Reducing dietary protein and supplementation with starch or rumen-protected methionine and its effect on performance and nitrogen efficiency in dairy cows fed a red clover and grass silage-based diet.

The increasing cost of milk production, in association with tighter manure N application regulations and challenges associated with ammonia emissions in many countries, has increased interest in feeding lower crude protein (CP) diets based on legume silages. Most studies have focused on alfalfa silage, and little information is available on low-CP diets based on red clover silage. Our objectives were to examine the effects of dietary CP content and supplementing a low-CP diet with dietary starch or rumen-protected Met (RPMet) on the performance, metabolism, and nitrogen use efficiency (NUE; milk N output/N intake) in dairy cows fed a red clover and grass silage-based diet. A total of 56 Holstein-Friesian dairy cows were blocked and randomly allocated to 1 of 4 diets over a 14-wk feeding period. Diets were based on red clover and grass silages at a ratio of 50:50 on a dry matter (DM) basis and were fed as a total mixed ration, with a 53:47 ratio of forage to concentrate (DM basis). The diets were formulated to supply a similar metabolizable protein (MP) content, and had a CP concentration of either 175 g/kg DM (control [CON]) or 150 g/kg DM (low-protein [LP]), or LP supplemented with either additional barley as a source of starch (LPSt; +64 g/kg DM) or RPMet (LPM; +0.3 g/100 g MP). At the end of the 14-wk feeding period, 20 cows (5 per treatment) continued to be fed the same diets for a further 6 d, and total urine output and fecal samples were collected. We observed that dietary treatment did not affect DM intake, with a mean of 21.5 kg/d; however, we also observed an interaction between diet and week with intake being highest in cows fed LPSt in wk 4 and CON in wk 9 and 14. Mean milk yield, 4% fat-corrected milk, and energy-corrected milk were not altered by treatment. Similarly, we found no effect of dietary treatment on milk fat, protein, or lactose content. In contrast, milk and plasma urea concentrations were highest in cows fed CON. The concentration of blood plasma ß-hydroxybutyrate was highest in cows receiving LPM and lowest in LPSt. Apparent NUE was 28.6% in cows fed CON and was higher in cows fed any of the low-protein diets (LP, LPSt, or LPM), with a mean value of 34.2%. The sum of milk fatty acids with a chain length below C16:0 was also highest in cows fed CON. We observed that dietary treatment did not affect the apparent whole-tract nutrient digestibility of organic matter, N, neutral detergent fiber, and acid detergent fiber, with mean values of 0.785, 0.659, 0.660, and 0.651 kg/kg respectively, but urinary N excretion was approximately 60 g/d lower in cows fed the low-CP diets compared with CON. We conclude that reducing the CP content of red clover and grass silage-based diets from 175 to 150 g/kg DM while maintaining MP supply did not affect performance, but reduced the urinary N excretion and improved NUE, and that supplementing additional starch or RPMet had little further effect.

Feeding lower-protein diets based on red clover and grass or alfalfa and corn silage does not affect milk production but improves nitrogen use efficiency in dairy cows.

Reducing the dietary crude protein (CP) concentration can decrease the financial cost and lower the environmental impact of milk production. Two studies were conducted to examine the effects of reducing the dietary CP concentration on animal performance, nutrient digestibility, milk fatty acid (FA) profile, and nitrogen use efficiency (NUE; milk N/N intake) in dairy cows fed legume silage-based diets. Thirty-six multiparous Holstein-Friesian dairy cows that were 76 ± 14 (mean ± SD) days in milk and 698 ± 54 kg body weight were used in a 3 × 3 Latin square design in each of 2 studies, with 3 periods of 28 d. In study 1, cows were fed diets based on a 50:50 ratio of red clover to grass silage [dry matter (DM) basis] containing 1 of 3 dietary CP concentrations: high (H) = 175 g of CP/kg of DM; medium (M) = 165 g of CP/kg of DM; or low (L) = 150 g of CP/kg of DM. In study 2, cows were fed 175 g of CP/kg of DM with a 50:50 ratio of alfalfa to corn silage (H50) or 1 of 2 diets containing 150 g of CP/kg of DM with either a 50:50 (L50) or a 60:40 (L60) ratio of alfalfa to corn silage. Cows in both studies were fed a total mixed ration with a forage-to-concentrate ratio of 52:48 (DM basis). All diets were formulated to meet the MP requirements, except L (95% of MP requirements). In study 1, cows fed L ate 1.6 kg of DM/d less than those fed H or M, but milk yield was similar across treatments. Mean milk protein, fat, and lactose concentrations were not affected by diet. However, the apparent total-tract nutrient digestibility was decreased in cows fed L. The NUE was 5.7 percentage units higher in cows fed L than H. Feeding L also decreased milk and plasma urea concentrations by 4.4 mg/dL and 0.78 mmol/L, respectively. We found no effect of dietary treatment on the milk saturated or monounsaturated FA proportion, but the proportion of polyunsaturated FA was increased, and milk odd- and branched-chain FA decreased in cows fed L compared with H. In study 2, DM intake was 2 kg/d lower in cows receiving L50 than H50. Increasing the alfalfa content and feeding a low-CP diet (L60) did not alter DMI but decreased milk yield and milk protein concentration by 2 kg/d and 0.6 g/kg, respectively, compared with H50. Likewise, milk protein and lactose yield were decreased by 0.08 kg/d in cows receiving L60 versus H50. Diet had no effect on apparent nutrient digestibility. Feeding the low-CP diets compared with H50 increased the apparent NUE by approximately 5 percentage units and decreased milk and plasma urea concentrations by 7.2 mg/dL and 1.43 mmol/L, respectively. Dietary treatment did not alter milk FA profile except cis-9,trans-11 conjugated linoleic acid, which was higher in milk from cows receiving L60 compared with H50. We concluded that reducing CP concentration to around 150 g/kg of DM in red clover and grass or alfalfa and corn silage-based diets increases the apparent NUE and has little effect on nutrient digestibility or milk performance in dairy cows.

Short Term Visual and Refractive Outcome following Surgical Intervention for Posterior Capsule Opacification (PCO) in Children in a Tertiary Eye Hospital.

BACKGROUND: PCO occurs commonly postoperatively following cataract extraction in children, obscuring vision as did the initial cataract. It may require a second surgical procedure when it is dense. It is expected that this results in restoration of vision and it is important to ascertain that this is the case as well as to examine any significant changes in refraction thereafter. METHODS: A retrospective observational study extracting demographic and clinical information from case notes of patients who had membranectomy and/or capsule polishing between October 2017 and September 2018. RESULTS: 57 eyes of 51 patients were enrolled. There was a 2:1 male: female ratio. Mean age at cataract surgery was 6.33± 3.59years whilst that for PCO surgery was 9.68±3.89years. Postoperative visual acuity (by WHO definition) was good (between 6/6 and 6/18) in 33.3%, compared to 8.8% preoperatively. Whereas presenting visual acuity was poor (<6/60) in 61.4% preoperatively, this reduced to 30% postoperatively. Visual outcome was influenced by age at cataract surgery, age at PCO surgery, interval between cataract and PCO surgery and type of cataract. Children >8 years of age at time of PCO surgery had a greater proportion of good post-operative best corrected visual acuity (BCVA) (52.6%), whilst 75% of children younger than 8years at time of surgery turned out with poor BCVA after surgery. Developmental cataracts proportionately had the best outcome of visual acuity. There was a range of refractive shift of +0.25D to - 5.25D with a mean myopic shift of -1.51D following membranectomy. CONCLUSION: There was a good proportion of children with significant improvement in visual acuity on the short term, and a mild myopic shift following membranectomy.

CONTEXTE: Résultats visuels et réfractifs à court terme à la suite d'une intervention chirurgicale pour l'opacité de l'axe visuel (PCO) chez des enfants dans un hôpital ophtalmologique tertiaire. METHODES: Une étude d'observation rétrospective extrayant des informations démographiques de cas de patients ayant subi une membranectomie et / ou un polissage de gélule entre octobre 2017 et septembre 2018. RESULTATS: 57 yeux de 51 patients ont été inclus. Il y avait un ratio hommes / femmes de 2: 1. L'âge moyen à la chirurgie de la cataracte était de 5,9 ans alors que celui de la chirurgie du VAO était de 9,2 ans. L'acuité visuelle postopératoire était bonne (entre 6/6 et 6/18) dans 33,3% des cas, contre 8,8% en préopératoire. Alors que l'acuité visuelle était faible (<6/60) dans 61,4% des cas en préopératoire, elle était réduite à 30% en postopératoire. Les enfants de plus de 8 ans au moment de la chirurgie PCO présentaient une plus grande proportion de BCVA postopératoires satisfaisants (52,6%), tandis que 75% des enfants de moins de 8 ans au moment de la chirurgie avaient un BCVA médiocre après la chirurgie PCO. Les résultats visuels étaient influencés par l'âge au moment de la chirurgie de la cataracte et de la PCO, l'intervalle entre les chirurgies de la cataracte et de la PCO et le type de cataracte. Il y avait une plage de décalage de réfraction de +0,25 à -5,25 avec un décalage myopique moyen de 1,51D après la membranectomie. La cataracte développementale avait proportionnellement le meilleur résultat en acuité visuelle. CONCLUSION: Il y avait une bonne proportion d'enfants présentant une amélioration significative de l'acuité visuelle à court terme malgré un léger déplacement de la myopie après une membranectomie. Mots-clés: opacification de l'axe visuel, cataracte, changement myope, résultat visuel.

Differences in the socio-demographic determinants of undernutrition in children aged <5 years in urban and rural areas of Bangladesh measured by the Composite Index of Anthropometric Failure.

OBJECTIVES: This study investigates the prevalence and determinants of undernutrition among children <5 years living in Bangladesh using the Composite Index of Anthropometric Failure (CIAF) and highlights the differences between urban and rural areas. STUDY DESIGN: Data are drawn from three cross-sectional Bangladesh Demographic Health Surveys conducted from 2007 to 2014. METHODS: A Chi-square test was used to assess the prevalence of <5 years child undernutrition. Logistic regression analysis was performed to identify various sociodemographic risk factors. RESULTS: The prevalence of undernutrition based on the CIAF was 52% among children <5 years in Bangladesh. The prevalence of undernutrition in children living in urban areas and rural areas were found to be 45% and 54%, respectively. As per the CIAF, undernutrition was highly prevalent among children in the older age group, children of uneducated and currently working mothers, those of underweight mothers, children of fourth and above in the birth order, children of fathers who were manual labourers, children of households who had no access to television and those in the poorest households whether in urban or rural areas. Children in the older age group, children of uneducated mothers, those with underweight mothers and those from the poorest households provided common key risk factors for undernutrition in both urban and rural areas. Children of fourth and above birth order and not watching television at all were additional risk factors of child undernutrition in rural areas. CONCLUSION: Half of the children in rural areas and two-fifths of them in urban areas are suffering undernutrition in Bangladesh, and several sociodemographic factors heighten the risks. Also, birth order and watching television were identified as the differential risk factors. This study therefore concludes that evidence-based interventions are needed to reduce the burden of undernutrition in children in the country.

Effect of dried oregano (Origanum vulgare L.) plant material in feed on methane production, rumen fermentation, nutrient digestibility, and milk fatty acid composition in dairy cows.

Essential oils (EO) from oregano may have antimicrobial properties, potentially representing a methane mitigation strategy suitable for organic production. This study aimed to (1) examine the potential of oregano in lowering enteric methane production of dairy cows fed differing levels of dried oregano (Origanum vulgare ssp. hirtum) plant material containing high levels of EO; (2) determine whether differing levels of dried oregano plant material of another subspecies (Origanum vulgare ssp. vulgare) with naturally low levels of EO in feed affected enteric methane production; and (3) evaluate the effect of various levels of the 2 oregano subspecies (containing high or low levels of EO) in feed on rumen fermentation, nutrient digestibility, and milk fatty acids. Each experiment had a 4 × 4 Latin square design using 4 lactating Danish Holstein dairy cows that had rumen, duodenal, and ileal cannulas and were fed 4 different levels of oregano. Experiment 1 used low EO oregano [0.12% EO of oregano dry matter (DM)] and evaluated a control (C) diet with no oregano and 3 oregano diets with 18 (low; L), 36 (medium; M), and 53 g of oregano DM/kg of dietary DM (high; H). Experiment 2 used high EO oregano (4.21% EO of oregano DM) with 0, 7, 14, and 21 g of oregano DM/kg of dietary DM for C, L, M, and H, respectively. Oregano was added to the diets by substituting grass/clover silage on a DM basis. Low or high EO oregano in feed did not affect dry matter intake (DMI) or methane production (grams per day, grams per kilogram of DMI, grams per kilogram of energy-corrected milk, and percentage of gross energy intake). Rumen fermentation was slightly affected by diet in experiment 1, but was not affected by diet in experiment 2. In both experiments, the apparent total-tract digestibility of DM, organic matter, and neutral detergent fiber decreased linearly and cubically (a cubic response was not observed for neutral detergent fiber) with increasing dietary oregano content, while milk fatty acids were slightly affected. In conclusion, dried oregano plant material with either high or low levels of EO did not lower the methane production of dairy cows over 4 consecutive days, and no substantial effects were observed on rumen fermentation or nutrient digestibility. This conclusion regarding methane production is in contrast with literature and requires further study.

Effects of dietary supplementation of spices on forage degradability, ruminal fermentation, in vivo digestibility, growth performance and nitrogen balance in Black Bengal goat.

The objective of the study was to evaluate the effects of spices on forage utilization and nitrogen (N) emission using in vitro and in vivo approach. A 6 × 5 factorial triplicate arrangement was used to assess the in vitro degradability of rice straw with control (without spices) and individual (40 mg/g rice straw) spices (cumin, coriander, clove, black cumin, turmeric) at five different incubation times. In vitro dry matter (DM) and organic matter (OM) degradability of rice straw were highest in presence of spices except for clove. Clove significantly reduced the total volatile fatty acids concentration, molar proportion of acetate and propionate ratio, but increased propionate production. Acetate and butyrate production were not affected by treatments. The ammonia-nitrogen concentration was lowest for clove and turmeric compared to other spices. Rumen pH was unchanged but gradually decreased over the incubation period. For in vivo study, 12 bucks with average live weight 7.65 ± 0.19 kg were assigned to a completely randomized design with three treatments and four replicates for a 28-day period. Bucks were fed a total mixed ration without (0 g/kg DM) or with (2.5, 7.5 g/kg DM) clove supplementation. DM intake, body weight and apparent total tract digestibility of crude protein (CP) and acid detergent fibre (ADF) were not affected by increasing dietary doses of clove but tended (p = .09) to increase DM and OM digestibility. The urinary N and urine urea N concentration of bucks decreased linearly with incremental doses of clove diet. In contrary, clove supplementation had positive effects on plasma urea N and retained N in bucks. We concluded that though some spices had positive effects on ruminal digestion and fermentation, the dosage level assessed in the current study (up to 7.5 g/kg DM clove) can be promoted as an effective dietary approach to mitigate N losses in bucks.

Ruptured Aneurysm of Sinus of Valsalva: A Case Report.

We have presented a case of ruptured aneurysm of sinus of valsalva, in a female of 24 years old, with the symptoms and signs of right heart failure. Diagnosis made by echocardiography. For further evaluation, cardiac catheterization was done. After improvement of her general condition, she was undergone operation. Per-operative findings were bicuspid aortic valve having no calcification. A fistulous tract having windsock appearance found in between fused RCC & NCC extending into the RV cavity, which was opened inferior to the tricuspid valve. Fistulous tract was excised and the opening in the root of the aorta was closed with PTFE patch by 5/0 polypropylene and RV side was closed by direct suture. Patient was symptomless after operation. Patient discharged on eighth postoperative day in stable condition.

Deciphering miRNA-lncRNA-mRNA interaction through experimental validation of miRNAs, lncRNAs, and miRNA targets on mRNAs in Cajanus cajan.

Pigeon pea (Cajanus cajan) is widely cultivated for its nutritional and medicinal value yet remains an orphan crop as productivity has not been improved because of a lack of genome and non-coding genome information. Non-coding RNAs, like miRNAs and long non-coding RNAs (lncRNAs), are involved in regulation of growth, metabolism, development, and stress response, and have a critical role in post-transcriptional gene regulation (PTGR). We attempted to elucidate the roles of miRNAs and lncRNAs in pigeon pea through experimental validation of computationally predicted miRNAs and lncRNAs and targets of miRNAs on mRNAs. We experimentally validated 20 miRNAs and 11 lncRNAs. We predicted cleavage sites of three miRNA targets: serine/threonine-protein kinase, polygalacturonase, beta-galactosidase. We identified 469 targets of 265 miRNAs and their functional annotations using computational methods. We built a miRNA-mRNA-lncRNA network model, with the miRNAs targeting both mRNAs and lncRNAs, to obtain information on the interplay of these three molecules. A confirmed interaction through experimental validation was established between miRNA, namely cca-miR1535a targeting the mRNA for beta-galactosidase, as well as the lncRNA cca-lnc-020033. Our findings increase knowledge of the non-coding genome of pigeon pea and their roles in PTGR and in improving agronomic traits of this pulse crop.

Association of Serum Vitamin D Concentration with the Severity of Patients with Atopic Dermatitis.

Atopic Dermatitis (AD) is a chronically relapsing, highly pruritic, allergic inflammatory skin disease with significant cost and morbidity to the patients and their families. The underlying cause of AD has not been understood, however some studies have shown initial epidermal barrier defect with subsequent immune activation as the underlying mechanism of AD. Vitamin D is now recognized as an immunomodulator. The role played by vitamin D in atopic dermatitis is controversial and has been the focus of many studies. The aim of the study was to measure serum vitamin D in the form of 25-hydroxy vitamin D in patients with AD and to correlate them with disease severity. This cross-sectional study included 41 patients (25 males and 16 females) of any age with the clinical diagnosis of AD seen in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to February 2017. Disease severity was determined using Scoring Atopic Dermatitis (SCORAD) index and the patients were divided into three groups: mild (SCORAD index <25), moderate (25-50) and severe (>50). Serum vitamin D levels were classified as sufficient (≥30ng/mL), insufficient (21-29ng/mL) and deficient (≤20ng/mL). Statistical analysis was performed using analysis of variance (ANOVA) and Pearson's correlation coefficient test. P value of <0.05 was considered as statistically significant. Among 41 patients 33 represent infantile and childhood AD and only 8 represent adolescent and adult AD. According to SCORAD index, 12 patients had mild, 20 had moderate and 9 had severe Atopic dermatitis. Levels of 25-hydroxyvitamin D were deficient or insufficient in 75.6% of patients and normal in 24.4% patients. There was no significant association between serum level of vitamin D and the severity of AD (r=-0.173). The mean±SD serum vitamin D level in mild AD (25.7±8.1) was higher compared with those with moderate (23.9±8.8) or severe (19.5±8.3) AD. But the result was not statistically significant (p=0.249). Variables such as sex, age, skin prototype, season and food allergy were not significantly associated with vitamin D levels. The results from this study suggesting that millions of children living in Bangladesh may have suboptimal levels of vitamin D, which should be a matter of public health concern. But these deficient results are not significantly related to AD severity. Thus, the study provides epidemiological evidence against the association of vitamin D status with atopic dermatitis for the first time in Bangladesh.

Vaccination against COVID-19 in Bangladesh: Perception and Attitude of Healthcare Workers in COVID-dedicated Hospitals.

Healthcare professionals are the crucial and influencing source of information for vaccines and their communication among patients and communities that can accelerate successful vaccination in a country. This cross-sectional study was one of the first and foremost ones in Bangladesh to observe the basic perception and attitudes towards vaccination against COVID-19 among the healthcare workers (HCWs) - doctors, interns, nurses, ward boys, cleaners, and medical technologists of major COVID-dedicated hospitals. The cross-sectional questionnaire-based study was conducted in February 2021 among 550 HCWs to assess the perception and attitude towards vaccination against COVID-19. The study participants were targeted as the priority group for COVID-19 vaccination, working in two major COVID-dedicated hospitals, Holy Family Red Crescent Medical College Hospital (HF-center), and Sheikh Russel National Gastro-liver Institute and Hospital (SR-center) in Dhaka, Bangladesh during the pandemic. The questionnaire was structured with a three-point scale of responses from 'true', 'false', and 'do not know'. The responses were calculated on point-score as +1 for the correct response, -1 for the wrong response, and 0 for 'do not know' with an overall highest and the lowest possible score of +5 to -5. Absolute (n) and relative frequencies (%) were presented for qualitative variables, while quantitative variables were presented as mean (± standard deviation). Chi-square test was done for univariate analysis of qualitative variables and Student's t-test for quantitative variables. With the 95.27% response rate, including 204 males and 320 were female and the male: female ratio was 1: 1.56. The majority of the participants were doctors (45.8%) followed by nurses (27.9%), and MLSS (26.3%) respectively. The respondents were between 18 to 64 years of age with a mean of 36.17±10.94 years. Most of the respondents (95.99%) responded correctly about the cost-free availability of a vaccine against COVID-19 in the country, 87.40% preferred vaccination as safe and effective. Again 29.77% HCWs think the vaccine might not be safe or effective due to emergency authorization. Only 38.93% of respondents could respond correctly about the necessity of vaccines for children, 31.10% think the vaccination was not required instead of natural immunity. The positive perception and attitude of the frontline HCWs in COVID-dedicated hospitals in Bangladesh are crucial which will positively influence motivation and wide acceptance among the general population for the attainment of the nationwide vaccination program, and adopt effective strategic modification to minimize the gaps for a low-middle income country like Bangladesh with its resource constrain.

Gastrointestinal Manifestations among COVID-19 Patients in Bangladesh: A Cross Sectional Study.

This study was done to find out the frequency of gastrointestinal manifestations among adult COVID-19 patients in Bangladesh. This descriptive cross sectional retrospective study was conducted from 27 May till 20 June 2020. Data were collected retrospectively from three different hospitals of Dhaka, Bangladesh. Patients were interviewed over telephone and verbal consents were taken. Their demographic and clinical profiles were put in the questionnaires by the investigators themselves. Statistical analysis was done thereafter. Out of 226 patients diagnosed with COVID-19, 145(61.4%) patients had gastrointestinal symptoms. Five of them had none other than gastrointestinal symptoms. Twenty six patients were asymptomatic. Mean age of the patients with were 41.6±14.8 years. Males were affected almost equally as the females (51.72% vs. 48.27%) (Ratio 1.1:1). Anorexia (44.7%) followed by diarrhoea (35%) and nausea (22.6%) were the predominant symptoms. Patients with co-morbidities (74.7%) were more prone to develop GI symptoms. Family members (71.6%) of COVID-19 patients with GI symptomatic patients were more affected than the others. Hospitalizations (77.6%) were more among GI symptomatic patients than the others. Thirty Five percent (35%) patients had diarrhoea. Mean duration of diarrhoea was 2.7±1.7 days with a frequency of were 4±1.8 days per day. Gastrointestinal manifestations are common among patients with COVID-19. Clinicians need to be aware of the GI features amongst COVID-19 patients so that they can be addressed and treated effectively and immediately. Further large scale study is needed to predict the disease outcome among COVID 19 patients with GI symptoms.

Cultural Variations in Symptom Presentations of Depression: A Cross-sectional Observation in a Tertiary Care Hospital of Bangladesh.

Depression is a normally occurring, severe, repeated disorder associated to diminished role functioning and quality of life, medical morbidity, and mortality. But presentation of depression differs culture to culture. We aimed to see the proportion of depressed patients presented spontaneously with the somatic complaints at department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This descriptive, cross sectional study was conducted within the time period of June 2016 to December 2017 among the outdoor patients of the university. Purposive consecutive sampling was used to collect data from 105 depressed patients. The diagnosis was confirmed by the psychiatrist based on the DSM-5 criteria of depression. Data were collected through face to face interview with semi structured preformed pretested questionnaire. All data were entered into SPSS 16.0 software and were analyzed. The mean±SD age was 32.09±12.13 years, ranging from 18 to 70 years. Among the 105 respondents 36% of the depressive patients had complaints of somatic symptoms spontaneously. Headache (34.21%), weakness (2%), body ache (5%), hearing problem, heaviness of the body, restlessness, chest pain, palpitation, dizziness, vertigo, breathlessness, abdominal discomfort and burning sensation were the mentionable symptoms. Fear (11), anger (2), undue suspiciousness (2) & sexual dysfunction were the mentionable psychological symptoms. Due to multiple factors depressed patients can spontaneously present with somatic complaints, but after questioning on depression they can be diagnosed as depression. So, unexplained somatic symptoms should be attended and addressed properly in any stage of care.

Wound Coverage of Infected Open Fracture of Distal Third of Tibia by Distally Based Medial Hemi-Soleus Muscle Flap.

We conducted a study to evaluate the reliability of the medial hemi-soleus muscle flap for wound coverage of infected open fracture of distal third of tibia. Wound coverage of exposed lower third tibia and ankle region remains a difficult task. Muscle flaps are preferred for infected wounds especially where there are exposed bone, joint and/or tendons. Soleus muscle is a good option for local reconstruction. Soleus being the prime ankle plantar flexor and stabilizer of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. So, medial hemisoleus muscle flap is a superior option than the whole Soleus. This post-intervention prospective study which was descriptive in nature was conducted at department of Orthopedics, Community Based Medical College Hospital, Mymensingh, Bangladesh from January 2012 to December 2012. Ten patients with distal third tibial defects were included in the study. Data was obtained by history taking, observation, clinical examination, supported by routine laboratory and radiological investigations. Before intervention they underwent to careful vascular study of the affected limb through Doppler ultrasonography. All the patients were provided soft tissue coverage with distally based medial hemi-soleus muscle flaps with split thickness skin graft on it. All the flaps survived with primary healing of the wound. Among the participants there were 7 male and 3 female with average age 44.60 years, SD 13.73 years. Eight patients were injured by road traffic accident and 2 patients had history of alleged assault. The wound size defects in primary site ranged from 4cm to 9cm in length and 3cm to 6.5cm in breadth. All the wounds in the primary site were infected. The fractures in the primary site were open fractures involving distal third of tibia. In the secondary site the injuries were fracture upper third tibia in the other lower limb 2, fracture femur on other lower limb 1, dislocation shoulder joint on the same side upper limb 1. The follow up period ranged from 8-16 weeks (average 12 weeks). The outcome was successful. All flaps survived without complication. Hemisoleus muscle flap is a valuable local option for soft tissue coverage of distal third of leg. It does not sacrifice the whole soleus muscle. Due to its longer arc of rotation, this flap can cover the defect of different size and shape in distal third of leg.

Utility of XY-amelogenin gene primers for detection of sex chromosomes.

The utility of polymerase chain reaction (PCR) amplification of amelogenin gene as a reliable and rapid means of determination of sex chromosomes was tested in 20 patients of X-linked disorders (Duchenne muscular dystrophy, haemophilia and Wiscott-Aldrich and Hunter's syndromes), 12 of intersex (testicular feminization syndrome, male pseudohermaphrodites, true hermaphrodites) and 21 of congenital adrenal hyperplasia. Of these, 26 (49%) cases were for prenatal diagnosis of X-linked diseases and congenital adrenal hyperplasia (CAH). The presence of X and Y chromosomes was determined within 24 h of receiving the samples. The results were in conformity with cytogenetic studies in all instances. The analysis of amelogenin gene proved helpful in the diagnosis and management of these patients.

Cytogenetic studies in ataxia telangiectasia & their use in prenatal diagnosis.

Cytogenetic studies were carried out in obligate ataxia telangiectasia (AT) heterozygotes, AT homozygotes and control subjects. Rate of chromosomal aberrations and the frequency of micronuclei were examined before and after radiation (100 rads). Significant differences in the rate of chromosomal aberrations and micronuclei were observed among heterozygotes, homozygotes and controls. The same methods were then applied for prenatal diagnosis of AT using amniotic cell culture in two families.

Improved method for study of chromosomes of chorionic villus samples.

Chorionic villus sampling (CVS) offers rapid prenatal diagnosis of chromosomal disorders. We evaluated four methods for chromosomal analysis of chorionic villi (three based on direct preparations and one on long-term culture) in order to define a method which would provide good quality metaphases in sufficient numbers. The direct culturing method using synchronisation and dissociation with dispase was as good as long-term culturing. The optimal period of gestation for study was 10-12 wk.

Effects of endothelins on fluid and NaCl absorption across the jejunum anesthetized dogs.

The aim of this study was to investigate the effects of endothelins on fluid the NaCl absorption across the jejunum, the jejunal fluid and NaCl absorption and mesenteric hemodynamics in jejunal loops in anesthetized dogs during infusion of saline, endothelin-1 or endothelin-3 into the superior mesenteric artery. Infusion of endothelin-3 decreased the net fluid, Na+, and Cl- absorption; however, saline and endothelin-1 had no effect. To investigate the role of nitric oxide and soluble guanylate cyclase activation in the mechanisms underlying endothelin-3-induced decrease in fluid and electrolyte absorption, measurements were obtained in the presence of the nitric oxide synthesis inhibitor, nitro-L-arginine methyl ester (L-NAME) or the soluble guanylate cyclase inhibitor, methylene blue. The endothelin-3-induced decrease in absorption was not influenced by the pretreatment with inhibitors. These results suggest that the endothelin-3 response was not mediated by nitric oxide or soluble guanylate cyclase.

An update on the prevalence of HIV/AIDS in Bangladesh.

The National AIDS Committee was formed in 1985 to develop and support policies that prevent transmission of human immunodeficiency virus (HIV). In 1990, the Institute of Epidemiology, Disease Control and Research in the Ministry of Health began sero-surveillance for AIDS/HIV infection. Convenience sampling was conducted among prisoners, sailors, truckers, antenatal attendees, repatriated Bangladeshi workers, and brothel-based prostitutes in Dhaka. In 1994, commercial sex workers in other high-risk areas were included in surveillance activities. Among over 75,700 HIV tests through 1998, 119 have been confirmed positive for HIV. While the cumulative HIV prevalence rate was only 1.5/1,000 tests, it was significantly higher among men (p < 0.0001) than among women. The rates among men were as high as 28/1,000 tests in 1996 and 21/1,000 tests in 1997. Almost 50% of the reported HIV cases are from cities on the border of India and Myanmar. It is anticipated that HIV transmission will increase further given the high prevalence of risk behaviors, core high-risk groups, and extreme poverty.

Association of cucumovirus and potyvirus with betelvine (Piper betle L.) as evidenced by ELISA and RT-PCR.

An attempt was made to detect various viruses of Piper betle grown at Mahoba and Banthara in India. DAC-ELISA and RT-PCR tests were performed in leaf sap samples of betelvine for detection of a cucumovirus (Cucumber mosaic virus) and potyvirus (Bean yellow mosaic virus) using specific antibodies and universal primers of respective viruses. DAC-ELISA could detect only CMV. However, RT-PCR detected both cucumovirus and potyvirus infection in betelvine samples. Association of CMV with betelvine was observed for the first time in the present study.

Recent advances in chromosome breakage syndromes and their diagnosis.

Chromosome instability is a characteristic cytogenetic feature of a number of genetically determined disorders collectively called as the chromosome breakage syndromes or DNA-repair disorders. They are characterized by susceptibility to chromosomal breakages, increased frequency of breaks and interchanges occurring either spontaneously or following exposure to various DNA-damaging agents. These diseases are a group of genetic disorders sharing a number of features. They are all autosomal recessive, show an increased tendency for chromosomal aberrations and to develop malignancies. The principal diseases in this group having a diverse etiology and clinical manifestations include Fanconi anemia (FA), ataxia telangiectasia (AT), Nijmegen breakage syndrome (NBS), Bloom syndrome (BS), xeroderma pigementosum (XP), Cockayne syndrome (CS) and trichothiodystrophy (TTD). The underlying defect in these syndromes is the inability to repair a particular type of DNA damage. A number of repair disorder phenotypes are caused by more than one gene. The diagnosis of these syndromes is made by the characteristic clinical features specific to each disease, but the definitive diagnosis is achieved by laboratory investigations such as cytogenetic, biochemical and molecular methods. The importance of prenatal diagnosis and our experience are discussed in this article.