bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Hepatitis B virus among the physicians of Department of Medicine of Dhaka Medical College Hospital, Dhaka
Authors: Saha Jayanto Kumar , Azad Khan Abul Kalam , Hossain Mohammad Zaid , Amin Md Robed , Wazib Amit , Rahman Kazi Monisur
Published: July 2013

Introduction: Hepatitis B virus is encountered sporadically throughout the year in Bangladesh. Bangladeshi physicians are also in a great risk for this blood-borne virus. To find out the seroprevalence of HBV and vaccination rate among the physicians, was the aim of this study. Methods: The study was an observational study and was conducted in the department of Medicine of Dhaka Medical College Hospital, Dhaka between April and September, 2012. Eighty physicians of department of Medicine were searched for hepatitis B virus with the help of a structured questionnaire. Physicians, who were found not vaccinated, were also investigated for HbsAg positivity by ELISA method. Results: Eighty five percent physicians were found vaccinated. Remaining 15% (12/80) physicians were investigated for HbsAg positivity but all were found negative. Vaccinated physicians who checked antibody titre (35.3%), were found well immunized. Fifty percent physicians experienced needle stick injury 2-5 times in their lifetime and 20% physicians did not use protective equipments during any invasive procedure. Conclusion: HBV remains a major cause of morbidity and mortality in Bangladesh. Hence, our physicians who were not vaccinated and also found HbsAg negative, should complete their vaccination schedule as early as possible. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15540 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 11-15
A postmortem study on morphometry of the human stomach in a Bangladeshi population
Authors: Begum Gul Newaz , Nurunnabi Abu Sadat Mohammad , Shahriah Sunjida , Rayhan Khandaker Abu , Perven Hosna Ara
Published: July 2013

Context: A Cross-sectional, descriptive type of study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from July 2005 to June 2006, to see the variation in the size of the stomach with age in Bangladeshi people. Methods: The study was performed on 60 post mortem human stomach collected from unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into four age-groups including group A (2-16 years), group B (17-22 years) and group C (23-65 years). The length and breadth of each stomach were measured by using a measuring tape. Results: The mean length of the stomach were found 12.18±1.77 cm in group A, 17.74±1.95 cm in group B, and 25.31±1.63 cm in group C. The mean breadth of the stomach were found 6.81±0.40 cm, 8.26±0.57 cm and 9.54±0.45 cm in group A, B and C respectively. The differences between age groups were statistically significant (P<0.001). Conclusion: The length and breadth of the human stomach increase with age. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15598 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 16-18
Maternal outcome in premature rupture of membrane - a study done in the tertiary Level specialized hospital in Bangladesh
Authors: Adhikary Sanchita , Tanira Shaorin , Sultana Arifa , Wazed Feroza , Chowdhury Saleha Begum
Published: July 2013

Context: Premature rupture of membrane is defined as spontaneous rupture of membrane before the initiation of labour, which is one of the most common complications of pregnancy having a major impact on maternal outcome. The aim of the present study is to find out the effect of premature rupture of membrane on maternal outcome. Methods: A cross-sectional study was done in the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February to July of 2008, on 50 pregnant women with more than 28 weeks of pregnancy both primigravid and multigravid with rupture of membranes prior to labour. Women who were admitted with rupture of membranes with established labour, or having antepartum haemorrhage, pre-eclampsia or eclampsia were excluded from the study. Out of 775, 95 patients were admitted with history of premature rupture of membrane (PROM). Among those patients, 50 cases were included in this study as per inclusion and exclusion criteria. Results: In this study, onset of labour was spontaneous in 30 cases (60%), 35 cases (70%) developed labour within 24 hours of rupture of membranes and 2 patients (4%) had latent period exceeding 7 days. Among those 50 patients, 24 i.e. 48% (primigravida 12 and multigravida 12) had normal vaginal delivery and 26 i.e. 52% (primigravida 16 and multigravida 10) underwent Caesarean section. 5 patients (10%) developed puerperal sepsis (primigravida 1 and multigravida 4). DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15600 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 26-29
Health care practice and life pattern of elderly women attending in a selected geriatric hospital in Dhaka city
Authors: Begum Mahjabeen Sultana , Hossain Mohammad Zaid , Deb Sudip Ranjan , Khan Md Mosaraf Hossain , Rahman Mostafizur , Azad Khan Abul Kalam
Published: July 2013

Objective: The study was carried out to find out the health care seeking practice among the elderly women attending a selected hospital in Dhaka city. Materials and methods: This was a cross sectional study and included 164 women aged 60 years and above. The study was carried out from March to June, 2001, at Prabin Hitayishi Hospital, Bangladesh Associated of Aged and Institute of Geriatric Medicine (BAAIGM), Agargaon, Sher E Bangla Nagar, Dhaka. Results: In the present study, 58.5% women were aged less than 65 years, 51.2% were illiterates, 65.9% were married, only 7.3% were living with their spouse, 86.6% were housewives, only 9.8% had self income, 25.6% were earning between Taka 10,001 and 15,000 per month, and 41.5% were staying in families with 7 8 members, 90.2% had regular daily bath, 80.5% with soap, 90.2% brushed their teeth at least once a day, only 12.2% were taking regular exercise, 70.7% had knowledge about self health care, however, only 22% were on regular health check up, 12.2% women thought egg, milk, fish, meat and fruits were good for health. Regarding old age diseases, 43.9% knew about diabetes, 39% high blood pressure, 36.6% heart, 17.1% respiratory and 2.4% orthopaedic diseases. Most common diseases were eye (26.8%), cardiovascular and orthopaedic (19.5%) and ENT (14.6%). Other diseases were gastrointestinal (9.8%), respiratory (7.1%), dental and endocrine (4.9%). Conclusion: Old women of our society should be made aware on old age diseases and self health care practices. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15602 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 30-33
Study on weight of the postmortem parathyroid glands in a Bangladeshi population
Authors: Mahbub Sabiha , Nurunnabi Abu Sadat Mohammad , Alim Abdul , Ahmed Rukshana , Ara Shamim
Published: July 2013

Context: A cross-sectional descriptive type of study was designed to find out the difference in weight of the parathyroid glands of Bangladeshi people in relation to age and sex and to compare with the previous studies. Methods: This study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2008. The study was performed on 207 post mortem human parathyroid glands collected from 60 unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age-groups including group A (10-30 years), group B (31-60 years) & group C (61-90 years) and the weight of the parathyroids were measured and recorded. Results: The mean weight of the right superior parathyroid glands were 13.43±13.77 mg in group A, 13.86±19.15 mg in group B and 9.25±5.12 mg in group C in males and 16.00±6.69 mg in group A and 8.57±5.97 mg in group B in females respectively. The mean weight of the right inferior parathyroids were 17.78±13.94 mg, 16.75±15.67 mg and 23.00±11.53 mg in group A, B and C respectively in males and 26.00±4.18 mg in group A and 15.20±4.32 mg in group B in females. The mean weight of the left superior parathyroid glands were 13.63±6.08 mg in group A, 10.58±7.57 mg in group B and 11.00±3.74 mg in group C in males and 16.20±7.89 mg in group A and 8.29±5.47 mg in group B in females respectively. The mean weight of the left inferior parathyroid gland was 26.11±24.29 mg, 15.81±10.28 mg and 25.25±25.28 mg in group A, B and C respectively in males and 32.25±13.82 mg in group A and 13.29±5.41 mg in group B in females. No difference was found in the weight of superior parathyroid glands at right side between sexes and age groups excepting in superior and inferior parathyroid glands at left side between group A & B (p<0.05). DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15603 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 34-38
Correlation of pap smear and colposcopic finding of cervix with histopatholgiocal report in a group of patient attending in a tertiary hospital
Authors: Parvin Suraiya , Kabir Nazneen , Lipe Yeasmin Samad , Nasreen Khaleda , Alam KM Nurul
Published: July 2013

Objective: To correlate Paps smear and colposcopic finding of cervix with histopathological report of abnormal area of cervix in a group of patient attending a tertiary hospital. Methods: It was a cross-sectional prospective study done in one year period from January to December 2007 in Colposcopy Clinic of Institute of Child and Maternal Health (ICMH) Hospital, Dhaka. The study carried out including fifty two female patients having clinically unhealthy cervices as in the form of hypertrophy, erosion, congestion or bleeds on touch or having positive pap smear found during P/V or P/S examination, attending gynaecology out patient department of ICMH Hospital after fulfilling all the inclusion criteria. Result: The present study showed a correlation between cervical cytology and colposcopically directed biopsy, the correlation was accurate within one grade in 39 of 51 cases (76.16%) (as cytology was not done in one case). Other studies showed cytologic accuracy (within one level of histologic finding) to about 83% and 88% cases. Conclusion: The study done here shows excellent correlation between findings of colposcopy with that of histopathology of guided biopsy. It also confirms the diagnostic value of colposcopy in the management of women with abnormal cervical cytology with squamous atypia. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15604 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 39-44
Sociodemographical and clinical presentation of traumatic brain injury patients
Authors: Mondol Muhammed Alamgir , Rahman Nadia , Akhter Shohela , Ahmed Badrunnesa , Rahman Azizur , Momen Md Abdul , Rahman Mahmudur , Talukder Debesh Chandra
Published: July 2013

Background: Traumatic brain injury (TBI) is a non degenerative, non congenital insult to the brain from an external force, possibly leading to permanent or temporary impairment of cognitive, physical and psychosocial functions with association of diminished and altered state of consciousness. It accounts for approximately 40% of all deaths from acute injuries in the united state. Twenty percent of TBI occurs in the paediatric age young people and men aged about 15-30 are the high risk of population. The study is to define TBI appropriately, to know the causes of TBI, clinical presentations and severity of TBI patients in our hospital. Methods: A direct observational study was carried out from 18th July, 2010 to 31st December, 2010. Total numbers of patients were 100. A semi structured pretest questionnaire was used to take proper history, clinical assessment, their management and programs. Results: A total of 100 patients with traumatic brain injury (TBI) in which 84% were male and 16% were female. Out of 100 patients irrespective of sex it was observed that most patients that is 26% belongs to age group 26-35yrs then 24% belongs to age group 16-25yrs. Out of 100 patients 48% was RTA (Road traffic accident) then 28% was assault and 22% belongs to fall in. Out of 100 patients it was observed that most presenting complaints was unconscious 42%, headache 36% and vomiting 26%, mental functions i.e. unconscious 42% and 36% belongs to normal. 42% showed impaired motor and 20% sensory. 62% complaint unable to walk. Bladder dysfunction belongs to 64%. Conclusion: Traumatic brain injury accounts 40% of all death from acute injuries in the developed country. This percentage is now increasing in developing country like Bangladesh. So government and private organizations should setup more trauma centre and can enhance to decrease the adverse conditions. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15623 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 45-50
Study on liver arsenic level in antibiotic treated rats
Authors: Choudhry Zubaida Khatoon , Afrin Munira , Saleh Ahmed Abu , Mojlish UKF
Published: July 2013

Rats treated with arsenic (1mg/L) in drinking ad libitum an increase in liver tissue arsenic was observed when orally pretreated with streptomycin (500mg twice daily). Inhibition of gut flora was confirmed by microscopic examination of stool. Control group showed a mean gut-bacterial count of 7.13-7.26×108cfu/g dry weight of stool, when administered with streptomycin orally (500mg twice daily) gut-bacterial count was not countable on day 7. Liver tissue arsenic level increased to 5.78 mg/g of liver tissue compared to that of the control group of 3.33mg/g of liver tissue. A decrease in gut-bacterial count of 2.83×108 cfu/g dry weight of stool was observed on day 14 in rats that were not pretreated with streptomycin but received only arsenic (1mg/L) in drinking water ad libitum throughout the study period. Increase in liver arsenic level in this group was almost similar to that of streptomycin pretreated rats. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15624 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 51-54
Sensitivity pattern of azithrymycin, ofloxacin and ceftriaxone in ciprofloxacin resistant salmonella causing enteric fever
Authors: Kawser Shamima , Miah Ruhul Amin , Sabah Khandker Md Nurus , Begum Tanzima , Sultana Shahin
Published: July 2013

The therapeutic alternatives available for use against ciprofloxacin resistant enteric fever isolates in an endemic area are limited. A cross sectional study was carried out in the Department of Microbiology & Immunology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from January to December 2008, to see the sensitivity pattern of azithrymycin, ofloxacin and ceftriaxone in ciprofloxacin resistant salmonella causing enteric fever. In this study, the MICs of various drugs were determined for 100 enteric fever isolates (72 Salmonella enterica serovar Typhi and 28 Salmonella enterica serovar paratyphi A). By agar dilution method, 40% Salmonella strains were ciprofloxacin resistant showing MIC values of (4-8 mg/ml), 36% strains were intermediate sensitive with MIC values of 1 to 4 mg/ml and 24% strains were sensitive to ciprofloxacin showing MIC values of 0.125 to 1 mg/ml. All ciprofloxacin- resistant isolates were sensitive to ofloxacin (inhibitory zone diamater 16-32mm), ceftriaxone (inhibitory zone diameter 21mm), 66.66 % isolates were sensitive to azithromycin. These results indicate that ofloxacin and ceflriaxone may be convenient alternative antimicrobial agents for Salmonella isolates. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15627 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 55-60
Breast cancer and some epidemiological factors: a hospital based study
Authors: Jabeen Suraiya , Haque Musarrat , Islam Md Johirul , Hossain Mohammad Zaid , Begum Atiya , Kashem Md Abul
Published: July 2013

Objective: The aim of this study was to determine risk factors associated with breast cancer in the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh. Methodology: A case control study was conducted from July 2009 to June 2010, on 262 biopsy proven cases of breast cancer from National Institute of Cancer Research and Hospital and 262 matched controls of acute diseases from Dhaka Medical College Hospital. Religion, residential status and age (±2 years) were matched. Statistical analysis was carried out using conditional logistic regression, odds ratios, chi-square and t- test with SPSS software (V-17). Results: Multivariate analysis showed that higher education (OR=1.72), personal income (OR=5.71), history of induced abortion (OR= 20.62), history of breast feeding (OR= 7.91), OCP users (OR= 1.47), current smokers (OR=6.78), personal history of breast disease (OR=10.99), family history of breast cancer (OR=3.85) and family history of other cancer (OR=2.21) were risk factors for breast cancer. Furthermore, having menarche at an early age (OR=0.35), giving birth to an early age (OR= 0.35), early menopause (OR= 0.22), longer duration of breast feeding (OR=0.30), parity of 2 and more (OR=0.29) and regular physical activity (OR=0.58) were shown to be protective factors. Conclusion: Physical inactivity, being menopause, positive family history of breast cancer and history of induced abortion were found important risk factors. Longer duration of breast feeding should be encouraged for its protective effect. Study revealed that the women who have one or more of the above risk factors should be given special attention for breast cancer prevention DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15628 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 61-66
Outcome of grand multi-gravidity & multiparity A retrospective study
Authors: Akther Rabeya
Published: July 2013

Objective: To examine the obstetric outcome in grand multi-parous and the effect of high parity among young women, aged 18-34 years vs. older women, aged 35years and above. Methods: This is a retrospective study done in DMCH from 1st August 2007 to 31st August 2008. For study purpose 98 patients were selected randomly whose gravidity 6th and more. To see peri-natal outcome, the cut-off point of 28 weeks was taken. Results: Mean age of the study group was 32(22-45) years. Mean gravidity and parity of the study group was 6.7 (6-11) and 4(1-8) respectively. Ninety percent pregnancy affected by different complications. Hypertensive disorder of pregnancy (14.3%) and ante-partum hemorrhage (14.3%) was more common. Bad obstetric history (12.35%), mal-presentation (11.23%) and intra-partum complications were also common. Twenty two percent (22.46%) pregnancies complicated by gestational diabetes, maternal medical disease and multi-fetal gestation. Regarding fetal outcome, peri-natal loss was 10(14%). Preterm delivery, ante partum hemorrhage, bad obstetric history, gestational diabetes and mal presentation were the cause of peri natal loss. Lack of reproductive knowledge, unmet need for contraception, poor obstetric performance and too early marriage are the main cause of grand multi-gravidity and multi-parity Conclusion: Diabetes mellitus, hypertension, ante partum hemorrhage, mal-presentation was more common in grand multi-parous irrespective of age. There was no significant difference in the incidence of obstetric complications and in perinatal outcome among both groups. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15629 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 67-71
Skeletal manifestations of hypoparathyroidism & spondylo-arthropathic features in hypoparathyroidism
Authors: Azad Khan Abul Kalam , Hossain Mohammad Zaid , Hussain Tahmeed , Ahmad Jamia , Abdullah Md Shayekh , Islam Mohammad Shaiful
Published: July 2013

Hypoparathyroidism is a condition where level of parathyroid in blood is very low or undetectable. Hyporapathyroidism is associated with structural changes in bones and can present clinically with spondylo-articular features. This review focuses on the skeletal manifestations of hypoparathyroidism & spondylo-arthropathic features in hypoparathyroidism, understansding the histomorphological and microscopic changes in bone, spondylo-articular changes, and the diseases which mimic spondyloarticular features of hypoparathyroidism. Spondylo-articular features of hypoparathyroidism can resemble ankylosing spondylitis. It is important to differentiate hypoparathyroid-related spondyloarthropathy from ankylosing spondylitis because the management for the two disorders is different. The clinical profile, biochemical parameters, and radiological features aid in differential diagnosis. Studies have suggested several patterns to differentiate this clinical entity from ankylosing spondylitis. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15630 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 72-76
Pseudomonas aeruginosa infection in cystic fibrosis patients
Authors: Ahmed Syed AK Shifat , Dooley James SG , Deb Sudip Ranjan , Talukder Debesh Chandra , Hossain Sheikh Shahinoor , Anwar ASM Tanim
Published: July 2013

Cystic Fibrosis is an autosomal recessive genetic disease where the lung is heavily colonized by biofilm forming Pseudomonas aeruginosabacteria. Biofilm due to its thick wall and presence of extracellular polymeric substances confers bacteria with a much higher resistance against antimicrobial compounds and environmental stress. Research has revealed the presence of extracellular DNA (eDNA) in significant amounts in the biofilm walls of such bacteria. Although the exact role of eDNA has not been elucidated but research prompts that eDNA to have significant role in stabilizing the biofilm complex structure as well as providing the bacteria with resistance against antimicrobial and antibiotic compounds. The presence of eDNA prompted research to use DNase as a biofilm destabilizing agent. Under experimental conditions, DNase has shown to dissolve early forming biofilm walls especially when used in combination with antibiotics therefore suggesting the use of DNase as an effective treatment strategy in CF patients. But ambiguity arises when some recent studies showed that P. aeruginosa can opportunistically use DNase for its survival advantage by using the enzyme to access phosphate, carbon and nitrogen constituentsof the DNA in nutrient limited conditions; and also by using the DNase to degrade the DNA component of neutrophil extracellular traps. These apparent contradictions call for more thorough investigations into the role of eDNA and DNase in CF biofilm infection. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15689 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 77-86
Penetrating injury extending from oral cavity to the neck - with an indigenous weapon
Authors: Talukder Debesh Chandra , Islam MZ , Khan MAS , Rahman Atiar
Published: July 2013

A penetrating injury that extends from oral cavity deep into the right side of the neck. It is a diagnostic and a therapeutic challenge to the treating surgeon, because a number of important structures are densely packed in a small area, and the injury to any of these structures may immediately cause a life threatening situation. We are describing an interesting case, where a 55- year old man presented with a penetrating neck injury which was caused by an indigenous weapon , which ran from the oral cavity to the right side of the neck, X ray revealed the elongated pointed tip foreign object ran through oral cavity to the level of the body of 7th cervical vertebrae. The patient was found to have stable vitals and no active bleeding from the wounds; exploration of the neck was done under General aneasthesia with endo tracheal intubation through tracheostomy opening . The weapon was dislodged from the bamboo made handle , and retrieved under direct vision. Surprisingly, there were no injuries to any vital structures of the neck. The patient made an uneventful recovery. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15690 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 87-89
Bullous systemic lupus erythematosus  a case report
Authors: Ali Chowdhury Mohammad , Kamal SM Bakhtiar , Khan Md Mosaraf Hossain
Published: July 2013

Bullous systemic lupus erythematosus (BSLE) is a rare but distinct disease, characterized by vesicobullous skin eruptions in systemic lupus erythematosus (SLE). It can arise either before or after a diagnosis of SLE has been established. BSLE is characterized by a dermatitis herpetiformis-like histology and an autoimmunity to type VII collagen. It must be differentiated from other autoimmune vesicobullous diseases such as epidermolysis bullosa acquisita, dermatitis herpetiformis, linear IgA disease, and bullous pemphigoid. A combination of clinical, histological, and immunofluorescence findings are necessary to establish a diagnosis of BSLE. We present a case of BSLE to illustrate and emphasize the need for an integrative diagnostic approach. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15691 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 90-92
Palindromic rheumatism - an unusual Presentation of rheumatoid arthritis
Authors: Biswas Sarmistha , Rahman Anonnya , Das Partha Pratim , Karim Md Enamul , Khan Abed Hussain , Afrose Rafia , Dey Pritam
Published: July 2013

We have reported a 24 years old woman presenting with recurrent episodes of joint pain, weakness and fever for last one and half year. Each episode persists for 3/4 days and intervals between episodes are variable. Laboratory investigations showed positive RF and anti-CCP. Each episode remits spontaneously with some NSAIDs. The case high lights the need of accepting Palindromic presentation of early Rheumatoid arthritis and it is not very rare as we think. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15707 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 93-95
A case of cushings disease evaluated by Inferior petrosal sinus sampling  a novel Approach in bangladesh
Authors: Prasad Indrajit , Ansari MA Jalil , Rahman Kazi Mohibur , Saha Joysree , Hossain Mohammad Zaid , Talukder Debesh Chandra
Published: July 2013

A 16 years old boy presented to the Department of Endocrinology, Sir Salimullah Medical College & Mitford Hospital with the complaints of occasional headache, vomiting and gradual weight gain for the last 5 years. He was overweight & has moon face, lipomastia, striae over the abdomen. His random blood sugar was 15 mmol/l, serum potassium was low, no suppression of serum cortisol on low dose 1mg dexamethasone suppression test (297 nmol/l)(cut of <140 nmol/l), loss of diurnal rhythm of serum cortisol (morning 430 nmol/l, midnight 992 nmol/l), 24h urinary free cortisol in the upper limit of normal (164mcg), modest elevation of serum adrenocorticotropic hormone (ACTH) (59.7 pg/ml), no significant gradient of serum ACTH level between internal jugular and femoral vein, normal adrenal glands on computed tomography (CT) abdomen, pituitary microadenoma on magnetic resonance imaging (MRI) of Sella. On above clinical examination and, investigation he was diagnosed as Cushings disease with diabetes mellitus. This patient was referred to department of neurosurgery for surgical management. The patient is now on medical treatment. Ketoconazole for hypercortisolism, lifestyle modification and metformin for diabetes mellitus. He is expected to have the neurosurgical treatment shortly. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15708 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 96-101
Families with neurocutaneous syndromea - Report of two cases
Authors: Saha Radheshyam , Mahmud Reaz , Hossain Mohammad Zaid , Sarkar Prodip Kumar
Published: July 2013

CorrigendumThe Article "Families with neurocutaneous syndromea - Report of two Cases" was published in JDMC Vol.22(1) in April 2013. The name of one of the authors was written 'Prodip Kumar Sarker', which is to be read as 'Prodip Kumar Sarkar'. (4th August 2014)Neurocutaneus syndrome is inherited as autosomal dominant condition.Tuberous sclerosis is one of the important neurocutaneous disorder characterized by development of widespread hamartomatous lesions involving skin, brain, kidney, retina etc. Recently we came across two cases of tuberous sclerosis. Both cases presented with status epilepticus and had a positive family history but the first case also had family history of neurofibromatosis. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15709 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 102-107
Au risque de créer
Authors: Gutton Philippe
Published: July 2013

L’héroïsation de l’adolescence comprendrait deux processus, l’un est de l’ordre de la création d’intersubjectalisation construisant les idéaux d’adolescence, l’autre place cette construction en face à face avec le regard du monde infantilo-adulte institutionnalisé en Surmoi sociétal. Le héros serait celui qui se refuse à succomber malgré le discours du maître qui le désavoue dans un breakdown lauferien et plaide, dressé, sa cause adolescente.
Travail du héros
Authors: Aubray Marie-Christine , Agostini Dominique
Published: July 2013

Pour questionner les liens entre travail d’adolescence et travail du héros, les auteurs font se rencontrer un héros mythique Héraclès et le héros adolescent Arkadi de Dostoïevski. Devient héros, l’adolescent qui sortira vainqueur des épreuves du pubertaire, pour s’engager dans le processus adolescens. Ce passage impliquant la rencontre de deux apories : parricide/infanticide et mortalité/immortalité.
Du héros tragique au héros ordinaire
Authors: Bonnet Gérard
Published: July 2013

Homère privilégie deux types de héros : celui d’Achille dans l’ Iliade , qui magnifie le combat à mort et a fait bien des émules au cours de l’histoire, et puis celui qu’incarne Ulysse dans l’ Odyssée où le héros s’illustre en déjouant les obstacles qu’il rencontre sur la route du retour vers son lieu d’origine. D’un côté nous avons une lutte duelle qui certes entraîne la notoriété, mais provoque la destruction de l’une des deux parties en présence, et de l’autre, un combat de tous les instants du héros pour sauver sa vie et retrouver sa place dans la cité. Le premier privilégie le regard et se soumet aux exigences du paraître, le second au contraire s’en prend d’abord à l’œil qui le domine et en démonte les rouages pour se donner un nom. Le processus adolescent participe de ces deux parcours à la fois, et suppose le dégagement progressif de l’emprise du voir qui fait miroiter l’idéal. En se référant à diverses œuvres littéraires, l’auteur montre à quelles conditions cette évolution est possible.
Constructions du héros à l'adolescence
Authors: Monniello Gianluigi
Published: July 2013

Deux définitions significatives de L. Arioste et de B. Fioretti sont utilisées par l’auteur pour décrire d’abord , le besoin naturel de construire , au niveau imaginaire, la figure du héros en tant que contribution possible au fonctionnement psychique adolescent et en tant que référent adéquat imaginaire pour se créer et pour créer sa propre ars vivendi  ; ensuite , pour souligner que la rencontre avec l’adolescent implique aussi la présence en lui de quelque chose qui va au-delà du processus naturel de construction , inhérent au développement et du jouer à faire le héros de l’enfance. L’auteur décrit trois possibles forces co-existantes vers l’héroïsme, avec des résultats très différents, qui s’ouvrent aux adolescents. La première poussée , réactive, est celle de continuer courageusement la recherche et la reconquête des valeurs du passé ; la deuxième poussée , positive et différenciatrice, invite l’adolescent à se détacher des mondes qui l’ont engendré et de leurs influences internes et externes ; la troisième , créative, est celle-là qui le rend fidèle à ses expériences sensorielles originaires en le poussant, inconsciemment, « à faire ce qu’il peut ».
Héros et adolescents
Authors: Carbone Paola
Published: July 2013

Cet article tente de répondre à deux questions : qui est « le héros » ? et quel est le rapport de la question héroïque avec l’adolescence ? Pour rencontrer les héros dans leur essence originaire, l’auteur retourne à l’ Iliade et l’ Odyssée , et repère certaines caractéristiques fondamentales qui identifient profondément la mission héroïque à celle de l’adolescence. Les deux poèmes organisés autour des dimensions narratives du siège et du voyage représentent assez bien les lignes de force le long desquelles se décline l’expérience adolescente. Le fil rouge de l’exposé se noue autour de quatre thèmes articulés en couples dialectiques : la Préhistoire et l’Histoire, l’Unique et le Double, le Cercle et l’Ellipse, la Vie et la Mort. Le mythe du héros – dans cette perspective – est le moyen grâce auquel il est possible de tenter une confrontation laïque avec la mort, confrontation qui paradoxalement représente un des points cardinaux du processus adolescent.
De Hector à Énée, via Achille
Authors: Baldini Tito
Published: July 2013

L’analyste qui accompagne l’adolescent dans son parcours vers l’âge adulte, s’identifie dans le transfert à une sorte de « Hector » et vit le parcours analytique de son patient comme une transfiguration de son être « Achille » vers son devenir « Énée », seul héros qui accède à un âge adulte satisfaisant. Le recours aux textes de l’Antiquité et aux figures mythologiques du héros offre en effet des supports et représentations utiles au travail avec les adolescents, notamment en permettant de faire évoluer le transfert et le contre-transfert.
Hacker vaillant
Authors: Cornalba Vincent
Published: July 2013

Dans cette étude, l’auteur rappelle le lien indéfectible entre la figure du héros et le destin qui lui est réservé. L’adolescent, confronté à cet exemple aux vertus à la fois structurantes et angoissantes, peut être conduit à solliciter le droit à l’anonymat tout en revendiquant une inscription héroïque. C’est ce que le mouvement des Anonymous , au-delà des objectifs manifestes qu’il poursuit, semble représenter. L’enjeu serait de parvenir à dissocier acte héroïque et destin du héros, relevant le refus chez le sujet de payer le tribut exorbitant d’un héroïsme qui pourtant nourrit la recherche en subjectivation. Le régime de l’impossible lui servirait de toile de fond et constituerait, de ce fait, la véritable question pour l’adolescent.
Meurtre héroïque et identité hybride à l'adolescence
Authors: de Kernier Nathalie , Abe Yuichiro
Published: July 2013

Le héros à l’adolescence surgit régulièrement dans la clinique et dans la littérature. L’ infans apparaît comme une figuration nécessaire de l’identité hybride de l’adolescent, passage nécessaire pour se défaire de son emprise. Cette déprise implique un meurtre symbolique, particulièrement héroïque. Le passage à l’acte est à entendre comme une quête de symbolisation de ce meurtre.
Père mort et père imaginaire dans la résurgence œdipienne chez un adolescent
Authors: Léon Julien
Published: July 2013

À l’adolescence, la destitution naturelle du père imaginaire permet le remaniement des fixations œdipiennes et le dépassement de la sexualité infantile. L’auteur évoque ici la difficulté d’une telle opération, quand la figure du père imaginaire renvoie à un père mort idéalisé. L’enjeu thérapeutique consiste alors à offrir une possibilité d’élaboration transférentielle à l’adolescent pour qu’il se défasse de cette prégnance du père imaginaire, étape cruciale pour le sujet en devenir.
Temporalités autistique, adolescente et virtuelle : à la croisée de trois mondes
Authors: Aubertin Solène , Haza Marion
Published: July 2013

Le virtuel est souvent décrié comme un nouvel objet d’addiction pour les adolescents. Nous aborderons ici le point de vue selon lequel cet outil favoriserait l’élaboration de la capacité dépressive avant une mise en « Je » dans le réel. Écran et corps du sujet, l’ordinateur serait un premier lieu de symbolisation afin d’accéder à une véritable subjectivation. Amenant dans un autre espace et dans un autre temps, le virtuel permettrait d’aborder autrement la question de la temporalité relative à la problématique de la perte. La perte de l’objet engendrant l’avènement du « Je », de quelle manière le virtuel peut être un nouveau lieu d’appropriation de l’absence ? Comment peut-il permettre le passage d’une intemporalité à une atemporalité ? Cette idée sera éclairée par le cas d’un jeune autiste comme archétype de la question de la perte ainsi que de celle du passage de l’imaginaire au réel.
Le sujet ce héros. Mais comment rentrer dans la ronde ?
Authors: Carrive Laurent
Published: July 2013

Cet article se propose d’aborder les problématiques adolescentes de l’acte et ses thématiques associées, la solitude et l’échec, à partir de leurs liens psychanalytiques avec la structure du mythe du héros. Dans un premier temps, nous rappellerons en quoi l’adoption par Freud du mythe d’Œdipe reste une démarche épistémologique d’une grande cohésion, présageant encore de riches enseignements. Nous expliciterons ensuite l’analogie fondamentale à établir entre la structure circulaire de la causalité mythique et le processus œdipien de subjectivation. Enfin, nous montrerons que la réactivation du complexe d’Œdipe à l’adolescence laisse apparaître le lien structurel profond, reliant Œdipe, héros tragique, à la science moderne.
Trajet d'une relation clinique avec un adolescent créateur
Authors: Guillier-Pasut Nathalie , Derivois Daniel
Published: July 2013

L’adolescent est extrêmement sensible à sa rencontre avec l’autre, à la fois très investie et fortement redoutée. À partir de la rencontre avec un adolescent accueilli en unité d’hospitalisation dans le champ de la psychiatrie infanto-juvénile, et au travers d’une réflexion sur les enjeux méthodologiques d’un dispositif thérapeutique, cet article interroge le trajet, pas à pas, de la relation clinique.
Héros par procuration
Authors: Brousselle André
Published: July 2013

Le film Dans la maison met en scène un professeur écrivain par procuration à travers un élève doué, qui lui ne peut vivre qu’à travers les personnages qu’il observe, et doit transformer en héros de roman. Le doute vient que l’analyste pourrait aussi vivre par procuration grâce à ses patients devenus, sinon héros de roman, tout au moins personnages de vignettes cliniques.
Homère et le tennis, le foot, la musique
Authors: de Azambuja Miguel
Published: July 2013

Roger Federer, Rafael Nadal, deux héros antinomiques, aux qualités contraires. L’un est elfique, l’autre est massif, l’un est élégance, l’autre est tellurique. Lointains descendants d’Ulysse et d’Achille, les héros marchent souvent par deux, à la fois indissociables et complémentaires. La psyché aurait-elle besoin d’une telle bipartition ?
Le théâtre de Facebook : réflexion autour des enjeux psychiques pour l'adolescent
Authors: Gozlan Angélique , Masson Céline
Published: July 2013

Les adolescents se retrouvent sur la toile après les cours. Les réseaux sociaux, et notamment Facebook, prennent une large place dans leur vie virtuelle. L’univers virtuel apparaît comme une véritable plateforme de jeux et d’enjeux pour l’adolescent. Nous envisagerons une partie du dispositif Facebook, dans cet article, comme un théâtre de soi, une scène en soi et pour soi. Parler de Facebook comme d’une scène où l’adolescent s’expose, présuppose qu’il y a un spectacle à voir, et nous pouvons nous demander s’il ne s’agit pas du spectacle du moment adolescent, de la projection de certains fantasmes, de scénarios internes qui nous sont permis d’entrevoir par la fenêtre de Facebook. Nous développerons au travers du cas d’Elisa comment Facebook peut devenir un lieu propre à l’adolescent, une interface sur laquelle se met à distance l’effroi adolescent tout en proposant un lieu d’identification aux pairs.
Plasma B Lymphocyte Stimulator and B Cell Differentiation in Idiopathic Pulmonary Fibrosis Patients
Authors: Xue Jianmin , Kass Daniel J. , Bon Jessica , Vuga Louis , Tan Jiangning , Csizmadia Eva , Otterbein Leo , Soejima Makoto , Levesque Marc C. , Gibson Kevin F. , Kaminski Naftali , Pilewski Joseph M. , Donahoe Michael , Sciurba Frank C. , Duncan Steven R.
Published: July 2013

We hypothesized B cells are involved in the pathogenesis of idiopathic pulmonary fibrosis (IPF), a progressive, restrictive lung disease that is refractory to glucocorticoids and other nonspecific therapies, and almost invariably lethal. Accordingly, we sought to identify clinically associated B cell–related abnormalities in these patients. Phenotypes of circulating B cells were characterized by flow cytometry. Intrapulmonary processes were evaluated by immunohistochemistry. Plasma B lymphocyte stimulating factor (BLyS) was assayed by ELISA. Circulating B cells of IPF subjects were more Ag differentiated, with greater plasmablast proportions (3.1 ± 0.8%) than in normal controls (1.3 ± 0.3%) (p < 0.03), and the extent of this differentiation correlated with IPF patient lung volumes (r = 0.44, p < 0.03). CD20+ B cell aggregates, diffuse parenchymal and perivascular immune complexes, and complement depositions were all prevalent in IPF lungs, but much less prominent or absent in normal lungs. Plasma concentrations of BLyS, an obligate factor for B cell survival and differentiation, were significantly greater (p < 0.0001) in 110 IPF (2.05 ± 0.05 ng/ml) than among 53 normal (1.40 ± 0.04 ng/ml) and 90 chronic obstructive pulmonary disease subjects (1.59 ± 0.05 ng/ml). BLyS levels were uniquely correlated among IPF patients with pulmonary artery pressures (r = 0.58, p < 0.0001). The 25% of IPF subjects with the greatest BLyS values also had diminished 1-y survival (46 ± 11%), compared with those with lesser BLyS concentrations (81 ± 5%) (hazard ratio = 4.0, 95% confidence interval = 1.8–8.7, p = 0.0002). Abnormalities of B cells and BLyS are common in IPF patients, and highly associated with disease manifestations and patient outcomes. These findings have implications regarding IPF pathogenesis and illuminate the potential for novel treatment regimens that specifically target B cells in patients with this lung disease.
Tick-Borne Encephalitis (TBE) and Hepatitis B Nonresponders Feature Different Immunologic Mechanisms in Response to TBE and Influenza Vaccination with Involvement of Regulatory T and B Cells and IL-10
Authors: Garner-Spitzer Erika , Wagner Angelika , Paulke-Korinek Maria , Kollaritsch Herwig , Heinz Franz X. , Redlberger-Fritz Monika , Stiasny Karin , Fischer Gottfried F. , Kundi Michael , Wiedermann Ursula
Published: July 2013

Low responsiveness/nonresponsiveness is characterized by an insufficient immune response upon primary and/or booster vaccination and affects 1–10% of vaccinees. In the current study, we aimed to investigate whether nonresponsiveness is an Ag/vaccine-specific phenomenon and to clarify underlying immunological mechanisms. Nonresponders to tick-borne encephalitis (TBE) or hepatitis B Ag with a history of previous TBE vaccinations were booster vaccinated with TBE and influenza vaccine and compared with TBE high responders in terms of humoral and cellular immune response. Postboosters in TBE high responder existing TBE titers increased, and solid humoral responses to influenza vaccine were induced. In TBE nonresponders, low to undetectable prevaccination TBE titers remained low, whereas sufficient influenza Abs were induced. In both TBE groups, a positive correlation of humoral and cellular immune response was seen as high/low TBE titers were associated with sufficient/lack of Ag-specific T cell proliferation. Furthermore, responses to influenza were robust in terms of Abs and cytokine production. In contrast, in hepatitis B nonresponders, sufficient humoral responses to TBE and influenza Ags were induced despite lacking specific IL-2 and IFN-γ production. Importantly, these patients showed high IL-10 baseline levels in vitro. HLA-DR subtypes associated with hepatitis B nonresponsiveness were overrepresented in this group, and high IL-10 levels were linked to these subtypes. Whereas TBE and hepatitis B nonresponders had increased IL-10–producing FOXP3+ T regulatory cells upon vaccination, only in hepatitis B nonresponders, showing elevated prevaccination IL-10 levels, a prominent population of B regulatory cells was detected. We conclude that immunological pathways of nonresponsiveness follow different patterns depending both on vaccine Ag and genetic predisposition of the vaccinee.
YB-1 Is an Early and Central Mediator of Bacterial and Sterile Inflammation In Vivo
Authors: Hanssen Lydia , Alidousty Christina , Djudjaj Sonja , Frye Björn C. , Rauen Thomas , Boor Peter , Mertens Peter R. , van Roeyen Claudia R. , Tacke Frank , Heymann Felix , Tittel Andre P. , Koch Alexander , Floege Jürgen , Ostendorf Tammo , Raffetseder Ute
Published: July 2013

In vitro studies identified Y-box–binding protein (YB)-1 as a key regulator of inflammatory mediators. In this study, we observed increased levels of secreted YB-1 in sera from sepsis patients. This led us to investigate the in vivo role of YB-1 in murine models of acute peritonitis following LPS injection, in sterile renal inflammation following unilateral ureteral obstruction, and in experimental pyelonephritis. LPS injection enhanced de novo secretion of YB-1 into the urine and the peritoneal fluid of LPS-treated mice. Furthermore, we could demonstrate a significant, transient upregulation and posttranslational modification (phosphorylation at serine 102) of YB-1 in renal and inflammatory cells. Increased renal cytoplasmic YB-1 amounts conferred enhanced expression of proinflammatory chemokines CCL2 and CCL5. Along these lines, heterozygous YB-1 knockout mice (YB-1+/d) that display 50% reduced YB-1 levels developed significantly lower responses to both LPS and sterile inflammation induced by unilateral ureteral obstruction. This included diminished immune cell numbers due to impaired migration propensities and reduced chemokine expression. YB-1+/d mice were protected from LPS-associated mortality (20% mortality on day 3 versus 80% in wild-type controls); however, immunosuppression in YB-1+/d animals resulted in 50% mortality. In conclusion, our findings identify YB-1 as a major, nonredundant mediator in both systemic and local inflammatory responses.
Identification of the Tetraspanin CD82 as a New Barrier to Xenotransplantation
Authors: Saleh Soad M. , Parhar Ranjit S. , Al-Hejailan Reem S. , Bakheet Razan H. , Khaleel Hala S. , Khalak Hanif G. , Halees Anason S. , Zaidi Marya Z. , Meyer Brian F. , Yung Gisella P. , Seebach Jörg D. , Conca Walter , Khabar Khalid S. , Collison Kate S. , Al-Mohanna Futwan A.
Published: July 2013

Significant immunological obstacles are to be negotiated before xenotransplantation becomes a clinical reality. An initial rejection of transplanted vascularized xenograft is attributed to Galα1,3Galβ1,4GlcNAc-R (Galα1,3-Gal)–dependent and –independent mechanisms. Hitherto, no receptor molecule has been identified that could account for Galα1,3-Gal–independent rejection. In this study, we identify the tetraspanin CD82 as a receptor molecule for the Galα1,3-Gal–independent mechanism. We demonstrate that, in contrast to human undifferentiated myeloid cell lines, differentiated cell lines are capable of recognizing xenogeneic porcine aortic endothelial cells in a calcium-dependent manner. Transcriptome-wide analysis to identify the differentially expressed transcripts in these cells revealed that the most likely candidate of the Galα1,3-Gal–independent recognition moiety is the tetraspanin CD82. Abs to CD82 inhibited the calcium response and the subsequent activation invoked by xenogeneic encounter. Our data identify CD82 on innate immune cells as a major “xenogenicity sensor” and open new avenues of intervention to making xenotransplantation a clinical reality.