The role of platelets and von Willebrand factor in the procoagulant phenotype of inflammatory bowel disease

OBJECTIVE

Although the risk for thrombosis is well documented for inflammatory bowel disease (IBD) patients, the underlying pathological mechanism seems to be different from other thrombotic conditions. Deciphering the actors responsible for the increased risk of thrombosis in IBD would help to improve management of this frequent complication.

DESIGN

We studied the interplay between platelets, coagulation, and von Willebrand factor (VWF) in 193 IBD patients and in experimental models (acute and chronic) of colitis in wild-type and VWF-deficient mice.

RESULTS

We found a platelet-dependent increase in thrombin generation in IBD patients and in our mouse model of colitis. Agglutinated platelets were present in the blood of patients and mice. Interestingly, we observed not only a significant increase in total VWF antigen, but we were able to detect the presence of active VWF (VWF in its platelet-binding conformation; 3.2±2.7µg/ml) in the plasma of 30% of all IBD patients. In healthy controls, active VWF levels were below 0.3µg/ml. This led us to further explore experimental colitis in VWF-deficient mice and we observed that these mice were protected against the procoagulant state triggered by the colitis. Unexpectedly, these mice also manifested a significant worsening of colitis severity both in acute and chronic models.

CONCLUSION

Platelets and VWF (including its active form) appear to be central players in the procoagulant phenotype in IBD. We observed that the role of VWF in hemostasis differs from its role in colic tissue healing, potentially opening new therapeutic avenues for a life-threatening complication in IBD patients.

Medical Knowledge versus Perception of Patients with Abdominal Gas in a Tertiary Level Hospital of Bangladesh

Every human being has gas in abdomen. But patients try to correlate varieties of symptoms with abdominal gas. So this cross sectional symptom based study was designed to see the patients view regarding abdominal gas and its relation with medically explained symptoms at the out patient department of North East Medical College, Sylhet from January 2017 to December 2019. Consecutive patients presenting with complain of abdominal gas were included in this study. Their demographic information and explanation of symptoms resulting from abdominal gas were recorded on a pre-designed data sheet. Statistical analysis was done using SPSS 20.0 version. Total 346 patients, male 239(69.1%), female 107(30.9%), age varying from 17-83 years (mean 38.27) were enrolled. Common symptoms were bloating (fullness) of abdomen (194, 56.1%), abdominal pain (164, 47.41%), belching or eructation (149, 43.1%), heart burn (137, 39.6%), anorexia (124, 35.8%), nausea (120, 34.7%), noisy bowel (88, 25.4%), chest pain (79, 22.8%), headache (56, 16.2%), whole body pain (58, 16.8%), incomplete bowel evacuation (185, 53.5%), excess flatus (76, 22.4%), movement of gas to different part of body including head 87(25.1%) and expulsion of hot air from ear, nose and head in 69(19.9%) patients. Among them 107(30.9%) patients believed abdominal gas to be a curable disease with treatment and 222(64.2%) believed it to be a relapsing disease even after treatment. And 307(88.7%) patients were taking proton pump inhibitor (PPI) as its remedy regularly. Most of the symptoms of patients can be explained by abdominal gas. Again some patients have a misperception regarding some symptoms like heart burn, noisy bowel and sense of incomplete bowel evacuations are also related with abdominal gas. But in some instances causal relations with patients' symptoms and abdominal gas could not be explained by medical knowledge. These differences in perceptions might be related to their personal thinking and social, cultural, educational, economic condition.

Prevalence of Sonologically Detected Non-alcoholic Fatty liver disease Among School Children of Sylhet City

This cross sectional descriptive type of observational study was designed to see the prevalence of NAFLD among school children of Sylhet, Bangladesh from December 2019 to January 2020. School children of three private schools of Sylhet City were randomly selected. Socio-demographic data and anthropometric measurement of them were recorded. Then they underwent screening sonologically for NAFLD. Data analysis was done using SPSS version 20.0. P value <0.05 was taken as significant. Total 174 students, boys 99(56.9%) and girls 75(43.1%) were included. Age of them varied from nine years to 17 years (mean 13.408). In this series 82(47.1%), 52(29.9%) and 40(23.0%) were of normal weight, overweight and obese children respectively. In this study 29(16.7%) children had NAFLD and seven (4.0%) had biliary sludge in gall bladder. NAFLD was significantly higher among children with higher BMI (p=0.00). Female sex, children consuming fast food and playing video games were about two times more prone to develop NAFLD. Biliary sludge was found significantly higher among children consuming fast food (p=0.02). NAFLD among school going children is not uncommon. Higher BMI is a significant risk factor of developing NAFLD. Girls and children consuming fast food and playing video games also are more prone to develop NAFLD. Prevalence of sludge in gall bladder is low among school children.

Respective roles of Glycoprotein VI and FcγRIIA in the regulation of αIIbβ3-mediated platelet activation to fibrinogen, thrombus buildup, and stability

BACKGROUND

The interplay between platelets and fibrinogen is the cornerstone of thrombus formation. Integrin αIIbβ3 is the main platelet adhesion receptor for fibrinogen and mediates an outside-in signal upon ligand binding that reinforces platelet activation. In addition, FcγRIIA and glycoprotein VI (GPVI) contribute to platelet activation on fibrinogen, thereby participating in thrombus growth and stability. To date, the relative importance of these two immunoreceptor tyrosine-based activation motif-bearing receptors in these processes remains unknown.

OBJECTIVE

The aim of this study was to evaluate the relative contributions of FcγRIIA and GPVI to platelet activation on fibrinogen and subsequent thrombus growth and stability.

METHODS

We evaluated human and mouse platelet adhesion to fibrinogen in static assays and a flow-based approach to evaluate the contribution of FcγRIIA and GPVI to thrombus growth and stability.

RESULTS

We first confirmed that integrin αIIbβ3 is the key receptor supporting platelet adhesion and spreading on fibrinogen. Using human platelets treated with pharmacological blocking agents and transgenic mouse platelets expressing human receptors, data indicate that GPVI, but not FcγRIIA, plays a prominent role in platelet activation on fibrinogen. Moreover, using a flow-based assay, we observed that blockade of GPVI with 1G5, but not FcγRIIA with IV.3, prevents thrombus growth. Finally, we observed that 1G5, but not IV.3, promotes the disaggregation of thrombi formed on collagen in vitro.

CONCLUSION

This study provides evidence that GPVI, but not FcγRIIA, induces platelet activation and spreading on fibrinogen, and promotes thrombus buildup and stability.

A Rare Case of Polyorchidism: Sonographic and MR Evaluation of Four Testes

Polyorchidism is a rare congenital anomaly reported about 200 cases in the world text. A number of theories have been planned concerning the making of polyorchidism, but the real explanation is still not acknowledged. Here we are going to present a case study of polyorchidism. A 70 years old gentleman complained with left supernumerary testes in the left hemiscrotum. His left hemiscrotum was painless with mass. Polyorchidism without malignancy or any other concomitant features were revealed by both ultrasound and MRI examinations. In most cases the ultrasonograph alone is diagnostic. In complicated cases of polyorchidism MRI may provide additional information.

Molecular Detection of Human Coronavirus from North Central Part of Bangladesh Depending on ORF1ab and N Gene

The Coronavirus disease 2019 (COVID-19) resulted severe respiratory illness such as pneumonia and lung dysfunctions that was first identified at Wuhan, the capital of Hubeiin China during the end of December 2019. The etiological cause of COVID-19 has been confirmed as a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was similar with the zoonotic virus SARS-CoV (2002). Now a days for early diagnosis of COVID-19 the nucleic acid based test like RT PCR (real time reverse transcription polymerase chain reaction) is most consistent and used all over the world. In this study among 11,280 cases 825(7.31%) were positive by molecular RT PCR method on June 2020 at Microbiology department of Mymensingh Medical College and the samples are collected from different areas of Northern part of Bangladesh. Among this positive cases 588(71%) N gene, 10 ORF1ab (2%) and 227(27%) both N and ORF gene showed significant curve which is specific for COVID-19 positive patients. Because N and ORF gene of this virus inhibit immune system of human body especially interferon. Out of SARS-CoV-2 positive cases maximum number of N gene were found in male patients and above 40 years old aged group. So, Molecular diagnosis of this pandemic virus especially by N and ORF gene might be helpful to reduce the spread of SARS-CoV-2 as well as early treatment for saving many lives.

Pharmacological Blockade of Glycoprotein VI Promotes Thrombus Disaggregation in the Absence of Thrombin

OBJECTIVE

Atherothrombosis occurs upon rupture of an atherosclerotic plaque and leads to the formation of a mural thrombus. Computational fluid dynamics and numerical models indicated that the mechanical stress applied to a thrombus increases dramatically as a thrombus grows, and that strong inter-platelet interactions are essential to maintain its stability. We investigated whether GPVI (glycoprotein VI)-mediated platelet activation helps to maintain thrombus stability by using real-time video-microscopy. Approach and Results: We showed that GPVI blockade with 2 distinct Fab fragments promoted efficient disaggregation of human thrombi preformed on collagen or on human atherosclerotic plaque material in the absence of thrombin. ACT017-induced disaggregation was achieved under arterial blood flow conditions, and its effect increased with wall shear rate. GPVI regulated platelet activation within a growing thrombus as evidenced by the loss in thrombus contraction when GPVI was blocked, and the absence of the disaggregating effect of an anti-GPVI agent when the thrombi were fully activated with soluble agonists. The GPVI-dependent thrombus stabilizing effect was further supported by the fact that inhibition of any of the 4 key immunoreceptor tyrosine-based motif signalling molecules, src-kinases, Syk, PI3Kβ, or phospholipase C, resulted in kinetics of thrombus disaggregation similar to ACT017. The absence of ACT017-induced disaggregation of thrombi from 2 afibrinogenemic patients suggests that the role of GPVI requires interaction with fibrinogen. Finally, platelet disaggregation of fibrin-rich thrombi was also promoted by ACT017 in combination with r-tPA (recombinant tissue plasminogen activator).

CONCLUSIONS

This work identifies an unrecognized role for GPVI in maintaining thrombus stability and suggests that targeting GPVI could dissolve platelet aggregates with a poor fibrin content.

Huge Splenomegaly with Pancytopenia Due to Gaucher's Disease in a 22 Years Old Woman

Gaucher's disease is one of the important storage disorders. It belongs to the lysosomal storage disorders group. There is defective activity of an enzyme named β-glucosidase which ultimately renders the cell of macrophage lineage loaded with glucocerebrosides. There is multi-organ involvement that manifests as hepatosplenomegaly, variable cytopenias, skeletal disorders, neurological features etc. When serum β-glucosidase level is below 15% of mean normal activity Gaucher's disease is confirmed. Enzyme replacement is the definitive treatment. Here we report a case of type 1 or non-neuropathic form Gauchers disease presented with feeling of a lump in left upper abdomen and progressive generalized weakness and hepatosplenomegaly. Her complete blood count revealed pancytopenia and bone trephine biopsy showed Gaucher's cells. Diagnosis and management may be delayed as this disease is rare. Clinical and bone marrow examination is the mainstay of diagnosis. So emphasis should be given in this regard.

Detection of Oncoprotein by a Novel Immunochromatoghaphic Test Depending on Age and Parity of the Patients Attending at Mymensingh Medical College Hospital, Bangladesh

In world wide cervical cancer is the fourth most common among women, with the majority of cases occurring in developing countries. Some HPV infections persist, and a subset of persistent infections may lead to development of cervical intraepithelial neoplasia (CIN) or invasive cancer. Because neoplastic change typically takes some years to occur and it depends on multiple factors among them age and parity play important role. The objective of the cross sectional observational study was detection of oncoprotein depending on age and parity by immunochromatographic test (OncoE6 cervical test). Informed consent was taken from patients and the protocol was approved by IRB, Mymensingh Medical College, Mymensingh, Bangladesh. From April 2016 to March 2017 following universal safety precautions a total of 280 endocervical swabs were collected from VIA outdoor and Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Laboratory work was done in the department of Microbiology, Mymensingh Medical College. The E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. In this study VIA and OncoE6 cervical test were done on 280 cases and among them 120 were VIA positive and sent for colposcopy. From 120 VIA positive cases 70 were positive for colposcopy test. Afterwards 50 cases were selected for histopathological examination and classified into different grades. The present study showed 21(7.5%) cases were OnE6 cervical test positive by OncoE6 cervical test and most of them were found in advance aged <50 (38.09%) and multi parity (women more than two, 32.5%). Based on the findings of the present study, it may be concluded that age and multi parity plays important factor to cause cervical cancer. Now for prevention of cervical cancer we need screening which is an early detection tool. This is a low cost device, easily performed which can detect this HRHPV (High Risk HPV) and it will be helpful to reduce over treatment and high predictability of the disease.

Distribution of HPV-16 and HPV-18 from the Patients Attending At Mymensingh Medical College Hospital by Newly Developed Oncoprotein Detection Assay

Cervical cancer is one of cause of death in women in many developing countries. Persistent infection with Human Papilloma Virus (HPV), primarily high risk types 16 and 18, is recognized as a causal and essential factor for the development of cervical cancer. The objective of this cross sectional observational study is to detect the distribution of HPV-16 and HPV-18 among Onco E6 positive cases. Following universal safety precautions a total of 180 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology Department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2016 to December 2016. Laboratory work was done in the department of Microbiology, Mymensingh Medical College. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. Onco E6 cervical test was done on 180cases. Among them 60% were VIA positive and 120% were VIA negative. From this VIA positive cases 12(16.25%) were On E6 cervical test positive and from VIA negative cases 3(2.5%) were positive by this On E6 cervical test. From this 12 Onco E6 cervical test positive cases 10(%) were HPV-16 and 2(%) were HPV-18 and from VIA negative cases 3 were only HPV-16 by this test. Histopathological test done on 35 suspected cases and out of 08 cervical carcinoma cases 07 were positive by this Onco E6 cervical test which was also HPV-16 type. It may be concluded that HPV-16 is most prevalent type to cause cervical cancer and by this newly developed protein detection assay will be helpful to reduce over treatment and save many lives.

Molecular Diagnosis of Human Papilloma Virus by PCR

Cervical cancer is a major world health problem and the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. So detection of HPV DNA by PCR may help in early detection and management of cervical cancer. This cross sectional observational study was done to detect L1 antigen gene of HPV from cervical swab by nested PCR. Following universal safety precautions a total of 141 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of MMCH from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh HPV DNA was tested among 141 VIA positive women aged between 20-70 years by nested PCR method. DNA was extracted by phenol-chloroform extraction method. Two pairs of consensus primers MY09-MY11 and GP5-GP6 were used in a nested PCR assay. Histopathological examination was done on 66 samples in the Department of Pathology, MMC, Mymensingh, Bangladesh. A total of 36.9% (52/141) cases were positive for HPV DNA by nested PCR. On Histopathological diagnosis PCR was positive in 42.9% chronic cervicitis, 21.2% CIN cases and 90.9% cervical carcinoma cases. Based on the findings of the study, it may be concluded that the HPV DNA testing has opened the door for an alternative surveillance mechanism to routine cytological screening. Detection of HPV may play an important role in diagnosis and clinical prognosis of precancerous lesions. So PCR may be done for all VIA positive cases for screening of cervical cancer.

Prevalence of Intestinal Parasites in Raw Vegetables Consumed by Inhabitants of Mymensingh City

Uncooked vegetables are an important part of a healthy diet in different parts of the world. The present descriptive cross sectional type of study was carried out to determine the parasitological contamination of vegetables sold at markets of Mymensingh city of Bangladesh. Parasitological examinations were performed in material derived from 200 specimens of 10 different vegetables to detect intestinal parasites in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2015 to July 2016. Each sample was washed with 5 liter distilled water, then washing fluid was centrifuged and resulting sediment was collected for iodine and normal saline wet mount slide preparation to detect human pathogenic intestinal parasites by microscopic examination. Out of 200 vegetable samples, 123(61.5%) were contaminated with different species of parasites. The vegetables red amaranth had the highest contamination rate of 18/20 (90%) followed by jute leaf 17/20 (85%), coriander leaf 15/20 (75%), onion 14/20 (70%), lady's finger 14/20 (70%), radish 13/20 (65%), green pepper 12/20 (60%), carrot 12/20 (60%), cucumber 5/20 (25%), tomato 3/20 (15%). Among the contaminating parasites Ascaris lumbricoides (egg) 36.5% was the most prevalent followed by Strongyloides stercoralis (larva) 35.5%, Entamoeba histolytica ( trophozoite and different cystic stages) 8.5%, Hook worm (egg and larva) 6.5% , Balantidium coli (trophozoite) 4.0%, Enterobius vermicularis (egg) 3.5%, Trichuris trichiura (egg) 1.5%, Giardia lamblia (cyst) 1.0%. To our knowledge, it was the first base line study pursued in Bangladesh. Contamination of raw vegetables from markets with pathogenic parasites would increase the risk of disease to the population that consumes or works with these products. So improperly washed raw eaten vegetables should be considered a potential risk for contracting parasites, particularly helminthes in Mymensingh city.

Ultrasonographic Evaluation of Malignant Pediatric Abdominal Tumour with Histopathological Correlation

Ultrasonography is a very useful diagnostic tool to evaluate pediatric abdominal mass. This cross sectional study was conducted among clinically suspected patients having malignant abdominal mass attending in the department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2008 to December 2009. Total 56 patients were included in this study. Patients were scanned by high resolution gray scale ultrasonography of the abdominal masses. After surgical procedure, biopsy specimen were collected in a container containing 10% formalin and sent for histopathological examination. Mean age of the patients group was 5.91 years with a standard deviation of ±3.21 years. All patients were within 2 to 13 years age. Out of all patients, male were 33(58.9%) and 23(41.1%) were female. Male and female ratio was 1.4:1. Ultrasonographic diagnosis as Wilm's tumour were 27(48.2%), hepatoblastoma 8(14.3%), lymphoma 7(12.5%), neuroblastoma 6(10.7%), suspected malignancy 6(10.7%) and lastly teratoma were 2(3.6%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ultrasonography in the evaluation of Wilm's tumour were 100.0%, 90.6%, 88.9%, 100.0% and 94.6% for neuroblastoma 83.3%, 98.0%, 83.3%, 98.0% and 96.4% for lymphoma 83.3%, 96.0%, 71.4%, 98.0% and 94.6% and for hepatoblastoma 100.0%, 100.0%, 100.0%, 100.0% and 100.0% respectively. It is a noninvasive and cost effective modality. Carefully performed ultrasonographic study would give reliable and accurate information needed in the diagnosis of abdominal malignancy in children.

Detection of Ovarian Tumor by Color Doppler Ultrasonography and CA-125

Ovarian cancer is the most frequent cause of death from all gynaecological malignancies because of its insidious onset, vague symptoms and late presentation. This cross-sectional study was carried out on purposively selected 43 patients with suspected ovarian tumor in the Department of Radiology and Imaging in collaboration with the Department of Gynaecology and Obstetrics and Department of Pathology, Mymensingh Medical College Hospital, Bangladesh from January 2015 to December 2016 to assess the diagnostic performance of color Doppler ultrasonography and CA-125 in a combination described as Novel Index in detection of ovarian tumor. Highest number of patients of ovarian tumor 10(23.26%) were in age group 35 to 44 years and 45 to 54 years with a mean of 37.72±15.65 years with a range of 8-70 years. Histopathology findings revealed 19(44.18%) benign tumors and 24(55.82%) malignant tumors. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Resistance Index (RI) in diagnosis of ovarian tumor were 91.67%, 89.47%, 91.67%, 89.47% and 90.69% respectively. Sensitivity, specificity, PPV, NPV and accuracy of serum CA-125 were 83.33%, 89.47%, 90.90%, 80.95% and 86.04% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Novel index were 95.83%, 89.47%, 92.00%, 94.44% and 93.02% respectively. Novel index showed better diagnostic performance. Based on the current study it is concluded that the combination of color Doppler ultrasonography and serum CA-125 can be useful for diagnosis of ovarian tumor.

OncoE6 Positivity among VIA Positive Suspected Cases from Colposcopy Clinic of Mymensingh Medical College Hospital, Mymensingh

Cervical cancer is a major world health problem for women. It is the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. Oncoprotein E6 and E7 play an important role in the development of cervical cancer which can be detected by OncoE6 cervical test. This Cross sectional observational study was performed to detect E6 Oncoprotein from cervical swab by OncoE6 cervical test. Following universal safety precautions a total of 47 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh medical college. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. The swab specimen was treated with lysis solution and conditioning solution. Then the specimen solution was clarified by centrifugation. After that the sample solution was transferred into Detector mAb vial, wash solution vial and finally into developing solution vial. The test unit was then placed on a reading guide. Positive result was indicated by the appearance of purple colored test line. Out of 47 specimens 21(44.68%) were OncoE6 positive by OncoE6 cervical test. Among 21 positive cases 19(90.48%) were HPV-16 and 2 were (9.52%) HPV-18. Histopathologically out of 22 cervical carcinoma cases 20(90.90%) were positive by this test. Based on the findings of the present study, it may be concluded that screening with HPV E6 may minimize the overtreatment as well as the colposcopy referral. So it can be used as primary screening to aid colposcopy and to identify real disease. HPV based screening may help to control cervical cancer in Bangladesh. As HPV is a sexually transmitted infection; so, male screening method should be established.

Complexity and the triple bottom line: an information-processing perspective

Purpose

The purpose of this paper is to empirically investigate the impact of complexity on the triple bottom line by applying information-processing theory. Specifically, the paper assesses the impact of internal manufacturing complexity on environmental, social, and financial performance. Furthermore, the paper assesses the moderating role of connectivity and shared schema in reducing the potential negative impact of complexity on performance.

Design/methodology/approach

Multi-country survey data collected through the Global Manufacturing Research Group were utilized to test the hypotheses. The authors used structural equation modeling to test the measurement and initial structural model. Furthermore, to test the proposed moderating hypotheses, the authors applied the latent moderated structural equations approach.

Findings

The results indicate that while complexity has a negative impact on environmental and social performance, it does not significantly affect financial performance. Furthermore, this negative impact can be reduced, to some extent, through connectivity; however, shared schema does not significantly impact on the complexity-performance relationship.

Originality/value

This study presents a comprehensive analysis of the impact of complexity on sustainability. Furthermore, it provides managerial applications as it proposes specific tools to deal with the potential negative influences of complexity.

Nationwide prevalence of Rickettsia felis infections in patients with febrile illness in Bangladesh

From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections.

Response & Side Effects of Injectable Labetalol in Pregnancy Induced Severe Hypertension

The study was performed to assess the response & side effects of injectable Labetalol in the treatment of pregnancy induced severe hypertension. This interventional study was carried out on 72 patients having pregnancy induced severe hypertension attended in the Department of Obstetrics & Gynaecology, Mymensingh Medical College & Hospital (MMCH), Mymensingh, Bangladesh from November 2009 to October 2010. All patients were treated with intravenous Labetalol 20mg & the dose was repeated at sequential escalating dosages every 15 minutes until a therapeutic goal of systolic blood pressure <160mm of Hg & diastolic blood pressure <105mm of Hg were achieved. Among 72 respondents highest number were observed having systolic blood pressure 160-169 and 180 & above mm of Hg. The mean systolic & the diastolic blood pressure at the initiation of the study were observed 198±13.17mm of Hg & 119±8.6mm of Hg respectively. After use of injection Labetalol mean systolic blood pressure were 138.61±15.43mm of Hg, which is statistically significant (p value <0.001) & mean diastolic blood pressure were 96.18±9.7mm of Hg, which is also statistically significant (p value <0.001). It was observed that majority patients' blood pressure was controlled by 1-2 doses. It was noticed that injection Labetalol controls blood pressure in 80% antenatal cases & 86% postnatal cases. Out of 72 patients 4 cases (5.5%) experienced nausea & vomiting and only 1 case (1.1%) experienced headache. Regarding fetal outcome 48% patients delivered healthy baby, about 31% patients delivered asphyxiated baby & neonatal death were noticed in 4% cases. This study assessing the response & side effects of intravenous antihypertensive drug in the treatment of pregnancy induced severe hypertension shows that Labetalol fulfils the criteria of an antihypertensive drug for this purpose.

Detection of Human Papilloma virus by Molecular method from Patients Attending at Colposcopy Clinic of Mymensingh Medical College Hospital, Mymensingh

Cervical cancer is the second most common cancer in women worldwide. Human papillomavirus (HPV) is considered as the main cause of invasive cervical cancer and cervical intra-epithelial neoplasia. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers. So HPV DNA testing for screening of cervical cancers may play a potential role in early detection and management of cervical cancer. With above background a cross sectional study was undertaken to estimate the prevalence and to identify the associated risk factors of human Papillomavirus infection among Visual Inspection with Acetic acid (VIA) positive women attending at colposcopy clinic of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2013 to December 2014. One hundred and forty three cervical swabs for nested PCR were collected from the patients attending colposcopy clinic of MMCH, for detecting target gene of L1 region of the HPV genome. Among the 143 VIA positive patient nested PCR showed 49.6% (71/143) positive. Biopsy of 54 colposcopy positive women revealed that 16 (29.6%) cases were chronic cervicitis, 33 (61.1%) cases were mild dysplasia (C1NI), 01 (1.9%) were having moderate dysplasia (C1NII) and 04(7.4%) patients were diagnosed as invasive squamous cell carcinoma. So, high grade cervical lesions were 100% positive by nested PCR for HPV.

Ultrasonographic Evaluation of Palpable Breast Mass and Correlation with Histopathology

Breast cancer is the most common malignancy in women and the second most common cause of cancer-related mortality. The distinction by physical examination of physiologic nodularity from abnormal masses can be difficult, while the clinical differentiation of a malignant mass from a benign one is difficult; the medical as well as potential legal consequences of missing a palpable carcinoma are high. There are significant number of reported cases of false-negative findings on mammography and the great desire not to miss a malignant lesion in the early stage of disease lead to aggressive biopsy, but the biopsy rate for cancer is only 10.0% to 30.0%. This means that 70.0% to 90.0% of breast biopsies are performed for benign diseases, which induce unnecessary patients discomfort and anxiety in addition to increasing costs to the patient. Clearly, there is a great need for development of additional reliable methods to complement the existing diagnostic procedures to avoid unnecessary biopsy. This cross sectional study was carried out on 43 patients having palpable breast mass, attended in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st January 2012 to 31st December 2013 for the period of two year. These patients were evaluated by USG at the Department of Radiology and Imaging and histopathological examination at the Department of Pathology of the same College to confirm the diagnosis. In diagnosis of malignant mass by USG, 9(20.9%) cases were diagnosed as malignant and 34(79.1%) cases as other than malignant. Eight out of 9 were sonographically diagnosed as malignant lesions also proved as malignant lesion by histopathology and 1 other than malignant. Out of 34 sonographically diagnosed cases of other than malignant lesions 32 were proved histopathologically and 2 did not match with sonographic findings. USG, in diagnosis of malignant lesion, sensitivity was 80.0%, specificity 96.97%, positive predictive value (PPV) (88.89%), negative predictive value 94.12% and accuracy was 93.02% and comparable to other study. In diagnosis of benign lesion by USG, sensitivity was 96.97%, specificity 80.0%, positive predictive value (PPV) (94.12%), negative predictive value 88.89% and accuracy was 93.02%. So, USG is an appropriate imaging method for diagnosis & differential diagnosis of palpable breast mass.

Correlation of Systemic Inflammatory Status and Cardiac Myonecrosis in Patients Undergoing Percutaneoues Coronary Intervention

Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Pre-Percutaneoues coronary intervention (PCI) plasma hs-CRP concentration has been reported to influence both short and long term outcome after percutaneoues coronary intervention (PCI). Studies have reported association between pre-PCI CRP and PCI induced cardiac myonecrosis evaluated by sensitive marker of myocardial injury. The present study attempts to evaluate the influence of pre-PCI CRP levels, factors related to the procedure and ongoing medications on the event of post-PCI cardiac myonecrosis. This prospective observational study was done in a Tertiary referral hospital (St. James's Hospital, Dublin, Ireland) involving 38 patients with normal pre-procedural serum troponin T (<0.03μg/litre) undergoing elective PCI. Significantly high basal levels of hs-CRP was detectable in >60% patients undergoing elective PCI. This was further increased to >65% after PCI. Median value of hs-CRP before PCI was 3.61 (range 0.21-47.2mg/L). This value increased to 4.58 (range 0.44-39.2mg/L) after PCI (p<0.05). Though there was significant increase in the post-PCI median value (compared to the pre-PCI value) of TnT (0.015 vs. 0.01μg/L; p<0.001) and CKMBM (4.54 vs. 2.40μg/L; p<0.001), no significant correlation was found between pre-PCI hsCRP and post-PCI TnT (spearman correlation coefficient - 0.074; p=NS) as well as post-PCI CKMBM (spearman correlation coefficient - 0.036; p=NS). The changes in the values of TnT & CKMBM showed moderate positive correlation (spearman correlation coefficient - 0.52; p<0.001). Procedural parameters (of balloon dilatation and stent implantation) did not have significant correlation either. No significant influence of age and ongoing medications was found. Increased hs-CRP levels in serum before PCI was not correlated with significant cardiac myonecrosis detected after PCI.

Doppler Assessment of Hepatic Venous Waves for Evaluation of Large Varices in Cirrhotic Patient

This cross sectional study was conducted to evaluate the role of doppler ultrasonography of hepatic venous waves for evaluation of large varices in cirrhotic patients from July 2013 to June 2015 in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Patients getting admitted in the ward with a diagnosis of cirrhosis were enrolled in the study and purposive sampling technique was adopted. The sample size was 43. Data were collected by face to face interview and some data were gathered by records review and analyzed with the help of SPSS windows version - 12 software programs. Statistical significance was set at P<0.05 and confidence interval set at 95%. The research protocol was approved by the local ethical committee. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although and it can certainly demonstrate the presence of varices. In 60.47% of patient's monophasic wave pattern was seen and in 39.53% of cases biphasic & triphasic wave pattern were detected. Endoscopic examination was performed in all selected patients. In this study, 67.44% is large varices, 32.66% is small varices. Chi Square test was done for hypothesis testing and it was found significant (<0.05) and it indicates monophasic wave in Doppler USG signifies large varices. This test was also done to find out whether any significant difference of hepatic venous waveform in between male and female but it was not significant (>0.05). Diagnostic performance of USG for evaluation of varices showed, Sensitivity: 86.2%, Specificity: 92.85%, PPV: 96%, NPV: 76.47%, Accuracy 88%. Correlation co-efficient was 0.0064 which indicates moderately positive correlation in between monophasic hepatic venous waveform pattern by Doppler USG and large varices in oesophagogastroduodenoscopic findings Normal hepatic wave form shows triphasic pattern. Loss of this pattern in cirrhosis is mainly due to loss of compliance of liver. In conclusion, the loss of triphasic pattern of hepatic wave form is highly sensitive in predicting the presence of large varices in cirrhotic patients and this doppler parameter may be used as a non-invasive test for cirrhotic patients, who wish to avoid upper GI endoscopy. Further studies using a combination of various doppler parameters are needed to create indices with a better predictive value.

Correlation between Umbilical Cord Diameter and Cross Sectional Area with Gestational Age and Foetal Anthropometric Parameters

The objective of the study was to find out correlation between umbilical cord diameter, cross sectional area with gestational age and foetal anthropometric parameters. This cross sectional study was conducted among healthy women between the 24(th) and 40(th) completed weeks of a normal pregnancy in the Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh during the study period, from July 2009 to June 2011. A total of 230 consecutive normal pregnancy patients were included in the study. The diameter & cross-sectional area of the umbilical cord were measured on a plane adjacent to the junction of the umbilical cord and the fetal abdomen, in cross-section, with maximum magnification of the image. The cord was manually circled, and it's cross sectional areas was automatically calculated by the ultrasonograph. The mean±SD age was 24.3±4.7 years with range from 19 to 36 years. The mean gestational age was 32.1±4.5 weeks and more than a half (56.4%) of the pregnant women were nulliparas. A positive significant (p<0.001) correlation were found between umbilical cord diameter with bi-parietal diameter (r=0.548); head circumference (r=0.411); abdominal circumference (r=0.444); femur length (r=0.366) and gestational age gestation age (r=0.643). Similarly, a significant (p<0.001) positive week correlation were found between umbilical cross sectional area with bi-parietal diameter (r=0.3303); head circumference (r=0.3202); abdominal circumference (r=0.2651); femur length (r=0.3307) and gestation age (r=0.4051). A positive significant better correlation was found with umbilical cord diameter than cross sectional area with foetal anthropometric parameters.

Comparison between Angiographic Findings of Coronary Artery Disease in STEMI and NSTEMI Patients of Bangladesh

Coronary Angiogram (CAG) has been used to detect coronary artery disease in myocardial infarction (both STEMI and NSTEMI) patients. The purpose of this study was to compare the degree of coronary artery disease among STEMI and NSTEMI patients. Among acute coronary syndrome in NSTEMI we found more widespread coronary artery disease other than STEMI. Lack of documentations encouraged us to perform this study in our center. In this retrospective observational study we summarized all myocardial infarction (MI) patients who underwent coronary angiography (CAG) from August 2013 to August 2014 at Enam Medical College Hospital, Dhaka, Bangladesh and data of degree of coronary artery disease were recorded. Data of 100 consecutive MI patients who underwent CAG during that period were recorded. Among them 50 patients having STEMI as Group I (male 45, female 5) & other 50 patients sustained NSTEMI as Group II (male 38, female 12). Among NSTEMI patient group 80% were having multi-vessel disease and in STEMI patient group 80% having single vessel disease and remaining having multi-vessel disease. The degree of coronary artery disease is extensive in NSTEMI patients than in STEMI group. Coronary angiogram can visualize the degree of coronary artery involvement and is a useful screening modality to compare disease extent in MI patients.

Study on Neurological Manifestations of Eclampsia & Findings of CT scan of Brain

This cross sectional study was carried out in the Department of Obstetrics & Gynaecology in Mymensingh Medical College Hospital during the period of January 2011 to December 2012 to evaluate neurological manifestations in eclampsia by CT scan of brain. A total 35 patients with eclampsia were studied, who underwent CT scan of brain in Radiology & Imaging Department of Mymensingh Medical College Hospital. The study patients were divided into two groups, those who had changes in brain on CT scan (Group A) & those who had no changes in brain on CT scan (Group B). Finally the study variables were compared between these two groups. Each selected patient fulfilling the criteria was sent to the department of Radiology & Imaging for CT scanning of brain. In antepartum cases of eclampsia CT scan of brain were done after delivery/ termination of pregnancy. In all cases, CT scan of brain was done within 72 hours of admission. Out of 35 patients total 85.72% had changes in brain on CT scan & 14.28% had no changes in brain on CT scan. Among them 45.72% patients had cerebral oedema, 37.14% had cerebral infarct & 2.86% patients had intracerebral haemorrhage. Comparison of neurological parameters were done & showed that there were statistically significant difference between the two groups regarding headache, visual disturbance, hypereflexia & depression of consciousness. There was no statistically significant difference regarding aphasia & hemiplegia between the two groups. So the CT scan of brain has been useful in demonstrating the lesion of brain in patients with eclampsia & also helpful to evaluate the neurological manifestations in eclampsia.

Etiology of Laryngeal Squamous Cell Carcinoma: Study of 50 Cases in Mymensingh Medical College Hospital

This cross sectional observational study was done in the Department of ENT & Head-Neck Surgery, Mymensingh Medical College, Bangladesh from January 2013 to July 2014. Fifty (50) cases of carcinoma larynx were purposively selected. Clinically diagnosed cases of carcinoma larynx and histologically proven squamous cell carcinoma were included. Among 50 cases age ranged from 35-75 years with an average age of 58.1 years. Maximum patients were in 5th and 6th decades with male-female ratio 16:1. Most of the patient (78%) came from rural areas and came from low socio-economic condition (58%); maximum patients were cultivator (42%) & illiterate (50%). Smoking was the commonest (64%) personal habit. The other common personal habits were chewing of Betel nut & leaf (44%) and chewing of Tobacco (36%). Most of them have more than one habit.

Measurement of Apolipoprotein B May Predict Acute Coronary Syndrome in Hyper-triglyceridemic Young Population

The purpose of this study is to measure apolipoprotein B (ApoB) in hyper-triglyceridemic (HTG) young people of Bangladesh for predicting risk of acute coronary syndrome. This case-control study was carried out in Department of Cardiology, of Mymensingh Medical College Hospital within the period from June 2009 to May 2010. A total 50 case of 18-45 years of age with first attack of acute coronary syndrome admitted in coronary care unit and 50 healthy controls of same age and sex distribution were studied. Twenty (40%) of the studied case and 21(42%) of controls had hyper hyper-triglyceridemia, of those 18(90%) of HTG cases and 12(57.1%) of HTG controls had hyper-ApoB condition. The present study shows significant association of apolipoprotein B as an independent determinant and estimation of ApoB may be an alternative tool for predicting risk of development of acute coronary syndrome in hyper-triglyceridemic young people.

Comparative analysis of serum malondialdehyde, antioxidant vitamins and immunoglobulin levels in patients suffering from generalized anxiety disorder

The relationship between the elevated levels of serum malondialdehyde, depleted level of antioxidants (vitamin A, E and C) and altered level of immunoglobulins (IgA, IgG and IgM) in several psychiatric disorders has been established by various experimental evidences over the past few years. But previously no study was carried out to determine these components in patients suffering from generalized anxiety disorder (GAD) in Bangladesh. This study was conducted to compare the serum concentration of these components in GAD patients and healthy volunteers; matched by socioeconomic and sociodemographic parameters. Serum level of malondialdehyde and vitamin C were determined by UV spectrophotometric method, vitamins A and E were detected by RP-HPLC method whereas immunoglobulin levels were determined by turbidimetric method. Data were analyzed by independent t-test, Pearson's correlation and regression analysis. Significantly lower level of vitamin E (p<0.05) and significantly higher level of vitamin C were found in GAD patients than the healthy controls, whereas the change of vitamin A was insignificant. Serum malondialdehyde content was significantly higher (p<0.05) and IgM level was significantly (p<0.05) higher than that of the controls. Change in concentrations of IgG and IgA were insignificant (p>0.05). Pearson's correlation coefficient suggested that there were some significant positive and negative correlations among these tested components. Our study reveals that GAD patients have considerably higher level of malondialdehyde, immunoglobulins and altered level of antioxidant vitamins. These findings may play a key role in the diagnosis and treatment of GAD patients.

Cutaneous metastatic adenocarcinoma - a case report

Cutaneous metastases from carcinoma are relatively uncommon in clinical practice but they are very important to recognize. Cutaneous metastases may herald the diagnoses, can lead to accurate diagnoses and timely treatment. A high index of suspicion is required because the clinical finding may be subtle. The patient of cutaneous metastases may present with rapidly developing nodules or tumors. Although asymptomatic in most instances, Pain and tenderness may be noted. Here we described a 38 year old male who presented with fever, anorexia, weight loss and multiple painful nodules, plaques and tumors on his scalp, face, upper trunk and proximal portion of the upper limbs. This case present with cutaneous metastatic adenocarcinoma with atypical presentation and detection of cutaneous metastasis before primary tumor detection.

CYP3A genotypes in Bangladeshi tuberculosis patients

The purpose of this study is to investigate the genotype and allelic frequencies of CYP3A in Bangladeshi Tuberculosis (TB) patients which may help for individualized drug dosing and improved therapeutics. Genotyping was done using the extracted genomic DNA from 90 TB patients followed by amplification of target alleles by Polymerase Chain Reaction (PCR). Amplified alleles were then digested by restriction enzymes followed by gel electrophoresis & sequencing to identify the targeted alleles namely CYP3A4*1B, CYP3A4*2, CYP3A4*4, CY3A4*5, CYP3A4*6, CYP3A4*10, CYP3A4*18, and CYP3A5*3. In TB patients, no samples were positive for CYP3A4*2, CYP3A4*4, CYP3A4*5, CYP3A4*6, CYP3A4*10, and CYP3A4*18 alleles. One sample was found to be heterozygous for CYP3A4*1B (1.11%). The wild homozygous (CYP3A5*1/*1) genotype frequency was 7.78%, the heterozygous (CYP3A5*1/*3) frequency was 42.22% and the homozygous mutant (CYP3A5*3/*3) frequency was 50% in Bangladeshi TB patients. The absence of the common polymorphic gene suggests that there will be no impact of CYP3A drug metabolizing enzymes on antituberculosis drugs.

Malignancy in solitary solid cold thyroid nodule

Solitary thyroid nodule is a common endocrine problem. The main concern of solitary thyroid nodule lies in excluding the malignancy & to operate on as few patients as possible. Other than history & clinical examination, hormone assessment, USG of thyroid gland, radionuclide scan & FNAC were used to differentiate malignant nodules from benign ones. In this study 127 cases with solitary thyroid nodule of all age group & both sexes were included from Endocrine & Thyroid clinic of BSMMU. They were clinically & biochemically euthyroid & had cold nodule on radionuclide scan. USG & FNAC were done & subsequently they underwent surgical procedure. On the basis of postoperative histopathological report the specimens were divided into benign & malignant groups. All the nodules were cold among which 104 were solid & 23 were mixed in consistency. Of the 104 solid cold nodules histopathology revealed 36(34.6%) malignant & 68(65.4%) benign cases. From the 23 mixed cold solitary nodule 5(21.7%) appeared malignant & 18(78.3%) were benign. So malignancy was higher in solid cold group than the mixed cold one but this was not statistically significant (p=0.673). FNAC was done & it revealed that 83(65.5%) cases were benign, 10(7.8%) cases were suspicious & 34(26.7%) were malignant. Finally histopathology showed 41(32.3%) cases were positive & 86(67.7%) cases were negative for malignancy.

Genetic Testing for Huntington's Disease in Parkinsonism

The study was conducted to find out Huntington's disease (HD) by genetic analysis from those presenting with parkinsonism in the Neurology department of Mymensingh Medical College & Hospital. A sample of about 5ml blood was collected by veni puncture in EDTA tube with informed consent from 9 patients & 7 healthy individuals after approval of the institutional ethics committee for genetic study. The neurological disorder along with a complete history and physical findings were recorded in a prescribed questionnaire by the neurologists of Mymensingh Medical College & Hospital. Extraction of genomic DNA from the venous blood using FlexiGene DNA kit (Qiagen, Japan) was performed in Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh. The extracted DNA was stored and accumulated and then these DNA were sent to Division of Clinical Genetics, Department of Medical Genetics, Osaka University Medical School, Suita, Osaka 565 0871, Japan for PCR and further analysis. PCR amplification of the CAG repeat in the 1T15 gene was performed with primers HD1 and HD3. HD PCR products revealed the DNA product of about 110bp (no. of CAG repeats=21) to 150bp (no. of CAG repeats=34) in both healthy individual and suspected PD patient DNA.

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.

Swine flu: a new emerging disease

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

Molecular characterization of group A human rotavirus among hospitalized children and adults in Bangladesh: finding of emerging G12 strain

Between July 2004 and June 2006, a total of 1438 fecal samples were collected from Hospitalized children and adults with diarrhea at an Infectious Disease Hospital (SK Hospital) in Mymensingh, Bangladesh. The diversity of rotavirus strains were investigated using electropherotyping and reverse transcription-PCR amplification of the VP7 and VP4 genes. Group A rotavirus was detected in 171 of 1438(11.9%) specimens: 13.3%(72/543) from children 6 months to </=15 years of age and 11.0%(99/895) from individuals aged >15-76 years. The electrophoretic patterns of dsRNA of rotavirus showed 11 different migrations (7 long and 4 short) by polyacrylamide gel electrophoresis (PAGE). Representative 60 positive samples were selected for PCR genotyping. For the entire period, the common rotavirus G types G1 (27%), G2 (45%), and G9 (7%), comprised 79% of the strains, and common P types, P[4] (43%), P[6] (12%), and P [8] (20%), comprised 75% of the total P types. Of note, we detected a high percentage of unusual G-type P-type combination (11%) strains and specimens with mixed (10% G and 23% P) rotavirus infection with a variety of genomic constellation. Overall, the most frequent rotavirus strains were G2P[4] (36.7%) both in children and adults which were mostly associated with VP6 genotype I (subgroup I), and NSP4 genotype A or B, followed by G1P[8] (10.0%), G9P[8] (6.7%). G12 was detected for the first time in the study area and the detection rate was G12P[6] (3.4%), and G12P[4] (1.7%). The nucleotide sequence of VP7 gene was highly homologous among G12 strains isolated in Mymensingh suggesting recent emergence from a common ancestor. The study highlighted the diversity of rotaviruses isolated from children and adults. Due to the effect of antigenic diversity on rotavirus vaccines, it is important to continue careful monitoring of these strains as rotavirus vaccine programs are being implemented in Bangladesh.

Role of immunochromatographic test for rapid diagnosis of malaria

The study was conducted to compare among the different diagnostic procedures for malaria in the department of Microbiology, Mymensingh Medical College, Mymensingh during the period from July 2005 to June 2006. In this study a total of 98 malaria patients were included as cases. Another 30 age and sex matched healthy people were included as controls. Blood sample from each of the case and control was collected and examined for malarial parasite by microscopic examination of peripheral blood film. Subsequently antigen and antibody were detected by immuno-chromatographic test (ICT). Out of 98 clinically suspected cases 59(60.20%) were positive for malarial parasite by microscopic examination of peripheral blood film, 57(58.16%) were positive by ICT for antigen and 58(59.19%) were positive by ICT for antibody. Sensitivity and specificity of ICT for antigen were 93.22% and 94.87% respectively. For antibody, sensitivity and specificity were 89.83% and 87.17% respectively. From this study, sensitivity and specificity of ICT for malaria was found quite satisfactory, so it is suggested that ICT for malaria could be an alternative to peripheral blood film for the diagnosis of malaria where parasite could not be detected in peripheral blood film.

Preliminary report on anaerobic culture at Mymensingh Medical College Hospital in Bangladesh

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. This study was undertaken to isolate and identify the anaerobic bacterial agents of puerperal sepsis among the patients admitted in Mymensingh Medical College Hospital (MMCH) during the period from July 2006 to June 2007. Endocervical swabs/secretions were collected from 50 cases of puerperal sepsis and were cultured anaerobically. Anaerobiasis was done by using gas pack (BD GAS PAK TM EZ) in anaerobic jar. Out of 50 samples, 42(84%) yielded growth in cultures. Among 42 culture positive cases, 20(40%) were Aerobic organisms and 22(44%) were mixed, i.e., Aerobic and Anaerobic bacteria. The isolated Anaerobic organisms were Peptostreptococcus 14(63.63%), Bacteroides fragilis 3(13.64%), Prevotella melaninogenica 3(13.64%) and Clostridium perfringens 2(9.09%). As a preliminary study, it was observed that anaerobic culture could be carried out with available logistic arrangement. So, it was recommended to design further study on anaerobic bacterial isolation with particular emphasis on their antimicrobial susceptibility.

Prevalence of VP7 and VP4 genotypes of human group A rotavirus in infants and children with acute diarrhea in a northern city of Bangladesh

The objective of this cross sectional prospective study was to determine rotavirus etiology and prevalence of the different rotavirus genotypes causing acute gastroenteritis in infants and children (</=5years) in Mymensingh Medical College Hospital, Bangladesh. The study was conducted during the period from January 2005 to June 2006. A total of 962 stool specimens from diarrheic children were analyzed by Polyacrylamide Gel Electrophoresis (PAGE). Rotavirus detection rate was 31.3% (301/962). Among the 71 representative rotavirus specimens examined genetically by RT-PCR, the most frequent G genotypes were G2 (57.7%), followed by G1 (21.1%), and G9 (15.5%). The G12 was detected from two specimens (2.8%) and was the first report in the study area. The predominant P genotypes were P[4] (54.9%), followed by P[6] (19.7%), and P[8] (15.5%). Among the single infection, the predominant G/P combinations were G2P[4] (52.1%), followed by G1P[8] (10%), and G1P[6] (8.5%). Nucleotide Sequence identity of VP7 gene of G2 rotaviruses were higher than 99.0% with each other and these G2 viruses showed genetically lower identity to G2 rotaviruses reported elsewhere in the world, except for some strains reported in African countries. All the G2 strains sequenced in this study were grouped into single cluster in phylogenetic tree for G2 strains. As rotavirus vaccine is implemented in immunization program worldwide, the hospital based surveillance study will provide valuable information to assess the future impact of vaccination.

Anti H.pylori IgM in symptomatic and asymptomatic population

To evaluate the usefulness of specific IgM in the diagnosis of Helicobacter pylori infection, a cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2006 to June 2007. A total of 45 patients having upper gastrointestinal symptoms underwent endoscopy and were subsequently diagnosed as patients with gastritis, peptic ulcer (PU) and non-ulcer dyspepsia (NUD) and another 45 asymptomatic individuals aged 18-65 years, were included in the study. The serum samples of participants were tested for presence of anti-H pylori IgM by using ELISA method. The ELISA for anti H. pylori IgM provided sensitivity and specificity of 73.33%, 93.33% respectively.

Perosteal osteosarcoma of clavicle-treated by limb salvaging surgery (total cleidectomy)

Osteosarcoma of clavicle is extremely rare. Improved survival in patients with osteosarcomas has been associated with recent advances in imaging techniques, histopathological methods, surgery and chemotherapy. In most cases the diagnosis can be made with confidence on the x-ray appearance. Other imaging studies like- radioisotope scans may show up-skip lesions, computed tomography (CT) and magnetic resonance imaging (MRI) show the extend of the tumour. Incisional biopsy or excisional biopsy is carried out after careful clinical study and proper investigations. A 30 years old cultivator with a late case of primary osteosarcoma of clavicle was treated with pre-operative and post-operative chemotherapy and was managed with surgical excision of tumor with limb sparing. The patient was clinically disease free for about 08 (eight) months. Then the patient developed recurrences and died 11 (eleven) months after operation.

Diagnosis of human rotavirus in stool specimens: comparison of different methods

A total of 345 stool specimens of hospitalized children below 5 years of age with acute gastroenteritis were tested for the presence of rotavirus by Polyacrylamide gel electrophoresis (PAGE), a monoclonal antibody based enzyme immunoassay (EIA) and a latex agglutination test (LAT). Detection rate for PAGE and EIA were 24.9% (345/86) and 20.9% (345/70) respectively. Using PAGE as the standard, the sensitivity and specificity of EIA were 75.6% and 98.1% respectively. The sensitivity of LAT was 70.9% with 100% specificity (LAT was done in only PAGE positive specimens). LAT appeared as the simplest and economic for both bed side and field use.

Genetic analysis of an ADRV-N-like novel rotavirus strain B219 detected in a sporadic case of adult diarrhea in Bangladesh

An unusual human rotavirus strain B219 was detected in a stool specimen from a 65-year old patient with diarrhea in Bangladesh during April 2002. Cloning and sequence analysis of five genes of the B219 strain indicated that this virus is genetically closely related to the ADRV-N strain, which caused an adult diarrhea outbreak in China, but distinct from groups A, B, and C rotaviruses known to cause diarrheal diseases in humans. Accordingly, rotavirus strains B219 and ADRV-N were considered to belong to a novel group of human rotavirus, and the ADRV-N-like novel human rotaviruses were suggested to be distributed to a geographically wider area.

Electrophoretic patterns of human rotavirus strains prevailing among hospitalized children with acute gastroenteritis

Polyacrylamide gel electrophoresis (PAGE) and silver staining was applied to detect rotavirus dsRNA from acute diarrheic stool of 365 hospitalized children below 5 years of age. The study was conducted at Mymensingh and Sunamgonj districts, Bangladesh from January 2002 to February 2003. Among 345 stool specimens tested, 86 (24.9%) were positive by PAGE. The rate of infection was highest in 0-12 months of age and declined significantly with increasing age. Males were slightly more infected than females and infection rate was more in winter. Twelve different electropherotypes were identified, of them eight were long and four were short. RNA profiles of the analyzed specimens, 88.6% were long and 11.4% were short patterns. Two of these long patterns (2F N 1 L, 2F N 3(U) L) circulated through out the study period and a single type was predominant (2F N 1 L). Mixed electropherotypes were also detected. Electropherotyping technique can be applied routinely to study the prevalence and epidemiological features of rotavirus infection. It is an excellent method for studying genomic variation, tracing mixed infections, detecting atypical rotaviruses lacking group-antigen and characterizing virus strains in outbreaks.

Radiation processed hydrogel of poly (vinyl alcohol) with biodegradable polysaccharides

Poly(vinyl alcohol) (PVA) can be modified to polymer hydrogels by radiation crosslinking and can be used in different biomedical applications. A study was done on the optimization of ingredients concentration for preparing good quality PVA hydrogels with natural polysaccharides. The synthesized hydrogels were also characterized by measuring the different physical properties e.g. gel fraction, swelling and absorption rate. Besides these, sterility test were also performed. Good quality hydrogels were obtained from PVA and natural polysaccharides solutions with 27 kGy radiation dose. There is an influence of natural polysaccharides on the gel fraction of hydrogel. The increase in the amount of polysaccharide causes a decrease in gel fraction that is decrease in the crosslinking density of PVA hydrogel network. The prepared hydrogels were found to be sterile.

Comparison of NSP4 protein between group A and B human rotaviruses: detection of novel diarrhea-causing sequences in group B NSP4

The human group B rotavirus is a causative agent of severe adult diarrhea. In this study, we analyzed the NSP4 structure of a group B rotavirus strain, CAL-1, and determined whether enterotoxin activity was present in CAL-1 NSP4. CAL-1 NSP4 was comprised of 219 amino acids which was longer than group A and C rotavirus NSP4, and the primary structures of their sequences differed considerably. However, CAL-1 NSP4 had an enterotoxin-like sequence (residues 106-127) that was only 27% identical to the enterotoxin region of NSP4 of KUN (a group A rotavirus strain) at residues 114-135. Interestingly, both of the synthetic peptides, one (residues 99-128) containing the enterotoxin-like sequence and the other (residues 191-219) containing 29 C-terminal amino acids of CAL-1 NSP4, induced diarrhea in 5.5-day-old mice, but not in 17.5-day-old mice, when administered parenterally. Thus, rotavirus "enterotoxin" sequences could be considerably divergent.

Post operative diagnosis of osteopetrosis

Osteopetrosis is a rare hereditary disease that was first described by a German Albert Schonberg in 1904. At least five types of osteopetrosis have been described. Among them osteopetrosis congenita (autosomal recessive) and osteopetrosis tarda (autosomal dominant) are most common. Here we are reporting a case of osteopetrosis tarda, who is a female of fifty years of age presented with fracture femur. Preoperatively there was no suspicion of osteopetrosis. She was only suspected while introducing an IM Nail during her fracture reduction. Diagnosis of osteopetrosis was confirmed post operatively by histopathology of medullary cavity of her femur.

Treatment of non union of humerus using G. A. Ilizarov technique

The management of the non union of humerus is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: I.M. Nailing, interlocking, plating, transplantation of allograft. In our series, 36 cases with non union has been treated by G.A. Ilizarov technique. The age range were: 21-62 years with an average of 32 years. The initial treatment were done by DCP, rush nails & plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the application of Ilizarov fixator a good range of elbow & shoulder motion were achieved. The average follow up period was 5 years with a range of 1-8 years. Union was achieved in all the 36 cases.

Detection of group- and subgroup-specific antigens of bovine rotaviruses in Bangladesh

The study was carried out to detect group- and subgroup-specific antigens of bovine rotaviruses. Stool specimens, collected from diarrhoeic calves of the Savar Dairy Farm, Bangladesh, were examined by an enzyme-linked immunosorbent assay, using group- and subgroup-specific monoclonal antibodies. Thirty-three specimens showed specificity for group A rotavirus. While subgrouping, 21 group A-positive specimens showed subgroup I specificity. Twelve specimens did not react with either of the subgroup I- and subgroup II-specific monoclonal antibodies.

Management of reproductive tract infections in rural Bangladesh

This study was undertaken to identify existing reproductive tract infection (RTI) treatment practices of the government family planning (FP) paramedics in rural Bangladesh. It also assessed the knowledge and perceptions of the clients about RTIs as well as the service-seeking behaviour of the clients and their husbands. Data on paramedic treatment practices were collected by observing paramedic-client interactions at the family welfare centres (FWCs) and satellite clinics (SCs). One hundred clients seeking RTI treatment were observed. The same clients were interviewed at departure from the health-care facility to assess their knowledge and perceptions about RTIs as well as service-seeking behaviour of the clients and their husbands. Twenty-four village practitioners were also interviewed to assess their knowledge on the subject. Results of the study showed that in the treatment of RTI, paramedics of government FP services commonly: (i) did not do a physical examination, (ii) used a substandard dosage of drugs, and (iii) made no attempt to notify or treat male partners. Thirty-one of the 97 clients reported that their husbands had some kind of genital problem. It was revealed from the study that as an alternative to the government FP services, the clients and their husbands often seek RTI treatment from the village practitioners though the village practitioners' knowledge concerning RTI is poor. Based on the findings of this study, it is recommended that the knowledge and skills of the paramedics and village practitioners for RTI treatment be strengthened. Prevention of RTI through awareness campaigns is essential for the control of RTIs, and especially of STDs.