Trajectories of otitis media and association with health determinants among Indigenous children in Australia: the Longitudinal Study of Indigenous Children

OBJECTIVES

Indigenous children in Australia experience high burden of persistent otitis media (OM) from very early age. The aim was to identify distinct trajectories of OM in children up to age 10-12 years and examine the association with socio-economic determinants.

STUDY DESIGN

A multistage clustered national panel survey.

METHODS

The study analysed the birth cohort of the Longitudinal Study of Indigenous Children from 2008 to 2018, comprising 11 study waves. Group-based trajectory modelling was used to identify different trajectories of OM outcome. Multinomial logistic regression was applied to examine the relationship between trajectories and individual, household and community-level socio-economic determinants.

RESULTS

This analysis included 894 children with at least three responses on OM over the 11 waves, and the baseline mean age was 15.8 months. Three different trajectories of OM were identified: non-severe OM prone, early/persistent severe OM and late-onset severe OM. Overall, 11.4% of the children had early/persistent severe OM from birth to 7.5 to nine years, while late-onset severe OM consisted of 9.8% of the children who had first OM from age 3.5 to five years. Children in communities with middle and the highest socio-economic outcomes have lower relative risk of early/persistent severe OM (adjusted relative risk ratio = 0.39, 95% confidence interval = 0.22-0.70 and adjusted relative risk ratio = 0.22, 95% confidence interval = 0.09-0.52, respectively) compared to children in communities with lowest socio-economic outcomes.

CONCLUSION

Efforts to close the gap in the quality of life of Indigenous children must prioritise strategies that prevent severe ear disease (runny ears and perforation), including improved healthcare access, reduced household crowding, and better education, and more employment opportunities.

Molecular genetic divergence analysis amongst high curcumin lines of Golden Crop (Curcuma longa L.) using SSR marker and use in trait-specific breeding

Curcuma longa L., is recognized worldwide as a medicinally and economically important plant species due to its curcumin content which is an industrially important compound. In this study, a total of 329 accessions were collected from four states of India and planted in the experimental farm of CSIR-NEIST, Jorhat, India, in augmented design. Among these, 152 high curcumin (> 1.50%) accessions were screened for molecular divergence study using 39 SSR primers. The primers showed the most efficient outcome with 2-8 allele/ loci and a total 163 number of alleles with 100% polymorphism. Cluster analysis revealed the construction of three clusters, out of which one cluster was geographically dependent, and germplasm was particularly from Assam state. Jaccard's pairwise coefficient showed maximum genetic dissimilarity of (0.75) between accession RRLJCL 3 and RRLJCL 126, indicating high variation as it was from two different states viz Arunachal Pradesh and Nagaland respectively and minimum genetic dissimilarity of (0.09) between RRLJCL 58 and RRLJCL 59 indicating significantly less variation as the two accessions were from same state, i.e., Arunachal Pradesh. Analysis of Molecular Variance (AMOVA) revealed high molecular variation within the population (87%) and significantly less variation among the population (13%). Additionally, Neighbour Joining dendrogram, Principal Component Analysis (PCA), and bar plot structure revealed similar clustering of germplasm. This diversity assessment will help in selecting the trait-specific genotypes, crop improvement program, conservation of gene pool, marker-assisted breeding, and quantitative trait loci identification. Moreover, to the best of our knowledge, it is the first molecular diversity report among 152 high curcumin lines of C. longa from North East India using 39 SSR primers.

Assessment of selection criteria using multi-year study for effective breeding program of Zingiber officinale L

Background

Ginger has been an important cash crop with numerous applications since ancient times. As the demand for ginger is ever-growing and being a seasonal crop, a high-yielding variety of ginger would be economically profitable.

Methods

In this study, 150 germplasm were collected from different regions of NE India and evaluated for three years in CRBD design with three replications. The present study thus focused on the variability, association, and diversity studies for the first time on 150 ginger germplasm from across North East India. The genotypic and phenotypic coefficient of variation, heritability, correlation, and path analysis were evaluated for the germplasm.

Results

Analysis of variance (ANOVA) revealed considerable differences among the studied germplasm for studied characters, revealing sufficient variability in the materials. The Mahalanobis D2 and Tocher methods grouped the 150 ginger germplasm into ten clusters. Based on the results of the path coefficient analysis determined for essential oil yield and rhizome yield per plant, it can be concluded that the characters' initial rhizome weight, the weight of mother rhizome, and weight of secondary rhizome were the most important and appeared promising in improving the overall yield potential of ginger rhizome and essential oil yield. Thus, selection based on the identified traits would lead to an effective ginger breeding program for higher rhizome and essential oil yield.

Knowledge, Attitude and Practice of Undergraduate Medical Students of Bangladesh Regarding COVID-19 and its Vaccination

Medical students are one of the socially active, reliable, and persuading population of information, prevention and control, and incentive of vaccination to stop the current pandemic situation. Consequently, knowing the status of medical students' knowledge, about symptoms, and transmission of disease, prevention of COVID-19 and their attitudes towards a vaccine is important. This multi-center cross-sectional descriptive study was one of the first ones in Bangladesh among the undergraduate medical students who completed pathology, microbiology, and pharmacology. The study was conducted from March to April 2021, using a convenience sampling method in twelve government and non-government medical colleges. Among 1132 who completed the questionnaire, and 15 students from different centers were excluded from the pre-testing and face validation. The age of the 1117 respondents were 22 to 23 years, of which the majority of the respondents were female 749 (67.0%), and 368 (33.0%) were male. Almost all participants had correct knowledge (84.1%) about the symptoms of COVID-19. But 59.2% had wrong knowledge about transmission of disease by an afebrile person. Above 60.0 % of the participants have worn a facial mask when contacting people, refrained from shaking hands, washed hands, avoided people with signs and symptoms suggestive of COVID-19, and avoided crowded places as a practice of prevention. 37.6% of medical students showed positive attitudes about the participation of management of a COVID-19 patient. Most of the participants' decided to have a vaccine depending on its availability. But 31.5% had trust in natural immunity rather than vaccination. Most undergraduate Medical college students understood the basic information, possessed a positive attitude, and presented good practice towards the COVID-19 and vaccination. They play a crucial role in motivation and acceptance of vaccines among the general citizen to fight back against the pandemic in the country with limited resources.

Estimation of genetic variation in yield, its contributing characters and capsaicin content of Capsicum chinense Jacq. (ghost pepper) germplasm from Northeast India

Capsicum chinense Jacq. (ghost pepper), a naturally occurring chili species of Northeast India is known throughout the world for its high pungency and a pleasant aroma. The economic importance is due to the high capsaicinoid levels, the main source for pharmaceutical industries. The present study focused on identifying important traits necessary for increasing the yield and pungency of ghost pepper and to determine the parameters for the selection of superior genotypes. A total of 120 genotypes with more than 1.2% capsaicin content (>1,92,000 Scoville Heat Unit, w/w on dry weight basis) collected from different northeast Indian regions were subjected to variability, divergence and correlation studies. Levene's homogeneity test of variance studied for three environments did not show significant deviation and so homogeneity of variance was reasonably met for analysis of variance study. Genotypic and phenotypic coefficient of variation was highest for fruit yield per plant (33.702, 36.200, respectively), followed by number of fruits per plant (29.583, 33.014, respectively) and capsaicin content (25.283, 26.362, respectively). The trait number of fruits per plant had maximum direct contribution to fruit yield per plant and the trait fruit yield per plant towards capsaicin content in the correlation study. High heritability with high genetic advance, which is the most favored selection criteria was observed for fruit yield per plant, number of fruits per plant, capsaicin content, fruit length and fruit girth. The genetic divergence study partitioned the genotypes into 20 clusters, where fruit yield per plant contributed maximum towards total divergence. Principal components analysis (PCA) studied to determine the largest contributor of variation showed 73.48% of the total variability, of which the PC1 and PC2 contributed 34.59% and 16.81% respectively.

Stability estimation through multivariate approach among solasodine-rich lines of Solanum khasianum (C.B. Clarke): an important industrial plant

Solanum khasianum is a medicinally important plant that is a source of steroidal alkaloids 'solasodine.' It has various industrial applications, including oral contraceptives and other pharmaceutical uses. The present study was based on 186 germplasm of S. khasianum, which were analyzed for the stability of economically important traits like solasodine content and fruit yield. The collected germplasm was planted during Kharif 2018, 2019, and 2020 in RCBD with three replications at the experimental farm of CSIR-NEIST, Jorhat, Assam, India. A multivariate approach for stability analysis was applied to identify stable germplasm of S. khasianum for economically important traits. The germplasm was analyzed for additive main effects and multiplicative interaction (AMMI), GGE biplot, multi-trait stability index, and Shukla's variance which were evaluated for three environments. The AMMI ANOVA revealed significant GE interaction for all the studied traits. The stable and high-yielding germplasm was identified from the AMMI biplot, GGE biplot, Shukla's variance value, and MTSI plot analysis. Lines no. 90, 85, 70, 107, and 62 were identified as highly stable fruit yielders while, lines no. 1, 146, and 68 were identified as stable high solasodine lines. However, considering both traits, i.e., high fruit yield and solasodine content, MTSI analysis was performed which showed that lines 1, 85, 70,155, 71, 114, 65, 86, 62, 116, 32, and 182 could be used in a breeding program. Thus, this identified germplasm can be considered for further varietal development and could be used in a breeding program. The findings of the present study would be beneficial for the S. khasianum breeding program.

Novel ethyl p-methoxy cinnamate rich Kaempferia galanga (L.) essential oil and its pharmacological applications: special emphasis on anticholinesterase, anti-tyrosinase, α-amylase inhibitory, and genotoxic efficiencies

Background

Kaempferia galanga (L.) is one of the prospective therapeutic plants with an aromatic rhizome, and belongs to the Zingiberaceae family. This herb is commonly used by local practitioners in traditional Asian medicine.

Methods

In the present investigation, the novel Kaempferia galanga rhizome essential oil rich in ethyl p-methoxy cinnamate (EMCKG) was evaluated using GC/MS for chemical composition analysis. EMCKG was analyzed for its possible antimicrobial, neurodegenerative inhibitory, acetylcholinesterase, anti-inflammatory, and antioxidant activities as well as for the genotoxic effects using the standard methodologies. ANOVA and post hoc was performed to test the statistical significance of the study.

Results

GC/MS analysis identified ethyl p-methoxy cinnamate as the major component of EMCKG essential oil with an area percentage of 66.39%. The EMCKG exhibited moderate (DPPH assay IC₅₀ = 15.64 ± 0.263 µg/mL; ABTS assay IC₅₀ = 16.93 ± 0.228 µg/mL) antioxidant activity than standard ascorbic acid (DPPH assay IC₅₀ = 21.24 ± 0.413 µg/mL; ABTS assay IC₅₀ = 21.156 ± 0.345 µg/mL). Similarly, EMCKG showed comparable activity in albumin denaturation (IC₅₀ = 2.93 ± 0.59 µg/mL) and protease inhibitor assay (IC₅₀ = 17.143 ± 0.506 µg/mL) to that of standard sodium diclofenac (IC₅₀ = 23.87 ± 0.729 µg/mL and IC₅₀ = 19.18 ± 0.271 µg/mL, respectively). The EMCKG exhibited a dose-dependent antimicrobial activity pattern with the highest inhibitory activity at 500 µg/mL against Staphylococcus aureus and considerable anticholinesterase activities (IC₅₀ = 21.94 ± 0.109 µg/mL) compared to the standard galanthamine (IC₅₀ = 27.18 ± 0.511 µg/mL). EMCKG also showed strong anti-diabetic activity (IC₅₀ = 18.503 ± 0.480 µg/mL) and anti-tyrosinase activity (IC₅₀ = 14.756 ± 0.325 µg/mL) as compared to the standards used (acarbose IC₅₀ = 20.39 ± 0.231 µg/mL and kojic acid IC₅₀ = 17.73 ± 0.192 µg/mL) in the study. Genotoxicity analysis of EMCKG revealed that at 1 µg/mL concentration has no toxic effects in mitosis of Allium cepa roots (Mitotic Index MI = 13.56% and chromosomal aberration CA = 07.60%). The ANOVA confirmed that except for the anticholinesterase activity, there is insignificant difference for essential oil and standards used for all the other bioactivities thus confirming their interchangeable applicability.

Conclusions

Current research provides the basis for the fact that besides being a rich source of ethyl p-methoxycinnamate, EMCKG has the potential for future formulation and development of an inexpensive skin-care agent and for the preparation of anti-diabetic drugs.

Use of stability statistics in the selection of Clausena heptaphylla (Roxb.) Wight & Arn for novel anethole rich strain (Jor Lab CH-2)

INTRODUCTION

Anethole is an industrially important compound which is extensively used in pharmaceuticals, cosmetics, perfumery, food and confectioneries. Anethole is primarily obtained from fennel, anise, and star anise which is highly expensive. Therefore, a study was performed to identify a cost-effective and natural anethole rich strain of Clausena heptaphylla through selection and confirmed through multilocation trial.

METHODS

The study was conducted using 23 accessions collected from North eastern region of India from 2014-2018 (initial evaluation trial) and 2018-2022 (multilocation trial). The initial trial was conducted in the experimental farm of CSIR-NEIST, Jorhat, Assam using Complete Randomized Block Design with three replications. Five agronomical traits (plant height, leaf length, leaf width, number of stem branching, herbage yield per plant per cutting) along with essential oil yield and anethole content were evaluated which led to the identification of anethole rich strain of C. heptaphylla. This identified strain was further evaluated along with the two check genotypes for stability based on three yield parameters viz. herbage yield, essential oil yield and anethole content at four multi-locations (Imphal, Jorhat, Runne and Madang) for four years using the same experimental design.

RESULTS AND DISCUSSION

The identified superior line (Jor Lab CH-2) showed consistent performance for the studied yield parameters across all the environments maintaining its superiority. The identified strain exhibited average herbage yield of 1.2 Kg/plant/cutting and essential oil yield of 1.22%. The GC-MS analysis of the essential oil depicted trans anethole as the major constituent (93.25%) followed by estragole (4.85%) while benzene, 1,2-dimethoxy-4-(1-propenyl Isoeugenol methyl ether and cis-anethole were the trace components. This is the first novel report of anethole rich variant of C. heptaphylla which has undergone multilocational trial over the years. Jor Lab CH-2 strain will open a new scope for the industries to isolate anethole from a different source in a cost-effective approach.

Did it hurt? COVID-19 vaccination experience in people with multiple sclerosis

Background

Current guidelines recommend vaccination against SARS-CoV2 for people with multiple sclerosis (pwMS). The long-term review of the safety and effectiveness of COVID-19 vaccines in pwMS is limited.

Methods

Service re-evaluation. PwMS using the MS service at Barts Health National Health Service Trust were sent questionnaires via email to report symptoms following first and second COVID-19 vaccinations (n = 570). A retrospective review of electronic health records was conducted for clinical and safety data post-vaccination(s); cut-off was end of September 2021. Separate logistic regressions were carried out for symptoms experienced at each vaccination. Two sets of regressions were fitted with covariates: (i) Disease-modifying therapy type and (ii) patient characteristics for symptoms experienced.

Results

193/570 pwMS responded. 184 pwMS had both vaccinations. 144 received the AZD1222 and 49 the BNT162b2 vaccine. 87% and 75% of pwMS experienced any symptoms at first and second vaccinations, respectively. The majority of symptoms resolved within a short timeframe. No severe adverse effects were reported. Two pwMS subsequently died; one due to COVID-19 and one due to aspiration pneumonia. Males were at a reduced risk of reporting symptoms at first vaccination. There was evidence that pwMS in certain treatment groups were at reduced risk of reporting symptoms at second vaccination only.

Conclusions

Findings are consistent with our preliminary data. Symptoms post-vaccination were similar to the non-MS population and were mostly temporary. It is important to inform the MS community of vaccine safety data.

Elemicin-rich Cymbopogon khasianus (Hack) Stapf (ex Bor) essential oil: pharmacological effects, toxicological investigation, and compositional analysis

Background:

Cymbopogon khasianus is a widely used industrial and pharmacologically important aromatic grass species.

Objective:

The present investigation was designed to study and compare the elemicin rich Cymbopogon khasianus essential oil (EREO) and its pharmacological effects, genotoxicity with pure compound elemicin

Materials and Methods:

Chemical composition, identification was performed using GC/MS and NMR techniques. 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH), reducing power assay for antioxidant; albumin denaturation, protease inhibitor for anti-inflammatory; acetylcholinesterase (AChE) for anti-cholinesterase; amylase inhibitory for anti-diabetic; tyrosine inhibitory for skin whitening; disc diffusion and minimum inhibitory concentration assay for antimicrobial, and Allium cepa assay for genotoxicity were used.

Results:

GC/MS analysis identified 38 compounds; among them elemicin 72.34%, D-limonene 3.81%; methyl eugenol 3.34% were the major compounds. A significant amount of antioxidant activity IC50 31.38 µg/mL; anti-inflammatory activity (protein denaturation assay) IC50 16.77 µg/mL; protease inihibitor assay IC50 51.08 µg/mL; anticholinesterase IC50 12.095 µg/mL; antidiabetic activity IC50 17.36 µg/mL; and anti-tyrosinase activity IC50 17.69 µg/mL were reported. Antimicrobial activity analysis against 13 microbial strains revealed negative effect. Genotoxicity study using Allium cepa assay revealed negative toxicity of EREO with aberration percentage of 04.30% and pure elemicin 05.30% which was very low in comparison to ethyl-methanesulfonate (EMS) 13.90%.

Conclusion:

To the best of our knowledge this is the first scientific evaluation of novel elemicin rich EREO pharmacological properties and to compare with pure compound elemicin. Together, it can be stated that EREO possesses antioxidant, anti-inflammatory, anti-cholinesterase activities way better than pure compound elemicin as well as standard drugs used.

Anethole rich Clausena heptaphylla (Roxb.) Wight & Arn., essential oil pharmacology and genotoxic efficiencies

Anethole, a widely used industrial flavoring agent is majorly sourced from anise and star anise. The present study is aimed to the in-depth pharmacological analysis i.e. anti-diabetic, skin whitening, neurodegenerative disorder inhibitory activities of anethole-rich Clausena heptaphylla leaf essential oil (ARCHEO) (88.59%) as revealed by the Gas Chromatography/Mass Spectrometry (GC/MS) analysis and further confirmed by proton nuclear magnetic resonance ¹H-NMR as well as to compare with standard compound anethole. ARCHEO (ABTS EC₅₀ 6.97 ± 0.004 µg/mL; Protease assay 4.51 ± 0.004 µg/mL) outperformed the standard compound anethole (ABTS EC₅₀ 9.48 ± 0.048 µg/mL; Protease assay EC₅₀ 22.64 ± 0.016 µg/mL) in antioxidant and anti-inflammatory experiments. ARCHEO was also shown to be more effective than the reference compound anethole in terms of anti-diabetic activity (EC₅₀ 22.35 ± 0.121 µg/mL), tyrosinase inhibitory activity (EC₅₀ 16.45 ± 0.012 µg/mL), and anti-cholinesterase activity (EC₅₀ 22.32 ± 0.016 µg/mL). However, ARCHEO exhibited lower antimicrobial activity towards all the tested microbes compared to standard compound anethole and as for the MIC, ARCHEO was effective only towards Salmonella typhimurium (60 µg/mL), Streptococcus mutans (20 µg/mL), and Aspergillus fumigatus (75 µg/mL). ARCHEO (11.11%) and anethole (12.33%) showed no genotoxic effect based on Allium cepa assay mitotic index value. Thus, ARCHEO could be a commercially viable and widely available cheaper source of anethole, which has buoyant demand in the field of food flavoring, fragrance, and pharmaceutical industries.

A drug-in-adhesive anti-onychomycotic nail patch: Influence of drug and adhesive nature on drug release, ungual permeation, in vivo residence in human and anti-fungal efficacy

A nail patch is an attractive option for the topical treatment of onychomycosis, although no product is commercially available. We previously identified optimal nail patch formulations for two anti-onychomycotic drugs, based on their properties, as well as those of the other patch components. In this paper, our aim was to further investigate the potential of the patch formulations as topical nail medicines, in particular, whether the drug-in-adhesive patches release drug which then permeates into and through the nail plate and show anti-fungal efficacy, and whether and to what extent they remain adhered to the human nail plate in vivo when tested over 2 week durations. In addition, the influence of the drug (amorolfine HCl, ciclopirox olamine) and PSA (Duro-Tak 2852 or Duro-Tak 202A) on these parameters was determined. We found that both the nature of the drug and of the PSA influenced in vitro drug release. The nature of the drug, but not that of the PSA, influenced ungual drug permeation through human nail clippings, with considerably greater (almost double) permeation for ciclopirox olamine, the smaller and less lipophilic molecule. In vivo residence, tested with 3 out of the 4 patches, excluding the patch where ciclopirox olamine degraded with time, showed greater residence on toenails compared to fingernails reflecting their far lesser exposure to environmental stresses during daily activities. In vivo residence was enhanced when the patch was cut to the shape of the nail, was applied at bedtime, and when a clear colourless nail varnish was applied on top of the patch to 'seal' it into place on the nail. Comparison of the patches indicated greater residence of Duro-Tak 202A containing patches over those containing Duro-Tak 2852. Amorolfine HCl in Duro-Tak 202A based patch also showed antifungal efficacy in contrast to Duro-Tak 2852-based patch, and is particularly promising for further development as a potential toenail medicine, remaining almost fully adhered to toenails for at least two weeks.

Evaluation of Genetic Diversity Based on Microsatellites and Phytochemical Markers of Core Collection of Cymbopogon winterianus Jowitt Germplasm

Cymbopogon winterianus Jowitt is an industrially important crop due to its value in the aromatic, perfumery and pharmaceutical industries. In this study, 72 accessions of C. winterianus were selected for molecular diversity analysis using SSR markers. It revealed a total of 65 polymorphic alleles showing an average of 68.10% polymorphism. The best SSR primer with competency in discriminating the germplasm was 3CM0506 with PIC (0.69), MI (0.69) and Rp (3.12). Genetic variation was studied between Assam, Manipur, Meghalaya and Arunachal Pradesh populations. A dendrogram based on the Neighbour-Joining Method showed clustering of germplasm on the collection site. A total of six relevant genetic populations were identified through a structure harvester software analysis. Moreover, a dendrogram based on similarity, complete linkage and Euclidean distance was also elucidated differentiating the genotypes with respect to the major phytochemical constituents of the essential oil. GC-FID and GC-MS analyses of the essential oil of the 72 germplasms revealed citronellal content from 2.58-51.45%, citronellol from 0.00-26.39% and geraniol from 0.00-41.15%. This is the first molecular diversity report with 72 accessions of C. winterianus collected from the NE region using 28 SSR primers as well as their diversity based on phytochemical markers. This diversity computation will help with acquisition of the knowledge and relationship among each individual accession leading to the development of improved and essential oil component-rich cultivars.

Induced variations by gamma radiation and EMS on the agronomic traits, essential oil yield with its quality and their exploitation in Java citronella (Cymbopogon winterianus Jowitt)

PURPOSE

The slips of Cymbopogon winterianus (Java citronella) are used to propagate this industrially important crop. It does not have a mating system that allows it to create new variability or develop superior progenies, which could be addressed by using induced mutation caused by physical or chemical agents. Physical treatments, rather than chemical treatments, are believed to be the most incredible alternative for mutation breeding. As a result, this study aims to assess the effects of gamma radiation and EMS treatment on the development of better C. winterianus progenies.

MATERIALS AND METHODS

The three superior lines, i.e. JC-62 (IC-0627007), JC-55 (IC-0627000), and JC-71 (IC-0627018) based on high herbage, essential oil yield and citronellal content were selected through clonal selection during three-year evaluation. These were then irradiated with ⁶⁰Co gamma rays (50 Gy, 100 Gy, 150 Gy, 200 Gy, 250 Gy, and 300 Gy) and treated with EMS dose (0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 1%) separately. Ten plants of each dose were mutated and planted in the experimental field to obtain the MV₂ progenies. After 4 months, the plants were harvested, and the slips were prepared and planted to get the MV₃ and subsequently MV₄ progenies. All morphological and essential oil data have been recorded and analyzed statistically. The essential oil was extracted through the Clevenger apparatus for all the progenies, followed by GC and GC-MS analysis.

RESULTS

The morpho-chemical study of the 112 healthy mutants has led to the identification of six superior progenies in MV₄ progenies, M17, M63, M77, M179, M233, and M392. In terms of the economic yield, it was observed that mutant M77 treated with 0.20% EMS dose increased the herbage yield and citronellal content tremendously. In contrast, the progeny M17 irradiated with γ-100Gy increased essential oil yield from 1.32% to 1.50%. The EMS treatment at 0.10% and 0.20% doses showed an increasing trend in plant height, leaf length, tillers/bush, leaves/bush, herbage yield, and citronellal content compared to the base variety. The LD₅₀ value of C. winterianus for gamma radiation and EMS treatment was averaged at 173 Gy and 0.72%, respectively.

CONCLUSION

In C. winterianus, both gamma rays and EMS treatment successfully created superior progenies with desired characteristics. The 0.20 percent EMS treatment significantly improved economic features, including herbage yield and citronellal content. Simultaneously, gamma radiation at 100 Gy produced the highest essential oil yield, which is a highly desirable characteristic in C. winterianus breeding.

Prospective Study of Deterioration of Quality-of-Life among Elderly Women with Untreated Fracture of Neck of Femur in Rural Areas of Mymensingh, Bangladesh

Elderly women are very much prone to develop fracture at neck of femur sustained by even minute trauma. Most of the cases are due to fall. Osteoporosis gives rise to this vulnerable condition. In developing countries like Bangladesh the women of rural areas are the prime victims mostly due to illiteracy. To assess the quality-of-life (QOL) of elderly women (>60 years) with untreated hip fractures in a rural areas in Mymensingh, Bangladesh is the objective of this study. This prospective study was done from January 2019 to December 2019 in Orthopaedics and Traumatology Department of Mymensingh Medical Hospital, Mymensingh, Bangladesh. Twenty-five elderly women with untreated fracture neck of femur were enlisted in this study. EuroQol (EQ-5D) was applied to assess the Quality of life of subjects before and after the situation. Twenty-five elderly women of healed operated neck of femur were included as comparison group, matched for age, economic condition and educational status among neighborhood people. So, sample size was fifty. Wilcoxon signed rank test and Mann-Whitney U test were applied to compare EQ-5D mean scores. Participants with hip fracture, 60% (15/25), 68% (17/25), 68% (17/25), 60% (15/25) and 92% (23/25) reported severe problems with mobility, pain, usual activity, self-care and anxiety respectively. The EQ-5D mean score among the elderly with fracture neck of femur was 0.198 (SD 0.14). It was low when compared with the same subjects before the occurrence of the event (Z-6.522, p<0.001) and as compared with the comparison group (Z-7.92 p<0.001). QOL scores assessed using EQ-5D index scores was poor among elderly women with untreated fracture neck of femur as compared with the healed operated comparison group. Vast majority of study participants in this study were reported severe problems like mobility, pain, usual activity and self-care and anxiety.

Evaluation of ultra high-performance liquid chromatography (uHPLC) assisted capsaicinoids content in four different extracts of (Capsicum chinense Jacq.): their pharmacological potentials and genotoxicity study

The present study determined the capsaicin, dihydrocapsaicin and nordihydrocapsaicin of Capsicum chinense Jacq., ethanol, methanol, acetonitrile and dry acetone extracts using ultra high-performance liquid chromatography (uHPLC) technique. Highest capsaicin (2.84%) and nordihydrocapsaicin (0.56%) content was recorded in ethanol extract, while methanol extracts constituted highest dihydrocapsaicin (1.27%). Strong anti-inflammatory activity was shown by ethanol extract. All the extracts were found to be weak anti-diabetic, skin whitening and neurodegenerative agent. In genotoxicity test, ethanol extract showed mitotic index (MI) of 13.16% which was close to distilled water 25.72%. The chromosomal aberration of 8.0% was shown by ethanolic extract. The mitotic index value and chromosome aberration percentages of all the four extracts were similar but far from positive mutagenic agent ethyl methane sulfonate. Ethanol extract proved to be the best solvent for capsaicinoids extraction in comparison to the other three solvents and emerged as a potential pharmacological candidate having excellent anti-inflammatory ability.

Clinical Outcome on Comminuted Femoral Shaft Fractures in Adults Treated by Minimally Invasive Plate Osteosynthesis (MIPO) with Locking Plate

Intramedullary nailing is a pillar in the treatment of femoral shaft fractures. But it is not possible in all cases especially in comminuted fractures. This study has been designed to explain the importance of Minimally Invasive Plate Osteosynthesis (MIPO) with the locking plate in the treatment of comminuted Femoral Shaft Fracture. Twenty (20) such patients were treated by MIPO and analysis has been done in this study to get fruitful result and to find out the effectiveness of this procedure who were admitted at Mymensingh Medical College Hospital, Mymensingh, a tertiary level hospital of Bangladesh from February 2018 to January 2019. Mean age of the patients were 49.20±14.41 years. Based on AO classification, there were 4, 8 and 8 patients belong to type A, B and C respectively. The union period for all the patients was in between 12 to 14 weeks. The mean union period was 12.90±1.997 weeks. Mean follow up period was 19.70±2.77 weeks. Mean full weight bearing period was 16.50±1.10 weeks. In Thoresen scoring system excellent result was 9(45%), good result was 10(20%) and fair result was 01(5%). Mal-alignment happened in two cases. However, delayed union and broken screws were found in two cases each of which was treated accordingly. Comminuted Femoral shaft fracture with MIPO procedure is more effective treatment than intramedullary nailing. Furthermore, mal-alignment is the basic complexity that must be taken away intraoperatively.

Chemical composition of Callistemon citrinus (Curtis) Skeels aerial part essential oil and its pharmacological applications, neurodegenerative inhibitory, and genotoxic efficiencies

Callistemon citrinus aerial part essential oil (CCEO) was analyzed for chemical compositions using GC/MS. Pharmacological activities such as neurodegenerative inhibitory, antioxidant, anti-inflammatory, antimicrobial, and acetylcholinesterase activities were evaluated using the standard methodologies. Genotoxicity was investigated using Allium cepa assay. GC/MS analysis identified 27 compounds; eucalyptol (55.40%) was the major component. Radical scavenging activity showed IC₅₀ value of 16.71 μg/mL. Protein denaturation assay showed IC₅₀ value of 21.19 μg/mL and 19.53μg/mL in protease inhibitor activity. MIC assay revealed antimicrobial potential of CCEO against microbial strains B. cereus at 2.00 mg/mL, S. typhimurium at 4.50 mg/mL, S. mutans at 2.50 mg/mL, C. albicans at 4.00 mg/mL, and S. cerevisiae at 4.50 mg/mL concentrations. Mitotic index value (MI) of CCEO showed negligible genotoxicity with MI 17.25% close to distilled water 18.22%. Acetylcholinesterase strong inhibitory activity of CCEO was observed from IC₅₀  = 6.335 μg/mL. CCEO could be a cheap and easy source for the extraction of the pure compound eucalyptol and possess various biological activities which increase its pharmacological value as well as its applicability in the field of flavor and fragrance industries. PRACTICAL APPLICATIONS: Eucalyptol is the major component of many pharmaceutical and food/flavor industries. The present investigation provides a new source for the isolation of pure compound eucalyptol in cost-effective way. Additionally, the essential oil could also be used for the pharmaceutical formulation of antioxidant, inflammation inhibitory, and neurodegenerative inhibitory drug preparation under the safety range concentration.

Experience with the COVID-19 AstraZeneca vaccination in people with multiple sclerosis

Background

Some people with multiple sclerosis (pwMS) are at increased risk of severe Coronavirus disease 19 (COVID-19) and should be rapidly vaccinated. However, vaccine supplies are limited, and there are concerns about side-effects, particularly with the ChAdOx1nCoV-19 (AstraZeneca) vaccine.

Objectives

To report our first experience of pwMS receiving the AstraZeneca vaccine.

Methods

Service evaluation. pwMS using the MS service at Barts Health NHS Trust were sent questionnaires to report symptoms following vaccination.

Results

Thirty-three responses were returned, 29/33 pwMS received a first dose of AstraZeneca vaccine, the remaining four received a first dose of BioNTech/Pfizer vaccine.

All but two patients (94%) reported any symptoms including a sore arm (70%), flu-like symptoms (64%), fever (21%), fatigue (27%), and headache (21%). In more than 2/3 patients, symptoms lasted up to 48 hours, and with the exception of two pwMS reporting symptom duration of 10 and 12 days, respectively, symptoms in the remainder resolved within seven days. No severe adverse effects occurred.

Conclusions

pwMS report transient symptoms following AstraZeneca vaccination, characteristics of which were similar to those reported in the non-MS population. Symptoms may be more pronounced in pwMS due to the temperature-dependent delay in impulse propagation (Uhthoff's phenomenon) due to demyelination.

Temporal trends in between and within-country inequalities in caesarean delivery in low- and middle-income countries: a Bayesian analysis

OBJECTIVE

To provide updated information about between-country variations, temporal trends and changes in inequalities within countries in caesarean delivery (CD) rates.

DESIGN

Cross-sectional study of Demographic and Health Survey (DHS) during 1990-2018.

SETTING

74 low- and middle-income countries (LMICs).

POPULATION

Women 15-49 years of age who had live births in the last 3 years.

METHODS

Bayesian linear regression analysis was performed and absolute differences were calculated.

MAIN OUTCOME MEASURE

Population-level CD by countries and sociodemographic characteristics of mothers over time.

RESULTS

CD rates, based on the latest DHS rounds, varied substantially between the study countries, from 1.5% (95% CI 1.1-1.9%) in Madagascar to 58.9% (95% CI 56.0-61.6%) in the Dominican Republic. Of 62 LMICs with at least two surveys, 57 countries showed a rise in CD during 1990-2018, with the greatest increase in Sierra Leone (19.3%). Large variations in CD rates were observed across mother's wealth, residence, education and age, with a higher rate of CD by the richest and urban mothers. These inequalities have widened in many countries. Stratified analyses suggest greater provisioning of CD by the richest mothers in private facilities and poorest mothers in public facilities.

CONCLUSIONS

CD rates varied substantially across geographical locations and over time, irrespective of public or private health facilities. Changes in CD rates continue across wealth, place of residence, education, and age of mother, and are widening in most study countries.

TWEETABLE ABSTRACT

Increasing caesarean delivery rates were greater among the richest and urban mothers than their counterparts, with widened gaps in LMICs.

Clinical Outcome in Intra Articular Distal Humerus Fractures in Adults Treated with Different Hardware in a Tertiary Level Hospital of Bangladesh

In adults, distal humerus fractures are infrequent and frequently intra-articular. Customarily encompass both medial and lateral columns. Operative management gives constructive outcomes. The aim of this study was to evaluate clinical outcome in intra articular distal humerus fractures in adults treated by different hardware. This prospective study consists of 20 purposively selected patients with intra articular distal humerus fractures treated by surgical intervention with different hardware who were admitted to Mymensingh Medical College and Hospital, Bangladesh in between November 2016 to October 2018. Surgical approaches were standard dorsal with or without olecranon osteotomy. The mean age of the patients was 32.3 years, range between 18-55 years. The maximum patients i.e. 85% were between 18-45 years. Seventy percent (70%) of the cases admitted were due to Road traffic accident (RTA). Most of the patients were males 14(70%) with right upper limb was involved in 13(65%) cases. Mean Mayo Elbow Performance Score was 81.5 post-operatively. According to Mayo Elbow Performance (MEP) score clinical outcome was excellent in 20%, good in 50%, fair in 25% and poor in 10% of patients. Distal humerus fractures are censorious in nature. Proper anatomical articular reconstruction and stable fixation by surgical intervention helps in fruitful results.

Measurement of Placental Index in Different Gestational Age Groups in Bangladeshi Women

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complications in pregnancy of mother. The growth and survival of the fetus in utero is directly related to formation, development and maturation of the placenta. Placental index was correlated to poor pregnancy outcomes. Placental index can help to identify fetal growth restriction which is result of placental insufficiency and is characterized by insufficient trasnsplacental transport of nutrients and oxygen. This cross sectional descriptive study would provide information about the ratio of placental index in different gestational age group in Bangladeshi women. To achieve this aim the study was performed on 60 human placenta and corresponding fetuses and gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), Group C (38-40). These sample and information 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% formal saline, study was done in Department of Anatomy in Mymensingh Medical College. In this study, the mean±SD placental index was in Group A (0.187±0.113), Group B (0.153±0.025) and Group C (0.166±0.025) and also observed that mean placental index decreased with age up to certain level then increase in Group C. The mean placental index was maximum in Group A (0.187±0.113) and was minimum in Group B (0.153±0.025). The mean difference of placental index between Groups A&B, A&C and B&C was statistically not significant. Observed findings of this study were compared with those of Western and Bangladeshi researches.

Comparative Analysis of In-Vitro Biological Activities of Methyl Eugenol Rich Cymbopogon khasianus Hack., Leaf Essential Oil with Pure Methyl Eugenol Compound

BACKGROUND

The essential oil of methyl eugenol rich Cymbopogon khasianus Hack. was evaluated and its bioactivities were compared with pure methyl eugenol. So far, methyl eugenol rich essential oil of lemongrass was not studied for any biological activities; hence, the present study was conducted.

OBJECTIVE

This study examined the chemical composition of essential oil of methyl eugenol rich Cymbopogon khasianus Hack., and evaluated its antioxidant, anti-inflammatory, antimicrobial, and herbicidal properties and genotoxicity, which were compared with pure compound, methyl eugenol.

MATERIAL AND METHODS

Methyl eugenol rich variety of Cymbopogon khasianus Hack., with registration no. INGR18037 (c.v. Jor Lab L-9) was collected from experimental farm CSIR-NEIST, Jorhat, Assam (26.7378°N, 94.1570°E). The essential oil wasobtained by hydro-distillation using a Clevenger apparatus. The chemical composition of the essential oil was evaluated using GC/MS analysis and its antioxidant (DPPH assay, reducing power assay), anti-inflammatory (Egg albumin denaturation assay), and antimicrobial (Disc diffusion assay, MIC) properties, seed germination effect and genotoxicity (Allium cepa assay) were studied and compared with pure Methyl Eugenol compound (ME).

RESULTS

Major components detected in the Essential Oil (EO) through Gas chromatography/mass spectroscopy analysis were methyl eugenol (73.17%) and β-myrcene (8.58%). A total of 35components were detected with a total identified area percentage of 98.34%. DPPH assay revealed considerable antioxidant activity of methyl eugenol rich lemongrass essential oil (IC50= 2.263 μg/mL), which is lower than standard ascorbic acid (IC50 2.58 μg/mL), and higher than standard Methyl Eugenol (ME) (IC50 2.253 μg/mL). Methyl eugenol rich lemongrass EO showed IC50 38.00 μg/mL, ME 36.44 μg/mL, and sodium diclofenac 22.76 μg/mL, in in-vitro anti-inflammatory test. Moderate antimicrobial activity towards the 8 tested microbes was shown by methyl eugenol rich lemongrass essential oil whose effectiveness against the microbes was less as compared to pure ME standard. Seed germination assay further revealed the herbicidal properties of methyl eugenol rich essential oil. Moreover, Allium cepa assay revealed moderate genotoxicity of the essential oil.

CONCLUSION

This paper compared the antioxidant, anti-inflammatory, antimicrobial, genotoxicity and herbicidal activities of methyl eugenol rich lemongrass with pure methyl eugenol. This methyl eugenol rich lemongrass variety can be used as an alternative of methyl eugenol pure compound. Hence, the essential oil of this variety has the potential of developing cost-effective, easily available antioxidative/ antimicrobial drugs but its use should be under the safety range of methyl eugenol and needs further clinical trials.

Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression

BACKGROUND

Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates.

OBJECTIVES

To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR.

SEARCH STRATEGY

PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019.

SELECTION CRITERIA

Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors.

DATA COLLECTION AND ANALYSIS

Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants.

MAIN RESULTS

We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation.

CONCLUSIONS

An appropriate reporting of CDMR should be a key priority in maternal health policies and practices.

TWEETABLE ABSTRACT

Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.

Study of Anti-oxidant, Anti-inflammatory, Genotoxicity, and Antimicrobial Activities and Analysis of Different Constituents found in Rhizome Essential Oil of Curcuma caesia Roxb., Collected from North East India

BACKGROUND

This investigation was designed to evaluate the chemical composition, antioxidant, anti-inflammatory, genotoxicity, and antimicrobial activities of Curcuma caesia Roxb rhizome essential oil.

METHODS

Gas Chromatography/Mass Spectroscopy (GC/MS) analysis was performed to determine the chemical composition, standard antioxidative test DPPH assay, reducing power assay, in vitro antiinflammatory activity (egg albumin denaturation, protease inhibitory assay) by using standard methods. Similarly, antimicrobial activity was tested using the disc diffusion method, minimum inhibitory concentration ability (MIC); while to test genotoxicity, Allium cepa assay was used.

RESULTS

GC/MS analysis revealed eucalyptol (28.55%), epicurzerenone (19.62%), and camphor (21.73%) as the major components of C. caesia rhizome essential oil. Potent antioxidant (IC50= 48.08±0.003 μg/mL), anti-inflammatory (IC50= 121.7±0.0013 μg/mL), and antimicrobial activities of the essential oil were recorded better than the standard drugs Fluconazole for fungus and Ciprofloxacin for bacteria. The essential oil also possessed a strong antibacterial effect against two tested bacterial strains B. subtilis and B. cereus with 7.5 μg/mL MIC value, while for fungal strains the essential oil was most effective against S. cereviaceae with an MIC value of 2.5 μg/mL. All the data were recorded in triplicates. Allium cepa assay revealed minor genotoxicity with mitotic index, MI= 27.70%; chromosome aberration, A= 1.1% of C. caesia rhizome essential oil.

CONCLUSION

C. caesia rhizome essential oil possesses potent antioxidant, anti-inflammatory, and antimicrobial properties with negligible genotoxicity. Hence, the present study is highly significant for the utilization of rhizome of C. caesia, a high-value ethnopharmacological plant for advanced R & D and commercial application.

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.

Age Related Variation in the Number of Endometrial Gland in Bangladeshi Cadaver

This cross-sectional descriptive study was done to see the variation in the number of endometrial gland in Bangladeshi cadaver in different age groups to find out the anatomical variation and to compare it with other study findings. For this purpose 30 post mortem specimens containing female genital organs particularly uterus were collected by purposive sampling technique from cadavers of different age groups. All the collected specimens were fixed in 10% formalin solution. This study was carried out in the department of Anatomy, Mymensingh Medical College from July 2006 to June 2007. After dissection of specimen, microscopic study was done to count the number of the endometrial glands. Mean±SD numbers of gland per square mm area were 5.88±1.56, 14.75±6.90, and 7.35±1.79 in age Group A (2-12 years), B (13-45 years) & C (46-80 years) respectively. Highest number of gland was seen in Group B (5.66 to 22.48 per sq mm) & lowest number of gland was seen in Group A (3.30 to 9.95 per sq mm). The present study findings were compared with that of the references.

Needs assessment for master of nursing programmes among Bangladesh nurses

AIM

This study aimed to assess the intent to enrol in a master of nursing programme among Bangladesh nurses, identify preferred programme options and measure the association among intent to enrol in the programme, clinical competency and job satisfaction.

BACKGROUND

Personal and professional aspects of potential students pursuing graduate education are beneficial in devising educational strategies. However, considering the pressing needs for higher nursing education, there are no masters of nursing programmes in Bangladesh.

METHODS

This study used a descriptive correlational design. Nurses working in Bangladesh public sector were recruited to participate in a self-administered survey (n = 260). The questionnaire consisted of perception of job satisfaction, clinical competency and the need for educational options, including the intent to enrol in a master of nursing programme, preferred specialty area, curriculum content and career goals after graduation. Data were analysed using descriptive statistics and point-biserial correlation.

RESULTS

Ninety per cent of the respondents reported that they intended to enrol in a master of nursing programme. Intention was significantly correlated with clinical competency but not with job satisfaction. The most preferred specialty areas were nursing management and education. Half of the respondents responded that teaching at nursing schools was a career goal after graduation.

DISCUSSION

The results of the needs assessment for the programme reflected the unique interest and priorities of the current status of Bangladesh.

CONCLUSIONS

The results indicate a strong motivation to enrol in a master of nursing programme, confidence in clinical competence and high demand for programme in nursing management and education. These findings should be considered to design the programme in order to meet the interest of Bangladesh nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Educational needs assessments should take precedence to ensure the best possible educational outcome and to produce competent nurses who will contribute in achieving the Millennium Development Goals of Bangladesh.

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.

Hypertriglyceridemia associated with eruptive xanthomas and lipemia retinalis in newly diagnosed diabetes mellitus

Severe hypertriglyceridemia can cause the deposit of lipids in the dermis (eruptive xanthomas) and in the retina (lipemia retinalis). Lipemia retinalis and eruptive xanthoma are occasionally seen in patients with diabetes mellitus and are thought to be due to abnormalities in the serum lipid fractions. Here a 15 year's old girl presented with typical symptoms of diabetes with skin lesions over hands and feet. On examination skin lesions were non-tender yellow papules with creamy-colored centers on extensor surfaces of the arms, hands and feet. Ophthalmoscopic examination showed creamy white retinal vessels with a faded pinkish white retinal back ground both in the periphery and posterior pole of the retina. Laboratory findings showed a grossly lipemic serum with markedly elevated serum levels of triglycerides 8869mg/dl cholesterol 498mg/dl. Her fasting blood glucose was 20.8mmol/l, 2 hours after breakfast was 50.5mmol/l and HbA1c was 14.6%. Eruptive xanthomas and lipaemia retinalis can occur in primary and secondary hyperlipoproteinemias, therefore a careful personal and family history as well as laboratory investigations is recommended in order to detect an underlying cause.

Aetiology and pathogenesis of endometriosis - a review

Endometriosis is a complex gynaecological disorder that affects nearly 1 in 7 women of reproductive age. Ectopic dissemination of endometrial cell and their subsequent implantation are the mechanisms involved in the development of endometriosis. Endometriosis is a common multifactorial disease caused by an interaction between multiple gene loci and environment. Causes of stress on immune functioning or may be genetically determined. Environmental factors can be responsible for immunosuppressive activities in patient with endometriosis. In addition, toxin modulates steroid receptors expression resulting in altered tissue specific responses to hormones. Chronic immunosuppression in combination with hormonal regulation may have facilitated the aberrant growth of endometrial tissue within the peritoneum. However, the mechanism appears to require endometrium and retrograde menstruation in most cases of the disease.

Prevalence of Metabolic Syndrome among Obese Children and Adolescents

Objectives: The Prevalence and magnitude of childhood obesity are increasing dramatically. The study was undertaken to see the prevalence of metabolic syndrome among children and adolescents with obesity, attending the Paediatric Endocrine OPD, BIRDEM. Methods: A cross sectional study was conducted from January 2006 to December 2008 among obese children and adolescents (6-18 years) attending Paediatric endocrine out patient department of BIRDEM. Children with any other endocrine disorder, dysmorphism/syndrome were excluded. Obesity was defined as BMIe”95th percentile for age and sex using CDC growth chart. Children underwent two-hour oral glucose tolerance test, anthropometric and blood pressure measurement. Fasting serum insulin and lipid profile were measured. Impaired glucose tolerance (IGT) was defined as fasting plasma glucose (FPG) <7 mmol/L and 2 hr post glucose load e”7.8 mmol/L to<11.1 mmol/L. Metabolic syndrome was identified if 3 or more of following criteria were met: BMI > 97th percentile for age and sex, high triglyceride (TGe”150 mg/dl), low high-density lipoprotein cholesterol (HDL cholesterol<40mg/dl), Systolic or diastolic blood pressure>95th percentile for age and sex, IGT. Results: A total of 161 children presented with obesity. Male to female ratio was 1.3:1. Mean age was 10.3±2.5 years. Metabolic syndrome was identified in 36.6% subjects (59 out of 161, twenty five male and 34 female). Higher BMI and hip circumference, systolic and diastolic hypertension, high TG, low HDL cholesterol and IGT were significantly associated with metabolic syndrome. Conclusions: The prevalence of metabolic syndrome is high among obese children and adolescents. Factors contributing towards obesity needs to be identified and strategies should be planned for prevention and management of this health problem. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12382 Birdem Med J 2011; 1(1): 21-25

Thermotolerance and sensitivity of human cancer cells to cisplatin and doxorubicin

Testis tumour cells are more sensitive than most other types of cancer cell to heat, radiation and chemotherapeutic drugs, both in the clinic and in vitro. Since heat shock proteins (HSP) can protect cells from the cytotoxic effects of stress, we studied their role in the sensitivity of testis tumour cells to the frequently used cancer chemotherapeutic drugs, cisplatin and doxorubicin. Clonogenic assays of 3 testis tumour cell lines (833K, GCT27, GH) and 3 bladder cancer cell lines (RT112, HT1376, MGH-U1) following a 1 h exposure to the two drugs confirmed that the testis tumour cell lines were inherently more sensitive. Having shown previously that heat shock proteins were upregulated in both cell types following a heat shock, in this study no induction of HSP was seen following treatment for 1 h with cisplatin or doxorubicin (at concentrations reducing colony forming ability by 50%) in either cell type. In contrast, chronic exposure to cisplatin (at concentrations on the threshold of cytotoxicity), but not doxorubicin, resulted in upregulation of HSP 27, but not HSP73/72, in both cell types. Testis and bladder cancer cells with heat-induced increases in HSP were thermotolerant, and this was associated with increased resistance to doxorubicin, but not cisplatin.

Prevalence of impaired glucose tolerance among children and adolescents with obesity

The study was undertaken to see the prevalence of impaired glucose tolerance among children and adolescents with obesity, attending the Paediatric Endocrine OPD, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders (BIRDEM), Dhaka, Bangladesh. A cross sectional study from January 2006 to December 2008 was conducted among obese children and adolescents (6-18 years). Children with any other endocrine disorder, dysmorphism/syndrome were excluded. Obesity was defined as BMI ≥ 95th percentile for age and sex using CDC growth chart. Children underwent two hours oral glucose tolerance test with 1.75 gm/kg or 75 gm of glucose, anthropometric and blood pressure measurement. Fasting serum insulin and lipid profile were measured. Impaired glucose tolerance (IGT) was defined as fasting plasma glucose (FPG) <7 mmol/L and 2 hours post glucose load ≥ 7.8 mmol/L to <11.1 mmol/L. Diabetes mellitus (DM) was defined as FPG ≥ 7 mmol/L or 2 hours post glucose load ≥ 11.1 mmol/L. Homeostasis model assessment was used to estimate insulin resistance. A total of 161 children presented with obesity. Male to female ratio was 1.3:1. Mean age was 10.3 ± 2 .5 years. Mean BMI was 27.86 ± 4.1 kg/m². IGT was found in 16.9% of children and adolescents. In children aged 6-10 years IGT was detected in 16.1% and in adolescents aged 11-18 years IGT was detected in 20%. Diabetes mellitus was detected in 2.1% of subjects, all were adolescents. Serum fasting insulin and hip circumference were significantly higher among children and adolescents with IGT compared to that of normal glucose tolerance. The high rate of IGT among obese children and adolescents is of concern. Factors contributing towards obesity needs to be identified and strategies should be planned for prevention and management of this health problem.

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.

Prevalence of obesity among affluent school children in Dhaka

A cross sectional study was conducted in September 2006 in one of the private schools in Dhaka, Bangladesh to see the prevalence of obesity among affluent school children and adolescents. Informed consent was taken from school authority to take anthropometric measurement of all school children. Standing height was measured with a stadiometer and weight with a bathroom scale. Waist and hip circumference were measured with a measuring tape. The body mass index (BMI) was calculated using weight in kilogram/(height in meter)2 formula. Obesity was defined as BMI≥95th percentile for age and sex, over weight as BMI≥85th percentile for age and sex, normal weight as BMI between 5th and 84th percentile and underweight as BMI <5th percentile. Official centers for disease control (CDC) growth chart for boys and girls age 2-20 years was used. Children and adolescents were divided into group 1(3-5 years), Group 2(6-9years), group 3(10-13 years) and group 4(14-18 years). There were a total of 468 children and adolescents (male 266, female 202). In group 1 there were 110 children, in group 2 there were177 children, in group 3 and 4 there were 149 and 32 adolescents respectively. The prevalence of obesity was 17.9%, higher among males (19.9%), compared to females (15.3%). Obesity was highest (27.7%) in group 2, 14.5% in group 1, 10.7% in group 3 and 9.4% in group 4.

Initiation of early empiric treatment based on clinical features and early obtainable CSF indices can prevent worse prognosis in childhood meningitis

Childhood meningitis is still a major cause of neurological disabilities and death, which can be reduced by early initiation of treatment. This study was done with an objective to diagnose childhood meningitis earlier based on clinical characteristics and early obtainable cerebrospinal fluid (CSF) indices, which help to start early empiric treatment and prevent worse prognosis. The study was conducted during the period of January to December; 2003. One hundred suspected cases of childhood meningitis aged 1 month to 12 years admitted into the Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh were selected for the study. It was a prospective study and sampling was purposive. Diagnosis was made by history, clinical examination, complete blood count and CSF study. Early treatment was started. Number of deaths was noted and neurological outcome was assessed in children who survived by clinical examination at the time of discharge. Study results showed 64% bacterial, 20% tuberculous and 6% viral meningitis. Fever (100%), altered consciousness (100%) were the most common features in all type of meningitis. Other predominant features were convulsion (90%), bulged fontanel (68%), reluctant to feed (67.18%), neck rigidity (67%) and vomiting(43.75%) in bacterial meningitis, convulsion (75%), neck rigidity (65%), vomiting (40%) and focal neurological signs (35%) in tuberculous meningitis, reluctant to feed (100%), convulsion (83.3%), neck rigidity (83.3%) and vomiting (66.6%) in viral meningitis. In all cases of meningitis CSF total leukocyte count was >5/mm3. Regarding immediate outcome in bacterial meningitis 48.8% improved without neurological sequelae, 43.7% patient developed neurological sequelae and 4.6% patient died. In tuberculous group, only 30% improved without neurological sequelae, 40% developed neurological sequelae and 20% patient died. In viral meningitis 83.3% improved without neurological sequelae. Duration of the main complaint specially fever at the time of presentation, level of consciousness, convulsion were the most important predictor of out come in childhood meningitis.

Usefulness of bone mineral density measurement in menopausal woman: a study of 217 post menopausal women

Bone mineral densitometry was done in 217 women in their menopausal period using Dual energy X-ray absorptiometry (DEXA) method. All the patients were presented with different post menopausal syndromes. Quantification of bone mineral density were done in proximal femur and lumber spines of all the patients along with plain X-ray of the sites. One hundred and thirty nine patients showed normal bone mineral density in our study. Rest 78 patients showed declination of bone mineral density from mild osteopenia to severe osteoporosis. We conclude that Dual energy X-ray absorptiometry bone mineral measurement is an unique, non-invasive method in detecting bone mass disorder in post-menopausal women with low back pain and should be the first choice of investigation, for the earliest detection of bone loss and thus fracture risk can be reduced by appropriate management.

Short-lasting impairment of tactile perception by 0.9Hz-rTMS of the sensorimotor cortex

To test whether low-frequency repetitive transcranial magnetic stimulation (rTMS) of sensorimotor cortex (SM1) has prolonged effects on somatosensory function, eight subjects were given 900 TMS pulses over the left hand SM1 (0.9Hz, 90% of the resting motor threshold) or at sites 3 cm anterior or posterior to it. Tactile threshold of the right hand was increased for a short duration after rTMS over SM1, but two-point discrimination and median nerve SEPs were unaffected after rTMS at any sites.

Elevated aminotransferase as a presenting finding in a patient with occult muscle disease

We report a patient with occult muscle disease who presented with raised serum aminotransaminases. This case report emphasises the importance of considering muscle disease in the differential diagnosis of raised serum aminotransaminases, as it may negate the need for invasive investigations such as liver biopsy.

Unofficial fees in Bangladesh: price, equity and institutional issues

The widespread collection of unofficial fees at health facilities is a common form of rent-seeking behaviour in Bangladesh. Typically, unofficial fees come in the form of cash payments for the performance of required services, for direct purchase of drugs and medical-surgical requisites, and for service access. Using observational and interview methods, this study explores linkages between official and unofficial fees at three Bangladesh health facility levels; primary care Thana Health Complexes, secondary or district hospitals, and medical college hospitals. The study estimates payment levels for different income classes and different payor types at these facilities, thereby highlighting potential equity, price and institutional questions associated with unofficial fees. Not only does the practice have clear income and equity effects, there also appear to be direct effects upon patient satisfaction, perception of quality, and the ability to pay for health services. The article concludes with a discussion of 'rent capture' processes at Bangladesh facilities and the effect of unofficial fees in six areas of health sector reform: displaced official policies, reduced merit goods production, upward income redistribution, distorted human resource development, growth of facility inefficiency, and obstruction of market reforms.

Serum, breast milk, and infant antibody after maternal immunisation with pneumococcal vaccine

Pneumococci are a leading cause of severe bacterial disease in infants and children world wide. A possible means of protecting infants in the first few months of life is immunisation of the mother during pregnancy. We prospectively assessed pneumococcal immunisation of pregnant women to determine the amount of pneumococcal antibody transmitted to the infants in serum and milk and the half-life of the passively acquired antibody. Healthy pregnant women in Dhaka, Bangladesh, were randomised to receive pneumococcal or meningococcal vaccine with routine prenatal tetanus immunisation at 30-34 weeks of gestation. Serum and breast milk specimens from the mothers and sera from infants were collected up to 22 weeks of age and assayed for specific serum IgG, IgG1, and IgG2 and for milk IgA antibodies to pneumococcal serotypes 6B and 19F. 55 mothers and 56 infants were followed from birth to five months. Women who received pneumococcal vaccine had geometric mean antibody increases of 2.6 and 3.4 to types 6B and 19F, respectively. The mean infant/maternal antibody ratios were 0.56 and 0.59 (range 0.11-1.46) for these serotypes. Infant cord antibody titres correlated with maternal titres. Infant/maternal IgG ratios correlated with the interval between immunisation and birth and were higher for specific IgG1 than for IgG2. Infants of pneumococcal vaccine recipients had geometric mean antibody concentrations of 6.8 and 7.5 micrograms/mL to serotypes 6B and 19F in cord blood; in cord blood and in all subsequent serum specimens the concentrations were 2-3 fold higher than in control infants. The median half-life of passive antibody was about 35 days; at five months of age 63-71% of infants of pneumococcal vaccine recipients had antibody concentrations greater than 0.15 micrograms/mL. Breast milk IgA antibodies for pneumococcal serotype 19F, but not for type 6B, were significantly higher in vaccine recipients up to five months after delivery. If maternal pneumococcal polysaccharide antibodies do not interfere with active immunisation of the infant with new glycoprotein conjugate pneumococcal vaccines, passive-active immunisation of infants can be a feasible strategy for developing regions.