) level were significantly low associated with febrile seizure (p<0.05). No significant difference was found between cases and control regarding MCV, serum iron and serum TIBC.

Nutritional status among primary school children of Mymensingh

The school age is a dynamic period of growth and development. During this period physical, mental, social development of child takes place. The purpose of the study is to observe the nutritional status among the school aged children and to compare the urban and rural children. It is a descriptive cross sectional study. Data were collected from 600 children of primary school in Mymensingh district for a period of one year from October 2009 to September 2010. Among the primary school children in Mymensingh, Bangladesh 15.1% were wasted, 22.1% were stunted, 2.3% were both stunted and wasted and 60.4% children were within normal limit. Malnutrition was more in rural area in comparison with urban area. In rural area severely underweight, moderately underweight children were 62.1%, 65.6%, and corresponding result in urban area were 37.9%, 34.4% respectively. In rural area severely stunted, moderately stunted children were 100%, 58.6%, and in urban area they were 0%, 41.4% respectively. Again severely wasted and moderately wasted, children were 62.5%, 59.5% in rural area and 37.5%, 40.5% in urban area respectively. Malnutrition among girls were more then the boys.

Endovascular management of a young patient of stroke with absent right upper limb pulse

A 39 years old, right handed, hypertensive non-diabetic smoker presented with ischemic stroke with left sided hemiplegia and absent right upper limb peripheral pulses. Possible causes of young stroke were searched. Cerebral digital subtraction angiography (DSA) revealed 95% stenosis at origin of brachiocephalic trunk with absent flow in right sub-clavian artery and 75% stenosis at osteum of left vertebral artery with flow reversal through right vertebral artery. Subsequently, stents were placed within the stenosed portion Right brachiocephalic trunk and left vertebral artery. The intervention resulted in immediate restoration of right upper limb pulses and cessation of flow reversal in vertebral artery.

Waste-water impacts on groundwater: Cl/Br ratios and implications for arsenic pollution of groundwater in the Bengal Basin and Red River Basin, Vietnam

Across West Bengal and Bangladesh, concentrations of Cl in much groundwater exceed the natural, upper limit of 10 mg/L. The Cl/Br mass ratios in groundwaters range up to 2500 and scatter along mixing lines between waste-water and dilute groundwater, with many falling near the mean end-member value for waste-water of 1561 at 126 mg/L Cl. Values of Cl/Br exceed the seawater ratio of 288 in uncommon NO(3)-bearing groundwaters, and in those containing measurable amounts of salt-corrected SO(4) (SO(4) corrected for marine salt). The data show that shallow groundwater tapped by tube-wells in the Bengal Basin has been widely contaminated by waste-water derived from pit latrines, septic tanks, and other methods of sanitary disposal, although reducing conditions in the aquifers have removed most evidence of NO(3) additions from these sources, and much evidence of their additions of SO(4). In groundwaters from wells in palaeo-channel settings, end-member modelling shows that >25% of wells yield water that comprises ≥10% of waste-water. In palaeo-interfluvial settings, only wells at the margins of the palaeo-interfluvial sequence contain detectable waste water. Settings are identifiable by well-colour survey, owner information, water composition, and drilling. Values of Cl/Br and faecal coliform counts are both inversely related to concentrations of pollutant As in groundwater, suggesting that waste-water contributions to groundwater in the near-field of septic-tanks and pit-latrines (within 30 m) suppress the mechanism of As-pollution and lessen the prevalence and severity of As pollution. In the far-field of such sources, organic matter in waste-water may increase groundwater pollution by As.

The palaeosol model of arsenic pollution of groundwater tested along a 32 km traverse across West Bengal, India

The distribution of As-pollution in groundwater of the deltaic aquifers of south-eastern Asia may be controlled by the subsurface distribution of palaeo-channel sediments (As-polluted groundwaters) and palaeo-interfluvial sediments (As-free groundwaters). To test this idea, termed the palaeosol model of As-pollution, we drilled 10 sites, analysed groundwater from 249 shallow wells (screened <107 mbgl), field-tested another 149 for As, and used colour as a guide to the presence or absence of As-pollution in a further 531 wells. Our work was conducted along a 32-km traverse running W to E across southern West Bengal, India. At seven drill sites we logged a palaeo-interfluvial sequence, which occurs as three distinct units that together occupy 20 km of the traverse. These palaeo-interfluvial sequences yield As-free groundwaters from brown sands at depth<100 m. The palaeo-interfluvial sequences are separated by two deep palaeo-channels, which were logged at 3 sites. The palaeo-channel deposits host As-polluted groundwater in grey sands. Our findings confirm the predictions of the palaeosol model of As-pollution. We show again that well-colour can be used both to successfully predict the degree of As-pollution in groundwater, and to locate regions of buried palaeo-interfluve that will yield As-free groundwater for the foreseeable future.

Causes of morbidity and mortality of wild aquatic birds at Billabong Sanctuary, Townsville, North Queensland, Australia

Infectious diseases are common causes of significant morbidity and mortality events of wild aquatic birds (WABs) worldwide. Reports of Australian events are infrequent. A 3-yr passive surveillance program investigating the common causes of morbidity and mortality of WABs was conducted at Billabong Sanctuary near Townsville, North Queensland, from April 2007 to March 2010. Forty-two carcasses were obtained and evaluated by clinico-pathologic, histologic, bacteriologic, and virologic (molecular) examinations. Morbidity and mortality were sporadic and more commonly observed in chicks and juvenile birds in April than other months of the year. Morbid birds were frequently unable to walk. Hemorrhagic lesions and infiltration of lymphocytes in various organs were the most common findings in dead birds. Identified bacterial diseases that could cause bird mortality were colibacillosis, pasteurellosis, and salmonellosis. Salmonella serotypes Virchow and Hvittingfoss were isolated from an Australian white ibis (Threskiornis molucca) chick and two juvenile plumed whistling ducks (Dendrocygna eytoni) in April 2007. These strains have been previously isolated from humans in North Queensland. A multiplex real time reverse transcriptase-PCR (rRT-PCR) detected Newcastle disease viral RNA (class 2 type) in one adult Australian pelican (Pelecanus conspicillatus) and a juvenile plumed whistling duck. No avian influenza viral RNA was detected from any sampled birds by the rRT-PCR for avian influenza. This study identified the public health importance of Salmonella in WABs but did not detect the introduction of the high pathogenicity avian influenza H5N1 virus in the population. A successful network was established between the property owner and the James Cook University research team through which dead birds, with accompanying information, were readily obtained for analysis. There is an opportunity for establishing a long-term passive disease surveillance program for WABs in North Queensland, an important region in Australian biosecurity, thus potentially significantly benefitting public health in the region and the country.

17β-hydroxysteroid dehydrogenase-3 deficiency in disorder of sex development

A 29 years old patient, claimed to be a male, presented to us with pubertal gender swing from female to male. Since birth he was reared as a female child. His breasts, axillary hairs and pubic hairs developed at about 11-12 years of age. At that time he also observed the mental and physical changes towards a male. He began to feel sexual attraction towards females due to enlargement of his phallus and he preferred to behave as a male. The patient further noticed deepening of voice as well as appearance of facial hairs at about 15 years of age. He never experienced menstruation. His parents are first degree cousins. On examination, there was facial hairs in upper lip and chin (G3), breasts were in mature stage (B5), pubic hairs were darker, coarser and curlier and spreading sparsely (P3), and stretched dorsal phallic length was 6cm. In perineoscrotal area, there was hypospadias with blind vaginal pouch, partially fused, pigmented & ruggated bilateral labio-scrotal folds and soft palpable ellipsoid gonads measuring about 8 ml (each) in volume within labio-scrotal folds. Ultrasound examination revealed no uterus and karyotyping test found 46XY. Provisionally, he was diagnosed as a case of 46,XY Disorders of Sex Development (DSD). On further investigations, serum testosterone was low, serum LH and DHEA were raised and serum electrolytes were normal. From history, physical examination and investigations we diagnosed the case as 46,XY DSD due to 17β-hydroxysteroid dehydrogenase-3 deficiency.

Bilateral, symmetrical and extensive cerebral calcification in pseudohypoparathyroidism

Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterized by hypocalcemia, hyperphosphatemia, increased serum concentration of parathyroid hormone (PTH), and insensitivity to the biological activity of PTH. Pseudohypoparathyroidism is rare sporadic or autosomal dominant disorder having several subtypes (type Ia, Ib, Ic, type II). We report a case who was 27 years old married lady having two children presented in the summer season 2009. Her trousseau's sign was positive, serum calcium 5.5 mg/dl, PTH 137 pgm/ml and CT scan of brain shows bilateral and symmetrical calcification. She had occasional doubtful seizure and headache for 7 years. Initially clinicians could not reach the diagnosis due to inadequate investigations.

Feeding practices and nutritional status of children under two years of age

A descriptive cross sectional study was done in the department of Pediatrics Mymensingh Medical College Hospital. The purpose of the study was to assess breast feeding pattern, complementary feeding pattern, types of complementary foods and also to assess the nutritional status and to detect any relationship with the nutritional status and the feeding practices. Mothers with their children aged less than 2 years were included and very sick children, mother less children, handicapped children were excluded. Four hundred (400) consecutive children were enrolled from eight upazillas of Mymensingh district who were selected randomly. Out of 400 children, 214 children (53.5%) were male and 186 children (47.5%) were female and M:F was 1.2:1. Exclusive breastfeeding rate was 41.5%. Pre-lacteal feeding rate were 30.7% and most common pre-lacteal foods were honey and sugar water. Colostrum was given in 69.3% children. Breast feeding continued at the time of interview was 58.1%. Complementary feeding started in time in 35.8%, early weaning in 44.5% children. Type of complementary food was mainly luta (rice powder mixed with boiled water and sugar only) in 38.8% and khichuri (rice, pulses, soybean oil) in 19.5%. Bottle feeding rate was 31.30%. Around 43% children were underweight and 10.25% children were severely underweight and common in between 12 to 23 months of age group. Around 29% children were stunted among 11.25% were severely stunted. About 13.5% children were wasted and among them 2.5% were severely wasted. Stunting prevalent over the age of 9 months and wasting started after 6 months of age. Malnutrition was common in partially breast fed and early weaning with carbohydrate rich food.

Status of liver enzymes in babies with perinatal asphyxia

Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. In this study, the functional status of liver of the asphyxiated babies was assessed through estimation of liver enzymes to see any correlation existing between enzyme changes and severity of perinatal asphyxia. A total of 70 full-term asphyxiated newborns (study group) were studied during January'2008 to December'2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrollment these babies were grouped according to Sarnat & Sarnat stages of Hypoxic-ischemic encephalopathy (HIE) as stage I, II & III. Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. Another 50 healthy newborns were also studied as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum AST, ALT & alkaline phosphatase (ALP). Unpaired student's 't' test and Spearman's rank correlation was used for data analysis and P value of <0.05 were considered significant. Mean AST, ALT and ALP of the asphyxiated babies were 76.27±37.44, 82.16±48.08 & 369.59±123.05 U/L and that of normal babies were 23.46±8.45, 26.54±7.76 & 208.20±46.95 U/L respectively and these rise were statistically significant (p<0.001). The levels of transaminases and ALP were positively correlated with the severity of asphyxia and these correlations were also statistically significant (p<0.001). So, this study concludes that AST, ALT & ALP significantly elevated in perinatal asphyxia and this elevation was proportional to the severity of hypoxia.

Development and calibration of bio-kinetic model for surfactant biodegradation with combined respirometric and titrimetric measurements

Substrate removal mechanism in aerobic activated sludge processes was lately modeled using the simultaneous storage and growth (SSAG) phenomenon. The SSAG model was further refined with titrimetric components and successfully calibrated using both respirometric and titrimetric measurements for common substrate acetate. However, the improved SSAG model calibration was not verified with other organic substrates. Furthermore, very few studies are available in the literature on surfactant bio-kinetics, which generally use off-line experimental measurements with limited model-based interpretation. Therefore, the aim of this paper is to demonstrate its applicability for surfactant biodegradation using on-line measurements. Batch experiments were conducted using sodium dodecyl sulfate (SDS) as a test surfactant. Model calibration was done successfully for three different SDS concentrations using respirometric, titrimetric and combined respirometric-titrimetric measurement approaches. The parameter estimation results from all three stated combinations were statistically evaluated and found to be very close validating the model.

Moyamoya disease presented as a case of hemiplegic migraine

Moyamoya disease is a rare cerebral vasculopathy characterised by progressive narrowing of the major intracranial vessels and development of collateral vessels. Clinically, it presents with cerebral ischaemic or haemorrhagic events, with eventual severe morbidity and mortality. A 10-year-old girl presented with episodic vascular headache and transient left sided hemiparesis, which persisted for a few hours and was clinically labelled as sporadic hemiplegic migraine according to International Headache Society criteria. We investigated all possible causes of unusual headache. Cerebral digital subtraction angiogram was carried out and moyamoya disease was finally diagnosed.

Factors limiting the health of semi-scavenging ducks in Bangladesh

Duck rearing is well suited to coastal and lowland areas in Bangladesh. It is an important component of sustainable livelihood strategies for poor rural communities as an additional source of household income. An epidemiological study was conducted during January 2005-June 2006 on 379 households in Chatkhil of the Noakhali District, Bangladesh which were using the recently devised "Bangladesh duck model". The overall objective of the study was to identify factors that significantly contributed to mortality and constrained productivity and to generate sufficient knowledge to enable establishment of a disease surveillance system for household ducks. The overall mortality was 15.0% in Chatkhil, with predation causing a significantly higher mortality compared with diseases (p < 0.001). Common diseases were duck plague and duck cholera. Morbid ducks frequently displayed signs associated with diseases affecting the nervous and digestive systems. Haemorrhagic lesions in various organs and white multiple foci on the liver were frequently observed in dead ducks. Epidemiological analysis with a shared frailty model that accounted for clustering of data by farm was used to estimate the association between survival time and risk factors. The overall mortality rate due to disease was significantly lower in vaccinated than in non-vaccinated ducks in all zones except zone 2 (p < 0.001). Only vaccinated ducks survived in zone 1. In conclusion, duck mortality and untimely sale of ducks appeared to be important constraints for household duck production in Chatkhil. Vaccination against duck plague appears to be an effective preventive strategy in reducing the level of associated duck mortality. A successful network was established amongst farmers and the surveillance team through which dead ducks, with accompanying information, were readily obtained for analysis. Therefore, there is an opportunity for establishing a long-term disease surveillance programme for rural ducks in Chatkhil of the Noakhali District of Bangladesh.

Endovascular embolization of life threatening intracranial arterio-venous malformation

Haemorrhagic stroke from cerebral arteriovenous malformations (AVMs) represents 2% of all hemorrhagic strokes. A clear understanding of the diagnostic and treatment algorithms of cerebral AVM management is very important, because AVMs are a cause of hemorrhage in young adults. Surgery, endovascular therapy, and radiosurgery can be used alone or in combination to treat an AVM. We reported a 40 years old man of cerebral arteriovenous malformation (AVM), complicated with intracerebral hemorrhage (ICH). Digital subtraction angiogram was done for diagnosis and endovascular embolization for treatment of the case. This is the first successful cerebral arteriovenous malformations (AVMs) embolization in any government hospital of Bangladesh. The aim of this case report is to inform about this new technologies and emerging treatment strategies in these areas.

Evaluation of latex agglutination test (KAtex) for early diagnosis of kala-azar

Kala-azar is one of the major public health problem in Bangladesh. But the diagnosis of the problem often is difficult, unusual and time consuming, a simple, noninvasive, easy to perform, reliable and rapid diagnostic test has been a long-felt need of the clinicians. Therefore, the present study was conducted to see the sensitivity and specificity of Latex Agglutination test (KAtex) to detect leishmanial antigen from urine of kala-azar cases. The study was carried out in the department of Paediatrics, Mymensingh Medical College and Hospital, Bangladesh during July to December, 2008. A total of 100 urine samples were collected of which 50 were confirmed kala-azar cases and 50 were age and sex matched controls. Out of 50 kala-azar cases 47 showed positive result of KAtex. The test was also positive in 01 out of 30 healthy controls. None of the febrile controls was positive by KAtex. The sensitivity, specificity, positive predictive value and negative predictive value of the test using presence of LD bodies in splenic and/or bone marrow aspirate as gold standard were 94%, 98%, 97.91% and 94.23% respectively. KAtex is simple, noninvasive, easy to perform, rapid and reliable test for diagnosing kala-azar in endemic area and useful for small, less equipped laboratories as well as for the laboratories with better facilities.

Tuberculosis of the central nervous system

Tuberculosis can involve any organ system of the body. Although rare tuberculosis of nervous system (NS) is not uncommon in our country. In the nervous system tubercle bacilli can cause tuberculous meningitis, abscess , tuberculoma in brain & spinal cord. Untreated Central Nervous System (CNS) tuberculosis is devastating. Early diagnosis & prompt treatment of NS is essential to avoid morbidity & mortality. Tubercle bacilli causes chronic caseating granulomatous lesion. Tubercular meningitis presents with fever, headache, neck stiffness & cranial nerve palsy. Tuberculoma may present with headache, seizure and focal deficit. In the spinal cord tuberculoma or tubercular abscess may result in para paresis or quadri-paresis. For diagnosis of nervous system tuberculosis CSF analysis and neuroimaging are important. CSF cell count, Gram staining, Culture and Polymerase Chain Reaction (PCR) are helpful for diagnosis. Imaging helps in the diagnosis of tuberculoma and tubercular abscess. Computed tomography (CT) guided Fine Needle Aspiration for Cytology (FNAC) helps to establish the histopathological diagnosis. Use of combination antitubercular drugs for long period (12-18 months) is necessary to treat nervous system tuberculosis.

Calibration of biokinetic model for acetate biodegradation using combined respirometric and titrimetric measurements

Simultaneous storage and growth model has recently gained increased acceptance among researchers that can better interpret the processes occurring in activated sludge processes during aerobic biodegradation of organic carbon. The model underwent further improvement and was successfully calibrated using respirometric measurements, acetate being a test substrate. However, model based interpretation of titrimetry needs to be verified for proper validation of this model since pH and dissolved oxygen dynamics occur simultaneously in a batch reactor. Hence, in this paper, it is aimed to modify the existing model by introducing stoichiometric parameters involved in titrimetry in each step of the growth and storage phases along with the consideration of non-linear carbon dioxide transfer rate in liquid phase. The model calibration was done for three different acetate concentrations using titrimetric, respirometric and combined respirometric-titrimetric measurements. The parameter estimation results from all three combinations were found to be very close that supports the validity of the model.

Fahr's disease: a very rare cause of epilepsy

Fahr's disease, first described by Karl Theodor Fahr in 1930, refers to sporadic or familial idiopathic basal ganglia calcification that is associated with many neurological and psychiatric abnormalities, but may also be secondary to other diseases. Most cases present with extrapyramidal symptoms. But here we describe a case of Fahr's disease, who presented with complex partial seizure and behavioral abnormalities. On screening, the cause of seizure was found to be bilateral calcification of cerebellum, basal ganglia and thalamus, due to abnormal calcium and phosphate metabolism. A clinical diagnosis of complex-partial seizure with secondary generalization due to secondary Fahr's disease was done on the basis of clinical features, investigations, and exclusion of other causes of intracranial calcification.

Influence of early postweaning traits on genetic improvement of meat productivity in purebred Berkshire pigs

The objective of this study was to estimate genetic parameters for growth and body composition traits at 60 d of age and at finish in a population of Berkshire pigs and to evaluate the effectiveness of selection at 60 d of age for meat productivity. A total of 4,548 purebred Berkshire (2,344 males and 2,204 females) pigs born between December 1994 and January 2005 were used in this study. The traits analyzed were BW at 60 d of age; daily BW gain from birth to finish, from weaning to 60 d, from weaning to finish, and from 60 d to finish; age at finish; backfat thickness at 60 d of age and at finish; loin eye area at 60 d of age (LEA60) and at finish; and the number of teats. The heritability estimates for BW at 60 d of age, daily BW gain from weaning to 60 d, backfat thickness at 60 d of age, and LEA60 were 0.22, 0.25, 0.49, and 0.22, respectively. The estimated common environmental effect for BW at 60 d of age, daily BW gain from weaning to 60 d, backfat thickness at 60 d of age, and LEA60 were 0.12, 0.13, 0.18, and 0.21, respectively. Therefore, the common environmental effect should be included in the model to analyze traits at 60 d of age. The positive genetic correlation between LEA60 and loin eye area at finish and the negative genetic correlation between LEA60 and backfat thickness at finish indicated that improvement of the ultrasonic loin eye area at 60 d of age may result in favorable correlated responses to the traits at finish, an increase in loin eye area, and a decrease in backfat thickness. In addition, genetic correlations of backfat thickness at 60 d of age with backfat thickness at finish and loin eye area at finish were found to be favorable, indicating that improvement of ultrasonic backfat thickness at 60 d of age may result in greater correlated responses to the traits at finish: an increase in loin eye area and a decrease in backfat thickness. Therefore, constructing a selection scheme that includes body composition traits at 60 d and traits at finish is practical for gaining a greater selection response.

Assessment on activated sludge models for acetate biodegradation under aerobic conditions

A comparison of four different established models along with parameter estimation was carried out in order to explain the aerobic biodegradation of acetate in an activated sludge system. These models were investigated using experimental OUR data from batch experiments of three different concentration studies. Model calibration reveals that ASM1 model is not suitable to explain the observed experimental OUR during the famine phase implying storage compounds could play an important role during that stage. Besides, the model corresponds to the accumulation concept and is not well fitted for all concentrations studies though it includes the storage phenomena. Both the ASM3 model and the model for simultaneous storage and growth on substrate can well describe the acetate biodegradation process, however the OUR data alone is not sufficient to justify the suitability of those models. Simulated profiles using the model outputs demonstrate that storage is overestimated while ammonia degradation is underestimated in ASM3 compared to simultaneous growth and storage model. The current study also gives reasonable outcomes related to parameter estimation as compared with previous study which is statistically interpreted in this paper.

Anti phospholipid syndrome

Anti Phospholipid Syndrome (APS) is a relatively new conception of syndrome complex first noticed in 1983. It may be primary or secondary to other diseases like SLE, RA, Systemic sclerosis, behchet's syndrome, temporal arteritis, sjogren's syndrome psoriatic arthropathy etc. Clinical manifestations are consequences of vascular thrombosis and embolism like DVT, pulmonary embolism, stroke, TIA, complication of pregnancy with pregnancy loss. We report a 34 years married female housewife who presented with sudden onset of nausea, vomiting, vertigo, dysphagia, dysarthria and ataxia. She had a chronic leg ulcer. Neurological findings were consistent with lateral medullary syndrome due to stroke though she was normotensive, nondiabetic with normal lipid profile. She had history of two abortions in last three years. Investigations were done accordingly and she fulfilled the diagnostic criteria of APS. No secondary cause was detected after thorough clinical examination and laboratory investigations. She was treated symptomatically along with oral anticoagulation. She improved slowly but steadily.

Flushing history as a hydrogeological control on the regional distribution of arsenic in shallow groundwater of the Bengal Basin

Whereas serious health consequences of widespread consumption of groundwater elevated in As have been documented in several South Asian countries, the mechanisms responsible for As mobilization in reducing aquifers remain poorly understood. We document here a previously unrecognized and consistent relationship between dissolved As concentrations in reducing groundwater and the phosphate-mobilizable As content of aquifer sediment for a set of precisely depth-matched samples from across Bangladesh. The relationship holds across nearly 3 orders of magnitude in As concentrations and suggests that regional as well as local patterns of dissolved As in shallow groundwater are set by the solid phase according to a remarkably constant ratio of approximately 250 microg/L dissolved As per 1 mg/kg P-mobilizable As. We use this relationship in a simple model of groundwater recharge to propose that the distribution of groundwater As in shallow aquifers of the Bengal Basin could primarily reflect the different flushing histories of sand formations deposited in the region over the past several thousand years.

Variance components due to direct genetic, maternal genetic and permanent environmental effect for growth and feed-efficiency traits in young male Japanese Black cattle

Variance components and genetic parameters were estimated using data recorded on 740 young male Japanese Black cattle during the period from 1971 to 2003. Traits studied were feed intake (FI), feed-conversion ratio (FCR), residual feed intake (RFI), average daily gain (ADG), metabolic body weight (MWT) at the mid-point of the test period and body weight (BWT) at the finish of the test (345 days). Data were analysed using three alternative animal models (direct, direct + maternal environmental, and direct + maternal genetic effects). Comparison of the log likelihood values has shown that the direct genetic effect was significant (p < 0.05) for all traits and that the maternal environmental effects were significant (p < 0.05) for MWT and BWT. The heritability estimates were 0.20 +/- 0.12 for FI, 0.14 +/- 0.10 for FCR, 0.33 +/- 0.14 for RFI, 0.19 +/- 0.12 for ADG, 0.30 +/- 0.14 for MWT and 0.30 +/- 0.13 for BWT. The maternal effects (maternal genetic and maternal environmental) were not important in feed-efficiency traits. The genetic correlation between RFI and ADG was stronger than the corresponding correlation between FCR and ADG. These results provide evidence that RFI should be included for genetic improvement in feed efficiency in Japanese Black breeding programmes.

Genetic parameters for feed efficiency traits and their relationships with growth and carcass traits in Duroc pigs

Genetic parameters for feed efficiency traits of 380 boars and growth and carcass traits of 1642 pigs (380 boars, 868 gilts and 394 barrows) in seven generations of Duroc population were estimated. Feed efficiency traits included the feed conversion ratio (FCR), and nutritional (RFI(nut)), phenotypic (RFI(phe)) and genetic (RFI(gen)) residual feed intake. Growth and carcass traits were the age to reach 105-kg body weight (A105), loin eye muscle area (EMA), backfat (BF), intra-muscular fat (IMF) and meat tenderness. The mean values for RFI(phe) and RFI(gen) were close to zero and for RFI(nut) was negative. All the measures of feed efficiency were moderately heritable (h(2) = 0.31, 0.38, 0.40 and 0.27 for RFI(nut), RFI(phe), RFI(gen) and FCR respectively). The heritabilities for all growth and carcass traits were moderate (ranged from 0.37 to 0.45), except for BF, which was high (0.72). The genetic correlations of RFI(phe) and RFI(gen) with A105 were positive and high. Measures of RFI were correlated negatively with EMA. BF was more strongly correlated with measures of RFI (r(g) > or = 0.73) than with FCR (r(g) = 0.52). Selection for daily gain, EMA, BF and IMF caused favourable genetic changes in feed efficiency traits. Results of this study indicate that selection against either RFI(phe) or RFI(gen) would give a similar correlated response in carcass traits.

Genetic parameters for measures of the efficiency of gain of boars and the genetic relationships with its component traits in Duroc pigs

Genetic parameters for the efficiency of gain traits on 380 boars and the genetic relationships with component traits were estimated in 1,642 pigs (380 boars, 868 gilts, and 394 barrows) in 7 generations of a Duroc population. The efficiency of gain traits included the feed conversion ratio (FCR) and residual feed intake (RFI) and their component traits, ADG, metabolic BW (MWT), and daily feed intake (FI). The RFI was calculated as the difference between the actual and expected FI. The expected FI was predicted by the nutritional requirement and by the residual of phenotypic (RFI(phe)) and genetic (RFI(gen)) regressions from the multivariate analysis for FI on MWT and ADG. The means for RFI(phe) and RFI(gen) were close to zero, and the mean for nutritional RFI was negative (-0.11 kg/d). The traits studied were moderately heritable (ranging from 0.27 to 0.53). The genetic and phenotypic correlations between ADG and FI were moderate to high, whereas the genetic correlation between MWT and FI was moderate, and the phenotypic correlation between them was low. The corresponding correlations between RFI(phe) and RFI(gen) were > 0.95, implying that they can be regarded as the same trait. The genetic and phenotypic correlations of FCR with measures of RFI were high but lower than unity. The RFI(phe) was phenotypically independent of its component traits, MWT (r(p) = 0.01) and ADG (r(p) = 0.03). The RFI(gen) was genetically independent of MWT (r(g) = -0.04), whereas there was a weak genetic relationship (r(g) = 0.15) between RFI(gen) and ADG. Residual FI was more heritable than FCR, and the genetic and phenotypic correlations of RFI(phe) and RFI(gen) with FI were positive and stronger than that of FCR with FI. These results provide evidence that RFI(phe) or RFI(gen) should be included in breeding programs for Duroc pigs to make genetic improvement in the efficiency of gain.

Impact of irrigating rice paddies with groundwater containing arsenic in Bangladesh

Soil and soil-water As profiles were obtained from 4 rice paddies in Bangladesh during the wet growing season (May-November), when surface water with little arsenic is used for irrigation, or during the dry season (January-May), when groundwater elevated in arsenic is used instead. In the upper 5 cm of paddy soil, accumulation of 13+/-12 mg/kg acid-leachable As (n=11) was observed in soil from 3 sites irrigated with groundwater containing 80-180 microg/L As, whereas only 3+/-2 mg/kg acid-leachable As (n=8) was measured at a control site. Dissolved As concentrations averaged 370+/-340 microg/L (n=7) in the upper 5 cm of the soil at the 3 sites irrigated with groundwater containing 80-180 microg/L As, contrasting with soil water As concentrations of only 18+/-7 microg/L (n=4) over the same depth interval at the control site. Despite the accumulation of As in soil and in soil water attributable to irrigation with groundwater containing elevated As levels, there is no evidence of a proportional transfer to rice grains collected from the same sites. Digestion and analysis of individual grains of boro winter rice from the 2 sites irrigated with groundwater containing 150 and 180 microg/L As yielded concentrations of 0.28+/-0.13 mg/kg (n=12) and 0.44+/-0.25 mg/kg (n=12), respectively. The As content of winter rice from the control site was not significantly different though less variable (0.30+/-0.07; n=12). The observations suggest that exposure of the Bangladesh population to As contained in rice is less of an immediate concern than the continued use of groundwater containing elevated As levels for drinking or cooking, or other potential consequences of As accumulation in soil and soil-water.