Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes

BACKGROUND

Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients.

METHODS

This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded.

RESULTS

A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury.

DISCUSSION

In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.

Associations of Hearing Loss Severity and Hearing Aid Use With Hospitalization Among Older US Adults

Importance

Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited.

Objective

To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization.

Design, Setting, and Participants

This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022.

Exposures

Audiometric hearing loss severity and participant-reported hearing aid use.

Main Outcomes and Measures

The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement.

Results

Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92).

Conclusions and Relevance

In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.

Retinopathy of Prematurity Treatment Trends from 2003 to 2020 in the United States

We used population-based data obtained from Optum’s Clinformatics® Data Mart Database to characterize recent trends in retinopathy of prematurity (ROP) treatments and outcomes in the United States. Laser photocoagulation was utilized more frequently every year compared to anti-VEGF.

Pattern of Glomerular Disease in a Tertiary Care Hospital of Bangladesh

Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.

Surgical Outcome of CSF Drainage in Paediatric Obstructive Hydrocephalus

Hydrocephalus (HCP) is occurred when there is inequality in the formation and absorption of CSF to such a level which causes accumulation of fluid and causing raised intracranial pressure. Hydrocephalus is the most frequent neurosurgical problem encountered in the paediatric age group. CSF diversion surgically is needed as treatment for certain condition. Endoscopic third ventriculostomy (ETV) and Ventriculo-peritoneal shunt (VPS) are most widely used CSF diversion procedure. Therefore, this study was conducted for comparing the surgical outcome of ETV and VP shunt in obstructive hydrocephalus. This is a prospective experimental study conducted in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to December 2019. Paediatric patients of both sex and 6 months to 18 years of age with obstructive hydrocephalus undergone endoscopic third ventriculostomy (ETV) or ventriculo-peritoneal shunt (VP shunt) were included after fulfilling inclusion and exclusion criteria. The patients divided into two groups (Group A and Group B). The Group A included 30 patients who treated by Endoscopic third ventriculostomy and the Group B include 30 patients, who was treated by Ventriculo-peritoneal shunt. Surgical outcome was analyzed in two procedures separately. In Group A (ETV group) symptomatic improvement, GCS score improves earlier and post-operative complications relatively less than Group B (VP shunt group). But in VP shunt group 3 months follow up reveals- improvement of papilledema, Occipital frontal circumference (OFC) regression and fontanelle size improvement was more than that of ETV group. This study concluded with suggesting that Endoscopic third ventriculostomy (ETV) is technologically superior surgical technique than VP shunt. Though ETV showed relatively more immediate procedural failure and intraventricular hemorrhage but long-term outcome is better and also associated with lower incidence of infection and re-operation in comparison to VP shunt.

Prevalence of Subclinical Hypothyroidism in Hospitalized Pre-dialysis Patients with Chronic Kidney Disease

Among general population sub-clinical primary hypothyroidism is common. The cross sectional descriptive type of observational study was conducted in medicine and allied wards in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2010 to December 2010; among 230 purposively selected hospitalized pre-dialysis patients with chronic kidney disease. The purpose of the study was to find out the prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease. Data were collected from the patients using a case record form by face to face interview, clinical examination and laboratory investigations. The collected data were entered into SPSS version 20.0 and analyzed accordingly. Mean age of the patients was 47.2 years with a SD of ±2.05 years. Maximum patients were male with a male female ratio of 5:1. A significant number of patients were smoker- 11.8% of sub-clinical hypothyroidism group and 13.6% of euthyroid group. Among the patients 40 (17.40%) had sub-clinical hypothyroidism while the majority 190 (82.60%) did not have it. Estimated prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease was 17.40%. Co-morbidities found in the patients were hypertension, diabetes mellitus, chronic glomerulonephritis and obstructive uropathy. All the patients (40, 100.0%) with sub-clinical hypothyroidism were hypertensive. On the other hand, 184 (97.1%) patients without sub-clinical hypothyroidism were hypertensive. Presence of co-morbidities in patients with sub-clinical hypothyroidism did not differ significantly (p>0.05) from patients without sub-clinical hypothyroidism. Patients in group with sub-clinical hypothyroidism were more over weight in comparison to patients without sub-clinical hypothyroidism (p<0.05). Biochemical parameters of patients with sub-clinical hypothyroidism differed significantly (p<0.05) from those of patients without sub-clinical hypothyroidism. There was no significant difference between urinary albumin of two groups of patients (p>0.05). Stage 4 CKD patients were more in sub-clinical hypothyroidism group in comparison to euthyroid group. As this study may not reflect the actual picture, further large scale multi-centric study is recommended to explore the real situation of sub-clinical hypothyroidism in patients with chronic kidney disease.

Comparison of Serum Amylase and Lipase Levels between Predialysis and Maintenance Haemodialysis CKD Patients

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.

Limited versus Aggressive Open Discectomy for a Single Level Lumbar Intervertebral Disc Prolapse

Open lumbar discectomy is the gold standard surgical procedure for intervertebral disc herniation but still controversy exit whether limited or aggressive open discectomy provides better outcomes. Retrospectively we evaluate 2380 patients to compare the clinical outcomes, complications and recurrence rate between limited (LD) and aggressive open discectomy (AD). Records of 745 men and 255 women aged 19 to 55 (mean, 38.03±9.1) years for LD and 995 men and 385 women aged 21 to 60 (mean, 43.7±9.3) years for AD were reviewed. Demographic data, surgical data, complications and re-herniation rate were collected and assessment done by Visual analogue score (VAS), Oswestry Disability Index (ODI) and modified Mcnab criteria. The mean follow-up period was 24.5 and 28.8 months respectively. In compare to aggressive discectomy, limited discectomy required significantly less operative time (95 vs. 55 minutes, p<0.001, unpaired 't' test), less used of post-operative analgesic (p<0.05) and better patients' satisfaction (p<0.05). But low back pain, leg pain, recurrence rate, infection, per-operative blood loss and periods of hospitalization were without significant difference. Both groups achieved satisfactory clinical outcomes 85%, 78.62 % respectively. Complications were foot drop (n=2, 5), dural tear (n=7, 14), superficial wound infection (n=7, 17) and discitis (n=19, 37) and reherniation (55, 64) respectively. Limited discectomy is an alternative to the aggressive discectomy. Both groups showed satisfactory outcome but in limited discectomy group shown better satisfaction in relation to aggressive discectomy.

Anterior Mediastinal Teratoma- A Rare Variety

Anterior mediastinal teratomas are rare germ cell tumors. We report a case of such rare tumor in a 16 years old boy who presented with sudden severe right sided abdominal pain which radiating to chest for one day. CT scan of the chest was suggestive of anterior mediastinal teratoma. Patient underwent Clamshell thoracotomy. Peroperatively a large mass was found in the anterior mediastinum containing huge amount of sebum like material. It was adherent to mediastinal surface of right & left lung, pericardium and great vessels (SVC, Aorta). The tumor and was resected out except part of its posterior surface which was adherent to pericardium and great vessels and was left in situ. He had a smooth & uneventful post-operative recovery. Histopathology reported as mature (benign) teratoma with no evidence of malignancy.Pulse Vol.10 January-December 2017 p.52-56

Left Atrial Myxoma with Mild Left Ventricular Dysfunction— A Case Report

Atrial Myxoma is the most common primary cardiac tumors accounting for about 50% of benign primary cardiac tumors, with the majority located in the left atrium. This is a case of large left atrial (LA) myxoma presented with features of mitral stenosis associated with moderate left ventricular failure (LVF) and mild pulmonary artery hypertension (PAH) The patient improved markedly after tumor excision.Pulse Vol.10 January-December 2017 p.29-33

Response of Proliferative Lupus Nephritis with Pulse Cyclophosphamide Therapy during Induction Period: A Single Centre Study in Bangladesh

This prospective study was conducted to assess the response of proliferative lupus nephritis with pulse cyclophosphamide therapy during induction period in the department of Nephrology of Dhaka Medical College, Dhaka, Bangladesh from December 2012 to November 2013. A total of 35 clinically diagnosed SLE patients of class III/IV lupus nephritis were included. But 3 patients were dropped out during follow-up, therefore finally 32 patients (class III = 4, class IV = 28) were studied. The patients were evaluated for response on the basis of proteinuria, serum creatinine & active sediment in urine after 6th cycle of cyclophosphamide and 62.5% patients achieved complete response, 25% patients achieved partial response & 12.5% patients achieved no response. The factors favored complete response was early clinical presentation (7 months duration), proteinuria ≤3gm/day& normal renal function during their initial presentation. And higher anti ds DNA titre was an independent predictor for partial response/no response.

Short-segment versus Long-segment Stabilization for Unstable Thoracolumbar Junction Burst Fractures

The treatment of unstable thoracolumbar junction burst fractures remains a controversial issue. We evaluate the efficacy of short segment (SS) compared with that of long-segment (LS) stabilization in terms of clinical and the radiological outcomes. Records of 88 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation from January 2004 to December 2015, studied retrospectively. These patients were divided into two groups: SS and the LS-group. Clinical parameters: back pain, disability, neurological deficit and radiologic parameters: Cobb angle, sagittal index, the kyphotic deformation of vertebral body, vertebral height and canal compromise were measured before surgery and immediately after surgery and at 3, 6 and 12 months postoperatively. Overall outcomes were evaluated using the modified Mcnab criteria at the last follow-up. Chi-squared test and paired-t test were used for statistical analysis using SPSS. There were 36 and 52 patients in the SS and LS- group, respectively. The mean age of the patients was 30.6±8.4 and 33.4±8.4 years and the mean follow-up period was 24.5 and 16.8 months in SS and LS-group respectively. In the SS-group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 15, 10, 6, 3 and 2 cases and LS- group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 22, 17, 5, 5 and 3 cases, respectively. Both groups achieved satisfactory clinical outcomes according to the modified Mcnab criteria. In the SS-group, 8(22.22%), 21(58.33%) and 7(19.44%) cases were considered to have excellent, good and fair outcome and LS-group, 18(34.61%), 25(48.08%), 6(11.54%) and 3(5.77%) cases were considered to have excellent, good, fair, and poor outcome, respectively. Short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar junction burst fracture.

Molecular characterization of extended spectrum βlactamase producing bacteria isolated from urinary tract infected patients, Bangladesh

The aims of the study were to examine the presence of extended spectrum βlactamase (ESBL) producing pathogen in urinary tract infected (UTI) patients and their respected molecular characterization and classification. The isolates collected from UTI patients attending a private hospital during the period between January and June, 2012, were biochemically identified and subjected to double disc synergy method for the detection of ESBL. ESBL genes were detected by multiplex PCR and antibiotic sensitivity test was performed. Thirty two percent of all Gram negative isolates were found as ESBL producer. Among 65 ESBL positive isolates, 77% were Escherichia coli, 20% Klebsiella pneumoniae and 3% were Pseudomonas spp. Around 48% isolates were found carrying at least one of the four ESBL genes, bla_CTX-M, bla_TEM, bla_SHV and bla_OXA, and were found in 32%, 23%, 18.5% and 3% of the isolates respectively. In antibiotic sensitivity assay, higher resistance was found in E. coli than K. pneumonia against ciprofloxacin and nalidixic acid. Interestingly, two E. coli and three K. pneumonia strains were found resistant to only 3^rd generation cephalosporines, but susceptible to all other antibiotics assessed. One E. coli strain was found resistant to ciprofloxacin but sensitive to nalidixic acid. Pseudomonas spp. was found resistant to most of the antibiotics. The susceptible rate to nitrofurantoin, amikacin, and gentamicin was also not satisfactory. Susceptibility (100%) to meropenem and imipenem render these as good alternatives to treat UTI. The majority of the isolates were positive for bla_CTX-M and adverted to molecular class A. Two strains carrying blaOXA gene along with bla_SHV/bla_TEM/bla_CTX-M, could not be included in any of the established ESBL classification.

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

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

Open-door Laminoplasty for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament (OPLL) using Titanium Reconstruction Miniplate and Screws

To review outcome of 25 patients who underwent open-door cervical laminoplasty for multilevel cervical spondylotic myelopathy (MCSM) and ossification of the posterior longitudinal ligament (OPLL) using titanium reconstruction miniplate and screws. Records of 18 men and 7 women aged 35 to 78 (mean, 62.6) years were reviewed retrospectively from October 2009 and October 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, Bangladesh. Four patients had 5 levels (C3-C7), 21 patients had 4 levels (C3-C6) decompression and 3 patients (12%) performed foraminotomies. A total of 104 laminae were opened, all of them were fixed with a titanium reconstruction miniplates. In 21 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 4 laminae and 4 patients fixed in 5 laminae levels. In most patients, screw fixation was unicortical and no spacer or bone graft was used. Demographic and surgical data were collected and clinical outcomes were assessed with neck pain score, neck disability index and Nurick's grading. Outcome analysis was done using Odom's criteria. The mean follow-up duration was 1.8 (range, 1-5) years. Diagnoses were MCSM (n=20), OPLL (n=5). Mean estimated blood loss (EBL) was 120ml (range: 50-200), mean surgery time was 153 min (range: 75-240). Following Nurick's grading, 23 patients (92%) improved, 2 (08%) had the same Nurick grade. No intraoperative complications were noted and average hospital stay was 6.12 days (range: 5 to 9). Significance improvements in overall NDI scores occurred at 1 year follow up (p<0.002). Radiographic evaluation showed an increase in the mean sagittal diameter from 13.3mm at pretreatment to 19.4mm post surgery. Two patients developed transient C5 palsy. Open-door Laminoplasty technique is safe, easy and achieves a good canal expansion and neurological recovery and can be used as an alternative treatment for cases of MCSM and OPLL patients without instability.

Surgical Outcome of Intradural Spinal Tumors

Results of 63 surgically treated intradural spinal tumors between the period of October 2003 and December 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, were analyzed retrospectively. There were 33 males, 30 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumors location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The tumors were located as, thoracic (n=32, 50.79%), lumbar (n=16, 25.39%), cervical (n=05, 07.93%), and junctional (n=10, 15.87%, CervicoThoracic-01, Thoracolumbar-09). The histopathological diagnosis included schwannoma (n=30, 47.7%), meningiomas (n=14, 22.3%), neurofibroma, arachnoid cyst and myxopapillary ependymoma (n=03, 04.76%) each and paraganglioma (n=01, 01.59%). Among the intramedullary tumors, ependymoma (n=03, 04.76%), astrocytoma and epidermoid cyst (n=02, 03.17%), haemangioblastoma, paraganglioma and cavernous haemangioma (n=01, 01.59%) each. The VAS score was reduced in all cases from 8.0±1.2 to 1.2±0.8 (p<0.003) and the Nurick's grade was improved in all cases from 3.0±1.3 to 1.0±0.0 (p<0.005). The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia and further neurological deterioration (Astrocytoma) (n=02, 03.17%) and dependant bedsore and recurrence (Ependymoma) (n=01, 01.59%). Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome except intramedullary tumors where initial treatment consists of maximum safe surgical resection or biopsy.

Association of rheumatoid factor and uric acid with psoriatic arthritis: a review

Psoriatic arthritis is a condition that causes inflammation of the joints of psoriatic patients. Psoriatic arthritis also affects tissues surrounding the joints including tendon and ligaments. Psoriatic arthritis (PsA), recognized for over 100 years, is the second most frequent diagnostic category after Rhematoid Arthritis (RA) and occurring up to 10% of patients with skin psoriasis. Although PsA is a sero-negative arthritis and the absence of rheumatoid factor is a characteristic laboratory finding, it may be present in 3% of psoriatic arthritis (PsA) patients. Hyperuricaemia has been generally accepted as a frequent accompaniment of psoriasis and psoriatic arthritis. It has been postulated that the hyperuricaemia results from increased purine synthesis from the rapid epidermal cell turnover. With its uniquely diverse pathophysiologic and clinical features and the ability to progress into one of the most destructive arthritis known as, psoriatic arthritis (PsA), remains a challenging disease deserving of the attention in recent years. High level of serum uric acid is a risk factor for many diseases like gout, hypertension, coronary heart diseases etc. Patients with PsA remain vulnerable for many diseases like above mentioned one. So, hyperurecemia may play a vicious link with PsA and gout, hypertension and so many diseases. This article may help all dermatologists and researchers for further evaluation of serum uric acid and RA factor in psoriatic arthritis (PsA) patients.

Acne vulgaris related to androgens - a review

Sebum production is stimulated by androgens and is the key in the development of acne vulgaris. Several investigators have looked for direct relationships between serum androgen levels, sebum secretion rate and the presence of acne. The presence of acne in prepubertal girls and sebum production in both sexes correlate with serum dehydroepiandrosterone sulfate (DHEAS) levels. Although increased serum androgen levels correlate with the presence of severe nodular acne in men and women, these levels are often within the normal range in mild to moderate acne. This raises the question of whether there is an increased local production of androgens within the sebaceous gland of patients with acne vulgaris that leads to increased sebum secretion.

Comparative efficacy of methotrexate and mini pulse betamethasone in the treatment of lichen planus

A clinical trial was conducted to evaluate the efficacy of methotrexate and mini pulse betamethasone in the treatment of lichen planus. A total of forty four patients of lichen planus, attending at the department of Dermatology and Venereology, BSMMU, Dhaka, Bangladesh during the period of January 2009 to December 2010 were enrolled in this study. Of them, 23 patients in Group A (case) and 21 patients in Group B (control) were selected. The case was treated with oral methotrexate and the control was treated with betamethasone oral mini-pulse therapy. Efficacy of drugs were measured to assess the improvement of mucocutaneous lesions, to change the colour of the lesions which became violaceous to postinflammatory hyperpigmentation, remission of itching, disappearance of existing lesions and stop appearance of new lession after initiation of treatment at 1st week, 2nd week, 6th week and 12th week. At the end of the present study, it was found that 16(69.6%) patients in cases completely cured the disease, whereas 10(47.6%) patients among the control cured the disease. Data showed that moderate remission was higher among the control 6(28.6%) compared to cases 5(21.7%) and the partial remission was also higher among the control 5(23.8%) compared to cases 2(8.7%). However, the efficacy was better in patients taking methotrexate and it also showed that macular and papular lesion responded well than plaque type lesion. Differences in treatment outcome were seen better in methotrexate group but the difference was not statistically significant.

Instrumented posterior lumbar interbody fusion (PLIF) with interbody fusion device (Cage) in degenerative disc disease (DDD): 3 years outcome

This prospective interventional study carried out at Bangabandhu Sheikh Mujib Medical University and a private hospital in Dhaka, Bangladesh during the period from October 2003 to September 2011. Surgical treatment of degenerative disc disease (DDD) should aim to re-expand the interbody space and stabilize until fusion is complete. The present study conducted to find out the efficacy of using interbody fusion device (Cage) to achieve interbody space re-expansion and fusion in surgical management of DDD. We have performed the interventional study on 53 patients, 42 female and 11 male, with age between 40 to 67 years. All the patients were followed up for 36 to 60 months (average 48 months). Forty seven patients were with spondylolisthesis and 06 with desiccated disc. All subjects were evaluated with regard to immediate and long term complications, radiological fusion and interbody space re-expansion and maintenance. The clinical outcome (pain and disability) was scored by standard pre and postoperative questionnaires. Intrusion, extrusion and migration of the interbody fusion cage were also assessed. Forty seven patients were considered to have satisfactory outcome in at least 36 months follow up. Pseudoarthrosis developed in 04 cases and 06 patients developed complications. In this series posterior lumbar interbody fusion (PLIF) with interbody cage and instrumentation in DDD showed significant fusion rate and maintenance of interbody space. Satisfactory outcome observed in 88.68% cases.

Efficacy of levamisole for the treatment of slow spreading vitiligo

Levamisole can be used as an immunomodifier for an effective treatment of vitiligo. A clinical trial was done to assess the efficacy of levamisole in patients of vitiligo. The study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to July 2011. A total number of sixty patients were assigned purposively. Among them thirty patients were belonged to Group A, treated with levamisole alone and another thirty patients belonged to Group B, treated with levamisole 160 mg weekly with topical 0.1% fluocinolone acetonide acetate on the lesions once a day for a duration of 6 months. Patients were followed up every 2 weeks interval and were continued up to 6 weeks. Out of all patients from group A, the mean sizes of the lesions were 8.17cm before treatment but 5.90cm, 4.32cm, and 3.57cm at 1st visit, 2nd visit and 3rd visit respectively after treatment. In Group B, the mean sizes of the lesions were 7.50cm before treatment but 4.92cm, 3.00cm, and 4.75cm at 1st visit, 2nd visit and 3rd visit respectively after treatment. Among the respondents of Group A & B, 25(83.3%) and 27(90%) were cured respectively. This study observed that Levamisol with topical 0.1% fluocinolone was more responsive in percentage but the difference was not statistically significant.

Traumatic gut injury: a study of 100 cases in Mymensingh Medical College Hospital

This study was done to find out the mode of presentations, management options and the factors which dictate the out-come of the patients with traumatic gut injury. It has been carried out in the department of Surgery, Mymensingh Medical College Hospital in 100 patients with traumatic gut injury from January 2009 to December 2010. Most of the patients were within 21-30 years (47%) and male patients were the predominant group (90%). In this study penetrating injury was more common (57%) than non-penetrating (43%) injury as a cause of gut injury. Stab (64.91%) was the main mechanism of penetrating abdominal trauma; while road traffic (58.14%) was the main mechanism of non-penetrating abdominal trauma. Diagnosis was made on clinical presentation, physical examination and some investigations. Abdominal pain (98%) was the chief complain and chief sign was abdominal tenderness (98%) and absent bowel sound (91%). Small gut injury was present in 71% patients, 20% patients had large gut injury and 9% had both gut injury. In small gut, jejunum (49.29%) was the most vulnerable portion and right sided colon (55%) was the most affected portion in large gut trauma. Spectrum of injury in small gut included single perforation (63%), multiple perforations (23%), laceration (11%) and devascularization (3%) injury. Primary repair in 60.87%, resection & anastomosis in 27.54% and resection anastomosis with proximal diversion in 11.59% patients were done in small gut injury. Injuries in the large gut were classified into three categories according to Flint Colon Injury Severity Scoring. Highest incidence was in Grade I (60%) category, second in Grade II (35%) and Grade III (5%) was the third one. Simple primary repair in 40%, primary repair or resection anastomosis with proximal diversion in 30%, loop ileostomy in 20% and Hartman's procedure in 10% were done in patients of large gut injury. Resection anastomosis with proximal diversion was performed in patients of both small and large gut injury. Outcome of management was quiet acceptable with 47% of patients having uneventful recovery. Delayed presentation, delayed definitive management, haemodynamically unstable patient, site and number of injuries in the gut were the crucial factor for the overall 44% morbidities of this series. Morbidity rate was 9%. More than half of the patients (56.04%) discharged from the hospital within 10 days. Only a few patients could be followed up for a few months after surgery, who reported to have a satisfactory outcome with no morbidity.

Comparative efficacy of hydroxyurea and methotrexate in treating psoriasis

A clinical trial study in the treatment of psoriasis was conducted in twenty three patients. The patients of psoriasis attending at the department of Dermatology and Venereology, BSMMU, Dhaka during the period of July 2009 to May 2010 were enrolled in this study. Eleven patients were treated with oral hydroxyurea (case), belonged to Group A and rest 13 patients were treated with oral methotrexate (control), belonged to Group B. Elements of the Psoriasis Area and Severity Index (PASI) were calculated as main outcome measure at baseline; follow up after 4 weeks and finally at 8 weeks. The mean PASI score for the Group A patients was 17.0±7 and that of Group B patients was 13.8±3. The mean reduction was higher among the Group B patients (11.8±3.5) than the Group A patients (13.5±6.8), but the mean reduction was not statistically significant (p>0.05) between two groups of patients. The mean percentage of decrease of PASI score was found to be high among the Group B patients (84.9±10.4, i.e. 85%) than the Group A patients (77.6±14.0, i.e. 78%), but the mean difference was not statistically significant (p>0.05). Analysis revealed that a statistically significant improvement of psoriasis was observed based on PASI score eight weeks of treatment in both treatment group (p=0.001). There was no statistically significant mean difference was found between Group A and Group B patients in terms of blood hemoglobin, erythrocyte sedimentation rate, WBC and platelet count and serum ALT (p>0.05). The current study showed adverse effects in 7(63%) patients of Group A and 8(66.6%) patients of Group B. In both groups of patients the adverse effects were few and mild in nature. So hydroxyurea can be alternative drug to methotrexate in the treatment of psoriasis.

Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh

A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.

Safety of low molecular weight heparin in the treatment of cutaneous lichen planus

An interventional study was undertaken to assess the safety of low molecular weight heparin in the treatment of lichen planus. Data were collected from the department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka, Bangladesh for a period from July 2009 to June 2010. During the data collection period, thirty seven patients of lichen planus were assigned purposively. The mean age of the patients was 36 ± 6.6 years and highest percentage of patients, 21(56.8%) were in between the 30-40 years old, majority of patients 32(86.5%) were male, two thirds of patients 24(64.9%) were married and majority of the patients 29(78.4%) were service holders. It was seen that about half of the patients 18(48.6%) had complaints of itching, maximum 12(32.4%) had involvement of shin area and 21(56.8%) suffered for a duration of 1 to 11 months. The study revealed that 29(78.4%) patients yielded no side effect, while 8(21.6%) developed local irritation 5(62.5%), bruises 2(25.0%) and headache 1(12.5%). The side-effects however disappeared spontaneously without medication. The study suggests that low molecular weight heparin has excellent safety profile for treatment option of cutaneous lichen planus.

Profile of infertility status of male in Dhaka city

A cross sectional study was done to determine the important etiological profile of infertility status of male in Dhaka city. A total of eighty seven patients of male infertility were selected purposively. Among them, highest percentage of patients, 44(50.6%) were in between the 21-30 years old, 36(41.4%) had 6-10 years of post- marriage duration, 56(64.4%) patients stated that they stayed with their wife interruptedly, 54(62.1%) had primary infertility and 33(37.9%) had secondary infertility. It was found that among the patients 6(5.50%) had anti-sperm antibody, 45(40.9%) had sexually transmitted disease (STD), 41(37.3%) had varicocele, 2(1.80%) had loss of libido, 4(3.6%) had premature ejaculation and 12(10.9%) had hydrocele. It was observed that 14(12.7%) were tobacco user, 26(23.6%) were obese, 12(10.9%) had malnutrition, 7(6.4%) had exposure to heat etc and it was found that 61(70.1%) had free testosterone below the normal level and 51(58.6%) had prolactin level above the normal level. The semen analysis revealed that 48(55.2 %) had abnormal morphology of sperm, 26(29.9%) had feebly motile sperm and 27(31%) had non-motile sperm, 36(41.4%) had oligospermia, 6(6.9%) had azoospermia and 17(19.5%) had oligoasthenozoospermia.

Efficacy of topical application of Pimecrolimus cream in the treatment of discoid lupus erythematosus

The interventional type of study to assess the efficacy of Pimecrolimus cream in the treatment of patient of localized discoid lupus erythematosus (DLE) was carried out for a period of July 2008 to June 2009. It was observed that before treatment, erythema was severe in 43.2% cases, moderate in 51.4% cases and mild type erythema was present in 5.4% cases. The post- treatment revealed, 29.7% severe type erythema, none evidenced moderate type erythema, only 43.2% had mild type and 27% cases no erythema at all. Before treatment, infiltration was severe in 27% cases, moderate in 54.1% cases and only 18.9% had mild type infiltration. But after treatment, 10.8% had severe type infiltration, 18.9% had moderate, 51.4% had mild and 18.9% had no infiltration at all. Similar response to treatment was noticed with squamation which exhibited a drop from 37.8% to 18.9% in severe cases and from 62.2% to 10.8% in moderate cases. There was a 45.9% mild case and 24.3% had no squamation. The scoring result of photosensitivity, itching, disfigurement evidenced analogously score reduction of 2.0, 3.05 and 3.12 respectively. In conclusion, it was interpreted that score of patients of DLE, before treatment was 6.83 ± 1.30 and after treatment was 3.83 ± 1.18. Unpaired 't' test was found statistically significant (p<0.05) between before and after treatment by drug. Improvement was shown in 26(70.27%) cases and 11(29.73%) cases shown no improvement at all. Marked improvement observed on the 2nd follow up visit at the end of 12 weeks. Response was good in 23(88.46%) cases, fair 2(7.69%) and poor 1(3.85%) cases. The study suggests that pimecrolimus 1% cream has significant efficacy profile for treatment option of cutaneous lupus erythematosus.

Non-culture diagnosis of Chlamydia trachomatis genital infection in sexually active women

Infections caused by Chlamydia trachomatis (CT) are one of the most prevalent of all sexually transmitted diseases (STD). This cross sectional study was carried out to diagnose genital CT infection on 108 (59 pregnant and 49 non-pregnant) women attending at Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009. This non- culture technique was based on detection of CT major outer membrane protein (MOMP) by Direct Fluorescence Antibody Test (DFAT) from endocervical swab. Chlamydial inclusion bodies (IB) were looked for using Iodine stain. CT antigens were detected in 45.3% (49/108) cases by DFAT; IBs were detected in 5.5% cases (06/108) by Iodine staining technique. Majority of CT positive cases (65%) were found in the younger age group (15 to 25 years). The CT infection was found 47.2 % (35/74) in symptomatic cases, 41.1% (14/34) in asymptomatic cases and 47.4% in pregnant group, 42.8% in non-pregnant group. Although high incidence of genital chlamydia infection is common both in pregnant, non-pregnant, symptomatic and asymptomatic women in Bangladesh an early and reliable diagnostic method for genital chlamydia infection in Bangladesh should be further explored.

Virulence of environmental Stenotrophomonas maltophilia serologically cross-reacting with Shigella-specific antisera

This research involved an environmental strain of Stenotrophomonas maltophilia which has been reported to produce serological cross-reactivity with Shigella dysenteriae type 8 specific antisera. Since clinical diagnosis of shigellosis is largely based on culture and serology, the investigation was aimed at in vivo and in vitro virulence comparison between the culturally similar environmental S. maltophilia isolate and the reference S. dysenteriae strains. The findings of this study revealed the absence of virulent genes of Shigella sp. like ipaH, virA and stx1 and characteristic invasive large plasmid in the test isolate. The Western blot analysis revealed that serological cross-reactivity of Stenotrophomonas maltophilia was due to certain protein component(s) in its outer membrane. The isolate was capable of producing extracellular protease, exhibited alpha hemolysis and was negative for hemagglutinating assay. The isolate gave negative reaction with rabbit ileal loop and Sereny tests. The S. maltophilia isolate did not possess any enterotoxic or invasive property as that of virulent S. dysenteriae strains. Further characterizations and adequate genetic manipulations of this environmental isolate may contribute to the development of a potential vaccine candidate for shigellosis.

Combination therapy of lamivudine and interferon-alpha in pediatric patients with chronic hepatitis B in Bangladesh: a safe and effective therapeutic approach for pediatric CHB patients in developing countries

Hepatitis B virus (HBV) is mainly transmitted during birth or perinatal period, however, treatment is not usually recommended for pediatric patients with chronic hepatitis B (CHB). Twelve pediatric patients with CHB in Bangladesh were treated with both lamivudine and interferon. Lamivudine was given at a dose of 3 mg/kg, daily for 12 months. Two months after commencement of lamivudine therapy, all patents were given interferon-alpha (3 million IU/square meter of body surface area) three times weekly, subcutaneously for 10 months. Combination therapy was safe for all pediatric CHB patients. The levels of serum HBV DNA became undetectable (less than 500 copies/ml) in 8 patients and reduced in 4 patients after the end of therapy. Anti-HBe was detected in 10 of 12 patients at this time point. The levels of serum alanine aminotransferase (ALT) were significantly reduced in these patients (p less than 0.05) due to therapy. Neither flare of HBV DNA nor elevation of serum ALT were detected during follow-up. In conclusion, combination therapy with lamivudine and interferon-alpha represents a new and novel therapeutic option for treatment of pediatric CHB patients.

Profile of lichen planus in Bangladesh

Lichen planus is one of the common inflammatory disorders of skin, mucous membrane, nail and hair characterized by violaceous, polish, pruritic, polygonal, flat-topped papules usually distributed bilaterally symmetrically over the extremities. Our objectives in this study were to explore the prevalence of lichen planus in large area of Dhaka in Bangladesh and to establish the clinical characteristics of lichen planus. This descriptive type of cross sectional study was carried out from September 2006 to August 2008 in the Department of Dermatology and Venereology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH) and Combined Military Hospital (CMH) in Dhaka. Patients suffering from lichen planus were selected as study population. By face to face interview and clinical observations, data were collected from sample. A total 120 patients of lichen planus were selected, on the basis of age, 30(25%) were 10-30 years of age, 75(62.56%) were 30-50 years and 16(13.33%) were over 50 years of age. The mean age of the patient was 40+/-4 years. Out of 120 patients, 80(66.66%) were male and 60(33.33%) were female and eight patients (6.67%) had positive family history among highest age group (30 to 50 years). In case of duration of disease, highest percentage (68%) of cases was 15 days to 6 months and considering clinical sign, koebnerization was present 45(37.5%) cases and Wickhams striae 22(18.33%) cases. Regarding site of onset of lesion, lesions were highest 100(83.33%) in upper limbs, next lower limbs, trunk, oral mucosa etc. The distribution of clinical pattern of lichen planus showing classic pattern (68.33%) was the most common type, followed by hypertrophic, actinic, ashy dermatoses, lichen plano-pilaris, erosive or ulcerative etc. This clinico-epidemiological study of lichen planus attending in the different hospital in Dhaka, Bangladesh has shown that lichen planus is usually associated with 30 to 50 years of age group, with higher male prevalence than female, 15 days to 6 months are mainly duration of disease, koebnerization and Wickhams striae are common clinical signs, upper limbs is mainly the site of onset of lesion, and classic pattern is the most common clinical type in lichen planus.

Various factors of attempted suicide in a selected area of Naogaon district

This descriptive type of study was carried out to determine the various factors of attempted suicide in a selected area at Patnitala and Dhamuirhat upazilla health complex of Naogaon district. All reported alive cases of attempted suicide (self poisoning, hanging, self burning or immolation, drowning etc) during the period from March to June 2003 were interviewed purposely. Data were collected by face to face interview and also from hospital records. Of the interviewed cases, the mean age was 21.4 years. Household workers, day labours, students and agricultural workers (42.6%, 23.9%, 15.5% and 11.3% respectively) were the major victims and nearly 60% had nuclear family. The highest number (77.5%) used organophosphorus compound. Highest number (25.4%) mentioned that husband mainly provoked for suicidal attempt, followed by mother and father. It was evident that 71.8% of suicidal attempt was due to their emotional stress, followed by family violence, disturbed family, social deprivation, stressful events and health problems (50.7%, 49.3%, 36.6%, 25.4%, and 8.5% respectively). It was evident that attempted suicide is proportionately higher among adolescents of unmarried, with early age at marriage, with higher income and with nuclear family compared with adult. Emotional stress, disturbed family, social deprivation, health related problems are appeared to be important reasons for attempted suicide among adolescents whereas family violence in adults.

Seroprevalence of human brucellosis among the population at risk in rural area

This study was performed to evaluate the seroprevalence of brucellosis among the risk group of population. A cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, between the period from July 2007 to June 2008. A total of 210 samples were included in this study from risk group of population. A variety of serological tests have been applied for detection of antibodies against Brucella spp. Among the 210 subjects from risk group of population, 9(4.28%), 7(3.33%) and 7(3.33%) were positive for brucellosis by slide agglutination test, rose bengal plate agglutination test (RBPA) and standard tube agglutination test (STAT) respectively. Out of total specimen 10 positive and 29 negative serum as detected by slide agglutination, rose bengal plate agglutination test (RBPT) and STAT were also examined by Enzyme linked immunosorbent assay (ELISA) for detection of IgG. Among them, 10 were positive by ELISA IgG. Seroprevalence among occupational groups were 11.11% in veterinary personnel, 6.45% in dairy workers and 4.67% in animal farmers. This study indicated that brucellosis is not uncommon at rural area of Mymensingh region in Bangladesh. It was suggested to conduct community survey and to plan properly the measures of control and prevention.

Swine influenza (H1N1) pandemic: developing countries' perspective

Since the first case of the current pandemic (H1N1) 2009 virus reported to WHO on 24 April 2009 on the American continent, the virus has spread in 160 countries and territories. By mid-2009, there were 135,000 cases and 816 deaths recorded. Pandemic preparedness is not advanced in most developing countries. Effective and essential measures include heightened surveillance, early detection and appropriate medical care. The use of local resources and capacity building with the assistance of developed nations will reduce the impact of this pandemic in the developing world.

Treatment of cervical disc prolapse by anterior cervical discectomy fusion and stabilization with plating

Different types of surgical techniques are used for effective treatment of cervical disc prolapse. Techniques with fusion without stabilization have some disadvantages like collapse of the graft, extrusion of graft, nonunion and recurrence of symptoms. We have carried out this prospective interventional study between March 2001 to November 2007 on 129 cases of cervical disc prolapse treated with anterior cervical discectomy, fusion & stabilization with plating at IBN SINA Hospital, Dhanmondi, Dhaka, Al-Manar Hospital, Lalmatia and Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka. There were 106(82.17%) male and 23(17.82%) female patients. The commonest age group of the patients was 4th decade. The commonest level of disc prolapse was found in C5/6 level and in each case, diagnosis was made on the basis of clinical findings, plain X-ray and MRI of cervical spine. We performed anterior cervical discectomy, fusion and stabilization with plating in all cases. A per-operative marking film was taken in each case to identify proper level. Per-operative undue hemorrhage from donor site occurred in 1 case, 27 patients complained of dysphagia temporarily, 64 patients complained of donor site pain significantly which was relieved within 3-6 months of follow-up period. Donor site infection was found in 1 patient. The post operative follow-up period was 3 months to 6 years. The functional out come obtained excellent in 71.43%, good in 19.64%, fair in 8.93%, poor in 2.32% in this series.

Pattern of aerobic bacteria with antimicrobial susceptibility causing community acquired urinary tract infection

Since antibiotic resistance among uropathogens have gradually been rising, so it is important to have knowledge about the pattern and antimicrobial susceptibility to choose the correct treatment regimen. A cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2007 to June 2008 to determine the prevalence, relationship between pyuria and urine culture and antibiotic resistance pattern among the bacterial isolates of community acquired UTI (CUTI). A total of 100 urine samples were subjected to microscopy and culture. Antimicrobial susceptibility of isolates was done by disk diffusion method according to Clinical and Laboratory Standard Institute (CLSI) 2007. Of the total samples, 45(45%) were culture positive and among them female were more (71.1%) than the male (28.9%). The predominant age group was 15-29. Having pus cell >5/HPF, 93.3% culture positive patients showed significant pyuria. The isolated microorganisms were Escherichia coli (73%) followed by Staphylococcus saprophyticus (11.1%), Klebsiella spp (6.7%), Enterobacter spp (4.4%), Pseudomonas aeruginosa (2.2%) and Proteus spp (2.2%). All the bacterial isolates were sensitive to imipenem, while they showed variation in sensitivity to other commonly used antibiotics. Imipenem, nitrofurantoin and gentamicin were found to be effective for Gram-negative isolates and imipenem, azithromycin, vancomycin, ceftazidime for Gram-positive isolates. Our study emphasized over the changing etiology and emergence of drug resistance of the UTI within our country.

Antibiotic susceptibility pattern of Staphylococcus epidermidis

The present study was done to evaluate the antibiotic susceptibility pattern of Staphylococcus epidermidis isolated from different clinical specimens and healthy controls in the department of Microbiology, Mymensingh Medical College from July, 2007 to June, 2008. A total of 62 Staphylococcus epidermidis were isolated from 230 specimens. Among them 32(23%) S. epidermidis were isolated from 200 cases and 30(100%) were isolated from 30 healthy controls. Antimicrobial susceptibility test of the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute, 2007. Isolates of S. epidermidis from cases showed multidrug resistance as follows-penicillin 94%, oxacillin 56%, gentamycin 44%, erythromycin 41%, doxycycline 37%, cephradine 34%, ciprofloxacin 28%, ceftriaxone 28%, fusidic acid 22% and cefuroxime 19%. On the other hand, isolates of S. epidermidis from controls were susceptible to all antibiotics except penicillin, which was only 10% resistant. A remarkable difference was observed in the resistance pattern of S. epidermidis isolated from cases and healthy controls. However in our study no isolates of S. epidermidis was resistant to rifampicin and vancomycin, which can be used as last line of drugs to treat nosocomial S. epidermidis infection.

Transport of sennosides and sennidines from Cassia angustifolia and Cassia senna across Caco-2 monolayers--an in vitro model for intestinal absorption

Laxative effects of Senna preparations are mainly mediated by rheinanthrone, a metabolite formed in the intestinal flora from dianthrones. Nevertheless, it was not clear whether dianthrones are bioavailable at all and contribute to the overall effects of this important medicinal plant. Using the Caco-2 human colonic cell line as an in vitro model of the human intestinal mucosal barrier, the bioavailability of dianthrones was studied in apical to basolateral (absorptive) and basolateral to apical (secretive) direction. Permeability coefficients (P(c)) and percent transport were calculated based on quantitations by HPLC. From the data obtained it was concluded that sennosides A and B, as well as their aglycones sennidine A and B are transported through the Caco-2 monolayers in a concentration-dependent manner and their transport was linear with time. The absorption in apical to basolateral direction was poor and P(c) values were comparable to mannitol. The transport was higher in the secretory direction, indicating a significant efflux (e.g. by efflux pumps) of the (poorly) absorbed compounds in the intestinal lumen again. Our findings support the general understanding that the laxative effects of Senna are explainable mainly by metabolites and not by the natively present dianthrones.

Comparison of enterotoxigenicEscherichia coliisolated from surface water and diarrhoeal stool samples in Bangladesh

Enterotoxigenic Escherichia coli (ETEC) is a common cause of bacterial infection leading to acute watery diarrhea in infants and young children. Although the prevalence of ETEC is high in Bangladesh and infections can be spread through food and contaminated water, limited information is available about ETEC in the surface water. We carried out studies to isolate ETEC from surface water samples from ponds, rivers, and a lake from a site close to field areas known to have a high incidence of diarrhea in Dhaka, Bangladesh, and Matlab, Bangladesh. ETEC strains isolated from the water sources were compared with ETEC strains isolated from patients with diarrhea at two hospitals in these areas. ETEC were isolated from 30% (45 of 150) of the samples from the surface water sources and 19% (518 of 2700) of the clinical specimens. One hundred ETEC strains isolated from patients with similar phenotypes as the environmental strains were compared for phenotypic and genotypic properties. The most common O serogroups on ETEC were O6, O25, O78, O115, and O126 in both types of strains. Pulsed-field gel electrophoresis analyses of the ETEC strains showed that multiple clones of ETEC were present within each colonization factor type and that some clones detected in the environment were also isolated from the stools of patients. The strains showed multiple and similar antibiotic resistance patterns. This study shows that ETEC is prevalent in surface water sources in Bangladesh suggesting a possible reason for the endemicity of this pathogen in Bangladesh.Key words: enterotoxigenic Escherichia coli (ETEC), surface water samples, colonization factors, pulsed-field gel electrophoresis, toxin types.

Dynamic chirality in donor-acceptor pretzelanes

[Figure: see text]. A series of donor-acceptor pretzelanes has been synthesized, using self-assembly and template-directed protocols, and the dynamic processes that these pretzelanes undergo have been investigated in solution. These compounds exist as libraries of diastereoisomers as a result of their multiple stereoelements, which are dynamically interconverted by several different, in some cases competing, processes. Altering the structure of the pretzelanes changes the rates and mechanisms by which these diastereoisomers equilibrate. Additionally, inserting an element of fixed chirality allows the equilibrium to be biased, while maintaining the barrier to the equilibration processes. These results bode well for the future construction of molecular devices based on switchable diastereoisomerism involving metastable states.

The emerging strains of Shigella dysenteriae type 2 in Bangladesh are clonal

A total of 113 strains of Shigella dysenteriae type 2 isolated from patients attending the Dhaka diarrhoea treatment centre of ICDDR,B: Centre for Health and Population Research during the period 1999-2004 were studied. Serotype of the isolates was confirmed using commercially available antisera. Except for arabinose fermentation, all the strains had similar biochemical reactions. More than 60% of the strains were sensitive to commonly used antibiotics; only 6% (n=7) of the strains were resistant to nalidixic acid, and none of the strains were resistant to mecillinam and ciprofloxacin. All strains were invasive as demonstrated by the presence of a 140 MDa plasmid, ial, sen and ipaH genes, Congo Red absorption ability and by the Sereny test performed on representative strains. Plasmid patterns were heterogeneous but more than 50% of strains were confined to a single pattern. All strains possessed a 1.6 MDa plasmid and 87% of the strains contained a 4 MDa plasmid. Middle-range plasmids (90 MDa to 30 MDa) present in 36% of the strains were not associated with antibiotic resistance. All the strains were clustered within a single type with four subtypes by pulsed-field gel electrophoresis while ribotyping patterns of all the strains were identical.

Biological characterization of Aeromonas spp. isolated from the environment

Cytotoxic enterotoxin (Act) is a key virulence factor in the pathogenesis of infections caused by Aeromonas spp. The cytotoxic enterotoxin gene (act) was detected in 32 out of 69 environmental isolates of Aeromonas spp. by hybridization with the act gene probe. To evaluate the pathogenic potential of the act gene probe-positive isolates, 32 act gene probe-positive and 31 randomly selected act gene probe-negative isolates were tested for enterotoxicity in a suckling mice assay (SMA), for haemolytic activity on sheep blood agar plates, for the presence of CAMP-like factors, and for cytotoxicity in a Vero cell line. The act gene probe-positive isolates significantly differed from the toxin gene probe-negative ones with respect to enterotoxicity in the SMA (P=0.009) and haemolytic activity (P=0.005). The CAMP-haemolysin phenotype was significantly associated with the rabbit ileal loop assay (P= 0.08), Vero cell assay (P= 0.064), and haemolysin production under the microaerophilic conditions (P= 0.056) of the act gene probe-positive isolates of Aeromonas spp. These data indicated the role of Act in the pathogenesis of Aeromonas infections and that the enterotoxic potential of Aeromonas spp. could be assessed by simply performing a CAMP-haemolysin assay.

Wastewater-grown duckweed may be safely used as fish feed

Duckweed has been used for the treatment of wastewater and as fish feed. A comparative study was carried out to determine (i) the efficacy of duckweed in treating hospital-based wastewater and (ii) the level of the microbial contamination of fish fed on wastewater-grown duckweed. There were two groups of ponds where fish farming was done. In one group of ponds (control ponds), duckweed that was grown using artificial fertilizer was used as fish feed; in another group (study ponds), wastewater-grown duckweed was used as fish feed. The faecal contamination of water, duckweed, and fish from study and control ponds were monitored by faecal coliform estimation. The presence of enteric pathogens among handlers, water, duckweed, and fish samples was also examined. It was observed that the faecal coliform counts of raw wastewater were 4.7 Log10CFU/mL, which was reduced to <1 Log10CFU/mL after treating with duckweed. There was no significant difference (P > 0.05) in faecal coliform counts in water collected from duckweed ponds and fish ponds of study and control areas. The wastewater-grown duckweed did not pose any health hazard to the handlers. These results demonstrated that the wastewater-treated duckweed may be safely used as fish feed.Key words: wastewater, duckweed, fish feed, contamination, safety.

Synthesis of enantiopure oxorhenium(V) and arylimidorhenium(V) "3 + 2" Schiff base complexes. X-ray diffraction, cyclic voltammetry, UV-vis, and circular dichroism characterizations

Two new oxorhenium(V) and two new arylimidorhenium(V) complexes of the Schiff base ligands 2-hydroxybenzaldehyde-((1R,2S)-1-amino-2-indanol)imine (1) (H(2)L(1)) and 3-(1-adamantyl)-2-hydroxy-5-methylbenzaldehyde-((1R,2S)-1-amino- 2-indanol)imine (2) (H(2)L(2)) have been prepared from the reaction of the precursor Re(O)(PPh(3))(2)Cl(3), Re(NC(6)H(5))(PPh(3))(2)Cl(3), or Re(NC(6)H(4)OCH(3))(PPh(3))(2)Cl(3) and the free ligands H(2)L(1,2). The complexes Re(O)(HL(1))(L(1)) (3), Re(O)(HL(2))(L(2)) (4), Re(NC(6)H(5))(HL(1))(L(1)) (5), and Re(NC(6)H(4)OCH(3))(HL(1))(L(1)) (6) have been isolated and fully characterized by IR, (1)H NMR, circular dichroism, LRMS-FAB, and elemental analysis. All the complexes have a chiral center at rhenium. A single enantiomer is obtained in all cases. Suitable crystals of 3 and 5 were used in X-ray structural determinations. Crystal data: (3) C(32)H(27)N(2)O(5)Re.CH(2)Cl(2), orthorhombic, P2(1)2(1)2(1), a = 9.5599(16) A, b = 9.9579(16) A, c = 31.712(5) A, V = 3018.9(9) A(3), T = 100(2) K, Z = 4. (5) C(40)H(38)N(3)O(5)Re, monoclinic, P2(1), a = 9.286(3) A, b = 18.759(6) A, c = 9.957(3) A, beta = 102.817(6) degrees, V = 1691.3(10) A(3), T = 100(2) K, Z = 2. The major characteristic of these complexes is the presence of two coordination modes for the Schiff base ligands on rhenium, a tridentate ligand (noted L(1,2)) and another bidentate ligand (noted HL(1,2)). In the latter, the -OH group of the indanol is free and tilts away from the coordination sphere. X-ray structural analyses in conjunction with circular dichroism were used to assign the absolute configuration at rhenium (C). Cyclic voltammetry, UV-vis, and circular dichroism data are presented and discussed. The complexes were found to be highly stable and to resist reduction even when treated with organic phosphanes.

Survival of Shigella dysenteriae type 1 on fomites

Studies have shown that various objects, such as utensils, toys, and clothes, can serve as vehicles for transmission of Shigella spp. Shigellae can become viable but non-culturable (VBNC) when exposed to various environmental conditions as shown in earlier studies. The present study was carried out to detect VBNC Shigella dysenteriae type 1 on various fomites by direct viable counting, polymerase chain reaction (PCR), and fluorescent antibody methods. S. dysenteriae type 1 was inoculated onto cloth, wood, plastic, aluminum, and glass objects. Results showed that 1.5-4.0 hours after inoculation, S. dysenteriae type 1 became non-culturable, and after five days, non-culturable but viable S. dysenteriae type 1 could be detected by both PCR and fluorescent antibody techniques. Fomites can be considered an important potential route of transmission of VBNC S. dysenteriae type 1 and a significant factor in the epidemiology of shigellosis.

Dodecahydroxy-closo-dodecaborate(2-)

The cesium salt of the icosahedral borane anion dodecahydroxy-closo-dodecaborate(2-), Cs(2)[closo-B(12)(OH)(12)], Cs(2)1, was prepared by heating cesium dodecahydro-closo-dodecaborate(2-), Cs(2)[closo-B(12)H(12)], Cs(2)2, with 30% hydrogen peroxide. The other alkali metal salts A(2)1 (A = Li, Na, K, Rb) precipitated upon addition of ACl to warm aqueous solutions of Cs(2)1. The ammonium salt, [NH(4)](2)1, and the (mu-nitrido)bis(triphenylphosphonium) salt, [PPN](2)1, were obtained similarly. The [H(3)O](2)1 salt precipitated upon acidification of aqueous solutions of Cs(2)1 with hydrochloric acid. The solubility of these salts in water was determined by measuring the boron content of saturated aqueous solutions of A(2)1 (A = Li, Na, K, Rb, Cs), [H(3)O](2)1, and [NH(4)](2)1 using ICP-AES. Although these salts are derived from a dianion with twelve pendant hydroxyl groups, the alkali metal salts surprisingly displayed low water solubilities. Water solubility decreases with a decrease in the radius of A(+), except for the lithium salt, which is slightly more soluble than the potassium salt. The [H(3)O](2)1 and the [NH(4)](2)1 salts provide rare examples of water-insoluble hydronium and ammonium salts. The low water solubility of the A(2)1 salts is attributed to the dianion's pendant hydroxyl groups, which appear to function as cross-linking ligands. Four alkali metal salts, A(2)1 (A = Na, K, Rb, Cs), were characterized in the solid state by single-crystal X-ray crystallography. These data revealed intricate networks in which several anions are complexed through their hydroxyl groups to each alkali metal cation. In addition, the anions are engaged in hydrogen bonding with each other and, if present, with water of hydration. This cross-linking results in the precipitation of aggregated salts. Cation coordination numbers decrease with cation radius. Thus, cesium and rubidium are ten-coordinate, whereas potassium is seven-coordinate and sodium is six-coordinate. The geometry of anion 1(2)(-) is independent of cation identity; the B-B and B-O bond lengths of the various A(2)1 salts (A = Na, K, Rb, Cs) are identical.