Bowel Habit Pattern of Patients with Self-Reported Constipation at Out Patient Department in North East Part of Bangladesh.

The aim of this study was to observe the symptoms and bowel habit pattern experienced by patients presenting with self reporting constipation at Out Patient Department in a tertiary care hospital. It was a cross-sectional study which was conducted in Out Patient Department of gastroenterology in North East Medical College Hospital, Sylhet, Bangladesh from January 2017 to December 2018. Total 228 consecutive patients with self reported constipation were enrolled in this study. Patients with history of abdominal surgery, known chronic disease, age below 18 years, pregnant women, patients using drugs like anti-depressant, anti-psychotic and patients unwilling to take part in the study were excluded. Demographic data, symptoms, bowel habit pattern and character of stool were recorded at enrollment in a pre-designed data sheet. Total 228 patients, male 130(57.0%) and female 98(43.0%), age varying from 18-81 years (mean age 38.7±15.10 years) were included. Among them 127 patients (55.7%) was experienced daily bowel motion with frequency varying from one to seven and 99 patients (44.3%) had infrequent stools. Sixteen (16) patients (7.0%), 182 patients (79.8%) and 30 patients (13.2%) had feeling of complete bowel evacuation all time, few days in a week and almost never respectively. Among the patients 127(55.7%), 29(12.7%), 06(2.6%), 02(0.9%) and 64(28.1%) complained of hard, soft, semi liquid, liquid and stool of variable consistency respectively. In this study 159(63.73%), 21(9.21%) and 43(18.85%) patients were regularly taking Proton pump inhibitor (PPI), anti- diabetic drugs and anti-hypertensive drugs respectively. The finding suggests that there was a wide variation of self perception of constipation among the patient. The study concludes that patient's perception regarding constipation does not always match the traditional medical definition. Overall findings signify that symptoms like stool consistency, volume, and feeling of incomplete evacuation are more important rather than frequency of bowel per week in patients' perception regarding constipation. However, further study with large sample size in different hospitals in different areas could explain this observation more precisely.

A Study of Association between H. Pylori Genotype and Chronic Gastritis.

The prevalence of Helicobacter pylori (HP) infection is very high in Bangladesh. Chronic gastritis due to H. pylori is commonly associated with important gastric diseases such as peptic ulcer diseases or gastric carcinoma and MALT-oma. The natural course of chronic gastritis is HP-associated antral gastritis or pangastritis or rarely atrophies. This study was done to see the association of H. pylori genotypes with chronic gastritis. This observational cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University from July 2012 to April 2013 to find out the association of H. pylori genotypes with chronic gastritis in dyspeptic patients of Bangladesh. A total of 50 dyspeptic subjects were involved in the study whose upper GI endoscopies were carried out in presence of an experienced endoscopist. During the procedure four biopsies were taken, two from the antrum and two from body of the stomach. Endoscopic diagnosis was categorized into normal and erosive gastritis. Two (one from antrum and one from body) biopsy samples were collected in phosphate buffer saline and PCR analysis carried out by Multiplex PCR assay. Another two were collected in 10% formalin and histopathological examination was done according to updated Sydney system of classification. Among 50 patents only 34 were PCR positive. So, only 34 subjects were included in the study. Among them 21 patients (61.8%) were male and 13 patients (38.2%) were female, with the mean age of 29.91 years. Endoscopy revealed erosive gastritis in 5(14.7%) patients and normal findings in 29(86.3%) patients. Amongst the strains, cagA gene was detected in 58.8% and was not significantly associated with severity of any parameter of chronic gastritis such as H. pylori density, inflammation (mononuclear infiltration), activity (neutrophilic infiltration), atrophy and intestinal metaplasia. All the strains were positive for vacA allele. s1m1 (55.9%) genotype was most predominant. No vacA allele (s1m1, s1m2, s2m1 and s2m2) were significantly associated with severity of chronic gastritis. In this study, H. pylori genotype -cagA, vacA-s1, s2, m1, m2 allele and histological grading of chronic gastritis according to updated Sydney system of classification is identified. This study will identify the genotypes associated with severe gastritis in our country and thereby help us to take appropriate preventive measure. Further study with larger sample size may be carried out to establish proper association between different genotypes and parameters of chronic gastritis.

Unraveling systematic inventory of Echinops (Asteraceae) with special reference to nrDNA ITS sequence-based molecular typing of Echinops abuzinadianus.

The present study explored the systematic inventory of Echinops L. (Asteraceae) of Saudi Arabia, with special reference to the molecular typing of Echinops abuzinadianus Chaudhary, an endemic species to Saudi Arabia, based on the internal transcribed spacer (ITS) sequences (ITS1-5.8S-ITS2) of nuclear ribosomal DNA. A sequence similarity search using BLAST and a phylogenetic analysis of the ITS sequence of E. abuzinadianus revealed a high level of sequence similarity with E. glaberrimus DC. (section Ritropsis). The novel primary sequence and the secondary structure of ITS2 of E. abuzinadianus could potentially be used for molecular genotyping.

Faecal elastase-1 concentration in cystic fibrosis patients with CFTR I1234V mutation.

AIM: To assess the exocrine pancreatic function among cystic fibrosis patients with cystic fibrosis trans-membrane conductance regulator (CFTR) I1234V mutation. METHODS: Cross-sectional study of 40 cystic fibrosis patients with homozygous CFTR I1234V mutation belonging to a large Arab kindred family and 25 healthy subjects as a control group over a period of 12 mo. Assessment of their exocrine pancreatic function was performed by measuring faecal elastase-1 (FE1) concentration with a commercial ELISA kit using polyclonal antibodies (BioServ Diagnostics) in CF patients compared to healthy subjects. The results were compared with those obtained from a second laboratory using another commercial ELISA (ScheBo; Biotech, Germany) that uses two monoclonal antibodies against different specific epitopes of human pancreatic elastase. RESULTS: All CF patients with CFTR I1234V mutation had normal levels of faecal elastase 1. No significant difference was found between the two methods for the CF groups or between the CF patients with and without pancreatic enzyme replacement. CONCLUSION: Cystic fibrosis with homozygous CFTR I1234V mutation is associated with pancreatic sufficiency. Assessment of exocrine function using polyclonal antibodies does not significantly differ from that using two monoclonal antibodies against different specific epitopes of human pancreatic elastase.

The effect of high plasma levels of angiotensin-converting enzyme (ACE) and plasminogen activator inhibitor (PAI-1) on the reperfusion after thrombolytic therapy in patients presented with acute myocardial infarction.

UNLABELLED: The resistance to thrombolytic agents and delays in reperfusion occur in more than 30% after acute myocardial infarction. This may play an important role in the unsuccessful recanalization after thrombolytic therapy. The aim of this study is to assess the clinical and biochemical markers of reperfusion after different types of thrombolytic therapy and to find out the relationship between PAI-1 and ACE serum levels and the short-term outcome. Pretreatment ACE and PAI-1 plasma levels of 184 patients with acute myocardial infarction, treated with thrombolytic therapy were determined. Failure of thrombolysis was considered when reperfusion was delayed as assessed by noninvasive reperfusion criteria, reinfarction, and impaired left ventricular function. High plasma level of ACE (> 50 U/L), PAI-1 (> 43 ng/ml) and both was found in 57, 108 and 32 patients respectively. Subjects with high ACE plasma levels were characterized by impaired LV systolic function (79.0% vs. 75.0%), new Q-wave (88.4% vs. 74.2%), less reperfusion arrhythmia (19.3% vs. 22.8%) and prolonged hospitalization (70% vs. 66%) but no statistical significance was observed. High enzymes levels of PAI-1 were observed with higher incidence of anterior myocardial infarction (50.0% vs. 41.0%), lesser ST segment resolution (65.6% vs. 58.8%), reinfarction (6.3% vs. 5.9%), and impaired LV systolic function (90.6% vs. 76.0%), and prolonged hospitalization (70.4% vs. 63.4). There was a statistically significant difference between thrombolytic agents in the presence of high ACE regarding hospital overstay (p = 0.02). While the presence of high PAI-1 was significantly affect the degree of ST-segment resolution (p = 0.03). CONCLUSION: High plasma ACE and/or PAI-1 plays a considerable role in the higher incidence of unsuccessful reperfusion and impaired left ventricular function after thrombolytic therapy. A rapid diagnostic tool that enables physician of detecting those enzymes before giving thrombolytic therapy may change the strategy of treatment to offer another effective revascularization method.

Gender differences in functioning for older adults in rural Bangladesh. The impact of differential reporting?

BACKGROUND: The purpose of this study is to examine gender differences in functional ability among older adults in rural Bangladesh in terms of both self-reported activities of daily living and observed physical performance and to evaluate the extent to which differential reporting by gender contributes to disparities between the two measures. METHODS: In 1996, the Matlab Health and Socio-Economic Survey collected data on self-reported activities of daily living (ADLs) and observed physical performance for 1,893 men and women aged 50 and older in the Matlab Surveillance area in rural Bangladesh. Gender differences were examined in both self-reported ADLs and physical-performance measures. With physical-performance measures as the gold standard, logistic regression was used to determine how much of the gender difference in the self-reported function was explained by physical-performance ability controlling for age. RESULTS: Older women in this study population consistently had more limitations than men in both self-reported ADLs and observed physical performance. For the same level of observed physical performance, however, older women were more likely than men were to report a higher level of ADL limitation. This reported female health disadvantage varied considerably depending on the nature of the ADLs being examined and the type of scoring system used for the ADLs. CONCLUSIONS: One has to be somewhat cautious in interpreting gender differences in self-reported ADL limitations, as they are affected by the gender-specific nature of the reported activity and by gender differences in the perception of response categories.

The impact of co-resident spouses and sons on elderly mortality in rural Bangladesh.

This paper uses prospective data from the Matlab surveillance system in rural Bangladesh to demonstrate that initially co-resident spouses and sons have a major impact on the subsequent mortality of old people, with significant differences by the sex of the elderly person, and the age of the son. Spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. Finally, this analysis suggests that the impact of spouses and sons on mortality in old age is not substantially mediated through changes in elderly economic status.

PIP: This study uses a prospective data with a large sample size from rural Bangladesh to examine the impact of co-resident spouses and sons on the subsequent mortality of old people, with significant differences depending on the sex of the elderly person and the age of the son. Findings revealed that spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. In conclusion, it is clear that in the study population, the presence of co-resident sons and spouses acts in a complex way to affect mortality in old age, with elderly women being particularly vulnerable to these effects. No single mechanism can fully explain the varying impact of spouses and sons. Not only may different mechanisms (protection through increased social integration/enhanced stress buffering/improved information networks, protection through improved economic status, and selection into co-residences on the basis of health status) be operative in the case of spouses versus son, but more than one mechanism may be responsible in each case.

Age and gender variation in the impact of household structure on elderly mortality.

BACKGROUND: There is little information about the impact of household structure and composition on elderly mortality in developing countries. This study examines the impact of relationship to head of household, and the presence of co-resident spouses and sons on elderly mortality in rural Bangladesh with a particular focus on age and gender differences. METHODS: A total of 9365 individuals aged > or = 60 at baseline (5128 males and 4237 females) in the Matlab Surveillance area in rural Bangladesh were followed for a period of 8 years (1974-1982) with all predictors (the presence of a spouse, one or more co-resident adult sons, relationship to head of household, household economic status, age and disability status) being measured at the beginning of follow-up. Cox proportional hazard models were used in the analysis. RESULTS: Being the head of household had a significant impact on reducing elderly mortality for both men and women. The presence of a spouse reduced mortality for all elderly men but had a significant beneficial impact only on women whose husbands were heads of households. Finally the presence of one or more co-resident adult sons reduced mortality for elderly women but not for elderly men. For all three of the above predictors there was a decline in effect with the age of the elderly. CONCLUSIONS: Relationship to head of household and the presence of spouses and sons have powerful impacts on reducing mortality for elderly men and women in rural Bangladesh with the effects varying significantly by gender and age. Furthermore, individual rather than joint access to material resources is an important determinant of elderly mortality.

An analysis of serum estradiol and serum progesterone in postmenopausal women of karachi suffering from breast cancer.

The cancer patients (39) and control (12) were subjected to postmenopausal hormonal evaluation in which serum estradiol and serum progesterone values were found to be 54.56 +/- 10.20 pg/ml as compared to 18.66 +/- 6.31 pg/ml and 0.170 +/- 0.01 ng/ml as compared to 0.229 +/- 0.01 ng/ml respectively. Consequently it was inferred that in cancer postmenopausal patients when serum estradiol level increases the serum progesterone level decrease and vice versa.

American families: trends and correlates.

PIP: Discussion focused on the nature of the roles of the family, a review of the major demographic changes (marriage, cohabitation, nonfamily households, remarriage, fertility, teenage pregnancy, and female employment) affecting the American family in the past decades, and the nature of the impact on women, men, and children. There were four major trends identified: 1) increased proportions of children living in single-parent families due to high rates of divorce and increased childbearing outside of marriage; 2) increased proportions of adults in nontraditional living arrangements; 3) increased female labor force participation during all stages of the life cycle; and 4) decreased proportions of children and increased proportions of older people out of total population due to declining mortality and fertility rates. Family formation arises out of childbearing and childrearing roles, the need for companionship and emotional support, and the opportunities for specialization and trade, and the economies of scale. The costs of family living may include the potential for disagreement, conflict, loss of privacy, and time and money. There were a number of reasons identified for not maintaining traditional families consisting of a married couple with children. The trends were for later age at marriage: 24.4 years in 1992 for women, increased cohabitation (almost 50% cohabiting prior to first marriage in 1985-86), decreased number of married couple households, and increased number of adults in non-family households. The divorce rate has risen over the past 100 years with peaks in the 1970s; the reasons were identified as increased baby boomers and new marriages, increased labor participation of women, and changes in gender roles. The stabilization and slight decline in rates may be due to a natural leveling, the likelihood of greater stability within new marriages, and the aging of the baby boomers. An anticipated increase in divorce rates in the future was also justified. Remarriage rates varied by gender, age at separation/divorce, presence of children, race/ethnicity, and education. Fertility remained stable at 1.8 during the late 1970s and early 1980s and increased slightly to 2.0 in 1989. IN 1990, there were 25% out-of-wedlock births compared to 5% in 1960. About 12% of births in 1989 were to teenagers. There has been an increase in female-headed households, the median income of which in 1992 was $13,012, or 33% of married couple income.^ieng

Health related response to natural disasters: the case of the Bangladesh cyclone of 1991.

This paper evaluates the health related response to large natural disasters using the example of the recent Bangladesh cyclone of 1991. After providing a description of the extent of the health response, it focuses on three major issues: (i) assessment of needs (ii) coordination of major groups involved in health relief and rehabilitation efforts and (iii) appropriateness and effectiveness of the health response in terms of definable outcome criteria. The conclusions are that in the case of the Bangladesh cyclone: (a) the assessment of needs was more reactive rather than anticipatory and was not based on any systematic data gathering from the field; (b) in contrast to previous disaster situations there was excellent coordination of the major groups involved in the aid process (the government, the armed forces and non-governmental organizations) and (c) given the caveat of inadequate baseline information, it appears that the health response was prompt and effective in preventing any increase in mortality from diarrheal diseases and measles. The reasons for the deficiencies and successes of the health response are analysed and finally a list of detailed recommendations to facilitate future disaster/cyclone management and response is provided.

American families: policy issues.

"Increases in the number of children living in single-parent (usually female-headed) households and in the proportion of mothers who work outside their homes have raised concern in the United States about the effects of these trends on the well-being of children and the possible need for policy intervention. This paper discusses the arguments for and against policies that affect families. We review a number of such policies and what research suggests about their likely effects. The policies discussed...include those concerning child support, welfare, income taxes, child and dependent care, family leave, family planning, programs to improve parenting skills and family function, and economic growth."

Extraction and identification of different prostaglandins in Allium cepa.

Green onions (Allium cepa) were homogenized in a blender and extracted by normal extraction methods except that diethyl ether was used as the first extracting solvent. Different analytical procedures were used for the identification of the prostaglandins separated. TLC was applied using silica gel 60 F254 plates and a mixture of benzene, dioxane and acetic acid (20:10:1) as eluent, and the Rf values were compared with those of authentic samples. GC analysis on an SE 30 packed column and FID was applied; relative retention times of the onion extract components were measured and matched with authentic prostaglandin samples using cholesterol as an internal standard. GC-MS analyses using the same conditions adopted for GC analysis were conducted on a Finnigan MAT 112S instrument. Four peaks were identified. The prostaglandins identified were F1 alpha, E1, B1 and A2.