Biochemical, morphological and molecular assessments of n butanol fraction of Phoenix dactylifera L. following exposure to inorganic mercury on the liver of Wistar rats.

BACKGROUND: Mercury chloride (HgCl2) damages tissues it comes in contact with in sufficient concentration. This study evaluated the protective effects of n-butanol fraction of Phoenix dactylifera (BFPD) on mercury-triggered liver toxicity in Wistar rats. 25 male rats were divided into 5 groups of 5 rats each. Group I was administered 2 ml/kg of distilled water; group II was administered 5 mg/kg of HgCl2; group III was administered 500 mg/kg of BFPD + 5 mg/kg of HgCl2; group IV was administered 1000 mg/kg of BFPD + 5 mg/kg of HgCl2, while group V was administered 100 mg/kg of silymarin + 5 mg/kg of HgCl2. orally for 2 weeks. The rats were euthanized and liver tissue blood samples were collected for histological, histochemical, stereological, immunohistochemical, molecular, and biochemical studies. RESULTS: The results revealed that HgCl2 induced oxidative stress in the rats evident by histoarchitectural distortions and altered levels of liver enzymes, proteins, and oxidative stress biomarkers when compared to the control. However, BFPD treatment restored these changes. Glutathione peroxidase levels decreased (p < 0.05) in the HgCl2-treated group when compared to the control and BFPD-treated groups. HgCl2 group revealed reduced reactivity with histochemical and immunohistochemical stains (Masson's Trichrome and B cell Lymphoma 2) when compared to the control, with a significant decrease in quantified liver Bcl-2 stain intensity when compared to the silymarin-treated group. BFPD administration revealed normal staining intensity comparable to the control. HgCl2 administration revealed a remarked decrease in the number of hepatocytes when compared to the control, BFPD, and silymarin groups. BFPD preserved (p < 0.05) the stereological features when compared to the HgCl2-treated group. GPx activity in the liver decreased (p < 0.05) with HgCl2 administration when compared to the control and silymarin-treated groups. BFPD attenuated GPx gene activity to levels similar to the control indicating some level of amelioration against HgCl2-induced toxicity. CONCLUSIONS: The ability of BFPD to mitigate HgCl2 triggered liver alterations could be attributed to the antioxidant property of its flavonoid content. Therefore, BFPD may be a potential candidate for treating and managing liver-induced mercury intoxication.

Death Due To Electrocution- An Autopsy Based Study at Chattogram Medical College Morgue House.

As we less frequently encounter cases of death due to electrocution, less attention is given to them. These all have significant impact on morbidity and mortality of the common people of different ages. This autopsy based retrospective study (from January 2014 to December 2016) was carried out by the history of the case, inquest report and by doing thorough autopsy of each of the cases at Chattogram Medical College Mortuary, Bangladesh. Fifty (50) cases of electrocution accounted for 1.23% of the total 4020 autopsies. Male victims i.e. 43(86%) outnumbered the females 7(14%). The majorly affected age group was 21-30 (24 cases) followed by 31-40 years (13 cases) and 41-50 years (5 cases). The commonest place of occurrence was on the street side in 33 cases (66%) followed by home 17 (34%). High tension wire i.e. in 28 cases (56%) were the main causative agents followed by home appliances 16 (32%) and water pump 6 (12%). In relation to distribution of entry and exit wounds, we observed evidence of both entry and exit wounds in 32 cases (64%) followed by no entry or exit wounds in 11 (22%) and entry wounds only in 7 (14%). As per this study, entry wounds were present in the upper limbs in 34 cases (68%) followed by head-neck (7 cases) and lower limbs (3 cases). We also observed maximum exit wounds were in the lower limbs i.e. in 36 cases (72%) followed by upper limbs (5 cases) and chest-abdomen (2 cases). Considering manner of death, we observed all the cases of electrocution i.e. 50 cases (100%) were of accidental. Electrocution accounts for a smaller proportion of all unnatural deaths which could be prevented by adequate awareness and adopting safety measures.

Do It Better: Cross Mattress for Chest Drain Insertion Site Security Offers Quality Outcome in Chest Trauma Patients Required Tube Thoracostomy.

We examined the hypothesis that the cross mattress for chest drain insertion site security is better than that of polypropylene horizontal mattress in chest trauma patient required tube thoracostomy at the Department of Casualty Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to June 2016. Accordingly we prospectively studied 50 consecutive patients who needed chest tube insertion. In 25 consecutive cases chest drain insertion site was secured with polypropylene horizontal mattress technique (Control- Group A) and another 25 consecutive patients had a cross-mattress with non-absorbable suture materials (Experimental- Group B). All chest tubes were inserted into the triangle of safety to following the BTS guideline. A baseline x-ray chest was compared with post-procedure chest x-ray. Male preponderance and young adults were comprised in both the groups; mean age in Group A and Group B was 38.7±15.5 and 37.3±14.1 respectively. Haemo-pneumothorax was the most common cause of tube thoracostomy among the trauma victims. This study shows that, polypropylene horizontal mattress results in increased chest tube site infection 52% in Control Group vs. 12% in Experimental Group (p=0.002). Although there was similar incidence of blood loss between the groups, the length of Hospital stay was significantly higher in Control Group. We conclude that cross mattress for chest drain insertion site security showed a better clinical outcome, less wound complications and less hospitalization.

Anti-hyperglycaemic Effects of Rutin on Blood Glucose, Oxidative Stress Biomarkers and Lipid Peroxidation in Alloxan-induced Hyperglycaemic Wistar Rats.

The present study investigated the anti-hyperglycaemic effect of rutin on blood glucose, oxidative stressbiomarkers and lipid peroxidation in alloxan induced hyperglycaemic wistar rats. Diabetes was induced in rats by anintraperitoneal (i.p) injection of alloxan monohydrate 150 mg/kg body weight. Twenty five wistar rats were divided asfollows; Group1 served as diabetic control received distilled water 2 mg/kg, Group served as positive control received 2mg/kg glibenclamide, 3, 4 and 5 received rutin at 50, 100 and 200 mg/kg body weight for 28 days respectively. At the end of the treatment, rats were sacrificed and the blood and serum were used for the analysis of blood glucose and oxidativestress biomarkers respectively. The determinations of blood glucose levels were carried out at intervals of 7, 14, 21 and 28days respectively Serum oxidative stress biomarkers lipid peroxidation, were done on the 28 days. Administrations of rutinat the three different doses 50,100 and 200 mg/kg to diabetic rats significantly (p<0.05) decreased the blood glucose levelsas compared to diabetic control. The dose of 200 mg/kg exhibited a maximum glucose lowering effect with blood glucoseof 102.8± 0.06 as compared to diabetic control 346.2±0.16. Furthermore, in relation to the oxidative stress biomarkers therewas a significant (p<0.05) increased in the levels of gluthathione peroxidase, superoxide dismutase and catalase as comparedto control. However, there was also a significant decreased in the malondialdehyde levels as compared to control. It may beconcluded that oral administration of Rutin for 28 days decreases blood glucose levels and prevented oxidative stress andantioxidant status in hyperglycaemic rats.

Pattern of Head Injuries (Cranio-cerebral) due to Homicide in Association with Other Injuries: A Retrospective Post-mortem Study Autopsied at Dhaka Medical College Morgue House.

Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%).

An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh.

BACKGROUND: Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. METHODS: Using adapted World Health Organization (WHO) hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6) and sub-district (n=12) hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS) data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. RESULTS: Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. CONCLUSION: Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy.

Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0.05). Positive findings were identified at endoscopy in 80%. Duodenal ulcers were the most common lesion and adrenaline the most common method of haemostasis. Median time to first endoscopy was 0 (IQR, 0-1) days. Seven (17%) patients re-bled, median Rockall score was six (IQR, 4-8). Three (7%) patients experienced procedural complications, two patients became hypoxic and one patient died. Following endoscopy, antiplatelets were restarted after a median of three (IQR, 3-5) days. On discharge, 27/28 (96%) patients continued with antiplatelet and proton-pump inhibitor therapy. Thirty-day inpatient mortality was 7% (3 patients). One patient re-bled within six months of discharge. Endoscopy helped assess the risk of re-bleeding and timing of antiplatelet re-introduction in cardiac inpatients experiencing UGIH.

Clostridium difficile-associated disease acquired in the neurocritical care unit.

BACKGROUND: Clostridium difficile is an important cause of nosocomial infection on the intensive care unit. Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired on the NICU. METHODS: Patients on NICU with a positive stool Clostridium difficile toxin assay, from August 2004 to February 2008, were identified by the Department of Microbiology. Each patient's medical notes and charts were reviewed in turn. Patients with a positive assay within 48 h of NICU admission were excluded. RESULTS: Twenty-one (0.6%) NICU patients developed CDAD. All were emergency admissions, 18 (86.0%) were neurosurgical. Subarachnoid hemorrhage was the most common diagnosis, 5 (23.8%) patients. Median age and APACHE II score on admission were 55 (IQR 40-66) and 21 (IQR 16-24), respectively. Thirteen (61.9%) patients were female. Median interval between NICU admission and diarrhea onset and CDAD diagnosis were 5 (3-8) days and 7 (4-12) days, respectively. At the time of diagnosis most, 11 (52.4%) patients, had moderate CDAD. Previously identified risk factors for ICU-acquired CDAD comprised: age > 65 (6), antibiotics (21), and medical device requirements (21). Five (23.8%) patients deteriorated clinically as a result of CDAD. The overall in-hospital mortality for those with NICU acquired CDAD was 19%. CONCLUSIONS: Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may experience complications. Prospective validation of severity definitions and treatment guidelines may help to reduce the complication rates.

Vaccination coverage survey in Dhaka District.

A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.

Studies on phlebotomine sandflies in an active focus of leishmaniasis in the Sudan.

The present work is a pilot experiment meant to provide base line information on cutaneous and visceral leishmaniasis in an active focus on the White Nile, Sudan. The topics covered include species of sandflies prevailing in the area, anthropophily, endophily, suspected vector and reservoir host, seasonal and daily rhythm of activity and susceptibility to insecticides.

Response of inbred mice to aerosol challenge with Mycobacterium tuberculosis.

An autosomal dominant gene (Bcg), which maps to mouse chromosome 1, has been shown to confer on mice resistance to attenuated Mycobacterium bovis BCG Montreal, Salmonella typhimurium, and Leishmania donovani. Most animal models used for the study of the Bcg gene have involved intravenous injection of a large number of microorganisms (greater than 10(4) CFU). The present study examines the effect of the Bcg gene on the resistance of inbred mice to challenge via the respiratory route with 5 to 10 CFU of virulent Mycobacterium tuberculosis. The number of tubercle bacilli recovered from the lung lobes indicates that the growth kinetics of the microorganism did not differ between BCG-resistant and BCG-susceptible strains of mice. The number of tubercle bacilli recovered from the spleen was also similar among strains. Although there were reproducible differences in the time of first recovery of bacilli from the spleen, these differences appeared to be unrelated to the expression of the Bcg gene. When mice were challenged with purified protein derivative, all strains responded similarly as observed by measurements of footpad swelling.