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.

Psychological Assessment of Health-Care Workers Working during COVID-19 Pandemic Condition in Bangladesh.

The study was aimed to assess the psychological aspects and relevant factors of the health-care workers (HCWs) working in COVID 19 pandemic condition in Bangladesh. This online cross-sectional survey was conducted from different tertiary, secondary and primary hospitals in Bangladesh. Eligible 638 HCWs who were directly involved in the caring of confirmed or suspected COVID-19 patients were recruited in this study. The mental health was assessed by the Patient Health Questionnare-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Athens Insomnia Scale (AIS). High frequency of depression 536(84.0%), anxiety 386(60.5%) and insomnia 302(47.3%) was found among the HCWs, which were significantly higher in physicians (p<0.001) than nurses. Moderate to severe depression was significantly higher in female, whereas minimal to mild depression was significant in male HCWs (p=0.014). Symptoms of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.004) were significantly higher among the HCWs of primary and secondary compared to the tertiary level. The HCWs developed psychological trauma due to family health (45.3%) and contagious disease property (66.6%). After adjusting confounders, multivariable logistic regression analysis showed that physicians and HCWs of secondary hospital had significant symptoms of severe depression (OR=2.95, 95% CI=0.50-17.24; p<0.001), anxiety (OR=2.64, 95% CI=0.80-8.72; p<0.001) and insomnia (OR=2.67, 95% CI=1.23-5.84; p=0.018); whereas female HCWs had more risk of developing symptoms of severe insomnia (OR= 1.84; 95% CI=1.23-2.75; p=0.003). High rate of depression, anxiety and insomnia was found among HCWs working in the COVID-19 pandemic condition in this survey.

Relationship between Echocardiographic Epicardial Adipose Tissue (EAT) Thickness and Angiographically Detected Coronary Artery Disease.

Epicardial adipose tissue (EAT) is a particular form of visceral adipose tissue deposited around the heart and there is growing evidence about the physiological and metabolic importance of EAT, especially in the association of cardiovascular risk profiles and the pathogenesis of atherosclerotic coronary artery disease. This observational, cross sectional study was done to determine the relationship between echocardiographic epicardial adipose tissue (EAT) thickness and coronary artery disease (CAD). Total 123 patients with established or suspected coronary artery disease admitted for coronary angiogram in the department of Cardiology of Bangabandhu Sheikh Mujib Medical University (BSMMU) from November 2010 to the end of April 2011 were included in this study. Epicardial adipose tissue (EAT) thickness measurements by echocardiography were compared with coronary angiographic findings. Echocardiographic epicardial adipose tissue (EAT) thickness was significantly higher in patients with CAD in comparison to those with normal coronary arteries (6.67±2.24mm vs. 4.61±1.62mm; p<0.001). Furthermore, EAT thickness increased with the severity of CAD (multi-vessel disease 7.99±2.12mm vs. single vessel disease 5.93±1.97mm; p<0.001). Gensini's score significantly correlated with EAT thickness (r=0.617, p<0.001). Optimum cut-off point (OCP) of epicardial adipose tissue (EAT) thickness as a predictor of angiographic CAD was 6.44mm with 45.31% sensitivity and 92.86% specificity [ROC area 0.756, p<0.001, 95%CI (0.66-0.85)]. Echocardiographic epicardial adipose tissue (EAT) thickness was significantly correlated with the presence and severity of angiographically detected coronary artery disease (CAD).

Mass Screening of Apolipoprotein B May Detect Young People at Risk of Acute Coronary Syndrome.

Incidence of acute coronary syndrome in young people is progressively increasing. Apolipoprotein B is now regarded as a nobel parameter over conventional lipid profile, predicting acute coronary syndrome. A case control study was carried out in Department of Cardiology of Mymensingh Medical College Hospital from June 2009 to May 2010. Total 50 cases of 18-45 years of age with first attack of acute coronary syndrome and 50 healthy controls of same age and sex distribution were studied. Of them 42(84.0%) of cases and 24(48%) of controls had hyper apoB condition. Mass screening of apolipoprotein B in apparently healthy young people may detect persons with hyper apoB status, who may develop acute coronary syndrome in future.

Portopulmonary hypertension.

Pulmonary involvement is common in patients with portal hypertension and can manifest in diverse manners. Changes in pulmonary arterial resistance, manifesting either as the hepatopulmonary syndrome or portopulmonary hypertension (POPH), have been increasingly recognized in these patients in recent years. The prognosis in patients with liver disease who also suffer from significant POPH is considered to be poor. Higher degree of pulmonary artery pressure (PAP) may preclude a patient from liver transplant as mortality in these patients is high. This review summarizes the clinicopathologic features, diagnostic criteria, as well as the latest concepts in the pathogenesis and management of POPH, which is defined as is a form of pulmonary arterial hypertension (PAH) associated with portal hypertension with or without underlying chronic liver disease.

Comparison of salbutamol and ipratropium bromide versus salbutamol alone in the treatment of acute severe asthma.

The use of nebulized Ipratropium bromide, quaternary anticholinergic bronchodilators in combination with beta-agonist for the treatment of acute asthma in adults is controversial. In a view of different recommendation the present study is undertaken in Bangladeshi patients. Combination of inhaled Ipratropium bromide and Salbutamol provides greater bronchodilatation than mono therapy with Salbutamol alone in acute severe asthma. Patients of severe asthma (PEFR <50% of predicted) were enrolled into control group (Salbutamol only) and case (Salbutamol + Ipratropium bromide) group. After measurement of peak expiratory flow, patient received 3 doses of 2.5 mg Salbutamol (n=40) only or 3 doses of both 2.5mg Salbutamol and 500mcg Ipratropium bromide at an interval of 20 minutes (n=40) through a jet nebulizer. Peak flow was reassessed 30 & 60 minutes after treatment. Peak flow at baseline was similar in two groups. Then at 30 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in combination group (60.01±35.01%) than Salbutamol group (44.47±25.03%) with difference of 16% (p=0.025). At 60 minutes the percentage increase in peak flow was about 32% greater in combination group than Salbutamol group (94.44±33.70% vs. 62.57±29.26%, p=0.000) and combination group reached percentage predicted peak flow more than 60% while Sabutamol group did not. Ipratropium Bromide and Salbutamol nebulized combinedly have better bronchodilating effect than Salbultamol alone in acute severe asthma.

Metaphase arrest and delay in cell cycle kinetics of root apical meristems and mouse bone marrow cells treated with leaf aqueous extract of Clerodendrum viscosum Vent.

OBJECTIVES: To study cell cycle delay and metaphase arresting activity of leaf aqueous extract of Clerodendrum viscosum Vent. (LAECV) in root apical meristems and mouse bone marrow cells. MATERIALS AND METHODS: Cell cycle delay and metaphase arresting activities of LAECV were analysed, in root apical meristems of onion and wheat, and in mouse bone marrow cells, by scoring mitotic index, metaphase frequency and transition of cells from metaphase to anaphase. Colchicine was used as the standard metaphase arresting drug. Phytochemicals present in LAECV were detected and their phytotoxic activity was evaluated by analysing green-gram (Vigna radiata) seedling's root growth retardation and branch root swelling phenomenon. RESULTS: LAECV treatment resulted in dose-dependent root growth retardation of green-gram seedling root length (P < 0.01) and half maximal growth inhibitory concentration (IC(50) ) of LAECV was 0.87 mg/ml at 144 h. In onion and wheat root meristem cells the mitotic index decreased, metaphase frequency increased and transition from metaphase to anaphase reduced. Experimentation with mouse bone marrow cells indicated that LAECV induced metaphase arrest (164.3% increase in arrested metaphases per 300 mg/kg body weight, over 2.5 h). Phytochemicals like carbohydrates, glycosides, saponins, terpenoids, triterpenoids, tannins and trace amounts of alkaloids were detected in LAECV. CONCLUSION: It may be said that LAECV contains mitostatic and metaphase arresting components that are able to induce significant metaphase arrest in root apical meristems and also in mouse bone marrow cells.

Cardiovascular complications of chronic renal failure - an updated review.

Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

Aortic valve sclerosis is an indicator of coronary artery diseases.

Aim of this study is to establish the relationship between echocardiographically detected Aortic Valve Sclerosis (AVS) and angiographically detected Coronary Artery Diseases (CAD). This observational and cross-sectional study was carried out in the department of cardiology BSMMU, Dhaka from January 2010 to November 2010. A total 140 patients of established or suspected coronary artery disease admitted for coronary angiogram was included in this study. Echocardiography and coronary angiography was done. AVS was found in 88(63%) patients. With AVS 81(92.05%) had significant coronary artery disease. Fifty two patients without AVS, 42(80%) had significant coronary artery disease. No significant difference of SVD in both groups but patients with AVS had a higher rate of DVD, TVD and LM disease. Patients without AVS had a higher rate of normal coronary angiogram. Multivariate analysis identified AVS (p=0.018) is an independent predictor of CAD.

Sex differentiation and risk factor evaluation in stroke patients.

This study was conducted to find out the possible influencing factors on stroke in two sexes. It was a descriptive type of cross sectional study, conducted on 177 stroke patients admitted in Mymensingh medical college hospital from February 2009 to March 2010. Patients were selected according to WHO stroke definition and confirmed by CT or MRI. The results of the study showed that Stroke was more common (58.19%) in male than female (41.8%), mean age of male stroke patients was 60.58±12.36 years and that of female was 63.58±13.62 years with no significant statistical sex difference. But after 70 years, females are more sufferer than male. Hypertension, Diabetes mellitus, ischemic heart disease, atrial fibrillation and dyslipidemia in male and female were equally present without significant difference, although male had a higher rate of smoking and previous stroke (p<0.05). Motor weakness was more in male than female and unconsciousness was more in female (p<0.05). Type and sub types of stroke showed no significant difference. Females had more severe stroke in terms of severity score (Scandinavian Stroke Scale) on admission. Duration of hospital stay were similar among male and female but on discharge functional scale (Modified Rankin Scale) score was higher in male (p<0.05) and in hospital mortality was higher in female (p<0.05) which was statistically significant.

POEMS Syndrome.

A 49 years old male patient admitted with 2 years history of lower extremity symmetrical sensorimotor polyneuropathy, sclerodermic skin change, erectile dysfunction, hepatosplenomegaly and monoclonal gammopathy. The clinical evaluation met the criteria for the diagnosis of (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) POEMS syndrome. The patient was treated with corticosteroid and melphelan and responded well. We present a case different from the other cases with severe unusual burning sensation all over the body, which was his sole complaint and with this complaint he visited lot of doctors including psychiatrist.

ISSR profiling of genetic variability in the ecotypes of Antheraea mylitta Drury, the tropical Tasar silkworm.

Antheraea mylitta, Drury, the semi-wild silk-producing lepidopteran insect commonly known as tasar silkworm is unique to India and is distributed over a wide tropical forest range covering the states of Andhra Pradesh, Bihar, Chhattisgarh, Madnya Pradesh, Maharashtra, Orissa and Uttaranchal. The populations found in different areas are know by their specific local names and are considered as different ecotypes, but it is difficult to separate the populations on the basis of morphological and life-cycle traits and thus molecular characterization was attempted. The present communication relates to the results obtained from the analysis of polymorphism unraveled by twelve ISSR primers for 11 populations of A. mylitta belonging to six ecotypes and 41 individuals of "Railey"--ecotype collected from five zones of Dandakarnya forest in Madnya Pradesh. This communication, further, presents molecular evidences on genetic differences between eleven ecotype populations and highlights the genotypic diversification of a single ecotype into further separate discrete gene pools. The canonical discriminant function analysis revealed grouping of the five populations of Railey ecotype into two "clumps", while accessions of other ecotypes stood separated from each other. Thr "Railey" populations on detailed study, further, revealed separation of two (Tokapal and Nangur) populations into discrete gene pools and the other three (Kondagaon, Darba and Tongpal) populations, in spite of larger geographic distance between them, overlapped one on the other. The analysis also identified nine markers, which can be utilized to characterize specific population and will be of help to follow the ongoing genetic changes triggered by various ecological factors and human influences on the "Railey" ecotype.