Effect of maximum TURBT before radical cystectomy on the prognosis of multiple bladder tumors / 中华泌尿外科杂志

Objective:to investigate the effect of maximum transurethral cystectomy ((TURBT)) before radical cystectomy on the prognosis of patients with multiple bladder tumors.Methods:the clinical data and follow-up records of 90 patients with multiple bladder tumors treated in our hospital from August 2010 to August 2018 were analyzed retrospectively. There were 72 males and 18 females. The age ranged from 20 to 84 years old, with an average of (64.6 ±11.7) years. There were 50 cases of age <60 years old and 40 cases of ≥60 years old. The median age of male was 68 years old and that of female was 69 years old. The diameter of Tumor was ≥3 cm in 52 cases and <3 cm in 38 cases. There were 53 cases with 2 lesions and 37 cases with more than 2 lesions. According to the extent of TURBT resection, 55 patients (61.1%) were divided into maximum TURBT group, 42 males and 13 females, with an average age of (56.2±12.0) years. Tumor diameter ≥3 cm(n=29) and <3 cm(n=26). There were 35 cases (38.9%) in the non-maximal TURBT group, including 30 males and 5 females, with an average age of (59.8±13.4) years. In the non-maximum TURBT group. The diameter of tumor was ≥3 cm in 23 cases and <3 cm in 12 cases. There was no significant difference in preoperative data between the two groups ( P > 0.05). In the maximum TURBT group, all the tumors visible to the naked eye were completely removed, and the tissues were taken from the base and surrounding mucosa for pathological examination. Diagnostic TURBT group: multiple tumors in the bladder were found during the operation, the surface was rough, and there were no ureteral orifices on both sides. Samples of ureteral orifice and surrounding mucosal tissues were taken for biopsy, and the bladder tumor was not completely removed. Radical cystectomy was performed in both groups. The relationship between two different surgical methods and clinicopathological factors was analyzed. After that, the recurrence-free survival time (RFS) and overall survival time (OS) of patients were analyzed by Kaplan-Meier method, and the statistical difference of survival curve was analyzed by Log-rank method. Univariate Log-rank and multivariate Cox regression analysis were used to analyze the influencing factors of RFS and OS. Results:In this study, 90 cases of radical cystectomy were completed successfully. The postoperative follow-up time was 7-60 months, 1 case lost follow-up, and the median follow-up time was 30 (15-46) months. There was no significant difference in all data between maximum TURBT group and diagostic TURBT group ( P>0.05). Urethral recurrence occurred in 6 (6.7%) cases and pelvic recurrence in 9 (10%) cases after RC. 15 (16.7%) cases died, of which 8 cases died of postoperative pelvic recurrence, 3 cases died of myocardial infarction, 2 cases died of bone metastasis and 2 cases died of pulmonary metastasis. The results of Kaplan-Meier method showed that the 1-, 3-and 5-year overall survival rates of patients with RC after maximum TURBT were 96.67%, 86.05% and 80.86%, respectively, and the 1-, 3-and 5-year relapse-free survival rates were 89.97%, 76.93% and 71.41%, respectively. Univariate Log-rank results showed that pathological stage ( P=0.018), urethral recurrence ( P<0.01), pelvic recurrence ( P<0.01) and maximum TURBT ( P<0.01) were the risk factors of OS and RFS. The risk of death in patients with pelvic recurrence was higher than that in patients without pelvic recurrence ( HR=41.850, 95% CI 12.597-139.036, P<0.01). The risk of death in patients with urethral recurrence was higher than that in patients without urethral recurrence ( HR=8.128, 95% CI 1.551-42.606, P<0.01). The risk of death in patients with RC after maximum TURBT was lower than that in patients with diagnostic TURBT ( HR=0.164, 95% CI 0.036-0.746, P<0.01). Among them, there were only 2(3.9%) pelvic recurrence in patients with maximum TURBT combined with RC, 7(6.1%) pelvic recurrence and 6(6.7%) urethral recurrence in patients without maximum TURBT combined with RC, and there was significant difference between patients without maximum TURBT and patients without maximum urethral recurrence. Multivariate Cox analysis showed that urethral recurrence ( HR=8.128, 95% CI 1.551-42.606, P=0.013, P<0.01) and pelvic recurrence ( HR=41.850, 95% CI: 12.597-139.036, P<0.01) were independent risk factors for OS, and urethral recurrence ( HR=18.637, 95% CI 5.443-63.817, P<0.01) and pelvic recurrence ( HR=22.94, 95% CI 8.635-60.973, P<0.01) were independent risk factors for RFS. The maximum TURBT was the independent protective factor of OS ( HR=0.164, 95% CI 0.036-0.746 P<0.01) and RFS ( HR=0.153, 95% CI 0.048-0.493, P<0.01). Conclusions:For patients with multiple bladder tumors, radical cystectomy with maximum TURBT before radical cystectomy might reduce urethral and pelvic recurrence after radical cystectomy, and might improve the prognosis of patients with multiple bladder cancer. Maximum TURBT is an independent protective factor for OS and RFS. Urethral recurrence and pelvic recurrence are independent risk factors for OS and RFS.

A clinical study of arrhythmias associated with acute coronary syndrome: a hospital based study of a high risk and previously undocumented population

Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.

Pregnancy induced hypertension: lipid peroxidation and antioxidant status

Background: Pregnancy is a stressful condition accompanied by a high energy demand and increased oxygen requirement. Oxidative stress has been recognized as a significant factor linked to hypertension. Elucidation of anti-oxidant cascade in patients with pregnancy induced hypertension (PIH). can give insights about the oxidative stress and lead to better management of the condition. It was a prospective case control study to elucidate the parameters of oxidative stress in patients with PIH.Methods: Levels of Malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT) were eludidated using enzyme linked immunosorbent assay (ELISA) in hypertensive mothers and their age matched pregnant and non-pregnant controls to determine the lipid peroxidation and oxidative stress.Results: A total of four hundred and twenty study subjects were enrolled in the study. Malondialdehyde levels from mothers with hypertension were significantly higher than their age matched pregnant controls. The results indicate that oxidative stress induced by pregnancy induced hypertension manifests as increased lipid peroxidation. Conclusion: There is a decrement in anti-oxidant status reflecting the ineffective scavenging of reactive oxygen species resulting in oxidative damage and tissue injury.

Role of Serum Prolactin Levels in Diagnosis of Epileptic and Pseudoepileptic Events in Children, A Tertiary Care Experience

Introduction: Transient elevation of serum prolactin levels occurs in immediate postictal period in true epileptic events only. Current study was aimed to investigate the role of postictal serum prolactin levels in differentiation of true seizures from pseudo epileptic events. Material and methods: A total of 110 patients of either sex between ages of 6 months to 12 years out of 676 cases admitted for seizure evaluation were enrolled in our study and divided into four groups. Group 1 included 30 children having frank seizures, group 2 included 30 children with typical febrile seizures, group 3 included 25 children with seizure mimics and group 4 included 25 children without seizures.The serum prolactin levels were quantitatively determined by using CoatA-Count Prolactin Immuno-radiometric assay (IRMA). All data was analyzed by standard statistical methods. Results: There were 64(58.2%) males and 46(41.8%) females with mean age of 60.8 and 61.3 months. The serum prolactin level was highest in group I with mean level of 25.5ng/ml ±10 SD(p value =0.00).The serum prolactin levels were raised in 30.3% (20/66) of patients in group I,II,and III when serum sample was obtained within 20 minutes and in none 0/19 (0.00%) when sample was taken after 20 minutes (p value =0.006).All patients with generalized tonic clonic seizures with abnormal EEG had abnormal prolactin levels while as only 83.3% with complex partial seizures and 20% with simple partial seizures had raised prolactin levels (p value =0.002). Conclusion: There was a significant rise in serum prolactin level in children with epileptic seizures as compared to febrile seizures and seizure like events.

Correlation of troponin-I level with left ventricular systolic dysfunction after first attack of non-ST segment elevation myocardial infarction

Background: Coronary Heart Disease (CHD) is the most common category of the heart disease and is found to be the single most important cause that leads to premature death in the developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has shown itself as a very sensitive and specific marker for AMI. Ventricular function is the best predictor of death after an ACS. It serves as a marker of myocardial damage and provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of LVEF on elevated troponin-I level in patients with first attack of NSTEMI.Methods: This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital from December, 2015 to November, 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with first attack of NSTEMI with LVEF: ≥55%. Group-II: Patients with first attack of NSTEMI with LVEF: <55%. Then LVEF and troponin-I levels were correlated using Pearson’s correlation coefficient test.Results: In this study mean troponin-I of group-I and group-II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). The mean LVEF value of groups were 65.31±10.30% and 40.17±4.62% respectively. It was statistically significant (p<0.05). The echocardiography showed that patients with high troponin-I level had low LVEF and patients with low troponin-I level had preserved LVEF. Analysis showed that patients with highest level of troponin-I had severe left ventricular systolic dysfunction (LVEF <35%) and vice versa-the patients with the lowest levels of troponin-I had preserved systolic function (LVEF ≥55%). In our study, it also showed that the levels of troponin-I had negative correlation with LVEF levels with medium strength of association (r= -0.5394, p=0.001). Our study also discovered that Troponin-I level ≥6.6ng/ml is a very sensitive and specific marker for LV systolic dysfunction.Conclusions: The study has enabled the research team to conclude that the higher is the Troponin-I level the lower is the LVEF level and thus more severe is the LV systolic dysfunction in first attack of NSTEMI patients.

Spectrum of congenital heart disease in a tertiary care centre of Northern India

Background: Congenital heart disease (CHD) is very common disease and it is the major cause of childhood mortality and morbidity. Not much of Indian data are available particularly from the northern part of the country. It is important to mention that this part of India is unique with respect to its demographic and geographical location. There are needs to further explicate the spectrum and epidemiology of the CHD in this part of the country.Methods: A prospective hospital-based study carried out over a period of 24 months (January 2016 to January 2018) where all suspected children (<14 years) of CHD were subjected to echocardiographic study. The age, sex, clinical presentation and echo findings were well documented.Results: Out of total 3210 cases CHD was diagnosed in 2072 cases (64.54%). Most CHDs were diagnosed between 1 month and 6 years of age in both cyanotic and a cyanotic disease group. Incidence of a cyanotic CHD was n=1529 (47.6%) and cyanotic CHD was n=543 (17%) with the ratio of acyanotic to cyanotic 2.8:1. Ventricular septal defect was commonest CHD (35.85%) among acyanotic CHD and Tetralogy of Fallot was the commonest (12.2%) among cyanotic CHD.Conclusions: Burden of CHD is highly underestimated and unrecognised, especially in this part of the country. This study can provide observed data that can help in policy making in the health sector. The contrasting result with respect to complex CHD in present study indicates need for good and effective antenatal cardiac screening in high risk mothers.

Metabolic outcomes of laparoscopic sleeve gastrectomy

Background Laparoscopic sleeve gastrectomy [LSG] is a recently developed technique for treating morbid obesity. As it is a simple procedure, many bariatric surgeons have adopted it in recent years with good results. LSG is a purely gastric restrictive procedure designed to reduce appetite by decreasing the size of the stomach

Objectives The aim of this study was to investigate the metabolic outcomes of LSG, including rate of weight loss, amelioration of obesity-related comorbidities as well as the intraoperative and postoperative complications

Patients and methods From August 2011 to August 2013, 60 consecutive patients with morbid obesity [eight males and 52 females] underwent laparoscopic sleeve gastrectomy at the Ain Shams University Hospital [El-Demerdash] and Ain Shams Specialized Hospital. Follow-up of the patients was done for a period of 2 years to investigate the preliminary results of this procedure including operative morbidity and mortality, short-term and long-term complications, rates and parameters of weight loss, as well as the effect on lipid and energy metabolism

Results There were two cases [2/60 [3.3%]] with intra-abdominal bleeding following LSG. Staple-line failure was detected in two cases [2/60 [3.3%]], two early complications [2/60 [3.3%]] were encountered, and late complications occurred in two patients [2/30 [3.3%]], with no mortality occurred. Substantial weight loss occurred in all patients. Mean excess weight loss was 48.04+/-4.34% at the end of first year and 67.85+/-3.75% at the end of the second year. Complete resolution of comorbidities was 73.3% for hypertension and 80% for diabetes mellitus at the end of second year

Conclusion LSG is a feasible and safe restrictive bariatric procedure, with good short-term results. It offers the advantages of a simple and reproducible technique with good outcome and low morbidity and mortality. LSG is accepted as a standalone definitive therapy, as it has a high percentage of postoperative excess weight loss as well as reduction of obesity-related comorbidities

Comparison of rectal, infra red tympanic and infra red skin temperature in term neonates

Background: The measurement of body temperature is an important parameter in neonatal care as it is useful in the assessment of clinical state and necessary for the provision of appropriate nursing support. Hypothermia is one of the important risk factor in causing death in newborns of all weight and gestational age groups. Aim and objectives: To compare rectal, infra red tympanic and infra red skin temperature in term neonates and to assess the accuracy and effectiveness of these non invasive thermometers in term neonates. Materials and methods: It was a Hospital based prospective, non randomized study conducted at Department of Pediatrics in G.B Pant Hospital (neonatology section) an associated Hospital of GMC Srinagar. This study was conducted over a period of 1 year from April 2013 to march 2014. Results: Total of 300 term neonates between the age of 1- 29 days were included in the study. Mean temperature recorded with rectal thermometer was 36.58 0C, with Infra red tympanic thermometer was 36.47 0 C and with Infra red skin thermometer was 36.55 0C. Difference between means of rectal and Infra red tympanic thermometer was statistically significant (P=0.015) and difference between means of rectal and Infra red skin thermometer was statistically not significant (P = 0.18). Coefficient of correlation between rectal and tympanic was 0.772 and between rectal and skin was 0.955 which was statistically significant in both (P valve < 0.001). Conclusion: Non contact Infra red skin thermometer is a very simple, safe and reliable method for measurement of body temperature in neonates. It can be used in peripheral settings as it is user friendly as well as patient friendly

Frequency of different infections in patients with hepatic encephalopathy due to cirrhosis liver

Objective: To determine frequency of different infections in patients with hepaticencephalopathy due to cirrhosis liver

Study Design: Cross sectional descriptive study

Place and Duration of Study: The study was conducted in the Department of Medicine, Combined Military Hospital, Peshawar over six months from April to October 2013

Patients and Methods: All patients with cirrhosis of liver of more than 18 years of age, manifesting signs of hepatic encephalopathy [HE] were included in the study. Detailed history, clinical examination and thorough investigations were done to look for different infections and the findings were recorded on a proforma. Descriptive statistics were used for data analysis

Results: One hundred and eighty five patients [70.81% males and 29.19% females] were enrolled. The mean age of the study subject was 49.2 +/- 3 years. Frequency of infections in the studied population was, spontaneous bacterial peritonitis [31.94%], UTI [25.00%], pneumonia [20.83%], sepsis [8.33%] and others infections [13.90%] like cholangitis, bronchitis, endocarditis, meningitis, and gastroenteritis

Conclusions: This study concluded that a substantial number of patients with hepatic encephalopathy due to cirrhosis liver have infections

Phytochemical and biological investigations of methanol extract of leaves of ziziphus mauritiana lam / Investigaciones fitoquímicas y biológicas de extractos metanólicos de hojas de ziziphus mauritiana lam

Seven compounds were isolated from the methanol extract of leaves of Ziziphus mauritiana. The structures of the isolated compounds were elucidated as y-fagarine (1), beta-sitosterol (2), stigmasterol (3), alfa-amyrin (4), lupeol (5), beta-amyrin (6) and betulin (7) by extensive spectroscopic studies and by co-TLC with authentic samples. This is the first report of isolation of compounds 1-7 from this plant species. The extractives from leaves were investigated for thrombolytic, membrane stabilizing, antimicrobial, antidiarrheal and analgesic potentials along with sleep inducing property on animal model. The thrombolytic and membrane stabilizing activities were assessed by using human erythrocyte comparing with standard streptokinase and acetylsalicylic acid, respectively. The methanolic extract reduced frequency of diarrheal faeces when compared to the standard loperamide. In castor oil induced diarrhea in mice a dose dependent decrease of gastrointestinal transits were observed. In radiant heat tail-flick method the methanol extract showed moderate antinociceptive activity, compared to standard morphine.

Siete compuestos fueron aislados del extracto metanólico de hojas de Ziziphus mauritiana. Las estructuras de los compuestos aislados fueron identificadas como y-fagarina (1), beta-sitosterol (2), estigmasterol (3), alfa-amirina (4), lupeol (5), beta-amirina (6) y betulina (7 ) por medio de extensivos estudios espectroscópicos y por co-TLC con muestras auténticas. Este es el primer informe de aislamiento de los compuestos 1-7 a partir de esta especie vegetal. Los extractos de las hojas fueron investigados por efectos trombolíticos, estabilizadores de membrana, antimicrobianos, antidiarreicos y potenciales analgésicos junto a la propiedad de inducir sueño en el modelo animal. Las actividades trombolíticos y la estabilización de la membrana se evaluaron mediante el uso de eritrocitos humanos comparando con estreptoquinasa estándar y el ácido acetilsalicílico, respectivamente. El extracto metanólico redujo la frecuencia de las heces diarreicas en comparación con el estándar de loperamida. En la inducción por aceite de ricino de diarrea en ratones, se observó una disminución dosis dependiente de los tránsitos gastrointestinales. En el método del coletazo producido por calor radiante, el extracto metabólico mostró una actividad antinociceptiva moderada, en comparación con la morfina estándar.

Transcatheter Closure of Ventricular Septal Rupture First in Bangladesh - A Case Report.

Ventricular septal rupture is a rare complication of acute myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. Early diagnosis is based on clinical examination and transthoracic echocardiography. Transcatheter closure of ventricular septal rupture in selected patients may save lives. We report a patient with ventricular septal rupture in acute myocardial infarction that was closed by an Amplatzer device

Significance of serum angiogenin assay as a novel marker for diagnosis of hepatocellular carcinoma in liver cirrhosis: a comparative study

Background: Hepatocellular carcinoma [HCC] is the third most common cause of cancer-related death worldwide. Angiogenin [ANG] is a potent angiogenic factor first isolated from the culture medium conditioned by colon carcinoma cells. Many reports have demonstrated an elevated serum ANG level in patients with various malignancies including colorectal carcinoma, melanoma, and pancreatic carcinoma. These results pointed to serum ANG as a novel marker for the diagnosis, progression, and aggressiveness of malignant tumors

Objective: The aim of this study was to evaluate the clinical significance of serum ANG as a novel marker for the diagnosis of HCC in liver cirrhosis and compare it with serum alpha-fetoprotein [AFP]

Patients and methods: The study included 40 patients who were divided into group I and group II. Group I included patients with HCC and group II included those with liver cirrhosis. Group III included age-matched and sex-matched apparently healthy controls. Patients in group I were further classified according to the TNM system into subgroup Ia, which included patients with tumor size less than or equal to 2 cm, and subgroup Ib, which included patients with tumor size greater than 2 cm. All individuals were subjected to an assay for evaluating the serum level of AFP and serum ANG

Results: For the diagnosis of HCC, serum AFP showed a sensitivity of 91.7% and specificity of 80%, whereas serum ANG showed a sensitivity of 95.8% and specificity of 85.7%. In discriminating patients with early hepatic cancer from those with more advanced stages, serum AFP showed a diagnostic sensitivity of 70% and specificity of 89.8%, whereas serum ANG showed a diagnostic sensitivity of 90% and specificity of 85.7%

Conclusion: Serum ANG is a promising marker for the diagnosis of HCC, being superior to serum AFP in both sensitivity and specificity. Moreover, serum ANG efficiently discriminates early from late stages of HCC

In vitro cytotoxicity of the hydroxyapatite/barium titanate biological piezoelectric ceramic coating / 中国组织工程研究

BACKGROUND:In order to optimize the biological activity of hydroxyapatite, previous experiments have used plasma spraying technique to prepare a piezoelectric ceramic coating on the surface of hydroxyapatite, but the cytotoxicity of this new material is not clear. OBJECTIVE: To evaluate the cytotoxicity of hydroxyapatite/barium titanate biological piezoelectric ceramic coatingin vitro. METHODS: The 3rd generation beagle bone marrow mesenchymal stem cels were seeded on hydroxyapatite/barium titanate piezoelectric ceramic specimens and hydroxyapatite specimens, respectively. After 5 days, the celladhesion was detected by scanning electron microscopy. The 3rd generation bone marrow mesenchymal stem cels were also co-cultured with hydroxyapatite/barium titanate piezoelectric ceramic specimen extract, hydroxyapatite specimen extract, low-glucose Dulbecco’s modified Eagle’s medium containing 5% dimethylsulfoxide and 15% fetal bovine serum, and low-glucose Dulbecco’s modified Eagle’s medium containing 15% fetal bovine serum, respectively. The cytotoxicity was tested by cellCounting Kit-8 assay at days 1, 3, 5 after co-culture. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cels on the surface of hydroxyapatite/barium titanate piezoelectric ceramic specimens and hydroxyapatite specimens grew proliferatively and presented with multi-layer growth. The connection between cels and pseudopodia was very close, which indicates that the two kinds of materials both have good cytocompatibility. cellCounting Kit-8 assay showed that the cels cultured in the extracts of hydroxyapatite/barium titanate biological piezoelectric ceramic and hydroxyapatite specimens proliferated more than 80%, and the toxicity was grade 1 that meant no cytotoxicity.

Disease Severity and Common Etiology of Diarrhea among Children Under-five in Mirzapur, Rural Bangladesh.

Aim: There is lack of information on the severity of diarrheal disease with etiology. Thus the study aimed to compare the etiology of under-five children with moderate-to-severe disease (MSD) and mild disease (MD). Study Design: Diarrheal disease surveillance. Place and Duration of Study: Mirzapur Kumudini Hospital, Tangail, rural Bangladesh, January 2010 – December 2011. Methodology: Overall, 2,324 under-5 diarrhea children were enrolled in the hospital who came from the demographic surveillance system (DSS) catchment area. Whole stool samples were collected from each enrolled child to detect rotavirus, Shigella, ETEC and V. cholerae. Information on socio-demographic and clinical characteristics was also collected. Results: Among all the study children, 1,098 (47%) were aged 0-11 months; 789 (34%) were 12-23 months, and 437 (19%) were 24-59 months. Rotavirus (33%) was mainly responsible for diarrhea amongst children under-5 and 90% of them were less than 2 years. Shigella represented 14%; of which, 45% were 24-59 months old. However, ETEC and V. cholerae represented only 3% and 2% respectively. Shigella was the most commonly detected pathogen (27%) for MSD followed by rotavirus (16%). Conversely, rotavirus (43%) was responsible for MD. MSD were most likely to be infected with Shigella flexneri [OR-9.81; 95% CI (6.38, 15.18)] and Shigella sonnei [6.29; (3.67, 10.87)] compared to their counterparts with MD. In logistic regression analysis, Shigella was responsible for a 2.25 times higher risk for MSD. Children with Shigella were 3.28 times at higher risk for bloody stool and 2.45 times more likely to have fever. However, rotavirus diarrhea was more likely to be presented with vomiting (OR-2.46) and fever (OR-1.28), and Vibrio cholerae, most often with watery diarrhea (OR-4.35). None of the clinical features were significantly associated with ETEC. Conclusion: Shigella was the leading pathogen that was detected most often in MSD, whereas rotavirus was often associated with MD.

Chemical and biological studies of Kalanchoe pinnata (Lam.) growing in Bangladesh

Objective: To isolate compounds from K. pinnata and elucidate their structures and to explore preliminary antioxidant, antimicrobial, cytotoxic and thombolytic activities of extractives of the plant. Methods: The methanol extract of whole plant of K. pinnata has been subjected to different chromatographic separation and purification processes to isolate the secondary metabolites. The structures of the isolated compounds have been elucidated by extensive NMR studies. The free radical scavenging activity of the crude extract and its different Kupchan fractions were determined on stable radical DPPH. In vitro antimicrobial activity was determined by the disk diffusion method. Cytotoxicity screening has been performed against Artemia salina. Total phenolics content, membrane stabilizing activity and thombolytic activities were assessed by following established protocol. Results: The isolated compounds were identified as glut-5(6)-en-3-one, taraxerone, 3β-friedelanol, β-amyrin-3-acetate, 3,5,7,3',5'-pentahydroxyflavone and β-sitosterol. The chloroform soluble fraction showed potent antioxidant activity of (IC50=80.0 μg/mL) and significant cytotoxicity, while the crude extract demonstrated noticeable total polyphenol content (149.24 mg of GAE/gm of extractive), moderate membrane stabilizing activity and inhibition of clot lysis of blood. Conclusions: The obtained results rationalize the folkloric use of the plant and can be further investigated to isolate the active compounds responsible for the biological activities.

Differential Host Immune Responses to Epidemic and Endemic Strains of Shigella dysenteriae Type 1.

Shigella dysenteriae type 1 causes devastating epidemics in developing countries with high case-fatality rates in all age-groups. The aim of the study was to compare host immune responses to epidemic (T2218) and endemic strains of S. dysenteriae type 1. Shigellacidal activity of serum from rabbits immunized with epidemic or endemic strains, S. dysenteriae type 1-infected patients, and healthy adult controls from Shigellaendemic and non-endemic regions was measured. Immunogenic cross-reactivity of antibodies against Shigella antigens was evaluated by Western blot analysis. Oxidative burst and phagocytic responses of monocytes and neutrophils to selected S. dysenteriae type 1 strains were assessed by flow cytometry. Rabbit antisera against epidemic strain were less effective in killing heterologous bacteria compared to endemic antisera (p=0.0002). Patients showed an increased serum shigellacidal response after two weeks of onset of diarrhoea compared to the acute stage (3-4 days after onset) against their respective homologous strains; the response against T2218 and heterologous endemic S. dysenteriae type 1 strains was not significant. The serum shigellacidal response against all the S. dysenteriae type 1 strains was similar among healthy controls from endemic and non-endemic regions and was comparable with the acute stage response by patients. Compared to endemic strains of S. dysenteriae type 1, T2218 was significantly resistant to phagocytosis by both monocytes and neutrophils. No obvious differences were obtained in the induction of oxidative burst activity and cathelicidin-mediated killing. Cross-reactivity of antibody against antigens present in the epidemic and endemic strains showed some differences in protein/peptide complexity and intensity by Western blot analysis. In summary, epidemic T2218 strain was more resistant to antibody-mediated defenses, namely phagocytosis and shigellacidal activity, compared to endemic S. dysenteriae type 1 strains. Part of this variation may be attributed to the differential complexity of protein/peptide antigens.

Clausenolide-1-methyl ether from Clausena heptaphylla W&A / Clausenolido-1-metil éter de Clausena heptaphylla W & A

From the stem bark of Clausena heptaphylla, the limonoid clausenolide-1-methyl ether (1) was isolated. The structure of the compound was elucidated by extensive spectroscopic studies, including 2D NMR and MS measurements and by comparison with spectroscopic and physical data from the literature. This is the first report of occurrence of clausenolide-1-methyl ether (1) in Clausena heptaphylla.

El limonoíde clausenolido-1-metil eter (1) fue aislado de corteza de Clausena heptaphylla. La estructura del compuesto fue determinada por metodos espectroscópicos, incluyendo 2D RMN, espectrometría de masas (EM) y comparación de los datos espectroscópicos y constantes físicas con los publicados en la literatura. Este es el primer informe del aislamiento de clausenolido-1-metil eter (1) de Clausena heptaphylla.

Preliminary antimicrobial activity and cytotoxicity of leaf extracts of mesua nagassarium (Burm.f. ) / Actividad antimicrobiana preliminar y citotoxicidad de extractos de hojas de Mesua nagassarium (Burm.f. )

In the present study the in vitro antimicrobial activity, along with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), of different extracts of leaves of Mesua nagassarium were evaluated against 13 pathogenic microorganisms. The methanol extract and its pet-ether and carbon tetrachloride soluble fractions showed the highest antimicrobial activity. The carbon tetrachloride soluble fraction showed the maximum inhibition zone of 24.33 mm against Bacillus megaterium with MIC and MBC values of 7.81 ug/ml and 250 ug/ml, respectively. Ciprofloxacin (30 ug/disc) was used as standard antimicrobial agent. In the Brine shrimp lethality bioassay, the crude methanol extract and its carbon tetrachloride soluble fraction showed significant cytotoxicity with LC50 of 2.99 and 1.74 ug/ml, respectively as compared vincristine sulphate (LC50 value 0.543 ug/ml).

En el presente estudio se evaluó la actividad antimicrobiana in vitro, incluyendo la concentración inhibitoria mínima (CIM) y la concentración bactericida mínima (CBM), de diferentes extractos obtenidos de hojas de Mesua nagassarium en 13 microorganismos patógenos. El extracto metanólico y sus fracciones solubles en éter de petróleo y tetracloruro de carbono, mostraron la mayor actividad antimicrobiana. La fracción de compuestos solubles en tetracloruro de carbono mostró la zona de inhibición máxima de 24.33 mm en Bacillus megaterium con valores de CIM y and CBM de 7.81 ug/ml y 250 ug/ml, respectivamente. Como agente antimicrobiano estándar se utilizó ciprofloxacina (30 ug/disco). En el bioensayo de mortalidad de Brine shrimp el extracto metanólico y su fracción soluble en tetracloruro de carbono mostraron importante citotoxicidad con CL50 de 2.99 y 1.74 ug/ml, respectivamente, comparadas con el sulfato de vincristina (CL50 0.543 ug/ml).

Novel drug delivery systems in topical treatment of psoriasis: Rigors and vigors.

Psoriasis is a chronic inflammatory skin disorder that may drastically impair the quality of life of a patient. Among the various modes of treatments for psoriasis, topical therapy is most commonly used in majority of patients. The topical formulations based on conventional excipients could serve the purpose only to a limited extent. With the advent of newer biocompatible and biodegradable materials like phospholipids, and cutting-edge drug delivery technologies like liposomes, solid lipid nanoparticles (SLNs), microemulsions, and nanoemulsions, the possibility to improve the efficacy and safety of the topical products has increased manifold. Improved understanding of the dermal delivery aspects and that of designing and developing diverse carrier systems have brought in further novelty in this approach. Substantial efforts and the consequent publications, patents and product development studies on the subject are the matter of interest and review of this article. However, majority of the work is related to the preclinical studies and demands further clinical assessment in psoriasis patients.