Comparison between Carbetocin and Oxytocin in Active Management of 3rd Stage of Labour in Preventing Post Partum Hemorrhage.

The third stage of labour is considered to be the most critical part of child birth due to the risk of post partum haemorrhage (PPH). To compare the effectiveness of carbetocin and oxytocin in the management of 3rd stage of labour in preventing post partum hemorrhage, this experimental clinical trial was conducted in the Department of Obstetrics and Gynecology, Sir Salimulla Medical College Hospital, Dhaka, Bangladesh from January 2015 to June 2016. Three hundred women undergoing normal vaginal delivery were consecutively enrolled. They were divided into two groups, one group was treated with carbetocin 100µg IV and another group was treated with oxytocin 10 unit IV. Post partum haemorrhage was developed in 23(15.3%) and 31(20.7%) patients in carbetocin and oxytocin groups respectively. Among these PPH patients, 17(73.9%) patients received oxytocin, 21(91.3%) patients received Ergometrin and 14(60.9%) patients received misoprostol in carbetocin group as additional drug. In oxytocin group 30(96.8) patients received ergometrin and 26(83.9) patients received misoprostol. Significantly higher number of patients was treated with balloon catheter in oxytocin group (77.4%) than carbetocin group (39.1%). Thirteen (41.9%) patients in oxytocin group and 4(17.4%) patients in carbetocin group needed to treat in ICU. In carbetocin Group I patient (4.3%) and in oxytocin Group II patients (6.5%) died. carbetocin is better than oxytocin in the management of 3rd stage of labour to prevent post partum haemorrhage (PPH).

Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Obstructive Jaundice in Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP).

This cross sectional study was carried out in the department of Radiology and Imaging in collaboration with Department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2014 to evaluate the efficacy of Magnetic resonance cholangiopancreatography (MRCP) and ERCP in the management of obstructive jaundice and also to determine diagnostic validity accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in evaluation of obstructive jaundice. For this purpose, a total of 60 patients with obstructive jaundice who underwent MRCP and Endoscopic retrograde cholangiopancreatography (ERCP) in the above mentioned hospital were enrolled. More than one third (35.0%) patients were in 5th decade and the mean age was 46.2±12.9 years. Male female ratio was 1.1:1. Most (45.0%) of the patients had filling defect, 28.3% had concentric stenosis and 26.7% eccentric stenosis. In MRCP findings more than one third (35.0%) patients had choledocholithiasis followed by 26.7% had cholangiocarcinoma, 10.0% benign CBD stricture and 8.3% had ascariasis. In ERCP findings 31.7% patients had choledocholithiasis followed by 16.7% had cholangiocarcinoma, 13.3% benign CBD stricture and 10.0% ascariasis. All patients had increased serum bilirubin.

The effect of air mass origin on the ambient concentrations of 7Be and ²¹°Pb in Islamabad, Pakistan.

Concentration of radionuclides ²¹°Pb and 7Be, having half lives of 22.3 years and 53.29 days, respectively, in the surface air samples of Islamabad (33.38°N, 73.10°E and Altitude ∼536 m asl.) are measured. The non-destructive technique of gamma-spectrometry, with a high purity germanium HPGe detector, was employed for the analysis of all samples. The annual average concentrations of ²¹°Pb and 7Be in the surface air samples were determined as 0.284 ± 0.15 and 3.171 ± 1.14 mBq m⁻³, respectively. Our results have shown a seasonal variation of the concentration of 7Be in air samples with high values for the spring season. High concentrations for ²¹°Pb are obtained when air masses originate from plain areas of Pothohar region, located in the South-West, West and North West of Islamabad. Our values of concentrations show a nice agreement with the relevant reported results.

Estimation of mean annual effective dose through radon concentration in the water and indoor air of Islamabad and Murree.

Different samples of water, indoor air and soil gas have been collected from Islamabad (33 degrees 38'N, 73 degrees 09'E, altitude of 1760 ft.), the capital of Pakistan and Murree (33 degrees 53'N, 73 degrees 23'E, altitude of 7323 ft.), lying on a geological fault line and are analysed for the estimation of mean effective dose through radon concentrations by using RAD-7, a solid state alpha-detector. The variation of radon concentration in water, indoor air and soil gas in Islamabad region ranges from 25.90-158.40 kBq m(-3), 43.26-97.04 Bq m(-3) and 17.34-72.52 kBq m(-3), having mean values 88.63 kBq m(-3), 70.67 Bq m(-3) and 45.08 kBq m(-3)(,) respectively. It ranges from 1.64-10.20 kBq m(-3), 18.48-42.08 Bq m(-3) and 0.61-3.89 kBq m(-3) with mean values 4.38 kBq m(-3), 28.63 Bq m(-3) and 1.70 kBq m(-3)(,) respectively in Murree and its surroundings. The total mean annual effective doses from water and indoor air of Islamabad and Murree regions are 2.023 and 0.733 mSv a(-1), respectively. These doses are within the recommended limits of the world organisations.

Occupational exposure from external radiation used in medical practices in Pakistan by film badge dosimetry.

Occupational exposure data of workers due to external sources of radiation in various medical practices such as nuclear medicine (NM), radiotherapy and diagnostic radiology (DR) in Pakistan were collected and analysed. Whole-body doses of workers were measured by film badge dosimetry technique during 2003-2007. Annual average effective dose in NM, radiotherapy and DR varied in the range of 1.39-1.80, 1.05-1.45 and 1.22-1.71 mSv, respectively, during 2003-2007. These values are quite low and well below the annual limit of 20 mSv averaged over a period of 5 consecutive years. Nobody received the radiation dose >50 mSv in any single year over a period of 5 consecutive years; therefore, no overexposure case has been detected. Decreasing trend of annual average dose values in aforementioned categories of work during 2003-2007 indicates the improvement of radiation protection status in medical field in Pakistan.

Radiological impact of composite food served at PINSTECH.

To determine radiological impact of composite food served at Pakistan Institute of Nuclear Science and Technology (PINSTECH) on its worker, cooked meals were collected during 2000-2007 and analysed by gamma and beta radiometry techniques for naturally occurring radionuclides and fission fragments. The only measurable radionuclide was naturally occurring (40)K. Its activity range was 40+/-1.5 to 182.4+/-3.8 Bq kg(-1) with cumulative average value of 89.4+/-35.1 Bq kg(-1). Based on annual meals taken by the worker in cafeteria, the measured value gives committed effective dose of 74 microSv and estimated cancer risk factor of 1.5 x 10(-4) that is a minor fraction of the total risk of 5 x 10(-3). It depicts that food served at PINSTECH cafeteria is radiologically safe for consumption.

Environmental gamma radiation measurement in district Swat, Pakistan.

External exposure to environmental gamma ray sources is an important component of exposure to the public. A survey was carried out to determine activity concentration levels and associated doses from (226)Ra, (232)Th, (40)K and (137)Cs by means of high-resolution gamma ray spectrometry in the Swat district, famous for tourism. The mean concentrations for (226)Ra, (232)Th and (40)K were found to be 50.4 +/- 0.7, 34.8 +/- 0.7 and 434.5 +/- 7.4 Bq kg(-1), respectively, in soil samples, which are slightly more than the world average values. However, (137)Cs was only found in the soil sample of Barikot with an activity concentration of 34 +/- 1.2 Bq kg(-1). Only (40)K was determined in vegetation samples with an average activity of 172.2 +/- 1.7 Bq kg(-1), whereas in water samples, all radionuclides were found below lower limits of detection. The radium equivalent activity in all soil samples is lower than the limit set in the Organisation for Economic Cooperation and Development report (370 Bq kg(-1)). The value of the external exposure dose has been determined from the content of these radionuclides in soil. The average terrestrial gamma air absorbed dose rate was observed to be 62.4 nGy h(-1), which yields an annual effective dose of 0.08 mSv. The average value of the annual effective dose lies close to the global range of outdoor radiation exposure given in United Nations Scientific Committee on the Effects of Atomic Radiation. However, the main component of the radiation dose to the population residing in the study area arises from cosmic ray due to high altitude.

Introduction of an early pregnancy assessment unit: audit on the first 6 months of service.

BACKGROUND: Women experiencing bleeding in early pregnancy suffer considerable anxiety. Waiting for a considerable time for a diagnosis adds to their grievance. Early Pregnancy Assessment Unit (EPAU) is a dedicated service that provides quick and easy accessibility to diagnosis, treatment and support service. AIM: To monitor the first 6 months of the EPAU service in the Rotunda Hospital, to identify its shortcomings, so that we can ensure effective EPAU care in future. METHODS: A retrospective audit between July and December 2002 was performed. RESULTS: A majority of patients (83.4%) were self-referrals. All patients were seen between 1 and 3 h. In the miscarriage group, 218/278 (78.4%) was managed surgically by evacuation and a further 60/278 (21.6%) received conservative or medical treatment. Among 13 ectopic pregnancies, 5/13 (39%) had laparoscopic management. CONCLUSION: This clinic has enabled us to manage early pregnancy bleeding in an effective manner within a satisfactory time period. The high surgical intervention rate for miscarriages is highlighted to support the need for greater emphasis on medical and expectant management.

Radiological impact of dietary intakes of naturally occurring radionuclides on Pakistani adults.

Daily dietary intakes of three naturally occurring long-lived radionuclides (232)Th, (238)U and (40)K were estimated for the adult population of Pakistan using neutron activation analysis (NAA), inductively coupled plasma mass spectrometry (ICP-MS) and atomic absorption spectrometry (AAS), respectively. The daily intakes of (232)Th ranged from 4 to 29 mBq, (238)U ranged from 17 to 82 mBq and (40)K ranged from 51 to 128 Bq. The geometric means of these intakes were 10 mBqd(-1) for (232)Th, 33 mBqd(-1) for (238)U and 78.5 Bqd(-1) for (40)K. The measured values give annual committed effective doses of 0.80, 0.53 and 178.75 microSvyr(-1) for (232)Th, (238)U and (40)K, respectively to Pakistani population. The net radiological impact of these radionuclides is 180.08 microSvyr(-1). This value gives cancer risk factor of 4.5 x 10(-4) and loss of life expectancy of 0.87 days only. Whereas ICRP cancer risk factor for general public is 2.5 x 10(-3) and total risk involve from the all natural radiation sources based on global average annual radiation dose of 2.4 mSvyr(-1) is 6.0 x 10(-3). The estimated cancer risk shows that probability of increase of cancer risk from daily Pakistani diet is only a minor fraction of ICRP values. Therefore, the diet does not pose any significant health hazard and is considered radiologically safe for human consumption.

Assessment of strontium and calcium levels in Pakistani diet.

To cope with nuclear emergency effectively due to ingestion of fission fragment (90)Sr, adequacy of nutritionally and radiologically important elements strontium and calcium was studied in typical Pakistani diet and baseline analytical data were generated. Concentrations of strontium and calcium were measured by using inductively coupled plasma-atomic emission spectroscopy (ICP-AES) and atomic absorption spectrometry (AAS) techniques. Daily dietary intake of strontium and calcium varied from 0.9 to 5.7 mg and 217 to 713 mg with the geometric mean value x geometric standard deviation of 2.6 x 1.7 and 487.1 x 1.4 mg d(-1), respectively. The average Sr concentration in the Pakistani diet was 1.4 times higher while Ca concentration was 0.4 times lower than the recommended values of the International Commission on Radiological Protection (ICRP). The calculated Sr/Ca ratio 5.3E-03 was also higher than the ICRP value. The study depicts that the strontium concentration in the Pakistani diet is adequate, while the calcium concentration is inadequate according to international standards and needs improvement.

Thorium concentration in Pakistani diet.

To evaluate radiation doses due to ingestion of thorium activity by members of the public, baseline analytical data on thorium concentration in a typical Pakistani diet was generated. Food samples were collected from major districts/ cities of the country using the market basket method, and typical daily diets were prepared. Thorium concentration was determined by instrumental neutron activation analysis. It was found to vary from 1.6 ng g(-1) to 12 ng g(-1). The median value was 4.6 ng g(-1). This leads to median daily thorium intake of 2.7 microg d(-1). The geometric mean was 2.6 microg d(-1), which was 13% less than the ICRP value. Based on these measurements the average intake of 232Th activity was 10 mBq d(-1), and the average annual and committed effective doses for adults were estimated to be 8.8 x 10(-7) Sv y(-1) and 4.4 x 10(-5) Sv, respectively.

Caesium concentration in the Pakistani diet.

Daily dietary intakes of radioactive and non-radioactive caesium for the Pakistani population were measured. Food samples were collected on market basket method and were analysed using Instrumental Neutron Activation Analysis technique. The radioactive caesium ((137)Cs) in these samples was below the detectable limit, i.e. 1 mBq g(-1). The geometric mean of the mass fraction of stable caesium was 9.56 x 1.53 ng g(-1). The estimated daily dietary intake of caesium was 5.65 x 1.53 microg d(-1) or 0.088 microg kg(-1) of body weight of the reference Pakistani man weighing 64 kg. These values are 38.2% smaller than the recommended ICRP values for a 70 kg standard man. However, caesium concentration in the Pakistani diet is comparable with other reported values in the literature.

Nutritional and radiological impact of dietary potassium on the Pakistani population.

The nutritional status of dietary potassium and the radiological impact of its isotope (40)K were estimated for the Pakistani population. Potassium concentration was determined in dietary samples by atomic absorption spectrometry. An average potassium concentration was 4.54+/-0.89 mg/g, which leads to potassium dietary intake of 2.69+/-0.54 g/day and the radiological hazard due to (40)K activity was 79.94 Bq/day. The annual and lifetime effective doses calculated for the reference Pakistani man weighing 64 kg due to measured activity of (40)K were found to be 1.65 x 10(-4) Sv y(-1) and 8.27 x 10(-3) Sv, respectively. Measured data showed that the potassium concentration in the Pakistani diet is adequate and safe according to international standards.

Intercomparison of INAA and ICP-MS results for thorium determination in Pakistani diet.

A pilot study on ingestion and organ content of trace elements of importance in radiological protection was to be carried out in Pakistan. Baseline analytical data on daily dietary intake of thorium was to be measured using Instrumental Neutron Activation Analysis (INAA) technique. To determine the accuracy and reliability of our technique, some samples were measured in Pakistan using INAA and in Japan using Inductively Coupled Plasma-Mass Spectrometry. For intercomparison of results overall mean Z-scores were calculated. The results showed validity of our technique. Mean value of 232Th concentration in Pakistani diet samples using INAA technique is 0.0062 +/- 0.0028 microg/g and with ICP-MS technique is 0.0069 +/- 0.0032 microg/g.

Evaluation of body mass index for a reference Pakistani man and woman.

To strengthen the radiation protection infrastructure, a pilot study on physical characteristics for Reference Asian Man was carried out in Pakistan. Physical data on height and weight of Pakistani men and women were collected and compiled for all age groups to establish a Reference Pakistani Man/Woman which contributed toward the Reference Asian Man/Woman. A correlation between Age and Body Mass Index (BMI) of Pakistani MALES (i.e., rm = +0.89) and FEMALES (i.e., rf = +0.71) was observed. Average BMI of Pakistani males and females for the age group of 20-50 y was found to be 21.95 kg m(-2) and 21.20 kg m(-2), respectively. From recent literature and work of others BMI for Reference Asian Male (RAM) and Reference Asian Female (RAF) has been found to be 20.79 kg m(-2) and 20.81 kg m(-2). Results of our study fall within BMI ranges for male/female adults of Asian countries, i.e., 19.14-22.98 kg m(-2) and 19.38-22.71 kg m(-2), respectively. However, no significant sex specific difference has been noted.

Defective corticogenesis and reduction in Reelin immunoreactivity in cortex and hippocampus of prenatally infected neonatal mice.

Recent reports indicate an association between second trimester human influenza viral infection and later development of schizophrenia. Postmortem human brain studies also provide evidence for reduction in Reelin mRNA (an important secretory protein responsible for normal lamination of the brain) in schizophrenic brains. We hypothesized that human influenza infection in day 9 pregnant mice would alter the expression of reelin in day 0 neonatal brains. Prenatally-infected murine brains from postnatal day 0 showed significant reductions in reelin-positive cell counts in layer I of neocortex and other cortical and hippocampal layers when compared to controls. Whereas layer I Cajal-Retzius cells produced significantly less Reelin in infected animals, the same cells showed normal production of calretinin and nNOS when compared to control brains. Moreover, prenatal viral infection caused decreases in neocortical and hippocampal thickness. These results implicate a potential role of prenatal viral infection in causation of neuronal migration abnormalities via reduction in Reelin production in neonatal brains.

Differential expression of synaptosome-associated protein 25 kDa [SNAP-25] in hippocampi of neonatal mice following exposure to human influenza virus in utero.

We investigated the role of maternal exposure to human influenza virus [HI] in C57BL/6 mice on day 9 of pregnancy on the hippocampal expression of SNAP-25 in postnatal day 0 neonates, and compared them to sham-infected pups. The expression of SNAP-25 in infected neonates varied along the septotemporal axis of hippocampus and in various anatomic layers. Quantitative densitometric analysis of specific immunogold silver-enhanced SNAP-25 immunoreactivity [IR] showed increases of 40-347% over control in all septal-dorsal hippocampal layers except for the subplate layer. In mid septo-temporal hippocampus, SNAP-25 IR increased by 10-114% over control in all layers, except for the hippocampal plate, but the extent of this increase was smaller than in the dorsal-septal area. Finally,in temporal-ventral levels, SNAP-25 expression was reduced in all infected layers by 21-33% below control except for mild increases of 8.8 and 10% in subplate and hippocampal plate layers. Additionally, the infected SNAP-25 maximal density bin shifted to lower values dorsally and to higher values medially, with ventral maximal bins remaining unchanged when compared to controls. The differential expression of SNAP-25 in the hippocampi of infected neonates indicates a variable degree of vulnerability across the septo-temporal axis of hippocampus. It is surmised that while viral infection may induce excitotoxicity in the ventral hippocampus, it may cause reactive synapto-genesis in the medial and dorsal sectors of the developing brains of postnatal day 0 neonates.

Human influenza viral infection in utero increases nNOS expression in hippocampi of neonatal mice.

We investigated the role of maternal exposure to human influenza virus (HI) in C57BL/6 mice on day 9 of pregnancy on hippocampal expression of nNOS in day 0 neonates and compared that to sham-infected pups. Qualitative analysis using polyclonal antibody to nNOS showed overall increases in immunoreactivity (IR) in hippocampal and dentate layers of day 0 infected neonates when compared to sham-infected animals. These increases in nNOS immunoreactivity were pronounced in hippocampal plate, intermediate, molecular, subplate, and dentate areas. Quantitative analysis of specific immunogold silver-enhanced nNOS IR via densitometry showed nNOS IR increases of 26-71.6% in all layers, i.e., hippocampal plate (35.1%), dentate area (71.6%), molecular area (43.75%), subplate (45.7%), and intermediate zone (26%) in infected neonatal brains vs. controls. The changes in levels of nNOS expression in hippocampi of neonates born to mothers exposed to HI virus during the second trimester of pregnancy may reflect the potential for glutamatergic excitotoxicity via activation of NMDA receptors in the developing brains of these neonatal mice.

Plasma level of antioxidant nutrients (retinol and alphatocopherol) in cases with different grades of cervical carcinoma.

A study was conducted on 23 patients on various grades of cervical cancer, selected purposely from Dhaka Medical College Hospital. Vitamin A and E level of this histologically proved cases showed mean serum level of vitamin A was 0.41 +/- 0.19 and that vitamin E was 4.21 +/- 2.15, and these low level was constant in all Histopathological grading of cervical cancer. Contraceptive user and smoker had very low level of vitamin A and E. Majority (51%) of the cases, were from lower middle class and 49% were from lower class, seventy seven percent were illiterate, 97% were married before 18 years, 57% had more than 6 children, 71% did not use contraceptive. The availability of vitamin A rich food were within reach of lower income group, than the food source of vitamin E which are usually of animal origin. It is concluded that in cervical cancer had low level of antioxidant vitamins A and E. Further study is indicated for understanding detail antioxidant nutrients role in aetiopathology of cervical cancer in Bangladesh.