Epidural Analgesia and Abnormal Coagulation in Patients Undergoing Minimal Invasive Repair of Pectus Excavatum

Background:Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum(MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE. Methods: In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ?1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR. Results: Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ?1.5 (1.9%). In patients with INR ?1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas. Conclusion: In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates

Age and Sex Related Changes in Weight of the Whole brain: A Postmortem Study.

Objective: Brain weight varies with age and gender. It decreases with age and also in many diseases. This cross-sectional analytical type of study was carried out to establish normal standard in different age groups in weight of the brain and to see the difference between sexes of adult Bangladeshi people. Materials and Methods: A total of 70 postmortem human brains of adult age groups ranging from 22-58 years in male and 22-48 years in female were collected from the unclaimed dead bodies during postmortem at the autopsy laboratory in the Department of Forensic Medicine, Dhaka Medical College, Dhaka, from January 2010 to December 2010. The samples were divided into four different age groups i.e. Group A (20-29 years), Group B (30-39 years), Group C (40-49 years) and Group D (50-59 years). The weight of the whole brain was measured and significant differences in weight of the whole brain between different age groups and between male and female were determined. Results: In male highest value of weight was 1326.67±41.53 gm in group A and lowest one was 1281.6±40.21 gm in group D. These values of female were 1235.56±48.51 gm in group A and 1197.14±38.61 gm in group C. Significant differences were found in mean weight of the whole brain in male and female in group A (p=0.001), B (p=0.001) and C (p=0.001). The difference of mean weight in different age groups was not statistically significant. Conclusion: The weight of the brain is higher in male than in female and it decreases with age.

A postmortem study on the volume of the human adrenal glands.

Objective: A Cross-sectional descriptive type of study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from July 2008 to June 2009, to see the variation in the volume of the adrenal glands with age in Bangladeshi people. Materials & Methods: The study was performed on 140 post mortem human adrenal glands collected from 70 unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into four age-groups including group A (11-20 years), group B (21-30 years), group C (31-40 years) & group D (41-60 years). The length, breadth and thickness of each adrenal gland were measured by using a slide calipers. Then the volume of each adrenal gland was determined by the product of its length, breadth and thickness multiplied by 0.52, according to the prolate ellipsoid formula. Results: The mean volume of the right adrenal glands were found 6.36±0.85 cm3 in group A (11-20 years), 6.49±0.76 cm3 in group B (21-30 years), 6.50±0.80 cm3 in group C (31-40 years), 6.76±0.79 cm3 in group D (41-60 years). The mean volume of the left adrenal glands were found 6.97±1.02 cm3 in group A (11-20 years),6.93 ±0.83 cm3 in group B (21-30 years), 6.65±0.79 cm3 in group C (31- 40 years), 7.09±0.81 cm3 in group D (41-60 years). The differences between the right and left adrenal glands and the difference between age groups were not statistically significant.

Histomorphometric study of the human spleen.

Context: The spleen is the largest single mass of lymphoid tissue in all vertebrates. Histological changes are evident in advancing age along with functional capability of the human spleen. A cross-sectional, descriptive type of study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2008, to see the age related microscopic changes in the human spleen. Methods: 30 human spleens were collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine of Dhaka Medical College, Dhaka. The samples were divided into three age-groups including group A (15-29 years), group B (30-49 years) & group C (50-69 years). Then 5 best prepared histological slides from each group were taken and examined under the light compound microscope to determine the thickness of capsule, diameter, number and percent amount of white pulp in the human spleen. Results: The thickness of the splenic capsule were found 84.60±7.97 ?m, 117.92±4.16 ?m, and 132.17±6.37 ?m in group A, B and C respectively. The diameter of the white pulp were found 0.32±0.01 mm, 0.32±0.01 mm and 0.31±0.01 mm, while the number of white pulp per sq. mm were 2.28±1.04, 2.38±0.93 and 2.04±0.76 in group A, B and C respectively. Moreover, the amounts of the white pulp were determined 23.09±1.38, 24.45±1.84 and 22.54±1.08 in group A, B and C respectively. The difference in thickness of the splenic capsule was statistically significant among the study groups (p<0.001). However, no difference was found in diameter, number and percentage of the white pulp of the spleen among those age groups. Conclusion: The thickness of the capsule of the spleen was found to increase with advancing age in humans. However, no age change was evident in diameter, number or amount of the white pulp.

Numbers of Purkinje Cell with Increasing Age-A Post Mortem Study.

The change in the number of Purkinje cells with increasing age is evident especially in disorders of fine movement, equilibrium, hypotonia, postural changes, and disturbances of voluntary movement. The present study was done to see the changes in the number of Purkinje cells per square mm in different age groups of Bangladeshi people. This cross sectional descriptive type of study was designed and done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2010, which was performed on the cerebellum of 28 Bangladeshi people, collected during autopsy examination of unclaimed dead bodies from Department of Forensic Medicine. Paraffin blocks of cerebellum were cut at 5mm thickness and stained with routine Harris' Haematoxylin and Eosin (H & E) stain. Estimation of number of Purkinje cell was done by using the counting circle and examined under the light microscope. The mean ± SD of number of Purkinje cell was 160.71 ± 24.47 in group A (Age 20-29 years) and 152.20 ± 6.49 in group D (age> 50 years), the mean reduction was 2.5% per decade. Histological studies revealed the number of Purkinje cell per square mm decreased with age which was statistically significant and further cytological study of Purkinje cell with larger sample size is recommended.

Thyroid Follicles and Parenchyma are Found to Increase with Advancing age during the first 50 years of life in Bangladeshi People.

Background: The structural components of the thyroid gland are very much responsive to many types of stimuli and their adaptation is evident in histological studies. The thyroid follicles change their size and shape with the physiological alterations and pathological deviations. Objective: To observe the histological changes of the thyroid gland with advancing age in Bangladeshi people. Methods: This cross-sectional study was carried out in the Department of Anatomy, Dhaka Medical College, Dhaka from January to December 2008. The present study was performed on 60 post mortem human thyroid gland (39 of male and 21 of female) collected from unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age-groups including Group A (10 – 20 years), Group B (21 – 50 years) & Group C (> 50 years) and the glands were studied histologically including number and average diameter of the thyroid follicles, percentage proportion of the parenchyma and stroma. Results and conclusion: All the histological values of the thyroid gland studied i.e. number and average diameter of the thyroid follicles and percentage of the parenchyma, are found to increase with advancing age during the first 50 years of life and later decrease.

Study of Right Marginal Artery in Post Mortem Hearts of Adult Bangladeshi People.

Background: Heart disease is one of the major public health problems in Bangladesh. Treatment of heart disease is costly & complex issue. The study of anatomy of the right marginal artery is essential for the proper diagnosis and treatment of the heart diseases. Materials: The study was carried out in the Department of Anatomy, Dhaka Medical College (DMC), Dhaka from February 2005 to January 2006. Post mortem study of sixty (60) adult human hearts of Bangladeshi people aging from 20 to 75 years was performed. The samples were divided into 3 age groups – Group A (20 to 40 years) consists of 35 males & 7 female, Group B (41 to 60 years) consists of 8 male & 3 female and Group C (61 to 75 years) consists of 7 male. All the samples of different age groups were examined morphologically. Results: In the present study, the right marginal artery was present in 54 and absent in 6, out of 60 samples. Out of 54, the right marginal artery was terminated at the apex in 15 and nearer to the apex in 39 cases. Conclusion: The result of the present study can be helpful to the cardiologists and cardiovascular surgeons for proper anatomical assessment of coronary arteries in patients with heart diseases.

The Dominance Pattern of Coronary Artery of Adult Bangladeshi People- A Postmortem Morphological Study.

Background: Incidence of the heart disease increases day by day in Bangladesh. Recent advances in cardiac surgery and the search for new techniques toward investigation of the heart are demanding a review of the anatomy of the coronary arteries. Method: The present study was performed on sixty (60) adult postmortem human hearts of Bangladeshi people. The samples were divided into 3 age groups: Group A (20 to 40 years) consists of 35 male & 7 female samples, Group B (41 to 60 years) consists of 3 female samples and Group C (61 to 75 years) consists of 7 male samples. Results: In the present study, dominance pattern of the coronary artery was right for male in-group A, B, C were 32 (91.4%), 7(87.5%), 6(85.7%), respectively and for female were 6 (85.7%). 3 (100%) respectively. It was left for male in-group A, B, C were 3 (8.6%), 1 (12.5%), 1(14.3%), respectively and for female was 1 (14.3%). Conclusion: The results of the present study can be helpful to the cardiologists and cardiovascular surgeons in the proper diagnosis and management of the heart diseases.

Determinación del sexo genérico fetal por ultrasonografía precoz: 11-14 semanas / Determination of fetal gender sex by early ultrasound: 11-14 weeks

Objective. To assess the accuracy (positive predictive value) of fetal sex determination at 11-14 weeks of gestation by routine ultrasound. Methods. Fetal gender assessment by ultrasound was prospectively carried out in 267 fetuses at 11-13+6 weeks of gestation (45-84 mm crown-rump length) in an unselected population including twin and singleton pregnancies. Transabdominal scan was performed by a single operator who examined the genital region in a midsagittal plane of the fetus as described by Efrat et al. in 1999. The fetal gender was assigned as male if the angle of the genital tubercle to a horizontal line trough the lumbosacral skin surface was greater than 30º and female when the genital tubercle was parallel or convergent (less than 30º) to the horizontal line. Sex confirmation data was obtained postnatally from hospital registries, parents information or by ultrasound performed after 22 weeks of gestation. Results. Fetal gender assessment was successfully achieved in 97 percent (259/267). The accuracy of sex determination (positive predictive value) increases from 74,2 percent at 11 weeks, trough 90,5 percent at 12 weeks to 95,7 percent at 13 weeks. Male fetuses were incorrectly assigned as female in 29,2 percent of cases at 11 weeks, 12,2 percent at 12 weeks and 5 percent at 13 weeks. In contrast, 14,3 percent of the female fetuses at 11 weeks were incorrectly assigned as male and this false-positive rate was 4,5 percent and 3,3 percent at 12 and 13 weeks, respectively. Conclusion. The clinical value of early ultrasound determination of fetal sex includes confirmation of zygosity and analysis of chorionic villous sampling in twin pregnancies, early information for demanding parents and a powerfull method to decide whether to carry out prenatal invasive testing in pregnancies at risk of sex-linked genetic disorders, because it would be unnecessary in pregnancies with female fetuses. Our results suggest that early sex determination by routine ultrasound reaches the best accuracy at the 13th week of gestation.

Congenital hearing impairment associated with rubella: lessons from Bangladesh.

Infection with rubella virus during pregnancy may cause fetal death or the multiple congenital fetal abnormalities that are known as congenital rubella syndrome (CRS). Studies have demonstrated that congenital hearing impairment is the most frequent abnormality associated with intrauterine rubella infection. In the present study, the first of its kind in Bangladesh, we investigated the presence of rubella antibody in hearing-impaired children in order to understand the possible role of rubella infection in the development of hearing impairment. A total of 198 hearing-impaired children and 200 children without hearing problems were studied. After taking a detailed history from the parents, blood samples were collected from both mothers and children; sera were subjected to enzyme-linked immunosorbent assay (ELISA) for anti-rubella IgG. Rubella antibody was detected in 74% of the hearing-impaired children and in 18% of those with normal hearing: this finding correlated with the presence of rubella antibody in the mothers (67%) of rubella seropositive hearing-impaired children. In contrast, we observed rubella antibody in only 14% of the mothers of the children without hearing problems. Consistent with the presence of antibody, 41% of the seropositive mothers who had hearing-impaired children gave a history of fever and rash during early pregnancy. Our study indicates a strong association between rubella infection and hearing impairment in Bangladeshi children. In addition, it also indicates that infection by rubella virus is common in Bangladesh: this suggests that priority should be given to implementing appropriate measures for the control of rubella.

Old-age homes & the profile of their residents.

Studies conducted on old-age homes and their inmates are reviewed. Though institutionalization of the elderly is a new phenomenon in India, a number of old-age homes have come up and there is a need for many more homes in India. Investigations with regard to the status of the aged in the changing social structure have more or less concluded on the breaking down of kinship and family organisations which has put the elderly in a state of helplessness, isolation and economic dependence.

Metabolic and hormonal profile of the offsprings of conjugal diabetics.

Oral glucose tolerance response to blood glucose, serum immunoreactive insulin (IRI) and plasma free fatty acid (FFA) levels were studied on 159 offsprings of both parent diabetics (connubials). Fasting serum cholesterol, triglyceride, phospholipid and total lipids were also measured in these subjects. We detected 6 diabetics out of 159 connubials at the time of our study. FFA level in 6 diabetic connubials were higher all time intervals than 153 non-diabetics connubials. Fasting and one hour post glucose response were less in 6 diabetic connubial but two hours post glucose IRI response to both 6 diabetic connubials and 153 non-diabetic connubials were same indicating a delayed insulin secretion in response to oral glucose level in 6 diabetic connubials.