bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of modified mallampati test between sitting and supine positions for prediction of difficult intubation
Authors: Khatiwada S , Bhattarai B , Pokharel K , Acharya R , Ghirnire A , Baral DD
Published: March 2012

Background: Modified Mallampati test is a standard method of assessing the airway for predicting potentially difficult laryngoscopy and intubation. This test requires the patient to be in sitting position for airway evaluation. Although applicable to the majority of patients, airway evaluation in sitting position may not always be convenient or advisable. Objectives: To compare modified Mallampati grades between sitting and supine position and to find out their corelation to Cormack and Lehane laryngoscopy grade. Materials: This prospective study was conducted in 215, ASA I and II patients undergoing various routine surgical procedures under general anaesthesia, in BPKIHS, Dharan over a period of 3 months. The airway assessment was done using modified Mallampati grade in sitting and supine positions. Mallampati grade of III or IV was defined as the predictor of difficult airway. The laryngoscopy grade was assessed using the Cormack and Lehane grading scale. Grade III or IV of Cormack and Lehane grades was defined as the difficult laryngoscopy and assumed as the predictor of difficult intubation. Statistical measures including sensitivity, specificity, positive and negative predictive values and accuracy were used for comparing the two positions for predicting difficult or ease of intubation. Results: Out of 215 patients, majority 146(68%) were females. Mallampati grade III or IV was observed in more patients in supine position compared to sitting position (48.3% vs. 35.8%, p = 0.008). Difficult laryngoscopy was observed in 13(6%) patients. Sensitivity of modified Mallampati test was 77% in both the positions. Predictive value of Mallampati grading for difficult intubation were 13% and 10% and for easy intubation were 96% and 97% respectively in sitting and supine position. Specificity and accuracy of modified Mallampati test were both 67% in sitting position, where as they were 54% and 55% respectively in supine position. Conclusion: Modified Mallampati grade significantly worsens in supine position compared to sitting. However, airway evaluation in both the positions almost equally predicts for difficult intubation. DOI: http://dx.doi.org/10.3126/hren.v10i1.6000 HREN 2012; 10(1): 12-15
Prevalence of urinary incontinence among gynecological admissions at tertiary care hospital in eastern Nepal
Authors: Regmi MC , Uprety D , Poonam M
Published: March 2012

Background: Urinary incontinence is a common medical disorder. However, in the developing countries the problem is not accepted as a major health problem. Objectives: To find out the prevalence of urinary incontinence in institutionalized gynecology patients at BPKIHS and to asses the severity of incontinence and to find out its perception as health problem. Methods: All the patients aged more than 20 years and excluding pregnancy related admissions during the study period of one year (February 2005 to February 2006) were questioned with preformed questionnaire and responses were noted. All together 630 patients participated. Results: 50.6% had incontinence. Urge incontinence was more common type (60%) than stress incontinence (40%).Most of the patients did not consider it as a health problem. Conclusion: Urinary leakage is highly prevalent and should be regarded as potential health problem. DOI: http://dx.doi.org/10.3126/hren.v10i1.6001 HREN 2012; 10(1): 16-19
Association of diabetes mellitus and high myopia in primary open angle glaucoma
Authors: Bhattarai S , Sapkota K , Prabhudesai SMN , Shrestha JK , Sharma AK
Published: March 2012

Background: Primary open angle glaucoma (POAG), a chronic, slowly progressive, optic neuropathy, is insidious in onset and painless, until it has caused a significant loss of vision and visual field. Diabetes mellitus and high myopia are the major risk factor of POAG. Objectives: To determine correlation of diabetes mellitus and high myopia in POAG and to estimate the duration of onset of POAG from the diagnosis of diabetes mellitus and high myopia. Method: This retrospective and cross sectional study was conducted in Prabhudesai eye clinic, Pune, India. All the patients diagnosed as POAG from 1st September 2008 to 1st March 2009 AD were included in this study. Association of high myopia with diabetes mellitus was determined by SPSS 13 software. The average duration of onset of POAG after the diagnosis of diabetes mellitus and high myopia was calculated. Results: There were 63.3% (38) male and 36.7% (22) female out of 60 patients of POAG with mean age 54.4±15.4 years. Among them, 27 (45.0%) patients had diabetes mellitus or high myopia. Onset of POAG was found to occur after 11.1±8.3 years of the diagnosis of diabetes and 10.6±3.2 years after the diagnosis of high myopia. Conclusion: The incidence of diabetes mellitus and high myopia was high and significantly associated in primary open angle glaucoma. POAG was detected soon after the onset of diabetes mellitus and high myopia. DOI: http://dx.doi.org/10.3126/hren.v10i1.6005 HREN 2012; 10(1): 35-39
Conjunctival flap revisited: is it only a temporary solution for difficult corneal diseases?
Authors: Sharma MK , Dhakwa K , Rai SKC , Kanskai I , Bhari AM , Karki R
Published: March 2012

Background: The conjunctival flap technique, first described by Gundersen in 1958 has not undergone any major modifications since then, except for some variations depending upon pathology and surgeons’ preferences. Objective: To show the importance of conjunctival (Gundersen) flap in different corneal diseases where keratoplasty is not possible immediately. Methods: Out of total 113 non-healing corneal ulcers of different etiologies, nine patients had undergone total conjunctival flap and the rest of the patients had partial conjunctival flap. Out of 104 partial flaps, 31 patients had bipedicle flap and 73 patients had pedicle conjunctival flap. Diagnoses for Gundersen flap surgery included chronic Non-healing infective keratitis with and without impending perforation(93) (fungal -30, no organisms on culture-42 and bacterial- 21), Neurotrophic keratitis(4),Herpes simplex keratitis(9),Bullous keratopathy(2),Infected nonhealing graft(2),presumed infective perforated keratitis(3)(anterior chamber formed after pad and bandage). Results: Eight flaps retracted due to ulcer necrosis out of which seven cases got perforated with complete healing of ulcer. One case had to be eviscerated due to panophthalmitis. One hundred five cases got cured. Conclusion: Conjunctival flap is the urgent and most reliable remedy (temporary or even permanent in some pathologies) for chronic nonresolving infective and presumed infective keratitis with or without impending perforation, neurotrophic keratitis, chronic herpes simplex keratitis, bullous keratopathy and persistent nonhealing epithelial defects where there are no immediate facilities for corneal transplantation. Conjunctival flap should be familiarized and emphasized as a primary and complementary surgical solution where penetrating keratoplasty or lamellar keratoplasty can’t be immediately performed due to lack of corneal tissue. DOI: http://dx.doi.org/10.3126/hren.v10i1.6006 HREN 2012; 10(1): 40-45
Laparoscopic cholecystectomy: an experience of university hospital in eastern Nepal
Authors: Bajracharya A , Adhikary S , Agrawal CS
Published: March 2012

Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall stones disease. Objective: To assess the safety of this procedure, to audit the conversion and bile duct injury rates and the factors which influence these. Methods: Demographics and ethnic group, conversion to open operation and bile duct injury recorded. Pre operative, operative and the relevant data collected prospectively. The X2 test to determine significance of any differences between subgroups. Results: A total of 346 laparoscopic cholecystectomy over a six months period (15 April 2010- 14October 2010), male to female ratio 1:4. The most common indication for surgery was biliary colic/dyspepsia (51%),cholecystitis (chronic- 49.4%, acute-12%), pancreatitis, gallbladder polyp, history of recurrent attacks 16.5%,obesity 19.1%. 128 were operated by consultant, 170 by junior consultants, 48 were by senior residents. There were no statistically significant difference found in the duration of surgery between consultants and junior consultants (P=0.264), however significant between consultants and senior residents (P=<0.001). Over all open conversion rate 2.9%, there was a single case of bile duct injury equating to a bile duct injury rate 0.3%. Conclusion: Despite limited resources, laparoscopic cholecystectomy is feasible and safety procedure for gallstones disease even in developing country like Nepal. DOI: http://dx.doi.org/10.3126/hren.v10i1.6007 HREN 2012; 10(1): 46-48
Elastics in orthodontics: a review
Authors: Singh VP , Pokharel PR , Pariekh K , Roy DK , Singla A , Biswas KP
Published: March 2012

For some decades elastics have been a valuable adjunct of any orthodontic treatment .Synthetic elastomers overcome various limitations of natural rubber. The use of elastics in clinical practice is predicted on force extension values given by the manufacturer for different sizes of elastics. Elastics can be used in various configurations for correction of a particular malocclusion. To minimize the plaque retaining capacity of elastomeric chains and risk of demineralization fluorides releasing elastomeric ligatures have been introduced. The elastics however don’t apply a continuous force over a interval of time due to the force degradation and are therefore inferior to Niti springs. There are increased incidences of latex allergies being reported in the literature and non latex products are available to overcome this limitation. It is very important for the orthodontist to educate the patient regarding the correct use of elastics as treatment results are dependent on patient cooperation. This article strives to summarize the currently available data on the various aspects of elastics including their properties, clinical usage and limitations. DOI: http://dx.doi.org/10.3126/hren.v10i1.6008 HREN 2012; 10(1): 49-56
Submucosal lipoma of the stomach – a rare benign gastric tumour
Authors: Agarwal RK , Regmi R , Paudel G , Pradhan A , Agarwal M , Agrawal CS
Published: March 2012

DOI: http://dx.doi.org/10.3126/hren.v10i1.6011 HREN 2012; 10(1): 62-63
Calcifying cystic odontogenic tumor- a unique developmental lesion arising in mandible
Authors: Vasudev S , Singh VP , Jhawar R , Roy DK
Published: March 2012

Calcifying cystic odontogenic tumor (CCOT) is a unique developmental lesion arising from the odontogenic epithelial remnants present in the jaw bones. It is a very rare lesion having a distinctive histopathologic appearance characterized by the presence of ghost cells with considerable amount of histopathologic diversity. The case report describes a rare and unusually large presentation of CCOT in an 18 year old female. The patient presented with a large swelling in the mandibular’ anterior region. After clinical, radiographic investigations, an incisional biopsy was performed and a diagnosis of CCOT was made. The cyst was enucleated with complete removal of cystic lining. The patient has recovered well and has been kept under observation. DOI: http://dx.doi.org/10.3126/hren.v10i1.6012 HREN 2012; 10(1): 64-68
Efficacy of intermaxillary fixation screws
Authors: Biswas KP , Ahuja A , Singh VP
Published: March 2012

Intermaxillary fixation (IMF) is a technique which is basically used for management of fracture.This includes IMF screws and various dental wirings. However IMF may not be advantageous in case of edentulous or partially dentulous patients. The purpose of this article is to report a case of unilateral parasymphyseal and zygomatic arch fracture managed successfully by IMF screws and to list the difficulties faced during the surgery. DOI: http://dx.doi.org/10.3126/hren.v10i1.6013 HREN 2012; 10(1): 69-71
A Structured Review and Classification of Demolding Issues and Proven Solutions
Authors: Delaney K. D. , Bissacco G. , Kennedy D.
Published: March 2012

The demolding of replicated parts can result in damage to both the replication tooling and finished parts and is a particular problem for the replication of smaller parts which can be quite fragile. Various techniques have been proposed in the literature to solve such problems by reducing the overall demolding force. This paper presents the challenge of demolding replicated parts and reviews the proven solutions from the literature which have been developed. A summary chart of these solutions is presented which may be used to implement plans to solve demolding problems with replicated parts. Such a rationalization of existing knowledge will enable replication tool developers to systematically select and apply proven solutions to solve, and ultimately prevent, demolding problems.
A Clean Method for the Synthesis of 1,2-Disubstituted Benzimidazoles through a Redox Reaction of o-Phenylenediamine and Aldehydes
Authors: Liu Yunyun , Wang Chunping
Published: March 2012

The reactions of o-phenylenediamine with aromatic aldehydes gave 1,2-disubstituted benzimidazoles in good to excellent yields under mild reaction conditions by using water as the reaction medium in the presence of 20 mol% FeCl3.
A Novel Porphyrin with a Two-Dimensional Topology and Highly Thermal Stability
Authors: Chen Wentong , Luo Zhigang , Chen Hualong , Kuang Hanmao , Liu Dongsheng
Published: March 2012

A novel iron porphyrin [FeTCPP] n [TCPP = meso-tetra(4-carboxyphenyl)porphyrin] has been synthesised via a hydrothermal reaction and structurally characterised. It has a two-dimensional structure and is thermally stable up to 320°C. UV–Vis, FT–IR and fluorescence data are also reported. Porphyrins have interesting roles in nature such as in green leaves and red blood cells, as well as applications in medicine, catalysis, optics, conductive materials, magnetism and solar energy conversion.
A Facile Synthesis of Novel Spiro Indoline-Based Heterocycles through 1,3-Dipolar Cycloaddition Reactions
Authors: Souzangarzadeh Saeid , Bazian Atiye , Anaraki-Ardakani Hossein
Published: March 2012

A simple and efficient one-pot route for the synthesis of novel spiro [indolin–3,3'-1,2,4-triazol] derivatives by 1,3-dipolar cycloaddition reaction of nitrilimines and isatin imines under classical or microwave irradiation conditions is described. Spiro heterocyclic compounds possess pharmacological properties such as antimicrobial, analgesic, anti-inflammatory, antimycobacterial, antifungal, antitumor and antiviral activities.
Synthesis of Thieno[2,3-d]Pyrimidines, Thieno[2,3-d]Triazinones and Thieno[2,3-e]Diazepinones of Anticipated Anti-Cancer Activity
Authors: Kandeel M.M. , Mounir Ashraf A. , Refaat Hanan M. , Kassab Asmaa E.
Published: March 2012

A novel series of 4-aminohexahydrocycloocta[4,5]thieno[2,3- d]pyrimidines, hexahydrocycloocta[4,5]thieno[2,3- d]-1,2,3-triazin-4-one and its N-3 substituted derivatives in addition to 3-aryl hexahydrocycloocta[4,5] thieno[2,3- e]-1,4-diazepin-5-ones were synthesised. Also, 2-(N-ethylcarbamothioylamino) hexahydrocycloocta[b] thiophene-3-carbonitrile and 19-imino tetradecahydrocycloocta[4’,5'] thieno[2’,3’:4,5]pyrimido[1,6- a] cycloocta[4,5]thieno [3,2- e]pyrimidine-9-thione were prepared. Almost all the synthesised compounds exhibited anti-tumour activity against human colon carcinoma (HCT 116) cell line in vitro. Five compounds (IC50: 15.92, 22.59, 25.85, 27.40 and 29.70 μM, respectively) exhibited 2.16 to 1.15 fold more potent antitumour activity than imatinib (IC50: 34.40 μM).
Correlation of Serum Level of Progesterone with Peak Expiratory Flow Rate (PEFR) in Different Phases of Menstrual Cycle
Authors: Mannan Sultana Rokeya , Begum Noorjahan
Published: March 2012

The present study has been carried out to observe the correlation of endogenous serum progesterone level with PEFR during luteal and follicular phases of two consecutive menstrual cycles. This study was conducted on 30 healthy young female volunteers with age ranges of 20- 24 years in the Department of Physiology of Bangladesh Shikh Mujib Medical University (BSMMU), Dhaka during July, 2005 to June, 2006. Serum progesterone level and PEFR of all subjects during all three phases of menstrual cycles were measured by ELISA method and a portable Spirometer respectively. Plasma progesterone level is highest during luteal phase; which is about 24 fold higher than that at follicular phases. (24.54ng/ml vs 1.4ng/ml). PEFR was positively correlated with progesterone level, but statistically not significant and it was significantly higher during luteal phase than follicular phase. This result indicates that changes in the pulmonary function occurred during different phases of menstrual cycle and this is more marked during luteal phase. DOI: http://dx.doi.org/10.3329/akmmcj.v3i1.10105 AKMMCJ 2012; 3(1): 6-9
Interesting Life Stories of Some Great Eponymous Anatomists
Authors: Amin NF , Uddin MM , Haque AQMA , Hossain MM
Published: March 2012

The word 'eponym' is derived from the Greek 'epi' which roughly means 'upon' and 'onyma' which means 'name'. Strictly speaking, an eponym is a word derived from the name of an actual person or a fictional or mythical character1. Eponyms have been officially excluded from anatomical nomenclature. Yet whether we like them or not, criticize them as archaic and unscientific, anatomical eponyms are still in current use, especially amongst clinicians2. The following paragraphs will cover the life events few famous eponymous anatomists who are renowned for their contribution to the field of anatomy. DOI: http://dx.doi.org/10.3329/akmmcj.v3i1.10109 AKMMCJ 2012; 3(1): 20-23
Gene Therapy: The Molecular Bandage for Treating Genetic Disorders
Authors: Karim Md Manjurul
Published: March 2012

The concept of gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ, with a view to curing a disease or at least improving the clinical status of a patient. Much of its success relies heavily on the development of an effective delivery system that is capable of efficient gene transfer in a variety of tissues, without causing any associated pathogenic effects. Viral vectors currently offer the best choice for efficient gene delivery, what has been discussed in this review article. Their performance and pathogenecity has been evaluated in animal models, and encouraging results form the basis for clinical trials to treat genetic disorders and acquired diseases. Despite some initial success in these trials, vector development remains a seminal concern for improved gene therapy technologies. DOI: http://dx.doi.org/10.3329/akmmcj.v3i1.10110 AKMMCJ 2012; 3(1): 24-27
Coexistence of Tubercular Lymphadinitis and Pleural Effusion - A Rare Presentation
Authors: Chowdhury A , Hoque M , Shaheeduzzaman M , Rokonudidn M , Chawdhury NA , Islam SM Monowarul
Published: March 2012

Tuberculosis (TB) is a prevalent systemic bacterial infection caused by Mycobacterium tuberculosis. In this article we are reporting a patient with bilateral pleural effusion and left sided neck swelling. Histopathologyof thc neck swelling diagnosed the case as tubcrculous lymphadcnopathy. Thorough investigation revealed no evidence of primary tuberculosis elsewhere, the patient improved dramatically within one month of `4 drugs combination of anti-tubercular therapy. The patient was asked to continue treatment till the prescribed period. There are limited global reports on the coexistence of tubercular lymphadenitis and pleural effusion and possibly this is the first case study from Bangladesh. DOI: http://dx.doi.org/10.3329/akmmcj.v3i1.10112 AKMMCJ 2012; 3(1): 31-33
Liver Enzymes In Diabetic And Non Diabetic Subjects With Clinically Diagnosed Hepatitis
Authors: Sarkar Bidhan Chandra , Saha Hasi Rani , Sarker Palash Kumar , Sana Niranjan Kumar , Sayeed M Abu , Choudhury Subhagata
Published: March 2012

The occurrence of liver disease and raised liver enzymes is common in diabetic patients and the increasing level of enzymes indicates the severity of hepatic injury. Very few studies have addressed this issue in Bangladesh though Bangladeshi population is very much susceptible to diabetes.This study investigated a total of 1400 diabetic patients and 100 non diabetic individuals to compare the level of liver enzymes between diabetic and non-diabetic subjects. The comparisons were made among subjects who were referred to the department of Gastro-hepato-pancreatic diseases (GHPD) of BIRDEM with the clinical diagnosis of chronic hepatitis and other gastro-intestinal disorders. The investigations included alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and bilirubin levels. The subjects were categorized with and without hepatitis based on these investigations.The biochemical markers (ALT, AST, ALP, bilirubin) did not differ significantly between nondiabetic male and female subjects. Neither the differences were significant between diabetic males and females though the diabetic patients had higher level of markers. In contrast, when compared between diabetic and non-diabetic subjects there were striking differences in either sex. Compared with the non-diabetic the diabetic subjects had significantly higher level of ALT (48.3 vs. 277.0), AST (42.0 vs. 213.0) and ALP (148 vs. 302) in males (p<0.005 for all). Similarly, these values were found significantly higher in diabetic females than their non-diabetic counterparts (p<0.01). For bilirubin, it was also found significant in males (p<0.001).The study revealed that the liver enzymes were found elevated in both diabetic and non-diabetic subjects who were referred with clinically diagnosed hepatitis. The enzymes were found markedly elevated among the diabetic than non diabetic patients, which indicate hepatic injury was more marked among the diabetic patients. Further study may confirm these findings. It is suggested that other socio-demographic and biophysical risk factors are important to be investigated in order to prevent increased hepatic damage among the diabetic subjects. DOI: http://dx.doi.org/10.3329/imcj.v5i2.10098 IMCJ 2011; 5(2): 46-50
Growth Of Very Low Birth Weight Infants And Its Association With Feeding Regimens
Authors: Haque Khan Mohammad Faizul , Chowdhury MAK Azad , Hoque Md Mahbubul , Maruf-ul-Quaeder Mohammed , Shirin Mahfuza , Hossain M Monir , Aziz Rumana
Published: March 2012

Clinical care of infants with very low birth weight (weighing<1500 gm at birth) in developing countries can be labour intensive and is often associated with a prolonged stay in hospital. Although several studies have shown the benefits of early discharge from the hospital for premature infants, it is still a common practice to delay discharge of these infants until they reach a weight of 2000 gm or more. The present study was undertaken to test the assumption that very low birth weight (VLBW) infants can attain optimum growth at home and to find its association with feeding regimens. This prospective observational study was conducted at Neonatal Out-patient Department, Dhaka Shishu Hospital over a period of 1 year from January 2010 to December 2010. A total of 92 very low birth weight neonates were enrolled during discahrge in the Neonatal Unit of Dhaka Shisu Hospital. Out of these 92 neonates 16 neonates expired while 7, 4 and 1 neonates dropped out in the first, second and third follow up respectively. The neonates after discharge were fed on three types of feeding regimens at home. The feeding regimens were expressed breast milk (EBM), EBM+ infant formula (mixed feeding) and infant formula only).The outcome variable was growth in terms of increase in weight, length and occiputo-frontal circumference (OFC). The other outcome measures were respiratory tract infection (RTI), diarrhoea and anaemia, visit to physician and readmission to hospital for the morbidities they encountered. The neonates were observed up to three consecutive follow-ups from their date of discharge. The median gestational age at birth was 31 weeks. Approximately 57% of the neonates were admitted within 72 hours of birth with median age at admission being 24 hours. Females were slightly higher (54.3%) than the males (45.7%). The mean weight, length and OFC at admission were 1208 gm 39.8 cm and 28.3 cm respectively. The study demonstrated a steady increase of weight, length and OFC of the infants up to a median age of 6 months with mixed and EBM feeding compared to infant formula group. Regarding RTI, diarhoea and anaemia the breast fed group suffered less frequently than the groups fed with infant formula and EBM+infant formula groups. The frequency of visits to physician and hospital admission were significantly lower in the EBM group than the other two groups. Higher frequency of breast feeding reduced the chance of infection and its severity. Infants discharged below1500 gm grew well with exclusive breast milk. DOI: http://dx.doi.org/10.3329/imcj.v5i2.10100 IMCJ 2011; 5(2): 54-58
Distribution Of Phenotypic And Genotypic Abo And Rhesus Blood Groups Among Bangladeshi Population
Authors: Dipta Tashmim Farhana , Iqbal Md Roushan , Hossain Ahmed Zahid , Rahman Md Tahminur , Chowdhury Subhagata
Published: March 2012

The present study is a retrospective analysis of allelic frequency of ABO and Rhesus (D) blood groups of donors attending the Deaprtment of Transfusion Medicine of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. BIRDEM IS a 625 bed hospital, where patients and blood donors come from all parts of Bangladesh. A total of 1, 28,506 blood donors of both genders were included in the study over fourteen years from June 1995 to June 2009 for analysis. Blood group was determined by performing the both tube and slide method blood grouping method. The distribution of blood groups in our population was B>O>A>AB in Rh positive groups donors and O>B>A>AB among Rh negative donors. Blood group B was more common among the males (37.42%) while O was predominant among female donors (33.83 %). On the other hand, blood group O negative was predominant in both genders (36.88%). In this study, Hardy- Weinberg equilibrium law was used to calculate the allelic frequency for ABO/ Rh system. Homozygous allelic frequency for Rh negative population was only 0.0007. Although phenotypically B group was dominant and AB was rare in our population, but according to Hardy- Weinberg equilibrium law the estimated allelic frequency of A (0.3694) and O (0.3040) showed higher frequency than B type (0.2300) in Bangladeshi population in both homozygous and heterozygous state. So, with increasing population of Bangladesh, this changing trend in estimated blood group in ABO system may play an important role in our genetic pattern. DOI: http://dx.doi.org/10.3329/imcj.v5i2.10101 IMCJ 2011; 5(2): 59-62
Emerging and Re-emerging Infectious Diseases: Bangladesh Perspective
Authors: Kahhar MA
Published: March 2012

DOI: http://dx.doi.org/10.3329/jom.v13i1.10041JOM 2012; 13(1): 1-2
Serum Lipid as a Risk Factor of Ischaemic Stroke in Bangladeshi People
Authors: Haque AKM Fazlul , Islam Quazi Tarikul , Rahman MD Khalilur , Tarik Mohammad Hassan , Ahmed Suraya , Das Aprna
Published: March 2012

Background: The incidence of cerebrovascular disease increases with age and the number of stroke is projected to increase as the elderly population grows. With the advancement of the health status of the Bangladeshi people gradually the segment of elderly populations is increasing and thereby inviting many diseases which are due to aging process. Stroke occurs when blood vessels that carry blood to the brain suddenly blocked or burst, preventing blood flow to the brain. The most common cause of blood vessel blockages are thrombosis (a blood clot) or an embolism (floating clot). Blood clots may form in the arteries that are damaged by atherosclerosis . Atherosclerosis is an aging process but some factors (risk factor) precipitate it to occur earlier. To find out the risk factors properly are of tremendous importance as risk factor change could directly influence or indirectly affect case fatality by altering the natural history of the disease. Serum lipids are thought to interact with the pathogenesis of stroke through atherosclerotic mechanism. As we the Bangladeshi people lives on rice mainly which is a carbohydrate food and we also usually do not practice regular exercise, so, though there is no clear statistical data but it can be presumed that serum lipids (cholesterol and triglyceride) of our people may be relatively in higher range and consequently we are gradually progressing to suffer from this fatal disease. Objectives: To identify the high serum lipid as an independent risk factor of stroke. Methods: This is a hospital based case-control study. Fifty (50) cases of stroke patients and age, sex matched 50 healthy control subjects were enrolled by non-random sampling. 12 hours fasting plasma lipids were estimated in both cases and control subjects. Then it was compared between cases and controls. Results: Hypercholesterolemia (raise of serum total cholesterol) was higher in case group than control (mean value 206 & 195.2 mg/dl respectively) but not statistically significant (>0.05). Mean LDL- cholesterol and triglycerides were significantly (P<0.05) higher in case group than control group (130.0mg/dl, to 106.3mg/dl & 230.7mg/dl, to 173.9mg/dl respectively). Mean value of serum HDL-cholesterol was not significantly lower is case group than control group (44.68 & 45.5 mg/dl respectively). Conclusion: Serum lipids are significantly higher in ischaemic stroke patients than control group (LDL cholesterol and triglyceride). So, it may be an independent risk factor of ischeamic stroke. DOI: http://dx.doi.org/10.3329/jom.v13i1.10043 JOM 2012; 13(1): 22-26
Effects of Activities of Daily Living (ADL) Instructions on Patient with Osteoarthritis of the Knee
Authors: Nobi MD Golam , Azad Abul Kalam , Ahmed Badrunnessa , Rashid Imamur , Islam Tariqul , Shakoor MA
Published: March 2012

This prospective experimental study was done in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical Universiry, Dhaka from 1st January 2008 to 31st July 2008 to observe the effects of ADL instructions on patients with osteoarthritis of the knee. A total of 60 patients with OA – knee were selected. Out of 60 patients 28(46.7%) were female and 32(53.3%) were male. The female to male ratio1.14:1. Age distribution varied from >40 years to <70 years with a mean age was 53.58 ± 6.86 years. Maximum patients 17(28.3%) belonged to age group of 56-60 years in both sexes and house wives were maximum in number 26 (43.3%).They were divided into two groups, 30 patients treated with therapeutic exercise plus NSAID and another 30 patients were with therapeutic exercise, NSAID and ADL. In both groups patients were treated for six weeks. In the present study, the group of patients who received NSAID, Exercise and ADL instructions improved more significantly than those who were not advised ADL instructions but received NSAID and exercise only (95% CI: 4.30 to 9.36, P = 0.001) .So, from the present study it may be concluded that activities of daily living instructions play a role to improve the symptoms of OA knee. DOI: http://dx.doi.org/10.3329/jom.v13i1.10044 JOM 2012; 13(1): 27-31
Spectrum of Neurological Disorders: Experience in Specialized Outpatient Clinic in Bangladesh
Authors: Chowdhury RN , Hasan ATM H , Rahman KM , Shyfullah M , Deb SR , Amin MA , Patwary SA , Miah T
Published: March 2012

Objective: To examine the burden of neurologic disorder as encountered in a specialized neurology clinic at tertiary care level. Methods: This retrospective study was carried out in specialized neurology outpatient clinic of Dhaka Medical College Hospital from July 2010 to June 2011, which included 3173 patients. Data were collected through a predesigned questionnaire from the hospital database kept at the clinic. Result: Among all the patients attending outpatient clinic, 88.7% had 44 types of neurological disorders. Distribution of disease was similar in all age group from 21-30 years to 51-60 years. Stroke (28.2%) and Headache (24.7%) were two most common neurologic disease, where headache was prevalent among female aged less than 30 years and stroke in male of >40 years. Epilepsy, peripheral neuropathy, Parkinson’s disease, pseudo vertigo were also present in a considerable number of patients. Patients with peptic ulcer (3.02%), anxiety neurosis (2.6%) and other non neurological disease were also given consultation in the clinic. Conclusion: Neurological diseases are not uncommon. Different diseases predominate in different age and sexes. Knowing pattern of disease distribution in community will help managing them properly. DOI: http://dx.doi.org/10.3329/jom.v13i1.10045 JOM 2012; 13(1): 39-42
Acute Confusional State: A Common Clinical Condition with Versatile Variability-A Prospective Study
Authors: Hossain Homayra Tahseen , Arefin Md Mshiur , Sultana Nusrat , Siddiqui FM
Published: March 2012

Acute confusional state account for a substantial proportion of admissions to emergency wards. As the etiology of acute confusional state are numerous and presentation also variable, so many time create confusion regarding the actual diagnosis and thus delay the prompt management which may result in fatal outcome. The objectives of this study was to explore the etiology and age & sex distribution of acute confusional state among hospitalized patients. In this prospective hospital based study, 345 adult patients presenting with acute confusional state were collected from medicine unit Dhaka Medical College Hospital during the period of July’08 to October’08. Patients known to have previous history of stroke, chronic dementing neurological disease were excluded from the study. This study revealed that, patients with acute confusional state constitute about 21% of total hospital admission in medicine wards. Peak incidence of acute confusional state was found to be in two age groups: one in 2nd to 3rd decades and another in 5th to 6th decades. The first peak was due to acute poisoning, CNS infection and hepatic encephalopathy; and the second peak was due to stroke, electrolyte imbalance, systemic infection and disturbance of glucose metabolism. This study also showed male preponderance over female and metabolic causes higher than the structural causes. Stroke comprised the highest percentage (25%) of cases in this series. DOI: http://dx.doi.org/10.3329/jom.v13i1.10047 JOM 2012; 13(1): 46-50
Probiotics: Should We Consider it in Therapeutics?
Authors: Patwary MD Ismail , Rahman MD Khalilur
Published: March 2012

Probiotics are receiving increasing attention in the medical field. This is partly due to the recognition that microbial resistance to antibiotics presents a serious world-wide problem. In addition, fast growing insight into host-microbe interactions opened new routes in the development of rational alternatives in therapy and prevention of diseases as result of the complex procaryotic-eucaryotic evolutionary symphony. Consequently, long existing aspects of probiotics came into focus, and already provide exciting prospects. DOI: http://dx.doi.org/10.3329/jom.v13i1.10049 JOM 2012; 13(1): 55-59
Emergency Medicine in Bangladesh  An Evolving Concept
Authors: Miah Md Titu , Imran Khan Mohammad Ashik , Ahasan HAM Nazmul , Gupta Ratan Das
Published: March 2012

DOI: http://dx.doi.org/10.3329/jom.v13i1.10054 JOM 2012; 13(1): 69-71
Spontaneous Chest Wall Hematoma - Unusual Presentation of Chronic Myeloid Leukemia
Authors: George Peter , Duble Shishir Nagesh , Hegde Narasimha
Published: March 2012

Chronic Myeloid Leukemia (CML) is known for the variety of its clinical presentations. We report on a 45 year old male, who presented with sudden swelling over chest wall on lifting weight; and clinically with pallor and massive splenomegaly. The peripheral, bone marrow smears; and chromosomal study confirmed CML. In this report, we have depicted interesting clinical, sonographic and microscopic images. To our knowledge, this is possibly the first report on CML presenting as spontaneous chest wall hematoma. DOI: http://dx.doi.org/10.3329/jom.v13i1.10082 JOM 2012; 13(1): 94-96
Laurence -Moon-Bardet- Biedl syndrome with Diabetes Mellitus
Authors: Quader Monzoor , Islam Mohammad Syedul , Uddin Ahmed Quazi Mamatz , Kalam Azad Md Abul , Rahim Md Abdur
Published: March 2012

A 13 year old boy presented with obesity, reduced vision, mental retardation, hypogonadism, delayed development and learning difficulty. On examination, he had polydactyly, moon face, bilateral gynaecomastia, small penis and testis. Retinitis pigmentosa was found on fundoscopy. With these typical features, he was diagnosed as a case of Laurence-Moon-Bardet-Beidle syndrome. It is a rare autosomal recessive disorder with mutation in 6 loci identified so far. It is commonly found in communities with high inter-family marriage. Clinical features appear early in childhood and diagnosis is usually done by puberty. Prominent features include rod-cone dystrophy leading to blindness, postaxial polydactyly, central obesity, learning disability, hypogonadism in males, renal dysfunction with increased risk for renal cell carcinoma. DOI: http://dx.doi.org/10.3329/jom.v13i1.10083 JOM 2012; 13(1): 97-99
Wilsons Disease: An Uncommon Presentation
Authors: Alam Md Billal , Biswas Shormistha , Biswas Mostakim , Rahman Ashrafur , Rahman Hafizur , Das Partha Pratim , Rahman Shahidur , Kabir Md Khyul
Published: March 2012

Wilson’s disease (WD), also known as hepatolenticular degeneration, is an inborn error of metabolism inherited as an autosomal recessive trait, characterized by toxic accumulation of copper in the body, particularly liver, brain and eyes. In children,WD presents more often with hepatic manifestations like acute hepatitis,cirrhosis of liver or liver failure.We present an unusual presentation of WD in a 15 years old male child who presented with neuropsychiatric manifestations without hepatic involvement. DOI: http://dx.doi.org/10.3329/jom.v13i1.10086 JOM 2012; 13(1): 103-105
An Uncommon Presentation of Myasthenia Gravis with Thymoma - A Case Report and Review of Literature
Authors: Hannan MA , Hassan Mohammad Sayeed , Begum Ayesha , Kabir AKM Nurul
Published: March 2012

Myasthenia Gravis (MG) is a rare disease of neuromuscular junction which typically presents with fatigable weakness of cranial and limb muscles. But patient may present with vague symptoms which may mislead physicians to an incorrect diagnosis. We are reporting a 45 year old cobbler presented with the complaints of lack of energy, aching pain in shoulder, back, upper arm and difficulty in swallowing of both solid and liquid food without any diurnal variation for two and half years. He was ultimately diagnosed as a case of MG and thymectomy revealed thymoma. DOI: http://dx.doi.org/10.3329/jom.v13i1.10087 JOM 2012; 13(1): 109-114
Pulmonary Hamartoma
Authors: Bairagya Tapan Das , Das Sibes Kumar , Bhattacharaya Somnath
Published: March 2012

DOI: http://dx.doi.org/10.3329/jom.v13i1.10093 JOM 2012; 13(1): 124
Incorrect Inhaler Technique Compromising Quality of Life of Asthmatic Patients
Authors: Hashmi Anjum , Soomro Jamil Ahmed , Memon Afzal , Soomro Tahira Kasur
Published: March 2012

Introduction: The inhalation route is widely used for the treatment of asthma. It is considered that inadequate inhaler technique is the leading cause of therapy failure. Objective: To determine the proportion of incorrect inhaler use and associated factors in asthmatic patients compromising quality of life.                   Methodology: It is a cross sectional study conducted at Specialist Chest Clinic Fatima Bhai Hospital Karachi from September 2010 to March 2011. A sample size of 215 was selected by Non-probability purposive sampling technique. Trained health care workers in presence Chest specialist requested patients to demonstrate their inhaler technique and assessed it according to the checklist. If any of the steps was missing or done incorrectly, it was marked as incorrect technique. Information was also collected through a structured questionnaire on socio-demographic variables such as age, gender, education, duration of asthma, duration of inhaler use, and patient education of inhaler technique. Data was entered and analyzed on SPSS-14. Results: There was an inverse relationship between education level and incorrect inhaler technique (p<0.05). Education of inhaler usage provided by doctors was more effective as compared to education provided by nurses (p<0.038). There was no significant relationship between age, sex, duration of asthma, duration of inhaler use, frequency of inhaler use and incorrect inhaler technique. Conclusion: Quality of life of a large percentage of patients is compromised by incorrect inhaler use and education level of patients had significant relationship with incorrect inhaler technique.DOI: http://dx.doi.org/10.3329/jom.v13i1.7980 JOM 2012; 13(1): 16-21
Deep Vein Thrombosis: A Rare Association with Tuberculosis.
Authors: Sarkar Supriya , Saha Kaushik , Maikap Malay Kumar , Jash Debraj
Published: March 2012

We are reporting two cases of bilateral extensive lower leg deep vein thrombosis in young male patients without any risk factors. First case was diagnosed as left sided tuberculous pleural effusion and second case was sputum smear positive pulmonary tuberculosis. In both patients, deep vein thrombosis developed during first month of treatment and inguinal pain was the first symptom. The second case had an attack of pulmonary thromboembolism. The cause effect relationship between deep vein thrombosis and tuberculosis or anti-tubercular drug (particularly rifampicin) has been discussed as such association may have significant therapeutic implications.DOI: http://dx.doi.org/10.3329/jom.v13i1.8843 JOM 2012; 13(1): 106-108
Study of Adenosine Deaminase Activity As A Biochemical Marker of Cell Mediated Immunity in Tuberculous Meningitis, Tuberculous Pleural Effusion and Tuberculous Ascites
Authors: Agrawal Shashikant
Published: March 2012

The present study conducted with the aim that ADA estimation is a simple cheaper and quicker biochemical test and could provide additional supportive evidence for the diagnosis of tuberculous meningitis, tuberculous pleural effusion, tuberculous ascites in clinically suspected cases and will therefore help in early institution of therapy to these patients. The data was collected and interpreted at department of Physiology and Department of Medicine Gandhi Medical College, Bhopal.DOI: http://dx.doi.org/10.3329/jom.v13i1.9065JOM 2012; 13(1): 32-38
Crystal Structure of 2-Ethylimidazole-1-sulfonyl Azide: A New Azidation Reagent
Authors: Laus Gerhard , Adamer Verena , Hummel Michael , Kahlenberg Volker , Wurst Klaus , Nerdinger Sven , Schottenberger Herwig
Published: March 2012

Crystalline 2-ethylimidazole-1-sulfonyl azide was designed as a convenient reagent with improved thermal stability for electrophilic azidation of carbanions. The compound crystallized in the monoclinic space group P21/c. The molecules are arranged into chains by short C–H...O contacts along a two-fold screw axis. The quaternary 1-azidosulfonyl-2-ethyl-3-methylimidazolium tetrafluoroborate crystallized in Fdd2 with two independent ion pairs which engage in C–H...F interactions.
Effects of Light and Temperature on Fatty Acid Production in Nannochloropsis Salina
Authors: Van Wagenen Jon , Miller Tyler W. , Hobbs Sam , Hook Paul , Crowe Braden , Huesemann Michael
Published: March 2012

Accurate prediction of algal biofuel yield will require empirical determination of physiological responses to the environment, particularly light and temperature. One strain of interest, Nannochloropsis salina, was subjected to ranges of light intensity (5–850 μmol m−2 s−1) and temperature (13–40 °C) and its exponential growth rate, total fatty acids (TFA) and fatty acid composition were measured. The maximum acclimated growth rate was 1.3 day−1 at 23 °C and 250 μmol m−2 s−1. Fatty acids were detected by gas chromatography with flame ionization detection (GC-FID) after transesterification to corresponding fatty acid methyl esters (FAMEs). A sharp increase in TFA containing elevated palmitic acid (C16:0) and palmitoleic acid (C16:1) during exponential growth at high light was observed, indicating likely triacylglycerol accumulation due to photo-oxidative stress. Lower light resulted in increases in the relative abundance of unsaturated fatty acids; in thin cultures, increases were observed in palmitoleic and eicosapentaenoic acids (C20:5ω3). As cultures aged and the effective light intensity per cell converged to very low levels, fatty acid profiles became more similar and there was a notable increase of oleic acid (C18:1ω9). The amount of unsaturated fatty acids was inversely proportional to temperature, demonstrating physiological adaptations to increase membrane fluidity. These data will improve prediction of fatty acid characteristics and yields relevant to biofuel production.
Isolation and Characterization of an Antibacterial Peptide Fraction from the Pepsin Hydrolysate of Half-Fin Anchovy (Setipinna taty)
Authors: Song Ru , Wei Rong-Bian , Luo Hong-Yu , Wang Dong-Feng
Published: March 2012

Enzymatic proteolysis of food proteins is considered a promising method to generate antibacterial peptides. The objective of the present study was to isolate and characterize peptide fraction from the pepsin hydrolysate of half-fin anchovy (Setipinna taty) with antibacterial activity against Escherichia coli. The most active peptide fraction HAHp2-3-I was isolated by a series of chromatographic methods, including Sephadex G-25 chromatography, reverse high-performance liquid chromatography (RP-HPLC) and Source 5RPC ST. Peptides identification of HAHp2-3-I was carried out using UPLC-LTQ-Orbitrap mass spectrometer. HAHp2-3-I contained five cationic peptides (MLTTPPHAKYVLQW, SHAATKAPPKNGNY, PTAGVANALQHA, QLGTHSAQPVPF and VNVDERWRKL) and three anionic peptides (LATVSVGAVELCY, NPEFLASGDHLDNLQ and PEVVYECLHW). Prediction of peptide secondary structure indicated that these anionic peptides should have extended strand and random coil structures, whereas cationic peptides PTAGVANALQHA and VNVDERWRKL could form alpha helixes. In addition, results of scanning electron microscopy (SEM) revealed that treatment by HAHp2-3-I could cause the morphological changes of E. coli and destruction of the cell integrity via irreversible membrane damage. The results could provide information for investigating the antibacterial model of antibacterial peptides derived from fish protein hydrolysates.
Synthesis of Amino Core Compounds of Galactosyl Phytosyl Ceramide Analogs for Developing iNKT-Cell Inducers
Authors: Huang Yin-Cheng , Chiang Li-Wu , Chang Kai-Shiang , Su Wen-Chin , Lin Yi-Hsian , Jeng Kee-Ching , Lin Kun-I , Liao Kuo-Yen , Huang Ho-Lein , Yu Chung-Shan
Published: March 2012

1-Aminophytosphingosine and 6-aminogalactosyl phytosphingosine were prepared in 61% and 40% yield libraries with 44 carboxylic acids showed that a 4-butylbenzoic acid-derived product exe, respectively. Glycosylation using benzoyl-protected lipid resulted in better a-selectivity for ceramide analogs, but the yield was less than that obtained with benzyl moieties. Screening the amide rted less cytotoxicity. These analogs were purified for validation of immunological potencies and the a-GalCer analog but not the sphingosine analog stimulated human iNKT cell population.