Association of Low Thyroid Hormone with Migraine Headache.

This cross sectional comparative study was done to investigate the association between low thyroid hormone level and migraine headache in adults patients. The study was conducted in Mymensingh Medical College Hospital, a tertiary level hospital of Bangladesh. Study period was from November 2017 to April 2018. The study subjects consisted of 50 patients with migraine headache as case, compared with 50 patients of headache other than migraine as control, seen in Neurology out patient department (OPD). Thyroid function test was performed by new automated immuno-chemiluminometric assay. Mean age was 29.80±9.87 years in migraine group and 34.18±11.82 years in non migraine group. Male female ratio was 1:2.3 and 1:1.7 in two groups. Level of TSH was significantly higher in migraine patients (3.52±2.53 vs. 2.25±2.13) than other headache patients (p=0.008). Thyroid disorder especially subclinical hypothyroidism was significantly higher (28% vs. 08%) in migraineurs than non migraineurs (p=0.032). No significant relationship was found between thyroid hormone level and headache characteristics of migraine patients (p>0.05). Migraine headache is associated with low thyroid hormone and thyroid disorder can be considered as comorbidity of migraine headache.

Musculoskeletal disorder (MSD) among agricultural workers.

Farming is a large and main industry in Bangladesh. Large numbers of people are directly involved in farming and have very unique exposure compare to other sectors. Musculoskeletal problems among farmer population are not infrequent. This study was carried out among 200 farmers in one selected district. The study revealed that musculoskeletal problems were common among the farmers working in a traditional way. All the respondents were male. The age of all respondents lie between 20-60 years. Among them 22.5% farmers were illiterate, about 45.5% below Class V. About half (42%) of the respondents had reported pain in different parts of the body at least one or more times during working in land. And about two third (65.5%) of the farmers had history of joint pain and stiffness in last 12 month. Most of the farmers who suffered from musculoskeletal symptoms were 41-60 years. Specially who worked more then 20 years (82.6%) and average 6 hours per day (66.7%). The occurrence of musculoskeletal problems in various part of the body included Knee pain - 48.1%, Back pain (back ache) - 22.9%, Waist pain (low back ache) - 13.3%, Neck pain - 18.3% and shoulder pain - 10.7%. Length of work in year and daily average working hours were found significant association with musculoskeletal pain. It was found that musculoskeletal pain were more common among the farmers when they worked in squatting position (52%) and specially during weeding of plants (31%). Among them only 22% also engaged in other business. Most of the farmers complained dull aching pain (40.6%), only 2.3% noticed severe acute pain, but about 86% farmers' temporary stop their work for pain and 80% get relief after discontinue of work. About 75% respondents visited doctors for their pain which was statistically significant (p=0.001). It was found that the rates of musculoskeletal complaints are more among those individuals who worked relatively bad ergonomic condition, such as body position probably play an important role.

Socio-demographic characteristics, types and Slit Skin Smear (SSS) of the leprosy patients: a hospital based study.

This study was aimed to identify the socio-demographic profile, to know the types and to find out the Slit Skin Smear (SSS) result associated with leprosy. It was a descriptive type of cross sectional study. Total 62 patients having clinical features of leprosy, attending in Department of Neurology of Mymensingh Medical College Hospital (MMCH) and Mymensingh Tuberculosis and Leprosy Hospital, Mymensingh from January 2010 to December 2011 were included. Patients underwent a detailed clinical evaluation followed by laboratory investigations. Out of 62 cases, the results showed that the mean age of leprosy patients were 37.8±14.6 years with the age range 12-80 years and the peak incidence was between 20-40 years. The frequency of male and female was 70.9% and 29.1% respectively with M: F of 2.4:1. From rural area 74.2% leprosy patients and 25.8% patients were from urban area and mainly day-labours (25.8%) and housewife (24.2%) by occupation. Married was 87.1% of patients and 12.9% were unmarried. Twenty one percent (21%) leprosy patients were found contact with leprosy. It was observed in this study that, 35.5% patients were PB (Pauci Bacillary) group and 64.5% of the patients were in MB (Multi Bacillary) group. Lepromatous Leprosy (LL) patients were (17.7%) and Borderline Lepromatous (BL) patients were (11.3%). Patients with Tuberculoid Type (TT) were (3.2%) and patients with Borderline Tuberculoid (BT) were (61.3%). The result of Slit skin smear (SSS) examination was negative in 59.7% patients and positive in 40.3%.

Serum-ascites albumin gradient in differential diagnosis of ascites.

The present study was aimed to find out causes of ascites based on serum-ascites albumin gradient (SAAG) and to compare the diagnostic accuracy of the serum-ascites albumin gradient, proposed as a new biochemical criterion for the differential diagnosis of ascites and to evaluate the value of serum-ascites albumin gradient in differential diagnosis of ascites. This study includes 50 patients with ascites admitted in Medicine wards of Comilla Medical College Hospital, Comilla during the period of July 2010 to June 2011. Blood was drawn from the antecubital vein and ascetic fluid was obtained by paracentesis at the same time. Determination of the concentrations of albumin in both the serum and the ascitic fluid was carried out simultaneously. Considering SAAG value of ≥1.1g/dl is high SAAG and a SAAG value <1.1g/dl is low SAAG. Out of 50 patients, male patients were 36 and female patients were 14. Male and female ratio was 2.5:1. Age range was 21 years to 70 years. Most of the patients fall in age group of 41-50(28%).Among the 50 patients with ascites, cirrhosis of liver accounted for 68%, followed by tubercular peritonitis 12%, nephrotic syndrome 8%, congestive cardiac failure 6%, hepatocellular carcinoma 4% and malignancy related 2%. In this study serum ascites albumin gradient accurately identified the cause of ascites in 97% cases. In contrast the exudate-transudate concept identified only 83% correctly. Serum ascites albumin gradient was found superior to the exudate-transudate concept. So, differential diagnosis of ascites should be based on the serum ascites albumin gradient which is a better distinguishing marker.

Prevalence of risk factors of chronic kidney disease in adults.

Chronic kidney disease (CKD) is an emergent public health burden. Its prevalence varies country to country, even in different professional and social groups in the same country. In Bangladesh there is no reported nationwide survey but there are some reports of survey in disadvantageous and advantageous population. In this study 125 CKD patients (cases) and 125 age and sex matched healthy subjects (control) in Mymensingh Medical College, a tertiary hospital of Bangladesh were compared for the presence of non-modifiable [age, sex, family history of hypertension (HTN), Cardiovascular disease (CVD), family history of kidney disease and Socioeconomic condition] and modifiable [HTN, Diabetes mellitus (DM), smoking habit, and obesity] risk factors. The mean age of control was 43.5 ± 6.3 years and the mean age of CKD cases was 44.7 ± 12.7 years. Out of 125 patients of CKD, males were 96 in number (76.8%) and females were 29 in numbers (23.2%). Most of the patients (52.8%) were in poor socioeconomic status while most of controls were from middle class (68.8%). Most of the participants were in stage-3 CKD [67.2%, creatinine clearance (Ccr):36.74 ± 13.61 ml/min]. Glomerulonephritis was the dominant cause of CKD (67.2%) followed by diabetes (24%), hypertension (4.8%) and others (4%). 72.8% of CKD patients were smokers. Among CKD, 86.4% participants had hypertension and 26.4% had diabetes. The difference of hypertension, diabetes and Body mass index (BMI) between case and control group is statistically significant (p<0.001). No statistically significant difference was found with risk factor like family history of kidney diseases. This emphasizes risk factor identification in general population to early diagnose CKD.

Proteinuria is an independent risk factor for ischemic stroke among diabetic patients.

This study was done to assess the relationship between proteinuria and ischemic stroke in subjects with diabetes mellitus, and to determine whether proteinuria is an independent risk factor for stroke. This comparative study was conducted in Mymensingh Medical College Hospital from January 2009 to June 2010. It was done to establish the relationship between proteinuria (Microalbuminuria) and ischemic stroke among diabetic patients. Other risk factors were also assessed. Patients were divided in Group A - diabetic patients with ischemic stroke (n=50) and Group B diabetic patients without stroke (n=50). Mean age of the Group A & B were 60.16±8.33 and 57.19±7.73 years (p=0.068). Mean Blood sugar (2 hours after Break Fast) was 14.68±4.32mmol/L in Group A and 14.75±4.02mmol/L in Group B (p>0.05). Albumin Creatinine ratio was abnormal in 84.0% in Group A and 22.0% in Group A (p=0.001) [Odds ratio (95%CI) = 18.61 (6.78-51.09)]. Logistic regression analysis has also shown that microalbuminuria (ACR) is an independent risk factor for ischemic stroke (p=0.001), [Odds ratio (95%CI) = 19.811(5.915-66.348)]. In diabetic patients increased urinary protein is a risk factor for stroke. Estimation of urinary protein (Microalbuminuria) may be used as a predictor for ischemic stroke in patients with diabetes.

Seasonal variation in types of stroke and its common risk factors.

The present descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of one year during November 2009 to October 2010. The study was conducted to describe the variations in types of stroke (ischemic stroke and hemorrhagic stroke) during summer and winter. An attempt was also made to observe the frequency of common risk factors of stroke by seasons. A total of 292 patients of any age irrespective of sex fulfilling the WHO criteria of acute stroke and confirmed by CT scan were selected from consecutive admission in the Department of Medicine, Mymensingh Medical College Hospital. Detail history and thorough clinical examinations were done. Routine and relevant investigations were carried out. The mean age of the patients was 59.9±14.3 years. A male preponderance was observed in the study. In summer 66% of patients and in winter 34% of patients were presented. Ischemic stroke was present in 54.1% patients and 45.9% patients had haemorrhagic stroke. The study found that the frequency of ischaemic stroke during summer (62.4%) was significantly greater than that during winter (37.8%). The frequency of haemorrhagic stroke during winter (62.2%) was significantly greater than that during summer (37.6%). Hypertension was the most important risk factor and other risk factors were smoking, diabetes mellitus, tobacco chewing, ischemic heart disease, dyslipidemia, oral contraceptive pill, alcohol consumption, atrial fibrillation and past history of stroke. Increasing age was also noted as a risk factor (60.7% >60 years). Most of the risk factors were homogenously distributed between two seasons and between ischemic and haemorrhagic group. Hypertension was significantly higher in haemorrhagic stroke patients compared to ischemic stroke patients.

A monoclonal antibody to Shigella dysenteriae serotype 13 cross-reacting with Shiga toxin.

A monoclonal antibody (mAb ICT6) was produced against the newly described Shigella dysenteriae serotype type 13. The mAb was of IgM isotype and recognized purified Shiga toxin in ELISA and immunoblot. It also recognized periplasmic extract S. dysenteriae type 13 in immunoblot as did an affinity-purified polyclonal rabbit antiserum and a previously described monoclonal antibody to the B subunit of Shiga toxin. The mAb ICT6 did not neutralize the cytotoxic effects or S. dysenteriae type 13, Shiga toxin or periplasmic extracts of S. dysenteriae type 1 for HeLa cells.