Antioxidant potential and α-glucosidase inhibitory activity of onion (Allium cepa L. ) peel and bulb extracts / Atividade antioxidante e potencial inibidor de glucosidase de extratos de casca e bulbo de cebola (Allium cepa) preparados por etanol e água

Abstract Allium cepa L. is a commonly consumed vegetable that belongs to the Amaryllidaceae family and contains nutrients and antioxidants in ample amounts. In spite of the valuable food applications of onion bulb, its peel and outer fleshy layers are generally regarded as waste and exploration of their nutritional and therapeutic potential is still in progress with a very slow progression rate. The present study was designed with the purpose of doing a comparative analysis of the antioxidant potential of two parts of Allium cepa, i.g., bulb (edible part) and outer fleshy layers and dry peels (inedible part). Moreover, the inhibitory effect of the onion bulb and peel extracts on rat intestinal α-glucosidase and pancreatic α-amylase of porcine was also evaluated. The antioxidant potential of onion peel and bulb extracts were evaluated using 2,2-diphenyl- 1-picryl hydrazyl (DPPH), ferric-reducing antioxidant power assay (FRAP), 2,2'-azino-bis- 3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging assay, H2O2 radical scavenging activity and Fe2+ chelating activity. Total flavonoids and phenolic content of ethanolic extract of onion peel were significantly greater as compared to that of onion bulb. Ethanolic extract of onion peel also presented better antioxidant and free-radical scavenging activity as compared to the ethanolic extract of bulb, while the aqueous extract of bulb presented weakest antioxidative potential. Onion peel extract's α-glucosidase inhibition potential was also correlated with their phenolic and flavonoid contents. The current findings presented onion peel as a possible source of antioxidative agents and phenolic compounds that might be beneficial against development of various common chronic diseases that might have an association with oxidative stress. Besides, outer dry layers and fleshy peels of onion exhibited higher phenolic content and antioxidant activities, compared to the inner bulb. The information obtained by the present study can be useful in promoting the use of vegetable parts other than the edible mesocarp for several future food applications, rather than these being wasted.

Resumo Allium cepa pertence à família Liliaceae e é rica em nutrientes e antioxidantes. Apesar das expressivas aplicações alimentares do bulbo da cebola, sua casca e outras camadas externas são geralmente consideradas resíduos, e seu potencial nutricional e terapêutico ainda é pouco explorado. O presente estudo foi delineado com o objetivo de investigar comparativamente o potencial antioxidante de duas partes de Allium cepa, por exemplo o bulbo (parte comestível) e camadas externas e cascas secas (parte não comestível). Além disso, o efeito inibitório dos extratos do bulbo de cebola e casca sobre a α-glucosidase intestinal de ratos e α-amilase pancreática suína também foi avaliado. O potencial antioxidante dos extratos da casca de cebola e bulbo foi avaliado utilizando-se 2,2-difenil-1-picrilhidrazil (DPPH), método de poder antioxidante de redução do ferro (FRAP), método 2,2'-azino-bis-3-etilbenzotiazolina-6-ácido sulfônico (ABTS) de eliminação de radicais, atividade de eliminação de radicais H2O2 e atividade quelante do Fe2+. Os flavonoides totais e os teores fenólicos do extrato de etanol da casca de cebola foram significativamente maiores quando comparados ao do bulbo. O extrato de etanol da casca de cebola também apresentou melhor atividade antioxidante e eliminação de radicais livres quando comparado ao extrato de etanol do bulbo, enquanto o extrato aquoso de bulbo apresentou menor potencial antioxidante. O potencial de inibição da α-glicosidase dos extratos de casca de cebola correlacionou-se com seus teores fenólicos e de flavonoides. Os resultados encontrados identificaram que a casca de cebola é uma possível fonte de agentes antioxidantes e compostos fenólicos que podem ser benéficos contra o desenvolvimento de várias doenças crônicas que estão associadas ao estresse oxidativo. Além disso, as camadas externas secas e as cascas da cebola exibiram maior conteúdo fenólico e atividades antioxidantes, em comparação com o bulbo interno. As informações obtidas pelo presente estudo podem promover o uso de outras partes vegetais além do mesocarpo comestível para futuras aplicações em alimentos, ao invés de serem desperdiçadas.

Payment for ecosystem services (PES): a holistic tool for sustainable forest management-a case study from Pakistan / Pagamento por serviços ecossistêmicos (PES): uma ferramenta holística para o manejo florestal sustentável: um estudo de caso do Paquistão

Abstract Economic valuation of ecosystem services is a new concept in forest management. Economic valuation provides basis for payment for ecosystem services (PES). Therefore, objective of this study was to evaluate eco-tourism and carbon stock services of the Maindam valley, District Swat, Pakistan. For the carbon stock calculation, a sample size of 155 plots of 0.1 hectare (Ha) was taken using preliminary survey at 95% confidence interval and 10% allowable error. The data for tourism services was collected from owners of all the hotels, 100 tourists and key informants of the area at 10% sampling intensity on pretested questionnaire for twenty years period (1997-2017). Results showed that Miandam valley has carbon stock worth US$ 16,306,000 while the value of eco-tourism was US$ 1,578,458 on annual basis. The results also showed that trend of tourism has drastically declined after the 9/11 incident for foreigners and locals and the situation was further deteriorated during the era of Talibanization or militancy from 2008-2011. This study recommends implementation of PES strategy at the rate of 5%, thus a total of US$ 78,922 can be earned from eco-tourism and carbon crediting in the study area annually, which could play important role in sustainable forest management.

Resumo A valoração econômica dos serviços ecossistêmicos é um novo conceito no manejo florestal. A avaliação econômica fornece base para o pagamento por serviços ecossistêmicos (PES). Portanto, o objetivo deste estudo foi avaliar o ecoturismo e os serviços de estoque de carbono do vale de Miandam, distrito Swat, Paquistão. Para o cálculo do estoque de carbono, um tamanho de amostra de 155 parcelas de 0,1 hectare (ha) foi tirado, usando pesquisa preliminar com intervalo de confiança de 95% e erro admissível de 10%. Os dados para serviços de turismo foram coletados de proprietários de todos os hotéis, 100 turistas e informantes-chave da área em 10% de intensidade de amostragem em questionário pré-testado para um período de 20 anos (1997-2017). Os resultados mostraram que o vale de Miandam tem estoque de carbono no valor de US$ 16.306.000, enquanto o valor do ecoturismo foi de US$ 1.578.458 anualmente. Os resultados também mostraram que a tendência do turismo diminuiu drasticamente para estrangeiros e locais após o incidente de 11 de Setembro, e a situação se agravou ainda mais durante a era da talibanização ou militância de 2008-2011. Este estudo recomenda a implementação da estratégia de PES na taxa de 5%, portanto um total de US$ 78.922 pode ser ganho com ecoturismo e crédito de carbono na área de estudo anualmente, o que pode desempenhar um papel importante no manejo florestal sustentável.

An ethno-botanical study of indigenous medicinal plants and their usage in rural valleys of Swabi and Hazara region of Pakistan / Um estudo etnobotânico de plantas medicinais indígenas e seu uso nos vales rurais da região de Swabi e Hazara, no Paquistão

Abstract An ethnobotanical study was conducted to document indigenous medicinal plants and their usage from knowledgeable and elderly persons in Razzar and Gadoon valley of Swabi and Allai and Tanawal valley of Hazara region of Pakistan during 2016-2019. Several systematic field visits and questionnaire surveys were carried out in selected sites of the study area to gather relevant information from the local community. Rapid assessment method was adopted for data collection by interviewing the local people having enough knowledge of medicinal plants use for treatment of different ailments. UV (UV) formula was applied to calculate the relative importance of medicinal plant species in each site of the study area. In the present study, 221 medicinal plants belonging to 105 families have been reported through 580 respondents (385 males, 138 females and 57 local health healer) from the Swabi and Hazara region. The main sources of herbal medicines were leaves (21%) followed by fruits (21%), seeds (17%), whole plants (14%), roots (9%), bark (9%), flowers (7%) and gum (2%). Mentha spicata L. and Berberis lycium Royle were reported with highest UV (UV) i.e. 0.92 and 0.68 in Razzar tehsil and Gadoon valley of Swabi, whereas Mentha longifolia L and Geranium wallichianum D were reported with highest UV i.e. (0.65) and (0.88) in Allai and Tanawal valley of Hazara region, respectively. It was concluded that Swabi and Hazara region is rich in medicinal plants species and associated traditional knowledge. Moreover, ethno-medicines have played significant role in the indigenous healthcare system of the study area. However, uprooting the entire plant for ethno-medicine is a big threat to conservation of medicinal plants diversity in the study area.

Resumo Um estudo etnobotânico foi realizado para documentar as plantas medicinais indígenas e seu uso por pessoas experientes e idosas em Razzar e Gadoon, no vale de Swabi e no vale Allai e Tanawal da região de Hazara, no Paquistão, durante 2016 a 2019. Várias visitas sistemáticas de campo e pesquisas por questionário foram realizadas em locais selecionados da área de estudo para coletar informações relevantes da comunidade local. O método de avaliação rápida foi adotado para a coleta de dados por meio de entrevistas com a população local, com conhecimento suficiente do uso de plantas medicinais para o tratamento de diferentes enfermidades. A fórmula UV (UV) foi aplicada para calcular a importância relativa das espécies de plantas medicinais em cada local da área de estudo. No presente estudo, 221 plantas medicinais pertencentes a 105 famílias foram relatadas por 580 entrevistados (385 homens, 138 mulheres e 57 curandeiros locais) da região de Swabi e Hazara. As principais fontes de medicamentos fitoterápicos foram folhas (21%), seguidas de frutas (21%), sementes (17%), plantas inteiras (14%), raízes (9%), cascas (9%), flores (7%) e goma (2%). Mentha spicata L. e Berberis lycium Royle foram relatados com maior UV (UV), ou seja, 0,92 e 0,68 em Razzar tehsil e vale Gadoon de Swabi, enquanto Mentha longifolia L. e Geranium wallichianum D. foram relatados com maior UV, isto é, 0,65 e 0,88 no vale Allai e Tanawal da região de Hazara, respectivamente. Concluiu-se que a região de Swabi e Hazara é rica em espécies de plantas medicinais e conhecimentos tradicionais associados. Além disso, etnomedicamentos têm desempenhado um papel significativo no sistema de saúde indígena da área de estudo. No entanto, arrancar a planta inteira para etnomedicina é uma grande ameaça à conservação da diversidade de plantas medicinais na área de estudo.

Major threats and habitat use status of Demoiselle crane (Anthropoides virgo), in district Bannu, Pakistan / Principais ameaças e estado de uso de habitat de Demoiselle crane (Anthropoides virgo), no distrito de Bannu, Paquistão

Abstract Cranes are the large and attractive Creatures of nature with long necks, legs, and life-span. Adults of both sexes are the same with similar color patterns. Demoiselle cranes spend most of their lifespan on dry grasses. They are also found around the stream, rivers, shallow lakes, natural wetlands, and depressions. To evaluate the current status of habitat use and major threats a study was conducted in tehsil Domel district Bannu. Line transect method and water quality tests (temperature, PH, contamination of E-coli bacteria) were used. To determine the major threats questionnaire method was used. The whole data was analyzed by using SPSS 21 version. Based on the distribution four study sites were selected and four water samples from each study site were taken. Most sites were moderate to highly degraded except Kashoo and kurram river mixing point which was low degraded with livestock grazing and human activities. Water quality tests showed PH ranges from 7-9, temperature 6.5-8.5, and contamination of E-coli in all samples. The social survey revealed that hunting, habitat degradation, and pollution as major threats. Effective long-term conservation and management in the study area are needed to focus on the protection of disturbance-free habitat.

Resumo Guindastes são a grande e atraente criatura da natureza com um pescoço longo, pernas e vida útil. Adultos de ambos os sexos são os mesmos com padrões de cores semelhantes. Guindastes Demoiselle passam a maior parte da vida em gramíneas secas. Também se encontram ao redor do córrego, rios, lagos rasos, pântanos naturais e depressões. Para avaliar o estado atual do uso do hábitat e as principais ameaças, um estudo foi realizado no distrito de Tehsil Domel, em Bannu. Foram utilizados o método transect e testes de qualidade da água (temperatura, pH, contaminação da bactéria E. coli). Para determinar as principais ameaçasfoi utilizado o método de questionário. Todos os dados foram analisados por meio da versão SPSS 21. Com base na distribuição, foram selecionados quatro locais de estudo e quatro amostras de água de cada local de estudo. A maioria dos locais estava moderada a altamente degradada, exceto no ponto de encontro dos rios Kashoo e Kurram, que teve baixa degradação com pastagem de gado e atividades humanas. Os testes de qualidade da água mostraram variação de pH de 7-9, temperatura 6,5-8,5 e contaminação de E. coli em todas as amostras. A pesquisa do questionário revelou que a caça, a degradação do hábitat e a poluição são as principais ameaças. Efetiva conservação e gestão a longo prazo na área de estudo são necessárias para se concentrar na proteção de um hábitat livre de distúrbios.

Sociodemographic Characteristics of Chronic Suppurative Otitis Media In Bangladesh

Objectives: To find out sociodemographic characteristics ofChronic Suppurative Otitis Media (CSOM) in Bangladesh.Methods: It was a prospective study conducted in thedepartment of otolaryngology & Head Neck Surgery,Bangabandhu Sheikh Mujib Medical University (BSMMU) andDhaka Medical College Hospital (DMCH), Dhaka, fromSeptember 2010 to February 2011. Fifty cases were selectedby random sampling. A descriptive analysis was performed forclinical features and results were presented as mean ±standard deviation for quantitative variables and numbers(percentages) for qualitative variables.Results: In tubotympanic group, 51.61% patients belong to 21-30 years age group, whereas for atticoantral, 63.15% patientsbelong to 11-20 years age group. People living in rural area(66%) were more sufferers. Bilateral involvement is morecommon in tubotympanic type of disease & unilateralinvolvement was more common in atticoantral type of CSOM.Conclusion: CSOM is the most common chronic ear diseasein Bangladesh. It is more common in rural peoples ofyounger age group in poor socioeconomic classes with malepredominance. Medical and surgical options are limited, withside effects and risks, and sometimes are not successful ineliminating disease. There is an urgent need to focus in thearea of CSOM and hence prevent hearing loss.

Outcome of Early Surgical Intervention in Acute Lower Limb Ischemia due to Thromboembolism.

Background: Acute lower extremity ischemia is a common vascular disease and considered limb- and life- threatening. The present study evaluated and compared the outcome of early and late surgical intervention in acute lower limb ischemia due to thromboembolism. Methodology: This non randomized comparative parallel study was conducted at the Department of Cardiovascular Surgery, NICVD, Dhaka, Bangladesh from January 2007 to December 2008 for duration of two year. Total 80 patients were enrolled in this study. The patients were divided into equal two groups, Group A, for early surgical intervention (with in 24 hours) and Group B, late surgical intervention (more than 24 hours). Results: Mean (±SD) age of both Group A and Group B was 51.93 (±11.73) and 47.00 (± 11.01) years. Male and female ratio of the total study population was 1.76:1 Pain and absence of pulse distal to occlusion was common for all. Cold extremity, sensory deficit, motor deficit, diminish vascular flow was the commonest findings of both group. In Group A, 57.5% had superficial femoral artery occlusion, 22.5% had iliac artery and 20.0% popliteal artery occlusion. In Group B, 42.5% had superficial femoral artery occlusion, 32.5% had popliteal artery occlusion and 25.0% had iliac artery occlusion. Fasciotomy was performed in 15.0% patients of Group A and in 22.0% patients of Group B. After Fogarty embolectomy in group A and group B had warm extremity (80.0% vs. 65.0%), pulsation distal to occlusion (90.0% vs. 75.0%), intact sensory function (82.5% vs. 67.5%), intact motor function (80.0% vs. 65.0%), and normal vascular flow by Doppler US (80.0% vs. 65.0%). During postoperative period history of bleeding, infection, reperfusion injury, muscle necrosis and limb amputation were 12.5% vs. 10.0%, 5.0% and 7.5%, 17.5% vs. 35.0%, 15.0% vs. 12.5% and 37.5% vs. 32.5% respectively. Conclusion: Duration of embolism may be the significant factor determining the outcomes of the management of acute arterial embolism in the lower extremities. The 24- hour duration of arterial embolism is a crucial factor influencing the surgical the management and early diagnosis and shifting of patients to specified centre as early as possible to save limb as well as life.

Brevundimonas vesicularis bacteremia in a neonate: a rare case report.

There are very few cases of Brevundimonas vesicularis reported worldwide. We present a case of bacteremia in a neonate who had aspirated meconium . A blood culture showed growth of a non hemolytic yellow colored colony at 37°C. It was identified as Brevundimonas vesicularis by Vitek 2 automated system (BioMeriuex). There are only a couple of reported cases of bacteremia caused by Brevundimonas vesicularis . To our best of knowledge this is the third case report of Brevundimonas vesicularis bacteremia from India.

A Case Report of Middle Aortic Syndrome: A Rare Vascular Disorder.

The middle aortic syndrome (MAS) is rare (about 0.5-2% of all the cases of aortic coarctation) vascular disorder characterized by severe narrowing in the descending thoracic aorta, abdominal aorta, or both. It can be congenital or acquired due to several conditions.MAS may present clinically as uncontrolled hypertension, abdominal angina or lower limb claudication. Surgical treatment is effective in controlling symptom and improves life expectancy.

Angiographic Comparison of Coronary Artery Disease between Diabetic Men and Women.

Background: Cardiovascular diseases are the leading cause of death and morbidity in diabetic patients and this group is two to four times as likely to develop cardiovascular disease than the nondiabetic group, women being specially involved in this situation. In women , diabetes appear to be a stronger risk factor for the development of coronary heart disease than in men regardless of age ,menopausal status and whether or not the patient is insulin or non-insulin dependent. Objective of this study was to compare the angiographic extent of coronary artery disease between diabetic men and diabetic women. Method: This observational study was undertaken on 100 diabetic patients ( 50 women and 50 men) admitted inNational Institute of Cardiovascular disease (NICVD) during the period of July, 2006 to April ,2007.Diabetic women with coronary artery disease constitute the study group-I and diabetic men with coronary artery disease matched for age (±5 years) and risk factors , the study group-II . Coronary angiography was done in all patients & findings were analyzed. Segmental distribution method for coronary artery lesions was used to describe the distribution of atherosclerotis in coronary artery. Results: The mean age of group I was 51.02 ±8.93 years and that of the group II was 50.99± 9.83 years. In this study it was found that Diabetic women with coronary artery disease (CAD) had a higher coronary artery score, CAS (11.02±5.034) as compared to the diabetic men with CAD ( 8.04±4.866) (p<0.001). Diabetic women had also higher number of diseased vessels ( 78.67% vs 67.34%; p<0.01) and higher number of vessel score 3 ( 58% vs 34%; p<0.001). As compared to the diabetic men, diabetic women had a higher total number of coronary artery lesions (183 vs 136; p<0.001), a higher number of lesions per patient (3.66/ patients vs 2.72/patients; p<0.001) and a higher number of diffuse vessels (13.56% vs 8.91%;p<0.05). Conclusion: Diabetic women with coronary artery disease have more severe disease on coronary angiography as compared to diabetic men with coronary artery disease. The diffuse coronary artery involvement was also significantly higher in diabetic women than men.

Patency of Multiple stents/Overlapping Stents in Single Artery Territory in Bangladeshi Patient: An Updated Single Center Experiences.

Background: Coronary artery disease (CAD) in Bangladeshi population is diffuse in nature with small caliber arteries. Now a day, these are treated, by PCI with stent deployment, often multiple in a single coronary artery. However, long term data on In-stent re-stenosis (ISR) in multiple or overlapping stent in single coronary artery in these patients is not yet available. Therefore, the aim of our present study was to assess long-term outcome of stent patency or the development of ISR of varieties stent in single vessel territory. Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the 3-36 months preceding the study for the quantifying period of 2007-2011. Total 51 patients (male: 42, Female: 9) who had multiple stents in one coronary artery were included in this study. Average age was Male: 57; Female:61. Average study period was 3.1 ± 2.4yrs. Results: Our results show that, among the total studied population 82.4% (42) were male and 17.6% (9) were female. Total 114 stent were deployed in 54 vessels of 51 patients. Territory wise distribution of deployed stent was LAD 52(45.6%), RCA 42 (36.8%) and LCX 20(17.5%). Stent used were BMS 45(39.5%), DES 69(60.5%). Re-look Coronary Angiogram (CAG) revealed that Significant ISR (ISR>60%) developed in BMS 8(17.8%) and DES 8(11.5%). Among the different DES the development of significant ISR were in Sirolimus 1(3.2%), Paclitaxel 4(16%), Everolimus 3 (30%). Conclusion: Our study has shown that deployment of multiple stents in a single artery territory (either separately or as overlapping) is safe and has reasonably lower degree of ISR, even when BMS was used. As a whole BMS shows higher degree of ISR than to DES for an average period of follow up of 3.1 yrs.

Molecular characterization of 'Bhut Jolokia' the hottest chilli.

The northeast region of India, considered as ‘hot spot’ of biodiversity, having unique ecological environment with hot and high-humidity conditions, has given rise to the world’s hottest chilli, ‘Bhut Jolokia’, which is at least two times hotter than Red Savina Habanero in terms of Scoville heat units (SHU). This study was undertaken to determine the distinctiveness of ‘Bhut Jolokia’ from Capsicum frutescens or Capsicum chinense through sequencing of the ribosomal RNA (rRNA) gene-internal transcribed (ITS) region along with its phylogenetic analysis. Although a compensatory base change (CBC) in the ITS2 region was not observed between the closely related species of C. frutescens and C. chinense when compared with Bhut Jolokia; phylogenetic analysis using ITS1, 5.8S and ITS2 sequences indicated a distinct clade for all the accessions of ‘Bhut Joloikia’, while C. frutescens and C. chinense occupied discrete lineages. Further, a unique 13-base deletion was observed in all the representative accessions of ‘Bhut Jolokia’, making it distinct from all other members within the genus and beyond. The degree of genetic variations along with its extreme pungency might be related to ambient environmental factors of northeastern India.

Mycotic Aneurysm of Aorta Following Mitral Valve Replacement – A Case Report.

The term mycotic aneurysm refers to aneurysm associated with infection by microorganism. Sir William Osler first coined the term mycotic aneurysm in 1885 by disclosing the relation between abnormal cardiac valves and infection with micrococci not with fungi. An 11 years old female from Feni presented with asymptomatic vascular swelling in abdomen referred by a cardiologist. CT angiogram revealed fusiform aneurysm in distal part of abdominal aorta involving ostioproximal part of both common iliac arteries and saccular aneurysm of distal part of superior mesenteric arteries suggestive of mycotic aneurysm. Patient underwent vascular operation aorto biilliac bypass by PTFE graft with excision and ligation of aneurysm of superior mesenteric arteries .Mycotic aneurysm in bacterial endocarditis is rare. It is a challenging job for the cardiologists, infectious disease specialists and vascular surgeon. Time appropriate skilled prompt surgical management can bring smile for both patients and physicians.

Assessment of antibacterial, thrombolytic and cytotoxic potential of Cassia alata seed oil.

Cassia alata is a pan tropical shrub. It has been reported to have medicinal activities like laxative effect and active against ringworm, skin diseases and ulcer. The leaf extract of this plant has shown antibacterial activity. In this study, seed oil extracted from Cassia alata , was studied for Antibacterial, Thrombolytic and Cytotoxic activity by using in vitro techniques. Chloroform extract of the seed oil was tested for Antibacterial activity using disc diffusion method and that extract showed potent antibacterial activity against both Gram(+) and Gram(-) bacteria. DMSO extract of the seed oil was tested for Brine shrimp lethality bioassay using Brine shrimp nauplii. The LC50 of DMSO extract of Cassia alata seed oil was found to be 250μg/ml, indicates that the oil has moderate pharmacological action. The DMSO extract of the seed oil was also tested for in vitro thrombolytic activity. The extract showed reasonable thrombolytic activity against negative control (water).Further investigation on the plant is required to confirm their pharmacological activity and thereby utilizing them as useful medicinal plant.

Aorto-bi-Femoral Bypass for Aorto-Iliac Occlusive Disease: Recent Experience at the National Institute of Cardiovascular Diseases (NICVD).

Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.

Lateral Medullary Syndrome (Wallenberg’S Syndrome) - A Case Report.

The Lateral medullary syndrome is not a very common stroke. Sometimes it is under diagnosed. Mr. Ibrahim Mollah, 50 years old male person, non diabetic, non hypertensive but smoker presented with the history of sudden onset of dysphagia, dysarthria and ataxia of the gait. He is clinically and radiologically diagnosed as a case of Lateral medullary syndrome (Ischaemic stroke). With treatment this patient improved significantly. It is commonly caused by occlusion of the cranial segment of the vertebral artery or the posterior inferior cerebellar artery. The occlusion may be due to thrombosis or embolism. The emboli are coming from the heart or the great vessels. We can diagnose Lateral medullary syndrome with expert clinical eye and CT/MRI of the brain. It should be managed with appropriate treatment and physiotherapy.

Surgical Management of Vascular Complications in Intravenous Drug Abusers: Experience at the National Institute of Cardiovascular Diseases (NICVD), Bangladesh.

Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible.

Cost- Effective Management of Venous Ulcer.

Background: Venous disorders are very common. About 20% of the population suffer from varicose veins, 2% have skin changes which may precede venous ulceration1. Venous ulcers represent a common and debilitating condition associated with significant financial loss for the patients as well as the society. Treatment options for these patients are costly and time consuming. In this study we tried to find out cost -effective measures for treating this group of patients. Method: To evaluate the effectiveness and safety of superficial and perforating leg venous surgery along with pharmacotherapy 66 patients with chronic venous leg ulcers are prospectively studied. After proper history taking and clinical examination all patients underwent venous duplex ultrasonography. Patients were divided into two groups. Group I (n=30) includes patients undergoing saphenofemoral ligation and stripping of the great saphenous vein (GSV). In group II (n=36) patients underwent saphenofemoral and incompetent leg perforator ligation along with stripping of the GSV. Conservative measures, local ulcer care and pharmacotherapy were common in both groups. Result: Postoperative complications, total hospital stay and ulcer healing were studied. Ulcer healing was earlier in group II. Remarkable complications were similar in both the groups. Conclusion: For effective and economic care of venous leg ulcers, combination of standard surgical procedures including incompetent perforator and saphenofemoral ligation with great saphenous vein stripping and standard physio-pharmacotherapeutic care is essential. This combined modality of treatment is highly effective in early and complete ulcer healing in patients suffering from venous ulcers.

Kartagener's Syndrome.

Kartagener's Syndrome or Immotile Cilia Syndrome, a variant of Primary Ciliary Dyskinesia (PCD), is a rare autosomal recessive genetic disorder caused by defect in the tiny hair like structure, the cilia lining the respiratory tract (upper and lower), sinuses, eustachian tubes, middle ear and fallopian tubes. Here electron microscopy shows abnormal arrangement of ciliary tubules and patients with Kartagener's syndrome has an absence of dynein arms at the base of the cilia. The inability of cilia to move results in inadequate clearance of bacteria from the air passages, resulting in an increased risk of infection and causing bronchiectasis. Another result of ciliary immobility is infertility. A 60 years old lady was diagnosed as a case of Kartagener's syndrome. She had history of chronic cough for 20 years, irregular fever for 20 years and occasional shortness of breath for 5 years. Relevant investigations revealed dextrocardia, situs inversus, bilateral maxillary sinusitis with non pneumatised frontal sinus and bronchiectasis. She was treated with low concentration oxygen inhalation, antibiotic, bronchodilator, chest physiotherapy including postural drainage, vitamins and other supportive treatment.

Initial experience with 10 cases of Indiana pouch continent urinary diversion.

Indiana pouch continent urinary diversion provides patient control over elimination of urine with periods of dryness. This allows emptying of urine from the pouch by catheter at convenient intervals avoiding major metabolic abnormalities with satisfactory renal function. Detubularization of the ascending colon and caecum with tapering of the terminal ileum and tunneled tenial implants of the ureters have resulted continent cutaneous urinary reservoir. In total 10 patients were included and follow-up period was for a period of 6 months to 5 years. One year after surgery overall day and night continence rate was in 70% patients, some leakage at day and night in 30% cases and no patient developed day or night incontinence. The mean capacity of the pouch was 530 ml at 12-18 months. Pouch pressure at full capacity was 16 cm H2O at 18 months. Indiana pouch provides better attention for urinary diversion in developing countries as it is well accepted, economically more suitable and relatively easy to construct, with good results in terms of continence and reduced complications with satisfactory renal function.