The Relationships between Thyroid Hormones and the Brain Serotonin (5-Ht) System and Mood: Of Synergy and Significance in the Adult Brain- A Review.

The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been conformed repeatedly. Interaction of the thyroid and monoamine neurotransmitter systems has been suggested as a potential underline mechanism of action. While catecholamine and thyroid interrelationships have been reviewed in detail, the serotonin system has been relatively neglected. Thus, the goal of this article is to review the literature on the relationship between thyroid hormones and the brain serotonin (5-HT) system. In humans, neuroendocrine challenge studies in hypothyroid patients have shown a reduced 5-HT responsiveness that is reversible with replacement therapy. In the majority of the studies, the effects of thyroid hormone administration in animals will experimentally-induced hypothyroid sates include an increase in cortical 5-HT concentrations and a desensitization of auto inhibitory 5-HT1A receptors in the rap he area, resulting in disinhibition of cortical hippocampal 5-HT release. Furthermore, there is some indication that thyroid hormones may increase cortical 5-HT2 receptor sensitivity. In conclusion, there is robust evidence, particularly from animal studies, that the thyroid economy has a modulating impact in the brain serotonin system. Thus it is postulated that one mechanism, among others, through which exogenous thyroid hormones may exert their modulatory effects in affective illness is via an increase in serotonergic neurotransmission, specifically by reducing the sensitivity of 5-HT1A auto receptors in the raphe area, and by increasing 5-HT2 receptor sensitivity.

New approach for measuring antioxidant activity via graphite sensor.

An ion selective membrane sensor from dioctyl phthalate as a plasticizer in a polymeric matrix of polyvinyl chloride (PVC) and β-cyclodextrin as an ionophore was constructed and evaluated according to IUPAC recommendations. Linear Nernestian response of 2, 2-diphenyl-1-picrylhydrazyl radical (DPPH•) within the concentration ranges of 10−6 to 10−2 mol L−1 was obtained with average recovery 99.87±0.617. Nernstian slope of 58.5 mV/decade with excellent selectivity over the pH range of 3–8 was observed. The suggested method was standardized using butylated hydroxyl anisole (BHA). The 50% radical scavenging activity (IC50) determined by the proposed sensor correlated well with that of the common colorimetric method based on scavenging of DPPH•. An algorithm implemented in Microsoft Visual Basic® 6.0 was used for calculating (IC50) values which are 7.38 μg/ml ± 0.35, 89.98 μg/ml ± 0.45 and 1.45 mg/ml± 1.50 for BHA, paracetamol and dipyridamole, respectively. The proposed sensor represents a simple and reproducible tool for measuring DPPH• scavenging activity of paracetamol and dipyridamole in bulk powder, pharmaceutical formulations and simulated intestinal fluid (SIF) without sophisticated separation techniques.

The Role of SPECT-Guided CT for Evaluating Foci of Increased Bone Metabolism Classified as Indeterminate on SPECT in Cancer Patients.

Planar and SPECT bone scintigraphy has played a major role in the staging of many cancers such as breast and prostate cancer, as well as in orthopedics. Integrated diagnostic CT combined with SPECT has helped improve localization and characterization of skeletal lesions, improving diagnostic confidence and helping management decisions, over traditional SPECT. A major advantage has been improved characterization of indeterminate bone lesions and differentiation of benign from malignant lesions due to additional CT information. In this treatise the role of SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate of SPECT in cancer patients is reviewed. Using this approach, the diagnostic confidence in differentiating malignant from benign bone lesions should better with the fused SPECT/CT image than with separate sets of bone scintigraphic and CT images.

Concomitant Aorto-axillary Bypass and Beating Heart Total Arterial Coronary Artery Bypass Grafting by RIMA-LIMA “Y” graft.

In common practice, left internal mammary artery (LIMA) along with great saphanous vein is used in coronary artery bypass grafting (CABG). Day by day total arterial CABG specially use of bilateral mammary arteries are becoming demanding. Coexisting occlusive disease may rarely affect coronary arteries along with left subclavian artery. We have reported a successful concomitant aorto-axillary bypass and CABG of a 52-year-aged man with the diagnosis of triple-vessel-disease (TVD) angiographically along with proximal stenosis in left subclavian artery. Aorto-axillary (left) bypass was done with 6-mm ring re-inforced polytetrafluoroethane (PTFE) graft and CABG was done by total arterial RIMA-LIMA “Y” graft on beating heart. The post-operative course was uneventful with reappearance of peripheral pulses in left upper extremity. The patient was discharged on the 9th post-operative day.

Association of dietary fiber with high sensitivity C-reactive proteinin type 2 diabetes mellitus.

Introduction: Hs-CRP is a nonspecific marker of the inflammatory response has been associated with development of type 2 diabetes mellitus. Cardiovascular disease is a major consequence of diabetes. DM confers a 2-4 fold rise in cardiovascular risk compared with general population. One of the many modifiable risk factors for both cardiovascular disease and diabetes is diet. Fiber is an important dietary factor that may modify the risk of both diseases. Material & methods: The current study is an attempt to explore the association of dietary fiber on inflammatory marker, hs-CRP in type2 diabetic subjects. Total 80 diabetic subjects were included in this study of which 40 were taking more dietary fiber and 40 were taking relatively low dietary fiber. Serum hs-CRP was measured by chemiluminescent immunometric assay (DPC Biermann Gmbh., Germany). Nutrient information was calculated using a pretested food recall questionnaire prepared by nutritionists for usual Bangladeshi food articles. Results: Hs-CRP was significantly higher in subjects taking low dietary fiber. There was significant negative correlation between CRP of subjects taking high and low intake of dietary fiber. Conclusion: So, low dietary fiber consumption maybe a possible causal factor of raised CRP. Type 2 diabetic patients who took less dietary fiber in their diets had elevated blood CRP levels.

Serum and Erythrocyte Magnesium levels in Offsprings of Essential Hypertensive Parents.

Hypertension is an important public health challenge worldwide, 95% of which are primary or essential hypertension, where the exact causes are not known. It has been thought that magnesium level has an association with hypertension and plays role in the pathogenesis of essential hypertension. Several evidences suggested that decreased magnesium level may be a significant modifiable risk factor for developing essential hypertension. To explore the relationship between serum and erythrocyte magnesium level with blood pressure, this case control study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), during the year 2006. Thirty offsprings of essential hypertensive parents were taken as cases and 30 age and sex-matched offsprings of normotensive parents were taken as controls. Serum & erythrocyte magnesium were measured by colorimetric Calmagite method. Significantly lower serum magnesium level (mg/dl) was found in cases than that of controls (1.90±0.210 vs 2.13±0.366, p<0.01) and erythrocyte magnesium (mg/dl) was also found to be lower in cases when compared with that of controls (4.46±0.699 vs 5.43±0.775, p<0.001). Mean systolic and diastolic blood pressure were found to be significantly higher (p<0.01) in cases as compared to controls. Though it is difficult to draw any definite conclusion, it may be assumed that, a hereditary predisposition to hypertension may be related to magnesium metabolism and magnesium deficiency might have a role in the future development of hypertension in the offsprings of essential hypertensive parents.

Rare Case of Ruptured Sinus of Valsalva: Ruptured Into Left Ventricular Cavity.

Rupture sinus of Valsalva is a relatively rare condition. We report a rare case of ruptured left sinus of valsalva with aneurysm, presenting with acute left ventricular failure. Transthoracic echocardiography showed an aneurysmal dilatation of the base of interventricular septum and part of the aortic root and a marked turbulent flow from the aortic root to the left ventricle with a continuous systolodiastolic shunting. The patient underwent successful repair of ruptured sinus of valsulva with closure of fistula. During Ventriculotomy the defect was repaired using pledgeted 5/ 0 prolene interrupted sutures and pericardial patch.

Pheochromocytoma with hypertensive crisis due to glucocorticoid administration: a case report and review of the literature.

We report a patient who presented with single episode of severe hypertension after intramuscular injection of betamethasone which was given to treat acute exacerbation of bronchial asthma. Episode of severe arterial hypertension was associated with pulmonary edema, acute renal failure and hyperkalemia. Further evaluation by appropriate diagnostic tests revealed that the patient is a case of phaechoromocytoma. This neoplasm was excised successfully and the patient is presently asymptomatic.We believe that this episode was initiated by glucocorticoid injection.

Correlation between serum bilirubin and serum ferritin Level in thalassaemia patients.

Thalassaemia is the most common hereditary disorder in the world including Bangladesh. Beta thalassaemia major and Hb-E thalassaemia both are common in our country. Iron overload causes most of the mortality and morbidity associate with thalassaemia. To assess the iron over load and liver function a cross sectional comparative study was carried out in the Department of Biochemistry, Dhaka Medical College, Dhaka in collaboration with Thalassaemia Center and Department of Pathology, Dhaka Shishu Hospital, Dhaka during the period of July 2006 to June 2007. The study was carried out with the patients who visited regularly in Dhaka Shishu Hospital Thalassaemia Centre (DSHTC) and had multiple transfusions (more than five) and age more than 2 years. To compare the state of liver function with normal healthy individuals' normal healthy persons were also included. Total 70 subjects were included in this study. The study subjects were distributed into two groups, the group - A (cases, n=40) and group - B (healthy controls, n=30). According to the major types of thalassaemia present in our country, group -A again divided into two, group - AI b-thalassaemia major (n=12) and group - AII of Hemoglobin E b-thalassaemia (n=28). The mean of serum Bilirubin in group - A and group - B were (2.04 ±0.70) mg/dl and (0.67±0.15) mg/dl respectively. Group - A had higher serum bilirubin than group -B in p value <0.001.The mean level of serum bilirubin in group - AI was (1.70±0.70)mg/dl and the mean of bilirubin in group AII was (2.18±0.66) mg/dl. Group -AI had lower serum bilirubin than group AII in p value <0.05. Pearson's correlation between serum bilirubin and serum ferritin had r value -0.26 was statistically not significant. Mean level of serum ferritin in the total was (2729.40 ± 1935.87) ng/ml, minimum level was 304 ng/ml and maximum was 7256ng/ml. Mean level of serum ferritin in the patients of b - thalassaemia major was (4098.67 ± 1598.63) ng/ml, minimum level was 1212ng/ml and maximum was 7560ng/ml. Mean level of serum ferritin in the patients of HbE b - thalassaemia was (2232.57± 1598.63) ng/ml, minimum level was 304ng/ml and maximum was 630ng/ml. Group AI had higher level of serum ferritin than group AII in p value <0.05.

Multifocal skeletal tuberculosis in children.

Multifocal bone involvement is though rare but is reported from some countries where tuberculosis is endemic. Here we report a case of three years old boy was admitted in Bangabandhu Sheikh Mujib Medical University, Dhaka with the complaints of difficulty in walking ,low grade fever for six months, swelling over the back, elbow joint, knee joint and upper part of forearm and legs for two months. Family history of tuberculosis was positive. Mantoux test was 18mm, ESR 85mm in first hour, chest X-ray reveals right hilar lymphadenopathy, X-ray dorsolumber spine shows wedge shaped deformity in T11, L4 and with paravertebral collection from L2-L4. X-ray of legs, knee joint and forearms show multiple lytic lesions in shaft with periosteal reaction and cortical thickening. Ultrasonograph of whole abdomen shows psoas abscess. Culture of bone marrow aspirate reveals Mycobacterium tuberculosis. Patient was given an anti tubercular regimen with Rifampicin, Isoniazid, Pyrazinamide and Streptomycin for initial two months which to be followed by Rifampicin and Isoniazid for another 10 months.

A case of renal transplantation.

A 12-year-old boy was admitted in paediatric nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) with massive proteinuria, hypertension, respiratory distress and anaemia and diagnosed as nephrotic syndrome. Percutaneous needle biopsy was consistent with diffuse endocapillary proliferative glomerulonephritis and initially managed conservatively with injection methyl prednisolone, cyclophosphamide, lisinopril etc. without any improvement. Living-related renal transplantation was done successfully from paternal uncle. Two episodes of acute rejection occurred, one immediately after transplantation and another after one month. These were managed with IV methyl prednisolone for 3 days. At present, he is on oral prednisolone, cyclosporine, azathioprine and antihypertensives with normal haemoglobin and stable serum creatinine level (pre-transplant level 12.5mg/dl to post-transplant level 1.5mg/dl). He has been maintaining his normal life including schooling for last few months. It is concluded that a patient with uncommon presentation of nephrotic syndrome should be confirmed by renal biopsy and renal transplantation may be considered if conservative measures fail.

Relationship of uterine artery with ureter.

The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

Effects of Magnesium Hydroxide on Disintegration Time and Dissolution Rate of Diclofenac Sodium Plain Tablet.

The objective of this study was to evaluate the effects of magnesium hydroxide (MH) on disintegration time (DT) and dissolution profile of diclofenac sodium (DS) plain tablet. The tablets of DS were formulated with conventionally used excipients and investigational agent Mg [OH] 2. Different parameters of tablets like hardness, thickness, friability, and disintegration time and dissolution rate were determined to assess the effects of MH on these parameters. The physical resistance against abrasion or shock of DS-MH tablets had been noticed by the results of hardness and friability test which were within the limits of standard specification. The disintegration times of tablets of the experimental batches except one, found 2.0 to 25 minutes were also within the limits of standard specification. The release rates of DS in simulated gastric fluid (SGF) at 30 minutes were inspiring about batches FO3: 84.78% and FO4: 90.38%. A positive correlation of coefficient determined between quantity of Mg(OH)2 in different batches of tablets and their effects on dissolution rate was found statistically significant (r = 0.66). The tmax of DS was not affected by the presence or increment of MH as evident in r tmax= 0.50. The overall study indicated that Magnesium hydroxide didn’t affect the different physical parameters of plain tablet rather it in certain quantity while present in some batches assisted rapid disintegration and release profile of active content Diclofenac sodium. The DS-MH plain tablet to provide rapid disintegration, dissolution and absorption hence fastest antiinflammatory action with acid neutralizing benefits by MH, might be considered sincerely

Morphological Study of Length, Breadth and Thickness of the Ovary at Different Age Group in Bangladeshi People.

The morphological study was done to see length, breadth and thickness of the ovary in different age group of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty two postmortem tissue block containing ovary and fallopian tube along with surrounding structures were collected from 62 female cadavers of different age groups and fixed in 10% formol saline solution. Gross & fine dissections were carried out to study these morphological parameters of ovary in different age group. In the present study, findings were compared with the finding of other researchers. In this study the mean length of ovary was maximum in found in group C (46-80 years) 4.32cm and minimum was found in group A (2-13 years) 2.81cm of both side. The mean breadth of ovary was maximum in group C 2.01cm and minimum was in group A 1.38cm. The mean thickness of ovary maximum was in group C 0.971cm and minimum was in group A 0.682cm of both sides. In statistical analyses significant difference between two groups was calculated by using students “t” test. A difference between two groups was considered to be significant when p<0.05. In the present study it is observed that the size of the ovary is not equal on both side of same individual.

Changes of placental diameter thickness and cotyledon in eclampsia.

The study was done to see the changes of placental diameter, thickness and number of cotyledons in eclapmsia. A total 45 placenta, 25 from eclamptic mother and 20 from normal pregnant mother were collected from Gynaecology and Obstetric department of Mymensingh Medical College and Hospital (MMCH). Study was done in Anatomy department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trend of less placental diameter in eclamptic group(p=0.0004). Cotyledon number was found to be significantly less in eclampsia (p=0.0001). However there was no significant difference in placental thickness in eclamptic placenta than that of normal group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005. The morphological changes in placenta are possibly due to reduced uteroplacental blood flow in eclampsia.

Morphological study of parathyroid in relation to thyroid gland of Bangladeshi people.

The morphological study was done to see the number and location of parathyroid glands in relation to thyroid gland of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty post mortem tissue block containing thyroid and parathyroids along with surrounding structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the topographic relationship and number of parathyroid glands in relation to thyroid gland. In the present study, findings were compared with the findings of Western and Bangladeshi researchers. In the present study, the so-called typical number of parathyroid glands that is 2 pairs per person (in relation to thyroid gland) was externally visible only in fifty percent (50%) of cases. According to this study, middle third of posterior border of thyroid gland lodged most of the glands (60-65%).

Impact of etiology of chronic renal failure on growth in children.

A prospective study was carried out in the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from October, 2001 to October, 2003 to find out the impact of different etiology of chronic renal failure on growth in children. Fifty children of both sexes under 15 years of age with clinical and biochemical evidence of chronic renal failure (CRF) with creatinine clearance (Ccr) of <75 ml/min/1.73m2 were included in the study. On the basis of underlying causes of CRF, the children were divided into congenital (n=30) and acquired (n=20) groups. All patients' height, weight, radiographs of different bones was obtained to evaluate the presence of renal osteodystrophy (ROD) and for assessment of bone age. Serum intact parathormone (iPTH) level was also assayed in all patients. These parameters were evaluated in two groups. CRF children due to congenital anomalies had stunting and wasting in 23 (76.7%) and 20 (66.7%) cases respectively and the difference between two groups was highly significant (P<0.001). Alkaline phosphatase (467.70+/-218.55 U/L) and iPTH (91.43+/-33.42 pg/ml) were also significantly higher in the congenital group (P<0.001 and P<0.05 respectively). Radiographic features of ROD were present in 15 (50%) cases in congenital group in comparison to 4 (20%) in acquired group and the growth zone lesion was the commonest type of ROD in congenital group (66.7%). CRF should be diagnosed as early as possible to maintain growth potential.

Placental changes in eclampsia and fetal outcome.

Eclampsia-a common pregnancy induced disorder that poses a great threat to the fetus secondary to the placental changes. Since placenta is mostly vascular organ, the present comparative study was designed to examine microscopic vascular changes as well as to observe their impact on the macroscopic dimensions of the placenta and on the fetus in eclamptic and normal pregnant women. The study was carried out in the department of Anatomy, Bangabandu Sheik Mujib Medical University (BSMMU) during the period of October 2000 to August 2001. Forty human placentas were collected just after Caesarian section at 37 to 40 weeks of gestation: 20 from mothers with eclampsia and 20 from non-diabetic, non-eclamptic, normotensive control mothers. Compared to the Control group the value regarding weight, volume, diameter and thickness were significantly smaller values in the Eclampsia group (p<0.001). Microscopically there was a general tendency of increased intimal thickness due to atherosclerotic type of changes in eclampsia in 1st, 2nd and last branching sites of chorionic arteries. Statistical significance difference was observed more in case of the 1st and 2nd branching site (p<0.001). The positive correlation between placental and neonatal weight reached a significant level. Although not all the significant findings support each other. Considering the tendencies of increased intimal thickness and suggestions from other studies, it seems that in the eclamptic placentas, successful compensatory effort against chorionic arterial atherosclerosis fails to protect the fetuses and placentas face more severe forms of atherosclerosis, and consequently gave rise to smaller babies.

Efficacy of combination therapy for the management regime of Alopecia areata.

Alopecia areata is a world wide cosmetic problem. Cases are seen in Bangladesh. Due to financial constraint and lack of modern facilities the patients of this country needs cheap, easily available and conveniently usable treatment modality. The present study revealed that the oral administration of prednisolone for 06 weeks followed by topical application of 02% minoxidil for another period of 14 weeks is noninvasive and could act as better remedy for alopecia areata. It is claimed that steroid could induce hair growth through immunosuppression rather than a direct effect on hair growth promotion. When applied together steroid it induced regrowing hair gave more encouraging result. The combination therapy indicated that the gradual loss of hair could be minimized and regrowth of hair could be made possible. To fulfill the demand for the best compliance of treatment modality further study should be directed and dictated amongst a large group of population.