Frequency of Post Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis in an Academic Hospital of Bangladesh.

Post-ERCP acute pancreatitis (PEP) is a common and serious complication with high morbidity and mortality rates. There is a paucity of data on the frequency of PEP in a resource constraint setting like Bangladesh. Hence we have conducted a prospective study to determine the frequency of PEP and the factors associated with its occurrence. This prospective, observational study was carried out in Gastroenterology Department of Dhaka Medical College & Hospital, Dhaka, Bangladesh from April 2018 to December 2018 on the consecutive patients who underwent ERCP. PEP and its severity were diagnosed according to consensus definition. Serum lipase was done in all patients before procedure and 24 hours after procedure or if patient develops abdominal pain after the procedure which became earlier. Total 168 patients were included (mean age 46.97±14.35 years; male 72(43.0%). The most common indication of ERCP was choledocholithiasis 97(58.0%) followed by malignant biliary obstruction 45(27.0%), recurrent pyogenic cholangitis 8(5.0%), chronic pancreatitis 4(2.3%), biliary ascariasis 4(2.3%) and others 10(6.0%). Overall post ERCP complication rate was 46(27.3%) including cholangitis 29(17.3%), pancreatitis 16(9.5%), bleeding 12(7.1%), aspiration pneumonia 4(2.4%) and death 3(1.8%). Regarding the severity of PEP, 50.0%, 43.7% and 6.3% patients developed mild, moderate and severe pancreatitis respectively. Number of cannulation attempts >5 times [22(48%) vs. 17(14%); p=0.001], cannulation attempts duration more than 10 minutes [25(55%) vs. 27(22%); p=0.001], unintentional passage of guide wire into the pancreatic duct [8(17%) vs. 18(15%); p=0.001], pancreatic duct contrast injection [12(26%) vs. 2(1.6%); p=0.001] and pre-cut sphincterotomy [16(35%) vs. 6(4.9%); p=0.001] were significantly different between the patients who developed PEP compared to those who did not. In multiple logistic regressions analysis, pancreatic duct contrast injection was significantly associated with PEP [OR 25.523 with 95% CI (4.049- 100.0%)]. Around ten percent patients had developed PEP. Regarding the severity half of them were mild, 44.0% patients had moderate and 6.0% patient had severe type of pancreatitis. Difficult cannulation, unintentional passage of guide wire into the pancreas, pancreatic duct contrast injection and pre-cut sphincterotomy were associated with PEP. Among them pancreatic duct contrast injection had independent significance in the causation of PEP.

Association of Prolonged QTc Dispersion with Diastolic Dysfunction of the Left Ventricle in Patients with Non ST Segment Elevation Myocardial Infarction.

Diastolic function usually declines before systolic function, and this precedes clinical signs in patients with acute coronary syndrome. Therefore, diagnosis of diastolic dysfunction is very important for early diagnosis, follow-up, treatment, and prognostic evaluation in heart failure with preserved ejection fraction (HFpEF) patients. The main objective of the study was to find out association between prolonged QTc dispersion and left ventricular diastolic dysfunction in Non ST Segment Elevation Myocardial Infarction (NSTEMI) patients in HFpEF. This cross sectional analytical study was conducted in the Department of Cardiology and 60 patients were included as study population from August 2015 to July 2016. Then the study population was divided into two groups, each group consisted of 30 patients. NSTEMI patients with prolonged QTc dispersion treated as Group I and NSTEMI patients with normal QTc dispersion treated as Group II. The study shows 20.0% vs. 26.6% patients had detected as Grade I in Group I and Group II respectively with statistically insignificant association (p=0.16). On the contrary, 30.0% vs. 13.4% patients had detected as Grade II in Group I and Group II respectively with statistically significant association (p=0.001). Again, 40.0% vs. 10.0% patients had detected as Grade III in Group I and Group II respectively with statistically significant association (p=0.001). QTc dispersion was found sequentially significant increased (p=0.007) among 3 grades of LVDD (63.6±4.9 vs. 79.4±8.6 vs. 98.2±28.8). QTc dispersion in surface ECG which is a cheap, non-invasive, easily available tool can help us predicting left ventricular diastolic dysfunction in patients with NSTEMI.

Evaluation of Requirements for Staging the Procedure of Reconstruction of Middle Ear After Canal Wall Down Mastoidectomy.

Cholesteatoma is a progressive destructive ear disease which can affect any age group. It has been found to be more severe in children and young adults. It erodes the surrounding bone of middle ear, mastoid and ossicles. It causes partial to total deafness, unpleasant smelling discharge, pain, tinnitus, vertigo and facial paralysis. It can even cause meningitis, brain abscess and death. The post-operative outcome of hearing, and the state of the reconstructed middle-ear cavity after concurrent and staged reconstruction of middle ear after canal wall down mastoidectomy was studied in 30 ears with middle-ear cholesteatoma. The reconstructed middle ear was re-aerated in 60.5 % of the cases, which was significantly higher than for the epitympanum (39.5 %). Tympanoplasty was successful in terms of hearing results in 68.9 % of all subjects and in 75.4 % of the ears having a re-aerated tympanic cavity, which was significantly better than the 38.5 % for ears in which the tympanic cavity was not re-aerated. The findings of recurrent cholesteatoma, tympanic atelectasis, and tympanic effusion were observed with significantly (p < 0.03) high incidence in ears with no re-aerated space in their reconstructed mastoid cavities. It was revealed that the post-operative outcome of this surgical technique was significantly related to the state of re-aeration of the reconstructed middle-ear cavity but not with either concurrent or staged reconstruction. Audiological results are same for both concurrent and staged reconstruction following canal wall down tympanomastoidectomy, and hence we reccommend that concurrent reconstruction is preferred in limited disease and staged reconstruction in severe disease.

Caldwell Luc Surgery: Revisited.

Caldwell Luc surgery (CWS) is almost 120 years old now and it still enjoys an important place in ENT Surgeons armamentarium. The logic behind this surgery is to replace the diseased and scarred mucosa from maxillary sinus with new mucosa. In the initial period of this long journey the surgery gained many other important indications which also includes approach to surrounding structures which makes us to think if it's really a radical surgery as it is used just an approach to other structure. This was a retrospective study of CWS done during period of 2002-2014 in Sri Venkateshwara ENT Institute and Bowring & Lady Harding Hospital both of these attached to Bangalore Medical College & Research Institute. In this study we have tried to analyze the indications and surgical procedure adapted and complications. Even though it has synonym of radical antrostomy the complications were minor and temporary, except for permanent tooth anesthesia and nasal vestibular stenosis. With reasonable expertise if this surgery is done for proper indication: its worth to face these complications and it's a versatile surgery even today.

Penetrating neck injuries.

The incidence of penetrating and lacerated neck injuries has been rising in recent decades largely because of urban violence. Injury to the neck frequently results in multiple regional injuries and in addition poses serious threat to vital structures in the neck.From 1999 to 2005, forty-two cases of penetrating neck injuries which were treated in our hospital were included in this study. Thirty one (73.8%) injuries were due to homicide, six cases (14.2%) were due to suicide attempt and five (11.9%) were accidental injuries. Surgical management included tracheostomy neck exploration and wound repair. All the patients were followed up for a minimum period of six months. Six patients (14.2%) had unilateral vocal cord paralysis. Two patients (4.7%) developed tracheal stenosis.A proper evaluation, rapid air way intervention and proper surgical repair are essential for a successful outcome.

Tropic failure of Phyllactinia corylea contributes to the mildew resistance of mulberry genotypes.

Different mulberry genotypes show great variation in their resistance to the powdery mildew Phyllactinia corylea. Conidial germination and hyphal growth of P. corylea on the leaf surface of two susceptible mulberry genotypes, viz., Kanva 2 (K2) and Victory 1 (V1) varieties of Morus indica, and on two resistant species, viz,, M. laevigata and M. serrata were studied by scanning electron microscopy. Conidial germination and growth of germ tubes were normal on all the leaves. The hyphae of P. corylea identify stomata on host leaves by their topographical features to produce the stomatopodia precisely over them. The holes and/or the grooves of stomata appear to provide the signals for the initiation of stomatopodia and similar structures are erratically developed over many local depressions or grooves on leaf surface. The abaxial surface of K2 leaf is smooth without prominent undulations of epidermal cell surface, and the stomata are flush with the leaf surface. Although successful penetration is also achieved on V1 leaf, its slightly undulated surface occasionally provides inaccurate tropic signals to the hyphae, inducing the development of stomatopodia away from the stomata. The leaf surfaces of M. laevigata and M. serrata are very rough with highly sculptured cuticle and abundant epidermal outgrowths. Stomata mostly remain sunken or hidden amidst the cuticular ornamentations and the hyphae fail to recognise the precise signals from them. As the surface architecture of the leaves provides many immense sources of tropic signals, stomatopodia are often produced over local depressions or grooves. In these cases the fungus fails to penetrate the leaf, does not develop beyond 24 h and penetration is rarely achieved on the leaves of the resistant plants. The study indicates that the stimulatory effect of the leaf surface topography of resistant varieties misleads the pathogen from successful penetration, thus contributing to the plant's resistance.

Production of monoclonal antibodies against Nosema bombycis and their utility for detection of pebrine infection in Bombyx mori L.

Latex agglutination assay based on monoclonal antibodies (MCAs) described in this communication may be useful for detection of Pebrine infection in silkworm. Four murine MCAs were produced against Nosema bombycis spore. In ELISA all 4 MCAs (IgM isotype) reacted with alkali treated Nosema spores and to variable extent with acetone precipitated surface protein. However, MA-310 and MA-542 showed a low degree of cross reactivity with BmNPV. In contrast, MA-503 and MA-515 were devoid of reactivity with BmNPV, B. thuringiensis, S. marcescens, Azotobactor, Rhizobium and normal hemolymph protein in ELISA. Latex beads sensitized with a combination of MA-503 and MA-515 (50 micrograms each per ml of 0.4% latex beads) could detect 1 x 10(5) Nosema spores per test. Sensitization of the latex beads with the cocktail of these two MCAs through protein-A bridge further led to a 10-fold increase in the sensitivity (1 x 10(4) spores/test) of the assay. No agglutination was observed in presence of BmNPV, Rhizobium, Azotobactor, E. coli, B. thuringiensis, S. marcescens and normal hemolymph protein indicating the specificity of the test. The results obtained by latex agglutination assay on hemolymph samples of infected as well as normal larvae collected from field, II instar larvae infected in the laboratory and from infected mother moth revealed 100% correlation with results by microscopic examination.

Sem study on the invasion of Nomuraea rileyi (Farlow) on silkworm, Bombyx mori Linn. causing green muscardine.

The mature conidia of Nomuraea rileyi (Farlow) germinate on the larval integument of Bombyx mori within 24 h and penetrate the cuticle within 36 h after inoculation at 24.0 +/- 1.0 degrees C temperature and 80.0 +/- 5.0% relative humidity. The penetrating hyphae multiply by budding and septa formation in the hemocoel, and the larva succumbs to the infection 6-7 days post-treatment. The hyphal bodies elongate and become interwoven with other hyphae forming a mycelial complex across different tissues. The ramification of hyphae along the epidermal tissue results in larval mummification in 7-8 days. Numerous conidiophores emerge, producing a confluent white fungal mat over the entire surface of the host larva by 9-10 days. Pale green conidia develop, making the larval body green. Life cycle of the fungus on B. mori is completed in 10-11 days.

Protein A linked latex antisera test for detection of infectious flacherie of silkworm, Bombyx mori L. caused by B. mori infectious flacherie virus.

Protein A linked latex antisera (PALLAS) test was used for detection of B. mori infectious flacherie virus (BmIFV) in silkworms. The test was found superior to direct latex agglutination (DLA) test for detection of BmIFV in infected larval and faecal matter extracts and purified preparations. Latex beads sensitized with anti-BmIFV IgG were able to detect up to 75 ng/ml BmIFV in PALLAS test and 300 ng/ml in DLA test. BmIFV was detected in diluted extracts of infected larvae (up to 1:200) and their faecal matter (up to 1:500). BmIFV progressive infection was detected at 12 and 24 hr of post infection in PALLAS and DLA tests, respectively in both larval and faecal matter extracts. PALLAS tests provides a simple, specific and highly sensitive test for detection of infectious flacherie virus.

Evaluation of protein-A linked monoclonal antibody latex agglutination test for diagnosis of nuclear polyhedrosis virus (BmNPV) of silkworm Bombyx mori L.

The symptomology of BmNPV infection in Bombyx mori L depends on the stages of infection. Discernible symptoms develop at later stages of infection, which leads to improper diagnosis and poor crop yield with sericulturists. In the present study development of direct and protein-A linked monoclonal antibody latex (PALMAL) agglutination test for the detection of BmNPV infection in silkworm is described. Latex beads were precoated with protein-A and then sensitised with monoclonal antibody MA-231 (125 micrograms/ml). PALMAL test could detect 1 x 10(5) nuclear polyhedra/test and is ten times more sensitive than the direct agglutination test employing purified polyclonal antibodies. No agglutination was observed in presence of B. thuringiensis, S. marcescens, N. bombycis, group-A streptococci, Staphylococcus aureus, E. coli and normal haemolymph protein indicating the specificity of the test. Fifty haemolymph samples collected from the field were evaluated by PALMAL test. Twenty one samples having infection other than BmNPV, failed to show positive agglutination. Twenty five samples having > or = 5 x 10(6) BmNPV/ml showed positive agglutination. However, 4 samples having < 5 x 10(6) BmNPV/ml failed to show positive agglutination thereby indicating the limit of sensitivity of the assay.

Purification and partial characterization of an induced antibacterial protein in the silkworm, Bombyx mori.

Injection of live Escherichia coli into larvae of the silkworm, Bombyx mori, induces antibacterial activity in the hemolymph. The major induced antibacterial activity was purified in two steps by CM-Sephadex C-50 and Sephadex G-100 column chromatography. After trypsin treatment, the purified antibacterial protein lost its activity and the antibacterial activity was found to be partially heat labile. The purified protein was a single polypeptide chain of molecular weight 16 kDa. The 20 N-terminal amino acid sequence of the protein was determined and this sequence showed homology with the N-terminal amino acid sequence of lysozymes reported in other species. The purified protein was found to have comparable antibacterial activity against both E. coli and Micrococcus luteus. The purification of antibacterial protein and the antibacterial properties of the purified protein are discussed.

Hierarchical clustering of 54 races and strains of the mulberry silkworm, Bombyx mori L: Significance of biochemical parameters.

A detailed analysis was undertaken to test the efficacy of hierarchical agglomerative clustering (UPGMA method) in grouping the races and strains of the mulberry silkworm, Bombyx moti L., and to ascertain the importance of biochemical parameters in the clustering process. The analysis was based on data from two rearing seasons with 54 selected races/strains of different geographic origin and varying yield potentials. The results indicate that seven clusters can be realised with yield parameters alone, whereas the inclusion of biochemical parameters in clustering resulted into two broad groups: one having all the breeds with high cocoon weight and shell weight, the other having all the low-yielding silkworm strains both from India and from other countries. Further sub-grouping under these two groups highlights genetical differences associated with the differentiation of various groups of races in temperate and tropical areas as well as their significance for silkworm breeding. Estimates of all ten variables were further subjected to 'quick clustering' and the results showed that cluster 5, constituted by 38 lowyielding strains of India, China and Europe, had the highest values of the final cluster centre for amylase and the effective rate of rearing (ERR), while clusters 1 and 4 had the highest values for invertase and alkaline phosphatase. The evolutionary aspect of the genetic channelisation of silkworm races from various countries is discussed against the background of differences in the biochemical parameters and yield variables.

Evaluation of three manually operated weeding devices.

Performance of three manually operated weeders was evaluated from ergonomics and mechanical considerations. Three operators were selected for laboratory and field trials; they represented the 5th, 50th and 95th percentiles of the operator population. Laboratory tests were conducted in a psychometric chamber to study physiological response under varying load and environmental conditions. From the data, relationships between energy expenditure rate and oxygen consumption rate vs heart rate were established. Field tests were carried out with the three weeders in a farm with Arhar crop (Cajannus Cajan L.) during August-September, when the average ambient temperature and relative humidity were 36 degrees C and 82% respectively. The results of this investigation indicated that weeding with the indigenous tools of a 'khurpi' and a spade and with the improved tool (3-tine hoe) could be rated as 'moderately heavy' work. However, a 'khurpi' demanded less energy expenditure than a 3-tine hoe followed by a spade. The squatting posture with a 'khurpi' appeared to be more comfortable than the standing posture with about 145 degrees erect position for the 3-tine hoe, followed by the standing posture with about 108 degrees erect position with the spade. For consideration of higher output, the order was spade, 3-tine hoe and 'khurpi', For weeding efficiency the trend was, however, just the reverse.

Non specific aortoarteritis (Takayasu's disease). An immunologic and autopsy study.

Large segments of the aorta and its major branches were found to be diseased in 14 autopsied cases of aortoarteritis. Both renal arteries and the left subclavian artery were frequently affected. Superior vena cava thrombosis and thickening of the inferior vena cava were noted in one case each. Tuberculosis was present as small foci in only 3 of the 14 cases. Angiographic evaluation also revealed thickening and narrowing of diseased segments. The descending thoracic and abdominal aorta and renal arteries were frequently involved. Aneurysmal lesions were infrequent. Antiaorta antibodies were investigated using 4 different parameters. None of our cases showed their presence. The role of tuberculosis and/or autoimmunity appears unlikely in the etiopathogenesis of aortitis.

Induction of dominant lethals with ethyl methane-sulfonate in male germ cells of mulberry silkwork, Bombyx mori l.

Sensitivity of male germ cells in the mulberry silkworm, Bombyx mori L., to ethyl methanesulfonate (EMS) was determined by treating newly emerged 5th- instar larvae, and 2-day- and 7-day-old pupae with 3 concentrations, 0.05, 0.1 and 0.15%, of the mutagen. The frequency of dominant-lethal mutations induced by EMS treatment was used as the parameter for the study. Spermatids and spermatozoa were markedly sensitive to EMS. Statistical analysis confirmed that differences in respect of percentage of egg hatch among the 3 different treatments as well as the interactions between the 3 factors, e.g. stages, hatchability and EMS treatment, were highly significant.

Mescaline-induced changes of brain-cortex ribosomes. Mescaline demethylase activity of brain-cortex soluble supernatant.

Brain-cortex slices demethylate mescaline and p-methoxyacetanilide, a reference O-demethylating substrate, though the rate of demethylation of mescaline is about one third that of the reference substrate. The demethylase activity is localized mostly in the soluble supernatant (105 000 x g). It is purified 47-fold with respect to the demethylation of mescaline by ammonium sulfate precipitation and DEAE cellulose chromatography. The partially purified demethylase, which is stable for 3-5 days at -5 degrees C in the presence of dithiothreitol and glutathione and is inhibited by p-chloromercuribenzoate, has maximal activity at pH between 7.2 and 8.0. It demethylates mescaline into 3,4-dimethoxy-5-hydroxyphenethylamine and 3,5-dimethoxy-4-hydroxyphenethylamine and some unidentified derivatives.

Binding of mescaline with subcellular fractions upon incubation of brain cortex slices with [14C] mescaline.

Incubation of brain cortex slices in the presence of glucose resulted in the permeation of about 65% of [14C] mescaline into slices. Of this, about one-third radioactivity was bound with nuclei, mitochondria, microsomes, and ribosomes. Dialysis of subcellular fractions did not markedly reduce the amounts of radioactivity bound to the fractions. The permeation into slices and the binding of mescaline to subcellular fractions were fairly time-dependent, but were inhibited by the presence of potassium cyanide, or by the absence of glucose and by heating to 80 degrees C for 1 min.