Short-segment versus Long-segment Stabilization for Unstable Thoracolumbar Junction Burst Fractures.

The treatment of unstable thoracolumbar junction burst fractures remains a controversial issue. We evaluate the efficacy of short segment (SS) compared with that of long-segment (LS) stabilization in terms of clinical and the radiological outcomes. Records of 88 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation from January 2004 to December 2015, studied retrospectively. These patients were divided into two groups: SS and the LS-group. Clinical parameters: back pain, disability, neurological deficit and radiologic parameters: Cobb angle, sagittal index, the kyphotic deformation of vertebral body, vertebral height and canal compromise were measured before surgery and immediately after surgery and at 3, 6 and 12 months postoperatively. Overall outcomes were evaluated using the modified Mcnab criteria at the last follow-up. Chi-squared test and paired-t test were used for statistical analysis using SPSS. There were 36 and 52 patients in the SS and LS- group, respectively. The mean age of the patients was 30.6±8.4 and 33.4±8.4 years and the mean follow-up period was 24.5 and 16.8 months in SS and LS-group respectively. In the SS-group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 15, 10, 6, 3 and 2 cases and LS- group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 22, 17, 5, 5 and 3 cases, respectively. Both groups achieved satisfactory clinical outcomes according to the modified Mcnab criteria. In the SS-group, 8(22.22%), 21(58.33%) and 7(19.44%) cases were considered to have excellent, good and fair outcome and LS-group, 18(34.61%), 25(48.08%), 6(11.54%) and 3(5.77%) cases were considered to have excellent, good, fair, and poor outcome, respectively. Short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar junction burst fracture.

Goldenhar syndrome - a case report.

Goldenhar syndrome is a developmental abnormality of 1st & 2nd branchial arch involving the craniofacial microsomia with ocular & vertebral abnormality. Though most of the cases are sporadic, some familial association is also found in autosomal dominant or recessive manner. Teratogenic effect of some toxic substances may lead to the condition. Ocular abnormalities are epibulbar dermoid, lipodermoid & coloboma. Otic defects are preauricular tags, microtia, anotia & conductive hearing loss. Cardio-pulmonary & genitourinary abnormalities are common associations. Here we have described the case of a 10 years old girl had ocular, auricular & vertebral changes consistent with Goldenhar syndrome, she was managed with multidisciplinary approach and she was symptomatically improved but corrective surgery was planned as schedule of respective department.

Acute renal failure following wasp sting.

Wasp stings can result in multi system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure cardiac involvement, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. We report here a case of eight year old boy presented with history of wasp sting followed by scanty micturation, generalized swelling and respiratory distress. After admission renal replacement therapy along with oral Prednisolone was started as serum creatinine level was gradually increasing. Kidney biopsy reveled Acute Interstitial Nephritis (AIN). Diagnosis was made of acute renal failure due to AIN following wasp stings.

Post-transfusion increment of platelet count in thrombocytopenic patients treated with platelet concentrates.

The Platelet (PLT) Transfusion Therapy plays an important role in the support of surgical, haematological, oncological and transplant patients. The present study was assigned to find out the post transfusion increment of platelet count among the thrombocytopenic patients in Bangladeshi population. This descriptive study was conducted at the Departments of Haematology and Transfusion Medicine, BSMMU, Dhaka. Total 42 thrmbocytopenic patients were randomly assigned to receive a transfusion when their platelet counts below 10000 per cubic millimeter or with active bleeding. Pre transfusion and post transfusion platelet count were measured in all patients. Out of 42 patients, 26(61.90%) were male and 16(38.10%) were female. Leukemia was the most common cause of thrombocytopenia (47.62%). Most of the patients (71.34%) required transfusion of multiple units of platelet and 12(28.57%) patients required double units. Before transfusion of platelet concentrate <30×108/L, 30-80×108/L and >80×108/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. After transfusion of platelet concentrate <50×108/L, 50-100×108/L and >100×108/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. In all patients post transfusion platelet count increases but 2 or multiple units of transfusion were needed.

Does hypertensive disorder of pregnancy predict offspring blood pressure at 21 years? Evidence from a birth cohort study.

Although few studies found that the offspring of women who experienced preeclampsia have higher blood pressure (BP) at childhood and adolescence, no study has observed whether this association exists for adult offspring. To examine whether maternal hypertensive disorder of pregnancy (HDP) predicts adult offspring BP. We followed a sub-sample of 2608 mother-offspring pairs for 21 years from an original cohort of 7223 singleton infants whose mothers gave birth in Brisbane, Australia between 1981 and 1983. HDP was defined as diastolic BP (DBP) over 90 mm Hg on at least two occasions beyond 20 weeks gestation associated with proteinuria and/or excessive fluid retention. Adult offspring's systolic BP (SBP) and DBP were measured at 21 years. Multivariable regressions were used to examine the independent associations of HDP with offspring BP. Unadjusted regression analysis showed that offspring of women who experienced HDP have 3.46 mm Hg greater SBP and 3.02 mm Hg greater DBP at 21 years. This association remained consistent after adjusting for potential confounding and mediating factors including offspring gender, age, percentile birth weight for gestation, placenta weight and body mass index (BMI) at 21 year, maternal age, education, racial origin, and smoking during pregnancy and their pre-pregnancy BMI. Findings of this study suggest that maternal HDP predicts adult offspring BP.

Epidemiological study of gastro-esophageal reflux disease in rural population.

The present survey was conducted to find out the prevalence of Gastro-Esophageal Reflux Disease (GERD) among rural population in Bangladesh. The survey was carried out between the periods of June and October 2005 in a defined population at Jangalia village of Gazipur district. All respondents were interviewed face-to-face at their home by using a structured questionnaire. Total 3948 respondents were interviewed and 3924 were included in the final analysis. Response rate was 87.73%. Among the respondents male and female were 2089(53.2%) and 1835(46.8%) respectively. Male: female ratio was 1:0.87. The mean±SD age was 33.74±15.52 years. The prevalence of heartburn for at least monthly, weekly and daily episodes was 17.8%, 12.1% and 2.7% respectively. The corresponding figures for acid regurgitation were 19.2%, 10.9% and 1.6% respectively. The prevalence of GERD, as defined by the presence of heartburn and/or acid regurgitation at least once weekly was 19.4%. Prevalence of GERD by scoring system using the questionnaire was 22.1%. The multivariate analysis revealed that the increasing prevalence of GERD in older age group (p>0.05; OR, 1.04; 95% CI 0.31-3.67), men (p>0.05; OR, 1.44; 95% CI, 0.89-2.36), with smoking habit (p<0.001; OR, 2.49; 95% CI, 1.94-3.20). Prevalence of GERD was significantly more in housewives (p<0.05; OR, 2.56; 95% CI, 1.80-3.63). This can be concluded from the present study that GERD is highly prevalent in the community.

Management of adult Still's disease-an update.

Adult Still's disease (ASD) is not uncommon disease. It is recognized as multi-systemic inflammatory disease of unknown aetiology. There is no significant racial and geographical distribution of the disease. In most of the cases-onset of disease course occur before the age of 35. Its main feature is the combination of symptoms, such as fever higher than 39°C, cutaneous rash during fever peak, polyarthritis, lymphadenopathy, raised white blood cell count, abnormalities of liver metabolism, raised serum ferritin etc. None of these signs is significant to establish the diagnosis. Some diagnostic criteria have been developed for diagnosis of ASD. Among them Yamaguchi criteria is superior to others in respect of its sensitivity and specificity. Some bacterial and viral infections, other rheumatic diseases, malignancy and drug hypersensitivity can also mimic ASD. The aim of treatment of ASD is to limit the intensity of the symptoms and to control disease evolution. Various types of drugs including biological agents are now promising to treat ASD.

Comparison between bipolar diathermy tonsillectomy and cold dissection tonsillectomy.

A prospective study was carried out in the department of otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Bangladesh Medical college Hospital, Dhaka. From January, 2007 to January, 2009 to compare between Bipolar Diathermy Tonsillectomy and Cold Dissection Tonsillectomy. Two hundred patients were divided equally into two groups- bipolar diathermy tonsillectomy and cold dissection tonsillectomy. The two groups were compared in age and sex distribution but there was no significant difference (p>0.05) between the two groups. Operative time, operative blood loss, postoperative pain, diet intake, activity level and complications were compared in the two groups. Operative time and blood loss was significantly less in the diathermy group which was highly significant (p<0.001). No significant difference (p>0.05) in the postoperative pain was observed. Percentage of normal diet taken was higher in the diathermy group on the 1st day and lower on the 7th day while the difference was not statistically significant (p>0.05). No significant difference (p>0.05) was noted between the two groups in terms of postoperative activity and postoperative blood loss. Operative blood loss & time was significantly less in bipolar diathermy tonsillectomy. So it is a safe technique and can be used safely with less morbidity & complication.

Maternal smoking during and after pregnancy and lung function in early adulthood: a prospective study.

BACKGROUND AND AIMS: There is a paucity of evidence about whether exposure to antenatal smoking impacts on offspring's lung function in early adulthood. This study aimed to examine whether (1) in utero exposure to maternal smoking is related to poorer respiratory functioning in early adulthood; (2) the impact of prenatal smoking is independent of postnatal maternal smoking; and (3) the link between prenatal smoking and a young adult's lung function is explained by the child's birth weight, smoking or history of asthma. METHODS: Data were from a 21-year follow-up of mothers and their children recruited into the Mater-University of Queensland Study of Pregnancy, a longitudinal prebirth cohort. The study is based on 2409 young adults (1185 males and 1224 females) who had prospective data available on respiratory function at 21 years and maternal smoking during and after pregnancy. A Spirobank G spirometer system was used to measure forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)) and forced expiratory flow between 25% and 75% of FVC (FEF(25-75)). RESULTS: In utero exposure to maternal smoking was associated with a reduction in FEV(1) and FEF(25-75) in males (regression coefficient, -0.16; 95% CI, -0.30 to -0.02), after accounting for maternal smoking after pregnancy. At least part of the effect of in utero smoking on young adults' lung function was explained by the child's birth weight and subsequent asthma. CONCLUSIONS: Adverse effects of antenatal smoking on development of airway growth may persist into early adulthood. Gender differences noted in this longitudinal cohort need to be explored further.

Relationship between blood groups and coronary artery disease.

There are mounting evidences of relationship of different blood groups to disease. For many years, ABO blood group has been associated with predisposition to both arterial and venous disorders, such as venous thromboembolism, peripheral vascular disease and coronary artery disease. To evaluate the relationship of ABO and Rhesus blood groups with coronary artery disease. Total ninety five patients with coronary artery disease admitted in the Cardiac Surgery Department of Zarina Sikhder Women Medical College, Dhaka, and ninety five healthy stuff of same Medical College were studied. Their ABO and Rhesus Blood Groups were determined by standard method in the department of Transfusion Medicine, Zarina Sikhder Women Medical College, Dhaka, Bangladesh with full support from the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The results obtained in this study show that the prevalence of Coronary Artery Disease (CAD) in blood group O is invariably higher than in all other ABO blood groups (p<0.05). It is striking that despite the fact that the most prevalent blood group among Bangladeshi people is phenotype B, the prevalence of CAD risk is associated with phenotype O (Odd ratio 2.034, 95% confidence interval 1.127 to 3.67). This suggests that a certain CAD risk is associated with phenotype O. Thus we conclude that, in Bangladeshi people, blood group phenotype O is associated with a substantially increased risk for CAD.

Increasing body mass index from age 5 to 14 years predicts asthma among adolescents: evidence from a birth cohort study.

BACKGROUND: Obesity and asthma are common disorders, and the prevalence of both has increased in recent decades. It has been suggested that increases in the prevalence of obesity might in part explain the increase in asthma prevalence. This study aims to examine the prospective association between change in body mass index (BMI) z-score between ages 5 and 14 years and asthma symptoms at 14 years. METHODS: Data was taken from the Mater University Study of Pregnancy and its outcomes (MUSP), a birth cohort of 7223 mothers and children started in Brisbane (Australia) in 1981. BMI was measured at age 5 and 14 years. Asthma was assessed from maternal reports of symptoms at age 5 and 14 years. In this study analyses were conducted on 2911 participants who had information on BMI and asthma at both ages. RESULTS: BMI z-score at age 14 and the change in BMI z-score from age 5 to 14-years were positively associated with asthma symptoms at age 14 years, whereas BMI z-score at age 5 was not associated with asthma at age 14. Adjustment for a range of early-life exposures did not substantially alter these findings. The association between change in BMI z-score with asthma symptoms at 14 years appeared stronger for male subjects compared with female subjects but there was no statistical evidence for a sex difference (P=0.36). CONCLUSIONS: Increase in BMI z-score between age 5 and 14 years is associated with increased risk of asthma symptoms in adolescence.

Direct trocar insertion: alternative abdominal entry technique for laparoscopic surgery.

The study was designed to assess the feasibility of direct trocar technique for accessing the abdominal cavity for operative laparoscopy. A retrospective review of 1500 patients who underwent Laparoscopic cholecystectomy in Mymensingh Medical College Hospital and a private hospital between January 1999 and July 2002 was done. The transumbilical direct trocar entry method was used in 1375, the veress needle insertion technique was employed in 106 patients and open laparoscopy was used in 19 patients. Six (0.4%) Major complications occurred; 4 enterotomy and 2 omental herniation. All the enterotomy was related to primary access. Three (0.22%) during direct trocar entry method and another by open laparoscopy method. The bowel was repaired. Two patients had omental herniation through the umbilical port site related to open laparoscopy method which were repaired. Based on our experience the direct trocar technique is a safe approach to abdominal entry for laparoscopic surgery without prior pneumoperitoneum.

Molecular cloning of the wild-type and mutant thyA gene from Shigella flexneri Y.

The thyA gene which codes for thymidylate synthase has been cloned and sequenced from the wild-type Shigella flexneri Y strain SH4 and a thyA mutant TSF21 after amplifying the gene by polymerase chain reaction (PCR). The nucleotide sequence revealed 98% homology to the E. coli K-12 thyA gene. The sequence of the wild-type thyA gene of Shigella flexneri Y was identical with that of the thyA mutant except that the residue T at position 345 was replaced by residue A in the thyA mutant. This change would cause a predicted amino acid substitution of leucine at position 44 in the polypeptide product of the wild type by glutamine in the mutant. Thus, Leu44 may be critical in enzymatic activity of the thyA gene product thymidylate synthase.