Comparative Study between Acacia Nilotica versus Povidone Iodine in Topical Treatment of Omphalocele Major.

Well established and common practice in conservative management of omphalocele major is escharotics therapy with different topical agents. Among them mercurochrome, alcohol, silver salts, povidone iodine, acacia nilotca paste are commonly used. It is a comparative study between application of acacia nilotica paste and povidone iodine solution as a primary non surgical treatment of omphalocele major regarding efficacy and safety of these two topical agents. A double blind randomized controlled study was conducted at the department of Paediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2019. In this study 20 cases of omphalocele major and randomly divided into two equal groups. Group A and Group B treated with acacia nilotica paste and povidone iodine solution respectively. Gastroschisis, ruptured-omphalocele major or omphalocele minor excluded in this study. The size of the fascial defect in cm, time required for full oral feeding tolerance and duration of hospital stay were evaluating parameters. Patients with Group A tolerated full oral feeding earlier, shorter total hospital stay duration and low mortality rate than those from Group B. Application of acacia nilotica is a safe and effective treatment of omphalocele major regarding rapid full oral feeding tolerance, shorter hospital stay and low mortality rate.

Iron Deficiency and Iron Deficiency Anemia in Women with Bronchial Asthma.

This case control study was conducted in the out patient department (OPD), Enam Medical College & Hospital (EMCH), Dhaka, Bangladesh from 1st January 2017 to 31st December 2017. The aim of our study was to find the possible association between serum iron state and iron deficiency anemia with bronchial asthma in women. We investigated 40 diagnosed female cases of well controlled bronchial asthma and 20 healthy female as control. In both groups complete blood count (CBC) with peripheral smear was done, C-reactive protein (CRP), serum iron, serum ferritin, and serum total iron binding capacity (TIBC) was measured. We found asthma cases had lower hemoglobin than control (mean±SD 10.92±1.34 vs. 12.30±0.73, p value 0.013), serum iron and serum ferritin were significantly lower (p value 0.016 and 0.000 respectively) and TIBC was higher (p value 0.000) in asthmatic cases as compared to controls. Non anemic asthmatics showed significant lower serum ferritin compared with non-anemic healthy controls (p value 0.005). So we conclude that iron deficiency anemia is more prevalent in asthmatic women as compared to healthy controls.

Molecular identification and phylogenetic assessment of species under genus Parapenaeopsis Alcock, 1901, from Indian waters.

Genus Parapenaeopsis constitute an important fishery resource in Indian waters. Parapenaeopsis stylifera, being morphologically very similar to Parapenaeopsis coromandelica, mainly differentiated using telsonic armature and it is subject of controversy regarding the number of armature for the species. The present study was aimed to resolve the taxonomic ambiguity between P. stylifera and P. coromandelica and to study phylogenetic relationship among five species under the genus Parapenaeopsis using partial sequences of mitochondrial 16S ribosomal DNA (rDNA) and cytochrome c oxidase subunit I (COI) genes. Sequence analysis revealed an average genetic divergence value ranging from 7.65 to 20.3% for COI gene and 2.4 to 12.0% for 16S rDNA gene between five species under study. The result shows that P. stylifera and P. coromandelica Alcock, 1906 are genetically a distinct species with average divergence value of 7.6% based on COI sequence and 2.4% based on the 16S rDNA. However, systematic relationship between the P. stylifera and P. coromandelica were closer than other species, thus formed separate clade in phylogenetic tree. The species specific molecular signatures developed in the present study will be helpful in effective fisheries management of the species in Indian waters.

Total Colonic Duplication Associated With Anorectal Malformation in a Male Boy.

Complete colorectal tubular duplication is very rare congenital anomaly and its association with anorectal malformation is extremely rare. Preoperative diagnosis is very difficult and management is also challenging. We report a case of a newborn present as a bucket handle variety of anorectal malformation which was per-operatively diagnosed as an ARM with rectal duplication. At his 14th months of age on laparotomy patient was diagnosed as a case of ARM with total colonic duplication with single appendix. We managed the case successfully without extensive bowel resection in staged procedure.

Outcome of Upper Gastrointestinal Surgery With or Without Nasogastric Intubation.

Nasogastric intubation is a common procedure with both merits and demerits. Controversies exist about the routine use of nasogastric intubation following upper gastrointestinal surgery. Good numbers of literatures were published in favour of selective nasogastric intubation pointing out some complications of routine use of nasogastric tube. In 1995, Cheatham et al. concluded in a meta-analysis that although patients may develop abdominal distension or vomiting without a nasogastric tube, this is not associated with an increase in complications or length of hospital stay. For every patient requiring insertion of a nasogastric tube in the postoperative period, at least 20 patients will not require nasogastric decompression. In July 2004, Cochrane database of systemic review published the result of their systemic review on the prophylactic decompression after abdominal surgery, that review was revised and updated in 2007. According to this database, routine nasogastric intubation should be abandoned in favour of selective use of nasogastric tube. In our country some surgeons are practicing it routinely and some are not. This observation prompted us to conduct this study in order to see and compare the outcome of upper gastrointestinal surgery with and without nasogastric intubation. This will help us to make decision whether nasogastric intubation will be done routinely or not following upper gastrointestinal surgery.

Improvement of Liver Function, Quality of Life and Survival after Insertion of Endoprosthesis in Advance Malignant Biliary Obstruction.

Obstructive jaundice due to advance malignancy is a fatal problem. It most commonly occurs at the distal common bile duct or at the hilum of liver. Magnetic Resonance Cholangio Pancreatography (MRCP) and Computed Tomography (CT) are most useful in identifying the underlying cause as well as localize the position of the stricture. For those patients with unresectable disease, progressive jaundice constitutes an immediate threat to their survival, in addition to significant loss to their quality of life secondary to pruritus, malaise and cholangitis. Effective and lasting decompression of the biliary tree is a priority and consists of positioning of a biliary endoprosthesis (stent). To observe the improvement of liver function, quality of life and survival after successful insertion of endoprosthesis (stenting) in malignant biliary obstruction, a study was performed in the department of surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2013 to August 2014, in 50 patients with clinically visible jaundice and unresectable disease. There were significant (p<0.001) reductions in the levels of serum bilirubin, serum alkaline phosphatase, serum SGPT and Prothrombin time from the time of admission to 2 weeks and 3 weeks after stenting. Physical and functional quality of life was greatly improved 2-4 weeks after stenting, where emotional quality remained the same throughout the study period. Successful palliation by stenting of malignant biliary obstruction is a priority to achieve improvements in liver function, quality of life and prolong survival. Endoscopic stent placement appears to be safe, well tolerated and can be offered without delay as a primary treatment option for all patients with unresectable malignant biliary lesion.

Renoprotective and antioxidative effects of methanolic Paederia foetida leaf extract on experimental diabetic nephropathy in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Paederia foetida Linn. (Family: Rubiaceae) is widely used as a natural remedy for diabetes mellitus by the Nepali and Lepcha tribes of Sikkim and Darjeeling Himalayan region. The plant is administered to a diabetic individual in the form of leaf infusion for 2-3 weeks. Therefore, we investigated the effects of methanolic leaf extract of Paederia foetida (MEPF) on alloxan (ALX) induced diabetic renal oxidative stress and NF-kB dependent renoinflammatory events in rat. Method Effects of MEPF on blood glucose, glomerular filtration rate (GFR), serum and oxidative stress markers were evaluated in ALX induced diabetic wistar rats. Enzyme linked immunosorbent assay (ELISA) was carried out to estimate serum IL-6, IL-1ß, TNF-α and renal tissue NF-kB p65 levels. MEPF treatment was given to the diabetic rats at a dose of 250 and 500mg/kg body weight (b.w.). RESULTS & DISCUSSION: MEPF treatment significantly reduced hyperglycaemia, serum creatinine, blood urea nitrogen (BUN), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglycerides (TRIGs), and total cholesterol (TCHOL) levels in the diabetic rats, whereas it significantly restored GFR and serum albumin level. The activity of enzymatic and non-enzymatic antioxidant machineries was remarkably augmented by MEPF treatment. Likewise, it also significantly lowered lipid peroxidation which was evidenced by decreased concentration of thiobarbituric reactive substances (malondialdehyde, MDA) in the renal tissue of treated diabetic groups. Moreover, MEPF treated animals exhibited low serum concentrations of IL-6, IL-1ß and TNF-α compared to the diabetic control rats. It showed a dose dependent inhibition of NF-kB activation in the diabetic kidney, but the effects were more prominent at a dose of 500mg/kg. Histopathological examinations also confirmed its nephroprotective action during diabetes. CONCLUSION: MEPF treatment mitigates oxidative stress and suppresses renal inflammation via inhibition of NF-kB in diabetic kidney in early progressive diabetic nephropathy.

Congenital duodenal web (wind-soak variety) in the fourth part of the duodenum causing obstruction in a female child.

Delayed presentation of Duodenal Obstruction is a great diagnostic dilemma due to non-specific, varied & wide spectrum presentation. In this study, a 6 years female child presented with recurrent, intermittent, colicky abdominal pain with bilious vomiting, and occasional constipation from 9 months of her age, without having any significant family history or associated condition. She was initially diagnosed as a case of recurrent small bowel obstruction due to atypical variant of malrotation. But, after laparotomy, she was finally diagnosed as a case of recurrent duodenal obstruction due to Congenital Duodenal Web (Wind-Soak Variety) with a central hole in the fourth part of the duodenum. After uneventful recovery of post operative period the patient was discharged at 7th postoperative day & followed up upto 3 months. She had been found alright without any complication.

Congenital urogenital sinus anomaly without Adrenal Hyperplasia.

Urogenital sinus anomaly is a mal-development of female urogenital system, usually associated with Congenital Adrenal Hyperplasia and may varied in presentation according to embryologic separation and length of sharing of common channel between vagina and urethra. We report a case of pure urogenital sinus anomaly of 2.5 years female child without any feature of Congenital Adrenal Hyperplasia or any other associated anomalies which is quite uncommon. The patient was diagnosed with thorough physical, biochemical, radiological and endoscopic evaluation. She had clitiromegaly, very poorly developed fused Labia minoras with a central hole, the length of common channel was about 2.5 cm and the level of vaginal confluence was at the mid portion of common channel. After in general counseling to parents, according to their desire she was operated. We performed Labialo-clitoro-vagino-urothroplasty and from post operative period to till now (after 3 months of operation) she is uneventful. Both functionally and cosmetically she is sound and her parents are also happy.

Comparison of post operative pain relief between paracetamol and wound infiltration with levobupivacaine in inguinal hernia repair.

The present study has been designed to compare the intensity of postoperative pain in children by wound infiltration with levobupivacaine with that provided by paracetamol administration per rectaly. This intervention study was carried out at the department of paediatric surgery, Mymensingh Medical College Hospital, Mymensingh and Dhaka Medical College Hospital, Dhaka, during the period of January 2009 to September 2010. A total of 120 patients were included in this study. Among them 60 patients in Group A (study group) where post incisional wound infiltration with levobupivacain after inguinal herniotomy before skin closure was done and 60 patients in Group B (control group) where paracetamol was given per rectally after induction of anaesthesia. Both groups were followed up post operatively for 23 hours. The intensity of post operative pain relief following inguinal hernia repair in children by wound infiltration with levobupivacaine is significantly higher than rectal administration of paracetamol.

Postoperative pain relief following inguinal hernia repair in children by wound infiltration with levobupivacaine.

The present study has been designed to compare the postoperative pain relief for inguinal hernia repair in children through wound infiltration with levobupivacaine with that provided by paracetamol administration per rectaly. This interventional study was carried out in the Department of Paediatric surgery, Mymensingh Medical College Hospital, Mymensingh and Dhaka Medical College Hospital, Dhaka, during the period from January 2009 to September 2010. A total of 120 patients were included in this study. Among them 60 patients in Group-A (study group) where post incisional wound infiltration with levobupivacain after inguinal herniotomy and before skin closure was done and 60 patients in Group-B (control group) where paracetamol was given per rectally after anesthesia induction. Both groups were followed up post operatively for 23 hours. In Group A maximum analgesic period was 8.30 hours and minimum analgesic period was 5.30 hours. On the other hand in Group B maximum analgesic period was 6.50 hours and minimum analgesic period was 4.50 hours. Duration of post operative analgesia between two groups of the patients were significant [p<0.01]. Post incisional wound infiltration with levobupivacain has significantly better efficacy to rectal administration of paracetamol with respect to providing pain relief following inguinal hernia repair in children. Longer duration of analgesic action is more achieved in the Levobupivacaine group.

Ultrasonographic evaluation of contralateral exploration of patent processus vaginalis in unilateral inguinal hernia.

To see accuracy of ultrasound scan to detect patent processus vaginalis in padiatric patient. We investigated the presence of contralateral patent processus vaginalis (CPPV) by Ultrasound scan (US) in children with clinically diagnosed unilateral inguinal hernia. Thirty patents (17 boys and 13 Girls) with unilateral inguinal hernia underwent US examination using a 7.5 MHZ transducer. If a CPPV was visible as a hydrocele (inflow of peritoneal fluid) in to a processus vaginalis on straining, then US scanning was performed while the patient was at rest and while inducing straining by standing, coughing and or crying. A groin with hydrocele in the inguinal canal on straining was diagnosed as a CPPV and was explored bilaterally through surgery. The US findings were compared with surgical results. In 30 patients, 12 cases were diagnosed by US as patients with a CPPV, these patients underwent bilateral surgery. Eleven of 12 Cases were confirmed surgically as CPPV. From the findings of the present study it could be concluded that a PPV could be correctly detected by US in pediatric patients with the accuracy of 91.67%. US is a non invasive and accurate method for evaluating the presence of a PPV. Preoperative diagnosis of CPPV is important to remove the need for a second operation with patients presenting with unilateral inguinal hernia.

Effect of repeated x-ray exposure on the resolution of amorphous selenium based x-ray imagers.

PURPOSE: A numerical model and the experimental methods to study the x-ray exposure dependent change in the modulation transfer function (MTF) of amorphous selenium (a-Se) based active matrix flat panel imagers (AMFPIs) are described. The physical mechanisms responsible for the x-ray exposure dependent change in MTF are also investigated. METHODS: A numerical model for describing the x-ray exposure dependent MTF of a-Se based AMFPIs has been developed. The x-ray sensitivity and MTF of an a-Se AMFPI have been measured as a function of exposure. The instantaneous electric field and free and trapped carrier distributions in the photoconductor layer are obtained by numerically solving the Poisson's equation, continuity equations, and trapping rate equations using the backward Euler finite difference method. From the trapped carrier distributions, a method for calculating the MTF due to incomplete charge collection is proposed. RESULTS: The model developed in this work and the experimental data show a reasonably good agreement. The model is able to simultaneously predict the dependence of the sensitivity and MTF on accumulated exposure at different applied fields and bias polarities, with the same charge transport parameters that are typical of the particular a-Se photoconductive layer that is used in these AMFPIs. Under negative bias, the MTF actually improves with the accumulated x-ray exposure while the sensitivity decreases. The MTF enhancement with exposure decreases with increasing applied field. CONCLUSIONS: The most prevalent processes that control the MTF under negative bias are the recombination of drifting holes with previously trapped electrons (electrons remain in deep traps due to their long release times compared with the time scale of the experiments) and the deep trapping of drifting holes and electrons.

Chronic esophagitis evolving to verrucous squamous cell carcinoma: possible role of exogenous chemical carcinogens.

BACKGROUND & AIMS: A patient exposed to aerosolized lye and ingested kerosene was followed up for 16 years with chronic esophagitis before developing verrucous esophageal squamous carcinoma. The aim of this study was to elucidate the pathogenesis of the carcinoma. METHODS: Multiple biopsy specimens were graded according to the severity of esophagitis and dysplasia. Molecular biological techniques and immunocytological assay were used to look for human papillomavirus infection, p53 mutations, loss of heterozygosity for TP53 and chromosome 8 markers, and ras mutations. RESULTS: Morphological features of the chronic esophagitis in this patient were similar to the precancerous lesions from high-risk areas for esophageal squamous cancer and the precancerous lesions induced in rats by N-methyl-N-nitrosoaniline. Gastroesophageal acid reflux and human papillomavirus infection were ruled out. No loss of heterozygosity of p53 or for chromosome 8 markers was found. Mutations of the ras oncogene were not identified. By immunocytological assay overexpression of p53 was identified only in the invasive portion of the carcinoma. CONCLUSIONS: In this patient, verrucous squamous carcinoma evolved from chronic esophagitis, squamous papillary hyperplasia, and dysplasia. Although exogenous carcinogens may have been important, they probably did not act by causing loss of heterozygosity or ras mutations. p53 overexpression occurred late.

Effect of polyamine oxidase inhibition on the colonic malignant transformation process induced by 1,2-dimethylhydrazine.

Recent studies of colon adenocarcinomas in humans and experimentally induced colonic tumors in rodents have demonstrated selective elevations in the level of N1-acetylspermidine in these malignant tissues. The exact relationship of these alterations in acetylated polyamine levels to the malignant transformation process, however, remains unclear. In order to clarify this issue, rats were given s.c. injections of 1,2-dimethylhydrazine (DMH; 20 mg/kg body wt/week) or diluent for up to 26 weeks. After 10 weeks of carcinogen treatment, one-half of the animals in each group were also concomitantly given i.p. injections of MDL 72527 (20 mg/kg body wt/week), a specific inhibitor of polyamine oxidase, until they were killed. Animals were killed after 15 weeks of DMH treatment and polyamine levels as well as the activities of polyamine oxidase, ornithine decarboxylase and spermidine-N1-acetyltransferase were measured and compared in rat proximal and distal colonic mucosa of each group. Polyamine levels were also assessed in each of these groups after 26 weeks of treatment with this carcinogen +/- MDL 72527. In addition, in view of recent studies that have indicated that polyamines may influence certain oncogenes in human colonic carcinoma cells, tumors from DMH +/- MDL 72527 were analyzed for K-ras mutations. The results of these experiments demonstrated for the first time that: (i) MDL 72527 was a specific inhibitor of polyamine oxidase in normal and malignant colonic tissue; (ii) concomitant administration of this agent with DMH enhanced the elevation of colonic N1-acetylspermidine and significantly reduced the mean colonic tumor burden, as assessed by total tumor area per rat, produced by this carcinogen alone; (iii) analysis of K-ras mutations revealed a similar incidence (62-69%) in adenocarcinomas for both groups (+/- MDL 72527); (iv) however, analysis of the K-ras-mutated and non-mutated tumors revealed that in both carcinogen-treated groups (+/- MDL 72527), tumors with such mutations were smaller than their counterparts without such genetic alterations. Moreover, MDL 72527 reduced the average size of tumors, with and without such mutations, to a similar extent.

Actinomycotic liver abscess. Case report and literature review.

A 28-year-old male with hepatic actinomycosis presented with several months of anorexia, weight loss, fever, night sweats, and mild right upper quadrant abdominal tenderness. Despite normal liver function tests, hepatic involvement was demonstrated by imaging studies. A liver biopsy and ultrasound-guided aspirate were, however, unrewarding. Laparotomy was, therefore, necessary to establish a definitive diagnosis. The patients was then successfully treated with intravenous penicillin followed by oral clindamycin. This case is presented to illustrate the diagnostic difficulties that may be encountered in such patients with hepatic actinomycosis.

Histiocytic appearance of metastatic lobular breast carcinoma.

Autopsy findings in a case of widely disseminated lobular breast carcinoma showed an unusual histiocytoid appearance in metastases to the uterus and parathyroid gland. This morphology for breast carcinoma has been previously reported in eyelid metastases. Recognition of this pattern in other metastatic sites has important diagnostic and therapeutic implications. Problems might have arisen if the polypoid uterine mass had been the presenting lesion during life. We also review the occurrence of metastatic breast carcinoma in the uterus and parathyroid gland.

Angiolymphoid hyperplasia demonstrating extensive skin and mucosal lesions controlled with vinblastine therapy.

Since Kimura's original description of an unusual subcutaneous disorder with distinctive histologic features of vascular and lymphoid proliferation, numerous descriptions of diseases with similar features have been reported. A variety of descriptive labels, including Kimura's disease, angiolymphoid hyperplasia (ALH) with eosinophilia, atypical pyogenic granuloma, papular angioplasia, and histiocytoid hemangioma, have been applied to these diseases. Although this information has broadened our understanding of the clinical and pathologic spectrum of ALH, the etiology and/or pathogenesis remains unknown. Our case report illustrates the wide range of clinical features of ALH, demonstrating extensive lesions on skin and mucosa. The extreme histologic variability with regard to eosinophils, lymphoid infiltrates, and vascular alterations is also illustrated. Dramatic response to vinblastine sulfate treatment has not been previously reported and may provide a viable treatment alternative in selected patients.