Rehabilitation of Persons with Spinal Cord Injury in Bangladesh.

There is a knowledge gap about the rehabilitation system for the persons with spinal cord injury (SCI). A rehabilitation scenario is necessary to conduct a national community survey in conjunction with the International Spinal Cord Injury Community Survey (InSCI) in order to gather data on the lived experiences of people with SCI, to map out the health and rehabilitation system of Bangladesh, it's demographic characteristics, accessible resources and rehabilitation challenges. Information for this narrative report was acquired through a structured questionnaire, which was supplemented by an online search of agencies, government websites, rehabilitation-related organizations and published papers during the period of March 2020 to April 2021. Bangladesh is a developing country with a vast population and a developing health care system. Representative government and non-government rehabilitative care settings a total of sixteen survey replies (n=16) were obtained. During the year 2019, a total of 1035 people with SCI were seen. The majority of patients with SCI were hospitalized by a non-government facility (38.65%), whereas the two main public general hospitals consulted roughly 30.0% of people with SCI. The rehabilitation team leader in the majority of the facilities (93.75%) was a physiatrist, but just a few had a full complement of rehabilitation professionals and only 12.5% of settings provide community care. Indoor rehabilitation facilities, equipment and a competent rehabilitation staff are not available at many of the tertiary care facilities including National Trauma Institute (NITOR), where most of the SCI report first after the trauma. A consistent and nationwide data source is unavailable and the majority of the available SCI research publications are hospital-based demographic studies in Bangladesh. SCI was commonly due to work-related trauma in young male manual laborers due to fall from height or road traffic accidents. The country faces multiple challenges in rehabilitation of people with SCI regarding triage, a referral system development, infrastructure and shortage of expert human resources in addition, currently there is no three-tier rehabilitation care continuum available. Keeping pace with the transition to a developed country by 2041, the Bangladesh health sector also has to be oriented to face the focused challenge of caring for people with SCI. As recommended by WHO Rehabilitation 2030 initiatives, establishment of an SCI dedicated national institute and escalation of number of related specialists such as trauma and orthopedic surgery, spinal neurosurgery and physical rehabilitation medicine, skilled professionals such as rehabilitation nurses, therapists, case managers and social workers to work in a team required for specialized care of SCI.

Pre-endoscopic tachycardia predicts increased sedation dose and lower adenoma detection rate in patients undergoing endoscopic procedures: a case control study.

BACKGROUND: Tachycardia prior to endoscopic procedures is commonly encountered which reflect patient anxiety status. Despite this frequent occurrence, it is unclear if in a patient with tachycardia sedation dose should be modified. The aim of our study was to assess the effect of pre-endoscopic tachycardia on sedation dose. METHODS: A retrospective analysis of all patients who underwent upper endoscopy and colonoscopy at EMMS Nazareth hospital were performed. We excluded patients with diseases and medications affecting the heart rate. RESULTS: A total of 2855 patients were included in the study. Two-hundred and thirty-seven patients had tachycardia before endoscopy (8.3%, group A) as compared to 2618 (group B) patients who had heart rate ≤100 beats per minute. The mean dosage of propofol in group A was significantly higher (62.6±33.2 mg vs. 57.4±29.9 mg) than in group B (P=0.01). There was no difference in the cecal intubation rate among the two groups (P=0.9). Notably, the adenoma detection rate was significantly lower among group A patients as compared to group B (13.6% vs. 22.8%, P=0.02) patients. There were no sedation related complications. CONCLUSIONS: Tachycardia prior to endoscopic procedures was associated with higher sedative dosage and lower adenoma detection rate, however no major complications were recorded. These data should be taken into consideration to optimize procedure quality.

Autoimmune diseases in first- and second-degree relatives of patients with inflammatory bowel diseases: a case-control survey in Israel.

BACKGROUND: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic, relapsing, inflammatory diseases of the gastrointestinal tract with unknown etiology. IBD are complex, multi-factorial disorders, in which genetic factors play a major role, the so-called phenomenon of familial aggregation or clustering of IBD. A positive family history of IBD is often reported among CD and UC probands, with percentages depending on the geographic context in which the studies are carried out. Israel is a complex and pluralistic society comprising of two major ethno-national groups (Arabs and Jewish) and, as such, represents a unique living laboratory in which to test the role of genetic factors in the development of IBD as well as of associated autoimmune disorders (ADs). While some studies have found a lower prevalence of ADs among Arabs when compared to Jews, few studies directly compared the two ethnicities. METHODS: The present case-control study was designed to compare the rate of ADs in first- and second-degree relatives of IBD patients, stratified according to Jewish or Arabic ethnicity. RESULTS: We found that first-degree relatives of Jews patients had a higher risk of developing ADs (OR=1.89, P=0.0086). Classifying ADs into systemic and local (endocrinological, gastrointestinal, dermatological, and neurological) types, first-degree relatives of Jews patients had a higher OR of developing local ADs (OR=2.12, P=0.0056). CONCLUSIONS: Israeli Jewish IBD patients had more first-degree relatives with local ADs as compared to Arab patients.

Selenium and L-Carnitine Ameliorate Reproductive Toxicity Induced by Cadmium in Male Mice.

Cadmium (Cd) has been reported to reduce male fertility, impair reproductive capacity, and play a major role in the pathogenesis of infertility. This study was conducted to investigate the possible protective role of Selenium (Se) and L-carnitine (LC) against the adverse effects induced by Cd on the male reproductive system in mice. Animals were randomly divided into seven groups (n = 10); control group and six treated groups, as follows: Cd (0.35 mg/kg), Se (0.87 mg/kg), LC (10 mg/kg), and a combination of either Se or LC and then a combination of both with Cd, and all animals were injected for a period of 30 days. Exposure of Cd showed a significant decrease in enzymatic antioxidant activities, deficiency in reproductive performance, decrease serum testosterone level, severe changes in the histopathological architecture, and higher degree of damages and appearance of unblemished DNA strands. Treatment with Se and LC has the highly synergistic and ameliorates the damaging effect of Cd on the testis through the elevation of the enzymatic antioxidant and diminish histopathological abnormalities and DNA damage.

Antioxidant, antiapoptotic, antigenotoxic, and hepatic ameliorative effects of L-carnitine and selenium on cadmium-induced hepatotoxicity and alterations in liver cell structure in male mice.

L-carnitine (LC) and selenium (Se) have significant protective and antioxidant effects on several tissues. Cadmium (Cd), widely used in some industries and emitted from fossil fuels, is a heavy metal having a number of side effects, including hepatotoxicity. This study aims to assess the ameliorative function of both LC and SeCl4 on cadmium chloride (CdCl2)-induced liver toxicity. In total, 70 male mice included in this study were allocated to seven groups: control, CdCl2, LC, SeCl4, CdCl2 plus SeCl4, CdCl2 plus LC, CdCl2 plus SeCl4 and LC groups. Hepatic aminotransferase (aspartate aminotransferase [AST] and alanine transaminase [ALT]) activity and tumor necrosis factor-alpha [TNF-α] levels, as well as the antioxidant biomarkers (superoxide dismutase [SOD], glutathione reductase [GRx], glutathione-S-transferase [GST] and catalase [CAT], were examined. Histological and transmission electron microscopic [TEM] variations in the liver were used as indicators of liver damage after the administration of CdCl2-alone or CdCl2 with LC, SeCl4, or both. Genotoxic effects of CdCl2 were also evaluated and the possible roles of SeCl4 and/or LC on the expression of the antioxidant enzymes were studied. Results showed that administration of LC and SeCl4 decreased CdCl2-induced increase in ALT and AST levels and reduced oxidative stress to normal levels. In addition, LC combined with SeCl4 had a highly synergistic effect and elevated significantly the enzymatic antioxidants and decreased lipid peroxidation levels compared with those in the CdCl2-treated group. It is clear from the data that both LC and SeCl4 inhibit liver injury and improve the redox state in mice.

International Spinal Cord Society (ISCoS) database: Asian Spinal Cord Network (ASCoN) Pilot Project [IDAPP].

STUDY DESIGN: Global mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database. OBJECTIVES: Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies. SETTING: Nine centers from Asia. METHODS: All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers. RESULTS: Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%). CONCLUSIONS: The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Morphological deformities of benthic foraminifera in response to nearshore pollution of the Red Sea, Egypt.

The Red Sea encompasses a wide range of tropical marine habitats that are stressed due to anthropogenic activities. The main anthropogenic activities are hydrocarbon exploration and important trading harbors. This work aims to assess the influence of the Red Sea coastal heavy metal contamination on the marine meiofauna along three sites (Ras Gharib, Safaga, and Quseir). Eight heavy metal (Cu, Cd, Zn, Pb, Cr, Co, Ni, and Mn) contents are considered in four benthic foraminiferal species (Elphidium striatopunctatum, Amphistegina lobifera, Amphisorus hemprichii, and Ammonia beccarii). Quseir Harbor showed the highest level of pollution followed by Safaga and Ras Gharib sites. The analyzed benthic foraminiferal tests displayed noteworthy high concentrations of Cd, Zn, and Pb in Quseir Harbor which could be attributed to the anthropogenic activities in the nearshore areas. Some foraminiferal tests exhibited abnormalities in their apertures, coiling, and shape of chambers. A comparison between normal and deformed foraminiferal tests revealed that the deformed ones are highly contaminated with elevated heavy metal contents such as Fe, Mn, Ni, and Cd. Statistics in addition to geo-accumulation and pollution load indices reveal a whistling alarm for the Quseir harbor. The present data are necessary to improve conservation and management of the Red Sea ecosystem in the near future.

Matrix metalloproteinase-3, vitamin D receptor gene polymorphisms, and occupational risk factors in lumbar disc degeneration.

BACKGROUND: Lumbar disc degeneration (LDD) is a process that begins early in life, contributing to the development of low back pain. LDD is a consequence of a variety of factors, and its etiology remains poorly understood. Objectives to investigate occupational and genetic risk factors inducing lumbar disc degeneration, and to evaluate the possible association of genetic polymorphisms of matrix metalloproteinase 3 (MMP-3) and vitamin D receptor (VDR) with the severity of LDD in an Egyptian population. SUBJECTS AND METHODS: A case control study involving 84 LDD and 60 controls was carried out. Five types of work related factors were investigated by questionnaire, complete neurological examination for all subjects and MRI for the cases. Polymerase chain reaction and restriction fragment length polymorphism methods were applied to detect polymorphisms in MMP-3 Promoter (-1,171 6A/5A) (rs 731236) and VDR-Apa (rs 35068180). RESULTS: We found that family history, back injury, smoking, high level of sitting, bending/twisting, physical workload, lifting, whole body vibration, mutant allele 5A of MMP-3 and mutant allele T of VDR were significantly associated with LDD (OR = 2.9, 3.1, 2.1, 11.1, 15.9, 11.7, 8.2, 12.6, 2.5 and 3.1 respectively, p < 0.05). Cases that carry allele 5A and/or allele T were associated with LDD severity. CONCLUSION: LDD is closely associated in occurrence and severity with occupational, environmental risk factors and susceptibility genes namely MMP-3, and VDR (ApaI). This study throws light on the importance of screening for early detection of susceptible individuals and disease prevention.

Efficacy evaluation of the protein isolated from Peganum harmala seeds as an antioxidant in liver of rats.

OBJECTIVE: To evaluate the curative effect of the 132 KD protein isolated from the seeds of Peganum harmala (P. harmala) L. against carbon tetrachloride (CCl(4)) induced oxidative stress in rats. METHODS: Animals were post treated intraperitoneally with 132 KD isolated protein at doses of 4 and 8 mg/kg body weight and bovine serum albumin (BSA) (8 mg/kg body weight) as well as vitamin C (250 mg/kg body weight p.o.) for 7 d after they challenged with CCl(4) orally (1 mL/kg body weight) in olive oil (50%) for 2 d. RESULTS: The purified protein from seeds of P. harmala plant showed in vitro antioxidant activity with DPPH assay. Administration of CCl(4) induced induction in serum aminotransferases (AST, ALT), alkaline phosphatase (ALP), lipid profile parameters and liver malondialdehyde (MDA) and decrease in serum total protein, liver superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) levels. 132 KD protein treatment of rats post CCl4 intoxication successfully alleviated the toxic effects of CCl(4). CONCLUSIONS: The isolated protein possessed strong antioxidant activity comparable to that of BSA (negative control) and vitamin C (positive control).

Efficacy evaluation of the protein isolated from Peganum harmala seeds as an antioxidant in liver of rats

OBJECTIVE@#To evaluate the curative effect of the 132 KD protein isolated from the seeds of Peganum harmala (P. harmala) L. against carbon tetrachloride (CCl(4)) induced oxidative stress in rats.@*METHODS@#Animals were post treated intraperitoneally with 132 KD isolated protein at doses of 4 and 8 mg/kg body weight and bovine serum albumin (BSA) (8 mg/kg body weight) as well as vitamin C (250 mg/kg body weight p.o.) for 7 d after they challenged with CCl(4) orally (1 mL/kg body weight) in olive oil (50%) for 2 d.@*RESULTS@#The purified protein from seeds of P. harmala plant showed in vitro antioxidant activity with DPPH assay. Administration of CCl(4) induced induction in serum aminotransferases (AST, ALT), alkaline phosphatase (ALP), lipid profile parameters and liver malondialdehyde (MDA) and decrease in serum total protein, liver superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) levels. 132 KD protein treatment of rats post CCl4 intoxication successfully alleviated the toxic effects of CCl(4).@*CONCLUSIONS@#The isolated protein possessed strong antioxidant activity comparable to that of BSA (negative control) and vitamin C (positive control).

Cervical spinal cord injury due to fall while carrying heavy load on head: a problem in Bangladesh.

STUDY DESIGN: Observational study. SETTING: Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. METHODS: This observational study was conducted on 84 patients of Cervical spinal cord injury (CSCI) due to fall while carrying heavy load on head. They were admitted at the CRP, Dhaka, Bangladesh between January 1999 and December 2001. Relevant personal information, neurological status, types of bony injuries and x-ray findings were noted down in pre-structured questionnaire. In addition, each subject was interviewed to find out the cause of accidental fall while carrying heavy load on head. RESULTS: Age of the studied subjects ranged between 10 to 50 years. All were male of whom 79 (94%) subjects were farmers and/or low cost daily laborers. In all, 72% percent of the subjects were carrying 60-80 kg weight on their head when fall occurred. A total of 48 (57%) subjects had complete neurological lesion. The most common vertebral levels were C5 and C6. So far the mechanism of injury is concerned hyper flexion of the cervical spine predominated (61%) over hyperextension (36%). CONCLUSION: Fall while carrying heavy load on head is a common cause of CSCI in Bangladesh. The victims are mostly young farmers or unskilled day laborers who were not habituated to carry heavy load on head.

Clinicovirologic analysis of hepatitis C infection in transfusion-dependent beta-thalassemia major children.

Regular blood transfusion puts beta-thalassemia major patients at a higher risk of developing hepatic iron overload and hepatitis C virus (HCV) infection. The association between several transfusion-related factors and an increased risk of developing HCV viremia has been reported. The effect of HCV infection on liver damage in transfusion-dependent thalassemia patients has been poorly described. A sample of 100 Egyptian transfusion-dependent beta-thalassemia major children were studied. Individual patients underwent full history taking, clinical examination and a panel of laboratory tests including HCV ribonucleic acid polymerase chain reaction (HCV-PCR) in blood samples. Liver biopsy was performed for 24 patients. HCV-PCR was positive in 64% of patients. A statistically significant correlation was found between HCV-PCR positivity (HCV viremia) and shorter inter-transfusion interval. There was a significant positive correlation between mean serum ferritin level and mean levels of alanine aminotransferase and aspartase aminotransferase. Histopathologic features of both chronic hepatitis and siderosis were present in 91.7% of biopsy specimens, and fibrosis was present in 41.67%. A higher risk of HCV viremia is noted with a shorter inter-transfusion interval. The reduced role of HCV infection in chronic liver injury in this group of patients may be surpassed by the associated effects of iron overload because of the chronic transfusion. However, the latter finding should be verified in larger studies.

Segmental tracheal replacement in mongrel dogs.

OBJECTIVE: To evaluate the use of alcohol- and detergent-preserved tracheal allografts in dogs. MATERIAL AND METHODS: Experimental segmental tracheal replacement was performed in 18 adult mongrel dogs. Three different techniques were tried in three groups of dogs. In the first group, a four-ring cervical tracheal segment was dissected out and implanted in the trachea of another dog. In the second group, the procedure was performed using a tracheal allograft that had been preserved in 70% ethyl alcohol for 20 days. In the third group, tracheal grafts were previously impregnated in 10% povidone iodine for 72 h before being implanted. Allografts were harvested 60 days after transplantation and assessed both histologically and in terms of the percentage patency. Dogs that died within 60 days were also included in the analysis. RESULTS: The best results were found in the group in which the tracheal allograft had been preserved in ethyl alcohol and this was explained by the reduced antigenicity of the graft in this group. CONCLUSIONS: The use of alcohol-preserved allografts is a practical method of tracheal transplantation, and the alcohol-preservation technique markedly reduces the immunogenicity of the grafts.

Schistosomal pelvic floor myopathy contributes to the pathogenesis of rectal prolapse in young males.

PURPOSE: Rectal prolapse is common in young males in Egypt. The role of schistosomiasis in the pathogenesis of rectal prolapse is not clearly defined. The purpose of this work is to study changes in the pelvic floor muscles in patients of rectal prolapse associated with schistosomiasis. METHODS: This study included 33 male patients with rectal prolapse of whom 27 patients with schistosomiasis and 6 patients free from schistosomiasis. Biopsies were taken from the pelvic floor muscle during surgery. The prepared sections were examined for histopathologic structural changes, for ultrastructural changes (by using electron microscopy) and after immunohistochemical staining by using anti-IgG and anti-IgM antibodies. RESULTS: The muscles from the patients without schistosomiasis had no histologic or EM changes and showed negative staining for IgG and IgM. Myopathic changes were found in the group of patients with schistosomiasis, including increased variation in the fiber diameter in 66.6 percent of patients, degenerative changes in 59.26 percent of patients, fiber splitting and fragmentation in 44.4 percent of patients, and endomysial fatty changes in 55.5 percent of patients. Ultrastructural study revealed starting loss of striation and margination of the nucleus in 70.37 percent of patients, distorted myofibrillar pattern in 51.85 percent of patients, disturbed endoplasmic reticulum and increased glycogen granules in all patients, the mitochondria are irregularly arranged with electron dense matrix in 40.74 percent of patients, and prominent nuclear sap in 13.72 percent of patients. The muscles of all the schistosomal patients showed a positive cytoplasmic staining for immunoglobulin G, of them only 12 patients showed positive staining for IgM. CONCLUSION: Patients with schistosomiasis suffer from pelvic floor myopathic changes that may contribute to the pathogenesis of rectal prolapse in young males. The immunohistochemical findings suggest immunologic mechanism for this myopathy.

[Surgical procedures in selected proctological patients with local anesthesia. Study of 150 cases]. / Procedimentos cirúrgicos em pa cientes proctológicos selecionados, sob anestesia local. Estudo de 150 casos.

Experience in the treatment of 150 patients with anorectal disorders and disorders of the sacrococcygeal region who were operated on with local anesthesia at the University Hospital, ABC Medical School, São Bernardo do Campo, SP, Brazil, from March 1995 to March 1998. The anesthesia technique, the operations carried out and the tolerance to the procedure are reported. Intraoperative morbidity was 10.6% (16 patients), and postoperative morbidity was 6% (nine patients). The age of patients was between 15 and 92 years old, with mean age 42 years old; 58% of patients were male and 42% female. Surgical mean time was 45 minutes and the patients remained in the hospital for a mean time of 8 hours. All of patients was instructed about the anesthesia technique, their advantages and disadvantages, and only with their permit the surgery was programmed. Hospitalization was required in five patients (3.3%). The anesthesia technique employed was the same for all patients. Upon survey, 96.7% of the patients stated they did not feel pain during the surgery and that they would go through the procedure again. The authors conclude the surgical treatment of anorectal disorders and disorders of the sacrococcygeal region with local anesthesia is viable and safe, and in addition, is well accepted by the patients.

A comparison between human, crustacean and bivalve isolates of Microsporidia.

Identification of Microsporidia detected in diarrhoeic stool of human and from press preparation of crabs, and bivalves muscles was done by staining with Giemsa, modified trichrome and H & E stains respectively. Positive samples were isolated & used for infection of 3 groups of mice viz group A human isolate, group B crab & group C bivalve isolates. Parasitological and histopathological studies using light and transmission electron microscopy (TEM) were done for samples from each group. The results clarified that human, crab & bivalve Microsporidia isolates showed common features. They were found in the supranuclear region of enterocytes. The stages observed were meronts, sporonts and free spores. Each spore was 1-2 um in length containing a single nucleus, a vacuole and a polar filament. Further genetical and biochemical studies will be undertaken to confirm the similarity or differences between these isolates.