Clinico-Pathological Profiles of Multiple Myeloma Patients in a Tertiary Care Hospital.

Multiple myeloma (MM), mature B-cell lineage neoplasm, is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein (M protein). The study was conducted to reveal presenting features, laboratory findings, Eastern Cooperative Oncology Group (ECOG) performance status and skeletal survey on patients with multiple myeloma. This descriptive, cross-sectional study was carried out in the Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 with a sample size of 81. Data were collected in a case record form after obtaining informed verbal consent from patients and /or their legal guardians. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with SPSS, Version 25.0 with presentation in figures and tables with frequency, percentage, mean and standard deviation based on data nature. Statistical tests were carried out as appropriate with 5.0% level of significance for assessing statistical association. Mean age of the patients was 58.9±12.0 years. Male female ratio was 2:1. 35(43.2%) patients were smokers with only 2(2.5%) had family history of haematological malignancies. Bone pain (72.8%) was the most common presenting feature, while hypertension (59.1%), diabetes mellitus (29.5%), respiratory illness (11.3%) and cardiac disease (11.4%) were the common co-morbidities. Most common ECOG performance status was ECOG-1(48.1%). Mean haemoglobin (Hb) was 9.4±2.3gm/dl and mean erythrocyte sedimentation rate (ESR) was 89.5±42.1 mm in 1st hour. Mean serum creatinine level was 2.0±1.85 mg/dl and ≥2.0mg/dl in 42(34.2%). Among 50 documentation serum lactate dehydrogenase (LDH) was raised in 18(36.0%). Mean serum calcium level was 9.6±1.8mg/dl >11.0mg/dL in 10(14.5%) cases. Serum albumin <3.5gm/dl in 37(49.3%), ß2-microglobulin >5.5mg/dl in 37(57.8%) cases, International staging system (ISS) stage III was in 59.4% and Bence Jones Protein (BJP) was present in 46.7% cases. Lytic lesions were present in 75.0%, In 38(74.5%) patients vertebrae were involved, while in 18(35.2%) ribs were involved, in 14(27.5%) patients skull was involved and in 3(5.9%) patients involved bones were femur, humerus, sternum and scapula. Mean plasma cells percentage was 62.1±24.9%. Immuno-Fixation Electrophoresis (IFE) revealed IgG (72.7%), IgA (18.2%), Free light chain (FLC) (9.1%). FLC ratio was ≥100 in 29.0% cases. Significant statistical association was observed between serum creatinine with Hb concentration (p<0.05), serum creatinine level with ISS staging (p<0.05) and serum calcium level (p<0/05), while insignificant association was revealed between BJP present status and serum creatinine level (p>0.05). Bone pain, fatigue, fever and neurological impairment were the common presenting features. Anaemia, renal impairment and skeletal lytic events were the prominent physical findings. ISS staging was statistically associated with serum creatinine level, while serum calcium level was associated with serum creatinine and lytic lesions.

Prevalence of Diarrhea and its Relation with Severity of the Disease among Covid-19 Positive Patient in a Selected Covid Dedicated Hospital.

Covid-19 has become a pandemic since its emergence in Wuhan, China. It involves Gastro intestinal (GI) system and diarrhea is recognized as an important symptom. Diarrhea is also associated with disease severity. This study was conducted to see the prevalence of diarrhea in Covid-19 positive patient and its relation with disease severity. Prospective observational study done among consecutive Covid-19 positive patient of both sex admitted in Mugda Medical College Hospital in Dhaka from February 2021 to April 2021. Informations were collected by face to face interview and severity was assessed on bedside. Among 166 Covid-19 positive patient 40.0% developed diarrhea. Mean age of the diarrheal patients was 44.21±14.40. Women affected more than men (51.0% versus 49.0%). In majority patient (62.0%) diarrhea persist for 3-7 days and majority had frequency of bowel movement 3-5 times per day. Regarding Bristol stool type 47.0% had stool type 6 followed by stool type 7(43.0%) and stool type 5(10.0%). Half of the diarrheal patient (48.0%) had severe pneumonia. Severe pneumonia is significantly more common in non-diarrheal patients (65.0%) than in diarrheal patient (35.0%) (p=0.007). This study reflects that a large number of Covid-19 positive patients developed diarrhea. Half of the diarrheal patients had severe pneumonia. But severe pneumonia is significantly common in non-diarrheal patient than diarrheal patients.

Development and validation of simultaneous quantification method for gemcitabine and betulinic acid: augmenting industrial application.

Combinatorial treatment utilizing a nucleoside analogue gemcitabine (GEM), with a characteristic pentacyclic triterpenoid betulinic acid (BET), has exhibited empowering adequacy in the therapy of cancer. It lessens the advancement of collagen and upgrades the saturation of tumour medicines. With the advancement in nanotechnology, the co-loaded formulation urges for a validated method of estimation. The purposed work entails a robust, simple, and economical analytical method for the simultaneous estimation of GEM and BET through RP-HPLC. Orthophosphoric acid (0.1%)-acetonitrile was considered as the mobile phase for the detection of GEM and BET at 248 nm and 210 nm with retention times of 5 min and 13 min, respectively. The method was further validated as per the regulatory guidelines with all the parameters found within the limit. The developed method with adequate resolution and quantification was found to be linear, accurate, precise, robust, and stable with an intra- and inter-day variability of less than 2%. The method was found specific for GEM and BET with no matrix interference of drug-spiked FBS samples. To demonstrate the applicability of the developed method, a nano-formulation containing GEM and BET was prepared and assessed for various parameters including encapsulation efficiency, loading efficiency, drug release, and drug stability. The method developed can be a possible tool for the simultaneous quantification of GEM-BET in analytical and biological samples.

Glasgow Coma Score Predicting the Poor Outcome of the Patients Presenting Fever with Altered Sensorium.

To assess the role of the Glasgow Comma Score (GCS) for predicting the outcome of the patient with fever and altered sensorium was the objective of the study. This prospective observational study was conducted for six months following ethical approval. Informed consent was obtained prior enrollment. A total of 50 patients with complaints of fever for <2 weeks duration with altered sensorium with or without seizure were included in the study. GCS was calculated for all patients just after admission and before starting interventions. All patients were investigated and managed according to the hospital protocol. The outcome of the patients (living or dead within the hospital) was evaluated against the admission GCS score. The study was performed in accordance with the current Declaration of Helsinki. Of all, 42.0% (n=21) of the patients had bacterial meningitis, followed by viral encephalitis, cerebral malaria and coma vigil. Complete recovery occurred in 60.0% of cases, while recovery with disability occurred in 28.0% of cases. Death occurred in 12.0% of cases (n=6) due to cerebral malaria, viral encephalitis and bacterial meningitis (n=2 each cause). A higher number of deaths occurred in the lower GCS group (n=5 in GCS group 3-5) and this difference was statistically significant (p<0.05). Moreover, considering death as an outcome, multivariate logistic regression showed that GCS (OR 70.598, 95% CI-1.243-4009.41; p=0.039) was an independent predictor of the outcome. GCS seemed to be a predictor of the short-term outcome of the patient presenting with fever and altered sensorium in our setting. However, further exploration in larger setting with appropriate study design is recommended.

Diseases Pattern and Outcome among the Neonates in A Newly Established Special Care Newborn Unit (SCANU) At Secondary Level District Hospital in Bangladesh.

Although huge improvement in neonatal mortality reduction in last two decades in Bangladesh but it is still very high compare with many other countries. High neonatal mortality also significantly contribute deaths among the under five children. Neonatal mortality reflects a nation's socio-economic status, efficiency and effectiveness of health care services. This was cross sectional study. The objective of this study was to analyse the diseases pattern and outcome of the neonates admitted in the newly established SCANU (Special care neonatal unit) of 250 bedded General Hospital of Tangail district, Bangladesh. Study period was one year from January 2017 to December 2017. Information from medical records of the SCANU was analysed. During the study period 1,379 neonates were admitted in the SCANU. The ratio between male and female was 1.5:1, 61% of the neonates admitted at first day of life. The reasons for admissions in SCANU were 31% of preterm and low birth weight, 23%birth asphyxia, 13% neonatal sepsis, 9% transient tachypnea of newborn, 5% congenital anomalies and 4% neonatal jaundice. Out of all neonates survival rate was 56% (779), while 25% (349) ended with fatality, 9% (122) were referred to tertiary level hospital and 10% (129) were left the hospital against medical advice. Among the fatal cases 63% died in first 24 hours and 88% in first week of life. Data shows that 47% deaths were due to preterm and low birth weight with its complication, other significant causes were birth asphyxia (30%), septicemia (16%) and congenital anomalies were (6%). Preterm and low birth weight, neonatal sepsis, birth asphyxia, transient tachypnea of newborn; congenital anomalies were the main reasons for admission in SCANU. Prematurity and its complication, birth asphyxia and neonatal sepsis as the major contributors to the neonatal mortality. The study findings will help researchers and policy makers to initiate further research and interventions to reduce fatality among the neonates in the SCANU.

Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study.

Eosinophilic esophagitis (EoE) is a disease of modern era. It was first described 40 years back. Since then it has drawn an immense interest among the clinicians. It is diagnosed by the presence of eosinophils count ≥15/HPF on esophageal biopsied mucosa in patients with symptoms of esopohageal dysfunction. It is more prevalent among patients with gastroesophageal reflux disease. As its symptoms overlap with that of gastroesophageal reflux disease (GERD), it is frequently overlooked & misdiagnosed which increases patients' sufferings. No data is available in Bangladesh. The objective of the study was to find out the frequency of eosinophilic esophagitis among patients with gastroesophageal reflux symptoms. The study was conducted at the Outpatient department of the department of Gastroenterology of Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2018 to April 2019. One hundred and thirty three (133) consecutive patients with symptoms suggestive of gastroesophageal reflux disease based on validated questionnaire underwent upper GI endoscopy. Biopsies were taken from proximal and distal esophagus as well as any other endoscopically abnormal esophageal mucosal lesion. Among 133 patients with gastroesophageal reflux symptoms, 7 patients (5.3%) were found to be positive for eosinophilic esophagitis. Mean age at diagnosis was 37.28±13.38 years. It was more common in younger age group. Female patients (56%) were more than male patients (44%). Heart burn was the major symptom followed by acid regurgitation. Nocturnal cough showed statistically significant relationship with eosinophilic esophagitis. Although the frequency is low, it may be considered as a differential diagnosis among patients with GERD.

Measuring Sensitivity, Specificity and Accuracy of HRCT of Chest and Comparison with Biomarkers in COVID-19 Suspected Patients: A Cross Sectional Study.

COVID-19 is a declared pandemic by World Health Organization. The diagnostic tests are not of high specificity and sensitivity, so far. Pro-inflammatory biomarkers and High Resolution Computed Tomography (HRCT) of chest are the common investigations performed to evaluate the diagnosis and prognosis of COVID-19. The objective of this study was to estimate the sensitivity, specificity and accuracy of HRCT and to find out the relationship between the biomarkers and HRCT findings. This was a cross-sectional descriptive study carried out in the COVID-19 suspected isolation unit of a tertiary hospital from July 2020 to November of 2020. Data were collected from electronic medical record (EMR). Relationship test were done by t-test and one-way-ANOVA test. Total 123 cases were enrolled after matching with selection criterion. Mean age of male was 62.5 years and female 57.7 years. Highest frequency of participants was observed in the 60-69 year age group. According to HRCT% findings 4 groups were made. They are below 25%, 25%-50%, 51%-75% and 76%-100%. The distribution of case among these groups was 15%, 44%, 35% and 6% respectively. The relationship between biomarkers (NLR, D-dimer, Ferritin and CRP) and HRCT% was found significant (p<0.05). In HRCT 92.5% lesion were peripherally placed and 99.2% cases were affected by both lungs. The sensitivity and specificity of HRCT were found 46% and 72.6% respectively with 62% accuracy. Raised biomarkers are significantly related to the more lung involvement in case of COVID-19 suspected pneumonia patients. These biomarkers will be helpful as diagnostic and prognostic markers for this disease. HRCT percentage can play an important role as diagnostic and prognostic tool in case of COVID-19 suspected cases.

Vas Deferens Calcification in a Diabetic CKD: An Incidental Finding.

Vas deferens calcification is a very rare condition. The causes can be categorized as inflammatory and non-inflammatory type. We are presenting such a non inflammatory type of bilateral vas calcification in a diabetic chronic kidney diseases (CKD) patient. Presented patient a 50 years old man admitted in Samorita Hospital Ltd., Dhaka, Bangladesh on 03 August 2014 in cabin - 537 with registration number 1904/14. He was labeled as Diabetes mellitus (DM), Hypertension (HTN), CKD & Urinary tract infection (UTI). Vas deferens calcification was diagnosed incidentally by X-ray KUB. Subsequently we have discussed all possible causes in this report. The purpose of presenting this rare imaging finding is to emphasize the under diagnosis of the disease and causes. It can also be diagnosed by simple, easily available and cheap investigations like Plain X ray KUB.

Genetic Variability of Exotic Sugarcane Genotypes.

Sugarcane is the main sugar producing crop in Bangladesh. However, improvement of this crop through breeding is limited due to lack of genetic diversity. Therefore, genetic variability and diversity assessment are necessarily important for the foreign introduced materials. Experiment was conducted with 9 exotic sugarcane genotypes at Regional Station, Bangladesh Sugar Crop Research Institute, Gazipur, during 2012-13, following RCBD. Data were collected on different growth and yield contributing characters. Individual cane weight exhibited high genotypic coefficient of variation and phenotypic coefficient of variation. Leaf blade length, leaf blade width, fresh leaf weight, dried leaf weight, number of tillers, millable cane, bud size, cane diameter, internodes number, internode length, plant height, stalk length, brix%, and individual cane weight showed high heritability. Individual cane weight showed highly significant and positive correlation with cane diameter, internode length, and stalk length, whereas path coefficient analysis revealed that cane diameter had maximum positive direct effect on individual cane weight followed by internode length, number of tillers, and chlorophyll content. Results indicate that the genotypes should be selected on the basis of individual cane weight, cane diameter, and millable canes number for future breeding to get higher sugarcane yield in respect to juice and brix content.

Study on Neurological Consequence of Eclampsia.

The present study was carried out in the Department of Obstetrics and Gynecology at Mymensingh Medical College Hospital, Mymensingh, Bangladesh for a period of one year from 1st June 2009 to 30th June 2010 to see the Neurological Consequence of Eclampsia. A total number of 37 patients were enrolled in this study. Among 37 patients majority are in the age group of 21-30 years which is 19(51.4%) cases followed by less than or equal to 20 years and more than 30 years which are 13(35.1%) cases and 5(13.5%) cases respectively. Knee jerk is present in 28(75.7%) cases and absent in 8(21.6%) cases. The exaggerated knee jerk is present in only in 1(2.7%) case. The rate of Glasgow coma scale is less than 5 in 21(56.8%) cases, 14(37.8%) cases in 5-10 and 2(5.4%) cases is in more than 10. Focal sign is absent in 22(59.5%) cases and present in 15(40.5%) cases. Majority of the patients is presented with absence of neck stiffness which is 35(94.6%) cases and the rest 2(5.4%) cases are presented with neck stiffness. Flexor planter response is found in 20(54.1%) cases which is the highest in number followed by extensor which is 15(40.5%) cases. In only 2(5.4%) cases the planter reflex is not elicitable. Presence of infarct is found in 15(40.5%) cases which is the highest number. Cerebral edema and Presence of haemorrhage is found in 3(8.1%) cases in each. Leuko-encephalopathy is found in 2(5.4%) cases. Encephalopathy and Both infarct & haemorrhage is found in 1(2.7%) case of each. Normal CT scan findings of brain are found in 12(32.4%) cases.

Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus.

Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups.

Wandering biliary ascariasis with hepatic abscess in a postmenopausal woman.

Hepatobiliary ascariasis is common in developing countries where there is a low standard of public health and hygiene. We are reporting a rare case of ascariasis which induced multiple liver abscesses in a post menopausal woman who presented with fever, anorexia, nausea, vomiting and mild hepatomegaly. Ultrasonography revealed biliary ascariasis with multiple hepatic abscesses. Laparoscopic drainage of hepatic abscesses was done and microscopic examination of drainage materials showed decorticated eggs of Ascaris Lumbricoides. The post operative recovery of the patient was uneventful. Ultrasonography is a reliable modality to diagnose and follow up of such cases.

Color Doppler sonography and resistivity index in the differential diagnosis of hepatic neoplasm.

The purpose of this study was to determine the usefulness of color doppler sonography and resistivity index (RI) in differentiating liver tumors. The study was carried out in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, and Institute of Nuclear Medicine and Allied Sciences (INMAS), Mymensingh, Bangladesh, during the period of July 2009 to June 2011. Total 50 consecutive cases were studied. Among them 27 were hepatocellular carcinomas, 19 were metastatic tumors, 03 were hemangiomas and 01 was hepatic adenoma. Doppler sonographic findings were then correlated, case by case, with final diagnosis- either pathologically by USG guided Fine-needle aspiration or by other imaging modalities (e.g., CT scan and RBC liver scan for hepatic hemangioma). The RI value of hepatocellular carcinoma was 0.69±0.096 and in metastatic tumors 0.73±0.079. The results showed no significant difference between the RI of hepatocellular carcinomas and metastatic liver tumors but it was significantly higher than benign lesions (p<0.05). RI of hemangiomas was 0.49±0.64 and in one hepatic adenoma was 0.65. When RI was <0.6 for benign liver tumors and ≥0.6 for malignant tumors we calculated a sensitivity of 89.14%, specificity of 66.7%, accuracy of 85.71% positive predictive value of 97.62% and negative predictive value of 28.57% in differentiating benign and malignant tumors. Thirty four of 46(73.9%) malignant lesions had intratumoral flow and 25% of benign lesions also showed intratumoral flow. The difference of intratumoral flow between malignant and benign lesions was significant (p<0.01). Two of 4 benign lesions (50%) had peritumoral vascularity where 6% of the malignant tumors showed peritumoral vascularity. In conclusion, combined studies of the type of intra-and peri-tumoral flow signals in CDFI and the parameter of RI would be more helpful in the differential diagnosis of benign and malignant liver tumors.

Selection of superior lentil (Lens esculenta M.) genotypes by assessing character association and genetic diversity.

Lentil is one of the most important pulse crops in the world as well as in Bangladesh. It is now considered a main component for training and body building practising in first world countries. Yield varies tremendously from year to year and location to location. Therefore, it is very important to find genotypes that perform consistently well even in ecological farming systems without any intercultural operations. Twenty lentil genotypes were tested during the period from November 2010 to March 2011 and from December 2011 to March 2012 with three replicates in each season to determine genetic variability, diversity, characters association, and selection indices for better grain yield. The experiment was conducted at the breeding field of the Department of Genetics and Plant Breeding, Bangladesh Agricultural University, Mymensingh. This study revealed that all the genotypes possess a high amount of genetic diversity. Plant height and 100-grain weight showed significant positive correlation with grain yield plant(-1) that was also confirmed by path analysis as the highest direct effect on grain yield. The genotypes BM-513 and BM-941 were found to be the best performer in both the seasons and were considered as consistent genotype. The genotypes were grouped into four clusters based on Euclidean distance following Ward's method and RAPD analysis. However, discriminant function analysis revealed a progressive increase in the efficiency of selection and BM-70 ranked as the best followed by the genotypes BM-739, BM-680, BM-185, and BM-513. These genotypes might be recommended for farmers' cultivation in ecological farming in Bangladesh.

Effectiveness of radioiodine therapy in treatment of hyperthyroidism.

The present non randomized clinical trial was conducted in the Center for Nuclear Medicine and Ultrasound, Mymensingh, Bangladesh for duration of one year. Total 30 patients with hyperthyroidism diagnosed by clinical and biochemical profile were included in the study. All patients received radioiodine treatment and regular follow up at 1st month, 3rd month, 6th month & 9th month were done to evaluate clinical and biochemical status and complications. Data were analyzed by computer with SPSS programme using 't' test and chi-square test. In the present study, out of 30 respondents more than three fourth of the respondents (76.6%) were in the age group of 31-50 years followed by less than 30 years are group (16.7%) and rest of respondents were in the age group of more than 50 years (06.7%). Mean±SD and range of age of the respondents were 39.80±10.02 years and 17-65 years respectively. Among the 30 respondents 11(36.7%) were male and 19(63.3%) were female. Male to female ratio was 1:1.73. Out of 30 patients 26(86.7%) presented with goiter and among them 21(80.8%) has diffused goiter and five (19.2%) had nodular goiter. Baseline mean±SD, median, range of serum T3 level were 5.24±3.62, 4.34, 1.48-14.65nmol/L respectively. Base line mean±SD, median range of serum T4 level were 192.25±99.17, 201.77, 1.75-336.25nmol/L respectively. Baseline mean±SD, median range of serum TSH level were 6.33±23.93, 0.15-0.07, 130.46nmol/L respectively. In the present study serum T3, T4 level among the respondents sharply decrease from baseline to 2nd follow up then gradually decrease from 2nd to 4th follow up. Serum TSH level gradually increases from baseline to 3rd follow up and then gradually decreases from 3rd to 4th follow up. The result showed radioiodine is an effective option for the treatment of thyrotoxicosis.

Evaluation of the results of operative management of lumbar spinal canal stenosis.

Lumber spinal canal stenosis is an important cause of low back pain and it frequently presents with low backache with neurogenic claudication. Operative management of lumbar spinal canal stenosis by decompression surgery is an effective method. This prospective interventional (quasi experimental) study was performed in patient having history of characteristic clinical features like low backache with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in the department of Orthopaedic Surgery and Neurosurgery, Dhaka Medical College Hospital and NITOR. Dhaka, from July 2008 to June 2010. Thirty patients were evaluated among those 18(60%) were 50 years and above. Male to female ratio was roughly 9:1. About 87% of the patients had sensory deficit and 50% had neurogenic claudication. Majority (83.3%) of the patients at presentation had a suffering of 12 or >12 months. Diagnosis shows that 3.5% of patients had L4 lesion, 60% L5, 6.5% patients had L4 & L5 and 30% S1. Laminectomy was done in 43.3% of patients, laminectomy and disectomy in 30% and laminectomy, discectomy & foraminal decompression in 26.7% of patients. Relief of symptoms occurred in 25(83.5%) of patients. Over three-quarter (76.7%) of patients exhibited minimal disability and 23.3% moderate disability based on Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

Sleep-wake and diurnal modulation of nitric oxide in the perifornical-lateral hypothalamic area: real-time detection in freely behaving rats.

Nitric oxide (NO) has been implicated in the regulation of sleep. The perifornical-lateral hypothalamic area (PF-LHA) is a key wake-promoting region and contains neurons that are active during behavioral or cortical activation. Recently, we found higher levels of NO metabolites (NOx), an indirect measure of NO levels, in the PF-LHA during prolonged waking (SD). However, NO is highly reactive and diffuses rapidly and the NOx assay is not sensitive enough to detect rapid-changes in NO levels across spontaneous sleep-waking states. We used a novel Nafion®-modified Platinum (NF-PT) electrode for real-time detection of NO levels in the PF-LHA across sleep-wake cycles, dark-light phases, and during SD. Sprague-Dawley male rats were surgically prepared for chronic sleep-wake recording and implantation of NF-PT electrode into the PF-LHA. Electroencephalogram (EEG), electromyogram (EMG), and electrochemical current generated by NF-PT electrode were continuously acquired for 5-7days including one day with 3h of SD. In the PF-LHA, NO levels exhibited a waking>rapid eye movement (REM)>non-rapid eye movement (nonREM) sleep pattern (0.56±0.03µM>0.47±0.02µM>0.42±0.02µM; p<0.01). NO levels were also higher during the dark- as compared to the light-phase (0.53±0.03µM vs. 0.44±0.02µM; p<0.01). NO levels increased during 3h of SD as compared to undisturbed control (0.58±0.04µM vs. 0.47±0.01µM; p<0.05). The findings indicate that in the PF-LHA, NO is produced during behavioral or cortical activation. Since elevated levels of NO inhibits most of the PF-LHA neurons that are active during cortical activation, these findings support a hypothesis that NO produced in conjunction with the activation of PF-LHA neurons during waking/SD, inhibits the same neuronal population to promote sleep.

Melioidosis in an adult male.

Infection with Burkholderia pseudomallei has been described, albeit rarely, patients in Bangladesh. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, which is present in soil and surface water in the endemic region. A 35-year-young male farmer presented with prolonged fever and significant weight loss. Patient gradually deteriorated despite getting different antibiotics including intravenous ceftriaxone and metronidazole. Panels of investigations were done which revealed no diagnostic confirmation except uncontrolled diabetes and multiple abscesses in different organs. Melioidosis was suspected and serum samples were positive for Burkholderia pseudomallei antibody. The case illustrates the importance of non-specific nature of the clinical presentation and high index of suspicion of uncommon diseases like melioidosis where the disease has not been considered as an endemic.

Efficacy of amitriptyline, pizotifen and propranolol in the prevention of migraine.

This intervention study conducted in the Neurology outpatient Department of Mymensingh Medical College Hospital (MMCH) from January 2006 to December 2007 to compare efficacy of amitriptyline, pizotifen and propranolol in the prophylaxis of migraine. Ninety cases were selected following certain inclusion and exclusion criteria. Result showed that the differences in duration, frequency and severity of attack were reduced in all groups but the differences among the groups were not significant (p>0.05). However, compared with amitriptyline and pizotifen, the propranolol group needed tablet paracetamol as abortive therapy less frequently which was statistically significant (p<0.05). All the drugs were well tolerated with minimum adverse effects.