Teaching transposon classification as a means to crowd source the curation of repeat annotation - a tardigrade perspective

BACKGROUND

The advancement of sequencing technologies results in the rapid release of hundreds of new genome assemblies a year providing unprecedented resources for the study of genome evolution. Within this context, the significance of in-depth analyses of repetitive elements, transposable elements (TEs) in particular, is increasingly recognized in understanding genome evolution. Despite the plethora of available bioinformatic tools for identifying and annotating TEs, the phylogenetic distance of the target species from a curated and classified database of repetitive element sequences constrains any automated annotation effort. Moreover, manual curation of raw repeat libraries is deemed essential due to the frequent incompleteness of automatically generated consensus sequences.

RESULTS

Here, we present an example of a crowd-sourcing effort aimed at curating and annotating TE libraries of two non-model species built around a collaborative, peer-reviewed teaching process. Manual curation and classification are time-consuming processes that offer limited short-term academic rewards and are typically confined to a few research groups where methods are taught through hands-on experience. Crowd-sourcing efforts could therefore offer a significant opportunity to bridge the gap between learning the methods of curation effectively and empowering the scientific community with high-quality, reusable repeat libraries.

CONCLUSIONS

The collaborative manual curation of TEs from two tardigrade species, for which there were no TE libraries available, resulted in the successful characterization of hundreds of new and diverse TEs in a reasonable time frame. Our crowd-sourcing setting can be used as a teaching reference guide for similar projects: A hidden treasure awaits discovery within non-model organisms.

High-resolution melt curve analysis: An approach for variant detection in the TPO gene of congenital hypothyroid patients in Bangladesh

TPO (Thyroid Peroxidase) is known to be one of the major genes involved in congenital hypothyroid patients with thyroid dyshormonogenesis. The present study aims to validate high-resolution melting (HRM) curve analysis as a substitute method for Sanger sequencing, focusing on the frequently observed non-synonymous mutations c.1117G>T, c.1193G>C, and c.2173A>C in the TPO gene in patients from Bangladesh. We enrolled 36 confirmed cases of congenital hypothyroid patients with dyshormonogenesis to establish the HRM method. Blood specimens were collected, and DNA was extracted followed by PCR and Sanger sequencing. Among the 36 specimens, 20 were pre-sequenced, and variants were characterized through Sanger sequencing. Following pre-sequencing, the 20 pre-sequenced specimens underwent real-time PCR-HRM curve analysis to determine the proper HRM condition for separating the three variations from the wild-type state into heterozygous and homozygous states. Furthermore, 16 unknown specimens were subjected to HRM analysis to validate the method. This method demonstrated a sensitivity and specificity of 100 percent in accurately discerning wild-type alleles from both homozygous and heterozygous states of c.1117G>T (23/36; 63.8%), c.1193G>C (30/36; 83.3%), and c.2173A>C (23/36; 63.8%) variants frequently encountered among 36 Bangladeshi patients. The HRM data was found to be similar to the sequencing result, thus confirming the validity of the HRM approach for TPO gene variant detection. In conclusion, HRM-based molecular technique targeting variants c.1117G>T, c.1193G>C, and c.2173A>C could be used as a high throughput, rapid, reliable, and cost-effective screening approach for the detection of all common mutations in TPO gene in Bangladeshi patients with dyshormonogenesis.

Prevalence of Thyroid Dysfunction in Type 2 Diabetes Mellitus

The level of thyroid hormones is often changed in uncontrolled diabetic patients. Screening for Thyroid dysfunction (TD) among patients with Type 2 Diabetes mellitus (T2DM) should be performed considering the increased prevalence of thyroid disorders. This cross-sectional comparative study was conducted in outpatient department of Endocrinology and Medicine, Mymensingh Medical College Hospital, Mymensingh (MMCH) from 1st March 2020 to 30th August 2021. One hundred (100) patients with type 2 diabetes along with 100 (hundred) non-diabetic controls of same age group were enrolled in the study. After taking clinical data, patients were investigated to estimate Fasting plasma glucose (FPG), serum free tri-iodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) level to see thyroid dysfunction. Patients were selected with purposive sampling. Thyroid dysfunction was found to be more in T2DM (15.0%) in comparison with non-diabetic controls (5.0%) and this difference was statistically significant (p=0.018). In both diabetic and non-diabetic groups, subclinical hypothyroidism and hypothyroidism were the most common thyroid dysfunction. Thyroid dysfunction was found more in 40-60 years that suggests the prevalence of thyroid dysfunction are increasing in diabetic patients with advancing age. Thyroid dysfunction was found more among overweight and obese patient in both groups. Mean BMI was found higher among diabetic patient with thyroid dysfunction. Logistic regression showed significant association of Thyroid dysfunction with age >50 years and high FPG level. We found thyroid dysfunction was more prevalent in patients with T2DM than non-diabetics. So, screening for thyroid dysfunction among type 2 diabetic patients by estimating Serum TSH, FT4 level should be performed.

Real-world evidence on the effectiveness and safety of gliclazide MR 60 mg in Bangladeshi patients with Type II diabetes during fasting: a sub-analysis from the global DIA-RAMADAN study

Aim: Many Muslims with Type II diabetes (T2DM) fast during Ramadan, which can put them at increased risk of hypoglycemia. This sub-analysis of the global DIA-RAMADAN study assessed the effectiveness and safety of gliclazide modified release (MR) 60 mg in the Bangladeshi cohort. Materials & methods: DIA-RAMADAN was an international, prospective, observational study conducted in adult T2DM patients intending to fast and receiving gliclazide MR 60 mg once daily for ≥90 days before Ramadan. Dosing was switched from morning to evening at the start of Ramadan. The primary outcome was the proportion of patients with ≥1 symptomatic hypoglycemic event. Secondary outcomes included changes between inclusion (V0) and end of study visit (V1) in glycated hemoglobin (HbA1c), body weight and fasting plasma glucose (FPG). Results: Among the 98 Bangladeshi patients, 80 (81.6%) were at moderate/low-risk (category 3) for fasting and 18 (18.4%) were high-risk (category 2), as per International Diabetes Federation and Diabetes and Ramadan International Alliance (IDF-DAR) guidelines. Gliclazide MR was being prescribed as monotherapy to 59 (60.2%) patients and in combination with metformin to 39 (39.8%). There was no incidence of severe hypoglycemic events. Mean (±SD) HbA1c change from V0 was -0.1 ± 0.8% (p = 0.159). Mean (±SD) changes in FPG and body weight were -0.8 ± 39.7 mg/dl (p = 0.876) and -0.0 ± 1.5 kg (p = 0.810), respectively. Conclusion: In a real-world setting, this sub-analysis in Bangladeshi patients shows that patients with T2DM treated with gliclazide MR 60 mg can fast safely during Ramadan with a very low risk of hypoglycemia, while maintaining glycemic control and body weight.

A two-generational reproductive study to assess the effects of Juglans regia on reproductive developments in the male and female rats

Environmental pollutants and lifestyle severely threaten human and animal health, leading to disturbances of various functions, including infertility. So, exploring a safe treatment that could effectively reverse infertility remains a challenge. The current study was intended to explore the fertility-enhancing effect of Juglans Regia oil in two successive generations of rats; F0 and F1. J. Regia oil was initially tested for in vitro antioxidant assay via ROS and DPPH, followed by in vivo toxicity testing. In the fertility assessment, eighteen pairs of male and female rats (n=36, 1:1, F0 generation) were divided into three groups and dosed with 1 mL/kg and 2 mL/kg daily of J. Regia oil and saline, respectively, up to pre-cohabitation, cohabitation, gestation and lactation periods. The reproductive performance, including body weight, live birth index, fertility index, and litter size, was assessed. Hormonal and antioxidant markers of F1 generations were assessed with the histopathological evaluation of male and female organs. The oil of J. Regia showed great antioxidant potential (P < 0.05) in DPPH (1,1-diphenyl-2-picrylhydrazyl) and ROS (Reactive Oxygen Species) methods (P<0.05). The continued exposure of the F0 and F1 generations to J. Regia oil did not affect body weight, fertility index, litter size, and survival index. We have found pronounced fertility outcomes in both genders of F0 and F1 generations with J. Regia 2 mL/kg/day in comparison to the control. Results showed that J. Regia significantly increased (P < 0.05) luteinizing hormone (LH), plasma testosterone, follicular stimulating hormone (FSH), glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in both generations. Histology of both generations reveals improved spermatogenesis and folliculogenesis with enhanced architecture. Altogether, the present results suggest that J. Regia improved fertility in both male and female rats by improving hormonal activities and oxidative stress.

Sex-Specific Total Testosterone and Dehydroepiandrosterone Sulfate Status in Noncritically Ill Hospitalized Patients with Coronavirus Disease 2019: A Cross-Sectional Study

BACKGROUND

In individuals with coronavirus disease 2019 (COVID-19), male subjects have consistently been linked to poor severity and prognosis. Data on sex hormones in non-critical COVID-19-infected patients are scarce. The aim of this study was to assess the status of total testosterone (TT) and dehydroepiandrosterone sulfate (DHEAS) among noncritical patients with COVID-19 according to sex and their associations with clinical and biochemical features.

MATERIALS AND METHODS

This cross-sectional observational study was done in the COVID-19 unit of a University hospital during the period of September 2021 to February 2022 among 91 adults (18-65 years) with reverse transcriptase- polymerase chain reaction confirmed noncritical COVID-19 patients. Blood was drawn by venipuncture before receiving steroids between 07:00 to 09:00 a.m. in a fasting state to measure serum TT and DHEAS by chemiluminescent microparticle immunoassay. Diagnosis and classification of COVID-19 were done according to World Health Organization's interim guidance. Age- and sex-specific laboratory reference values were used to classify the TT and DHEAS status of the patients.

RESULTS

Only three males (8.1%) had low TT and the rest had normal TT. On the other hand, 15 (27.8%) of the females had high TT with normal levels in the rest. Similarly, 11 (29.7%) males had low DHEAS. Females had low, normal, and high DHEAS in four (7.4%), 48 (88.9%), and two (3.7%) cases respectively. Males with moderate severity of COVID-19 had significantly lower DHEAS (post hoc P=0.038) than the mild group. Both TT (P=0.008) and DHEAS (P=0.023) significantly correlated with neutrophils/lymphocytes ratio and only DHEAS with platelets/lymphocytes ratio (P=0.044) in males. In females, TT significantly correlated with serum sodium (P=0.034).

CONCLUSION

In noncritical COVID-19 patients, substantial gender variations in TT and DHEAS were detected and correlated with severity markers in males.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Serum homocysteine level in newly diagnosed young patients with abnormal glucose tolerance

Background

Hyperhomocysteinemia is an emerging risk factor causing early-onset cardiovascular events. The objective of the study was to assess serum homocysteine levels in newly diagnosed young persons (age < 30 years) with abnormal glucose tolerance.

Methodology

This cross-sectional study included 40 young participants with newly diagnosed abnormal glucose tolerance (including prediabetes and diabetes mellitus) and an equal number of young persons with normal glucose tolerance (normal glucose tolerance vs prediabetes vs. diabetes mellitus-age (years): 25.0 (22.0, 28.0) vs 25.50 (21.50, 27.0) vs 28.0 (25.0, 29.0), median (interquartile range)). Glycemic status was diagnosed by American Diabetes Association, 2021 criteria. After taking clinical information, fasting blood was collected to measure homocysteine by chemiluminescent immunoassay.

Results

Homocysteine level was different across the spectrum of glycemic status (normal glucose tolerance vs. prediabetes vs. diabetes mellitus: 15.57 (13.89-20.71) vs 13.19 (11.40-18.11) vs 12.27 (9.97-14.42) µmol/L; median (interquartile range); p = 0.006). Serum homocysteine was significantly elevated in participants with normal glucose tolerance than diabetes mellitus (p = 0.006) but statistically similar in prediabetes in comparison to both normal glucose tolerance and diabetes mellitus (p = NS for both). Homocysteine level was above the normal level in 47.5% of participants with normal glucose tolerance and in 22.5% with abnormal glucose tolerance (p = 0.019).

Conclusions

Patients under 30 years with diabetes mellitus had lower homocysteine levels than those with normal glucose tolerance.

A dataset for successful recognition of cucumber diseases

Plant disease is a common impediment to the productivity of the world's agricultural production, which adversely affects the quality and yield of crops and causes heavy economic losses to farmers. The cucumber is a frequently grown creeping vine plant that has few calories but is high in water and several vital vitamins and minerals. Due to the unfavorable ecological environment and non-biological circumstances, cucumber diseases will adversely harm the quality of cucumber and cause heavy financial loss. Early identification and protection of crop diseases are essential for disease management, crop yield enhancement, cost reduction, and boosting agricultural production. The traditional diagnosis of crop diseases is often time-consuming, laborious, ineffective, and subjective. To cope with this scenario, the development of a machine-based model which can detect cucumber diseases is a demand of time for increasing agricultural production. This article offers a major cucumber dataset to build an effective machine vision-based model which can detect more variety of cucumber diseases. The dataset includes eight different types of classes containing disease-affected and disease-free cucumber images (Anthracnose, Bacterial Wilt, Belly Rot, Downy Mildew, Pythium Fruit Rot, Gummy Stem Blight, Fresh leaves, and Fresh cucumber) which were collected from the 6th to 30th of May 2022 from real fields with the cooperation of an expert from an agricultural institution. The dataset is hosted by the Department of Computer Science and Engineering, Jahangirnagar University, and is freely accessible at https://data.mendeley.com/datasets/y6d3z6f8z9/1.

Hypothalamic-Pituitary-Adrenal Axis Activity in SARS-CoV-2 Infected Noncritically Ill Hospitalized Patients

Objectives

This study determined the baseline hypothalamic-pituitary-adrenal axis hormonal levels and their associated factors in noncritically ill hospitalized patients with coronavirus disease 2019 (COVID-19).

Methodology

This cross-sectional study was carried out in 91 noncritical RT-PCR-confirmed COVID-19 patients (aged 18 to 65 years) recruited consecutively from the COVID unit of two tertiary care hospitals over a period of six months. After the screening, relevant history and physical examinations were done, and blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum cortisol and plasma adrenocorticotropic hormone (ACTH) by chemiluminescent microparticle immunoassay.

Results

Of 91 patients, 54, 26, and 11 had mild, moderate, and severe COVID-19, respectively. Median values of serum cortisol (p = 0.057) and plasma ACTH (p = 0.910) were statistically similar among the severity groups. Considering a cortisol cut-off of 276 nmol/L (<10 μg/dL), the highest percent of adrenal insufficiency was present in severe (27.3%), followed by mild (25.9%) and least in the moderate (3.8%) COVID-19 cases. Using the cortisol/ACTH ratio >15, only 6.6% had enough reserve.

Conclusions

The adrenocortical response was compromised in a significant percentage of noncritically ill hospitalized patients with COVID-19, with the highest percentage of adrenal insufficiency present in severely infected cases. The HPA axis parameters of serum cortisol, plasma ACTH and cortisol/ACTH were similar across the severity of noncritical patients with COVID-19.

Magnetic Resonance Imaging Evaluation of Common Spinal Intramedullary Tumours: Ependymoma and Astrocytoma

This cross-sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2015 to June 2016 in collaboration with Department of Neurosurgery and Department of Pathology of same hospital, to assess MRI findings of common IMSCTs and to find out the validity of MRI in the diagnosis of spinal ependymoma and astrocytoma, thereby differentiating these two common intramedullary entities. For this purpose, 40 patients aged from 15 to 60 years, who were diagnosed or suspected cases of having intramedullary spinal cord tumours were enrolled. These patients underwent preoperative MRI for evaluation of the spinal cord tumours during the study period in department of Radiology and Imaging. Also, patients were diagnosed by MRI as having IMSCTs incidentally was included. All of them were followed by histopathological examination of the same lesions after surgery. Among these 40 patients after exclusion for valid reason 28 cases were included as study population. MR images were obtained on a 1.5 Tesla (Avanto Magnatom, Siemens) unit with a spine surface coil. MRI findings were compared with histopathology after surgery keeping histopathology as gold standard. Out of 28 clinically and MRI diagnosed IMSCTs cases, 19 cases of ependymoma, 8 cases of astrocytoma and one diagnosed as hemangioblastoma by MRI. The mean age was 34.11±9.55 years, ranging from 15 to 56 years for ependymoma, 26.88±8.08 years ranging from 16 to 44 years for astrocytoma. Highest incidence (47.4%) was in between 31 to 40 years for ependymoma, 50.0% were in between 21-30 for Astrocytoma. On MRI majority 12(63.2%) of the cord ependymomas and majority 5(62.5%) of astrocytomas were in cervical region. While considering axial location ependymomas are mostly 17(89.5%) central and astrocytomas 5(62.5%) are eccentric in location. It was observed that out of 19 cases of ependymoma more than half 10(52.6%) had elongated shape, 12(63.1%) had well defined margin. Associated syringohydromyelia was present in 16(84.2%) cases. On T1WI 11(57.9%) and 8(42.1%) cases were iso and hypo respectively. On T2WI 14(73.7%) cases were hyper intense. After Gd-DTPA in most cases, 13(68.4%) cases showed diffuse enhancement. Noticeable and sizeable solid component observed among 13(68.4%) of the cases. Hemorrhage with cap sign was found in more than one third 7(36.8%) cases. Out of 8 cases of astrocytomas 4(50.0%) had lobulated shape, ill-defined margin 5(62.5%). T1WI: Iso 5(62.5%), hypo 3(37.5%), T2WI: hyper 5(62.5%), After Gd-DTPA: focal and heterogenous enhancement 3(37.5%) and rim enhancement 4(50.0%). Component: mixed 4(50.0%), cystic 3(37.5%) and solid 1(12.5%). Hemorrhage without cap sign 2(25.0%), associated syringohydromyelia 1(12.5%). In the case of evaluation of intramedullary ependymoma sensitivity of MRI in the present series is 94.44%, specificity 80.0%, Positive predictive value (PPV) 89.5%, Negative predictive value (NPV) 88.9% and accuracy 89.28%. In case of MRI evaluation of intramedullary astrocytoma sensitivity of MRI in the present study is 85.71%, specificity 90.47%, PPV 75%, NPV 95% and accuracy 89.2%. Thus present study shows MRI is a sensitive and effective noninvasive imaging modality in diagnosing common intramedullary spinal cord tumours.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Antenatal and postnatal factors associated with neonatal death in the Indian subcontinent: a multilevel analysis

OBJECTIVES

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality.

STUDY DESIGN

Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used.

METHODS

Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths.

RESULTS

Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days.

CONCLUSIONS

The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.

Turner Syndrome With Isochromosome Structural Abnormalities: A Case Report

Turner syndrome (TS) is the most common cause of short stature and delayed puberty in females. Approximately half of the patients have the classic form with a genotype of 45,XO, one-fourth of patients have different mosaic forms, and the remaining one-fourth have structural abnormalities on the X chromosome. Among the structural abnormalities, the most common is isochromosome Xq. Females with structural variants of TS can present with delayed menarche, amenorrhea, and infertility rather than classic manifestations of TS. This study describes two rare variants of TS. One was a structural abnormality on the X chromosome, 46X,iso(Xq), and the other involves a mosaic variety of TS, including isochromosome X in the form of 45,XO/46X,iso(Xq). Both patients presented with short stature and secondary amenorrhea without classic manifestations of TS. In TS with or without mosaicism, the frequency of isochromosomes is reported to be about 15% to 18%. Owing to the absence of classical manifestations of TS, diagnosis may be delayed or missed. Therefore, females of short stature with secondary amenorrhea should be evaluated for rare variants of TS by chromosomal analysis.

Combined Effects of Nickel and Arsenic on Growth and Mineral Nutrients Accumulation in Kalmi (Ipomoea Aquatica), Red Amaranth (Amaranthus SP.) And Spinach (Spinacia Oleracea L.) And Nutrient Release Pattern In Soil at Different Days of Incubation

Arsenic (As) is a broadly distributed toxic metalloid that accumulates in the environment through natural and anthropogenic sources. Numerous techniques were evolved for arsenic remediation from water including adsorption, flocculation, ion exchange and reverse osmosis. Due to the excessive affinity between iron and inorganic arsenic species, iron-based adsorption is an emerging technique for the remediation of arsenic-contaminated water and soil. Whereas iron (Fe) and nickel (Ni) belong to the same chemical group (VIIIB) in the periodic table, it is expected to get similar interaction of Ni with As. An in vitro incubation study and pot experiment were conducted to evaluate the effect of Nickel on mineral release patterns in soil and growth yield of kalmi (Ipomoea aquatica), red amaranth (Amaranthus sp.) and Spinach (Spinacia oleracea L.). Nickel was applied as different doses of Nickel of 10, 40 and 160 mg/kg respectively where As was applied with irrigation water at the rates of 1 mg/L and incubated at field moisture condition for 10, 20 and 30 days individually in different pots. Total organic carbon (C), total nitrogen (N), phosphorus (P), sulfur (S), potassium (K) and 0.1N HCl extractable arsenic (As), iron (Fe) contents were determined at 10, 20 and 30 days of incubation. The pot experiment was carried out in triplicates for 45 days till the plants were grown to maturity. The growth performance of plants and the remedial effect of Ni on As toxicity in soil and plant was examined. Nickel showed a significant impact on fresh and dry yield of three plants and an antagonistic relationship between Ni and As was also observed i.e., Ni in soil was found to lessen the availability of As in soil likewise its accumulation in plants. J. Biodivers. Conserv. Bioresour. Manag. 2022, 8(2): 79-88

Diagnostic Accuracy of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Tear

The anterior cruciate ligament (ACL) is the most generally injured one of the major knee ligaments. These injuries plague both athletes and non-athletes. This cross-sectional and comprehensive study was conducted in the Department of Radiology and Imaging collaborating with Department of Orthopedics of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, completed from January 2014 to December 2015. The study evaluated the role of MRI in the diagnosis of anterior cruciate ligament injury of knee joint, keeping Arthroscopy as standard, compared the MRI and arthroscopic findings to determine accuracy, sensitivity and predictivity of MRI in the diagnosis of ACL injury in knee joint. For this purpose, a total of 50 patients having clinical suspicion of ACL injury in knee joint were enrolled in this study to perform MRI and Arthroscopy. MRI was done in all these patients. Clinically suspected but MRI diagnosed as no ACL injury, patients who were not willing to undergo arthroscopy examination and patient who were not fit for arthroscopy were excluded from the study. More than half (52.0%) of the patients were in 3rd decade and male to female ratio was 3.5:1. Less than one fourth (24.0%) of the patients were service holder. Forty two percent patients had duration of suffering for 2 weeks. Most 49(98.2%) patients had history of trauma, 45(90.0%) had pain in Knee joint, 24(48.0%) had difficulty in walking, 19(38.0%) had swelling in Knee joint and 13(26.0%) had restricted range of motion. Anterior drawer test was 37(74.0%) and Lachman test 16(32.0%). Loss of normal contour of ACL was found in 50.0%. Signal change of ACL in PD and T2W1 was found 42(84.0%) patients, and thickened ACL in 33(66.0%) patients. In MRI diagnosis tear was present in 80.0% of the patients. ACL tear diagnosed by MRI among the patients, 20(40.0%) had partial tear and 20(40.0%) had complete tear. In arthroscopy diagnosis 38(76.0%) had tear present. ACL tear diagnosed by arthroscopy of the patients 15(30.0%) had partial tear and 23(46.0%) had complete tear. Majority 20(40.0%) patients had medial meniscus injury, 15(30.0%) had lateral meniscus injury, 11(22.0%) had PCL injury, 4(8.0%) had lateral co-lateral ligament injury and 2(4.0%) had medial co-lateral ligament injury. In MRI diagnosis of anterior cruciate ligament tear, 37 cases were true positive, three cases false positive, one case false negative and nine cases was true negative. The validity of MRI diagnosis evaluation for anterior cruciate ligament tear was 97.4% sensitivity, 75.0% specificity, 92.0% accuracy, 92.5% positive predictive values and 90.0% negative predictive values.

Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children

Meningitis literally means inflammation of the meninges. It is mostly caused by bacteria, virus, fungus and protozoa and pyogenic meningitis constitutes a serious neurological disorder associated with significant morbidity and mortality in developing countries. This study was carried out to evaluate the clinical presentation and immediate outcome of pyogenic meningitis in children. This was a prospective observational study and conducted at department of Paeditrics in Cumilla Medical College Hospital, Cumilla, Bangladesh from July 2014 to June 2015. Total 50 children were diagnosed as pyogenic meningitis fulfilling the inclusion criteria was included in this study. Cases were enrolled purposively. Immediately after admission through history and clinical examination, complete blood count, random blood sugar, Cerebrospinal fluid (CSF) examination and blood culture was done in all patients. For statistical analysis chi-square test was done and significance of analysis was made when p value <0.05. This study includes patients aged between 2 months to 12 years and male female ratio was 1.5:1. Several risk factors like male sex (60.0%), age below one year (42.0%), Protein energy malnutrition (PEM) (30.0%), not exclusively breastfed (44.0%) were identified. Common presenting complaints were fever (100.0%), convulsion (96.0%), altered consciousness (42.0%) and vomiting (38.0%). Common physical signs were neck rigidity (56.0%), Kernig's sign (26.0%) and bulged fontanelle (34.0%). CSF was hazy in 54.0%, clear in 38.0% and turbid in 08.0% cases, CSF protein was more than 100mg/dl in 90.0% of the cases and glucose was less than 40mg/dl in most of the cases (94.0%). Streptococcus Pneumoniae (49.0%) followed by Neisseria Meningitidis (38.0%) were the two most commonly isolated organism responsible for pyogenic meningitis. Mortality rate during hospital stay was 18.0% and complications developed in 18.0% of cases. To avoid maltreatment in our resource limited setting due to failure of identifying organism, this study might help to administer appropriate antibiotics against organism and to reduce morbidity and mortality in meningitis. This study revealed less mortality rate in our country than neighbors and severe malnutrition important risk factors for the burden of pyogenic meningitis. It requires large scale multicentre studies to establish the whole scenario of Bangladesh.

Evaluation of Liver Function Tests in β-Thalassemia Major Children

Thalassemia is the most prevalent single gene defect in human beings worldwide. Repeated blood transfusions along with chelation therapy are mainstay of treatment in thalassemia patients. However these recurrent blood transfusions result in iron overload which along with chelation therapy causes deterioration of liver function. Aim of the study was to evaluate the liver function tests in β-thalassemia major patients. This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. In this study, 50 diagnosed patients of β Thalassemia major (Group A) and 50 apparently healthy children (Group B) of both sexes were selected from the department of Paediatrics, Dhaka medical college. The study parameters were serum ferritin, bilirubin, AST, ALT, ALP. The results were compared statistically between groups. Serum ferritin level (mean±SD) in thalassemic major patients in Group A (890±446.38 microgram/L) which is significantly higher above normal level. Serum bilirubin in Group A (3.27±2.62 mg/dl) and in Group B (0.48±0.24 mg/dl), Serum ALT in Group A (53.06±34.0 U/L) and in Group B (16.70±4.81 U/L), AST in Group A (84.56±33.54 U/L) and in Group B (11.60±2.72 U/L) and ALP levels in Group A (422.42±226.99 IU/L) and in Group B (221.86±80.54 IU/L). All the values were significantly higher (p<0.001) in β-thalassemia patient than that of normal children. This study concludes that liver function parameters are significantly higher in β thalassemia major patients. So routine evaluation of liver function tests may be advocated for thalassemic patients to predict early onset of hepatic dysfunction.

Localization and management of mediastinal parathyroid adenoma – a case report

Ectopic parathyroid adenoma sometimes poses diagnostic challenge and can be a cause of persistent and recurrent primary hyperparathyroidism. Anterior mediastinum is one of the locations for ectopic parathyroid adenoma. Surgical excision is the only cure and for successful surgery, pre-operative localization is crucial. Chance of failed surgery is being increased without prior localization of the ectopic gland. The combination of single photon emission computed tomography (SPECT) and computed tomography (CT) has got high sensitivity for accurate localization of ectopic parathyroid. On the other hand, with accurate localization surgical outcome is excellent. Here we report, successful localization and management of a case of primary hyperparathyroidism due to adenoma in anterior mediastinum in 47-year-old man. IMC J Med Sci 2022; 16(2): 003. DOI: https://doi.org/10.55010/imcjms.16.013 *Correspondence: Dr. Nusrat Sultana, Room no-1620, Block-D, 15th floor, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Email: nusrat_sultana@bsmmu.edu.bd

Age Related Changes in the Purkinje Cells in Human Cerebellar Cortex in Bangladeshi People

This study was done to see the changes in the number of Purkinje cells per square mm in different age groups of Bangladeshi people. This cross-sectional descriptive type of study was done on total 40 postmortem human cerebellums, in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2016 to June 2017. The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, by purposive sampling technique. All the specimens were grouped into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 to 59 years). Paraffin blocks of cerebellum were cut at 4-5μm thickness and stained with routine "Haematoxylin and Eosin" (H & E) stain. Estimation of number of Purkinje cell was done by using the counting circle and examined under the light microscope. In the present study, the mean±SD number of Purkinje cell was found 128.67±25.15 per sq mm in Group A, 136.53±34.45 in Group B per sq mm, 135.55±29.44 per sq mm in Group C, 127.69±35.31 per sq mm in Group D.

Number and Diameter of White Pulp of Spleen in Different Age and Sex Groups of Bangladeshi People

Spleen is a haemo-lymph organ and belongs to the reticuloendothelial system of human body, develops from mesodermal proliferation between the two leaves of dorsal mesogastrium. The microscopic structure of spleen is variable depending on the developmental stage of the organ, and the age and immune status of the individual. In our country, we depend on foreign data which came from the subjects of different races and from the individuals under different geographic conditions. So the study was carried out to minimize the dependency on foreign standards and to identify the diameter of white pulp in different age and sex of the Bangladeshi individuals with a view to establish local data bank related to spleen of Bangladeshi people. This cross-sectional descriptive study was performed on 65 postmortem human spleens (34 of male and 31 of female) to find out the number and diameter of white pulp of spleen of Bangladeshi people by purposive sampling technique. And done in Autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College, Bangladesh from 16th October 2016 to 15th January 2017. The samples were divided into three age groups including Group A (5-20 years), Group B (21-40 years) and Group C (41-60 years). Dissection was performed according to standard autopsy techniques. For statistical analysis, unpaired student 't' test was done. The mean±SD number of white pulp of male spleen was greater than female spleen in Group A, B and C but mean±SD diameter of white pulp of female spleen was found greater than male spleen in all groups. Comparison of number of white pulp between sexes showed that statistically there was no significant difference within all the age groups at p>0.05 level. No age change was evident in diameter of white pulp but in between sexes, diameter is greater in females than males. Mean difference of diameter of white pulp between sexes showed no significant difference within the age groups at p>0.05.

706 IMPROVING PRESCRIPTION OF PARKINSON’S DISEASE MEDICATIONS FOR PATIENTS ON ELDERLY CARE WARDS AT ROYAL STOKE UNIVERSITY HOSPITAL

Introduction

Patients with Parkinson’s disease (PD) are commonly admitted into hospital with various acute medical conditions. Inaccurate prescription can result in adverse effects, increased hospital stay, and increased morbidity and mortality. We present a QIP conducted to improve PD medication prescription pattern among doctors and medication delivery from the nursing staff.

Method

In PDSA 1, we conducted a survey among doctors and nurses to assess their initial knowledge on PD medications. A baseline review of PD prescriptions on our Frail Elderly Assessment Unit (FEAU) was conducted. Our interventions include Introduction: of PD medication alert sticker attached to drug charts and recorded drug chart when they are taken off the wards. In PDSA 2, repeat survey was carried on Elderly care wards. We also reviewed PD prescriptions over a 2-week period on Elderly care wards.

Results

During the surveys, there were 55 respondents in PDSA 1 and 51 respondents in PDSA 2. The percentage of those who feel PD medications are critical medications remain similar in both cycles (98%). There was an improvement in the awareness of PD stickers from 44% to 83%. Those who feel PD alert stickers are appropriate improved from 93% to 100%. Respondents who chose all included appropriate PD medication sources for improving prescription pattern improved from 38% to 62%. There were 8 prescriptions during PDSA 1 and 21 prescriptions during PDSA 2. The use of PD stickers improved from 0% to 76%. The numbers of PD medications prescribed appropriately improved from 50% to 65%.

Conclusion

An improvement in prescription pattern was demonstrated, as we hope to improve patient safety and increase awareness across the trust. Our recommendations include use of PD medication alert sticker and recorded drug chart. We discussed our plans in Medicine Governance meeting, departmental newsletter, and presented in departmental audit meeting.

Precocious puberty: diagnosis and management

Precocious puberty is commonly defined as puberty that starts before age 8 years in girls and 9 years in boys. The causes of it may range from a variant of normal development to various pathologic conditions. The etiology of precocious puberty is classified by the underlying pathogenesis into gonadotropin dependent central precocious puberty and peripheral precocious puberty which is independent of gonadotropin but due to different other causes. Variants of precocious puberty include premature thelarche, premature puberche and isolated premature menarche which imply onset of isolated changes without any other signs of sexual development. Precocious puberty might have an impact on final stature owing to premature epiphyseal fusion and also it has got influence on psychosocial wellbeing. Evaluation includes a detailed history, physical examination, biochemical testing and imaging directed towards suspected etiology. Gonadotropin releasing hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the specific cause. Pubertal variants are usually non-progressive and need no treatment but should be monitored carefully. BIRDEM Med J 2022; 12(1): 62-69

Abnormal fractional flow reserve and non-hyperaemic pressure ratios in patients with severe aortic stenosis and non-obstructive coronary artery disease

Background

Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) are well-validated tools that assess the physiological significance of coronary artery disease (CAD). Low coronary lumen to myocardial mass (V/M) ratio on CT is associated with lower FFR/NHPRs and predisposes towards ischaemia in CAD. Whilst CAD and aortic stenosis (AS) frequently co-exist, patients report angina despite obstructive disease.

Purpose

We therefore sought to study the interrelationship between V/M and invasive pressure indices in patients with severe AS.

Methods

35 patients with severe AS were prospectively recruited as part of CAST-FFR study. Patients underwent CT coronary angiography and invasive pressure-wire assessment. All pressure-indices were assessed in the left anterior descending artery (LAD). Data was extracted to calculate FFR, iFR, diastolic pressure ratios (DPR and dPR) and Diastolic Hyperaemia-free Ratio (DFR). Patient-specific V/M were extracted off-site by independent core lab.

Results

Mean age was 75±7.5 years, median V/M ratio was 20.7 and mean aortic gradient and DI were 44.3±11.6mmHg and 0.23±0.4 respectively. 79% of patients had CADRADs score of &lt;2. There were moderate positive correlations between FFR/NHPRs and V/M, including FFR (r=0.60), PdPa (r=0.48), iFR (r=0.59), DPR (r=0.59), dPR (r=0.63), DFR (r=0.67), (all p&lt;0.005). In patients with positive pressure assessments, 69% (FFR), 71% (iFR), 70% (DPR) and 65% (DFR) had CADRADs score &lt;2. In severe AS, lower V/M was associated with lower pressure-indices (FFR 0.75 vs 0.86, iFR 0.79 vs 0.92, DFR 0.80 vs 0.91, all p&lt;0.005), leading to high rates of positive physiologic assessment (FFR 88%, PdPa 72%, iFR 67%, DPR 78%, DFR 74%).

Conclusion

Patients with severe AS exhibit high rates of abnormal FFR and NHPR values, despite having no obstructive CAD. Their propensity for having abnormal physiological results is, in part, influenced by coronary volume to mass ratio. These results are important for clinicians considering using invasive physiological tools to guide revascularisation decisions in patients with severe AS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Monash University, Cardiac Society of Australia and New Zealand Correlation between NHPR/FFR and VMInvasive pressure indices and VM

Ongoing efforts to improve the management of patients with diabetes in Bangladesh and the implications

BACKGROUND

Prevalence rates of patients with diabetes are growing across countries, and Bangladesh is no exception. Associated costs are also increasing, driven by costs associated with the complications of diabetes including hypoglycemia. Long-acting insulin analogues were developed to reduce hypoglycemia as well as improve patient comfort and adherence. However, they have been appreciably more expensive, reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is a need to document current prescribing and dispensing rates for long-acting insulin analogues across Bangladesh, including current prices and differences, as a result of affordability and other issues.

METHODS

Mixed method approach including surveying prescribing practices in hospitals coupled with dispensing practices and prices among community pharmacies and drug stores across Bangladesh. This method was adopted since public hospitals only dispense insulins such as soluble insulins free-of-charge until funds run out and all long-acting insulin analogues have to be purchased from community stores.

RESULTS

There has been growing prescribing and dispensing of long-acting insulins in Bangladesh in recent years, now accounting for over 80% of all insulins dispensed in a minority of stores. This increase has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs than the originator, with this trend likely to continue with envisaged growth in the number of patients. Consequently, Bangladesh can serve as an exemplar to other low- and middle-income countries struggling to fund long-acting insulin analogues for their patients.

CONCLUSIONS

It was encouraging to see continued growth in the prescribing and dispensing of long-acting insulin analogues in Bangladesh via the increasing availability of biosimilars. This is likely to continue benefitting all key stakeholder groups.

Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future

INTRODUCTION

Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies.

METHODOLOGY

Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries.

RESULTS

Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries.

CONCLUSIONS

Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.

Correlation between Length of Ala and Transverse Diameter of First Sacral Vertebral Body in both Sexes

Sacrum is a triangular bone formed by the fusion of five sacral vertebrae. It is situated near the lower end of the spinal column, where it joins both hip bones to form the posterio superior wall of the pelvic cavity. It is an important bone for identification of sex in human skeletal system. This cross sectional and descriptive study was done among 150 (59 male and 91 female) fully ossified dry human sacrum in Mymensingh Medical College, Mymensingh, Bangladesh from January 2017 to December 2017. The sex of sacrum was determined by previously measured different parameters. Sample collection was done by purposive sampling technique from anatomy department of Mymensingh Medical College and Community Based Medical College of Bangladesh, Mymensingh. The parameters included the length of ala and transverse diameter of first sacral vertebral body which were measured by digital vernier slide caliper and was expressed in mm. In present study the mean length of ala in male and female were 29.21±6.30mm and 30.77±5.56mm respectively. The mean transverse diameter of first sacral vertebral body in male and female were 48.10±4.83mm and 44.05±6.16mm respectively. Comparison of both length of ala and transverse diameter of first sacral vertebral body was done between male and female by unpaired student 't' test which was statistically significant. There was positive correlation between these two parameters and the differences were statistically highly significant in both sexes.

The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

Frequency of Hepatitis B, C and HIV Infections among Transfusion-Dependent Beta Thalassemia Patients in Dhaka

Transfusion transmitted infections have remained a major deterrent to public health, particularly among the patients with transfusion-dependent Beta thalassemia in developing countries. Although proper donor selection through adoption of WHO-advised infection panel has lowered the rate of infections, the multi-transfused patients are not free of risk. In this study, we screened 148 transfusion-dependent Beta thalassemia patients to determine the frequency of Hepatitis C Virus (HCV), Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) using the ELISA method. Among them, infected cases with HCV, HBV and HIV were 13.51%, 3.37% and 0%, respectively. Moreover, 2% of the patients were found to be co-infected with both HBV and HCV. The percentage of infections in the patients with frequent transfusion interval (≤30 days) was significantly higher (p < 0.0005) than that in the patients with less frequent transfusion intervals (>30 days). Immunochromatography (ICT)-based rapid test kits are usually used to screen and confirm these infections in the blood of the patients. However, ICT-based tests are not sensitive enough to detect the infections. So, a combination of both Nucleic Acid testing (NAT) and serological testing are suggested to significantly reduce the risk of viral infections during blood transfusion.

Doppler Evaluation of Carotid Vessels in Type 2 Diabetes

Type 2 diabetes considered as a compound of metabolic syndrome. It can cause both micro and macrovascular complications. Diabetes is a strong risk factor in the development of atherosclerosis and likewise carotid artery disease. Carotid artery stenosis may cause stroke. Doppler ultrasound is the most common imaging technique for the diagnosis of carotid disease. Objective of the study was to assess the percentage of atherosclerotic carotid disease in asymptomatic Type 2 diabetics (T2D) by Doppler sonography and to find out the association of different risk factors of diabetic patient with atherosclerosis. A cross sectional study was done. A total of 43 type 2 diabetic patients (27 male, 16 female) referred from the out patient department and admitted patients in Mymensingh Medical College Hospital (MMCH) during January 2017 to December 2017 for the purpose of evaluation of intima media thickness (IMT) and carotid artery stenosis by Duplex color Doppler ultrasonography examination were enrolled in this study. Patients with previous history of recent stroke or transient ischemic attack (<6 weeks), history of carotid surgery or cervical radiotherapy were excluded. Carotid artery disease was found 65.1% in asymptomatic type 2 diabetics. Among them increased IMT in 48.8% and carotid stenosis was present in 37.2% and >50% stenosis (Peak systolic velocity >125cm/sec) was present in 9.3%. Age >50% years, smoking, duration of DM >10 years, hypertension, history of ischaemic heart disease and history of diabetic retinopathy were found to be associated with carotid atherosclerosis as well as carotid stenosis. High percentage of carotid artery disease (65.1%) was found in asymptomatic type 2 diabetes mellitus. This result suggests the need for carotid Doppler evaluation of all Type 2 diabetics as a first measure of stroke prevention, with the hope that timely intervention might avert stroke and its accompanying disability.

Prevalence of Diabetic Nephropathy in Patients Attending the Endocrine Department of Mymensingh Medical College Hospital

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Due to severe morbidity and mortality of DN and limited effective therapies, research has mainly focused on prevention of this debilitating illness by modification of risk factors. Aims of this study were to find out the prevalence of diabetic nephropathy, its factors and to correlate the functional status of the kidney. This cross-sectional study was conducted in the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st January 2013 to 30th June 2013. A total 105 patients having clinical diagnosis of Diabetes mellitus were enrolled in this study. Data were collected by interview of the patients, clinical examination and laboratory investigation. Data was analyzed using the Chi-square test for Categorical variables and unpaired Student's 't' test for differences in means for continuous variables. P value <0.05 was considered significant. With DN (30.5%) patients 21.1% had micro-albuminuria and 9.5% had macro-albuminuria. The mean age for the DN patient was 47.9±14.7 years and male female ratio was 1:1. BMI was found significantly low in patients with DN (p<0.05). Prolonged duration of diabetes (>5 years) and uncontrolled diabetes were found as significant risk factors associated with DN. Other risk factors were hypertension, family history of hypertension, family history of diabetes mellitus and irregular treatment of diabetes mellitus. Mean serum creatinine, mean estimated glomerular filtration rate (GFR) and mean blood sugar level was 1.3±0.6mg/dl, 69.4±26.7ml and 15.6±7.1mmol/L respectively in DN patients. Relation was significant for higher serum creatinine and lower eGFR values (p<0.05). Prevalence of diabetic nephropathy was 30.5%. Long standing diabetes (>5 years) and uncontrolled diabetes were the important risk factors for the development of diabetic nephropathy. Diabetic nephropathy is associated with higher serum creatinine and lower eGFR values.

Bioinformatic and Molecular Analysis of Satellite Repeat Diversity in Vaccinium Genomes

Bioinformatic and molecular characterization of satellite repeats was performed to understand the impact of their diversification on Vaccinium genome evolution. Satellite repeat diversity was evaluated in four cultivated and wild species, including the diploid species Vaccinium myrtillus and Vaccinium uliginosum, as well as the tetraploid species Vaccinium corymbosum and Vaccinium arctostaphylos. We comparatively characterized six satellite repeat families using in total 76 clones with 180 monomers. We observed that the monomer units of VaccSat1, VaccSat2, VaccSat5, and VaccSat6 showed a higher order repeat (HOR) structure, likely originating from the organization of two adjacent subunits with differing similarity, length and size. Moreover, VaccSat1, VaccSat3, VaccSat6, and VaccSat7 were found to have sequence similarity to parts of transposable elements. We detected satellite-typical tandem organization for VaccSat1 and VaccSat2 in long arrays, while VaccSat5 and VaccSat6 distributed in multiple sites over all chromosomes of tetraploid V. corymbosum, presumably in long arrays. In contrast, very short arrays of VaccSat3 and VaccSat7 are dispersedly distributed over all chromosomes in the same species, likely as internal parts of transposable elements. We provide a comprehensive overview on satellite species specificity in Vaccinium, which are potentially useful as molecular markers to address the taxonomic complexity of the genus, and provide information for genome studies of this genus.

Length of Umbilical Cord in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh

This cross sectional descriptive study was performed on 80 human placenta and umbilical cord to find out the variation in length of umbilical cord of healthy Bangladeshi mother in relation to different gestational age. This study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January to December 2018. The specimens were collected from the Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh by purposive sampling technique. According to gestational age the collected samples were divided into three groups. They were Group A (28 to 36 weeks), Group B (37 to 40 weeks) and Group C (above 40 weeks) and examined morphologically by fine dissection method. The length of umbilical cord was measured with the help of flexible tape in cm. For statistical analysis, differences of length between age groups were analyzed by using unpaired student 't' test. The mean±SD length of umbilical cord was 56.15±7.61cm in Group A, 62.54±8.78cm in Group B and 68.54±10.53cm in Group C. It was also observed that the mean length of the umbilical cord was increased with increase of gestational age. The mean difference of length of umbilical cord between Groups A and C was statistically highly significant (p<0.001), difference between Groups A and B was statistically moderately significant (p<0.01) but the difference between Groups B and C was statistically significant (p<0.05). This study was done to provide information about the length of umbilical cord in different gestational ages of healthy pregnancies.

Nationwide carrier detection and molecular characterization of β-thalassemia and hemoglobin E variants in Bangladeshi population

Background

ß-thalassemia is one of the most common inherited blood disorders in the world and a major deterrent to the public health of Bangladesh. The management of thalassemia patients requires lifelong frequent blood transfusion and the available treatment options are unsatisfactory. A national policy on thalassemia prevention is mandatory in Bangladesh. However, precise and up-to-date information on the frequency of ß-thalassemia carriers are missing due to lack of accurate diagnostic approaches, limited access to information and absence of national screening program. This study aims to determine the nationwide carrier frequency of hemoglobin E (HbE) and β- thalassemia and mutation spectrum among the carriers using molecular, hematological and biochemical methods.

Methods

The study enrolled a total of 1877 individuals (60.1% male and 39.9% female) aged between 18 and 35 years. Total sample size and its division-wise breakdown were calculated in proportion to national and division-wise population. Venous blood was collected and subjected to CBC analysis and Hb-electrophoresis for each participant. Serum ferritin was measured to detect coexistence of iron deficiency anemia with thalassemia carrier. DNA-based High Resolution Melting (HRM) curve analysis was performed for confirmation of carrier status by mutation detection.

Results

Of 11.89% (95% CI, 10.43–13.35) carriers of β-globin gene mutations, 8.68% (95% CI, 7.41–9.95) had HbE trait (ETT) and 2.24% (95% CI, 1.57–2.91) had beta-thalassemia trait (BTT). Among eight divisions, Rangpur had the highest carrier frequency of 27.1% (ETT-25%, BTT-2.1%), whereas Khulna had the lowest frequency of 4.2% (ETT-4.2% only). Moreover, α- thalassemia, HbD trait, HbE disease, hereditary persistence of HbF were detected in 0.11, 0.16, 0.43 and 0.16% participants, respectively. HRM could identify two individuals with reported pathogenic mutations in both alleles who were erroneously interpreted as carriers by hematological indices. Finally, a total of nine different mutations including a novel mutation (c.151A > G) were detected in the β-globin gene.

Conclusions

Since carrier frequency for both HbE and β-thalassemia is alarmingly high in Bangladesh, a nationwide awareness and prevention program should be made mandatory to halt the current deteriorating situations. Mutation-based confirmation is highly recommended for the inconclusive cases with conventional carrier screening methods to avoid any faulty detection of thalassemia carriers.

A Hospital-Based Study of Iodine Nutrition Status of Breastfeeding Mothers in Bangladesh

Adequacy of iodine nutrition status in breastfeeding mothers is vital in preventing iodine deficiency disorder (IDD) in neonates and children. The aim of the study was to assess urinary iodine status in breastfeeding mothers attending Bangabandhu Sheikh Mujib Medical University (BSMMU) hospital in Bangladesh. In this cross-sectional study carried out from January 2014 to January 2015, urinary iodine (UI; μgm/L) level of 266 mothers (age 26.6 ± 4.7 years (mean ± SD), exclusively breastfeeding: 132 and nonexclusively breastfeeding: 134), recruited on consecutive basis from BSMMU outdoor and indoor, were measured in spot urine following the wet digestion method. Median UI in the participants was 298.6 (interquartile range, IQR 206.6-454.9) μgm/L and only 6.4% lactating mother had low UI (i.e. <100 μgm/L). There was no difference of median UI in relation to exclusive or nonexclusive breast feeding, presence of goiter, parity, and age of breastfed baby (p=ns for all). But median UI was higher in older subjects (≥30 years vs. <30 years: 364.4 (228.4-529.9) vs. 283.7 (205.4-434.0); median (IQR) p=0.040)), with good socioeconomic condition (good vs. average or less: 328.2 (243.8-510.0) vs. 274.4 (200.0-433.3); median (IQR); p=0.020), and in those who are aware regarding the importance of iodine (aware vs. unaware: 316.6 (225.2-506.3) vs. 270.1 (196.0-407.2); median (IQR); p=0.018). The proportion of participants with UI < 100 μgm/L was similar in all the groups. Logistic regressions to predict deficient UI status revealed none of the variables to be an independent predictor. This study indicates that deficient iodine nutrition status in Bangladeshi breastfeeding mothers is not frequent at present.

Diagnostic Evaluation of Isotropic 3D MRCP Images in the Diagnosis of Cholangiocarcinoma

This is a cross sectional study to establish that Magnetic resonance cholangiopancreatography (MRCP) could be accepted as the most effective imaging modality for the diagnosis of cholangiocarcinoma. Cholangiocarcinoma is the most common malignant tumor of the bile duct. It is much less common than hepatocellular carcinoma, accounting for 5-30% of all hepatic malignancies. Clinically suspected patients with obstructive jaundice due to cholangiocarcinoma were referred to the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was carried out in 60 patients, of which 38(63%) were male and 22(37%) were female. Out of 60 cases 56 cases were truly diagnosed by MRCP, 4 were normal, among these 1 case was diagnosed as cholangiocarcinoma as compared with histopathology. Forty four (44) patients (73.2%) of the patients were in sixth decade of life. The overall sensitivity and specificity were found to be 98.2% and 75%. The diagnostic accuracy was 96.7% & positive predictive value was about 98%.