Association of Admission Glycemic Gap on Short-term Outcome of Neuro-critical Patients with Diabetes.

Both of neurological emergencies and hyperglycemia are independently associated risk factors of mortality in the ICU patients. In critically ills, hyperglycemia is secondary to already existing DM or stress-induced hyperglycemia (SIH). Admission glycemic gap (AGG) is considered as a reliable indicator of SIH. This study aimed to explore the association of AGG on diabetic neuro-critical patients' short-term mortality, and understand the potential of AGG as the predictor of outcome. Sixty adult diabetic neuro-critical patients admitted in ICU and stayed at least for 24 hours, were prospectively observed for 30 days, or until discharge or death, whichever came first. The patients' initial clinical assessment and HbA1c, CBC, ABG, and blood glucose level were done within 24 hours of admission. A1c derived admission glucose (ADAG) was calculated as, ADAG = (1.59 × HbA1c) - 2.59 (mmol/L). The AGG was calculated by subtracting ADAG from admission blood glucose level (ABGL). Death or survival of 30 days was our primary outcome and participants were divided between survivor or non-survivor groups according to primary outcome. Statistical comparisons of the study variables between the groups were performed and the relationship between parameters derived from blood glucose and mortality was prospected. Among the 60 patients enrolled, 35(58.3%) were non-survivors and 25(41.7%) were survivors. Age, sex, residence, primary diagnosis, co-morbidity, or drug history had no association with survival/non-survival. Among the initial clinical assessment parameters, lower GCS had significant association with non-survival. AGG, HbA1c, ADAG and ABGL were significantly different between the groups, with higher values in the non-survivors. Lower GCS, and higher AGG, HbA1c, ADAG and ABGL showed significant odds of non-survival. The highest odds of non- survival was for AGG (OR 2.95, 95% CI: 1.83-4.75; p<0.001). For ABGL and HbA1c the OR were 2.03 (95% CI: 1.44-2.86; p<0.001) and 1.93 (95% CI: 1.04-3.58; p<0.04) respectively. The final adjusted odds (aOR) of non-survival for higher AGG was 3.25 (95% CI: 1.71-6.16; p<0.001), signifying that AGG is independently associated with non-survival. AGG, GCS level, ABGL, HbA1c level, and ADAG can predict short-term outcome (mortality). However, AGG has the greatest potential to predict short-term outcome in diabetic neuro-critical patients.

Comparison of Serum Zinc in Children of Wilson Disease and Non-Wilsonian Volunteers in Bangladesh.

Wilson disease (WD) is an autosomal recessive disorder of copper metabolism with diverse clinical manifestations. Zinc (Zn) has been used for treatment of WD. Recent studies showed low serum zinc level in patients suffering from WD than the normal. This cross-sectional analytical study has been designed to compare the serum zinc level between paediatric patients suffering from WD but yet not started treatment and children who have normal ALT level. This study was carried out at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from July 2018 to June 2019. Total 51 children were included in this study. Among them 27 were diagnosed case of WD aged between three to eighteen years and 24 children of same ages who were suffering from other than liver disease having normal ALT were included as volunteers. The patients of WD were divided into four groups according to their presentation as acute hepatitis, chronic liver disease (CLD), acute liver failure & neuropsychiatric manifestation. Informed written consent was obtained from all patients and volunteers for participation in this study. Along with other physical findings and laboratory investigations 3 ml of venous blood were collected for estimation of serum zinc level. After estimation of serum zinc level results were analyzed statistically. The difference in serum zinc levels were compared between the groups. Serum zinc level was significantly lower in Wilson disease patients (43.8±19.7µg/dl; range: 13-83) compared to volunteers group (67.8±11.8µg/dl; range: 47-97) p<0.001. Among the diseased group, serum zinc level were significantly lower in 18 CLD (38.4±17.4µg/dl) and in 4 acute liver failure (33.1±3.7µg/dl) compared to 4 acute hepatitis (71.8±4.3µg/dl) (p=0.001) and (p<0.001) respectively. Mean serum zinc level was low in 4 Wilsonian acute liver failure (33.1±3.7µg/dl), which was significant compared to those (23) who presented as Wilson disease non acute liver failure (45.7±20.8µg/dl) (p=0.013). Serum zinc level was significantly lower in Wilson disease children compared to the volunteers. Zinc level was also found significantly low in Wilson disease presented as CLD and acute liver failure in comparison to Wilson disease presented as acute hepatitis.

Health Related Quality of Life in Patients with Pulmonary Tuberculosis.

Tuberculosis (TB) is one of the major public health issues in many developing nations especially in Bangladesh. Though most focus is being directed towards mortality and incidence rate, the changes in morbidity and other health status parameters are not been well considered. The aim of the study was a comprehensive assessment of patients with pulmonary tuberculosis by measuring patient's quality of life which may lead to better outcome in patients' health, infection surveillance and prevention programs. This prospective study was conducted in the department of Respiratory and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to March 2017. The quality of life scores of 61 smear positive pulmonary tuberculosis cases were measured by validated Bangla version of SF-36 questionnaire before or at the starting of treatment, after the initial phase and at the end of treatment. Then the score was compared with those of 75 healthy matched controls. The changes of the quality of life with the stage of treatment and with socio-demographic variables were assessed. Before treatment, all domains of HRQoL of the pulmonary TB patients were significantly lower than those of the control group (p<0.001). At the end of six-month treatment period, HRQoL of the pulmonary TB patient had significantly increased compared to before treatment (p<0.001). There was no significant difference of scores after six months of treatment with that of control (p>0.05). The lowest score in tuberculosis patients was related to general health perception and vitality. Patients with low socio economic status, low educational level, prolonged disease duration and increased number of symptoms had lower HRQoL scores.

COVID 19 in Children: Gastrointestinal, Hepatobiliary and Pancreatic Manifestation.

The most devastating pandemic of this era coronavirus disease-2019 (COVID-19) is caused by a novel virus named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Although it is primarily a respiratory pathogen, it can also result in several extra-pulmonary manifestations includes gastrointestinal symptoms, hepatocellular injury. Angiotensin-converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2), the entry receptor for the causative coronavirus SARS-CoV-2 is co-express in the gastrointestinal tract, hepatocyte, and cholangiocytes similar to the respiratory mucosa. The presence of these receptors facilitates the entry into the tissue and causes direct viral tissue damage, which is a proposed mechanism of injury. Diarrhoea, nausea, vomiting, abdominal discomfort are common gastrointestinal manifestations, whereas derangement of liver function tests is the most hepatic manifestation in COVID-19. In this article, we reviewed on SARS-CoV-2 disease COVID-19 regarding gastrointestinal, hepatic, and pancreatic manifestation, the mechanisms by which the virus may inflict damage, and their management perspective.

Anatomical, physiological, and chemical alterations in lichen (Parmotrema tinctorum (Nyl.) Hale) transplants due to air pollution in two cities of Brahmaputra Valley, India.

The lichen species Parmotrema tinctorum (Nyl.) Hale was transplanted in two cities-Tezpur (small) and Guwahati (large)-of the Brahmaputra Valley to assess the impact of air pollution on the anatomy and physiology, and accumulation of pollutants. Significant damage to the anatomy was observed in samples, and the degree of damage was found to be higher in the transplants of the larger city. In the lichen transplants from locations having high traffic density, the total chlorophyll content was found to fall; on the contrary, electrical conductivity was found to be higher. The exposed-to-control ratio showed severe accumulation of Cd in all the transplants. Elements such as Cd, Pb, and Zn were found to be enriched in all the lichen samples from both Guwahati as well as Tezpur city. Besides, Cr, Cu, K, and Ni were also realized to be enhanced to a moderate extent. The correlations of indicator metal species pairs showed that anthropogenic influence was quite clear.

Chitosan-cinnamaldehyde Schiff base: A bioinspired macromolecule as corrosion inhibitor for oil and gas industry.

A Schiff base of chitosan with cinnamaldehyde (Cinn-Cht) was synthesized in a single step using microwave irradiation and characterized using spectroscopic techniques. The synthesized Schiff base was used for the mitigation of carbon steel corrosion in 15% HCl. The corrosion evaluation was performed using weight loss tests, electrochemical impedance measurements, and polarization studies. The corrosion inhibition efficiency increased with inhibitor dosage and achieved a high value of 85.16% at 400 mgL-1. The inhibitor adsorption followed the Langmuir isotherm and displayed a mixed physical and chemical adsorption behavior. To further improve the corrosion inhibition efficiency, potassium iodide (KI) was incorporated in the corrosive solution, which increased the inhibition efficiency further to 92.45% at a concentration of 10 mM. Surface studies carried out via SEM analyses indicated the inhibitor adsorption and protective film formation on the steel surface. The computational studies carried out via DFT revealed that mainly the protonated form of inhibitor adsorbs on the metal surface. Monte Carlo simulation studies also showed that the protonated form of the inhibitor molecule exhibited higher adsorption energy than the neutral inhibitor.

Microwave-assisted synthesis of a new Piperonal-Chitosan Schiff base as a bio-inspired corrosion inhibitor for oil-well acidizing.

A new Schiff base of chitosan, namely Piperonal-chitosan (Pip-Cht), was synthesized for the first time, using a microwave irradiation method and characterized using spectroscopic techniques. The corrosion inhibition behavior of the new Schiff base was evaluated on carbon steel in 15% HCl medium via gravimetric and electrochemical techniques. This is the first work on the application of chemically functionalized chitosan as a corrosion inhibitor in the oil-well acidizing environment. The Pip-Cht inhibitor exhibited a high corrosion inhibition efficiency of 85.16% at a moderate dose of 600 mg L-1. Further, the addition of potassium iodide as a synergistic agent to the corrosive electrolyte produced a significant improvement in the inhibition efficiency to 91.15% at a low dosage of 10 mM of KI. At a higher temperature of 65 °C, the combination of both the inhibitor and KI yielded a high inhibition efficiency. The results of the gravimetric and electrochemical experiments were corroborated using AFM and SEM studies. The DFT calculations indicated that corrosion inhibition behavior of the Schiff base mainly occurs in the protonated form.

Biomonitoring by epiphytic lichen species-Pyxine cocoes (Sw.) Nyl.: understanding characteristics of trace metal in ambient air of different landuses in mid-Brahmaputra Valley.

This study presents a comparative assessment of the trace metal air pollutants of urban, peri-urban, and rural areas of the Brahmaputra Valley plain in the Eastern Himalayan region using biomonitoring of Pyxine cocoes. In situ collection of the thalli growing on Bombax sp. from representative locations was done, which was analyzed for Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn using ICP-OES. The metals, viz. Cd, Cr, Ni, Pb, and Zn, were highly enriched, indicating anthropogenic influences. The coefficients of variation (CV) of Co, Cr, and Ni were also high, pointing at their accumulation from local sources. Influence of local sources was also observed for Cd, Fe, and Mn in peri-urban and Cd in urban samples. Metals related to automobiles were accumulated in greater volume in samples of peri-urban locations, which implies the impact of the highway that runs through these locations and other associated human activities. The samples of urban areas were found to be enriched with metals originating from both vehicular emissions and road dust. Also, accumulations of Co, Cr, Cu, Fe, Mn, and Ni in the lichen thalli were found to be around tea gardens. Inter-species correlations were found to be positively significant for most of the elements. Principal component analysis (PCA) of the metal data revealed that vehicular emission and coal burning, street dust, and crustal dust were the major sources of trace metals in the ambient air of the region.

Etiological Evaluation of Patients with Lymphadenopathy by Clinical, Histopathological and Microbiological Assessment.

Lymph node enlargement is a common presenting complaint in outpatient and inpatient department. The present observational cross sectional study was conducted in department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from December 2014 to May 2016 to evaluate etiologies of significant lymphadenopathy by clinical, histopathological and microbiological assessment. Biopsy/FNA materials of 177 patients of 18-75 years age range with significant lymphadenopathy were sent for histopathology/cytology, Gram stain & culture, AFB stain & culture and Gene Xpert. Among them, 102(57.62%) were granulomatous lymphadenitis, 52(29.38%) were lymphoma, 12(6.78%) reactive lymphadenitis, 7(3.95%) metastatic malignancy, 2(1.13%) atypical lymphoid hyperplasia, 1(0.57%) myeloid sarcoma and 1(0.57%) chronic sialadenitis. Growth of MTB was on 23(22.55%) cases; among 102 granulomatous lymphadenitis and Gene Xpert was positive in 73(71.56%) cases with 100% Rif. sensitive. Gene Xpert is an important tool for diagnosis of tuberculous lymphadenitis. Time of symptoms to diagnosis of most of the TBL patients was within 2-8 months.

Comparison of Ultrasonogram of Brain Findings of Asphyxiated and Non-Asphyxiated Baby Admitted in Neonatal Ward in a Tertiary Level Hospital.

Perinatal asphyxia is a major cause of neonatal mortality and morbidity in developing countries. A significant portion of patient with perinatal asphyxia is admitted with complications. Cerebral complications are the most devastating and the child may be left with lifelong neurological impairment. Therefore, the high index of suspicion, prompt recognition and thorough understanding of common sonographic abnormalities are necessary to ensure timely intervention, management and counseling. A hospital based case control study was conducted in the neonatal unit of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Study period was six months (June 2012 to December 2012). This study was done to compare the ultra sonogram of brain findings of admitted asphyxiated babies with admitted non-asphyxiated babies. A total of 30 asphyxiated (case) and another 30 non-asphyxiated (control) neonate of this department were enrolled in the study. Necessary information was collected by taking detailed history, clinical examination and also close follow up of the neonates according to pre-designed questionnaire. The main outcome variable was abnormality in cranial ultrasound. Among case group (30 neonates), ultrasonogram of brain findings were abnormal in 9(30.0%) cases. Among them most common was ventricular dilatation 5(16.6%), followed by Intraventricular hemorrhage (IVH) 1(3.0%), intracranial hemorrhage 1(3.0%), HIE 1(3.0%) and cerebral edema in 1(3.0%) cases. On the contrarary, among asphyxiated control group all 30 cases had normal ultra sonogram of brain. In case group 22 babies had normal birth weight and 08 had low birth weight. Among the 22 normal birth weight neonates in case group total 6(27.2%) cases had abnormal ultra sonogram findings. Among normal birth weight cases 3(13.6%) had ventricular dilatation, 1(4.5%) Intracranial hemorrhage (ICH), 1(4.5%) HIE, 1(4.5%) cerebral edema. Among 08 low birth weight neonates in case group total 3(37.5%) cases had abnormal ultrasonogram of brain finding. Among low birth weight cases 2(25%) had ventricular dilatation, 1(12.5%) IVH. Ultrasonogram brain findings difference between two groups was statistically significant. Abnormal findings were also common in low birth weight babies than normal birth weight babies. So, early detection of abnormal brain changes can help us for proper management and counseling.

Serum Zinc Concentrations in Patients with Pulmonary Tuberculosis.

Bangladesh is a tuberculosis (TB) burden country. It is one of the most important causes of mortality and morbidity and a major barrier of social and economic development. Zinc is a major trace element and an essential component of the body immune system. It's an important determinant of resistance to infection by maintaining cell mediated immunity. This analytical case control study was conducted in the Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to see the association of serum zinc concentrations with pulmonary tuberculosis (PTB) in adult population (18-60 years) from January 2015 to January 2016. Freshly diagnosed PTB patients before initiating anti-TB chemotherapy as cases (N=43) and TB negative subjects as controls (N=48) were included conveniently in this study with a rigid selection criteria. Serum zinc concentrations were estimated by using atomic absorption spectrophotometer. The mean±SD age and BMI of the case group and control group were 33.30±14.71 and 32.69±11.60 years, 19.88±2.31 and 22.08±2.80 kg/m2 respectively. The concentrations of serum zinc were significantly lower (P=0.01) in PTB group (840.9±230.0 µgm/l) compared with the control group (965.6±219.9 µgm/l). There was marked variation of mean±SD serum zinc concentrations between male (1008.95±246.16 µgm/l) and female (937.24±200.35 µgm/l) in control group (P=0.182) though the variation is minimal in PTB group (P=0.724). The serum zinc concentrations showed positive correlation with BMI (P=0.642) but negative correlation with age (P=0.023) in both case and control. The lower serum zinc concentrations (12.06%) in PTB patients indicate relative immune deficiency. Routine assessment of serum zinc concentration of PTB patients should be considered and further outcome should be assessed with zinc supplementation.

Irritable Bowel Syndrome: Is it Rare in Children?

Irritable bowel syndrome (IBS) is one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. Visceral hypersensitivity and increased GIT motility are the main patho-physiological mechanism for developing IBS. IBS present with diarrhea and constipation or both. Investigation is least needed for diagnosis of IBS rather done to exclude differential diagnosis. Diagnosis is done on the basis of Rome-III criteria. Proper counseling, dietary management, anti-spasmotic and antidepressant are the mainstay of treatment.

Childhood Wilson Disease: Bangladesh Perspective.

Wilson's disease (WD) is an autosomal recessive disorder affecting copper metabolism causing copper induced damage to various organs. In children liver is commonly involved. Central nervous system, eyes, RBC, kidneys, brain and bones may also be affected. Aim of the study is to evaluate clinical & laboratory profile of Wilson's disease in children. This cross sectional descriptive study was conducted at the department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2011 to December, 2013. One hundred consecutive children of WD between 3 to 18 years of age were evaluated for clinical & biochemical profile. Mean age of studied children was 8.5±1.5 years. Male female ratio was 2:1. Ninety one percent patients were Muslim and nine percent Hindu. Consanguinity of marriage was found in 30% cases. Seven parents were first degree cousin. Family history of chronic liver disease was present in 15% of patients. Most (53%) cases of the hepatic WD presented between 5 to 10 years of age and most of the neurologic WD manifested in 10-15 years age group. Among 100 patients of WD, 69 children presented only with hepatic manifestations, 6 only with neurological manifestations, 14 with both hepatic & neurological manifestation, 10 children was asymptomatic and 1 patient presented with psychiatric features. WD presented as chronic liver disease (CLD) in 42%, CLD with portal hypertension in 34%, acute hepatitis in 20% and fulminant hepatic failure in 4% cases. Stigmata of chronic liver disease were found in 18% patients. Commonest stigmata was thenar and hypothenar wasting (n=8). Keiser- Fleischser ring (K-F ring) was found in 76% of the total patients. K-F ring was present in 84% ( 58 out of 69) of the hepatic only Wilsonian patients and in 90% (18 out of 20) of all neurologic Wilsonian patients. Asymptomatic and psychiatric patient had no K-F ring. About 26% of the WD patients had Coombs negative hemolytic anemia in PBF. Most of the WD patients had altered liver function. Elevated serum transaminase was found in 85% of all cases, prolonged prothrombin time in 59% cases & low serum albumin in 53% cases. Seventy three percent patients had low serum ceruloplasmin, basal urinary copper of >100µgm/day was found in 81% cases and urinary copper following penicillamine challenge of >1200µgm/day was found in 92% cases. In 28 cases with hepatic presentation esophageal varices were identified by upper gastrointestinal endoscopy. WD patient with hepatic presentations were given zinc sulphate along with penicillamine. All patients with neurological manifestation as well as asymptomatic cases were maintained on zinc therapy. WD is a treatable metabolic cause of liver disease. Majority of studied WD children presented with hepatic manifestation of which 76% presented with CLD. Any child presented with jaundice after the age of 3 years should be investigated for WD.

Aetiology and Outcome of Acute Liver Failure in Children: Experience at a Tertiary Care Hospital of Bangladesh.

Acute liver failure (ALF) is a rapidly progressive, potentially fatal syndrome resulting from rapid death or injury to a large proportion of hepatocytes, caused by a variety of insult, leaving insufficient hepatic paranchymal mass to sustain liver function. The aetiology of ALF varies according to the age of patient and development of the country. The outcome of ALF also varies according to aetiology: survival is better in paracetamol poisoning whereas it is poor in metabolic diseases. The present study was undertaken to observe the underlying aetiology and outcome of ALF in children under 18 years of age admitted at the department of Paediatric Gastroenterology & Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. It was a retrospective review of medical records from November 2011 through October 2014. During this period a total of 35 patients were diagnosed to have ALF. Aetiology was established in 25(71.4%) cases, whereas in 10(28.6%) cases, no identifiable cause was found. Viral hepatitis was the underlying cause in 12(34.3%) cases. After treatment 15(43%) ALF patients survived, 8(23%) left hospital with risk bond (DORB), and 12(34%) patients died. The study showed that among the 12 death patients, 5(41.7%) had viral hepatitis, 3(25%) Wilson's disease, and in 4(33.3%) no cause could be identified. Viral hepatitis and Wilson disease were found to be two common causes of ALF in this study. Future studies with larger sample size are required to know the actual causes of acute liver failure in Bangladeshi children.

Heavy metals in drinking water: Occurrences, implications, and future needs in developing countries.

Heavy metals in drinking water pose a threat to human health. Populations are exposed to heavy metals primarily through water consumption, but few heavy metals can bioaccumulate in the human body (e.g., in lipids and the gastrointestinal system) and may induce cancer and other risks. To date, few thousand publications have reported various aspects of heavy metals in drinking water, including the types and quantities of metals in drinking water, their sources, factors affecting their concentrations at exposure points, human exposure, potential risks, and their removal from drinking water. Many developing countries are faced with the challenge of reducing human exposure to heavy metals, mainly due to their limited economic capacities to use advanced technologies for heavy metal removal. This paper aims to review the state of research on heavy metals in drinking water in developing countries; understand their types and variability, sources, exposure, possible health effects, and removal; and analyze the factors contributing to heavy metals in drinking water. This study identifies the current challenges in developing countries, and future research needs to reduce the levels of heavy metals in drinking water.

Penicillamine challenge test in the diagnosis of Wilson's disease.

Wilson's disease (WD) is one of the most common metabolic liver diseases encountered in children. Early diagnosis of the disease is essential because specific treatment can be offered, that will prevent further hepatocellular injury and neurologic complications. There is no single diagnostic test that can exclude or confirm the disease with certainty. Penicillamine challenge has proved itself to be a useful diagnostic test in the detection of WD. The main purpose of this study was to observe the reliability of penicillamine challenge test, in the diagnosis of WD. The cross sectional study was done with a case control design in the department of paediatric gastroenterology & Nutrition, BSMMU, Dhaka. The study was carried out on 60 patients of CLD. Along with other physical findings and laboratory investigations, 24 hours urinary copper excretions were estimated before and after penicillamine challenge. Study results were analyzed statistically. Thirty CLD patients who fulfilled the inclusion and exclusion criteria of WD were considered as cases (Group I) and remaining 30 CLD patients were considered as non-Wilsonian CLD and was labeled as control (Group II). Among the control group, 12 CLD patients were found to be HBsAg positive, 1 had hepatitis-C virus infection, 1 had autoimmune hepatitis and the remaining 16 CLD patients were Cryptogenic. The (mean±SD) age of WD patients was 9.90±28 years; male female ratio was 1.5:1. Most common presentation was ascites (70%). K-F ring was found in 86.7% cases. Serum ceruloplasmin level was found significantly lower in WD patients (mean±SD, 0.1197±23g/L, p<0.001). Baseline urinary copper excretion of WD patients differed significantly from controls (Median 219.0µg/24hour, range 35-2018µg/24hour, versus median 44µg/24hour, range 20-238µg/24hour, p<0.001). Baseline urinary copper excretion above 100µg/24hour was observed in 80% WD patients whereas it was 10% in controls. post penicillamine urinary copper excretion was significantly greater in WD patients than controls (Median 2635µg/24hour, range 648-6222µg/24hour, versus median 423µg/24hour, range 91-1250µg/24hour, p<0.001). Post penicillamine urinary copper above 1600µg/24hour observed in 70% of WD patients whereas not a single patient reached the value in control group. Twenty four hours urinary copper estimation after penicillamine challenge was found to be a valuable test in the diagnosis of WD.

Wilson's disease in children with blindness: an atypical presentation.

Wilson's disease (WD) is an autosomal recessive disease affecting copper metabolism causing copper induced organ damage. Common organs involved are liver and central nervous system. But RBC, eye, kidneys and bone may also be affected. In WD main defect remains in copper transporter protein p type ATPase resulting from gene mutation in chromosome 13. Neurological manifestations in WD develop due to deposition of copper in different brain areas like basal ganglia, cerebral cortex, corticospinal and corticobulbar pathway. Different types of neurological manifestations develop in WD but visual impairment is very rare. A 14 years old boy of WD presented to us with blindness, tremor and slurred speech along with end stage liver disease. Blindness was thought to be due to optic neuropathy which reversed after drug treatment.

Cell-adhesive thermogelling PNIPAAm/hyaluronic acid cell delivery hydrogels for potential application as minimally invasive retinal therapeutics.

Copolymers of N-isopropylacrylamide (NIPAAm) and acrylic acid N-hydroxysuccinimide (NAS) were synthesized via free radical polymerization and conjugated with amine-functionalized hyaluronic acid (HA) and cell adhesive RGDS peptides. These novel copolymers were designed to facilitate noninvasive delivery of a liquid suspension of cells into the delicate subretinal space for treatment of retinal degenerative diseases such as age-related macular degeneration (AMD) and diabetic retinopathy. The various synthesized copolymers all displayed subphysiological phase transition temperatures, thereby allowing temperature-induced scaffold formation and subsequent entrapment of transplanted cells within an adhesive support matrix. Successful grafting of HA and RGDS peptides were confirmed with Fourier Transform Infrared (FTIR) spectroscopy and quantified with (1)H Nuclear Magnetic Resonance (NMR) spectroscopy. All copolymers demonstrated excellent compatibility with retinal pigment epithelial (RPE) cells in culture and minimal host response was observed following subcutaneous implantation into hairless SKH1-E mice (strain code 447).

Development of injectable, resorbable drug-releasing copolymer scaffolds for minimally invasive sustained ophthalmic therapeutics.

Copolymers based on N-isopropylacrylamide (NIPAAm), acrylic acid N-hydroxysuccinimide (NAS) and varying concentrations of acrylic acid (AA) and acryloyloxy dimethyl-γ-butyrolactone (DBA) were synthesized to create thermoresponsive, resorbable copolymers for minimally invasive drug and/or cell delivery to the posterior segment of the eye to combat retinal degenerative diseases. Increasing DBA content was found to decrease both copolymer water content and lower critical solution temperature. The incorporation of NAS provided an amine-reactive site, which can be exploited for facile conjugation of bioactive agents. Proton nuclear magnetic resonance analysis revealed the onset of hydrolysis-dependent opening of the DBA lactone ring, which successfully eradicated copolymer phase transition properties and should allow the gelled polymer to re-hydrate, enter systemic circulation and be cleared from the body without the production of degradation byproducts. Hydrolytic ring opening occurs slowly, with over 85% copolymer mass remaining after 130 days of incubation in 37°C phosphate buffered saline. These slow-degrading copolymers are hypothesized to be ideal delivery vehicles to provide minimally invasive, sustained, localized release of pharmaceuticals within the posterior segment of the eye to combat retinal degenerative diseases.

Serum adiponectin in patients with coronary heart disease.

Adiponectin is an adipocyte derived hormone, a modulator of lipid metabolism and systemic inflammation. It has potential anti-atherogenic property. Adiponectin is present in low concentration in patients with obesity, insulin resistance (IR), Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). In this case control study, we studied the association of Serum adiponectin with CHD. Sixty-four subjects were enrolled. Consecutive 31 CHD patients (Group I) and 33 healthy controls (Group II) were included. Serum adiponectin & lipid profile were estimated in all. Serum adiponectin was significantly lower in CHD patients (3.90±2.21µg/ml) in comparison with controls (5.09±2.13µg/ml)(P<0.05). There was no significant difference of any fraction of lipid profile between cases and controls. Significant negative correlation was observed between Serum adiponectin and Serum triacylglyceride (STG) in cases (P<0.01). It may be concluded that low serum adiponectin may have some important role in development of CHD and probably low adiponectin and dyslipidemia are linked in the development of atherosclerosis. Further study is recommended with larger sample size to explore the role of hypoadiponectinemia in the causation of CHD.