Ecological risk posed by heavy metals contamination of ship breaking yards in bangladesh

Pollution of water and soils by heavy metals is an emerging problem in industrialized countries. The present study was conducted to investigate the heavy metals concentration in water and sediment samples from ship breaking sites of Sitakunda to assess the potential ecological risk posed by heavy metal using different methods. Heavy metals concentration was analyzed by Atomic Absorption Spectroscopy Concentrations of all the tested heavy metals except Cr in water samples of ship breaking site, Sitakunda were lower than recommended values. The mean concentration of Cr was found 0.51 1 +/- 0.284 mg/1. Concentrations of all the tested heavy metals except Mn in sediment samples were higher than standard limit. The concentrations of Pb, Mn, Cr, Cu and Zn in the sediment were 55.93 +/- 18.70, 20.08 +/- 4.03, 106.8 +/- 47.65, 50.09 +/- 18.31, and 70.71 +/- 19.45 mg/kg, respectively. Based on Geoaccumulation Index, Contamination factor. Sediment Quality Guidelines, the sediment of ship breaking site can be treated as unpolluted to moderately polluted with Pb, Zn, Cr and Cu but unpolluted with Mn. The Enrichment factors of Pb, Mn, Cr, Cu and Zn in the sediment were: 2.97 +/- 0.98, 0.035 +/- 0.008, 1.97 +/- 0.88, 1.99 +/- 0.73, and 1.17 +/- 0.32, respectively. The Enrichment factor [>1] in all sampling sites, suggesting source of those metals [Pb, Cr, Cu and Zn] were more likely to be anthropogenic. Based on the Potential Ecological Risk Index the ship breaking site posed to low risk to the environment. The results of present study clearly indicated that the ship breaking site was moderately polluted with heavy metals and pose low risk to the ecosystem

Pulmonary Hypertension: A Review.

Pulmonary hypertension is a relatively common disorder that leads to right heart failure if untreated. Symptoms and signs of pulmonary hypertensionare often subtle and nonspecific. As a result a significant delay between the onset of symptoms and the diagnosis of pulmonary hypertension is common. Recently improved understanding of the pathophysiology of pulmonary hypertension leads to various treatment options that enable us to treat this disorder more efficiently.

High-Density Lipoprotein as a Therapeutic Target: Treatment Strategies.

Coronary artery disease (CAD) is one of the most important causes of morbidity and mortality worldwide despite considerable therapeutic advances that control the risk factors. Numerous clinical trials have shown an inverse association between high density lipoprotein cholesterol levels and the risk of coronary artery disease. So, high density lipoprotein has become a new therapeutic target after low density lipoprotein in the management of risk factors of coronary artery disease. In this review, we explore existing and future treatment strategies along with their benefits and failures which will guide our management strategy. HDL raising therapies showed very promising results in many clinical trials but larger clinical trials are ongoing.

Effect of Oral Zinc Supplementation on the Growth of Preterm Infants.

Objective: To compare the effect of oral zinc supplementation on growth of preterm infants. Design: Randomized controlled trial. Setting: Dhaka Shisu Hospital (Tertiary care hospital). Subjects: 100 appropriate for date preterm infants weighing between 1000 to 2500g were randomized to receive zinc and multivitamin supplement (Group I; n=50) or only multivitamin supplement (Group II). Intervention: Zinc supplementation was given 2mg/kg/ day for 6 weeks along with multivitamin in Group I and only multivitamin to Group II. Primary outcome variable: Increment of weight and length. Results: At enrollment, serum zinc (62.1±12.4μg/dL in Group I and 63.1±14.6μg/dL in Group II) and hemoglobin levels (14.9±2.4g/dL in Group I and 14.4±1.7g/dL in Group II) were almost similar in both groups. Serum zinc levels were in lower limit of normal range. After supplementation, serum zinc and hemoglobin levels were significantly higher in Group I (105±16.5μg/dL) than Group II (82.2±17.4μg/dL) (P<0.05). Weight, length and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found in first and second follow up between two groups but OFC increments were not significant (P>0.05). Reduction of morbidity was apparent in zinc supplemented group. No serious adverse effect was noted related to supplementation therapy. Conclusion: Zinc supplementation for preterm low birth weight babies is found effective to enhance the growth in early months of life.

Study Of Serum Lipid Profile In Pre-Eclampsia And Eclampsia.

The present study was designed to evaluate the association of lipid profile in pre- eclampsia and eclampsia. This case-control study was carried out in the department of biochemistry, M.A.G. Osmani Medical College, Sylhet, during July 2005 to June 2006. Total 100 study subjects were evaluated, 40 normotensive pregnant women (mean age 24.90 ± 4.04) as normal and 60 already diagnosed preeclamptic & eclamptic women (mean age 24.17 ± 4.90) as study group. Age range was 15-45 years, gestational age 24 weeks to term were included. Patients with pre-existing hypertension were excluded. Serum lipid profile (total lipids, cholesterol, triglycerides, HDL-cholesterol and LDLcholesterol) of hundred women with Pre-eclampsia and Eclampsia (n=60), normotensive women (n=40) were monitored. The preeclampsia was associated with a significant rise in triglyceride (225.6 ± 28.93 vs 165.6 ± 17.22) and fall in HDL cholesterol concentration (42.4 ± 9.29 vs 55.7 ± 7.11), while eclamptic women showed significant fall in HDL cholesterol (41.8 ± 8.79 vs 55.7 ± 7.11) and rise in LDL cholesterol (133.4 ± 11.75 vs 115.2 ± 10.72) as compared to normal pregnant women. Lipid metabolism plays a key role in the pathophysiology of Pre-eclampsia and Eclampsia. Increased triglycerides levels along with decreased HDL-cholesterol levels and delayed triglycerides clearance and high blood pressure are associated with development of preeclampsia and eclampsia. This association may be significant in understanding the pathologic processes of preeclampsia and may help in developing strategies for prevention or early diagnosis of the disorder.

Determining Gestational Age in a Low-resource Setting: Validity of Last Menstrual Period.

The validity of three methods (last menstrual period [LPM], Ballard and Dubowitz scores) for assessment of gestational age for premature infants in a low-resource setting was assessed, using antenatal ultrasound as the gold standard. It was hypothesized that LMP and other methods would perform similarly in determining postnatal gestational age. Concordance analysis was applied to data on 355 neonates of <33 weeks gestational age enrolled in a topical skin-therapy trial in a tertiary-care children’s hospital in Bangladesh. The concordance coefficient for LMP, Ballard, and Dubowitz was 0.878, 0.914, and 0.886 respectively. LMP and Ballard underestimated gestational age by one day (±11) and 2.9 days (±7.8) respectively while Dubowitz overestimated gestational age by 3.9 days (±7.1) compared to ultrasound finding. LMP in a low-resource setting was a more reliable measure of gestational age than previously thought for estimation of postnatal gestational age of preterm infants. Ballard and Dubowitz scores are slightly more reliable but require more technical skills to perform. Additional prospective trials are warranted to examine LMP against antenatal ultrasound for primary assessment of neonatal gestational age in other low-resource settings.

Risk Factors Analysis and Angiographic Profile in Postmenopausal Women with Coronary Artery Disease.

Background : Postmenopausal women are at greater risk for coronary artery disease (CAD) than premenopausal women. This may be due to deprivation of estrogen, which acts directly and indirectly on the vasculature. In light of this finding the aim of the study was to find the relation of serum estrogen level with severity of atherosclerotic lesion and number of risk factors in CAD among postmenopausal women. Methods: One hundred postmenopausal women undergoing coronary angiography (CAG) were studied. Among them 50 patients with estrogen level <25 pg/ml constituted study Group I and another 50 postmenopausal women with >25 pg/ml constituted study Group II. Serum estrogen level was measured by radioimmunoassay. Other important risk factors like dyslipidaemia, diabetes mellitus, hypertension, family history of CAD, smoking and waist circumference were evaluated between the 2 groups of patients. CAG findings were analyzed by eye estimation and by Gensini score. Results: All the risk factors were significantly higher in Group I patients than that of Group II. Among the risk factors hypertension was most prevalent (64%) in Group I and dyslipidaemia (40%) in Group II. Multivariate regression analysis showed that serum estrogen was a strong and an independent predictor of CAD (p=0.001) when considered with other standard risk factors. Association between the angiographic severity of CAD and serum estrogen level were evaluated and negative correlation was observed, i.e. lower the serum estrogen level higher the vessel score. Conclusion: In postmenopausal women serum estrogen level is a strong & an independent predictor of CAD. It is also found that low estrogen group of postmenopausal women with CAD have more severe atherosclerotic lesions in comparison to the group with normal estrogen level.

Splenic Mass and its Relation to Age Sex and Height of the Individual in Bangladeshi Peoples.

The aim of this study was to establish the standard weight of the normal spleen in Bangladeshi people. One hundred and twenty human cadavers of which eighty seven male and thirty three female were dissected to remove spleen with associated structures. Collected specimens were tagged with specific identification number, and divided into five groups according to age, sex and height of the individual. Gross and fine dissections were carried out after fixing the specimen in 10% formal saline solution. Weight of the spleen was measured by analytical balance and expressed in gram and findings of the study were compared with the findings of national and global studies. This cross sectional descriptive study was carried out in the Department of Anatomy of Mymensingh Medical College, Mymensingh. In this study maximum mean weight of spleen was 86.35 gram in male and 85.33 gram in female in 31 – 45 years age group. Minimum mean weight of spleen was 47.37 gram in male and 38.83 gram in female up to 15 years age group. The weight of spleen increases with age of the individual. Mean weight of spleen in male was 73.43 gram, which was higher than the mean weight of female spleen (59.17 gram). According to height of individual the mean weight of spleen was maximum 84.32 gram in 165.01 to 180 cm height group and minimum in 54.87 gram in up to 120 cm height group which indicate that weight of the spleen increases with height of the individual. In conclusion, the weight of the spleen depends on the age, sex and body height of the individual.

Origin and Position of Cystic Artery in Bangladeshi Corpse.

This cross sectional descriptive morphological study was done to see the site of origin of cystic artery supplying the gallbladder in Bangladeshi people to increase the knowledge regarding variation anatomy in our population. Sixty post mortem tissue blocks containing liver and gallbladder along with surrounding structures were collected from 40 male and 20 female cadavers of different age groups and fixed in 10% formal saline solution. This study was carried out in the Department of Anatomy in Mymensingh Medical College, Mymensingh , from July 2007 to June 2008. Gross and fine dissections were carried out to study the different origin of cystic artery and its topographic relationship with adjacent structures. In the present study, findings were compared with the findings of Western researchers. In the present study, the so-called typical origin of the cystic artery from right hepatic artery was 90% and in 10% cases it was found to arise from other sources. Out of 10%, 3% arise from left hepatic artery, 3% from junction between right and left hepatic artery, 2% from hepatic artery proper and 2% from gastro duodenal artery.

Complementary and Alternative Medicine in Cardiovascular Care.

Complementary and alternative medicine (CAM) refers to a broad set of health care practices that are not part of a country’s own tradition and are not integrated into the dominant health care system. Herbal remedies, dietary supplements, acupuncture, homeopathy, ayurveda, unani, traditional Chinese medicine, prayer, yoga and meditation are the common examples. CAM therapies often represent an enormous area of unregulated and widely practised therapeutics with an inadequate scientific literature. However, there is emerging evidence that some of the CAM therapies are effective in certain clinical conditions. Presently, throughout the world, there is rampant growth of CAM industries, and increasing number of reputed pharmaceutical companies are producing herbals and dietary supplements. Herbal products used for cardiovascular purposes include garlic, hawthorn, ginkgo, horse chestnut and arjun. These substances are often popularly believed to be ‘natural’, hence safe. But adverse reactions including deaths have been reported with some of the CAM products. There is also growing concern for significant drug interaction among commonly used herbals, dietary supplements and cardiovascular drugs. At present, CAM therapies may best be regarded as an adjunct to standard medical care. More scientific research and strict regulation by standard national and international authorities are needed to ensure their efficacy and safety in cardiovascular care.

Acceptability of massage with skin barrier-enhancing emollients in young neonates in Bangladesh.

Oil massage of newborns has been practised for generations in the Indian sub-continent; however, oils may vary from potentially beneficial, e.g. sunflower seed oil, to potentially toxic, e.g. mustard oil. The study was carried out to gain insights into oil-massage practices and acceptability of skin barrier-enhancing emollients in young, preterm Bangladeshi neonates. Preterm infants of <33 weeks gestational age were randomized to high-linoleate sunflower seed oil, Aquaphor Original Emollient Ointment, or the comparison group (usual care). A survey was administered at admission to assess routine skin-care practices prior to admission and at discharge to assess acceptability of emollient therapy during hospitalization. Oil massage was given to 83 (21%) of 405 babies before hospital admission, 86% (71/83) of whom were delivered at home. Application of oil, most commonly mustard oil (88%, 73/83), was started within one hour of birth in 51 cases (61%) and was applied all over the body (89%, 74/83) one to six (mean 2.2) times before admission. Of infants who received emollient therapy in the hospital, 42% (n=32) of mothers reported that the emollient applied in the hospital was better than that available at home, and only 29% would use the same oil (i.e. mustard oil) in the future as used previously at home. No problems resulted from use of emollient in the hospital. Topical therapy with sunflower seed oil or Aquaphor was perceived by many families to be superior to mustard oil. If caregivers and health professionals can be motivated to use inexpensive, available emollients, such as sunflower seed oil that are beneficial, emollient therapy could have substantial public-health benefit.

Clinical and bacteriological profile of neonatal septicemia in a tertiary level pediatric hospital in Bangladesh.

The present article is a descriptive analysis of clinical and bacteriological profile of neonatal septicemia in a tertiary care hospital in Bangladesh. Eighty six neonates with suspected sepsis were enrolled, out of which 30 were culture positive. Clinical presentation was non-specific. Majority (70%) of the cultures isolated gram negative bacilli, most commonly E.coli and Klebsiella. These isolates were most often sensitive to gentamicin, ciprofloxacin, and third generation cephalosporins. Twelve out of 30 culture positive cases died.

Comparative study between tubotympanic and atticoantral types of chronic suppurative otitis media.

This prospective study was done to compare the different aspects of tubotympanic (group I) and atticoantral types (group II) of chronic suppurative otitis media. The study included 200 patients of chronic suppurative otitis media, of them 100 were of tubotympanic type and 100 were with atticoantral disease. The age (mean +/- SD) of group I and II were 17 +/- 2.7 years and 12 +/- 2.3 years respectively (P < 0.05). The majority of the patients having poor socio-economic condition 69% in group I and 87% in-group II. In both groups, slum dwellers with bathing habit in pond or river and illiterate were more sufferer (P < 0.05). There was central perforation in all patients in-group I, and in-group II, 67% were with attic and 33% were with marginal perforations. In group I, aural discharge was mucoid or mucopurulent in majority of cases 80% and in-group II foul smelling scanty ear discharge was from 88% of subjects. In atticoantral type, hearing impairment was more than tubotympanic disease. Complications were more in atticoantral type of disease. In-group II, post auricular sinus 25% was the commonest extracranial complication followed by subperiosteal abscess 18%, and meningitis 10% was the commonest intracranial complication followed by brain abscess 8%. In tubotympanic type conservative treatment with reconstructive surgery were the treatment of choice, whereas radical or some modifications of radical surgery (with or without reconstruction) were the treatment plan for atticoantral disease. Among the groups the mortality rate was only 4% in-group II and was due to intracranial complications. The study recommends early detection and effective surgical treatment of the disease to improve the situation.

Vegetarian diet in the treatment of fibromyalgia.

Brain tryptophan is low in fibromyalgia. Intake of protein rich in large neutral amino acids is reported to lower brain tryptophan. This study was undertaken to assess whether any reduction of such proteins by exclusion of animal protein from the diet reduced pain and morbidity in fibromyalgia patients. It was an open, randomized controlled trial. 37 subjects with fibromyalgia were enrolled in the vegetarian diet and 41 in the amitriptyline groups. The outcome was assessed with the help of frequencies of fatigue, insomnia & non-restorative sleep, pain score on a 10-point VAS and tender point count. Fatigue, insomnia and non-restorative sleep were present in 41, 26 and 32 subjects before and in 3, 0 and 0 subjects respectively at six weeks of treatment in the amitriptyline group. The pain score and tender point count were 6.2 +/- 1.9 & 16.1 +/- 2.3 before and 2.3 +/- 1.3 & 6.4 +/- 3.0 after treatment. All these differences were significant (P < 0.001). In the vegetarian diet group, fatigue, insomnia and non-restorative sleep were present in 36, 24 and 27 subjects before and in 34, 29 and 29 subjects at six weeks of treatment. The pain score and tender point count were 5.7 +/- 1.8 and 15.7 +/- 2.4 before and 5.0 +/- 1.8 & 14.7 +/- 3.6 after treatment. All these differences were insignificant except that in the pain score. The decrease in the pain score, though significant, was much smaller than that in the amitriptyline group. So, it may be concluded that vegetarian diet is a poor option in the treatment of fibromyalgia.

IgA nephropathy in teaching hospitals of Dhaka.

A light and immunofluorescence microscopic study on renal biopsies were performed on 42 patients. Nephrotic syndrome with accompanying microhematuria and recurrent hematuria (Macroscopic/microscopic) with or without renal failure were the commonest indications for renal biopsy. Primary IgA nephropathy was diagnosed in five cases. Among the IgA nephropathy patients, the commonest light microscopic finding was mesangial proliferative glomerulonephritis. Macroscopic hematuria with proteinuria was the commonest feature. Three of the patients had hypertension at the time of renal biopsy. The age of the patients ranged from 19-38 years with a mean of 26 years. The high frequency of hypertension, degree of proteinuria and associated renal failure in one patient that it is a progressive disease. This preliminary study revealed that IgA nephropathy exists in Bangladesh. Larger samples need to be studied with a view to find out its prevalence and its peculiarities in this part of the world.

Dissecting microscopic (DM) and light microscopic (LM) study of the intestinal mucosa of Bangladeshi population.

A total of 67 specimens of proximal intestinal mucosa, one from each subject, were examined under dissecting microscopy (DM) and light microscopy (LM). Majority of the subjects were adults and males. The overall per-oral biopsy failure was 13. DM was found to be useful to demonstrate gross villous atrophy. It also helped to orientate the specimens properly before fixation for embedding and sectioning. DM and LM findings did not concord in 17% of the specimens. In all of these specimens the mucosal surface which appeared normal under DM revealed grade-2 change under LM. The present study showed that dissecting microscopy (DM) of the intestinal mucosa is not an alternative for histologic examination under LM. However, scanner of light microscope (SLM) can be used as an alternative for DM.