Serum calcium and lipid profile in acute ischemic stroke.

Background: Worldwide acute ischemic stroke (AIS) is a major public health problem. Therefore, this study was undertaken to see the association of some biochemical risk factors with AIS in Bangladesh. Methodology: This study was conducted in Biochemistry department of Dhaka Medical College, Dhaka from January 2014 to December 2014. In this study, 50 patients of AIS considered as case and 50 age and sex matched healthy individuals taken as control. Blood sample was collected and tested for serum calcium and lipid profile in case and control. All the parameters then compared statistically between two groups. Results: Study showed that serum calcium was significantly lower (p= 0.001) in cases and serum TChol, TAG, LDL-C significantly higher (p= 0.035, 0.001 and 0.019 respectively) and HDL-C significantly lower (0.001) in cases compared to controls. Conclusions: This study concludes that low serum calcium level and altered lipid profile are significantly associated with AIS.

Synchronous primary cancers in the head and neck region and upper aero digestive tract: Role of triple endoscopy.

BACKGROUND: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. AIM: The aim of this study is to see the role of endoscopy in the pre‑therapeutic works‑up of patients with the cancers in the head and neck region. MATERIALS AND METHODS: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history and the average age of patients at presentation with synchronous cancers. The Chi‑square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of mode for average age have been employed for analyzing results. RESULTS: Incidence of synchronous primaries has been found to be 1.43% and mostly males were affected. The common index sites for synchronous primaries are oropharynx 22 (36.6%), oral cavity 14 (23.3%), hypopharyx 12 (20%) and larynx eight (13.3%) cases in decreasing order, 58.3% synchronous occurred at esophagus and 0.83% of all head and neck cancers developed synchronous primary at esophagus. Association of UADT synchronous cancers with smoking (odds ratio = 13.42, Chi‑square 7.12 at 95% confidence interval, P = 0.0076) is highly significant and the average age is 62.6 years in males and 62 years in females. CONCLUSION: Endoscopy can be rationally used during the pre‑therapeutic work‑up of patients with a history of smoking and/or in patients over the age of 62 years. Instead of complete upper gastro intestinal endoscopy up to the second part of duodenum, only esophagoscopy is needed for the detection of synchronous primary of upper aero‑digestive tract in cancers of the head and neck region.

Synchronous primary cancers of the head and neck region and upper aero digestive tract: Defining high-risk patients

Background: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. Aim: To see the epidemiology of synchronous cancers of the head and region and identification of high-risk factors for the development of synchronous primary in the head and neck cancers. Materials and Methods: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history, stage of index head, and neck tumor and the average age of patients at presentation with synchronous cancers. The Chi-square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of median for calculating the average age have been employed for analysis. Results: Incidence of synchronous primaries has been found to be 1.33%, majority were seen at the oropharynx (39.2%) and 60.7% synchronous occurred at the esophagus, 0.81% of all head and neck cancers developed synchronous primary at the esophagus. Approximately, 65% of all synchronous primaries were in Stage III and Stage IV disease and 88.2% esophageal synchronous had Stage II disease. Association of UADT synchronous cancers with smoking is highly significant, relative risk = 1.95 95% confidence interval for relative risk 1.05-3.64 P = 0.00010981 (P < 0.05) and the average age is 62.4 years in males and 57.8 years in females. Conclusion: Patients who are at the high-risk for the development of synchronous primary tumors in the cancers of the head and neck region are patients with oropharyngeal carcinoma, smoking population, patients over the age of 62 years in males, and 57 years in females and in patients with higher staged index tumor.

Effects of Pleurotus ostreatus on Blood Pressure and Glycemic Status of Hypertensive Diabetic Male VolunteersS.

Different species of mushrooms are being used increasingly for their nutritional and medicinal values. They are used in traditional medical practice in the treatment and prevention of diabetes, obesity, heart diesaes, hyperacidity, cancer and hypertension. This study was designed to see the effects of Pleurotus ostreatus on blood pressure and glycemic status of hypertensive diabetic male volunteers. The study was carried out in the National Mushroom development and Extension Center (NAMDEC) laboratory, Savar, Dhaka in collaboration with the Department of Pharmacy along with the Department of Biochemistry and Molecular Biology, Jahangirnagar University. A total of 27 hypertensive male volunteers suffering from type 2 diabetes mellitus with age range of 32 to 68 years, who were free from renal impairment and other known acute or chronic diseases were included in the study. Blood pressure, fasting plasma glucose, HbA1c and serum creatinine were measured before and after 3 months of regular intake of 3 grams mushroom powder capsule daily in in 3 divided doses. However they were allowed to continue the drugs they were taking already. The study showed that after 3 months of regular intake of Pleurotus ostreatus mushroom, both systolic and diastolic blood pressure decreased significantly (p<0.001). It was also observed that, Pleurotus ostreatus decreased fasting plasma glucose level significantly (p<0.001). Reduction of HbA1c % observed after 3 months of mushroom intake was found to be significant (p<0.001). But there was no significant change of plasma creatinine level (p>0.05) indicating Pleurotus ostreatus has no detrimental effect on renal system. From the study, it can be said that, Pleurotus ostreatus mushroom intake improves glycemic status and blood pressure control in diabetic hypertensive subjects.

The efficacy and safety of low dose epidural butorphanol on postoperative analgesia following cesarean delivery.

Butorphanol is considered an effective and safe analgesic after cesarean delivery but is associated with profound dose-dependent sedation. Somnolence may cause hindrance in early mother-baby interaction. This study was designed to assess the analgesic efficacy and to monitor side-effects of low doses (0.5 mg and 0.75 mg) of epidural butorphanol with bupivacaine compared to bupivacaine alone in parturients following cesarean delivery. One hundred and twenty parturients (American Society of Anesthesiologists physical status 1 and 2) undergoing cesarean delivery were allocated into three groups: group 1 received epidural 0.125% bupivacaine while group 2 and 3 received an additional 0.5 mg and 0.75 mg butorphanol respectively. A combined spinal, epidural technique was used. Spinal anaesthesia was used for surgery. The epidural route was used for postoperative analgesia with the study drug. Onset, duration and quality of analgesia, lowest visual analogue scales (VAS) score, and side effects were noted. The onset and duration of analgesia in group 2 (4.1+/-2.6 min and 202.4+/-62.8 min) and group 3 (4.0+/-2.5 min and 192.3+/-69.1 min) were significantly different (P<0.01) from group 1 (6.6+/-2.7 min and 145.7+/-89.6 min). The quality of analgesia in terms of time to first independent movement and satisfactory VAS were statistically better (P<0.01) in group 2 (3.9+/-0.3 hour and 8.1+/-0.1 mm) and group 3 (3.8+/-0.4 hour and 8.1+/-0.9 mm) than in group 1 (5.2+/-0.4 hour and 6.3+/-1.3 mm). The incidence of sedation was 5% in all the three groups. A lower dose of epidural butorphanol with bupivacaine produces a significantly earlier onset, longer duration and better quality of analgesia than bupivacaine does.

Prevention of Stroke in Nonvalvular Atrial Fibrillation.

Cerebro-vascular Disease (CVD) is the third most common cause of death in developed world after cancer and IHD. Atrial fibrillation (AF) is responsible in 45% of cases cardioembolism leading to CVD. Atrial fibrillation is considered to be one of the growing cardiovascular epidemics in the 21st century. Warfarin is a proven drug for prevention of stroke in patients with atrial fibrillation. Newer anticoagulants are being tried, fibrillation. Newer anticoagulants are being tried, but not yet well established by clinical trials. Separation of left atrial appendage from circulation by surgery or device implantation is a promising one in this field.

Fluoroscopy guided chemical lumbar sympathectomy for lower limb ischaemic ulcers.

The purpose of this study was to assess the effectiveness of chemical lumbar sympathectomy in relieving pain and healing ischaemic ulcers in patients with peripheral vascular diseases. Thirty-one consecutive patients with ischaemic/ gangrenous lower limb ulcers, referred to the BPKIHS, Pain Clinic were observed prospectively after chemical lumbar sympathectomy using modified Reid Technique with 3 ml of 70% alcohol each at L2 and L3 level under fluoroscopic guidance. Pain relief and ulcer healing were noted in the follow up. Moreover, patients' abilities to resume at least part of their day to day work were also noted at three months follow up. Of the total 31 patients, 16 had Buerger's disease and the remaining 15 had non-Buerger's ischaemic ulcers of which 7 were diabetic. There was significant decrease in the pain score from mean+/-SD of 8.3+/-0.9 (pre-block) to 4.2+/-2.5 (post-block after 3 days) in zero to 10 Numerical Analogue Scale (NAS). By 3 months, 6 patients declined for follow up; 19(76%) of the remaining 25 patients reported pain relief, 18(72%) reported healing or decrease in the size of ulcers and 11(44%) were able to resume at least part of their usual work. Minor complications occurred in 5 patients and amputation was needed in 6 patients. Fluoroscopy- guided chemical lumbar sympathectomy is feasible, safe and effective in relieving pain and promoting ulcer healing in patients with ischaemic lower limb ulcers due both to Buerger's disease and non-Buerger's peripheral vascular diseases.

Percutaneous dilational tracheostomy: an initial experience in community based teaching hospital.

Percutaneous dilational tracheostomy (PDT) is frequently performed in the intensive care unit to prevent the long term complications associated with prolonged endotracheal intubation. OBJECTIVE: To report the analysis of our experience with percutaneous dilation tracheostomy. STUDY DESIGN: A prospective documentation of 40 patients who received percutaneous dilational tracheostomy in a multidisciplinary intensive care unit during a 12-month period. METHOD: The patients demographic, indications of intubation and PDT, time required to perform the procedure, complications and the outcome of these patients in the intensive care unit were noted. RESULT: Among 425 patients, 40 underwent percutaneous dilational tracheostomy that included 22 females and 18 males with the median age of 35 years. Prolonged ventilatory support was the most common indication for tracheostomy. The average duration of intubation before PDT was 5 days. Median procedure time was 20 minutes. Complications included minor bleeding in two (5%), subcutaneous emphysema with pneumothorax in two patients (5%), tracheal stenosis in three (7.5%), tracheo-esophageal fistula and glottic granuloma in one patient each (2.5%). Among forty patients, 28 (70%) were discharged to the ward, 8 died in intensive care unit and 4 left hospital against medical advice. CONCLUSION: Percutaneous dilational tracheostomy is a safe, quick and effective way for long term airway management in critically ill patients.

Analgesia after inguinal herniotomy in children: combination of simplified (Single Puncture) ilioinguinal and iliohypogastric nerve blocks and wound infiltration vs. caudal block with 0.25% bupivacaine.

OBJECTIVE: To assess whether simplified ilioinguinal and iliohypogastric nerve block in combination with minimal wound infiltration with local anaesthetic is better than caudal block with local anaesthetic alone in children undergoing inguinal herniotomy for easy transition to safe oral analgesia. SUBJECT AND METHODS: Sixty children of both sexes undergoing herniotomy were allocated randomly to receive either simplified (single puncture) ilioinguinal and iliohypogastric nerve block described by Dalens in combination with small volume wound infiltration with 0.1 ml/kg of 0.25% bupivacaine (Group I) or caudal block with 1 ml/kg of 0.25% bupivacaine (Group II) at the end of surgery under general anaesthesia using halothane in oxygen and nitrous oxide mixture. Duration of analgesia, complication associated, parents and children's satisfaction were compared. RESULTS: The mean duration of analgesia was 253+/-102.6 minutes in group I as compared to 219.6+/-48.4 minutes in group II. Six (20%) patients in group I and two (6.67%) patients in group II required parenteral analgesic. Complications and parents and children's satisfaction were comparable in both the groups. CONCLUSION: Simplified ilioinguinal and iliohypogastric nerve blocks described by Dalens in combination with small volume local anaesthetic wound infiltration with its longer mean duration of analgesia offers better safety margin to start oral analgesics than caudal block with local anaesthetic alone in children undergoing herniotomy. Larger studies may further confirm the findings.

Isolation and characterization of Helicobacter pylori strains from peptic ulcer patients in Dhaka, Bangladesh.

To study the association of Helicobacter pylori with peptic ulcer and the associated histopathological changes, to characterize the isolated strains in terms of their protein profile, 83 peptic ulcer cases were studied. A high association of H pylori with peptic ulcer (duodenal ulcer 77%, gastric ulcer 75%) and gastritis (74%) was observed. Age and smoking did not have any relationship with H pylori infection. The infection was predominantly associated with the 'quiescent' form of chronic gastritis. Comparative sodium dodecyl sulfate polyacrylamide gel electrophoresis of whole cell extracts of the local isolates and a reference strain from Australia showed a general homogeneity between the strains with obvious interstrain differences. However, the difference between the local isolates and the reference strain was more marked. Significant association of H. pylori with peptic ulcer along with strain variations were observed.

High vaginal swab(HVS), routine microscopy and culture sensitivity in diabetic and non diabetic, a comparative retrospective study of five years.

Diabetic women are significantly more prone to develop vaginitis (both bacterial and fungal) than non diabetic. Among the positive cases predominant bacterial isolate being E. Coli. All fungus positive culture yielded the growth of candida species. Direct wet film preparation of the fungus positive cases revealed only 30% were positive for fungus, thus if candida vaginitis is suspected, the diagnosis cannot be ruled out on the basis of negative direct preparation. More over, diabetics should be advised maintain proper glycaemic control and personal hygiene to get rid of this distressing problem.