Free Flap Reconstruction in Head and Neck Surgery: Experience in Bangabandhu Sheikh Mujib Medical University.

Free flap reconstruction after surgical ablation of head & neck cancer greatly improve the surgical outcome. Microvascular anastomosis is an important part of Microsurgery and it is not widely practiced in every center. A retrospective review was conducted in the Head & Neck Division of Otolaryngology-Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from May 2016 to June 2017. Total 20 patients with head & neck cancer had been treated surgically between this period and 14 patients were reconstructed with free flap. The focus of this study is to establish the surgical outcome, which is more with free flap reconstruction in the patients previously diagnosed as head & neck cancer. We reconstructed 14 cases of oral cavity carcinoma (Stage IV) with the free flap. Majority cases were carcinoma involving the buccal mucosa with retromolar trigone (36%) followed by buccal mucosa (22%), buccal mucosa with lower alveolus (21%), carcinoma tongue with floor of the mouth (14%) and floor of the mouth (7%). Radial forearm freflap (RFFF) were commonly used in 10 cases (71.4%) and Anterolateral thigh flap (ALT) used in four cases (21.5%). Partial flap loss was seen in one case and wound infection occurred in another case but both were managed successfully with postoperative dressing and debridement. Microvascular free flap reconstruction can be a good choice after surgical removal of the head & neck cancer diseases and it should be practiced in every well-equipped tertiary medical center with the help of properly trained surgeon.

Total Lip Reconstruction after Excision of Cancer with Composite Radial Forearm Palmaris Longus Tendon Free Flap.

Reconstruction of total lip is a challenging task for a plastic surgeon. It becomes more complicated when there is loss of additional tissues like angle of mouth, buccal mucosa or floor of the mouth. Radial forearm flap with palmaris longus tendon provides an easier but reliable technique for three dimensional lip reconstructions with good functional and aesthetic outcome. In this short observational series we included 5 patients of total lip reconstruction and conducted at Sylhet MAG Osmani Medical College Hospital and Private Clinic of Sylhet, Bangladesh from January 2014 to December 2017. Among these one was a case of basal cell carcinoma of upper lip and rest was squamous cell carcinoma of lower lip. The mean age was 71 years. All the flaps survived and patients had normal speech and oral continence. Composite radial forearm flap with palmaris longus tendon is a good, reliable option for total lip reconstruction.

Sex differences in forebrain estrogen receptor regulation of hypoglycemic patterns of counter-regulatory hormone secretion and ventromedial hypothalamic nucleus glucoregulatory neurotransmitter and astrocyte glycogen metabolic enzyme expression.

The female ventromedial hypothalamic nucleus (VMN) is a focal substrate for estradiol (E) regulation of energy balance, feeding, and body weight, but how E shapes VMN gluco-regulatory signaling in each sex is unclear. This study investigated the hypothesis that estrogen receptor-alpha (ERα) and/or -beta (ERß) control VMN signals that inhibit [γ-aminobutyric acid] or stimulate [nitric oxide, steroidogenic factor-1 (SF-1)] counter-regulation in a sex-dependent manner. VMN nitrergic neurons monitor astrocyte fuel provision; here, we examined how these ER regulate astrocyte glycogen metabolic enzyme, monocarboxylate transporter, and adrenoreceptor protein responses to insulin-induced hypoglycemia (IIH) in each sex. Testes-intact male and E-replaced ovariectomized female rats were pretreated by intracerebroventricular ERα antagonist (MPP) or ERß antagonist (PHTPP) administration before IIH. Data implicate both ER in hypoglycemic inhibition of neuronal nitric oxide synthase protein in each sex and up-regulation of glutamate decarboxylase65/67 and SF-1 expression in females. ERα and -ß enhance astrocyte AMPK and glycogen synthase expression and inhibit glycogen phosphorylase in hypoglycemic females, while ERß suppresses the same proteins in males. Differential VMN astrocyte protein responses to IIH may partially reflect ERα and -ß augmentation of ERß and down-regulation of alpha1, alpha2, and beta1 adrenoreceptor proteins in females, versus ERß repression of GPER and alpha2 adrenoreceptor profiles in males. MPP or PHTPP pretreatment blunted counter-regulatory hormone secretion in hypoglycemic males only, suggesting that in males one or more VMN neurotransmitters exhibiting sensitivity to forebrain ER may passively regulate this endocrine outflow, whereas female forebrain ERα and -ß are apparently uninvolved in these contra-regulatory responses.

Management of mango hopper, Idioscopus clypealis, using chemical insecticides and Neem oil.

An experiment was conducted in Field Laboratory, Department of Entomology at Bangladesh Agricultural University, Mymensingh, during 2013 to manage the mango hopper, Idioscopus clypealis L, using three chemical insecticides, Imidacloprid (0.3%), Endosulfan (0.5%), and Cypermethrin (0.4%), and natural Neem oil (3%) with three replications of each. All the treatments were significantly effective in managing mango hopper in comparison to the control. Imidacloprid showed the highest efficacy in percentage of reduction of hopper population (92.50 ± 9.02) at 72 hours after treatment in case of 2nd spray. It also showed the highest overall percentage of reduction (88.59 ± 8.64) of hopper population and less toxicity to natural enemies including green ant, spider, and lacewing of mango hopper. In case of biopesticide, azadirachtin based Neem oil was found effective against mango hopper as 48.35, 60.15, and 56.54% reduction after 24, 72, and 168 hours of spraying, respectively, which was comparable with Cypermethrin as there was no statistically significant difference after 168 hours of spray. Natural enemies were also higher after 1st and 2nd spray in case of Neem oil.

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.

Pattern of chronic suppurative otitis media.

This observational study was conducted to know the bacteriological pattern of chronic suppurative otitis media. For this 110 patients of Chronic Suppurative Otitis Media (CSOM) were selected from January 2006 to December 2007 at the out patient department of Otolaryngology and Head Neck surgery, BSMMU and Dhaka Medical College Hospital, Dhaka. Among the 110 patients unilateral involvement was 76.36% and bilateral involvement was 23.64%. Ninety percent patients presented with tubotympanic variety and 10% patients presented with attico-antral variety. Bacteriologically pure growth was found in 79.09% cases, mixed growth in 10.91% cases, no growth in 10% cases. Only aerobic bacteria were isolated in the present series. Pseudomonas aeruginosa was the most common organism (43.68%) isolated in pure culture followed by staphylococcus aureus 27.59%, E. coli 10.35%, Kleibsiella spp. 9.19%, proteus spp. 8.04%. Amikacin was the most effective antibiotic followed by Gentamycin, Ciprofloxacin, Ceftazidime, Cetriaxone. Before giving therapy bacterial growth and sensitivity pattern is to be known where facilities are available.

Persistence of low serum iron and high total iron binding capacity in pregnant women.

A cross sectional descriptive type of study was done in 98 women of reproductive age. Among them 25 were in control group of non pregnant women and 73 were pregnant women of 1st, 2nd and 3rd trimester of pregnancy with and without iron supplementation. The period of study was July 2004 to June 2005. The main objective of our study was to compare serum iron and total iron binding capacity in pregnant and non pregnant women. In present study serum iron was significantly increased in 2nd and 3rd trimester of pregnancy that was supplemented with iron when compared with the same category of women who were not supplemented with iron. On the other hand serum total iron binding capacity (TIBC) was significantly increased in 3rd trimester of pregnancy that was not supplemented with iron when compared with the same category of women who were supplemented with iron. It is evident that the significantly low serum iron and high TIBC in pregnant women is due in part to dietary iron deficiency. Therefore, iron therapy in pregnancy is helpful to maintain the serum iron and TIBC nearer to that of non pregnant normal women.

Is serum C-reactive protein really a sensitive stress marker in Bangladeshi people.

The present study was done to determine the serum C-reactive protein (CRP) concentration in normal subjects and patients suffering from infection, psychiatric disorders and of surgery. A total number of 55 subjects within 18-55 years age were selected from Mymensingh Medical College Hospital during the period from July 2003 to June 2004. Normal subjects as control were 13 and 42 comprised the group experimental. According to different types of stress the experimental group was further divided in to four subgroups: infection, psychiatric, pre and post surgery. Serum CRP concentration was measured by Immunoturbidimetric method from each subject. Statistical analyses were done by using Student's ' t' test. Statistically significant rise of serum CRP was observed in infection, psychiatric disorders and post surgery group in comparison to control group (P< 0.001). The study indicated that subjects with infection, psychiatric disorder and post surgery stage were in stressful conditions that resulted increased synthesis of CRP by liver cells due to Hypothalamopituitaryadrenal (HPA) axis hyperactivity and immune mediated inflammation.

Phorbol ester stimulates catecholamine synthesis in isolated bovine adrenal medullary cells.

In isolated bovine adrenal medullary cells, the phorbol ester 12-O-tetradecanoyl phorbol 13-acetate (TPA), an activator of protein kinase C, stimulated [14C]catecholamine synthesis from [14C]tyrosine, but not from [14C]DOPA. This stimulatory effect of TPA on [14C]catecholamine synthesis was not dependent upon extracellular Ca2+, and TPA did not affect the uptake of 45Ca2+ or the release of catecholamine by the cells. TPA also did not affect the intracellular cyclic AMP (cAMP) level. 4 alpha-Phorbol 12, 13-didecanoate, which is not an activator of protein kinase C, did not stimulate the synthesis of [14C]catecholamine from [14C]tyrosine. The stimulatory effect of TPA on [14C]catecholamine synthesis was additive with that of carbamylcholine, but not with that of dibutyryl cAMP (DB-cAMP). From these results, it was suggested that protein kinase C is involved in the regulation of tyrosine hydroxylase activity and that this regulatory mechanism might be similar to that involving cAMP.