Effect of Intravenous Paracetamol with Bupivacaine Scalp Nerve Block on Haemodynamics Response as Well as Anaesthetic Requirements during Supratentorial Craniotomies.

Noxious stimuli during craniotomy may encourage hypertension and tachycardia, which may rise to morbidity in patients with intracranial hypertension. After craniotomy a moderate level of postoperative pain observed. The objective of this study was to observe the effect of intravenous paracetamol with bupivacaine scalp nerve block (SNB) on haemodynamics response as well as anaesthetic & analgesic requirements during supratentorial craniotomies. This is a single-blind, placebo-controlled, randomized clinical trial carried out in the Neurosurgery operation theatre from August 2015 to July 2017 under supervision of Department of Anaesthesia, Analgesia and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 40 patients aged 18-60 years with supratentorial space occupying lesion undergoing craniotomy under general anaesthesia who were attended in the department of Neurosurgery, BSMMU were enrolled in this study and they were divided randomly into two groups, 20 patients in each. The Group A received 100ml normal saline infusion and 0.25% bupivacaine (20ml) in scalp block, while the Group B received intravenous injection paracetamol (1gm) and 0.25% bupivacaine (total 20ml) in scalp block. Statistical analyses were obtained Statistical Packages for Social Sciences (SPSS-22). The mean systolic blood pressure varied within the normal range in both groups. The mean DBP of Group B remained significantly lower than that of Group A in different follow up except at 30 minutes and 60 minutes after dura incision. However, mean MAP of Group B remained significantly lower than that of Group A in different time interval. The mean heart rate of Group B remained significantly lower than that of Group A. The mean intraoperative propofol as well as fentanyl requirements were significantly decreased in Group B in comparison to Group A. The combination of intravenous paracetamol with bupivacaine scalp nerve block provides better intra-operative haemodynamic stability and neurosurgical compliances for the patients undergoing supratentorial craniotomies under general anaesthesia.

Miltefosine Induced Reduced Male Fertility Capacity after Treatment of Post Kala-azar Dermal Leishmaniasis, Bangladesh.

Post Kala-azar Dermal Leishmaniasis (PKDL) is the sequel of visceral leishmaniasis in Indian subcontinent and may appear among patients with or without previous history of visceral leishmaniasis (VL). The aim of the study is to understand the male reproductive safety profile of miltefosine used for the treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in Bangladesh. From January 2017 to March 2017, an exploratory study was carried out on male fertility capacity in Bangladesh among male patients above 14 years old with PKDL treated with miltefosine. Twenty nine male patients were included to observe the effect of miltefosine on reproductive health. All PKDL patients had history of visceral leishmaniasis (VL) in different time periods. Among them three (10.3%) patients were unable to ejaculate semen. In semen analysis, 3 patients (10.3%) were found azoospermia (sperm count & motility- 0, viscosity- good, pH- 7 to 8), microscopically there was presence of RBC (5-15/HPF), WBC (8-15/HPF). Another 3 patients (10.3%) were found oligospermia (sperm count- 4.2 to 15.3 million/ml, motility- 20 to 50%, viscosity- good, pH- 6 to 9, RBC- 4 to 15/HPF, WBC- 4 to 15/HPF). The study documented some important findings in evaluating male infertility and selection of drug regimens in treating PKDL patients with miltefosine for 12 weeks.

Evaluation of Post Guillain-Barre Syndrome (GBS) Patients: A Cross Sectional Study.

Guillain-Barre syndrome (GBS) is related with significant morbidity and also mortality. Little is known about the long term outcome of GBS patients who survived. The objective of this study is to determine the lasting outcome and consequences of GBS patients. This is a cross-sectional study of patients who diagnosed GBS and managed at the Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2004 to December 2017. All survived patients were invited for a structured interview, questionnaires, and full neurologic exam to record their current clinical condition focused on complaints and symptoms, neurological deficits, disabilities, behaviour, and quality of life. Thirty-eight patients participated, with a median age of 20 years (range 4-39 years) and a median interviewed time of 7 years (range 1-13 years). Residual complaints were reported by 24(63%) patients, including paresthesias (10.5%), unsteadiness of gait (37%), painful hands or feet (29%), and severe fatigue (13%). Questionnaires identified a wide range of behavioural problems. Most Patients showed good recovery of neurological deficits after GBS, but many have persisting long-term residual complaints and symptoms that may lead to psychosocial problems interfering with participation in daily life.

Ultrasonographic Evaluation of Malignant Pediatric Abdominal Tumour with Histopathological Correlation.

Ultrasonography is a very useful diagnostic tool to evaluate pediatric abdominal mass. This cross sectional study was conducted among clinically suspected patients having malignant abdominal mass attending in the department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2008 to December 2009. Total 56 patients were included in this study. Patients were scanned by high resolution gray scale ultrasonography of the abdominal masses. After surgical procedure, biopsy specimen were collected in a container containing 10% formalin and sent for histopathological examination. Mean age of the patients group was 5.91 years with a standard deviation of ±3.21 years. All patients were within 2 to 13 years age. Out of all patients, male were 33(58.9%) and 23(41.1%) were female. Male and female ratio was 1.4:1. Ultrasonographic diagnosis as Wilm's tumour were 27(48.2%), hepatoblastoma 8(14.3%), lymphoma 7(12.5%), neuroblastoma 6(10.7%), suspected malignancy 6(10.7%) and lastly teratoma were 2(3.6%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ultrasonography in the evaluation of Wilm's tumour were 100.0%, 90.6%, 88.9%, 100.0% and 94.6% for neuroblastoma 83.3%, 98.0%, 83.3%, 98.0% and 96.4% for lymphoma 83.3%, 96.0%, 71.4%, 98.0% and 94.6% and for hepatoblastoma 100.0%, 100.0%, 100.0%, 100.0% and 100.0% respectively. It is a noninvasive and cost effective modality. Carefully performed ultrasonographic study would give reliable and accurate information needed in the diagnosis of abdominal malignancy in children.

An Unusual Case of Suicide Attempt Using Intravenous Injection of Kerosene.

Kerosene belongs to the hydrocarbon group of compounds, used as a fuel for lamps, as well as heating and cooking in developing countries. Accidental kerosene poisoning and intoxication usually occur by inhalation or by occupational percutaneous absorption. Adults usually ingest kerosene for the purpose of self-harm, and children may ingest accidentally. Suicidal attempt using intravenous kerosene is an extra ordinary and very rare occurrence. A very few data are available regarding effects of intravenous administration of kerosene and its management.

Effect of single dose intravenous zoledronic acid on bone mineral density in post-menopausal osteoporosis of Bangladeshi women.

The osteoporosis is a major health threat that affects every third post-menopausal women. Postmenopausal osteoporosis is complicated with vertebral, femoral or radius fracture. This prospective study on post-menopausal osteoporosis was carried out in the Pain Centre, Department of Anaesthesia, Analgesia and Intensive Care Medicine of BSMMU, Dhaka during the period of January 2008 to January 2010. The post-menopausal women with back pain were screened by spinal radiographs and dual-energy X-ray absorptiometry (DXA) of lumbar spine to determine the bone mineral density (BMD). The woman after menopause with a BMD T-score of -2.5 or less with or without evidence of vertebral fracture is considered as post-menopausal osteoporosis. A total of 55 post-menopausal osteoporotic patients were assigned to receive a single dose of IV infusion of zoledronic acid (5 mg) along with dietary calcium and vitamin-D. The spinal radiographs and dual-energy X-ray absorptiometry (DXA) were repeated in all the 55 patients at 12 months following zoledronic acid infusion. The mean BMD of lumbar spine increased significantly from pre-infusion value of 0.75695 g/cm2 to post-infusion of 0.80216 g/cm2. The T-score also increased from pre infusion value of -3.567 +/- 0.77 to -3.158 +/- 0.08 in 12 months following the infusion (P < 0.01). The increase is 5.026% higher than pre infusion values. The spinal radiographs taken before infusion of zoledronic acid, showed 14 fractures. There was no new fracture in any case during the 12 months study period. So, it can be concluded that once yearly IV infusion of zoledronic acid is associated with a significant increase in BMD and decrease in the risk of vertebral fracture.

Pertussis toxin enhances human immunodeficiency virus type 1 replication.

Pertussis toxin (PTX) has been used as a reagent to identify involvement of the G protein-mediated signal transduction pathway. In this study, we found that PTX enhanced HIV-1 replication in acute infection systems at a high dose (1-10 microg/ml) in vitro. PTX treatment enhanced the infectivity of HIV-1-based pseudovirus enveloped with HIV-1 or amphotropic murine leukemia virus (A-MuLV), but not with vesicular stomatitis virus (VSV). This high dose of PTX treatment did not affect HIV-1 gene expression. These data suggested that the effect was virus envelope dependent and that PTX acted on an early stage of viral infection. Treatment with B-oligomer, a nonenzymatic subunit of PTX, mimicked this enhancing effect of PTX. However, desialylation of viral and cellular surface glycoproteins, which are receptors for B-oligomer, did not affect the augmentation induced by PTX. These results indicate that the enhancement of HIV-1 replication is mediated through an unknown biological function of B-oligomer.

vif-negative human immunodeficiency virus type 1 persistently replicates in primary macrophages, producing attenuated progeny virus.

The vif gene of human immunodeficiency virus type 1 (HIV-1) is required for efficient infection of primary T lymphocytes. In this study, we investigated in detail the role of vif in productive infection of primary monocyte-derived macrophages (MDM). Viruses carrying missense or deletion mutations in vif were constructed on the background of the monocytotropic recombinant NLHXADA-GP. Using MDM from multiple donors, we found that vif mutants produced in complementing or partially complementing cell lines were approximately 10% as infectious as wild-type virus when assayed for incomplete, complete, and circularized viral DNA molecules by quantitative PCR amplification or for viral core antigen p24 production by enzyme-linked immunosorbent assay. We then determined the structure and infectivity of vif mutant HIV-1 by using MDM exclusively both for virus production and as targets for infection. Biosynthetic labeling and immunoprecipitation analysis of sucrose cushion-purified vif-negative HIV-1 made in MDM revealed that the virus had reduced p24 content compared with wild-type HIV-1. Cell-free MDM-derived vif mutant HIV-1 was infectious in macrophages as determined by the synthesis and maintenance of full-length viral DNA and by the produc- tion of particle-associated viral RNA, but its infectivity was approximately 2,500-fold lower than that of wild-type virus whose titer was determined in parallel by measurement of the viral DNA burden. MDM infected with MDM-derived vif-negative HIV-1 were able to transmit the virus to uninfected MDM by cocultivation, confirming the infectiousness of this virus. We conclude that mutations in vif significantly reduce but do not eliminate the capacity of HIV-1 to replicate and produce infectious progeny virus in primary human macrophages.

Redefinition of tropism of common macrophage-tropic human immunodeficiency virus type 1.

Previous studies have suggested that the abilities of human immunodeficiency virus type 1 (HIV-1) to infect primary macrophages and transformed T cell lines are mutually exclusive and define an important biological distinction among HIV-1 strains. In a survey of eight macrophage-tropic HIV-1 strains and nine T cell lines, all frequently used in studies of tropism, we have found that six virus strains replicate in one or more T cell lines and that four T cell lines are highly susceptible to macrophage-tropic HIV-1. Passage through T cell lines did not affect the tropism or the env V3 sequence of monocytotropic HIV-1 strains. We conclude that HIV-1 replication in transformed T cells and primary macrophages are not mutually exclusive, and that as such, these definitions of tropism per se are not generally useful markers for other biological properties of HIV-1.

Pertussis toxin inhibits induction of human immunodeficiency virus type 1 in infected monocytes.

Tumor necrosis factor alpha (TNF-alpha) and 12-0-tetradecanoyl phorbol-13-acetate (TPA) activate human immunodeficiency virus type 1 (HIV-1) in U1 cells that are latently infected with HIV-1 to produce viral particles. Pertussis toxin, which inactivates several members of the G protein family of signaling components, including Gi, Go, and transducin, was found to inhibit either TPA or TNF-alpha induction of HIV-1 in U1 cells at the concentration of 1-10 ng/ml. Chloramphenicol acetyl transferase (CAT) assay revealed that pertussis toxin could inhibit HIV-1 gene expression. B-oligomer, the mitogenic and non-ADP-ribosylating component of pertussis toxin, did not show any effect on HIV-1 replication alone or in combination with TNF in the same concentration range. It was of particular interest to note that a single protein (Gi) with a molecular weight of 40 kDa was dose-dependently ADP-ribosylated after treatment with pertussis toxin in U1 cells. The degree of ADP ribosylation of Gi corresponded well to that of inhibition of HIV-1 upon treatment with pertussis toxin. These results strongly support the contention that TPA and TNF-alpha induction of HIV-1 is mediated by a Gi-like receptor-effector coupling protein in the membrane of U1 cells. On the basis of these findings, we propose a model for signal transduction of HIV-1 expression through c-kinase-dependent (TPA) and c-kinase-independent (TNF-alpha) pathways in the U1 cell to determine the point at which Gi-like protein is involved.

Evaluation of anti-human immunodeficiency virus effect of recombinant CD4-immunoglobulin in vitro: a good candidate for AIDS treatment.

CD4 molecule, a surface marker of helper T lymphocytes, interacts with gp120 of human immunodeficiency virus (HIV) with a high affinity and, hence, serves as a virus receptor. Soluble chimeric CD4-immunoglobulin (Ig) possesses anti-HIV activity due to its binding activity to gp120. Furthermore, this recombinant molecule has unique Ig-like properties representing Fc receptor-binding activity and a long half-life in vivo. In this report we have thoroughly evaluated the effect of this compound on HIV infection using different in vitro systems. Treatment with 4 micrograms/ml of recombinant CD4-Ig after infection completely blocked the HIV-specific cytopathic effect, antigen expression, and virus release in MT-4 cells, a human T cell line which is highly susceptible to HIV. Similarly, this molecule blocked the HTLV-III/B and YU-1 strains of HIV infection in peripheral blood mononuclear cells even at 1 microgram/ml. Pretreatment of the Fc receptor-positive cell line U937 with this reagent resulted not in enhancement but again in blocking of HIV infection. About 95% of HIV infection was inhibited in U937 cells when cells were treated with this compound at the time of exposure to HIV. Recombinant-CD4-Ig also completely inhibited HIV-induced syncytia formation between MOLT-4 and MOLT-4/HIV and resulting virus release at 8 and 2 micrograms/ml, respectively. Due to its stability and long half-life, this compound could be a promising therapeutic agent against HIV infection.

Mycoplasma can enhance HIV replication in vitro: a possible cofactor responsible for the progression of AIDS.

Mycoplasma membrane protein (MMP) augmented HIV production from MOLT-4 cells chronically infected by HIV. A nearly 3-fold increase of HIV p24 antigen was detected in MMP-treated culture as compared to control culture at 100 micrograms/ml. MMP also augmented HIV production in different T cells chronically infected by HIV-1 and ARV-1. Kinetic experiment showed that HIV production was maximally elevated 24 hr after exposure to MMP. Similarly, MMP also augmented HIV-induced cell fusion and virus production in coculture. Hybridization experiment revealed that this augmentation was due to enhancement of HIV transcription.

The phorbol ester TPA strongly inhibits HIV-1-induced syncytia formation but enhances virus production: possible involvement of protein kinase C pathway.

Cocultivation of MOLT-4 and MOLT-4/HIVHTLV-IIIB cells with more than 0.01 ng/ml of 12-O-tetradecanoylphorbol-13-acetate (TPA) for 20 hr strikingly inhibited HIV-induced syncytia formation resulting from cell to cell infection. Interestingly, the production of HIV-specific p24 antigen in the culture fluid was significantly enhanced by TPA. TPA down-modulated the expression of CD4. CD4 is essential for syncytia formation through interaction with viral envelope protein gp120 on the surface of MOLT-4 cells. The effects of TPA on syncytia formation and on CD4 expression were specifically interfered with by nontoxic doses of blockers of protein kinase C (PKC) such as staurosporine and H7. These data suggest that (1) TPA inhibits HIV-induced syncytia formation through down-modulation of CD4 molecules on the surface of MOLT-4 cells and (2) PKC may play an important role in cell to cell as well as in cell-free infection of HIV.