Adaptations to the first wave of the COVID-19 pandemic by private sector tuberculosis care providers in India

Background

India’s dominant private healthcare sector is the destination for 60–85% of initial tuberculosis care-seeking. The COVID-19 pandemic in India drastically affected TB case notifications in the first half of 2020. In this survey, we assessed the impact of the first wave of COVID-19 in India on private providers, and changes they adopted in their practice due to the pandemic.

Methods

The Joint Effort for Elimination of TB (JEET) is a nationwide Global Fund project implemented across 406 districts in 23 states to extend quality TB services to patients seeking care in private sector. We conducted a rapid survey of 11% (2,750) of active providers engaged under JEET’s intense Patient Provider Support Agency (PPSA) model across 15 Indian states in Q1 (February–March) of 2021. Providers were contacted in person or telephonically, and consenting participants were interviewed using a web-based survey tool. Responses from participants were elicited on their practice before COVID-19, during the 2020 lockdowns (March–April 2020) and currently (Q1 2021). Data were adjusted for survey design and non-response, and results were summarised using descriptive statistics and logistic regression.

Results

Of the 2,750 providers sampled, 2,011 consented and were surveyed (73 % response). Nearly 50 % were between 30 and 45 years of age, and 51 % were from Uttar Pradesh, Maharashtra and Gujarat. Seventy percent of providers reported reduced daily out-patient numbers in Q1 2021 compared to pre-COVID times. During the lockdown, 898 (40 %) of providers said their facilities were closed, while 323 (11 %) offered limited services including teleconsultation. In Q1 2021, 88 % of provider facilities were fully open, with 10 % providing adjusted services, and 4 % using teleconsultation. Only 2 % remained completely closed. Majority of the providers (92 %) reported not experiencing any delays in TB testing in Q1 2021 compared to pre-COVID times. Only 6 % reported raising costs at their clinic, mostly to cover personal protective equipment (PPE) and other infection control measures, although 60–90 % implemented various infection control measures. Thirty-three percent of TB providers were ordering COVID-19 testing, in addition to TB testing.

To adapt, 82% of survey providers implemented social distancing and increased timing between appointments and 83% started conducting temperature checks, with variation by state and provider type, while 89% adopted additional sanitation measures in their facilities. Furthermore, 62% of providers started using PPE, and 13% made physical changes (air filters, isolation of patient areas) to their clinic to prevent infection. Seventy percent of providers stated that infection control measures could decrease TB transmission.

Conclusion

Although COVID-19 restrictions resulted in significant declines in patient turn-out at private facilities, our analysis showed that most providers were open and costs for TB care remained mostly the same in Q1 2021. As result of the COVID-19 pandemic, several positive strategies have been adapted by the private sector TB care providers. Since the subsequent COVID-19 waves were more severe or widespread, additional work is needed to assess the impact of the pandemic on the private health sector.

Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India

INTRODUCTION

Delaying care-seeking for tuberculosis (TB) symptoms is a major contributor to mortality, leading to worse outcomes and spread. To reduce delays, it is essential to identify barriers to care-seeking and target populations most at risk of delaying. Previous work identifies barriers only in people within the health system, often long after initial care-seeking.

METHODS

We conducted a community-based survey of 84 625 households in Chennai, India, to identify 1667 people with TB-indicative symptoms in 2018-2019. Cases were followed prospectively to observe care-seeking behaviour. We used a comprehensive survey to identify care-seeking drivers, then performed multivariate analyses to identify care-seeking predictors. To identify profiles of individuals most at risk to delay care-seeking, we segmented the sample using unsupervised clustering. We then estimated the per cent of the TB-diagnosed population in Chennai in each segment.

RESULTS

Delayed care-seeking characteristics include smoking, drinking, being employed, preferring different facilities than the community, believing to be at lower risk of TB and believing TB is common. Respondents who reported fever or unintended weight loss were more likely to seek care. Clustering analysis revealed seven population segments differing in care-seeking, from a retired/unemployed/disabled cluster, where 70% promptly sought care, to a cluster of employed men who problem-drink and smoke, where only 42% did so. Modelling showed 54% of TB-diagnosed people who delay care-seeking might belong to the latter segment, which is most likely to acquire TB and least likely to promptly seek care.

CONCLUSION

Interventions to increase care-seeking should move from building general awareness to addressing treatment barriers such as lack of time and low-risk perception. Care-seeking interventions should address specific beliefs through a mix of educational, risk perception-targeting and social norms-based campaigns. Employed men who problem-drink and smoke are a prime target for interventions. Reducing delays in this group could dramatically reduce TB spread.

A Postmortem Study of Length & Depth of the Central Sulcus in Different Age & Sex Groups of Bangladeshi People

The central sulcus (CS) is a prominent landmark of the brain, separating the parietal lobe from the frontal lobe and the primary motor cortex from the primary somatosensory cortex. Variations in the morphology of the central sulcus are seen with respect to the length and depth of the central sulcus. This study was done to establish a normal standard of length and depth of central sulcus in different age and sex groups of Bangladeshi people. Interhemispheric age and gender differences of the central sulcus were done by cross sectional descriptive study which was performed 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 years & above). The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, Bangladesh by purposive sampling technique. The length of central sulcus was measured by using thread and the depth was measured by using wooden stick at middle of the upper, middle and lower third of the central sulcus in superolateral surface. The mean length of central sulcus was 10.51±0.529cm to 9.78±0.996cm in male and 10.27±0.786cm to 8.83±0.379cm in female. Depth of the central sulcus was 1.333±0.100cm to 1.029±0.125cm in male and 1.173±0.144cm to 1.01±0.200cm in female. The difference in mean length & depth of the central sulcus for both left and right hemisphere between male and female was statistically non significant in all age groups. In present study the length and depth of the central sulcus showed gradual decreasing values with advancing age. Knowledge of morphometry of central sulcus is not only important during neurosurgery of brain but also holds tremendous significance in diagnosis and management of diseases of the cerebral cortex. The present study will help to increase the information pool on the length and depth of the central sulcus of Bangladeshi people which will minimize the dependency on foreign standards.

Variation of Length of Calcarine Sulcus in Different Age & Sex Groups of Bangladeshi People

Calcarine sulcus, one of the major sulcus of occipital lobe of cerebral hemisphere which is intimately related with visual function. The detailed anatomy of this lobe is essential for the surgeons and radiologists for clinical investigation & surgery. The aim of the present study was to identify the variation of this sulcus of the occipital lobe. This study was done to establish a normal standard in length of calcarine sulcus in different age & sex groups of Bangladeshi people. Inter-hemispheric age and gender differences of this sulcus was done by cross sectional descriptive study which was performed 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 years & above). The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique. The length of calcarine sulcus was measured by using thread. The mean length of calcarine sulcus was lowest to highest values 7.07±0.616cm to 7.86±0.792cm in male and 6.53±0.808cm to 7.62±0.806cm in female. The mean difference of the length of right calcarine sulcus between group A & D was statistically significant at p<0.05, but not significant in any other age & sex groups for both left and right hemisphere. In present study, the length of the calcarine sulcus showed gradual decreasing values with advancing age. For proper planning of neurosurgical procedures and radiological representation of visual functional areas, detailed knowledge on the variation of this sulcus is essential. Proper knowledge of calcarine sulcus can permit safer access to deep structures and reduce operative complications. The present study will also help to increase the information pool on the length of the calcarine sulcus of Bangladeshi people which will minimize the dependency on foreign standards.

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.

Study of Diameter of Lymphoid Follicle of Vermiform Appendix in Bangladeshi People of Different Age and Sex

A cross sectional descriptive study was performed on 40 postmortem vermiform appendix (male 24 and female 16) to find out the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique and were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). For this purpose, about 3mm long of whole thickness transverse section was taken from the middle of the vermiform appendix and thus the permanent slides were made for microscopic examination. To measure the diameter of the lymphoid follicle two measurements were taken. One was taken at the maximum diameter and another was perpendicular to it by ocular micrometer. Diameter of one largest and one smallest lymphoid follicles were measured and find out the mean diameter of lymphoid follicle between them. Diameter of lymphoid follicle = (Maximum transverse diameter + perpendicular diameter) /2. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. It was observed that diameter of lymphoid follicle of vermiform appendix gradually decreased as age advanced. The mean±SD diameter of lymphoid follicle was 580.31±37.07, 545.58±38.37, 485.68±40.20 and 428.12±68.41μm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of diameter of lymphoid follicle between A&B, C&D were statistically non significant at p= or >0.05 level, difference between Group B&C was statistically moderately significant at p<0.01 level and differences between Group A&C, B&D, A&D were statistically highly significant at p<0.001 level. Mean diameter of lymphoid follicle of vermiform appendix in male was higher (584.30±12.65μm in Group A, 549.42±38.36μm in Group B, 487.38±39.91μm in Group C, 430.68±70.30μm in Group D) than in female (576.31±53.77μm in Group A, 536.61±45.14μm in Group B, 483.14±46.68μm in Group C, 424.28±75.95μm in Group D) but mean difference between sexes in the different groups was statistically non significant at p=or >0.05 level. The present study will help to increase the information pool on the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people.

Morphological Changes of Length of Prostate in Different Age Groups of Bangladeshi Cadaver

Benign prostatic hyperplasia is the most common prostatic problem for men older than age 50. It is a condition in men in which the prostate is enlarged but it is not cancerous. The prostate goes through 2 (two) main growth periods as a person ages. The first happens early in pubescence, when the prostate doubles in size. The second stage of growth begins around age twenty five and continues throughout most of a man's life. Benign prostatic hyperplasia often occurs with second growth phase. In the treatment of prostatic disorders, estimation of the length of prostate has been used to select the surgical approach. Transurethral resection of prostate (TURP) is preferred for small glands and open prostatectomy for larger ones. As the prostate gland is dependent on androgen for its growth, the prostatic length reflects the hormonal status of the subjects. This cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh from April 2015 to September 2015 to find out the difference in length of the prostate of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate glands collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College, by non random purposive sampling technique. The specimens were collected from Bangladeshi dead body, age starting from 10-80 years. All the specimens were classified into 3(three) classes - Group A (upto 18 years), Group B (19-45 years) and Group C (>45 years) according to age. Dissection was performed according to standard autopsy techniques. The length of the prostate was measured and recorded. The mean±SD length of the prostate was 1.76±0.60cm, 2.65±0.56cm and 2.88±0.70cm in Group A, B and C respectively. The maximum mean length of the prostate was in Group C (2.88cm) and minimum was in Group A (1.76cm). It was observed that the length of the prostate was increased with age. Variance analysis shows that mean differences of length of the prostate were highly significant among all age groups. The length of prostate gland was found to be increase with age. For statistical analysis, variations between age groups were analyzed by students unpaired 't' test. The present study will help to increase the information pool on the length of prostate gland of Bangladeshi people.

Chronic stress, depression and personality type in patients with myasthenia gravis

BACKGROUND AND PURPOSE

Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type.

METHODS

In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type.

RESULTS

Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R² = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003).

CONCLUSIONS

A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.

Variations in the Position of Vermiform Appendix in Bangladeshi People

This cross sectional descriptive study was performed on 70 postmortem vermiform appendices (male 34 and female 36) to find out the various positions of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique from October 2016 to March 2017. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy technique. During postmortem examination abdominal cavity was routinely exposed by classical midline incision from xiphoid process to the symphysis pubis and a semicircular incision around the umbilicus and the flaps were reflected to give a good view of the abdominal cavity along with its contents and then the taeniae coli of the caecum were identified. The three taeniae coli of the caecum converge at the base of the appendix and become its longitudinal muscle coat. The anterior caecal taeniae coli acts as the best guide for identification of the vermiform appendix. The relation of the base of the appendix to the caecum is constant but the position of the vermiform appendix, which is variable, was studied in relation to caecum and the terminal part of the ileum. Accordingly the position of the vermiform appendix was noted either retrocaecal, pelvic, preileal or postileal, subcaecal. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. Among 70 specimens, 44(62.9%) vermiform appendices were retrocaecal in position. The next common position was pelvic which was in 22(31.4%) specimen followed by postileal in 3(4.3%) specimen and subcaecal was observed only in 1(1.4%) specimen. In this study in all age groups incidence of retrocaecal vermiform appendix was highest and it was about 67.6%, 50%, 69.2% and 72.7% in Group A, B, C, D respectively. Pelvic position was 7.1%, 46.9%, 23.1% and 27.3% in Group A, B, C, D respectively. Subcaecal vermiform appendix was absent in Group A, B and Group D. On the other hand postileal vermiform appendix was absent in Group C and Group D. The findings of this study may help the physician and the surgeons for proper diagnosis, management and treatment of disease of vermiform appendix.

A Study of Sacral Index for Identification of Sexual Dimorphism

Sacrum is an important bone for identification of sex in human skeletal system. Being a component of axial skeleton it contributes to formation of pelvic girdle. 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. Sample collection was done by non-random purposive sampling technique from Anatomy department of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. The parameters included the straight length of sacrum and width of sacrum which was measured by digital vernier slide caliper and was expressed in millimeter (mm) and sacral index was calculated from these measurements. In present study the mean straight length of sacrum in male and in female was 104.27±5.76mm and 92.82±7.59mm respectively. The mean width of sacrum in male and in female was 99.51±5.80mm and 102.98±6.69mm respectively. Mean sacral index were 95.42±3.14 and 111.27±7.66 in male and female respectively. Comparison of straight length and width of sacrum and sacral index were done between male and female by unpaired student 't' test which was statistically significant.

External Diameter of Vermiform Appendix in Bangladeshi People of Different Age & Sex

This cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the external diameter of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The external diameter of vermiform appendix was measured with the help of digital slide calipers. Three measurements were taken at its base, middle and near the tip (1cm away from the tip) and expressed in mm. The data were analyzed by using student unpaired 't' test and compaired with the findings of other national and international studies and standard text books. It was observed that external diameter of vermiform appendix gradually decreased as age advanced. The mean±SD external diameter of vermiform appendix at base was 6.50±0.82 mm, 6.22±0.60 mm, 6.00±0.51 mm and 5.51±0.57 mm in Group A, B, C & D respectively. The mean±SD external diameter of vermiform appendix at middle was 6.09±0.89 mm, 5.67±0.65 mm, 5.38±0.59 mm and 4.95±0.76 mm in Group A, B, C and D respectively. The mean±SD external diameter of vermiform appendix near the tip (1 cm away from the tip) was 5.73±0.88 mm, 5.21±0.72 mm, 4.81±0.74 mm and 4.34±0.74 mm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of external diameter of vermiform appendix at its base between Group A&D, B&D were statistically moderately significant at p<0.01 level. Between Group C&D was statistically significant at p<0.05 level and between Group A&B, B&C, A&C were statistically non significant at p = or >0.05 level. Mean differences of external diameter of vermiform appendix at its middle between Group A&D, B&D were statistically moderately significant at p<0.01 level. Between Group A&C was statistically significant at p<0.05 level and between Group A&B, B&C, C&D were statistically non significant at p = or >0.05 level. Mean differences of external diameter of vermiform appendix near its tip (1 cm away from the tip) between Group A&D was statistically highly significant at p<0.001 and mean differences between Group B&D, A&C were statistically moderately significant at p<0.01 level. Between Group A&B was statistically significant at p<0.05 level and between Group B&C, C&D were statistically non significant at p = or >0.05 level. Mean external diameter of vermiform appendix in male was higher than that of female in all age group at its base, middle and near the tip (1cm away from the tip) but mean difference between sexes in the different study groups was statistically non significant at p = or >0.05 level. The present study will help to increase the information pool on the external diameter of vermiform appendix of Bangladeshi people.

Measurement of Length of Umbilical Cord in Different Gestational Age Groups in Bangladesh

The umbilical cord and placental have been considered to significantly contribute to the perinatal outcome. Long or short cord can lead to intrauterine fetal demise. So this type of study in placenta and umbilical cord can yield information for immediate and later management of newborn. This information may also be essential for protecting the attending physician in the event of a fetal outcome. This Cross sectional descriptive study would provide information about the length of umbilical cord in different gestational age groups in Bangladesh. To fulfill this aim the study was performed on 60 human placentas and umbilical cords and Gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), and Group C 38 weeks and above. These samples were collected from normal pregnancy in Gynecology and Obstetrics Department of Mymensingh Medical College Hospital from July 2009 to June 2010. After preservation in 10% normal saline, study was done in the department of Anatomy of Mymensingh Medical College. In this present study the mean±SD length of umbilical cord was found in different gestational age groups in Group A 63.00±5.40, Group B 63.69±8.80 and Group C 67.03±10.64cm and also observed that the mean length of umbilical cord increased with gestational age. The mean length of umbilical cord was maximum in Group C (67.03cm) and was minimum in Group A (63.00cm). The mean difference of length of umbilical cord among different groups was statistically not significant. Observed findings of this study were compared with those of western and Bangladeshi researches.

Variation of Luminal Diameter of the Right Principal Bronchus in Different Age and Sex Group of Bangladeshi Cadaver

The respiratory system is involved in the intake and exchange of oxygen and carbon dioxide between an organism and the environment which is essential for human survival. The bronchial tree includes the trachea, right and left principal bronchi and their branching upto alveoli. A common medical problem with the respiratory tract is acute respiratory tract infection (ARI) which is the leading killer of children under five. The aim of the present study was to find out the variation of the luminal diameter of right principal bronchus in Bangladeshi people. This cross sectional descriptive study was performed on 70 post mortem human right principal bronchus (44 of male and 35 of female) to find out the difference in luminal diameter of the right principal bronchus of Bangladeshi people in relation to age and sex in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique from July 2014 to June 2015. All specimens were grouped into three categories, Group A (upto 20 years), Group B (21-40 years) and Group C (41-60 years) according to age. Dissection was performed according to standard autopsy techniques. The right principal bronchus was cut horizontally within 1cm of its origin and the average luminal diameter was measured with the help of a point divider and metric scale and was expressed in centimeter. All data were recorded in the pre-designed data sheet and statistical analysis was done using computer based statistical package, SPSS to evaluate the significance of variance between the different findings. In the present study the maximum luminal diameter of the right principal bronchus was 1.45, 1.55 and 1.70cm in age Group A, B and C respectively. The minimum luminal diameter of the right principal bronchus was 0.75cm in Group A, 0.80cm in Group B and 0.80cm in Group C. The mean±SD luminal diameter of the right principal bronchus was 1.21±0.23, 1.24±0.21 and 1.20±0.22cm in age Group A, B and C respectively. In most cases (87%) it was >1cm. The maximum mean luminal diameter of the right principal bronchus was in age Group B (1.24cm) and minimum was in age Group C (1.20cm). The mean difference of luminal diameter of the right principal bronchus between groups was statistically insignificant. The mean±SD luminal diameter of the right principal bronchus in male was 1.24±0.19, 1.30±0.18 and 1.23±0.21cm in age Group A, B and C respectively and 1.18±0.28, 1.16±0.23 and 1.12±0.24cm in female in age Group A, B and C respectively. It is evident from the results that the mean luminal diameter of the right principal bronchus in male was higher than that of female in all the groups but this mean difference between sexes in the group was statically non significant. The study would help to establish a normal standard data on the luminal diameter of the right principal bronchus of Bangladeshi people.

Length of Vermiform Appendix in Bangladeshi People of Different Age and Sex

A cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the length of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The length of the vermiform appendix was determined by measuring the distance from its base to tip with the help of a flexible thread. Then the thread was placed on measuring scale graduated in centimeter which represents the length of vermiform appendix. The data were analyzed by using student unpaired 't' test and compared with the findings of other national and international studies and standard text books. It was observed that length of vermiform appendix gradually decreased as age advanced. The mean±SD length of vermiform appendix was 9.41±1.26cm, 8.63±1.32cm, 7.96±1.20cm and 6.81±0.75cm in Group A, B, C and D respectively. Mean length of vermiform appendix in male was 9.92±1.55cm in Group A, 9.09±1.19cm in Group B, 8.04±1.10cm in Group C, 6.88±0.86cm in Group D and in female mean length of vermiform appendix was 9.12±1.06cm in Group A, 8.31±1.34cm in Group B, 7.79±1.60cm in Group C, 6.69±0.63cm in Group D. Statistical analysis shows that the mean differences of the length of vermiform appendix between A & D, B & D were statistically highly significant. The mean difference between Group A & C was moderately significant. Between Group C & D the difference was statistically significant and between Group A & B, B & C were statistically non significant. No significance difference of length of vermiform appendix between male and female was observed. The present study will help to increase the information pool on the length of vermiform appendix of Bangladeshi people.

Correlation of Triceps Skin Fold Thickness with Weight of Bangladeshi Garo Population

This cross sectional, observational, descriptive and analytic type of study was designed to formulate a standard for Bangladeshi Garo population and an attempt has been made out to formulate a linear regression equation for estimation of weight from the triceps skin fold thickness in different areas of Mymensingh district (Mymensingh Sadar & Haluaghat Upazilla), Bangladesh from July 2015 to June 2016. The material consists of 104 Garo people (60 male, 44 female) between 20-40 years of age in Bangladesh. The triceps skin fold thickness (Right & Left) was measured by spreading caliper. The weight was measured in standing erect, anatomical position with weighing machine. Data tabulated and statistically analyzed using Microsoft excel. A positive correlation of weight was observed with triceps skin fold thickness and it was statistically highly significant for right side and significant for left side. The results of present study would be useful for Anthropologist and Forensic Medicine experts.

Correlation of Stature with Foot Length in 5-10 Years Aged Bangladeshi Children

This cross sectional, descriptive and analytic type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat) on 109 Bangladeshi children (70 male and 39 female) from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of foot deformity resulting either from congenital or physical injury were excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding foot length, to measure correlation of stature with foot length and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Stature of the subject was measured with the stadiometer and foot length was measured using slide calipers. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean foot length of 5, 6, 7, 8, 9 and 10 years aged male were 16.72±1.11cm, 17.12±.72cm, 19.04±1.27cm, 19.10±.76cm, 20.11±1.25cm and 20.88±1.01cm respectively and those of same aged female were 16.44±1.2cm, 17.85±0.50cm, 18.53±0.76cm, 19.14±0.58cm, 19.87±1.88cm and 20.95±1.36cm respectively. Correlation between stature and foot length was made. Foot length showed non- significant positive correlation with stature in 5 years old male and female, 6 years old male, 7 years old male and female, 8 years old male and female, 9 years old and 10 years old female. In case of 9 years and 10 years old male, it showed significant positive correlation with stature. Comparison of foot length between male and female children was done by Unpaired Students 't' test which was statistically non-significant.

An Anthropometric Study of Bimalleolar Breadth and its Relationship with Stature on Bangladeshi Garo People

A cross sectional descriptive study was conducted at different areas of Mymensingh (Haluaghat, Vatikashor and Kachijhuly) from July 2015 to June 2016 on 101 Bangladeshi Garo people. Among them 60 were male and 41 were female. Sample collection was done by nonrandom purposive sampling technique. Mixed ethnicity and any kind of foot deformity resulting either from congenital or physical injury were excluded to construct standard measurement for Garo ethnicity. Bimalleolar breadth was measured using slide calipers. The subjects were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The maximum right and left bimalleolar breadth for male was found 8.32cm and 8.34cm respectively; minimum was 5.42cm and 5.43cm respectively. In case of female maximum right and left bimalleolar breadth was 9.63cm and 9.64cm respectively and minimum was 5.41cm for both feet. In this study, difference of mean bimalleolar breadth of male and female were statistically analyzed by using students unpaired 't' test which was highly significant. Correlation was done with stature and found significant in case of male but non-significant in case of female.

Anthropometric Study of Carrying Angle on Bangladeshi Garo People

The present study was designed to construct an anthropometric data of 20-40 years aged 104 Bangladeshi Garo people (60 male and 44 female) regarding carrying angle and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Participants were selected through purposive sampling for this cross sectional, observational, descriptive and analytic type study which was carried out in different areas of Mymensingh district (Haluaghat, Mymensingh Sadar), Bangladesh from July 2015 to June 2016. The carrying angles of both side were measured by goniometer. Data were tabulated and statistically analyzed using Microsoft excel and SPSS software. Carrying angle was found to be higher in males but angle of inclination was higher in females. Comparison of differences of means between male and female was statistically significant. The results of present study would be useful for Anthropologist and Forensic Medicine experts.

Study of Prostatic Volume and its Variations in Different Age Groups of Bangladeshi Cadaver

Benign prostatic hyperplasia and carcinoma of the prostate are the most common disorders of Bangladeshi male in recent years. Volume of the prostate is necessary to estimate the amount of BPH adenoma to determine the appropriate therapy or to select the surgical approach. Transurethral resection of prostate (TURP) is preferred for small glands and open prostatectomy for larger ones. Decrease in prostatic mass after hormonal manipulation or radiation therapy can be used as an indicator of therapeutic efficacy. The effect of prostate volume on biopsy outcome was assessed and was noted that there was an inverse relationship in between size of the gland and prostate cancer. A cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh to find out the difference in volume of the prostate gland of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate gland collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College by non random purposive sampling technique. The specimens were collected from Bangladeshi cadaver of age ranging from 10 to 80 years. All the specimens were grouped into three categories: Group A (upto 18 years), Group B (19 to 45 years) and Group C (above 45 years) according to age. Dissection was performed according to standard autopsy techniques. The volume of the prostate gland were measured and recorded. The mean volume of the prostate gland was 13.75ml in Group A, 24.44ml in Group B and 29.72ml in Group C. Variance analysis shows that mean differences of volume of the prostate were highly significant among all age groups. The volume of prostate gland was found to be increased with increasing age. For statistical analysis, differences between age groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the volume of prostate gland of Bangladeshi people.

Variation of Length of Trachea in Different Age & Sex Group of Bangladeshi Cadaver

A cross sectional descriptive study was performed on 70 post mortem human trachea (44 of male and 35 of female) to find out the difference in length of the trachea of Bangladeshi people in relation to age and sex. The specimens were collected from the morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique. All specimens were grouped into three categories, Group A (upto 20 years), Group B (21-40 years) and Group C (41-60 years) according to age. Dissection was performed according to standard autopsy techniques. The length of the trachea was measured with the help of a metallic tape and data was analyzed by using one way ANOVA test. A general trend of increasing tracheal length was observed as age advanced. The mean±SD length of the trachea was 7.88±1.01cm in Group A, 8.81±0.81cm in Group B and 8.94±1.04cm in Group C. The mean length of the trachea in male were 8.1±0.81cm, 8.95±0.69cm and 8.92±1.1cm in Group A, Group B and in Group C respectively and in female the length were 7.57±1.24cm, 8.61±0.96cm and 9±1cm in Group A, Group B and Group C respectively. Variance analysis shows significant difference in mean length of the trachea between the age Group A & B and Group A & C but no significant difference was shown between Group B & C. No significant difference of length of trachea between male and female was observed. The study would help to increase the information pool on the length of the trachea of Bangladeshi people.

Variations of Weight of Prostate Gland in Different Age Groups of Bangladeshi Cadaver

Now a days, benign prostatic hyperplasia and carcinoma of the prostate are the most common disorders in men. A cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh to find out the difference in weight of the prostate gland of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate gland collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College by non random purposive sampling technique. The specimens were collected from Bangladeshi cadaver of age ranging from 10 to 80 years. All the specimens were grouped into three categories - Group A (upto 18 years), Group B (19 to 45 years) and Group C (above 45 years) according to age. Dissection was performed according to standard autopsy techniques. The weight of the prostate gland were measured and recorded. The mean weight of the prostate gland was 10.13gm in Group A, 17.27gm in Group B and 22.50gm in Group C. Variance analysis shows that mean differences of weight of the prostate were highly significant among all age groups. The weight of prostate gland was found to increase with increased age. For statistical analysis, differences between age groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the weight of prostate gland of Bangladeshi people.

Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?

Introduction

Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM).

Aim

To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to TB treatment under the Revised National Tuberculosis Control Programme (RNTCP).

Materials and Methods

A retrospective cohort study was conducted that included medical record reviews of SAM children registered for TB screening and RNTCP care during July–December 2012.

Results

Among 440 SAM children screened, 39 (8.8%) were diagnosed with TB. Among these, 34 (87%) initiated TB treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilograms—the current weight requirement for receiving drugs under RNTCP.

Conclusion

ICF approaches are feasible at NRCs; however, screening for TB entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with TB were treated by the RNTCP. More effort is needed to link this vulnerable population to TB services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilograms.

Variations of Thickness of Splenic Capsule of Different Age and Sex in Bangladeshi Cadaver

The spleen is the most frequently injured organ in the abdomen. Splenic rupture is usually precipitated by a crushing injury or severe blow. If ruptured the spleen will bleed profusely because its capsule is thin and its parenchyma is soft and pulpy. Such "spontaneous ruptures" never occur in truly normal spleen but rather than from some minor physical insult to a spleen that has been rendered fragile by an underlying condition. The most common predisposing conditions are infectious mononucleosis, malaria, typhoid fever and lymphoid neoplasms. These diverse entities can all cause rapid splenic enlargement, producing a thin, tense splenic capsule that is susceptible to rupture. Understanding of splenic capsular structure may help explain mechanical properties of the normal and diseased spleen. Histological changes are evident in advancing age along with functional capability of the human spleen. This cross sectional descriptive study was done to measure the thickness of splenic capsule to establish the difference between sexes of different age groups in Bangladeshi cadaver. The study was carried out in the department of Anatomy, Mymensingh Medical College, Mymensingh from June 2013 to July 2014. A total 30 human spleen were collected by purposive sampling technique from October 2013 to April 2014, among them 14 were male and 16 were female. The specimens were collected from Bangladeshi cadavers of age ranging from 6 months to 60 years, from autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College. For convenience of differentiating the thickness of splenic capsule in relation to age and sex, the collected specimens were divided into three groups like Group A (upto 20 years), Group B (21 to 40 years) & Group C (41 to 60 years). Each group was again divided into male & female groups. In this study 10 slides from each age group were chosen for measuring the thickness of splenic capsule and examined under low power objective. In present study the mean capsular thickness of spleen was 107.71±8.70, 125.71±31.29 and 136.39±6.49 μm in Group A, B and C respectively. The mean difference of capsular thickness of spleen between Group A & B, Group B & C was statistically non-significant but the difference between C & A was highly significant (p<0.001). From this study it was also observed that the mean±SD thickness of splenic capsule was higher in male than that of female among the age groups but there was no significant difference between sexes. In statistical analysis, differences between age groups and sexes were calculated by using one way ANOVA test and unpaired 't' test respectively.

Variations of Weight of Thyroid Gland in Different Age and Sex Groups of Bangladeshi Cadavers

A cross sectional descriptive study was designed to find out the difference in weight of the thyroid gland of Bangladeshi people in relation to age and sex. The present study was performed on 70 post mortem human thyroid gland (35 of male and 35 of female) collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh by purposive sampling technique. The specimens were collected from Bangladeshi cadavers of age ranging from 10 years to 85 years. All the specimens were grouped into three categories Group A (upto 20 years), Group B (21 to 50 years) and Group C (>50 years) according to age. Dissection was performed according to standard autopsy techniques. The weight of the thyroid glands were measured and recorded. The mean weight of the thyroid gland was 6.94 ± 5.20 gm in Group A, 7.91 ± 5.89 gm in Group B and 10.42 ± 6.27 gm in Group C. The mean weight of the thyroid gland in male was 7.0 ± 5.77 gm in Group A, 9.94 ± 7.63 gm in Group B and 11.89 ± 5.73 gm in Group C and in female was 6.88 ± 4.88 gm in Group A, 5.88 ± 2.15 gm in Group B and 9.10 ± 6.74 gm in Group C. Variance analysis shows that there was no significant difference in mean weight between the Age Group A & B, B & C and C & A. There was significant difference of weight of thyroid gland between sex in age Group B but in Group A and Group C were statistically insignificant. The weight of the thyroid gland was found to increases with age. In statistical analysis, differences between age groups were analyzed by using one way ANOVA test. The present study will help to increase the information pool on the weight of thyroid gland of Bangladeshi people.

Length of papillary muscles in both ventricles of different age group on Bangladeshi cadaver

Papillary muscle rupture and dysfunction can lead to complications of prolapsed atrioventricular valve and valvular regurgitation. Morphology, measurements and attachments of papillary muscles in both tricuspid and bicuspid valve gains utmost importance in cardiac surgeries and variations in the papillary muscle morphology is one of causes for myocardial infarction in recent time. Therefore, it is important to know both the normal anatomy and variations of papillary muscles. The study was carried out in the department of Anatomy, Mymensingh Medical College, Mymensingh from July 2013 to June 2014. A total 80 human hearts were collected by purposive sampling method, among them 49 were male and 31 were female. The specimens were collected from Bangladeshi cadavers of age ranging from 6 months to 60 years, from autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College. All the specimens were grouped into three categories Group A (upto 20 years), Group B (21 to 40 years) and Group C (41 to 60 years) according to age. Dissection was performed according to standard autopsy techniques. Length of each papillary muscle was measured in both ventricles in different age groups. In present study the mean length of the anterior papillary muscles of right ventricle was higher than both the posterior and septal papillary muscles among the age groups. The mean±SD length of the anterior papillary muscle was 1.07±0.48, 1.50±0.37 and 1.60±0.25cm in Group A, B and C respectively. The mean±SD length of the posterior papillary muscle was 1.02±0.35, 1.31±0.40 and 1.37±0.34cm in Group A, B & C respectively. The mean±SD length of the septal papillary muscle in right ventricle was 0.51±0.42, 0.65±0.31 and 0.81±0.35cm in Group A, B & C respectively. It was also observed that the mean length of anterior, posterior and septal papillary muscle was increased with age. In present study the mean length of the anterior papillary muscles in left ventricle was higher than that of the posterior papillary muscle among the age groups. The mean±SD length of the anterior papillary muscle was 1.53±0.34, 2.05±0.39 and 2.01±0.25cm in Group A, B and C respectively. The mean±SD length of the posterior papillary muscle was 1.33±0.34, 1.95±0.89 and 1.81±0.76cm in Group A, B and C respectively and it was also observed that the mean length of both anterior and posterior papillary muscle was increased with age. In statistical analysis, differences between age groups were calculated by using one way ANOVA test.

Morphometric study of dentate nucleus of cerebellum in Bangladeshi cadaver

This cross sectional descriptive study was done by using nonprobability sampling technique and performed by examining 63 (sixty three) cerebellum. Out of them 40 postmortem human cerebellum collected from Bangladeshi cadavers of both sexes (male 25 and female 15) age ranging from 5 to 60 years and 23 cerebellums from caesarian section of intrauterine death cases of both sexes (male 14 and female 9) age ranging from 34 to 41 weeks of gestation. Specimens were collected from dead bodies autopsied on different dates from April' 2009 to September' 2009 at the autopsy laboratory of department of Forensic Medicine and prenatal cases from Gynaecology and Obstetrics Department of Mymensingh Medical College, Mymensingh. The collected specimens were grouped into three age groups like Group A (28 to 42 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years) and, two sex groups (male and female) and two sides (right and left). A transverse section was made at the level of horizontal fissure, and length and breadth of dentate nucleus were measured by divider and scale. The mean (±SD) length and breadth of dentate nucleus was 8.619±2.995mm and 14.770±3.604mm respectively and it was observed that length and breadth of dentate nucleus increased with age upto certain level then slightly decreased in the late age Group C. In this study, differences of the mean length of dentate nucleus on both right and left sides were statistically moderately significant between age Groups A&B. The differences of mean breadth of dentate nucleus on both right and left side were statistically highly significant between age Groups A&B and moderately significant between age Groups A&C on right side and only significant on left side. The differences between male & female were statistically insignificant in length and breadth of dentate nucleus.

The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.

Variations of thickness of trigonal muscle layer in different age and sex

This cross sectional descriptive study was to measure the thickness of muscular layer in trigone of the urinary bladder and to establish the difference between sexes of different age groups in Bangladeshi cadaver. A total 60 human urinary bladders were collected by purposive sampling from May 2013 to October 2013. Among them from male 43 and from female 17 were collected from Bangladeshi cadavers of age ranging from 01 to 60 years, from autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College, Mymensingh. The thickness of muscular layer in trigone of the urinary bladder was measured and significant differences of the value between age and sex groups were observed. The mean±SD thickness of muscular layer of trigone of the urinary bladder was 318.59±93.15μm in age Group A (01 to 20 years), 633.25±79.79μm in age Group B (21 to 40 years), and 352.50±116.15μm in age Group C (41 to 60 years). The mean difference of muscular layer of the trigone of the urinary bladder between age Groups A&B, B&C was statistically highly significant, where p=0.001. In statistical analysis, differences between age groups were calculated by using one way ANOVA test. The present study revealed that the value of thickness of muscular layer in trigone of the urinary bladder was increased with the increase of age and it was declined to a low level in the late age. The mean value of muscular layer of the trigone of the urinary bladder was higher in male than that of in female of Group A, B & C.

Morphometric study of thyroid angle in different age and sex in Bangladeshi cadaver

This cross sectional descriptive study was to measure the thyroid angle and to establish the difference between sexes of different age groups in Bangladeshi cadaver. A total 60 human larynges were collected by purposive sampling from October 2008 to March 2009. Among them 45(male 23 and female 22) were collected from Bangladeshi cadavers (9 to 60 years) at the autopsy laboratory of Department of Forensic Medicine and 15 (male 6 and female 9) from stillborn infants of viable age (28 to 40 weeks of gestation) from Gynaecology and Obstetrics Department of Mymensingh Medical College, Mymensingh. The thyroid angle was measured and significant differences of the dimensions between different age and sex groups were observed. In the present study observed findings was compared with those of other researchers. The mean±SD thyroid angle was found as 65.00±11.65 degree in age Group A (28 to 40 weeks of gestation), 73.69±6.56 degree in age Group B (9 to 16 years) and 77.76±7.76 degree in age Group C (17 to 60 years). The mean thyroid angle was higher in female (83.1667±5.78220 degree) than that in male (73.9412±7.09460 degree) and statistically moderately significant in Group C, where t = 3.853 and p = 0.001. In statistical analysis, differences between age and sex groups were calculated by using Students (unpaired) 't' test. The present study revealed that the value was significantly greater in adult female than male and the value increased with age.

Histomorphological study of germinal centre of vermiform appendix in Bangladeshi cadaver

The study was done to find out the number of germinal centre in human vermiform appendix of Bangladeshi people to magnify the knowledge regarding the diverse number of germinal centre of human vermiform appendix in our population in the department of Anatomy, Mymensingh Medical College, Bangladesh from July 2006 to June 2007. Total 40 appendices were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of department of Forensic Medicine, Mymensingh Medical College. This cross sectional study was done by convenient sampling technique. For convenience of differentiating the changes in number of germinal centre of vermiform appendix in relation to age and sex, findings were classified in four groups, Group A up to 20 years, Group B 21-35 years, Group C 36-55 years and Group D 56-70 years. In the present study the number of germinal centre was highest in Group B (52.38%) but in Group D it was nil. Here mean number of germinal centre in male (1.05) were more than in female (0.8).

Weight of uterus in bangladeshi cadaver

This cross sectional descriptive study was done to see the weight of uterus in Bangladeshi cadavers to increase the knowledge regarding variational anatomy in our country. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected by non random or purposive sampling technique from cadavers of different groups and fixed in 10% formol-saline solution. This study was carried out in the Department of Anatomy of Mymensingh Medical College, Mymensingh from July 2006 to June 2007. Gross and fine dissection was carried out to study the weight of uterus. In this study our findings were compared with those of the references. Maximum weight of the uterus was found in age group B (13 to 45 years). It is about 51.35 ± 17.95 gm.

Morphometric study of splenic volume in Bangladeshi cadaver

To determine the volume of spleen of Bangladeshi people by water displacement method, this cross sectional descriptive study was carried out over 120 cadaveric spleen of which 87 male and 33 female, in the department of Anatomy of Mymensingh Medical College from July 2007 to June 2008. The maximum volume of male spleen was 200ml in group D (46-60 years) and female spleen was 150ml in group B (16-30 years). The minimum volume was 30ml in group A (up to15 years) in both male and female. The maximum mean volume of male was 84.23 ml in group B (16-30 years) and minimum mean volume was 47.75ml in group A (upto 15 years). The mean volume of female spleen was highest, 78.33ml in C (31-45 years) age group and lowest 45.62ml in A (upto 15 years) age group. From this study it was evident that the volume of spleen increases with age during childhood and adolescence remains stable in young adult and declined in older age groups. Volume of spleen shows positive correlation with age up to 60 years of age. Mean±SE volume of male spleen was 75.27±3.78ml, ranges from 30-200ml and in female; mean±SE volume was 60.51±4.90ml, ranges from 30-150ml. Here it is observed that volume of spleen was higher in male than in female but the difference was not statistically significant.

Sputum smear microscopy at two months into continuation-phase: should it be done in all patients with sputum smear-positive tuberculosis?

Background

The Revised National Tuberculosis Control Program (RNTCP) of India recommends follow-up sputum smear examination at two months into the continuation phase of treatment. The main intent of this (mid-CP) follow-up is to detect patients not responding to treatment around two-three months earlier than at the end of the treatment. However, the utility of mid-CP follow-up under programmatic conditions has been questioned. We undertook a multi-district study to determine if mid-CP follow-up is able to detect cases of treatment failures early among all types of patients with sputum smear-positive TB.

Methodology

We reviewed existing records of patients with sputum smear-positive TB registered under the RNTCP in 43 districts across three states of India during a three month period in 2009. We estimated proportions of patients that could be detected as a case of treatment failure early, and assessed the impact of various policy options on laboratory workload and number needed to test to detect one case of treatment failure early.

Results

Of 10055 cases, mid-CP follow-up was done in 6944 (69%) cases. Mid-CP follow-up could benefit 117/8015 (1.5%) new and 206/2040 (10%) previously-treated sputum smear-positive cases by detecting their treatment failure early. Under the current policy, 31 patients had to be tested to detect one case of treatment failure early. All cases of treatment failure would still be detected early if mid-CP follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment. This would reduce the related laboratory workload by 69% and only 10 patients would need to be tested to detect one case of treatment failure early.

Conclusion

Discontinuation of mid-CP follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive-phase of treatment will reduce the laboratory workload without impacting overall early detection of cases of treatment failure.

Morphometry of seminiferous tubules of human testes in different age groups in Bangladeshi cadavers

This cross sectional descriptive study was done to observe the mean diameter of seminiferous tubules and to determine its differences between different age groups in Bangladeshi male. Thirty human testes of different age groups were collected by purposive sampling technique. Among them 22 specimens were collected from cadavers during routine postmortem examination and 8 specimens were from dead fetuses from Gynaecology & Obstetrics Department. The specimens were grouped into three categories Group A (28 to 42 weeks of gestational age), Group B (Up to 14 years) and Group C (15 to 70 years). The mean diameter of seminiferous tubules was measured and significant differences of the dimensions between different age groups were determined. The mean±SD diameter was 85.37±15.51 μm in Group A, 144.04±63.34 μm in Group B and 227.92±22.47 μm in Group C. Statistically, differences between age groups were calculated by using Unpaired Students 't' test. The present study revealed that the diameter increased with age and mean differences were statistically significant between Groups A&C, B&C and A&B.

Morphometry of isthmus of thyroid gland in Bangladeshi cadaver

This cross sectional descriptive study was carried out to determine the length, breadth & thickness of isthmus of thyroid gland of Bangladeshi people. To fulfill this aim sixty postmortem tissue blocks containing thyroid gland and its neighbouring structures were collected by convenience sampling technique from 48 male and 12 female cadavers of different age groups, age ranging from 11 to 70 years and fixed and preserved in 10% formol-saline solution. Specimens were collected from dead bodies autopsied on different dates from October'2004 to February'2005 at the autopsy laboratory of Forensic Medicine Department of Mymensingh Medical College, Mymensingh, Bangladesh. Gross and fine dissection was carried out to study the length, breadth and thickness of isthmus of thyroid gland. In the present study, observed findings were compared with those of Western and Bangladeshi researchers. It was seen that the mean±SD lengths of isthmus were 10.42±7.49 mm, 10.17±5.70 mm and 9.33±6.64) mm in Group A(upto 18 years), B(19 to 45 years) and C(>45 years) respectively. Highest length (30mm) was observed in Group A and lowest length (2mm) was observed in Group C. Variance analysis showed that there was no significant difference in mean length between the age groups (F=0.086, p=0.918). The mean±SD values of breadth were 13.66±5.06 mm, 14±5.41 mm and 12.27±3.97 mm in Group A, B and C respectively. In the ranges, there was much overlapping among the groups. In Group B breadth of the isthmus was greater than other age groups. But these differences were statistically not significant, where F=0.430 & p=0.654. It was interesting to note that in this study the mean breadth of isthmus was significantly greater than the mean length (where, t=-2.727 and p=0.01). In the present study the mean±SD thickness of the isthmus of thyroid glands were 4.91±1.78 mm, 4.72±2.68 mm and 4.45±1.36 mm in three age groups respectively & the thickness of isthmus of thyroid gland was also greater in Group B than other two groups. But the variance analysis reveals that, there was insignificant difference in the thickness (F=0.133, p=0.876) of isthmus of thyroid gland among different age groups.

Morphometry of purkinje cell body of cerebellum in bangladeshi cadaver

This cross sectional descriptive study was performed by examining 30 (thirty) relatively fresh cerebellum. Out of them 20 postmortem human cerebellum collected from Bangladeshi cadavers of both sexes (male 10 and female 10) age ranging from 5 to 60 years and 10 cerebellums from caesarian section of dead fetuses of both sexes (male 6 and female 4) age ranging from 34 weeks to 41 weeks. Specimen containing cerebellum was collected from dead bodies autopsied on different dates from April'2009 to September'2009 at the autopsy laboratory of department of Forensic Medicine and Gynaecology and Obstetrics of Mymensingh Medical College, Mymensingh. Samples were collected by using nonprobability sampling technique. The collected sample was grouped in to three age groups like Group A (34 to 41 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years) and two sex groups (male and female). Ten cerebellums were studied from each age group for this histological study. Sections were processed following standard histological procedure and were stained with Hematoxylin and Eosin stain. Slides were examined under 15X40 magnifications and measurement of vertical and transverse diameter of the cell body were taken with the help of ocular micrometer. In this study, the mean difference of mean vertical and transverse diameter of Purkinje cell body between Groups A & B and Groups A & C was statistically highly significant (p<0.001) but differences between Groups B & C was statistically significant only in case of transverse diameter.

Morphological study of extrauterine length of the fallopian tube at different age group in Bangladeshi people

This cross sectional descriptive study was done to see the length of the right & left fallopian tube in Bangladeshi female and to increase the knowledge regarding variational anatomy in our country. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected by non random or purposive sampling technique from cadavers of different age groups and fixed in 10% formol saline solution. This study was carried out in the department of Anatomy of Mymensingh Medical College, Mymensingh from July 2006 to June 2007. Gross and fine dissection was carried out to study the length of fallopian tube (right & left). In this study our findings were compared with those of the standard text books. Maximum length of fallopian tube was found in middle age group (B = 13 to 45 years). It is about 9.19 cm in right side and 8.82 cm in left side. It is also important to note that more kinking was observed in middle age group.

Study of prenatal and postnatal development of spleen of Gallus Domesticus (deshi chicken)

Spleen is one of the secondary or peripheral lymphoid organs along with cecal tonsils in birds. The growth of the spleen of Gallus Domesticus (deshi chicken) from prenatal embryonic day fifteen (ED15) to postnatal day ninety (D90) were studied. In macroscopic study it was found that the shape of the spleen was rounded with slightly flattened from side to side at its middle part at prenatal period (ED15, ED18) and becomes rounded at postnatal stages of the deshi chicken (D90). Regarding position it lies close to the right side of the junction between proventriculus and gizzard and was similar in prenatal and postnatal stages. The result of the present study revealed that the mean diameter and weight of the spleen in deshi chicken gradually increases with increase of age, which were 2.00+/-0.136mm and 0.007+/-0.00gm respectively at ED15 stage and it reaches upto 10.40+/-0.331mm and .303+/-0.004gm respectively at day 90 (D90). It was observed that the differences of diameter & weight of the spleen between different ages were statistically significant (p<0.01). Histologically the spleen was surrounded by thin capsule in prenatal life, which gradually becomes thicker in postnatal life. The splenic pulps were not differentiated into white and red pulp on 15th day of embryonic life (ED15) but they were gradually differentiated into white and red pulp in the late prenatal (ED18) and postnatal period. The growth and development of spleen at each stage of the study period were found to be significantly high. Present study indicates that chicken splenic cell population, structure and function were similar to human spleen histologically. It was also found that the chicken embryo allows easy experimental access to all the stages of the splenic development, so the present study will be helpful for experimentation on lymphoid organs and to understand pathophysiology of immunological diseases of human.

Measurement of different external dimensions of the heart in adult Bangladeshi cadaver

The cross sectional descriptive study was carried out to determine the gross morphological parameters regarding heart to establish a racial characteristic of Bangladeshi adult population. To fulfill this aim, different external dimensions of the heart in Bangladeshi adult people of both sexes were measured and compared with the findings of other researchers of Bangladesh and western countries. A total fifty normal human hearts from both sexes were collected during routine postmortem examination in autopsy laboratory of Forensic medicine department of Mymensingh Medical College, Mymensingh on different dates from August 2003 to April 2004. The age at death of cadavers was ranged from 20 to 60 years. The mean weight, length, breadth and antero-posterior diameter were measured and the following values were found. In male the mean (+/-SD) weight was 247.92(+/-40.26) gm, mean (+/-SD) length was 10.5(+/-0.62) cm, mean (+/-SD) breadth was 8.51(+/-0.61) cm and mean (+/-SD) antero-posterior diameter was 5.86(+/-0.63) cm. In female the mean (+/-SD) weight was 164.29(+/-33.56) gm, mean (+/-SD) length was 9.2(+/-0.89) cm, mean (+/-SD) breadth was 7.67(+/-0.61) cm and mean (+/-SD) antero-posterior diameter was 5.47(+/-0.55) cm. In statistical analysis, difference between male and female values was calculated by using students 't' test. The present study revealed that the values were always greater in male than in female group, though statistically there was no significant difference (p>0.05) between them.

Relationship of uterine artery with ureter

The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

An anatomical study on pyramidal lobe of thyroid gland in Bangladeshi people

The study was done to see the incidence of pyramidal lobe of thyroid gland including its position, attachment, length and incidence of its association with levator glandulae thyroidae in Bangladeshi population. Sixty postmortem tissue blocks containing thyroid gland and its related neighbouring structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Gross and fine dissection was carried out to study the incidence of presence of pyramidal lobe, its attachments, length, breadth and association with levator gladulae thyroidae. In the present study, findings were compared with those of Western and Bangladeshi researchers. It was evident that, fifty percent of the thyroids possesses pyramidal lobe. Incidence was more in male (52.1%) than in female (41.7%). It also appeared from the observations that, this lobe was commonly situated on the left side. In the majority of cases (56.66%), base of the pyramidal lobes were attached to the upper border of the isthmus with or without encroachment on the adjacent part of the left lobe. The range of length and breadth of the pyramidal lobe was from 1.8 to 35mm and 1.3 to 19mm respectively. In 73.33% cases, pyramidal lobe was associated with levator glandulae thyroideae and in only 26.66% cases pyramidal lobe was found independently.

An anatomical study on interventricular septum of postmortem hearts of adult Bangladeshi people

To study the thickness of interventricular septum (both muscular and membranous parts) of adult Bangladeshi people, fifty postmortem hearts were collected, fixed in 10% formol saline and examined. The thickness of both muscular and membranous parts of the septum was measured. Among fifty hearts, thirty-six were collected from male and fourteen from female cadavers. All hearts were collected from medicolegal cases. The findings were compared between male and female cadavers of our country as well as with the findings of the western countries. The findings suggest that in female, the thickness of both muscular and membranous parts of the septum was less than that of male though there was no significant difference statistically (P>0.05). The findings were compared with the findings of other workers and not so much variation was found. There was no available data regarding the thickness of the membranous part of the septum to compare.

Interventions for latent autoimmune diabetes (LADA) in adults

BACKGROUND

Latent autoimmune diabetes in Adults (LADA) is a slowly developing type 1 diabetes which presents as non-insulin dependent diabetes and progresses to insulin dependence. However, the best treatment strategy for LADA is unclear.

OBJECTIVES

To compare interventions used for LADA.

SEARCH STRATEGY

Studies were obtained from searches of electronic databases (including MEDLINE, EMBASE), supplemented by hand searches, conference proceedings and consultation with experts.

SELECTION CRITERIA

Selection was in duplicate by two independent reviewers. RCT and controlled clinical trials evaluating interventions for LADA or type 2 diabetes with antibodies were included.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed study quality. Studies were summarised in a descriptive manner.

MAIN RESULTS

Searches identified 8067 citations. Eight publications (seven studies) were included, involving 735 participants. All studies had high risk of bias. There were no data on use of metformin or glitazones alone. Rosiglitazone or sulphonylurea (SU) with insulin did not improve metabolic control significantly more than insulin alone. SU alone gave either poorer (one study, mean difference in HbA1c 2.8% (95% confidence interval (CI) 0.9 to 4.7) or equivalent metabolic control compared to insulin alone (two studies). There was evidence that SU caused earlier insulin dependence (insulin treated at two years: 60% (SU) and 5% (conventional care) (P < 0.001); classified insulin dependent: 64% (SU) and 12.5% (insulin group) (P = 0.007)). No interventions influenced fasting C-peptide, but insulin maintained stimulated C-peptide better than SU (one study, mean difference 7.7 ng/ml (95% CI 2.9 to 12.5) and insulin with rosiglitazone was superior to insulin alone (one study) at maintaining stimulated C-peptide. A pilot study showed better metabolic control at six months with subcutaneously administered glutamic acid decarboxylase (GAD) GAD65, a major autoantigen in autoimmune diabetes, compared to placebo. There was no information regarding quality of life, mortality, complications or costs in any of the publications. Time from diagnosis varied between recruitment at diagnosis to recruitment at nine years of disease duration and there was a great deal of variation in the selection criteria for LADA patients, making it difficult to generalise findings from these studies.

AUTHORS' CONCLUSIONS

There are few studies on this topic and existing studies have a high risk of bias. However, there does seem to be an indication that SU should not be a first line treatment for antibody positive type 2 diabetes. There is no significant evidence for or against other lines of treatment of LADA.

Morphological study of parathyroid in relation to thyroid gland of Bangladeshi people

The morphological study was done to see the number and location of parathyroid glands in relation to thyroid gland of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty post mortem tissue block containing thyroid and parathyroids along with surrounding structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the topographic relationship and number of parathyroid glands in relation to thyroid gland. In the present study, findings were compared with the findings of Western and Bangladeshi researchers. In the present study, the so-called typical number of parathyroid glands that is 2 pairs per person (in relation to thyroid gland) was externally visible only in fifty percent (50%) of cases. According to this study, middle third of posterior border of thyroid gland lodged most of the glands (60-65%).

Vascular change in the placenta of diabetic mothers and hypertensive diabetic mothers

Pregnancy complicated by diabetes and/or hypertension is a significant medical problem not only affecting maternal health, but also jeopardizing fetal normalcy. The placenta being the bridge between maternal fetal activity, this structure is considered as a window through which understanding of maternal dysfunctions as well as of their impacts on fetal wellbeing can be obtained. And as it is an almost all-vessel organ, its functional status depends primarily on the structural status of its vessels. To observe vascular changes in the placenta, a study was carried out on 44 placentas.19 from overt diabetic mothers having no hypertension and 5 from hypertensive diabetic mothers, and 20 from control group having no hypertension or diabetes. These were collected just after delivery though caesarian section. Macroscopic findings of the study was that there was a trend of increase weight, volume and number of cotyledons in overt diabetes group, where as the in the hypertensive diabetes group was the opposite. But none of these levels has reached a significant level. For all these variables, the hypertensive diabetes group had smaller values than the overt diabetes group, significantly so for the number of cotyledons. The placental diameter was non-significantly larger in the overt diabetes group than in the control group, but a smaller than control value was found in the hypertensive diabetes group. Although neonatal weight did not show any significant change in either group, but in overt diabetes group, it showed a significant positive correlation with placental weight.

Morphological study of recurrent laryngeal nerve in relation to thyroid gland

The study was done to see the relationship of recurrent laryngeal nerves with corresponding inferior thyroid artery with the aim to increase the knowledge regarding variational anatomy in our population. Sixty samples were collected as block dissection of thyroid gland along with the surrounding structures containing the supplying vessels and adjacent nerves from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Fine dissections were carried out to study the toporgaphic relationship of recurrent laryngeal nerves with corresponding inferior thyroid artery. The findings were compared between different age groups and also with the findings of western researchers. In this study, in majority of the cases the recurrent laryngeal nerves were found in their usual location that is posterior to the terminal branches of inferior thyroid artery on the left side and anterior to that artery on the right side. It was important to note that, on both sides recurrent laryngeal nerves were also frequently found to pass in between the terminal branches of inferior thyroid artery.

Gross morphometry of human placenta in eclampsia

The study was done to see the gross morphologic changes of placenta in human normal pregnancy and eclapmsia, with the aim that it would be able to increase the general body of knowledge regarding the gross morphology of normal placenta and the changes that occur in eclampsia in our population. Total of 45 (n=45) placenta, 25 (n=25) from eclampsia and 20 (n=20) from normal pregnant cases were collected from Gynaecology and Obstetric Department of Mymensingh Medical College & Hospital (MMCH). Study was done in Anatomy Department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trends of lower weights and volumes of placentas in eclamptic group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005.