Effect of Arsenic (As) on the Spermatogenesis of Black Bengal Goat (Capra hircus) Reared at the Arsenic Prone Area of Mymensingh District in Bangladesh.

Aim: Arsenic (As) alters the spermatogenic process as well as testicular histology has been reported in different species of domestic, wild, aquatic life, and laboratory animals. The present study was conducted to investigate the impact of toxicity of arsenic poison on the spermatogenesis of the Black Bengal goat at the most arsenic polluted area of Mymensingh district in Bangladesh by using histopathological techniques. Methods: A total of 12 adult Black Bengal male goats (Capra hircus) were used in this study.Among these, 6 were selected from the arsenic polluted area, and the rest were from the less contaminated area as control. Goats were sacrificed by using conventional animal killing method adopted in the laboratory. Both the right and left testes were collected aseptically. Testicular tissues were cut perpendicular to the long axis of the testis and preserved in Bouin’s solution. Paraffin block was made and tissue sections were cut at 5-μm in thickness. Tissues were processed for routine hematoxylin and eosin and Periodic Acid-Schiff (PAS)-hematoxylin stains. Thickness of tunica albugenia, spermatigenic cell layer, diameters of the seminiferous tubules, number of spermatogenic, sertoli, and leydig cells were counted and tabulated. Apoptotic spermatogenic cells were detected by using Apoptosis Detection Kit. The data collected was statistically analyzed for any significant differences between the arsenic exposed and control goats. Results: Our results revealed comparatively increased thickness of the tunica albugenia, wide intertubular spaces, low height of the spermatogenic cell layer, decreased diameter of the seminiferous tubules, decreased spermatogenic, sertoli, and leydig cell counts, and marked increased of apoptotic spermatogenic cells in the arsenic affected goats. The data differences between the arsenic affected and control goats were statistically significant (P<0.01). Conclusion: Our histopathological study revealed alteration of testicular tissues in arsenic affected goats. This morphological changes of testes significantly affected on the spermatogenic processes. But it was not possible to determine the possible stage of the spermatogenesis was interrupted by the arsenic. Decreased number of spermatogenic, sertoli, and leydig cell counts, and distinctly increased number of apoptotic spermatogenic cell indicates high toxic effects of arsenic poisoning on the male gonad. The mechanism of action of toxicity of the arsenic could not be understood clearly. It is suggested here that the Black Bengal goats can be experimentally used as animal model in the laboratory for investigating the role of arsenic on the reproduction of the domestic animals.

A Case of Congenital Cystic Adenomatoid Malformation in a 10 Years Old Boy.

Congenital Cystic Adenomatoid Malformation (CCAM) is a relatively rare congenital pulmonary cystic disease. By ultrasonography prenatal diagnosis can be made and most baby born without complication. Some babies need surgery at the first year of life for recurrent respiratory tract infection. Here a case of CCAM in a 10 year old boy is reported who presented with recurrent respiratory tract infection and underwent surgical resection successfully.

A Comparative Study on the Hepatoprotective Effect of Tamarindus indica and Vitamin E in Long Evans Rats.

The protective effects of ethanolic extract of Tamarindus indica leaves and seeds in compoarison to vitamin E, were studied on paracetamol induced hepatotoxicity in Long Evans Rats. Different groups of animals were administered in the paracetamol (1500mg /kg, p.o.) for 7 days. Ethanolic extracts of leaves and seeds of Tamarindus indica (1250mg/kg) with parallel vitamin E (500 mg/kg), were administered to paracetamol pretreated rats. On treatment with paracetamol a significant increase in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin and alkaline phosphatase were observed. On administration of ethanolic extracts of leaves and seeds a significant decrease in the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin and alkaline phosphatase (ALP) were observed and histopathological examination of liver tissue revealed an almost return to normal architecture. The result were almost comparable to vitamin E, a known hepatoprotective agent.

Extent of ST-Segment Depression Predicts In- Hospital Outcome in Non ST-Segment Elevation Acute Coronary Syndrome.

Background: The presence of ischemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined. The severity of ST-segment depression on admission ECG has a strong association with adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. The study was done to observe the extent of ST-segment depression and in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. Methods: This study was conducted in the Department of Cardiology in NICVD Dhaka, from January 2006 to December 2007. Considering inclusion and exclusion criteria, a total of 183 patients were evaluated. All the patients were evaluated clinically after admission. ECG, blood biochemistry and echocardiography were done. Patients were categorized into three groups according to the extent of ST- segment depression. Results: In this study, analysis of the baseline parameters revealed no statistically significant difference among the three groups of patients (p>0.05). Mean sum of the ST-segment depression analysis was done and all mean values were more in group III patients. 41.0% patients developed complications during the study period. Acute LVF (22.9%) was the most common complication followed by arrhythmia (11.5%), cardiogenic shock (4.4%) and STEMI (2.2%). All the complications were more in group III patients. During this period 6% patients died and more death (12.3%) was observed in group III patients. Conclusion: The amount of ST-segment depression is a powerful predictor of adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome.

Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement.

Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases.

A Comparative Study Between Efficacy Of Esmolol And Lignocaine For Attenuating Haemodynamics Response Due To Laryngoscopy And Endotracheal Intubation.

Haemodynamic stability is an integral and essential goal of any anaesthetic management plan. Laryngoscopy and intubation can cause striking changes in haemodynamics. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic and vagal discharge in response to laryngotracheal stimulation, which in turn leads to increased plasma norepinephrine concentration. This study was designed to compare efficacy of esmolol and lignocaine for attenuating haemodynamics response due to laryngoscopy and endotracheal intubation. The aim of this study was to compare the effects of Esmolol with that of Lignocaine to attenuate the detrimental rise in heart rate and blood pressure during laryngoscopy and tracheal intubation. One hundred and twenty adult patients randomized into group-L and group-E, were received lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg I.V. respectively. Heart rate and blood pressure in each minutes for the 10 minutes after intubation was recorded. Time span around intubation up to 4 minutes has been looked specifically to isolate the effect of the study drugs at the time of intubation. For statistical analysis Student's 't' test was used for comparing means of quantitative data and chi-square test was used for qualitative data. Difference was considered statistically significant if p<0.05. The mean heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product before starting anesthesia were similar in group-L (Lignocaine group) and in group-E (Esmolol group) (p>0.05). The mean values of heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product at 2, 3 and 4 minutes after intubation were significantly lower in group-E than group-L (p<0.05). In conclusion, esmolol 1.5 mg/kg is superior to lignocaine (1.5 mg/kg) for attenuation of haemodynamic response to laryngoscopy and endotracheal intubation.

Radiofrequency Catheter Ablation of WPW Syndrome in National Institute of Cardiovascular Diseases, Dhaka: Initial and Four Years Follow-up Results.

Background: Radiofrequency (RF) catheter ablation is an effective method of treatment of patients with WPW syndrome. The purpose of this study was to analyze the initial and follow -up results of RF ablation of such cases in our hospital. Methods: 255 cases with WPW syndrome that had delta wave in sinus rhythm ECG underwent electrophysiological studies in this hospital. All the cases underwent radiofrequency ablation. These cases are selected for analysis. Results: Ablations were performed in these 255 patients between December 2005 and December 2008. One accessory pathway (AP) was found in 250 patients, two accessory pathways-in 05 patients. The mean duration of the procedure was 130 ± 32 min. The initial and overall success rate was 92.15% and 95.68% respectively. Major complications encountered are none. Conclusions: RF ablation of WPW syndrome has good initial (92.15%) and overall (95.68%) success rate and low recurrence rate (5.00%) at long term follow-up.

Correlations of Serum Magnesium and Potassium in Acute Myocardial Infarction, Chronic Ischemic Heart Disease and Normal Healthy Volunteers of Bangladesh.

Magnesium (Mg) and potassium (K) are the major intracellular cations whose presence in the serum are low, but minor changes of those may show a remarkable change in the various body functions specially in the heart. The study was designed to find out the correlation between serum Mg and K in acute myocardial infarction (AMI), chronic ischemic heart disease (CIHD) and normal healthy volunteers. It was carried out over a period of 18 months in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with Department of Cardiology, Sir Salimullah Medical College & Mitford Hospital (SSMC & MH) and Atomic Energy Center, Dhaka. A total of 101 subjects were included in which 32 subjects were AMI, 34 CIHD and 35 normal healthy volunteers. Serum glucose and serum creatinine were estimated to exclude diabetes and renal dystrophies. Estimation of serum CK-MB and ECG tracing were done as diagnostic tools of AMI and to categories the subjects into various groups. Serum Mg was estimated by Atomic absorption spectrophotometer and serum K by Ion sensitive electrode. The present study shows that there is a strong positive correlation of serum Mg and K in AMI, CIHD and healthy control subjects (r = 0.566, p<0.01 level). So it is suggested to estimate and supplement both Mg and K in IHD patients for their better management.

Histological variant of nephrotic syndrome with atypical presentation in children.

Aims of the present study were to find out the histological pattern of atypically presenting nephrotic syndrome children and their response with oral corticosteroid therapy. This prospective study was carried out in the Paediatric Nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, for a period of two years, from September 2001 to September 2003. Forty children with nephrotic syndrome with atypical presentations such as gross haematuria, renal impairment, hypertension and hypocomplementaemia were enrolled for the study. For each patient proper investigations were done to screen out infection and necessary treatment was given accordingly. Renal biopsy was done in all cases after treating infection and controlling hypertension and specimen were evaluated by light and immunoflourescence microscopy. All the patients were treated with oral prenisolone 60 mg/m2/day for 4 weeks and response were observed by heat coagulation test. In present study it was observed that mean age of presentation was 8.73+/-4.36 years. Hypertension, gross haematuria, impaired renal function and hypo-complementaemia were observed in 50%, 45%, 19% and 15% cases respectively. When histopathologies were considered, 90% cases had other than minimal change disease (MCD) and Mesangial proliferative glomerulonephritis (MesPGN) was the most common histopathology (47.5%). Regarding steroid therapy only 43.2% patients were responsive to oral prednisolone therapy within 28 days. Atypically presented nephrotic syndrome usually manifested with higher age of onset, gross haematuria, hypertension, renal insufficiency and hypocomplementaemia. Mesangial proliferative glomerulonephritis was the predominant histological type. The majority (56.8%) of these atypically presented nephrotic syndromes were resistant to steroid therapy.

Long-Term Follow -Up After Radiofrequency Catheter Ablation of Fascicular Ventricular Tachycardia at National Institute of Cardiovascular Diseases.

Introduction: Verapamil-sensitive, idiopathic left ventricular tachycardia (ILVT) with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. In this study we evaluate the results of long-term clinical outcome in patients who underwent radiofrequency catheter ablation of idiopathic fascicular ventricular tachycardia in National Institute of Cardiovascular Diseases. Methods: Electrophysiological studies and radiofrequency ablation were performed in 46 consecutive patients (42 men,04 women), age ranging from 16 to 36 years (mean 20±5 years) with verapamilsensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous administration of verapamil in all patients. Mapping was performed using a Bard electrophysiology system. The target site for ablation was the mid-septum of left ventricle where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential during VT in all patients to meet the ablation endpoints which were termination of the VT and non-inducibility of the tachycardia. Results: All 46 patients had successful ablation of the ILVT. During 3 years follow up 02 patients had recurrence. Conclusion: Idiopathic left ventricle tachycardia occurs most commonly in young population. Prompt recognition of this arrhythmia is important since radiofrequency ablation can cure this rhythm problem. This can be achieved in a country like Bangladesh where resources are limited.

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.

Congenital nephrotic syndrome, an uncommon presentation of cytomegalovirus infection.

Cytomegalovirus (CMV) infection is a very rare infection in children as well as in infancy. In CMV infection extra renal manifestations in central nervous system (CNS), eyes and hematological are prominent and common than renal manifestation. We are describing two case reports one at the age of 5 months and another at one month with features of both extra renal and renal manifestations of nephritic syndrome. Our first case presented with predominant features of CNS manifestations like convulsion and spastic monoplegia, sensory type of deafness and absence of light reflexes along with nephritic features. Deafness and absence of light reflex were confirmed by audiometric and ophthalmological examination and brain atrophy was confirmed by CT scan. Our second case had features of hypothyroidism along with nephritic features. Hypothyroid status was confirmed by elevated serum TSH level and reduced T4 level. In both cases nephritic features were confirmed at bed site urine examination by heat coagulation test and other relevant investigations. CMV infection was confirmed in both cases by detecting anti CMV IgM by ELISA method. Both patients were clinically improved with intravenous gangcyclovir therapy. In these two cases reports, clinical, serological and therapeutic observation established the causal relationship between the CMV infection and nephrotic syndrome.

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.

Unusual perforating foreign body in the neck.

Penetrating injury in the neck is not an uncommon condition, but a perforating foreign body like bamboo in the neck is uncommon. A 36 years old young man was admitted in Otolaryngology and Head Neck surgery department, Mymensingh Medical College hospital, with a history of accidental perforating injury in the neck with a bamboo, while driving a vehicle (tempo). Clinical examination revealed a bamboo measuring 4.6 X 0.09 ft. perforated in his neck from left to right. Surprisingly great vessels and air way spared. Due to difficult intubation, elective tracheostomy was done. Neck was explored and foreign body removed under general anesthesia. Haemostasis ensured and wound closed in layers after putting drain tubes. Recovery was uneventful and was discharged after three weeks.

An in vitro microleakage study of different filling materials using dye penetration method.

In the present study, the marginal integrity of different filling materials was evaluated in invitro. Furthermore, the effect of manipulation technique on their microleakage was also investigated. A total of sixty standard prepared class V cavities were filled with glass ionomer cement (both auto-cured and light-cured), light cured packable variety composite resin pretreated with echant and bonding agent and dental amalgam (both mechanically and conventional hand mixed) with or without pretreatment by cavity varnish. Cavities were then subjected to microleakage test following thermocycling. Statistical analysis was performed by One way ANOVA and Sheffe's multiple comparison tests. The results showed that mechanically mixed Silver Amalgam pretreated with cavity varnish showed the least microleakage, whereas, autocured glass ionomer showed highest marginal leakage. Light-cured packable composite was superior in resisting microleakage than both types of glass ionomer but was inferior to dental amalgam in the same respect. From this study, it can be concluded that composite resin can be used to fill class V cavities for esthetic reason but their properties should be improved.

Extracranial complications of chronic suppurative otitis media.

The aim of this study was to find out the pattern of extracranial complications of CSOM cases who attended to the department of ENTD, Mymensingh Medical College Hospital during the period from July'1999 to June' 2001. Different types of extracranial complications of CSOM were presented here. A total of 100 cases, diagnosed clinically and radiologically were included in the study of which 66 were male and 34 were female giving a male to female ratio of 1.94 : 1 (p < 0.05). Majority cases (53) were in the age group of 11- 20 years followed by the age group of below 10 years where there were 30 cases. Majority (64) cases came from low socio-economic class. The number of different types of extracranial complications of CSOM were as follows: mastoid abscess 57, discharging sinuses 28, purulent labyrinthitis 07, Bezold's abscess 04, fascial nerve paralysis 03 and zygomatic abscess 01. In all cases of CSOM Cholesteatoma were detected. In 14 cases, Cholesteatoma were associated with granulation tissue/polyp. Modified radical mastoidectomy were performed in all cases. On analyzing the findings of the present study it was observed that mastoid abscess were the predominant extracranial complications of CSOM, affecting mostly the male population of 11 - 20 years age group coming from low socio-economic class.

Chronic renal failure in children.

The study was carried out to see the etiology and outcome of chronic renal failure in children. It is a prospective study, carried out to evaluate all new cases of CRF in children < 15 years in nephrology unit of BSMMU from May 2000 to May 2002. Diagnosis of CRF was based on Ccr < 75 ml/min/m(2) along with other features of CRF with no evidence of recovery over ensuing three months. A total of 44 children with CRF having mean age of 8.73 3.56 years were diagnosed during study period, among them, 30 cases (68.19%) were male and 14 cases (31.81%) were female. Causes of CRF were obstructive uropathy in 24 cases (54.55%) followed by glomerular diseases in 15 cases (34.9%), hereditary disorders in 3 cases (6.81%), and reflux nephropathy in 2 cases (4.54%). At presentation, 13 (29.55%) children had mild to moderate CRF and 31 (70.45%) children had severe CRF and ESRD. Mean follow up period was 32.3 weeks. At the end of the study period, 8 patients of mild to moderate CRF were on conservative treatment, 6 patients of severe CRF and ESRD group attended for maintenance dialysis irregularly of which 3 died at hospital and rest of the patients did not attend at follow up due to financial reason or opted against IPD. In the present study, majority of the children with CRF is due to treatable obstructive uropathy; mostly PUV and most of them presented with advanced renal disease.

Correlation of serum parathormone level with biochemical parameters in chronic renal failure.

A prospective study was carried out to assay the level of serum intact parathormone and its correlation with biochemical parameters in patients with chronic renal failure (CRF). The study included 64 children (44 with CRF, and 20 age and sex matched controls). Serum intact parathormone (iPTH), serum creatinine, urea, calcium, inorganic phosphate and alkaline phosphatase were estimated. Creatinine clearance (Ccr) was estimated by Schwartz formula. Patients with CRF were divided into four groups based on their Ccr (mild CRF with mean Ccr 59.17 +/- 1:18.53 mL/min/1.73 m2 (n = 6) moderate CRF with mean Ccr 34.98 +/- 7.75 mL/min/1.73 m2 (n = 7); severe CRF with mean Ccr 17.71 +/- 5.40 mL/min/1.73 m2 (n = 15); and end-stage renal disease with mean Ccr 6.46 +/- 1.71 mL/min/1.73 m2 (n = 16). Mean serum iPTH levels were 93.00 +/- 46.62 pg/mL in CRF and 16.52 +/- 9.35 pg/mL in controls. Groupwise mean serum (iPTH) levels were 48.50 +/- 4.76, 67.29 +/- 7.91, 82.42 +/- 9.67 and 130.66 +/- 58.74 pg/mL in mild, moderate, severe CRF and endstage renal failure respectively. Mean serum iPTH level of CRF (93.00 +/- 46.42 pg/mL) negatively correlated with mean Ccr (22.02 +/- 18.53 mL/min/l.73 m2) (P < 0.001) and mean serum calcium (7.30 +/- 1.02 mg/dL) (P < 0.001) and positively correlated with mean inorganic phosphate (5.76 +/- 1.1 mg/dL) (P < 0.05) and mean alkaline phosphatase (355.14 +/- 185.53 UL) (P < 0.001). We conclude that increased iPTH level occur even early in the course of CRF and progressive hypocalcemia and hyperphosphatemia are the initiating factors for the development of hyperparathyroidism.

Outcome of patients treated with the endoscopic dacryocystorhinostomy.

DCR allows an abstracted lacrimal drainage system to be drained into the nasal fossa. Since the development of endonasal endoscopic surgical technique, the endonasal approach presents it self as an alternative choice to the conventional external approach as in the former skin scar can be avoided. We performed DCR of 50 cases in endonasal endoscopic approach in Mymensingh Medical Collage Hospital. The age range of patient was found between 7 to 35 years, average 21 & male female ratio was 1:1.5 with follow up to 2.10 years with high success rate. Associated nasal disease correction septoplasty was done in 7 cases. In each & every case silicon tube was introduced & removed after 3 to 6 months. The only complication was periorbital injury in 5 cases, punctal tear in 2 cases and granuloma formation in 2 cases. Overall success rate was 86%.