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ABSTRACT Introduction: Hypogonadism is one of the most frequent complications in transfusion-dependent thalassemia patients and early recognition and treatment is the core element in restoring impaired gonadal function. Despite the high burden of disease, relevant studies are scarcely addressing the gonadal function of such patients in Bangladesh. The pattern of gonadal function in transfusion-dependent thalassemia patients must be characterized before planning a generalized management plan. Moreover, since iron overload is a key reason behind hypogonadism in thalassemia patients, investigating the role of serum ferritin level as a diagnostic tool for hypongadism was also an aim of this study. Methods: This cross-sectional study was conducted at the Department of Transfusion Medicine of the Bangabandhu Sheikh Mujib Medical University. According to the inclusion and exclusion criteria, a total of 94 patients were enrolled in this study. A detailed history and thorough clinical examination were carried out in each patient and recorded using a pretested structured questionnaire. In addition, the laboratory assessment of serum ferritin, luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and estradiol in serum were also performed. The data were analyzed using the STATA (v.16). Results: The mean age of the patients with transfusion-dependent thalassemia was 18.81 ± 4.65 (SD), with 53.3% of the patients being male. The overall prevalence of hypogonadism was 35.11%, 18.1% being normogonadotropic, 11.7% being hypogonadotropic and 5.3% being hypergonadotropic. The serum ferritin level was significantly higher (p < 0.001) in patients with hypogonadism (Eugonadal: 2,174.79 (± 749.12) ng/ml; Hypogonadal: 3,572.59 (± 1,199.49) ng/ml). The area under the receiver operating characteristic (ROC) curve of serum ferritin was high (0.83) and the p-value was highly significant (< 0.001). Conclusion: Therefore, the serum ferritin level and gonadal hormone analysis of transfusion-dependent thalassemia patients can be considered a screening tool for assessing gonadal function and early detection and prevention of hypogonadism.
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Background & objectives: Japanese encephalitis virus (JEV) is one of the most important causes of acute and uncontrolled inflammatory disease in Asia. Matrix metalloproteinases (MMPs) and chemokines play a detrimental role in the host response to JE disease, aetiology, and disease outcome. Evidently, MMPs are widely circulated in the brain and regulate various process including microglial activation, inflammation, blood-brain barrier disruption as well as affects central nervous system (CNS). The present study was to assess the association of single nucleotide polymorphisms of MMP-2, MMP-9 and chemokine (CXCL-12/SDF1-3’) in the north Indian population. Methods: We performed case-control study comprising of 125 patients and 125 healthy controls in north Indian population. Genomic DNA was extracted from whole blood and gene polymorphism have been determined by PCR-RFLP method. Results: MMP-2, MMP-9 and CXCL-12 gene was not significantly associated with JE disease, but homozygous (T/T) genotype of MMP-2 was statically associated with disease outcome (p=0.05, OR=0.110). A/G and G/G genotype of CXCL-12 was significantly associated with severity of disease. (p=0.032, OR=5.500, p=0.037, OR= 9.167). The serum level of MMP-2 was observed significantly increased in JE patients with homozygous (T/T) genotype whereas increased MMP-9 level was associated with heterozygous genotype. Interpretation & conclusion: MMP-2, MMP-9 and CXCL-12 gene polymorphism were not associated with JE susceptibility, but MMP-2 may be contributed to disease protection. CXCL-12 was associated with disease severity. In our concern this is the first report from northern India.
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Introduction: Myxoid soft‑tissue tumors are a diverse group of tumors which have similar histomorphology but have varied geneticsequence and clinical outcome, hence differentiating and diagnosing them is a challenge for any pathologist. This study describes the varioushistomorphological spectrum and vascular pattern of various myxoid soft‑tissue tumors. Materials and Methods: This was a retrospective and prospective observational study of myxoid soft‑tissue tumors over a period of 13 years. A total of 224 cases with myxoid morphology were included and were examined morphologically with a special focus on the vascular pattern. SPSS v 24 was used for statistical analysis. Results: The predominant lesions were benign in 164 (73.21%) cases, followed by malignant lesions in 43 (19.19%) cases and intermediate lesions 17 (7.58%) cases. Both benign and malignant lesions showed a male preponderance and were seen to arise predominantly from the extremities. The most common benign myxoid lesions in this study were of neural origin with myxoid neurofibroma constituting 65 (29. 01%) cases, followed by schwannoma 38 (16.9%) cases. Myxoid dermatofibrosarcoma protuberans was the most common intermediatelesion. Tumors with adipocytic differentiation were the predominant lesions among the malignant group, i.e myxoid liposarcoma seen in 17 (7.5%) cases. Conclusions: Vascular pattern in the myxoid lesions are subtle yet crucial in arriving at a histo‑morphological diagnosis. Further studies correlating the vascular pattern with the genetic profile of these tumours can help arriving at a histo‑morphological diagnosisof myxoid lesions.
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Objectives: Chryseobacterium indologenes has recently been identified as an inherently drug-resistant organism, responsible for a wide spectrum of infections, mainly device-associated infections in hospital settings. The presence of carbapenem resistance due to blaNDM-1 metallo-?-lactamase (MBL) gene further complicates the matter, leading to widespread dissemination of carbapenem resistance. This study aims to find out the presence of blaNDM-1 gene among C. indologenes strains causing bloodstream infections in a tertiary care hospital. Materials and methods: During 1 year of the study period, blood culture samples were collected from patients with features of bacteremia, and C. indologenes strains were isolated and identified as per protocol. Antibiotic sensitivity test was performed by using VITEK 2 Compact Automated AST machine (Biomerieux, France). Carbapenem-resistant strains were subjected to a combined disk diffusion test for detecting the presence of MBL enzyme. Strains positive for MBL production were subjected to a polymerase chain reaction (PCR) for detection of blaNDM-1 gene. Results: Out of 21 strains isolated during the study period, 12 strains (57.1%) were carbapenem-resistant. Among them, seven strains (58.3%) were MBL producers. After PCR, 3 strains (42.9%) were found to be harboring blaNDM-1 gene Discussion: As per our knowledge, this is the first report of blaNDM-1 gene harboring C. indologenes strain from Northeast India. This shows the emerging therapeutic dilemma due to the narrowing of treatment options against bloodstream infections due to C. indologenes strains. Strict antimicrobial stewardship has to be implemented to prevent the further compounding of the problem.
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Secondary Hypertension comprises approximately 5% of Systemic Hypertension1. Renal parenchymal, Renovascular and Endocrine Diseases are amongst the common causes of Secondary Hypertension. Takayasu,s Arteritis is a rare form of Primary Systemic Vasculitis that appears to be commoner in Asia than Europe or North America2 and in contrast to Japanese patients, who have a higher incidence of aortic arch involvement, the series from India reports higher incidences of thoracic and abdominal involvement. In general, patients from Indian subcontinent tend to have greater prevalence of Pan-aortic Disease (both above and below the diaphragm) when compared with the west. In India the women : men ratio is around 1.5:1. Takayasu, s Arteritis most frequently affects young women3. Therapeutic intervention like Percutaneous Transluminal Angioplasty (PTA) and Stenting, By-pass Surgeries or surgical reconstruction should be performed when disease is made inactive by the use of effective immunosuppressive Therapy4
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Introduction:Head‑and‑neck cancer (HNC) treatments are elusive, and the hunt for an appropriate radiation strategy continues.Hypofractionation has the potential to provide several advantages, including a shorter overall duration that reduces rapid repopulation, dosage escalation with a higher biologically effective dose, and patient convenience. Hypofractionation is also beneficial in minimizing the danger of catching an infectious agent by reducing the number of hospital visits during the height of the COVID‑19 epidemic. Materials and Methods: Between January 2020 and August 2021, 120 patients with squamous cell carcinoma of the head‑and‑neck subsites were randomly allocated to either the hypofractionated arm A (n = 60) or the standard fractionation arm B (n = 60) with concomitant treatment. Results:Locoregional tumor response, acute and late toxicity, and compliance were the study’s endpoints. The normal tissue toxicities of each patient undergoing radiation were monitored weekly. Clinical and radiographic evaluations of locoregional control were conducted. Conclusion:Hypofractionation effectively overcomes tumor repopulation in rapidly growing tumors such as HNC, and we conclude in our study that the hypofractionated chemoradiation schedule appears to be more efficacious, with relatively superior locoregional control when compared to conventional chemoradiation with comparable normal tissue toxicities and compliance
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Dual concept has been recognized in appreciation of Kaala or time employing the scholars of Ayurveda. Saambatsara or Nityaga Kaala denotes the year and climate changes throughout the year and Atura Avastha or Avastika Kaala stands for the health repute along with ailment prevalence and their control about the weather changes. The weather change can steer the earth’s biological structures. Developing countries with restricted assets are expected to face a host of health consequences because of weather change, along with vector-borne and water-borne diseases. The distribution of infectious ailment includes complex social and demographic factors. Global climate change is a phenomenon this is now taken into consideration strongly associated with health and hazards. The outcomes of climate change on exposed biological incidences, in addition to societies prone to expose with disease, are a challenge for the complete scientific community. Rising temperatures, warm waves, floods, tornadoes, hurricanes, droughts, fires, lack of forest, and glaciers, in conjunction with the disappearance of rivers and desertification, can directly and circuitously concern with human pathologies which can be physical and mental.
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Purpose: Data regarding the efficacy of various radiotherapy techniques for post mastectomy chest-wall radiotherapy (PMRT) using hypofractionation is scarce and cardiac toxicity remains a concern. This study aims to compare effect of IMRT (Intensity Modulated Radiation Therapy) and 3D-CRT (3-Dimensional Conformal Radiation Therapy) techniques on cardiac dose. Materials and Methods: In this retrospective study, we compared IMRT and 3DCRT plans of 20 patients who received PMRT to a dose of 42.56Gy/16# and the dosimetric parameters in terms of planning target volume (PTV) coverage and dose to organ at risk (OARs) including heart and ipsilateral lung were recorded and analyzed. Result: PTV coverage were comparable with both techniques. IMRT planning provided a better conformity index as compared with 3DCRT (0.95 vs 0.91, p<0.001). The mean dose to the heart significantly reduced with IMRT (4.36Gy vs 8.2Gy, p<0.00001). Conclusion: IMRT offers a significant reduction in mean heart dose than 3DCRT in patients treated with hypofractionated post-mastectomy irradiation.
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One of the major causes of morbidity and mortality in tropical and subtropical regions is Dengue viral infection. This virus belongs to family flaviviridae comprising of four antigenically distinct serotypes DENV 1 - 4. A small number of studies conducted in North Eastern (NE) Region of India reported Dengue cases in Assam, Meghalaya, Nagaland, Manipur and Arunachal Pradesh. However, no studies have been conducted in the state of Tripura, with regard to pattern of Dengue viral infection and its circulating serotypes. Therefore, this study was undertaken to identify the serotypes circulating in Tripura. MethodsPatients with acute febrile illness were tested for detecting Dengue viral infection by MAC ELISA and / or NS1 detection test at Viral Research and Diagnostic Laboratory (VRDL), of a tertiary care centre in Tripura for a period of 3 years. All NS1 positive samples were further tested for presence of viral RNA by Reverse Transcriptase –PCR (RT - PCR) and serotyping was done using serotype specific primers. ResultsA total of 2515 acute febrile cases seen over a period of 3 years from 2014 to 2017 was tested for Dengue virus infection by serology. Out of 2515 of cases, 405 cases tested for NS1 antigen, where 10.61 % (43 / 405) was NS1 positive. The remaining 2110 cases were tested for IgM antibody MAC ELISA and 15.68 % (331 / 2110) was MAC ELISA positive. Out of all NS1 antigen positive cases 34.88 % of PCR positive and serotype characterisation showed DENV - 1 was predominant serotype followed by DENV - 2 and DENV - 4 respectively. ConclusionsThere is a rising trend of Dengue virus infection in Tripura with circulation of multiple serotypes. Moreover, cocirculation of multiple serotypes is a risk to the emergence of recombinant strains and also heterotypic infection in the near future might lead to development of DHF and DSS. Hence, molecular characterization of circulating serotypes may be helpful in addressing the probabilities of Dengue outbreak and possibilities of complications.
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Good pain relief after palatoplasty is important as inadequate analgesia with vigorous cry leads to wound dehiscence, removal of sutures and extra nursing care. Decrease in oxygen requirement and cardio-respiratory demand occur with good pain relief and also promotes early recovery. Preoperative opioids have concerns like sedation, respiratory depression and airway compromise. Greater palatine nerve block with bupivacaine is safe and effective without the risk of respiratory depression. The study was done to compare pain relief postoperatively with intravenous fentanyl and greater palatine nerve block in children following palatoplasty. Methods80 children of ASA I & II, between 1 to 7 years were included and allocated into two groups of 40 each. Analgesic medication was given preoperatively after induction of general anaesthesia, children in Group B received greater palatine nerve block with 2 mL 0.25% inj. Bupivacaine (1 mL on each side) and Group F received 2 μg Kg-1 I.V. fentanyl as 2 mL solution. Assessment of pain was done by FLACC scale and recovery profile by Modified Aldrete Score. Haemodynamic monitoring along with side effects was assessed. Data was analysed using SPSS software (Statistical Package of Social Science) version 17.0. p-value of < 0.05 was considered significant. ResultsPatients receiving block showed significantly better recovery profile (9.22 ± 0.39) vs (8.78 ± 0.61), duration of analgesia (482.59 +93.76) vs (174.13 +84.91) and less mean paracetamol consumption (126.66 +18.70) vs (151.79 +60.03) with comparable haemodynamics and side effects. ConclusionsGreater palatine nerve block provides effective postoperative pain relief after palatoplasty in children compared to I.V. fentanyl. It is safe, easy to perform, and free of complications.
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Chronic Obstructive Pulmonary Disease (COPD) is a disorder that is characterized by progressive airflow limitation that is not fully reversible, with important extra-pulmonary manifestation. In practice, this is measured as the FEV1/FVC ratio and the arbitrary definition of airflow obstruction is generally taken to be an FEV1/FVC ratio lower than 0.70. The objective of the current study is to find out clinical presentation and asses the comorbid condition along with chronic obstructive pulmonary disease (COPD) patients. METHODSA one-year observational study was planned to assess the diagnosis and clinical presentation of COPD patients along with comorbidity as per GOLD-2009 guidelines. RESULTSOne hundred patients of Chronic Obstructive Pulmonary Disease (COPD) were included in our study. Among them, 84 were males (84%) and 16 were females (16%). Most of the patients were in above-50-years age group (as 89% male vs. 87.5% female) and among these, most of the patients were above 65 years (48% male vs. 50% female). The most common presenting complaint was shortness of breath. 10.7% of male and 18.75% of female COPD patients were found to have anaemia. Anaemia of chronic disease and iron deficiency anaemia was commonly occurrence. In our study, it was found that, 14 cases were having diabetes (14%) and 20 cases were having hypertension (20%). None of the patients in my study suffered from both diabetes and hypertension. In this study, 6 (7%) male COPD patients had ischemic heart disease and 12.5% of female patients had ischemic heart disease. CONCLUSIONSShortness of breath was the most common presentation. Males are more prone to develop COPD. Diabetes, hypertension, anaemia, ischemic heart disease were found to be the co-morbid conditions.
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Distant metastases in squamous cell carcinoma of the head and neck are uncommon, and the incidence rises with neck node metastasis. The lung, liver, and bones are the common possible sites for distant metastasis. Cutaneous and cardiac metastases are extremely rare situations with aggressive behaviors and present in the late course of the disease. Here, we report a case of anterior tongue cancer with cutaneous, bone, cardiac, lung, and soft tissue of right suprascapular area metastases after a gap of 2 years of follow-up of completion of treatment with radical surgery and adjuvant concurrent chemoradiation therapy. The present case developed such type of aggressive distant metastases without any locoregional recurrence and died within 6 months of diagnosis of distant metastases
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Abstract Background Thought suppression has been associated with a number of psychiatric disorders. However, the association with conversion disorder (CD) has not been investigated yet. Objective To investigate the role of thought suppression in CD. Methods Eighty consecutive outpatients with a diagnosis of CD and sixty age, sex and neighborhood-similar controls were evaluated using Beck Depression Inventory-I (BDI-I), White Bear Suppression Inventory (WBSI), Symptom Interpretation Questionnaire (SIQ) and Sleep Hygiene Index (SHI). Cases and controls were compared in regard to thought suppression scores considering their status of high depression scores via a logistic regression model. The reciprocal associations of thought suppression with other clinical dimensions in CD were assessed. Finally, structural equation modelling was applied to untangle the possible connections. Results CD patients had significantly higher scores of thought suppression than the control group. However, the difference was below the significance level when CD patients without comorbid high depression scores were taken into account. Thought suppression was associated with the clinical severity of CD. According to the structural equation model, older age and somatic attributions to the common bodily sensations were the significant correlates of thought suppression among CD patients. Discussion Thought suppression may be considered as a non-specific marker of clinical severity in CD.
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Background: About 15% married couples face problem of infertility of which male factor is implicated in 20% of them. In about 30% infertile men no causative factor is found and the condition is termed “Idiopathic”. They are often treated by empirical medications or Assisted Reproductive Technologies (ART) although success in few; our present study is carried on effects of clomephene citrate on seminal parameters in idiopathic oligospermia.Methods: This single blinded prospective randomized controlled trial was conducted at the infertility clinic with 200 idiopathic oligospermic men (sperm count <15 millions/ ml of ejaculate) after fulfilling inclusion and exclusion criteria and were alternately allocated into two equal groups - “Group C” receiving clomephene citrate tablets and “ Group P” receiving placebo after concealment. Semen analysis data were collected at baseline and every month and three months of completion of treatment and were summarized by routine descriptive statistical analysis.Results: The demographic characteristics like mean age is comparative in both groups but duration of infertility of >2 years is more in group C than group p (4.3±3.06 versus 4.1±2.57). The semen volume, spermatozoa count, sperm motility and not normal form are all increased after three months of treatment in group C as are biochemical parameters like total testosterone and serum FSH, LH and as also pregnancy rate (22% versus 4%).Conclusions: This study showed clomiphene citrate treatment protocol is inexpensive, relatively safe and easy to administer and improves semen volume, sperm count and sperm motility but not sperm morphology by increasing serum testosterone, FSH and LH in male and resulting in improved pregnancy rate in female partners.
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Several indexes are used to classify physician burnout, with the Maslach Burnout Inventory currently being the most widely accepted. This index measures physician burnout based on emotional exhaustion, detachment from work, and lack of personal achievement. The overall percentage of physicians with burnout is estimated to be around 40%, but the proportion varies between specialties. Neurology currently has the second-highest rate of burnout and is projected to eventually take the top position. The purpose of this review is to provide a comprehensive overview focusing on the causes and ramifications of burnout and possible strategies for addressing the crisis. Several factors contribute to burnout among neurologist, including psychological trauma associated with patient care and a lack of respect compared to other specialties. Various interventions have been proposed for reducing burnout, and this article explores the feasibility of some of them. Burnout not only impacts the physician but also has adverse effects on the overall quality of patient care and places a strain on the health-care system. Burnout has only recently been recognized and accepted as a health crisis globally, and hence most of the proposed action plans have not been validated. More studies are needed to evaluate the long-term effects of such interventions.
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The in vitro seed germination which results in the production of disease-free seedlings and greenhouse germination of the seeds of Mansonia altissima was investigated in order to establish a better way of germination of the timber species. Five levels of GA3 treatment were used in in vitro germination with three replicate and two seeds were inoculated in each of the jam bottle. Whereas, in greenhouse germination, five levels of different treatments were used, replicated three times and each Petri plate contained 15 seeds. The experiment was repeated twice and the data from each experiment was put together and used for the statistical analysis. The results showed that seeds germination occurred eight days after inoculation in in vitro but in the case of greenhouse germination, it took only five days. For in vitro rapid germination of Mansonia altissima, the MS medium should be supplemented with 1.0 μm of GA3. Equally, in greenhouse germination, the seeds need to be soaked in 1.0 mM of GA3 for 24 hours. Alternatively, in the absence of GA3, the seeds can be soaked in water for 24 hours before broadcasting the seeds on the seedbed for germination, as this will help to identify nonviable seeds.
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Extinción Biológica , Germinación , Malvaceae/crecimiento & desarrollo , Técnicas In VitroRESUMEN
Bacteria have the ability of biofilm formation, in which the cells attach to each other within a self-producedmatrix of extracellular polymeric substance (EPS). The aim of the present research work was to isolateEPS-producing bacteria from wastewater. Total 21 bacterial isolates were screened for EPS production basedon mucoid and slimy colonies. Out of 21 isolates, nine efficient isolates were selected for the production ofEPS. These efficient bacterial strains were also checked for their antimicrobial potential against Salmonellasp., Escherichia coli, and Klebsiella sp. The isolates ASA3, H2E7, H2F8, and ASB4 inhibited the growth ofSalmonella sp., E. coli, and Klebsiella sp, while isolate ASB5, H2C6, and H2E9 only showed inhibitory effectsagainst Salmonella sp. The maximum concentration of EPS (i.e., 17.2 g/l) was produced by strain ASB4 within3 days of incubation.
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Diabetes mellitus is considered to be a state of persistent low grade inflammation which contributes to the pathogenesis of disease. Inflammation is a state of local protective response to tissue injury. In addition to local response, systemic response called as acute-phase response is depicted by the changes in levels of acute phase reactants like CReactive Protein(CRP), complement system proteins, serum amyloid A, haptoglobin and fibrinogen. Methods: 50 Type 2 Diabetic patients and 50 non diabetic subjects between the age group of 30-65 years who were all attending in OPD at Santosh Medical college and Hospital Ghaziabad, were selected for the study. Results: Both the study and control groups were comparable with respect to age (p 0.012). The study group had higher body mass index(p 0.0003), higher fasting blood glucose (p<0.0001), higher 2 –hour postprandial blood glucose (p<0.0001), higher HbA1c levels (p<0.0001), higher serum total cholesterol (p<0.0001), higher triglyceride levels(p<0.0001), higher LDL cholesterol(p<0.0001), and lower HDL cholesterol levels(p<0.0001), higher hsCRP level (p<0.0001), higher MDA level (p<0.0001) and Lower Thiols level (p<0.0001) in type 2 DM subjects. Conclusion: In conclusion, the mean concentrations of fasting & postprandial serum glucose, lipids, high-sensitivity C-reactive protein, MDA, & glycated hemoglobin were significantly increased in type 2 diabetic subjects when compared to controls. There was no significant increase in plasma protein Thiols levels found in type 2 diabetic subjects when compared to controls.
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Background: The objective is to determine the prevalence of metabolic syndrome (MBS) and the effects of insulin sensitizers to improve the clinical and hormonal milieu for better reproductive outcome in PCOS women.Methods: This prospective cross-sectional study was conducted on 50 PCOS women and 50 age matched control to determine the prevalence of the MBS in two tertiary hospitals over one year. Diagnosis of PCOS was based on at least two of ESHRE/ASRM criteria and diagnosis of MBS was based on at least three of NCEPATPIII criteria. Patients already diagnosed as PCOS were treated with insulin sensitizers myoionositol and metformin which were compared.Results: The study revealed that the prevalence of MBS was 40 % (20/50) nearly 4-fold higher than that of control groups. Among PCOS women, the most prevalent MBS factors were high BMI (52%) and low serum HDL-C (42%). The least prevalent factor was high fasting serum glucose level (16%). The resumption of spontaneous regular menstrual cycle and pregnancy rate in infertile groups of PCOS patients with myoionositol and metformin were 61% vs. 26% and 50% vs.91% respectively. The myoionositol group did not require any extra ovulating agents for pregnancy, while 7 out of 11 patients in metfromin group needed clomiphen citrate for ovulation induction to achieve pregnancy. With myoinositol there is significant reduction of weight, BMI, LH/FSH ratio and fasting insulin level; whereas metformin shows decrement of weight and BMI only.Conclusions: The prevalence of MBS in PCOS is nearly 4 times in present study and there is significant improvement of symptom profile, weight, BMI and change of hormonal pattern in myoinositol group.