Europium radionuclides in samarium-153-Ethylene Diamine Tetramethylene phosphonic acid (153Sm-EDTMP) radiopharmaceutical waste.

153Sm-EDTMP is widely used as a palliative radiopharmaceutical for treatment of metastatic bone pain. It is produced by neutron activation of enriched 152Sm targets in a nuclear reactor. The long-lived europium radionuclides are co-produced along with production of 153Sm and it give rise to radioactive waste in 153Sm-EDTMP production. The gamma radiation dose rate was found significant on the radioactive waste generated during the production of 153Sm-EDTMP. Residual activity in six waste samples generated in different batches of 153Sm-EDTMP production were analysed for percentage contributions of 152,154,155Eu using gamma-ray spectrometry. 154Eu was a major contributor with around 62%, and the other radioisotopes, viz. 152Eu &155Eu contribution were ∼29% & ∼9% respectively. The activity concentration of these long-lived europium radionuclides in samarium radiopharmaceutical production waste may be utilised for the dose rate estimation, and vice versa.

Comparison of Serum Bilirubin with Transcutaneous Bilirubinometry in Late Preterm and Term Newborn.

Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns. It can progress to develop kernicterus unless intervention is initiated. Severity and decision for management are usually based on serum bilirubin which needs blood sampling. Transcutaneous bilirubin measurement is a noninvasive technique and correlates closely with serum bilirubin. This Cross sectional study was done in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University from March 2013 to August 2014 to evaluate the transcutaneous bilirubin in comparison to serum bilirubin. Total 160 infants with ≥35 weeks were purposively included over a period of 16 months. Neonates with less than 35 weeks, previously exposed to phototherapy, serious illness which leads to impaired circulation, who have had exchange transfusion, having major congenital malformation were excluded. Transcutaneous bilirubin measurement was performed within 30 minutes of obtaining sample for total serum bilirubin measurements. Of the enrolled infants, mean birth weight was 2631±520 grams, postnatal age was 4.99±3.02 days ranging from 2 to 25 days and mean transcutaneous bilirubin and serum bilirubin value was 14.59±2.55 and 13.62±2.86mg/dl respectively. Mean difference of transcutaneous bilirubin and serum bilirubin was 0.97±1.01mg/dl. In the total enrolled infant, transcutaneous bilirubin and serum bilirubin values showed significant correlation (r = 0.93, r2 = 0.876, p<0.001) and this was not affected by sex, gestational age, postnatal age, and birth weight. The area under ROC curve for transcutaneous bilirubin was 87% (p value <0.001). If the cut off value of transcutaneous bilirubin was set at 15 mg/dl, then a sensitivity of 77%, specificity of 88% and accuracy of 82% were obtained. Use of transcutaneous bilirubin can reduce need for serum bilirubin in assaying neonatal jaundice; as it showed significantly high correlation with serum bilirubin. Predictive accuracy of transcutaneous bilirubin was found to be statistically significant in comparison to serum bilirubin.

Randomized Controlled Trial of Slow Versus Rapid Enteral Feeding Advancements on the Clinical Outcomes in Very Low Birth Weight Neonates.

Starting and advancement of feeding in very low birth weight (VLBW) infants are big challenges for the neonatal practitioners. Wide variations in volume of feed advancement have observed in earlier trials both in slow and rapid advancement groups. Volume advancement in slow advancement groups have ranged from 10ml/kg/day to 23ml/kg/day and in rapid advancement groups have ranged from 15ml/kg/day to 45ml/kg/day in earlier different studies. This randomized controlled trial was conducted in neonatal intensive care unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2013 to July 2014 to evaluate the effects of slow versus rapid rates of feeding advancements on the clinical outcomes in very low birth weight infants. A total 95 infants were enrolled into two strata according to their birth weight. Infants of each stratum were randomly allocated to either slow or rapid advancement group during initiation of feeding. After gut priming over five days, feeding was advanced daily 10ml/kg in slow and 15ml/kg in rapid advancement group for 1000 - <1250gm weighing infants. For 1250 - <1500gm weighing infants, feeding was advanced daily 15ml/kg in slow and 20ml/kg in rapid advancement group. The primary outcome variable was time taken to achieve full enteral feed. Total 82 infants completed the trial. Demographically both groups were same. Infants in the rapid feeding advancement group achieved full enteral feedings before the slow advancement group, had significantly fewer days of parenteral nutrition and regained birth weight earlier. There were no statistical differences in episodes of feed interruption, number of infants with apnea, feed intolerance or diagnosis of sepsis. Rapid enteral feeding advancements were well tolerated by very low birth weight infants.

A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly.

Dosimetry of indigenously developed (192)Ir high-dose rate brachytherapy source: An EGSnrc Monte Carlo study.

Clinical application using high-dose rate (HDR) (192)Ir sources in remote afterloading technique is a well-established treatment method. In this direction, Board of Radiation and Isotope Technology (BRIT) and Bhabha Atomic Research Centre, India, jointly indigenously developed a remote afterloading machine and (192)Ir HDR source. The two-dimensional (2D) dose distribution and dosimetric parameters of the BRIT (192)Ir HDR source are generated using EGSnrc Monte Carlo code system in a 40 cm dia × 40 cm height cylindrical water phantom. The values of air-kerma strength and dose rate constant for BRIT (192)Ir HDR source are 9.894 × 10(-8) ± 0.06% UBq(-1) and 1.112 ± 0.11% cGyh(-1)U(-1), respectively. The values of radial dose function (gL(r)) of this source compare well with the corresponding values of BEBIG, Flexisource, and GammaMed 12i source models. This is because of identical active lengths of the sources (3.5 mm) and the comparable phantom dimensions. A comparison of gL(r) values of BRIT source with microSelectron-v1 show differences about 2% at r = 6 cm and up to 13% at r = 12 cm, which is due to differences in phantom dimensions involved in the calculations. The anisotropy function of BRIT (192)Ir HDR source is comparable with the corresponding values of microSelectron-v1 (classic) HDR source.

Neonatal Conjunctivitis Leading to Neonatal Sepsis--A Case Report.

Neonatal conjunctivitis is the most common occular disease in neonates. Most infections are acquired during vaginal delivery. In spite most of these cases are benign; some of them may progress to systemic complications like loss of vision if left untreated. The authors present a case of a newborn who developed late onset neonatal sepsis from E. coli positive conjunctivitis. The baby was treated with Injection Meropenem and Injection Amikacin for 10 days. The course was uneventful, after that baby responded well and discharged home on 24th day.

Salt Losing Variety of Congenital Adrenal Hyperplasia--A Case Report.

Congenital adrenal hyperplasia is a genetic endocrinologic disorder. The severe classic form occurs in one in 15,000 births worldwide. Twenty-one-hydroxylase deficiency (21-OHD) is the most common cause in this autosomal recessive disease. It can cause virilization, ambiguous genitalia at birth and severe life threatening condition due to salt wasting. In this report we describe the clinical course of a male neonate presenting with lethargy, failure to thrive (FTT), genital pigmentation, electrolytes imbalance and high serum 17-hydroxy-progesterone (17-OHP) level and subsequently diagnosed as Congenital Adrenal Hyperplasia. After the initial crises management, the child was continued on replacement therapy. During the follow up, he was found to grow appropriately and achieving normal milestones for age.

Osteopenia of Prematurity: Are We at Risk?

The continuous advances in intensive care have led to increased survival of premature infants. As a consequence, the problem of less imminent, slowly progressing disorders such as osteopenia of prematurity has been emerging. Osteopenia of prematurity (OOP) also called metabolic bone disease of prematurity (MBD) or rickets of prematurity is characterized by a reduction in bone mineral content usually manifest between 6th to 12th weeks of corrected gestational age. It occurs in up to 55% of infants born with weight <1000gm and 23% of infants weighing <1500gm. Clinical features of osteopenia of prematurity are mostly non-specific often appears as a late symptoms. Several biochemical markers have frequently been used as screening tools and diagnostic markers, but timing of measurements and the levels at which treatment should be initiated vary widely. Dual energy X-ray absorptiometry (DEXA) and Quantitative ultrasnogram are important diagnostic tool. Standard X-ray, a widely accepted but cannot detect osteopenia unless 20% loss of bone mineralization. The treatment of osteopenia includes provision of adequate mineral supplementation. Monitoring of serum and urinary markers are mandatory. The focus on prevention has largely centered on providing adequate intake of phosphorus and calcium but more research is needed. Till date there are neither enough data regarding clinical risk factors, valid biochemical markers which can detect premature babies at risk of osteopenia nor supplementation as well as appropriate timely management protocol is practicing in Bangladesh.

Newborn hearing screening: what are we missing?

The objectives of the study were to demonstrate hearing status in newborns at first screening by Transient Evoked Otoacoustic Emissions and to find out the relationship between abnormal hearing screening and known risk factors. This study was conducted in the department of neonatology of Bangabandhu Sheikh Mujib Medical University in collaboration with department of otolaryngology and department of obstetrics and gynaecology. This prospective observational study included a cohort of 168 neonates from Neonatal Intensive Care Unit and neonatal Nursery (Minimal care unit). All were screened for hearing impairment using Transient Evoked Otoacoustic Emissions in out-patient department of otolaryngology by a trained audiologist before discharge from hospital. Risk factors analysed were according to the criteria of American Academy of Pediatrics. Of the total neonates screened, Refer rate was 32.7% irrespective of presence or absence of risk factors. Small for gestational age, in-utero infections, ototoxic medications, birth weight < 1500, sepsis/meningitis, hyperbilirubinemia were found to be significant risk factors (p < 0.0001). It can be recommended that hearing screening should be universally done for all newborns.

Human rabies among the paediatric population in Bangladesh.

This cross sectional study in the Infectious Disease Hospital (IDH), Mohakhali, Dhaka on rabies affected paediatric population was carried out to see the patterns of presentation, age group at risk, state of vaccination following animal exposure and the interval between animal exposure and the development of the disease. This one year study included the patients aged less than 15 years with clinically diagnosed rabies referred to the IDH between July 2008 and June 2009. Data was collected from the case sheets of rabies patients given by the relatives and attendants of the victims. A total of 70 cases were included in the study. In the present study most common age group were 5 to 10 years of age with 31(44.3%) patients followed by less than 5 years 23(32.9%) and the rest 16(22.9%) were more than 10 years of age. The male female ratio was 3:1. Among the 70 patients 59(84.3%) were from rural areas and only 11(15.7%) were from urban areas. Sixty six (94.3%) patients presented with bleeding from the site of injury and 4(5.7%) were without bleeding. Among the patients 53(75.7%) presented with bite on the limbs followed by bite on the face 8(11.4%), body 5(7.1%) and head 4(5.7%) cases. Thirty nine of the cases (55.7%) presented with multiple bites and 31(44.3%) had single bite. More than half that is 37(52.9%) patients presented with severe bite, 31(44.3%) had moderate bite and only 2(2.9 %) patients presented with mild bite. Fifty nine (84.3%) patients were unvaccinated whereas 11(15.7%) had history of vaccination after bite. Fifty two (74.3%) gave the history of bite by stray animal, 10(14.3%) by known rabid animal whereas 8(11.4%) had the history of bite by pet animal. Sixty eight patients (97.1%) had the history of bite by dog whereas 2(2.9%) reported cat bite. The mean±SD incubation period 45.38±26.91 days and range was 11-150 days. In the present study it is concluded that the 5-10 years group children were affected most, bites were mostly by stray animal, most of the children did not get post exposure prophylaxis and incubation period was between 11 to 150 days.

Risk factors, morbidity and mortality of neonatal tetanus.

A retrospective study was conducted to identify the risk factors, mortality and morbidity of neonatal tetanus in an Infectious Disease Hospital, Mohakhali, Dhaka, Bangladesh, the only referral hospital in the country of its kind. Hospital records of all cases of neonatal tetanus admitted over one year period from 1st May 2008 and 30th April 2009 were analyzed. Demographic data, clinical presentation, progression, hospital stay and outcome were evaluated. Overall mortality was found 52.9%. Hospital stay among the patients was 11.00 ± 8.37 days. Among the patients about two third had unsatisfactory outcome and only 6(35.3%) patients recovered completely. The retrospective study identified that mortality due to neonatal tetanus was very high and the common morbidities were lock jaw, inability to suck, abdominal rigidity, convulsion, fever, irritability etc. It has been explored that low socioeconomic conditions, mothers' illiteracy, lack of antenatal care and involvement of untrained persons during delivery of baby and unclean cord care practices were the important factors contributing to neonatal tetanus. A further study with a larger sample size is recommended for evaluating the findings of the study and formulating the possible preventive strategies against neonatal tetanus.

Selectivity of mixed-function oxygenase enzyme induction in flounder (Pseudopleuronectes americanus) collected at the site of the Baie Verte, Newfoundland oil spill.

A marked level of mixed-function oxygenase (MFO) enzyme induction was observed in kidney but not in liver tissues of winter flounder collected at the site of a spill of No. 2 fuel oil in Newfoundland. A number of MFO-linked, electron transport components including cytochrome P450, cytochrome P450 reductase and cytochrome b5 reductase were also slightly elevated in kidney tissues of fish at the oiled site. The results obtained in this particular field trial demonstrate that reliance on the measurement of liver MFO parameters alone could lead to false negatives in biological monitoring programs. The study also indicates that the exclusive use of liver tissues to investigate the induction potential of various chemicals should be avoided.

Long term exposure of marine fish to crude petroleum-I. Studies on liver lipids and fatty acids in cod (Gadus morhua) and winter flounder (Pseudopleuronectes americanus).

1. Total lipids, total phospholipids, lipid class and fatty acids have been studied in the livers of cod and winter flounder from the Northwest Atlantic following long-term exposure to crude petroleum. 2. The levels of free fatty acids and total phospholipids were elevated and triglycerides depleted significantly in the males and females of both species in the experimental groups. 3. The essential fatty acids of C20.5, C22.5 and C22.6 series were significantly altered in the oil-exposed animals. 4. These findings indicate that marine fish, following long-term exposure to crude petroleum, tend to (a) use up their stored energy of neutral lipids and (b) develop changes in membrane structure and function.

Comparison of the properties of phosphoglucomutase from muscle of turbot (Reinhardtius hippoglossoides, Greenland Halibut) and witch flounder (Glyptocephalus cynoglossus) from the Northwest Atlantic and the Gulf of St. Lawrence.

1. Phosphoglucomutase from muscle of turbot and witch has been purified and the properties studied from two regions of the Northwest Atlantic and the Gulf of St. Lawrence. 2. The enzyme, purified 157 fold from turbot and 164 fold from witch had specific activities of 596 and 475 U/mg/min respectively. 3. The M.W. and pH optimum of the enzyme from both species were 63,500 and 7500; and 63,000 and 7800 for the Northwest Atlantic and the Gulf samples respectively. 4. The amino acid contents and responses towards different inhibitory agents were different for the enzyme from the Gulf than the Northwest Atlantic samples. 5. The findings compares well with the genetic analysis of the electrophoretic properties of the enzyme in relation to stock discrimination of the two species.