Modified Snodgrass Urethroplasty for Distal Penile Hypospadias: Our Experience at BSMMU Hospital.

Hypospadias is a developmental defect of male urethra characterized by absence of meatal opening at the tip of glans but is present at the ventral surface of penis anywhere along the shaft, even in the perineum. Usually this defect is associated with ventrally curved penis. Surgery is the single option to correct this birth defect. More than 300 techniques have been developed but none is universally acceptable as because, surgery is usually associated with fistula. Rate of fistula formation varies from technique to technique. Now a day, Snodgrass technique is widely practiced because of its low rate of fistula formation. Many factors are responsible for this post-operative complication. Most important one is developmentally defective ventral penile skin where some local factors like vascular and collagen tissues are insufficient. This observational study was performed to evaluate the role of dorsal vascular flap over the neourethra following urethroplasty by Snodgrass technique in terms of post-operative fistula formation in the Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2018 to March 2020. A total of 39 patients with distal penile hypospadias were included in this study. All underwent Snodgrass urethroplasty with additional dorsal vascular flap over the neourethra to support this ventrally deficient local factor. The outcome in terms of post operative urethrocutaneous fistula was evaluated. Only two patients (5.15%) developed urethrocutaneous fistula. In conclusion, addition of dorsal vascular flap over the neourethra by Snodgrass technique reduces the rate of the fistula formation.

Impact of Myocardial Blush Grade on In-Hospital Outcome after Primary Percutaneous Coronary Intervention.

Primary percutaneous coronary intervention (PPCI) is the optimal reperfusion strategy in patients with ST elevation Myocardial Infarction (STEMI). However, despite achieving TIMI 3 flow after PPCI, some patients have less optimal perfusion at the myocardial tissue level, as assessed by Myocardial Blush Grade (MBG) and consequently show adverse outcome. This prospective observational study was performed in the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from March 2016 to February 2017. Total 74 patients with STEMI who underwent primary PCI and achieved TIMI 3 flow were included among them 37 patients were taken with low MBG (grade 0 or 1) in Group I and other 37 patients with high MBG (grade II or III) were taken in Group II. Mean age of Group I and Group II were 53.70±9.17 and 51.49±9.41 years respectively (p=0.536). Male to female ratio was 5.7:1. Smoking (59.5% versus 35.1%, p=0.036) and diabetes mellitus (43.2% versus 18.9%, p=0.024) were significantly higher in low MBG group than high MBG group. Multi vessel involvement (24.3% versus 5.4%, p=0.022) and anterior MI (72.9% versus 51.4%, p=0.047) were significantly higher in low MBG group. LVEF was significantly lower in low MBG group than high MBG group (49.92?6.60% versus 58.84?4.55%, p=0.003). Among the complications acute heart failure was found significantly higher in low MBG group than high MBG group (8.1% versus 0.0%, p=0.048) along with total adverse in hospital outcome (24.3% versus 5.4%, p=0.041). In study population total mortality was 2.7% and all were in low MBG group (5.4%). Multivariate logistic regression analysis showed MBG was an independent predictor of adverse in hospital outcome after PPCI (OR 6.553, 95% CI 1.984-21.643, p=0.002). Low MBG is associated with more adverse in hospital outcome after PPCI. So, along with TIMI 3 flow following PPCI we have to assess MBG for evaluation of complete reperfusion and further outcome.

Neurofibrosarcoma of the Subglottis-A Rare Case Report.

A frazzled man in his early thirties presented with a 4 year long history of frequent progressive airway obstruction. He had undergone two open laryngeal surgeries and multiple endolaryngeal procedures for excision of a subglottic lesion which recurred. Each time the histopathology showed a different entity ranging from hemangioma and fibrihystiocytic lesion and spindle cell carcinoma. Finally the case was proven to be an intermediate grade sarcoma of neurogenic origin. He underwent widefield laryngectomy with placement of Provox-2 prosthesis followed by radiotherapy. Five years following surgery, he is progressing well. The case is being reported for its rarity and also for the histogenetic problems associated with this group of lesions. Authors found only one other case of laryngeal neurofibrosarcoma that was reported 29 years back [3].

Tuberculous otitis media.

Tuberculosis is one of the most common infectious diseases of developing countries including Bangladesh. It rarely affects the middle ear. The objective is to review the literature on tuberculous otitis media and know the facts, incidence, etiology, clinical presentation, investigations and treatment of tuberculous otitis media. It is characterized by painless otorrhoea which fails to respond to the usual antimicrobial treatment, in a patient with evidence of tubercle infection elsewhere followed by multiple tympanic membrane perforations, abundant granulation tissue, and bone necrosis, preauricular lymph node enlargement. Loss of hearing is also found in patients with development of the diseases seen by the otoscopy. Combination chemotherapy is prescribed. Surgery may be required in some cases to remove sequestra and improve drainage. A high level of clinical suspicion is needed for early diagnosis and antitubercular therapy should be started as soon as possible to prevent the possible complication.

Effect of method and time of first colostrum feeding on serum immunoglobulin concentration, health status and body weight gain in mithun (Bos frontalis) calves.

The effect of method and time of first colostrum feeding on the concentration of serum immunoglobulin (Ig) was evaluated in mithun (Bos frontalis) calves. The hypotheses were that the variable method and time of first colostrum feeding might affect the level of serum Ig and in turn the growth performance and health status of the claves during the early age. The newborn calves were randomly allotted to one of the four experimental groups - G-1: allowed to suckle the dam at own choice, G-2: separated immediately after birth and allowed to suckle the dam first at 6 h and then at own choice, G-3: bottle fed ad libitum colostrum of its own dam first at 6 h and then at 6-h intervals until 24 h, G-4: bottle fed ad libitum colostrum of its own dam within 1 h, at 6 h and then at 6-h intervals until 24 h. The concentrations of IgG, IgM, and IgA were lowest (p < 0.01) at birth and increased following colostrum feeding irrespective of the experimental group. Highest concentrations of all the Ig classes were observed at 12-24 h after birth. The concentrations then transiently decreased from day 7 to 14, and then steadily increased after day 28. The concentrations of IgG (p < 0.01) and IgA (p < 0.05) were higher in G-1 in relation to the other groups during the first week after birth. Similarly, higher concentration of IgA (p < 0.05) was found in G-1 in relation to the other groups during the rest of the experimental period. The apparent absorption efficiency of colostral IgG was higher (p < 0.05) in G-4 in relation to G-3. Growth rate and health status were not influenced by the method and time of first colostrum feeding. In conclusion, a 6-h delay in the first colostrum feeding reduced the level of serum Ig noticeably.

Fiber Bragg grating sensor for monitoring bone decalcification.

INTRODUCTION: Estimation of decalcification is a vital tool to discern bone health. Different techniques are used for its quantitative measurement, e.g. DEXA, QCT & QUS. All these techniques, although noninvasive, suffer from limitations such as radiation exposure and inaccurate values. Recently, fiber optic techniques are fast emerging for medical applications owing to their various attractive features like immunity to EMI/RFI, geometric versatility, chemical inertness, etc. MATERIAL AND METHODS: The effect of decalcification on strain response of a goat tibia was investigated in vitro using fiber Bragg grating (FBG) sensing technique. The bone was strained by using three-point bending technique and corresponding Bragg wavelength shifts were recorded. Two similar bone samples from the same animal were taken and one was partially decalcified. Strain response of decalcified and untreated bone was taken concurrently to monitor the effects of calcium loss and that of degradation with time. RESULTS AND CONCLUSION: The strain generated for same stress increased with greater degree of decalcification and a steep increase occurred after 2g calcium loss, indicating the onset of damage. The strain response, therefore gives a direct indication of the degree of calcium present in the bone. LEVEL OF EVIDENCE: Level III.

A ten year clinicopathological study of female genital tuberculosis and impact on fertility.

INTRODUCTION: To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis. METHODS: A total number of 68 cases of gynaecological tuberculosis affecting different parts of female genital tract from 56 patients were selected. The age range of the patients was 17-36 years with mean age of 25.6 years. The diagnostic procedures used included endometrial curettage and biopsy, histopathological examination, culture and Mycobacterium Tuberculosis Polymerase Chain Reaction (MTB PCR), laparoscopy, Hysterosalpingography (HSG) and Ultrasonography (USG). Most of the specimens received were biopsies of endometrial curettage for evaluation of infertility. In 7 cases, specimens of total hysterectomy with bilateral salpingo-oophorectomy were submitted with lesions involving multiple sites. RESULTS: Patients presented with infertility (65-70%), pelvic/abdominal pain (50-55%), and menstrual disturbances (20-25%). Tuberculosis involved the endometrium in 55.88%, tubes in 23.53%, ovaries in 14.71% and cervix in 5.88% of the 68 cases. The endometrium(38 cases)was in the proliferative phase in 31 cases (81.57%), secretory phase in 4 cases (10.52%) and it was atrophic in 3 cases (7.89%).Caseation was present in 9 out of 68 cases and Ziehl-Neelsen (ZN) stain revealed Acid Fast Bacilli (AFB) in tissue sections in only 4 cases . After therapy, 9 patients conceived of which 8 suffered spontaneous abortions. Only one patient had a successful pregnancy and the baby was born through caesarean section. CONCLUSIONS: Genital tuberculosis is an important cause of female infertility in developing countries like India, Nepal, Bangladesh and Pakistan. Successful uterine pregnancy is rare after treatment and chances of ectopic pregnancy are high.

Hydatid cyst of radial bone.

Hydatidosis is a parasitic disease caused by Echinococcus granulosus or, less frequently Echinococcus multilocularis. The liver and lungs are most often affected; hydatid disease of radius without involvement of other sites is extremely rare. Osseous hydatid disease should be included in the differential diagnosis for cystic lesions of bone. The diagnosis of bone hydatidosis is primarily based on radiological and histopathological findings. Here we present a case of hydatid cyst in the lower third of radius in a 34-year old woman. The cysts were removed with wide excision and post-operative albendazole was given. No recurrence was observed on two years follow-up.

Spread of cholera with newer clones of Vibrio cholerae O1 El Tor, serotype inaba, in India.

During 2004 and 2005, cholera was recorded in 15 states of India, with 7 outbreaks. The newly emerged Vibrio cholerae O1 Inaba had a different antibiogram and ribotype, different pulsotypes, and different mutations in the wbeT gene. Due to the absence of serogroup O139, the Inaba serotype may have acquired the potential to affect the population at large.

Observations of hepatic encephalopathy profile in a tertiary care centre.

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.

Validation of the inactivant binary ethylenimine for inactivating rabies virus for veterinary rabies vaccine production.

The rabies vaccine is produced by inactivation of rabies virus propagated on BHK21 cells. In the rabies inactivation process, BEI is added at a final concentration of 1.6 mM to the viral harvest at 37 degrees C, followed by a second dose of BEI at 24 h post-inactivation. Inactivation was confirmed by the mice innocuity test and tissue culture amplification test as per B.P (Vet) 2004. Validation of test procedure is essential as per cGMP requirement. The dose of BEI was validated by using lower and higher concentrations of BEI in inactivation process. The study indicated that BEI at a lower concentration (0.4 mM) was able to inactivate the rabies virus within 30 h and the routine concentration (1.6 mM) of BEI is effective in inactivating rabies virus within 18 h. The amplification test used for confirming the inactivation of the live virus was validated by spiking the sample with different dilutions of pretitrated live rabies virus. The test revealed that the amplification method is sensitive to detect live rabies virus if present in the inactivated sample. The validation of BEI as an inactivant and the amplification test are discussed.

An el tor cholera outbreak amongst tribal population in Tripura.

An outbreak of acute diarrhoeal disease occurred in Dhalai and North Tripura district, Tripura during month of May 2004. An investigation was done to identify causative agent with anti microbial susceptibility pattern and to know the epidemiological feature. Overall attack rate and Case Fatality Rate (CFR) was 18.8%. and 6.9/1000 respectively. Vibrio cholerae O1 biotype El Tor, Ogawa was isolated as sole pathogen in 40% of hospitalized acute diarrhoea patient and from a water samples examined. The strains were sensitive to Tetracycline, Doxycycline, Norfloxacin, Ciprofloxacin, Chloramphenicol, and Azithromycin. Bad peridomestic sanitation, use of contaminated surface water along with low literacy, lack of personal hygiene, frequent movement might be the factor associated with persistence and spread of pathogen amongst tribal groups leading to outbreak of cholera.

Impact of zinc supplementation on diarrhoeal morbidity in rural children of West Bengal, India.

AIM: To determine the role of zinc supplementation in reducing diarrhoeal morbidity in children. METHODS: A randomized, double-blind, community-based intervention study was conducted in 280 rural children aged between 6 and 41 mo. Children were randomly allocated into three groups. One group received a daily dose of 10 mg zinc for 5 d wk(-1), another group received 50 mg zinc once weekly and the remaining group received placebo. Zinc was supplemented for 16 wk from November 1999. Diarrhoeal episodes were detected by weekly surveillance during the supplementation period. RESULTS: Eighty diarrhoeal episodes were detected among 59 children in all 3 groups. The groups were compared with each other at baseline and as regard to the outcome variable (incidence of diarrhoea). The proportion of children suffering from diarrhoea during the period was significantly lower in the zinc-supplemented groups (15.8% in daily and 16.5% in weekly group) than in the placebo group (30.8%). The incidence of diarrhoea in the daily and weekly zinc-supplemented groups was 0.68 and 0.69 episodes child(-1) y(-1), and that in the placebo group was 1.67 episodes child(-1) y(-1) (relative risk 0.41, 95% confidence interval 0.24-0.71). Diarrhoeal incidence of < 4 d duration was found to occur significantly less often in the supplemented groups. There was no difference in diarrhoeal incidence between the daily and weekly zinc-supplemented children. There were no detected adverse reactions in any of the supplemented groups. CONCLUSION: The study indicates that zinc supplementation is effective in reducing diarrhoeal morbidity when administered either daily or in a weekly schedule.

Sinonasal tuberculosis in diabetics : An unusual presentation and diagnosis.

Sino-nasal Tuberculosis constitutes 5-6% of Head & Neck tuberculosis1. We present two cases of sino-nasal tuberculosis in diabetic hosts not only due to the clinical rarity and unusual presentation as in one case which presented with subperiosteal abscess, but also to emphasize on the effective modality of management which constituted transnasal endoscopic clearance supplemented with antitubercular regimen.

A localised outbreak of Vibrio cholerae O139 in Kolkata, West Bengal.

BACKGROUND & OBJECTIVES: An explosive outbreak of diarrhoeal disease which occurred in the Baishnabghata, Patuli area of Kolkata Municipal Corporation during September 28 to October 12, 2000, was investigated by a team from the National Institute of Cholera and Enteric Diseases, Kolkata, to identify the causative agent and determine the antimicrobial susceptibility pattern. METHODS: Clinical and epidemiological data were collected from domiciliary cases and also from patients attending two medical camps that had been set up for the purpose. Stool and water samples were collected for isolation of diarrhoeagenic pathogens. RESULTS: A total of 710 cases of diarrhoea occurred with an attack rate of 7.1 per cent; majority were adults. All 6 faecal samples and 2 water samples collected, were positive for Vibrio cholerae O139. The strains were uniformly (100%) susceptible to the commonly used drugs for cholera such as tetracycline, norfloxacin, ciprofloxacin, co-trimoxazole and nalidixic acid but resistant (100%) to furazolidone and ampicillin. INTERPRETATION & CONCLUSION: This is the first localised outbreak of V. cholerae O139 in Kolkata since the devastating epidemic in 1992. Extensive chlorination of all water sources resulted in a dramatic decline of the outbreak. The appearance of resistance in V. cholerae O139 to furazolidone is a matter of great concern since this drug is used for the treatment of cholera in children and pregnant women.

A fatal oomycotic disease of the fresh water fish Aplocheilus panchax in India caused by Aphanomyces laevis.

The fish, Aplocheilus panchax (Hamilton-Buchanan, 1839), is recorded as a new host of Aphanomyces laevis de Bary, 1860. It is the first and only report of any oomycete causing disease on A. panchax. Aphanomyces laevis was found to be a virulent parasite of A. panchax that caused cotton-wool disease involving the skin and fins. The hyphae also penetrated deep into the tissues of the infected fish and all of them ultimately died.

Structural features of a water soluble gum polysaccharide from Murraya paniculata fruits.

A water soluble gum polysaccharide was isolated from Murraya paniculata fruits. Hydrolytic experiments, methylation analysis, periodate oxidation studies and NMR data revealed that the polysaccharide was extensively branched and it consisted of 1,3-, and 1,3,6-linked beta-D-galactopyranosyl units, terminal beta-D-galactopyranosyl units and terminal alpha-D-glucopyranosyl 1,4-beta-D-galactopyranosyl units. Small amounts of 4-O-methylglucuronic acid residues were also present.

Isolation, purification and some structural features of the mucilaginous exudate from Musa paradisiaca.

The water-soluble polysaccharides isolated from the vascular gel of Musa paradisiaca, were fractionated via anion exchange chromatography into four fractions. Fractionated polymers contained arabinose, xylose and galacturonic acid as major sugars, together with traces of galactose, rhamnose, mannose and glucose residues. Methylation analysis revealed the presence of a highly branched arabinoxylan with a significant amount of terminal arabinopyranosyl units and an arabinogalactan type I pectin. Periodate oxidation studies supported the results of methylation analysis.

Impact of vitamin A supplementation to rural children on morbidity due to diarrhoea.

BACKGROUND AND OBJECTIVES: a number of studies have shown the association between vitamin A deficiency and the increased risk of diarrhoeal and other childhood morbidities and mortality. However, some studies have raised controversies regarding the reduction of the incidence of diarrhoea after vitamin A supplementation to children. This study was undertaken to evaluate the effectiveness of vitamin A supplementation to young rural children in reducing the incidence of diarrhoea. METHODS: a double-blind randomized intervention trial was carried out amongst 404 rural children between 6-59 months of age to assess the impact of vitamin A supplementation on morbidity due to diarrhoea. Children aged 6-59 months were enrolled and allocated to receive either 200,000 or 50,000 IU of vitamin A and the same dose was repeated after six months. Morbidity due to diarrhoea was observed by twice-a-week household surveillance, during the subsequent one year of follow up. The incidence of diarrhoea was compared between the two supplemented groups. In addition, the overall incidence of diarrhoea n the two supplemented groups was also compared with the incidence observed during the year preceding supplementation. RESULTS: the incidence of diarrhoea was similar in the two supplemented groups (Incidence Rate Ratio = 1.05. 95% C. I. 0.79-1.40). However, the overall incidence of diarrhoea among all the children in the two supplemented groups (0.56 episodes/child/year) was significantly lower than the incidence before supplementation (1.15 episodes/child/year). The Incidence Rate Ratio was 0.49 with 95% C.I 0.40-0.59. INTERPRETATION AND CONCLUSIONS: the results of this study indicate that vitamin A supplementation in a dose of 200,000 IU, has no additional advantage over 50,000 IU, at least when the aim is to reduce the incidence of diarrhoea. For control of morbidity due to diarrhoea, vitamin A supplementation in a dose of 50,000 IU every six months appears to be adequate, cost effective and suitable for younger children.