Treatment Seeking Practices and Etiology of Infertile Couples in Bangladesh

Infertility is a major reproductive health problem, at least in part, a cultural problem also. In developing countries like Bangladesh, infertility is a devastating experience for a couple, particularly in women. For this reason many women suffer from many social and medical consequences. Most of the infertile patients of Bangladesh have no access to adequate comprehensive treatment. Also due to lack of proper knowledge, some couples use varied traditional methods and religious practices. This study was done to assess the treatment seeking behavior of infertile couple and also to find out the gross causes of infertility of patients attending at Motherhood Fertility center, Dhaka, Bangladesh. This prospective study was done over 3 years from June 2016 to June 2019. Two thousand two hundred and fifty (2250) patients attending a secondary infertility center at Dhaka were included in this study. Out of 2250 infertile patients 56.00% were rural and 44.00% urban. Of 737 (58.49%) rural and 658 (66.46%) urban infertile patients had consulted with General practitioner and Gynae specialist before coming to secondary and tertiary care center. Out of 1260 rural, 463(36.75%) and 990 urban, 291 (29.39%) had visited the infertility center as the first choice for treatment. Still about 8.8% infertile couple visited quacks and traditional healers for solving infertility. The overall primary and secondary infertility were 67.69% and 32.31% respectively. In 12.57% couples, male factor was the obvious cause (azoospermia and abnormal semen parameters). In 27.43%, female factors and in 28.0% couples both male and female had obvious reasons responsible for infertility. Thirty two percent (32.00%) cases were unexplained infertility. Out of female factors 43.00% anovulation, 29.00% tubal factors, 11.00% endometriosis, 5.00% Uterine factors, 2.00% POF (premature ovarian failure) and 10.00% others (Thyroid disorder, DM, Hyper-prolactinemia, Luteal phase defect). Infertility is an important health problem in Bangladesh. Etiology of infertility varies from regional, social and cultural conditions so that it requires proper diagnosis and then treats this problem accordingly. It is necessary to build up proper referral system and also proper training should be needed to service provider and traditional healers. Reproductive technology should be widely available in our society where motherhood is one of the most desired stages of a women's life.

Autologous Adipose Tissue-Derived Mesenchymal Stem Cells Introduced by Biliary Stents or Local Immersion in Porcine Bile Duct Anastomoses

Biliary complications (strictures and leaks) represent major limitations in living donor liver transplantation. Mesenchymal stem cells (MSCs) are a promising modality to prevent biliary complications because of immunosuppressive and angiogenic properties. Our goal was to evaluate the safety of adipose-derived MSC delivery to biliary anastomoses in a porcine model. Secondary objectives were defining the optimal method of delivery (intraluminal versus extraluminal) and to investigate MSC engraftment, angiogenesis, and fibrosis. Pigs were divided into 3 groups. Animals underwent adipose collection, MSC isolation, and expansion. Two weeks later, animals underwent bile duct transection, reanastomosis, and stent insertion. Group 1 received plastic stents wrapped in unseeded Vicryl mesh. Group 2 received stents wrapped in MSC-seeded mesh. Group 3 received unwrapped stents with the anastomosis immersed in an MSC suspension. Animals were killed 1 month after stent insertion when cholangiograms and biliary tissue were obtained. Serum was collected for liver biochemistries. Tissue was used for hematoxylin-eosin and trichrome staining and immunohistochemistry for MSC markers (CD44 and CD34) and for a marker of neoangiogenesis (CD31). There were no intraoperative complications. One pig died on postoperative day 3 due to acute cholangitis. All others recovered without complications. Cholangiography demonstrated no biliary leaks and minimal luminal narrowing. Surviving animals exhibited no symptoms, abnormal liver biochemistries, or clinically significant biliary stricturing. Group 3 showed significantly greater CD44 and CD34 staining, indicating MSC engraftment. Fibrosis was reduced at the anastomotic site in group 3 based on trichrome stain. CD31 staining of group 3 was more pronounced, supporting enhanced neoangiogenesis. In conclusion, adipose-derived MSCs were safely applied to biliary anastomoses. MSCs were locally engrafted within the bile duct and may have beneficial effects in terms of fibrosis and angiogenesis.

Feasibility and Safety of Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Thalassemia in Bangladesh

Thalassaemia is one of the commonest inherited disorders in Bangladesh. Since population is rapidly increasing in Bangladesh, therefore birth of large number of new cases is expected every year. Chorionic villus sampling (CVS) is an invasive diagnostic procedure done in early pregnancy to obtain fetal cells for the prenatal diagnosis of chromosomal and genetic disorders like thalassemia. To investigate the feasibility, safety, and outcome of transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of Beta Thalassemia, this retrospective analytical study was carried out on women who had undergone transabdominal CVS for prenatal diagnosis of Beta thalassemia. All CVS are done at Fetal Medicine Centre, Family Foundation, Green Road, Dhaka, Bangladesh from June 2013 to December 2016. A total of 236 couples who were referred for prenatal diagnosis of thalassemia (Beta thalassemia & Hb-E beta thalassemia) were studied. Transabdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. Most procedures were done between 11 and 13 weeks (range 11-14 weeks). All CVS were performed with the "2 operators" technique. The samples were sent for prenatal diagnosis by genetic analysis. Results were recorded and analyzed for descriptive statistics. Out of 236, 123 (52.1%) fetuses were diagnosed as trait (Beta trait or HbE trait), 64 (27.1%) as healthy fetuses and 49 (20.7%) as affected fetuses. A total of 236 CVSs were performed as outdoor basis. Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% & 1.3% respectively which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases. Transabdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis of beta thalassaemia in early pregnancy without significant risk to the mother and the fetus.

An outbreak of hepatitis E in an urban area of Bangladesh

We investigated an outbreak of jaundice in urban Bangladesh in 2010 to examine the cause and risk factors and assess the diagnostic utility of commercial assays. We classified municipal residents reporting jaundice during the preceding 4 weeks as probable hepatitis E cases and their neighbours without jaundice in the previous 6 months as probable controls. We tested the sera collected from probable cases and probable controls for IgM anti-hepatitis E virus (HEV), and the IgM-negative sera for IgG anti-HEV using a commercial assay locally. We retested the IgM-positive sera for both IgM and IgG anti-HEV using another assay at the Centre for Disease Control and Prevention (CDC), USA. Probable cases positive for IgM anti-HEV were confirmed cases; probable controls negative for both IgM and IgG anti-HEV were confirmed controls. We explored the local water supply and sanitation infrastructure and tested for bacterial concentration of water samples. Probable cases were more likely than probable controls to drink tap water (adjusted odds ratio: 3.4; 95% CI: 1.2-9.2). Fifty-eight percentage (36/62) of the case sera were IgM anti-HEV positive; and 75% of the IgM-positive samples were confirmed positive on retesting with another assay at CDC. Compared to confirmed controls, cases confirmed using either or both assays also identified drinking tap water as the risk factor. Two tap water samples had detectable thermotolerant coliforms. Research exploring decentralized water treatment technologies for sustainable safe water might prevent HEV transmission in resource-poor cities. Detection of serological markers in a majority of probable cases implied that available diagnostic assays could adequately identify HEV infection during outbreaks.

Instrumented assessment of test battery for physical capability using an accelerometer: a feasibility study

Recent work has identified subdomains (tests) of physical capability that are recommended for assessment of the healthy ageing phenotype (HAP). These include: postural control, locomotion, endurance, repeated sit-to-stand-to-sit and TUG. Current assessment methods lack sensitivity and are error prone due to their lack of consistency and heterogeneity of reported outcomes; instrumentation with body worn monitors provides a method to address these potential weaknesses. This work proposes the use of a single tri-axial accelerometer-based device with appropriate algorithms (referred to here as a body worn monitor, BWM) for the purposes of instrumented testing during physicality capability assessment. In this pilot study we present 14 BWM-based outcomes across the subdomains which include magnitude, frequency and spatio-temporal characteristics. Where possible, we compared BWM outcomes with manually recorded values and found no significant differences between locomotion and TUG tasks (p ≥ 0.319). Significant differences were found for the total distance walked during endurance (p = 0.037) and times for repeated sit-to-stand-to-sit transitions (p < 0.000). We identified reasons for differences and make recommendations for future testing. We were also able to quantify additional characteristics of postural control and gait which could be sensitive outcomes for future HAP assessment. Our findings demonstrate the feasibility of this method to enhance measurement of physical capacity. The methodology can also be applied to a wide variety of accelerometer-based monitors and is applicable to a range of intervention-based studies or pathological assessment.

iCap: Instrumented assessment of physical capability

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Instrumented testing of five physical capability tasks with a single accelerometer.

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Evaluated on a large cohort of older adults.

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iCap provides robust quantitative data about physical capability.

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iCap captures gait and postural control data known as sensitive to ageing/pathology.

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Methodology may have practical utility in a wide range of surveys and studies.

Objectives

The aims of this study were to (i) investigate instrumented physical capability (iCap) as a valid method during a large study and (ii) determine whether iCap can provide important additional features of postural control and gait to categorise cohorts not previously possible with manual recordings.

Study design

Cross-sectional analysis involving instrumented testing on 74 adults who were recruited as part of a pilot intervention study; LiveWell. Participants wore a single accelerometer-based monitor (lower back) during standardised physical capability tests so that outcomes could be compared directly with manual recordings (stopwatch and measurement tape) made concurrently.

Main outcome measures

Time, distance, postural control and gait characteristics.

Results

Agreement between manual and iCap ranged from moderate to excellent (0.649–0.983) with mean differences between methods low and deemed acceptable. Additionally, iCap successfully quantified (i) postural control characteristics which showed sensitivity to distinguish between 5 variations of the standing balance test and (ii) 14 gait characteristics known to be sensitive to age/pathology.

Conclusions

Our findings show that iCap can provide robust quantitative data about physical capability during standardised tests while also providing sensitive (age/pathology) postural control and gait characteristics not previously quantifiable with manual recordings. The methodology which we propose may have practical utility in a wide range of clinical and public health surveys and studies, including intervention studies, where assessment could be undertaken within diverse settings. This will need to be tested in further validation studies in a wider range of settings.

Diagnostic evaluation of supraclavicular lymphadenopathy

Patients presented with the supraclavicular lymphadenopathy in the medicine department have a strong suspicion of serious illness like tuberculosis, sarcoidosis, toxoplasmosis and malignancy of lymphnode, blood, lung, upper GIT, breast, ovary, testes, and other sites of body. This prospective type of observational study carried out in the indoor and out patient department of medicine of Mymensingh Medical College Hospital over a period of 6 month from April 2011 to September 2011 to diagnose the causes of supraclavicular lymphadenopathy. Patient of either sex, 18 years or above presented with supraclavicular lymphadenopathy were included. Biopsy or FNAC were done. The study showed that mean age of the patient of supraclavicular lymphadenopathy that finally diagnosed as malignant was 49.7 years and that of non malignant was 33.7 years. Male patient have suffered more (60%) from malignant disease than that of female patient (40%). Discrete, hard, non tender either fixed or non fixed supraclavicular lymphadenopathy was found malignant (18 of 18 cases, 100%) and discrete, firm, tender lymphnode were found non malignant (5 of 5 cases, 100%). Increased frequency (11 of 28, 39.3%) of granulomatous inflammation from the tuberculoid lymphadenitis were found among the patient undergone supraclavicular lymphnode biopsy. FNAC result was also of simillar type and finally it was found that frequency of tuberculosis (20 of 53, 37.7%) was highest and bronchial carcima was the second most frequent diagnosis (14 of 53, 26.4%). This study showed that supraclavicular lymphadenopathy is associated mostly with serious disease like tuberculosis and malignancy.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

Histopathological changes in different stages of alopecia areata

Alopecia areata is a common disorder affecting any of the hair bearing areas of the body. Most of the cases are diagnosed on the clinical ground only. Histopathological changes may help in the diagnosis in difficult cases. The present study was designed to observe the histopathologic changes of alopecia areata at different stages. Thirty consecutive patients suffering from alopecia areata were enrolled. Face to face interview was performed using a structured pre-tested questionnaire. At the initial visit, one 4mm punch scalp biopsy specimen was taken from an area of hair loss. Biopsy specimens were sent in a test tube filled with formalin to the department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) where tissue was processed, sectioned and slides were prepared. Haematoxylin and eosin stains were used. Aanagen hairs were decreased in all stages of alopecia areata. Telogen hairs increased in acute and chronic stages whereas catagen hairs increased markedly in sub-acute stage. Although miniaturized (atrophic) follicle was frequently found in chronic stage. It was absent in acute and sub-acute stages. Moderate to dense peribulbar infiltration of lymphocytes were observed in acute stage and mild to moderate infiltration in sub-acute stage. In chronic stage either no or mild infiltrations were observed. Peribulbar infiltration of eosinophils and macrophages were seen in all stages of alopecia areata. Alopecia areata can be diagnosed with some confidence, even when inflammatory infiltrate is absent, based on increased numbers of telogen hairs in the acute and chronic stages, increased miniaturized hairs in chronic stage and markedly increased catagen hairs in sub-acute stage.

Single dose (400 mg) versus 7 day (200 mg) daily dose itraconazole in the treatment of tinea versicolor: a randomized clinical trial

Tinea (pityriasis) versicolor is a superficial fungal infection and one of the most commonly found pigmentary disorders of skin caused by the yeast Malassezia. Multiple topical as well as systemic therapies are available for treatment. Systemic therapies are used for extensive disease, frequent relapse or where topical agents have failed. The aim that translates the rationale of the study was to compare the efficacy, safety, tolerability and cost effectiveness of single dose 400mg versus 7 day 200 mg daily dose of itraconazole in the treatment of tinea versicolor. A clinical study was done to compare the efficacy of single dose (400 mg) of itraconazole and 7 day 200 mg daily dose of itraconazole in the treatment of extensive tinea versicolor. Total 60 patients (aged 18-50 years) were selected for the study during the period of June 2007 to May 2008 in the department of Dermatology of three different hospitals in Bangladesh. Cases having with extensive involvement, diagnosed clinically and confirmed by wood's lamp and KOH microscopy were taken. Patients were randomly allocated into equal groups. Group A was given single dose 400 mg itraconazole and Group B was given 7 day 200 mg daily itraconazole. Fifty three (88%) male and 7(12%) female were included in the study. The mean age of group A was 32.37+/-9 years and in group B 33.23+/-8 years. The mean duration of the disease in group A was 2.63+/-2 months and 2.76+/-2 months in group B. In group A clinical responders was found cure 22(73.33%) and improvement 5(16.33%) and in group B it was found cure 24(79.99%) and improvement 4(13.33%). The measure at the End point (EP1) equals to 90% response and in-group B it was found cure 24 (79.99%) and improvement 4(13.33%). (Here the End point EP2) equals to 93.33%. The EP clinical analysis however shows 91.66% response. Both single dose and 7 day daily dose of itraconazole can be effective in the treatment of tinea versicolor with extensive involvement but single dose appears to be better for improving compliance and decreasing the cost of treatment.

Cutis laxa: a case report and an update

Very few cases of Cutis Laxa are reported worldwide. This is the first case report of its kind from Bangladesh. A 10 year-old girl looking very aged was admitted in the paediatric ward of Dhaka Medical College with most striking skin feature. There was loosely hanging skin over the face which was inelastic, hyper extensible and which recoils slowly after stretching. She had downward slanting palpebral fissures, periorbital oedema, a broad flat nose with everted nostril, sagging cheeks, and large and soft ears. Skin biopsy showed fragmentation of the elastic tissue with collagen tissue in the dermis, which was suggestive of Cutis Laxa. Her chest x-ray showed hypertranslucent lung fields, prominence of pulmonary conus area and some ring like opacity near the lower zone with cardiomegaly, which is suggestive of corpulmonale with bronchiectasis. Her echocardiography showed dilated right atrium, ventricle and pulmonary artery which were suggestive of corpulmonale. All these confirmed the diagnosis.

Cutaneous leishmaniasis

Leishmaniasis is an increasingly prevalent, major world health problem caused by infection with a protozoan which is transmitted by sand fly bites. It is endemic in 88 countries on 4 countries. More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and Sudan. Although Bangladesh is one of four countries those bearing the most burden of visceral leishmaniasis, cutaneous leishmaniasis is rare in Bangladesh. Cases of cutaneous leishmaniasis (CL) are usually imported to Bangladesh from other endemic countries. A patient from an endemic area of cutaneous leishmaniasis, a non-healing nodulo-ulcerative lesion with "volcanic crater" on exposed part of the body, constant dermal infiltration with lymphocytes, histiocytes and plasma cells and demonstration of intracellular parasites in lesional skin establish the diagnosis of cutaneous leishmaniasis. We here represent a case of cutaneous leishmaniasis in an overseas worker, returned from Saudi Arabia. He presented with multiple asymptomatic nodulo-ulcerative lesions on exposed part of the body. The patient's clinical history, morphology of lesions, laboratory analysis and histopathological examination of lesional skin were consistent with cutaneous leishmaniasis, a rare disease for Bangladesh. Cutaneous leishmaniasis may arise as a health problem among people returned from the Middle-East. Our findings of high titre (>1:64000) direct agglutination test (DAT) in cutaneous leishmaniasis may be an additional point of further study.

Association between morphological changes of nail and nail arsenic level in patients with arsenicosis

This case-control type of analytical study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to find out the association between morphological changes of nail and nail arsenic level in arsenicosis patients. Majority of arsenicosis patients were male (56.67%). The mean age of the cases was 43.07+/-13.73 years. Nail changes were found in 26.67% of cases, most were nail dystrophy (23.33%) and rest were Mee's line (3.34%). There was significant difference between cases with or without nail changes and nail arsenic level. But cases with or with out nail changes had a significant difference between duration of intake of arsenic contaminated water. There was no correlation between nail changes and nail arsenic level for nail dystrophy and Mee's line. The study result failed to establish association between the morphological changes of nail and nail arsenic level.

Fixed drug eruptions due to cotrimoxazole

This prospective study on Fixed Drug Eruption (FDE) was carried out between January 2003 to December 2006 in Dermatology department of Mymensingh Medical College Hospital & private chambers. This study was carried out with an objective to see the specific site of involvement and other clinical parameters in FDE due to cotrimoxazole. In each case, a detailed history was taken and a thorough physical examination was done by at least one dermatologist. Patients with suspected FDE, who had consented, were included in the study. Oral re-challenge test was done in each case after written or verbal consent of the patient or legal guardian. For oral re-challenge, usually half of the usual therapeutic dose of the suspected drug (s) was given first and reactions were observed and if no reaction, then full therapeutic dose was given and then again reactions were observed. In case of no reaction to one drug, the next drug was tested after 2 to 7 days. Age & sex distribution, number of attacks of FDE, number of lesions, distribution of sites of involvement were determined in each case of FDE. All informations were recorded in pre-tested data sheet. Among 93 patients of suspected FDE, 61 patients were confirmed as FDE with identified causes, of which 36 cases were due to cotrimoxazole (59.02%). Age range of patients was from 5 years to 65 years with mean of 24.92 years. Male was predominantly affected (M:F=6.2:1). In 50% cases presenting attack was the 2nd attack. Rest 50% had 3 to more than 10 attacks. Number of lesions was: 2-5 lesions in 50%, solitary lesion in 16.67%, 6-10 lesions in 13.89% and more than 10 lesions in 19.44% cases. Sites of involvement in cases of FDE due to cotrimoxazole (n=36) were as follows: lips 58.33%, genitalia 33.33%, oral 13.89%, trunk 38.89%, limbs 55.56%, hands 16.67%, feet 19.44%, face 19.44% and conjunctiva 2.78%.

Management of external hernias: analysis of 1020 [corrected] cases

A prospective study was done to find out the incidence of different external hernias, identify the predisposing factors and type of repair performed. Over a period of 8 years, 1020 patients were admitted with different varieties of external hernias in Chittagong Medical College Hospital. Among them 743 patients had inguinal hernia, 130 had incisional hernia, 58% had indirect inguinal hernia, 29% had direct inguinal hernia, Bilateral inguinal hernia was present in 13% cases. 272 (32.08%) presented with complications like, irreducibility, obstruction, strangulation, 576 (67.92%) was admitted from out-patient department for elective operation. 97.04% of patients with inguinal hernia were male, 2.96% of patients were female. But among incisional hernia 77.70% are female and 22.30% are male patients. The highest incidence of both inguinal hernia and incisional hernia were found in 4th decade of life. Predisposing factors could be identified in 42.06% cases. 90.76% patients approached doctors for advice after 6 months of noticing hernia only 36.37% could mention the cause of delay. Out of 1020 patients (812) 72.18% patients underwent different operations. 2.5% patients were inoperable due to associated disease like Ca-liver, IHD, renal transplant, CLD, uncontrolled DM. Others refused or absconded, being afraid of operation. Effort for post operative follow up was not very satisfactory as only a small number could be followed for a limited period.

Possible link between glycolysis and apoptosis induced by sodium fluoride

Fluoride has been used to prevent caries in the dentition, but the possible underlying mechanisms of cytotoxicity induction by this compound are still unclear. Since fluoride is known as an inhibitor of glycolytic enzymes, we investigated the possible connection between NaF-induced apoptosis and glycolysis in human promyelocytic leukemia HL-60 cells. NaF-induced apoptotic cell death is characterized by caspase activation, internucleosomal DNA fragmentation, loss of mitochondrial membrane potential, and production of apoptotic bodies. Higher activation of caspases-3 and -9, as compared with that of caspase-8, suggested the involvement of an extrinsic pathway. Utilization of glucose was nearly halted by NaF, whereas that of glutamine was rather enhanced. NaF enhanced the expression of Bad protein, but not that of Bcl-2 and Bax proteins, and reduced HIF-1alpha mRNA expression. Analysis of these data suggests a possible link between glycolysis and apoptosis.

A case of molluscum contagiosum

Molluscum contagiosum is a benign contagious disease caused by a poxvirus. The virus proliferates within keratinocytes and forms intracytoplasmic Molluscum bodies. Though it is a common clinical condition, histologically is not yet reported from this region of Mymensingh. We received a skin biopsy specimen in a pathology laboratory for histological examination. The Haematoxylin and Eosin stained sections revealed typical intracytoplasmic Molluscum bodies in keratinocytes. The lesions were in the trunk, which is a common site for Molluscum Contagiosum (MC). As the diagnosis of Molluscum contagiosum is easy by histological examination, every patient suspected to be this disease is recommended to be examined histologically to exclude other similar types of lesions.

Changes in corticothalamic modulation of receptive fields during peripheral injury-induced reorganization

The influence of corticothalamic projections on the thalamus during different stages of reorganization was determined in anesthetized raccoons that had undergone previous removal of a single forepaw digit. Single-unit recordings were made from 522 sites in the somatosensory nucleus of the thalamus (ventroposterior lateral nucleus) before and after lesioning parts of primary somatosensory cortex. In those parts of ventroposterior lateral nucleus that had intact input from the periphery, the cortical lesion resulted in an immediate 85% increase in receptive field (RF) size. In animals studied 2-6 weeks after digit amputation, peripherally denervated thalamic neurons had unique RFs that were larger than normal, and these were not further enlarged by cortical lesion. However, at longer periods of reorganization (>4 mo), when the new RFs of denervated neurons had decreased in size, cortical lesion again produced expansion of RF size. These data demonstrate that corticothalamic fibers modulate the spatial extent of thalamic RFs in intact animals, probably by controlling intrathalamic inhibition. This corticothalamic modulation is ineffective during the early stages of injury-induced reorganization when new RFs are being formed, but is reinstated after the new RFs have become stabilized. The fact that neurons in the denervated thalamic region retained their unique RFs after cortical lesion indicates that their new inputs are not being relayed from a reorganized cortex and support the view that some plasticity occurs in or below the thalamus.

Critical roles of CD30/CD30L interactions in murine autoimmune diabetes

CD30/CD30L is a member of tumour necrosis factor (TNF) receptor/TNF superfamily and has been implicated in immune-regulation. A genetic study has also suggested a possible implication of CD30 in spontaneous autoimmune diabetes in NOD mice. In this study, we investigated the involvement of CD30/CD30L in the development of diabetes in NOD mice. Flow cytometric analysis showed that CD30 and CD30L were highly expressed on CD4+ or CD8+ T cells in the spleen and pancreatic lymph node of younger NOD mice. In addition, islet-specific CD4+ or CD8+ T cell lines expressed CD30 and CD30L. Administration of a neutralizing anti-CD30L monoclonal antibody (mAb) from 2 to 10 week of age completely suppressed the development of spontaneous diabetes in NOD mice. In addition, the treatment with anti-CD30L mAb also inhibited the development of diabetes induced by adoptive transfer of spleen cells from diabetic NOD mice or islet-specific CD4+ or CD8+ T cell lines into NOD-SCID mice. Furthermore, anti-CD30L mAb inhibited T cell proliferation in response to islet antigens. These results suggested that CD30/CD30L interaction plays important roles in both induction and effector phases of autoimmune diabetes in NOD mice.

Interactions between inputs from adjacent digits in somatosensory thalamus and cortex of the raccoon

Interactions between somatosensory afferents arriving from different points in the periphery play an important role in sensory discrimination and also provide the substrate for plasticity following peripheral injury. To examine the extent and time course of such interactions, extracellular recordings were made from neurons in the primary somatosensory cortex and the ventroposterior lateral thalamus of anesthetized raccoons. Interactions between adjacent digits were studied using the conditioning-test paradigm in which a test pulse was delivered to the digit containing the neuron's receptive field (the on-focus digit) at various intervals following conditioning stimulation of an adjacent, off-focus digit. Off-focus stimulation produced predominantly inhibition of the test response with a maximum effect at 20-40 ms in both cortex and thalamus. The mean inhibition was approximately twice as large in the thalamus as in the cortex. Recordings were made in other animals after unmyelinated C fibers had been destroyed in the on-focus digit by subcutaneous injection of capsaicin. This resulted in a doubling of the responses evoked by the test stimulus in both regions, but the spontaneous discharge rate was not changed. The amount of inhibition produced in the cortex was unchanged by capsaicin treatment, but was reduced in the thalamus compared to control animals. This indicates that capsaicin-sensitive peripheral afferents provide a tonic control over interdigit inhibition in the thalamus.

Corticocortical inhibition of peripheral inputs within primary somatosensory cortex: the role of GABA(A) and GABA(B) receptors

A conditioning-test pulse paradigm was used in combination with microiontophoresis to examine the corticocortical modulation of somatosensory processing. Single-cell recordings were made in the glabrous digit representation of primary somatosensory (S1) cortex in anesthetized raccoons. Test stimulation of the periphery (the on-focus digit) was preceded by conditioning stimulation of the cortical area that represents an adjacent digit at interstimulus intervals ranging from 5 to 200 ms. An early and prolonged inhibitory modulation was produced in most of the 61 neurons examined, and an early facilitation followed by inhibition was produced in about one-third of the cells. Microiontophoretic administration of a potent GABA(B) receptor antagonist, CGP 55845, blocked the inhibition and in many cases revealed a facilitation of the sensory response. Microiontophoretic administration of a GABA(A) receptor antagonist, gabazine, blocked inhibition at short interstimulus intervals and reduced the longer inhibition by half. These results indicate that connections between glabrous digit representations within S1 cortex produce predominantly inhibitory modulation of sensory input and that both GABA(A) and GABA(B) receptors contribute to this modulation. The relevance of these connections to the effects of peripheral nerve injury and subsequent reorganization is discussed.

Effect of GABAB receptor blockade on receptive fields of raccoon somatosensory cortical neurons during reorganization

Single unit recordings were made in the fourth digit representation of raccoon somatosensory cortex after amputation of the fourth digit. The receptive fields of neurons in this "reorganized" cortex were studied before and after microiontophoretic application of a highly specific GABA(B) receptor antagonist, CGP 55845. When the recordings were performed early in the reorganization process, 3-5 weeks after amputation, CGP 55845 produced a greater expansion of the receptive field (184%) than at longer post-amputation intervals (17-34 weeks, 137% increase) or previously reported in intact animals (105%). Most of the receptive fields in these animals were restricted to either an adjacent digit or the palm and the expansion was adjacent to the predrug receptive field. However, in some cases block of GABA(B) receptors unmasked new responsive areas that were separated from the predrug field. In addition, GABA(B) receptor block often revealed higher threshold fields on an adjacent digit or palm. These results reinforce previous studies that used a GABA(A) receptor antagonist, and together they reveal the importance of GABAergic synapses in regulating the various inputs to cortical somatosensory neurons during reorganization.

Comparison of receptive field expansion produced by GABA(B) and GABA(A) receptor antagonists in raccoon primary somatosensory cortex

Recordings were made from 62 neurons in the forepaw representation of primary somatosensory cortex in anesthetized raccoons. Microiontophoretic administration of a specific GABA(B) receptor antagonist, CGP 55845, produced receptive field expansion in 74% of 46 neurons, in which it was tested first. The mean receptive field area was approximately doubled, with increases ranging from 12 to 500%. The GABA(B) receptor agonist baclofen reduced the receptive field in most (11 of 16) neurons, but increased the size in 4 neurons. Comparison of the effects of GABA(B) and GABA(A) antagonists in the same cells showed that GABA(A) receptor blockade produced greater expansion than GABA(B) blockade (144% vs 114%, respectively). Simultaneous administration of the two antagonists produced additional expansion in 16 of 25 neurons. There was no evidence of separate skin regions being masked by the two GABA receptor subtypes, as the larger expansion usually included the skin that was unmasked by the less effective drug. These results indicate that both GABA(B) and GABA(A) receptors play a role in shaping the normal receptive fields in somatosensory cortex.

Evaluation of antitumor activity of some medicinal plants of Bangladesh by potato disk bioassay

The antitumor activity of the ethanolic extracts of 12 medicinal plants of Bangladesh, including the vincristine-vinblastine producing Catharanthus roseus was studied using the potato disk bioassay technique. Among these, 10 plant extracts at 25.0-microgram/disc exhibited significant inhibition of crown gall tumors caused by Agrobacterium tumefaciens.

Agranulocytosis--a case report

Drug induced agranulocytosis is a rare condition. Yet one hundred and five drugs have been claimed to be associated with agranulocytosis and this list has since been updated. Some drugs are associated with relatively high risk. Dapsone is one of the drugs that was associated with a sufficiently high incidence of fatal agranulocytosis. It was withdrawn from use as prophylaxis against malaria. Here we present a case of a 27 years old female who had suffered from agranulocytosis after taking Dapsone, Amitriptyline and Oflacin for treatment of Dermatitis Herpetiformis.

Reorganization of the frequency map of the auditory cortex evoked by cortical electrical stimulation in the big brown bat

In a search phase of echolocation, big brown bats, Eptesicus fuscus, emit biosonar pulses at a rate of 10/s and listen to echoes. When a short acoustic stimulus was repetitively delivered at this rate, the reorganization of the frequency map of the primary auditory cortex took place at and around the neurons tuned to the frequency of the acoustic stimulus. Such reorganization became larger when the acoustic stimulus was paired with electrical stimulation of the cortical neurons tuned to the frequency of the acoustic stimulus. This reorganization was mainly due to the decrease in the best frequencies of the neurons that had best frequencies slightly higher than those of the electrically stimulated cortical neurons or the frequency of the acoustic stimulus. Neurons with best frequencies slightly lower than those of the acoustically and/or electrically stimulated neurons slightly increased their best frequencies. These changes resulted in the over-representation of repetitively delivered acoustic stimulus. Because the over-representation resulted in under-representation of other frequencies, the changes increased the contrast of the neural representation of the acoustic stimulus. Best frequency shifts for over-representation were associated with sharpening of frequency-tuning curves of 25% of the neurons studied. Because of the increases in both the contrast of neural representation and the sharpness of tuning, the over-representation of the acoustic stimulus is accompanied with an improvement of analysis of the acoustic stimulus.

Peripheral blood cells transplantation--a review article

In the twelve years since the first PBSCT were reported, impressive advancements in BCT techniques have made it easy to perform, effective, less costly, rapid haematologically recoverable, reduced morbidity and mortality, shorten overall duration of cancer treatment and hospital stay. Development of high-dose chemotherapy and new novel effective antitumor drugs otherwise limited by haematological toxicities may now become possible. Treatment of haematological malignancies with purged autologous PBPCT, e.g. Ph Chromosome negative progenitor cells in CML or with immunologically manipulated allogeneic PC having preserved GVL but not GVHD action, with hopeful prospects, is now becoming possible. Tailoring of BC for ex-vivo selection and expansion of specially active T Iymphocytes, NK cells and other immune effector cells will enable adoptive immunotherapeutic approach and treatment of Minimal residual disease [MRD] after high-dose chemotherapy both in grafts and in patients. The discovery of a nonhaematopoietic, engraftment facilitator cell form donor BM may usher in further precision in GVHD prevention by purification and in adoptive immunotherapeutic approach. Therefore, it is likely that BCT will supersede BMT, though the follow-up is too short to draw conclusions.

Partial characterization of apoptotic factor in Alzheimer plasma

We have previously demonstrated that a plasma natriuretic factor is present in Alzheimer's disease (AD), but not in multi-infarct dementia (MID) or normal controls (C). We postulated that the natriuretic factor might induce the increased cytosolic calcium reported in AD by inhibiting the sodium-calcium antiporter, thereby activating the apoptotic pathway. To test for a factor in AD plasma that induces apoptosis, we exposed nonconfluent cultured LLC-PK1 cells to plasma from AD, MID, and C for 2 h and performed a terminal transferase-dUTP-nick-end labeling (TUNEL) assay. The plasma from AD increased apoptosis nearly fourfold compared with MID and C. The effect was dose dependent and the peak effect was attained after a 2-h exposure. Additionally, apoptotic morphology was detected by electron microscopy, and internucleosomal DNA cleavage was found. We inhibited apoptosis by removing calcium from the medium, inhibiting protein synthesis with cycloheximide, alternately boiling or freezing and thawing the plasma, and digesting a partially purified fraction with trypsin. Heating AD plasma to 56 degrees C did not deactivate the apoptotic factor. These results demonstrate the presence of an apoptotic factor in the plasma of patients with AD.

Stability of neurological soft signs in chronically hospitalized schizophrenic patients

Neurological soft signs (NSS) have been shown to be more prevalent in chronically ill and in acute or never-mediated patients with schizophrenia. If neurological soft signs are trait-like, then NSS scores should be relatively stable over time and should not be related to changes in patients' psychopathology or medication. Chronically hospitalized patients with schizophrenia were rated two or more times over a 5-year period with standard NSS and psychopathology scales. Total NSS scores were highly correlated over time, and changes in NSS scores at two time points were not significantly related to changes in psychopathology scores. Total NSS scores did not change significantly in a subsample rated when they were first treated with a traditional neuroleptic and later with an atypical neuroleptic. The findings suggest total NSS scores may have some characteristics of a trait-like feature in chronically hospitalized patients with schizophrenia.

Dopaminergic modulation of transcallosal activity of cat motor cortical neurons

The effects of dopamine (DA) and its antagonists on the transcallosal activity of pyramidal tract neurons (PTNs) and non-PTNs in the anesthetized cat motor cortex were studied with iontophoretic applications; dopamine, SCH 23390 (D1 antagonist), sulpiride (D2 antagonist) and haloperidol. Neuronal activity was recorded with a multi-barreled glass microelectrode. Transcallosal neuronal activity was evoked by stimulation of the contralateral motor cortex. The number of spikes thus activated was counted for the control and test conditions after application of each drug: (1) dopamine application decreased the number of spikes evoked by transcallosal stimulation; (2) application of SCH 23390, sulpiride and haloperidol restored these decreased spike numbers to the control level; (3) latency of neuronal response to transcallosal stimulation was not affected by the application of either DA, SCH 23390, sulpiride or haloperidol; and (4) there was no significant difference between PTNs and non-PTNs in the manner of response to DA and its antagonist applications. Our conclusion is that dopamine modulated the transcallosal neuronal response in the cat motor cortex in a suppressive manner. This fact suggested that interhemispheric neuronal communications could be subjected to suppressive modification by the dopaminergic system.

Acquired pure red cell aplasia--a case report

A married female patient of 36 years with chronic anaemia, because of pure erythroid aplasia with a haemolytic component and hypothyroidism due to antithyroid auto-antibodies, was subsequently discovered as a case of systemic lupus erythematosus (SLE). She was treated with corticosteroid and immunosuppressive therapy and her anaemia was corrected. The response of erythroid aplasia to corticosteroid and other immunosuppressive agents suggests that immunological factors play a role in erythroid aplasia in SLE. The occurrence of red cell aplasia in association with a variety of immune phenomenon supports the concept that in SLE, erythroid aplasia may be of immune aetiology.

Induction of labor by intracervical prostaglandin gel and oxytocin infusion in primigravid women with unfavorable cervix

The rate of Cesarean Section for failed induction of labor and maternal and fetal compilations are high when labor is induced in a nulliparas women with an unripe cervix by amniotomy and oxytocin infusion. Prostaglandins (PG) in different forms have been used for ripening the cervix with an aim of reducing these problems. A prospective randomized trial was performed on one hundred primigravid women between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavorable cervix (Modified Bishop Score < or = 5) in the department of Obstetrics & Gynaecology of Institute of Postgraduate Medicine & Research from 1st May 1996 to 30th April 1997. In this study the efficiency of prostaglandin E2 intracervical (PGE2 IC) gel in induction of labor in a group of primigravid women with unripe cervix was assessed and compared with another group with similar characteristics using oxytocin infusion and artificial rupture of membrane (ARM). The Modified Bishop Score (MBS), interval between IOL and onset of labor and the duration of labor after insertion of PGE2 gel was significantly different from those of oxytocin infusion group. But the Apgar Score at 1 & 5 min had shown no statistically significant difference. Any significant difference could also not be detected in the mode of delivery between the two induction group. The proportion of emergency Cesarean Section (CS) was high in the oxytocin infusion group than that of in the prostaglandin group. There was also no significant difference regarding the acceptability of both the induction methods.

Protein utilization during energy undernutrition in sheep sustained by intragastric infusion. Effect of body fatness on the protein metabolism of energy-restricted sheep

The effect of body fat content on the protein metabolism of energy-restricted sheep has been studied in two experiments. In the first experiment, six Suffolk-cross wether sheep, three weighing about 39 kg and three of about 61 kg, were given progressively increasing amounts of casein-N from 0 to 3000 mg N/kg metabolic body weight (W0.75) daily with constant energy, 91 kJ/kg W0.75 daily, from a high-propionic acid mixture of volatile fatty acids (VFA). In the second experiment, two lean and two fat sheep of similar body weights were given progressively increasing amounts of casein with the same VFA mixture. All the animals attained a positive N balance when they were in negative energy balance. N balance was not affected by body fatness of the magnitude studied, although lean animals utilized increasing levels of standard VFA (acetate-propionate-butyrate 65:25:10, molar proportions) infusion for N accretion more efficiently than fat animals. Endogenous energy was utilized for protein accretion with an efficiency of 0.56. Supply of glucogenic VFA equivalent to 28 mmol glucose/kg W0.75 reduced fasting N excretion by 39%. Fasting heat production decreased from 335 to 300 kJ/kg W0.75 with the infusion of casein and glucogenic VFA. It is argued that fasting induces additional heat losses due to raised protein metabolism and is unsuited as a baseline for dietary assessment.

Protein utilization during energy undernutrition in sheep sustained by intragastric infusion: effects of protein infusion level, with or without sub-maintenance amounts of energy from volatile fatty acids, on energy and protein metabolism

Utilization of endogenous and exogenous energy for protein accretion during energy undernutrition has been studied. Nine lambs nourished by intragastric infusion were given either progressively increasing or decreasing amounts of casein-N up to 2550 mg/kg metabolic weight (W0.75), with or without 250 kJ/kg W0.75 of volatile fatty acids daily. Energy balance (respiration calorimetry) and N balance were measured. While all experimental animals were in negative energy balance, N balance increased curve-linearly with the increase in casein-N infusion and attained positive N balance. Endogenous energy (presumably body fat) was found to meet the energy needs for protein accretion during energy undernutrition. It is concluded that body fat can be effectively utilized to support lean-tissue growth during energy undernutrition, so that the classical nutritional concept of dietary energy:protein ratio is only meaningful when both endogenous and exogenous energy are considered.

GABAergic characteristics of transcallosal activity of cat motor cortical neurons

GABAergic characteristics of transcallosal activity of cat pyramidal tract neurons (PTNs) and non-PTNs (nPTNs) were studied with stressing on GABAB receptors. PTNs and nPTNs were further classified into group 1 (< 10 ms) and group 2 (> 10 ms) based on the latency upon transcallosal stimulation. However, mainly the results of group 1 neurons were presented here, due to the small number of group 2 neurons. GABA, bicuculline, CGP 35348 and phaclofen were iontophoretically applied. The spike number to 20 trials of transcallosal stimulation was 8.9 +/- 4.3 (mean +/- S.D.) for group 1 PTNs (n = 14) and 10.4 +/- 4.5 for group 1 nPTNs (n = 38) under the control conditions. CGP 35348, phaclofen and bicuculline significantly increased the spike numbers in both cases. The increase was greater for nPTNs than for PTNs. GABA decreased them. The transcallosal latency was 3.9 +/- 1.1 ms for PTNs under the control conditions. CGP 35348, phaclofen and bicuculline significantly shortened the latency, and GABA elongated it. The transcallosal latency for nPTNs under the control conditions was 2.7 +/- 1.2 ms. This was significantly shortened by application of CGP 35348, phaclofen or bicuculline. GABA restored it. In conclusion, CGP 35348, phaclofen and bicuculline increased spike discharge and shortened the latency upon transcallosal stimulation for both group 1 PTNs and nPTNs.