Clinical Evaluation of Bucco-lingual Crestal Bone Remodeling in Mandibular Posterior Implants placed immediately and Delayed into Extraction Sites.

The objective of this cross sectional study was to evaluate the bucco-lingual crestal bone remodeling in mandibular posterior implants placed immediately and delayed into extraction sites and carried out in the department of Prosthodontics of Dhaka Dental College and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2010 to July 2014. Forty patients were evaluated in this study; of them 25(62.5%) patients were males and 15(37.5%) were females with age range from 24 to 70 years. At first surgery during implant placement the mean distance from buccal bone to lingual bone was 11.11mm for immediate implants and 9.265mm for delayed implants. At second-stage surgery the mean distance from buccal bone to lingual bone was 9.765mm for immediate implants and 6.25mm for delayed implants. The mean±SD change of bone reduction at second surgery was 1.28±0.31 for immediate implants and 3.01±0.33 for delayed implants. Unpaired t test was done for statistical analysis and p value was less than 0.05. So, the changes were statistically significant.

Sonographically Detected Non Alcoholic Fatty Liver Disease in Apparently Healthy Adults and Associated Factors.

This hospital-based study was done to see the prevalence of sonologically detected non alcoholic fatty liver disease and associated factors in the apparently healthy adults. Apparently healthy and non alcoholic companions of the patients visiting the Centre of Nuclear Medicine and Ultrasound, Sylhet were subjected to abdominal ultrasonography to see the presence of fatty liver. Demographic features and other relevant data were collected in a semi structured questionnaire to find out the associated factors for non alcoholic fatty liver disease (NAFLD). Total 1019 persons with mean age of 37.23 years were included in the study. Among them 703 (69%) were female and 316 (31%) were male. Out of them 189 (18.5%) persons had sonologically detectable nonalcoholic fatty liver disease. NAFLD was more prevalent in male than female (25.6% vs. 15.4%, p=0.000). In univariate analysis NAFLD were more in male (25.6%) 41-50 years age group (29.3%, p=0.000), over weight (32.3%)/obese subjects (51.4%), businessmen (24.0%), service holders (28.7%), high income group, diabetics (27.0% vs. 18.0%, p=0.000) and hypertensive subjects (43.3% vs. 15.24%, p=0.000). In multivariate analysis, BMI over 23kg/m² (OR 6.683, p=0.000), age >30 years (OR 1.787, p=0.006) and higher income (OR 1.788, 95% CI 0.970-3.293) were independent factors associated with NAFLD. Sonologically detected nonalcoholic fatty liver disease (18.5%) is common in our apparently healthy adults. BMI over 23kg/m² was the most important predictor for NAFLD.

Peptic Ulcer Disease in Bangladesh: A Multi-centre Study.

The incidence of peptic ulcer has steadily declined through out the world. This decreasing trend is also noticeable in this subcontinent. The point prevalence of peptic ulcer (PUD) in Bangladesh was around 15% in eighties. The aim of this study was to see the present prevalence of peptic ulcer at endoscopy and to identify changing trends in the occurrence of peptic ulcer in Bangladesh. This retrospective analysis of the endoscopic records of multiple tertiary referral centres of Dhaka city were done from January 2012 to July 2013. A total of 5608 subjects were the study samples. We included those patients having peptic ulcer in the form of duodenal ulcer, benign gastric ulcer including pre-pyloric ulcer and gastric outlet obstruction due to peptic ulcer. Duodenal ulcer and benign gastric ulcer were found in 415(7.4%) and 184(3.28%) patients respectively and gastric outlet obstruction due to peptic ulcer was found in 23(0.40%) patients.

Evaluation of Body Mass Index Before and After Prosthetic Rehabilitation with Complete Denture Therapy.

The objective of this study was to compare body mass index (BMI) of the edentulous patients before and after complete denture therapy. Forty five (45) patients who had been edentulous for six months to one year and required complete dentures were selected for this study; of them 25(55.56%) were males and 20(44.44%) were females and age range was between 40 to 70 years. Every patient was provided with complete dentures fabricated with ethical standard procedures. Analysis of the body mass index (BMI) was done at base line; and at three and six months follow up. The mean BMI values were found 19.58±1.93; 20.63±1.89 and 22.02±1.80 at base line, at three months follow up and at six months follow up respectively. The differences of the BMI values were found to be statistically significant (p<0.05) both at 3 months and 6 months follow up compared to the base line value.

Pattern of Changes in the Findings among the Patients Undergoing Diagnostic Esophagogastroduodenoscopy in Bangladesh.

This cross-sectional observational study was conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College and Mitford Hospital, Holy family Red Crescent Medical College and Hospital and Popular Diagnostic Centre, Shantinagar branch, Dhaka, Bangladesh from January 2012 to July 2013. Study subjects were included in the study irrespective of age and sex having different upper GI tract. Complaints like dysphagia, heart burn, abdominal pain/dyspepsia, nausea, vomiting, haematemesis and/or malena, anorexia, unexplained anemia, weight loss etc. All the findings of oesophagus, stomach and duodenal lesions were observed and data were recorded. The results were considered positive based on the macroscopic appearance using standard diagnostic criteria. During the study period endoscopy was performed in 5608 subjects. Among which 2968(52.92%) were male and 2640(47.07%) were female. The patients age range from 7 years to 108 years. The majority of the patients were from 40-50 years. Normal findings were observed among 3321(59.21%) cases. Gastroduodenal erosions were present among 684(12.19%) cases, Oesophageal varices in 444(7.91%) cases, duodenal ulcer diseases in 415(7.40%) cases and gastric ulcer in 184(3.28%) cases. Ca stomach was found among 165(2.94%) cases. A number of diseases were identified through this procedure. Current study observed a large proportion of patients (40.79%) had positive upper GI endoscopy.

Comparative Study of Adenosine Deaminase and Other Conventional Diagnostic Parameters in Diagnosis of Tuberculous Pleural Effusion.

Though pulmonary tuberculosis is the common presentation of Mycobacterium tuberculosis infection, extra-pulmonary tuberculosis is also a growing problem worldwide. Tuberculous pleural effusion is the second frequent form of extra-pulmonary presentation after tuberculous lymphadenitis and if untreated up to 65% of patients with tubercular pleural effusions will eventually develop active TB. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. So,the aim of this study was to evaluate the diagnostic value of ADA level in plural fluid and other conventional methods for diagnosis of tubercular plural effusion. This was a cross sectional study. This study was carried out in 64 Patients suffering from plural effusion and were consecutively selected and divided into two groups: tuberculous (n=40) and non tuberculous (n=24), depending upon etiology. Details clinical history, physical examination, routine and other relevant investigations including ADA estimation was measured. The mean value of ADA in the tuberculous group was 64.11 ± 19.50 U/L which was significantly higher (p<0.05). Cut off value of ADA was ≥ 40 U/L with 97% sensitivity and 93%specificity. In this study, sensitivity, specificity, PPV and NPV of ADA level in pleural effusion were more significant than other conventional parameters.

Comparison of Serum CA72-4 and CEA Levels in Patient with Endoscopically Suspected Gastric Carcinoma.

Several serum tumour markers have been described for gastric cancer. Preoperative level of tumor marker helps to predict the diagnosis of gastric carcinoma. CA72-4 as a serum tumour marker for gastric cancer is evaluated, and compared its utility in this regard with that of carcinoembryonic antigen (CEA). Analysis of gastric carcinoma by serum levels of CEA and CA72-4 and their correlation with histopathology help the clinician to develop his management strategies for gastric carcinoma. A prospective observational study was carried out in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with Department of Surgery BSMMU, DMCH, Delta Hospital Limited, Dhaka, during the period of October 2010 to September 2011. Serum CA72-4 and CEA were analyzed in 71 endoscopically suspected patients for gastric carcinoma. Among them 58 cases were diagnosed as malignant gastric disease and 13 cases were nonmalignant gastric disease. Sensitivity of CA 72-4 and CEA were 48.3% and 31% respectively and specificity were 92.3% and 76.9% respectively. In poorly differentiated carcinoma, positivity for CA72-4 and CEA were 55.6% and 36.1% respectively. Because of the high positivity of CA72-4 in poorly differentiated carcinoma, CA72-4 is reliable tumour marker in advanced cases. As the sensitivity of CA72-4 was more than that of CEA in diagnosis of gastric cancer, CA72-4 can be used in conjunction with other diagnostic tests like endoscopy that would be more helpful for the patients.

Correlation of Connective Tissue Growth Factor (CTGF/CCN2) with Hepatic Fibrosis in Chronic Hepatitis B.

CTGF/CCN2 plays an important role in the formation and development of hepatic fibrosis. This study determined the correlation between serum CTGF/CCN2 and stages of hepatic fibrosis and explored the clinical value of serum CTGF/CCN2 in the assessment of hepatic fibrosis in chronic hepatitis B. This cross sectional study was done in department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2012 to February 2013. Serum CTGF was measured by using of a sandwich immunoassay technique. Forty (40) chronic hepatitis B patients were included in this study. The sensitivity of CTGF/CCN2 was 71.6%, specificity 67.5%. Spearman's rank correlation coefficient was 0.652 between serum CTGF/CCN2 and stages of hepatic fibrosis (p<0.001). The area under receiver-operating curve (ROC) was 0.750 for identification of hepatic fibrosis. This present data revealed that serum CTGF/CCN2 in chronic hepatitis B were strongly associated with stages of hepatic fibrosis. CTGF/CCN2 may useful diagnostic tool for assessing the hepatic fibrosis in chronic hepatitis B.

Efficacy of adefovir dipivoxil therapy in patients with chronic hepatitis B viral infection.

Hepatitis B virus (HBV) infection is a major public health problem in the world. About 30% of world population has serological evidence of HBV infection. The prevalence of chronic hepatitis B in Bangladesh is reported to be 7.8%. Several potentially effective agents with different mechanisms of action have entered clinical practice and adefovir dipivoxil is one of them. Studies on the efficacy of adefovir dipivoxil in Bangladeshi patients are lacking. This was a prospective study to find out the effect of one year adefovir therapy in patients with chronic hepatitis B virus infection who were HBeAg positive. Total number of patients included in this study was 68. Among them 53(77.94%) patients continued the therapy and completed follow up. At the end of one year of therapy, intention to treat analysis showed that the rate of response (HBeAg seroconversion and HBV DNA negative) was 37.73% which was comparable to the results obtained in other studies. There was major difference in the pre treatment serum ALT level between the responders and non-responders. Comparison of reduction of serum ALT level before treatment and after treatment showed that ALT level to be lower in both responder group and non responder group. Adefovir was effective in replicative HBV infection in Bangladeshi population. So we suggest that treatment can be started and subsequent follow up can be done in chronic HBV patients who are HBeAg positive without liver biopsy.

Disease extent and local complication of ulcerative colitis in Bangladeshi population.

Ulcerative colitis may involve anywhere from the rectum alone to the entire colon. Local complications like perforation, life threatening haemorrhage, toxic megacolon, pseudo polyps, stricture, and carcinoma of colon are seen. Patients who were diagnosed as Ulcerative Colitis in Departmental Ulcerative Colitis record book from January 1990 to June 2010 was considered as study population. Information regarding the extent of the disease and local complications were taken from earliest documented Lower GIT Endoscopy. Out of 164 patients disease extent were seen in 126(76.83%) patients and among them proctitis/proctosigmoiditis were seen in 57(45.24%) patients, left sided colitis were seen in 11(8.73%) patients, extensive/pan colitis were seen in 58(46.03%) patients. Complication were seen in 164 patients and 1(0.60%) patient had life threatening haemorrhage, 25(15.24%) patients developed pseudo polyps. There was no report of perforation, toxic megacolon, stricture or carcinoma of colon. The differences found between our study and studies from other Western and Asian countries in terms of complication rate and disease extent for were probably due to low index of suspicion, incomplete workup, or incomplete records, and influence of various environmental factors. So, further large scale prospective evaluation is suggested.

Cirrhosis of liver and portal vein thrombosis - a review article.

Cirrhosis is characterized by diffuse hepatic fibrosis and nodule formation which can occur at any age with significant morbidity and is an important cause of premature death. Occlusive portal vein thrombosis (PVT) is common complication of chronic liver disease with prevalence ranging from 1% to 16% of population. The occurrence of portal vein thrombosis is influenced by local factors (cirrhosis with associated liver architectural changes and increased resistance effects), systemic factors (inherited and acquired abnormalities leading to hyper coagulability) and development of hepatocellular carcinoma. The majority of patients with cirrhosis PVT are diagnosed on radiographic studies although in some patients PVT may present with decompensated chronic liver disease but the natural history of PVT in patients with cirrhosis is largely unknown. However patients with cirrhosis and PVT have been shown to have inferior survival in comparison with patients without PVT.

Peginterferon α-2a and rivabirin in the treatment of chronic hepatitis C.

Peginterferon α-2a with ribavirin produces significantly higher sustained virological response (SVR) in comparison to conventional interferon monotherapy in patients with chronic hepatitis C virus (HCV) infection. We evaluated the efficacy and safety of peginterferon α-2a plus ribavirin combination in the treatment of chronic hepatitis C among Bangladeshi patients. A total of 64 patients were randomly selected in this study and were assigned for treatment with peginterferon α-2a 180µg once weekly plus ribavirin daily for 24 weeks in case of genotypes 2 and 3 infections and 48 weeks in case of genotypes 1 and 4 infections. Ribavirin was given 800mg in divided doses in case of genotypes 2 and 3 infections and 1000mg-1200 mg in case of genotypes 1 and 4 infections according to body weight daily(1000 mg in divided doses if body weight <75kg and 1200mg in divided doses if body weight >75kg). Efficacy was assessed by measurements of serum HCV-RNA and serum ALT. A higher proportion of patients (71.87%) who received peginterferon α-2a plus ribavirin had a sustained virological response. It is observed that genotype 3 (a and b) patients showed poor response (SVR-47.05%), where as genotypes 1(a,b), 3 and 4 mixed, 2b and 4 infections showed response rate of 100%. So it can be concluded that once weekly peginterferon α-2a plus daily ribavirin is effective in chronic HCV infection in Bangladesh and overall response rate is similar to that reported in other studies.

Clinical, biochemical, virological and sonographic profile of incidentally detected asymptomatic HBsAg positive subjects, in Bangladesh.

Chronic hepatitis B virus (HBV) is known to be the significant cause of Liver related morbidity and mortality, affecting 400 million people worldwide and a major public health problem in Bangladesh where carrier rates of HBV infection varies from 7.5 to 10%. In Bangladesh prevalence of asymptomatic HBV infection and incidentally detected HBsAg positive subjects were not well studied. The aim of this study is to evaluate the disease activity, replicative status of the virus and to find out the stages of chronic liver disease among incidentally detected asymptomatic HBsAg positive Bangladeshi subjects. Two hundred (200) incidentally detected healthy HBsAg positive subject were evaluated clinically, biochemically, serologically and ultrasonographically from January 2004 to June 2008. HBeAg was found positive in 17(8.5%), anti-HBe was positive in 174(87%), raised serum ALT (>45iu/L) in 45(22.5%), prothrombine time (PT) >3 sec of control in 33(16.5%). Ultrasonography showed coarse hepatic echotexture in 13(6.5%). Evidence of active viral replication and signs of chronic liver disease were observed among incidentally detected healthy HBsAg positive subjects. Such individuals should be followed up at regular interval to evaluate the replicative status of the virus and disease activity so that appropriate measures could be initiated in time.

Comparative efficacy and safety of trimebutine versus mebeverine in the treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a functional disorder characterized by chronic or recurrent abdominal pain or discomfort with bowel disturbances. This prospective, randomized clinical trial has been conducted on IBS patients, using trimebutine and Mebeverine in separate group in parallel design to compare the efficacy and safety of Trimebutine 100mg twice daily with mebeverine 135mg twice daily. Patients of 15 to 60 years old and both sexes were included from the out patient department (OPD) of gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from June 2010 to December 2011. A validated IBS-QOL instrument consisted of 34 questions used to assess improvement of quality of life before and after treatment. A total of 140 patients were enrolled in this study. Eighteen patients dropped out. One hundred twenty two patients completed the trial. In this study at the end of 6 weeks therapy, improvement of symptoms was statistically significant. However, differences of improvement between the two groups in relieving various symptoms were not statistically significant. Mean QOL score before treatment was 103 in Trimebutine group and 106 in Mebeverine group. After 6 weeks of treatment mean QOL score was 82 in Trimebutine group and 95 in Mebeverine group indicating improvement in both groups was statistically significant. The difference between the two groups was also significant. No worsening of symptoms and no side effects of the therapeutic agents was observed in any patient during the trial.

Clinical profile of 250 cases of amoebic liver abscess.

Liver abscess is an emergent public health burden with considerable morbidity. Its prevalence varies from country to country. This prospective study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh and Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh from January 2004 to December 2009 to asses clinical pictures of 250 cases of amoebic liver abscess. Majority of patients were male (84%) presenting with upper abdominal pain (96.8%). High grade fever was present in 74% cases. Vomiting & nausea in 29.2% while loss of appetite in 42% patients. Only 4% patients showed diarrhea. On examination, tenderness in right hypochondriac was the predominant signs (95%) associated with hepatomegaly in 80% cases. Seventy eight percent cases showed leucocytosis. Serum alkaline phosphatase was raised in 66% patients. Colour of the aspirate was chocolate/brown in 80% cases. It is our experience that although complications are found hardly, they may take a menacing course if diagnosed, managed or both at the eleventh hour.

Bioavailability and plasma concentration of omeprazole in healthy bangladeshi population after ingestion.

This cross-sectional observational study was conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Plasma concentration of omeprazole was assayed in the quality control laboratory of Novartis (Bangladesh) Limited, Tongi, Gazipur, Bangladesh. The study was conducted from January 2006 to April 2007 and was designed to find out the bioavailability of omeprazole in capsule form in healthy Bangladeshi population and to compare this with that of the other population in the world. Twelve healthy volunteers were included in this study. The subjects were divided into two groups; six of them were randomly selected in each. One group received 40mg omeprazole intact capsule of one trade and other group received 40mg omeprazole intact capsule of another trade once daily for consecutive 8 days at 8.00 hours on each day. On the first and eight days of dosing, 10ml of blood sample was collected from each subject at 0.0, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 and 6.0 hours after dosing. Blood samples were centrifuged at 2500rpm for 15 minutes and plasma was stored at 20°C. Omeprazole concentration in plasma was determined using a reverse phase high performance liquid chromatography (HPLC). From the concentration, the area under the curve (AUC) of omeprazole was determined for each subject by the trapezoidal rule. From the result it was observed that the plasma concentration of omeprazole was increased up to 6 hours in both trade-A and trade-B in day 1 and 8. Thus the AUC of omeprazole was also increased. But most of the studies in western population showed that the maximum plasma concentration was within 0.5 to 2.0hours indicating a difference from that of western studies. In this study all the subjects exhibited increased plasma concentration and AUC which may be due to genetic variation of omeprazole metabolism as an Asian which may be due to slow or "Poor metabolizers" (PMs), of the study population, who are deficient in CYP2C19. It is revealed that the plasma concentration and AUCs of both the products after single and repeated doses of omeprazole capsule were higher in comparison to other studies in western population.

Ultrasonographic evaluation of morphologic pattern of amoebic liver abscess.

We evaluated sonographically 250 cases of amoebic liver abscess (ALA). Seventy eight percent (78%) of the ALA was located in the right lobe of the liver and 15% in the left lobe and rest of the abscesses occupied both lobes. ALA was round in 50% and oval in 40% of the cases without significant wall echoes. Eighty eight percent (88%) of these were inhomogeneous. Twenty one percent (21%) of these lesions was contiguous with the liver capsule. Post therapy sonographic evaluation showed that there was complete resolution of the abscesses within one year in 90% cases, other showed residual abnormalities in the form of hypoechoic in 7% and hyperechoic in 3% cases. We concluded that serological and clinical data in combinations with these non specific sonographic features are sufficient for the management and follow up of ALA obviating the need for expensive and invasive techniques in most of the cases.

Serum transaminase level changes in dengue fever and its correlation with disease severity.

It was observed that liver enzymes are elevated in dengue fever. In this study our aims were to determine the changes in serum transaminases in dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and to find out the relation of transaminase level changes with the disease severity. This cross sectional, prospective hospital based observational study was carried out in the department of Gastrointestinal Hepatobiliary and Pancreatic diseases and Internal Medicine department of BIRDEM Hospital, Dhaka. Patients are classified into 3 groups depending on clinical & laboratory findings: Group 1 dengue fever (DF), Group 2 dengue hemorrhagic fever & Group 3 dengue shock syndrome. A total of 240 cases were taken in this study who fulfilled the selection criteria. Out of whom 125 male and 115 female patients. DF was 157(65.4%) & DHF was 83(34.6%). Aminotransferases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] were significantly raised in DHF cases compared to those of classical dengue fever (AST 84.5±42.4 in DF vs. 507±106.8 IU/L in DHF and ALT 59.9±31.3 in DF vs. 234±30.6 IU/L in DHF). The rise of AST is far greater than ALT in both DF and DHF. Dengue fever is usually associated with mild to moderate elevations of aminotransferase levels. The increase in aminotransferases, mainly AST has been associated with disease severity and serves as an early indicator of dengue infection.

Role of Saccharomyces boulardii in diarrhea predominant irritable bowel syndrome.

Several studies with probiotics have shown promising results in the treatment of IBS. One of the probiotics used was saccharomyces boulardii. This is a randomized double blind placebo controlled clinical trial of S. boulardii in diarrhoea predominant IBS and was carried out in the hospital of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2004 to July 2005. Thirty five (35) patients were included in each of the control and study groups. The study group was treated with S. boulardii 250 mg twice daily orally for one month. Patients were evaluated before therapy, at the end of therapy and 30 days after end of therapy by a scoring system which included symptoms as well as personal and professional life. No significant difference between the two groups was found in any of the parameters evaluated on any of the observation days. S. boulardii treatment for 30 days in diarrhoea predominant IBS patients did not result in any improvement in this study.