The MURCS Association: Mullerian Duct Aplasia, Renal Hypoplasia and Cervicothoracic Somite Dysplasia - A Case Report.

We report on a 22 years old lady with aplasia of uterus and most of the vagina with normal secondary sexual characteristics, unilateral renal hypoplasia and anomalies of cervico throacic somites (MURCS Association), growth retardation, cardiac defect and congenital urethrovaginal fistula. Although there is a broad spectrum of anomalies described with MURCS association genitourinary fistula is not yet reported and reviewed in published articles. The relevance of this paper is to show the importance of further investigation in cases of primary amenorrhoea with mullerian agenesis to establish that the patient has MURCS association and not simply MRKH (Mayer Rokitansky-Kusterhauser Syndrome) syndrome. Consequently we should provide guidance to the patients and their families about the best way to conduct the case including genetic counseling and family screening.

A 7 years old girl with abdominal lump and per-vaginal bleeding of hypothyroidism.

Hypothyroidism is a common endocrine disorder resulting from decreased secretion of thyroid hormone. The diagnosis of hypothyroidism is suggested from the clinical and laboratory findings. Here we present a case report on this disease with rare presentation of abdominal lump and pervaginal bleeding in childhood. A 7 years old girl admitted in a tertiary level hospital with abdominal lump and irregular per vaginal bleeding. Abdominal swelling was gradually increasing in size & associated with lower abdominal pain for last 5 months. On examination the girl was moderately anaemic, mildly oedematous, distended lower abdomen and a mass in left iliac region. Her thyroid function test, serum FSH, serum LH, serum Prolactin was done and high FSH, LH, Prolactin levels were found. Ultrasonography of lower abdomen revealed bulky uterus and bilateral ovarian cysts. MRI of Brain showed feature of pituitary microadenoma. Finally the patient was diagnosed as primary hypothyroidism and bilateral follicular ovarian cyst with pituitary adenoma developed as its consequence. The case is reported for clinical awareness & to share our experience.

Autoamputed uterus within pelvic cavity: a tale of negligence.

At maternity worldwide we recognize the complexity and interlinking nature of the many different factors which can prevent women and girls from being able to have access to high quality maternal and family planning care. Our integrated maternal health approach draws on the Three Delays Model which recognizes the different barriers women face in achieving the timely and effective medical care needed to prevent deaths occurring in pregnancy and childbirth. The three delay model proposed by Main in 1993 depicts the roles of communities and the health system as emergency service to protect safe motherhood. The model shows that the result of an obstetric emergency is influenced by factors which govern the decision to seek care, reaching the medical facility and receiving adequate treatment. The three delays break the use of emergency obstetrics care facilities. The article flushes the neglected tragic view of young women for all three delays suffering from septic abortion even at tertiary level care. In our study the substandard management is focused causing the woman to loss her reproductive life.

Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial.

This study was done to determine the effects and outcome of inhaled budesonide in addition to standard management of asthma exacerbations in pediatric age groups. A randomized, double-blind, placebo controlled trial was done in a tertiary care urban hospital. Sixty six children aged 5 to 15 years with moderate to severe asthma exacerbations were eligible. All patients received a single dose of prednisolone 1mg/kg orally as first dose of systemic corticosteroids and then salbutamol (0.15mg/kg) and ipratropium bromide (500mcg) was nebulized every 20 minutes for 3 doses and then hourly for 2 hours as a part of standard treatment of asthma exacerbations. The intervention was 2mg (4mL) of budesonide or 4mL of normal saline which was nebulized immediately after the 1st dose of nebulized salbutamol and ipratropium bromide. The baseline characteristics of the budesonide group (n=33) and placebo group (n=33) were similar, but at 1 hour, 2 hour and 3 hour PEFR, respiratory rate, pulse rate, SaO2 and asthma score were significantly improved in the budesonide group compared to placebo group (p<0.01). The positive immediate effect of nebulized budesonide added to standard treatment of asthma exacerbations is an encouraging finding for further investigations of its routine use in the treatment of asthma exacerbations in children.

Comparison between azithromycin and cefixime in the treatment of typhoid fever in children.

An intervention study was carried out in the department of paediatrics of Mymensingh Medical College Hospital, Mymensingh to compare the clinical efficacy of Azithromycin in the treatment of childhood typhoid fever with that of cefixime for a period of one year from January 2011 to December 2011. A total of 60 cases of typhoid fever were enrolled in to a randomized clinical trial and was divided into two groups. The inclusion criteria of the cases were: Documented fever for more than 4 days plus two or more of the following clinical features: toxic physical appearance, intestinal complaints, coated tongue, ceacal gurgling, hepatomegaly and splenomegaly, diarrhoea and constipation plus positive Widal test and/or blood culture positivity. Patients who had complication like GIT heamorrhage; intestinal perforaion and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg/day for a period of 07 days Cefixime was given at a dose of 20mg/kg/day in two divided dose for 14 days. The mean time of defervesence was 4.05+1.14 days with azithromycin and 3.41+0.95 with cefixime respectively. The minimum defervesence time was 02 days and maximum defervesence time was 07 days. Clinical cure rate was 87% in azithromycin group and 93% in cefixime group. No serious adverse effect was noted related to azithromycin and cefixime therapy except nausea, vomiting, diarrhoea and jaundice. It was found that azithromycin is almost as effective as cefixime in the treatment of typhoid fever.

Towards imagined speech: Identification of brain states from EEG signals for BCI-based communication systems.

BACKGROUND: The electroencephalogram (EEG) based brain-computer interface (BCI) system employing imagined speech serves as a mechanism for decoding EEG signals to facilitate control over external devices or communication with the external world at the moment the user desires. To effectively deploy such BCIs, it is imperative to accurately discern various brain states from continuous EEG signals when users initiate word imagination. NEW METHOD: This study involved the acquisition of EEG signals from 15 subjects engaged in four states: resting, listening, imagined speech, and actual speech, each involving a predefined set of 10 words. The EEG signals underwent preprocessing, segmentation, spatio-temporal and spectral analysis of each state, and functional connectivity analysis using the phase locking value (PLV) method. Subsequently, five features were extracted from the frequency and time-frequency domains. Classification tasks were performed using four machine learning algorithms in both pair-wise and multiclass scenarios, considering subject-dependent and subject-independent data. RESULTS: In the subject-dependent scenario, the random forest (RF) classifier achieved a maximum accuracy of 94.60 % for pairwise classification, while the artificial neural network (ANN) classifier achieved a maximum accuracy of 66.92 % for multiclass classification. In the subject-independent scenario, the random forest (RF) classifier achieved maximum accuracies of 81.02 % for pairwise classification and 55.58 % for multiclass classification. Moreover, EEG signals were classified based on frequency bands and brain lobes, revealing that the theta (θ) and delta (δ) bands, as well as the frontal and temporal lobes, are sufficient for distinguishing between brain states. CONCLUSION: The findings promise to develop a system capable of automatically segmenting imagined speech segments from continuous EEG signals.

Effects of dyes used in photodynamic therapy on color stability of composite resins.

PURPOSE: The aim of this study was to evaluate the effect of dyes used in photodynamic therapy (PDT) on color changes of resin-based composites (RBCs). METHODS: A total of 120 composite discs were made of microfilled, nanohybrid, and nanoceramic RBCs, and the CIE Lab system was used to assess initial colors with a spectrophotometer. Photosensitizers were used in accordance with the experimental design, as follows: MB (methylene blue), TB (toluidine blue), ICG (indocyanine green), and control (no dye). The samples were irradiated with a 940-nm diode laser. After irradiation, the photosensitizers were removed with distilled water (∆E1) and sodium hypochlorite (∆E2), and final colors were measured. Data were analyzed by the three-way ANOVA and Bonferroni tests (α = 0.05). RESULTS: There was no statistically significant difference between the ICG and control groups; however, the TB and MB groups exhibited the strongest staining. The nanohybrid RBC exhibited the greatest color change, and there were no significant differences between the microhybrid and nanoceramic RBCs. After NaOCl irrigation, ΔE2 values decreased to clinically acceptable values (ΔE2 < 3.3). CONCLUSION: The intensity of staining of the RBCs differed according to the type of photosensitizer used and the content of the composite resin. The irrigant NaOCl was effective in removing discoloration.

Change of Hemoglobin Level among Exclusively Breastfed Term and Preterm Babies up to Six Months of Age.

There is progressive increase of Hb levels is observed during course of intrauterine development of fetus but high concentrations found at birth. In preterm neonate normal Hb is characteristically deviated from term neonate. Breast milk is the only natural ideal food for both term and preterm babies from birth up to 6 months. Preterm milk was found to contain significantly higher concentrations nutrients particularly iron than term milk. Preterm human milk is more suitable for the premature infant than term human milk. As Hb concentration varies in term and preterm babies in different counties in different feeding practices. The purpose of this longitudinal descriptive study is to find out the pattern of changes in the Hb level among exclusively breastfed preterm and term infants during the first six months of life. This study was carried in the Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital (MMCH), Mymensingh from September 2016 to February 2018. One hundred fifty (150) neonates both term and preterm were included in this study and followed up to 6 months of age. After admission informed written consent was taken from parents, thorough history taking and clinical examination were done. Data were collected in a pre-designed case record form. All the babies of Group A provided 2mg/kg iron supplementation from 6 weeks for 2 months for universal recommendation. Hb level was measured of all exclusively breast feed babies at admission after birth then next follow-up at 6 weeks, 3 months and 6 months. All information regarding history, anthropometrics measurement, Hb level was recorded in structural questionnaire. Data analysis was done by SPSS version 20.0. Male were predominant in both groups. Most of the preterm (72.0%) and term babies (65.3%) were delivered by vaginal route. Mean Hb level was found significantly higher among preterm babies than term babies after birth were 16.55g/dl and 15.98g/dl respectively. Sharp fall of Hb concentration was observed after birth up to 6 weeks in both preterm and term babies but Hb level was found significantly lower in preterm in comparison to term babies (9.27gm/dl vs. 9.58gm/dl). In term babies, even after 6 weeks fall of Hb level continued to 3 months of age followed by gradual increase up to 6 months without iron supplementation. Hb level of in preterm babies gradually increased from 6 weeks up to 6 months with universal iron supplementation. Hb level fall sharply up to 6 weeks in both exclusively breastfed term and preterm babies but even after 6 weeks term babies experienced gradual fall of Hb levels up to 3 months. Hb level increases in exclusively breast-fed term babies without iron supplementation from 3 months of age. Hb level in exclusively breastfed preterm babies increase from 6 weeks onward might be effect of universal iron supplementation.

Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital.

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.

Clinical Risk Index for Babies II Score as a Predictor of Neonatal Death among Preterm Low Birth Weight Babies.

Clinical risk index for babies II (CRIB II) score is simple, validated and widely used risk-adjustment instrument for predicting mortality among preterm low birth weight babies. To assess the efficacy of CRIB II score as a tool to predict the risk for neonatal death among the preterm and LBW babies admitted in NICU of BSMMU, a tertiary care hospital in Bangladesh. This prospective observational study was conducted in Department of Neonatology in BSMMU from September 2016 to August 2017. Inborn preterm neonates with gestational age ≤34 weeks admitted were enrolled in the study. CRIB-II score was calculated for each infant within 1 hour of birth from birth weight, gestational age, sex, admission temperature and base excess. The primary outcome measured in the study was neonatal death or survival up to 28 days. Total 112 patients were finally analyzed in this study. Mean CRIB II score was significantly higher in the non-survivor group compared to the survivor group (p-value <0.0001). Receiver operating characteristic (ROC) curve analysis for mortality prediction by CRIB II score, gestational age and birth weight showed AUC 0.87 (95% CI 0.76-0.97), 0.76 (95% CI 0.63-0.88) and 0.79 (95% CI 0.66-0.92) respectively. ROC curve analysis also revealed that the most suitable cut-off points for predicting mortality were 5 for CRIB II score, 32 weeks for gestational age and 1250 gram for birth weight. Using these most suitable cut-off points, CRIB II score had the highest sensitivity and specificity followed by birth weight and gestational age. In this study, CRIB II score was found to be an effective tool for predicting neonatal death among preterm LBW babies. It predicted outcome more accurately than birth weight or gestational age alone.

Understanding the magnitude of still birth in Mymensingh Medical College Hospital.

To understand the incidence and causes of still-births occurred in Mymensingh Medical College Hospital, we conducted a retrospective record review study in Department of Gynaecology of the hospital. The study population were the cases of still births occurred the months of January and December 2007. We administered a structured questionnaire to all the Medical Officers working in the department. They were requested to provide information on the still-births they noticed during the study period. They review their personal log books and hospital records to complete the questionnaire. We also reviewed the hospital records to obtain the service statistics. In total 11,146 patients were admitted to seek obstetric care during the study period and of them 7,069(63%) sought delivery care. During this period there were 735(10%) still births. The incidences of still births were more during December and January. The pre-existing maternal diseases that were frequently associated with still births were Antepartum Haemorrhage (APH) 38% and hypertension (27%). The frequently reported direct causes of the still births were obstructed labour (42%), misuse of oxytocin (28%) and foetal distress (20%). In many cases the loss is completely unexpected. Hospital based surveillance and issuing of still-birth certificates may increase the awareness of the problem among the obstetricians and in the community.

Source of metal contamination in sediment, their ecological risk, and phytoremediation ability of the studied mangrove plants in ship breaking area, Bangladesh.

Samples for sediment and two species of native mangrove plants were collected from seven sampling sites for assessing the level of metal contamination. Results of the studied metals displayed the order of pollution as Fe > Ti > Zr > Rb > Zn > Sr > Pb > Y > Cu > Cr > As accordingly. Geoaccumulation index and contamination factor revealed that the sediment samples were unpolluted to moderately polluted by Zn, Fe, Ti, Rb, Y, and Zr. Ecological risk factor depicted a pollution-free condition in the study areas. PCA, CA, and correlation coefficient indicated that the source of the metals in the environment was anthropogenic. Bioconcentration factor values were found to be below 1 in both plant species. Conversely, transfer factor values for most heavy metals were found to be >1 in both plant species, which reflects the phytoremediation ability of plants.

Burst abdomen-A preventable morbidity.

A burst abdomen is considered present, when intestine, omentum or other viscera's were seen in the abdominal wound following obstetric surgery. In our country no study found, but observational incidence in the tertiary hospital varies between 0.2-3%. It occurs mostly between the sixth and eight day after operation. Factors relating to the incidence of burst abdomen are suture, closure, incision, coughing, vomiting, distension, obesity, jaundice, malignancy, diabetes mellitus, hypoproteinaemia, anaemia, immuno-compromised patients and wound infection. During the period of February 2001 to February 2006 four cases of burst abdomen were managed in cooperation with team of surgery department. In these cases wound were closed by "May/Mary closure". Abdominal wound dehiscence remains a major cause of morbidity following any laparotomy whether elective or emergency. We should correct the primary risk factors for wound dehiscence. Transverse incisions are generally considered to dehiscence much less than the vertical incision. The suture should have excellent handling and knotting. Its prevention is important to reduce postoperative morbidity, mortality and increased cost of care both in terms of increased hospital stay and treatment of the complication.

Serum total protein, albumin and A/G ratio in different grades of protein energy malnutrition.

The serum total protein, albumin and serum A/G ratio was studied on 20 healthy children and 30 children suffering from protein energy malnutrition of different grade such as grade-I grade-II and grade-III. Serum total protein and albumin levels in grade-I grade-II and grade-III PEM were significantly lowers than control. Serum total protein between different grades of PEM was changed but not significantly. Serum A/G ratio of grade-1 & grade-II PEM were high than that of control, but not significantly. Serum A/G ratio of grade I and grade II PEM were higher than that of control, but not significantly. But in grade-III PEM this values were significantly higher than that of control. When comparison were done within the different grades of PEM, it was found that their A/G ratio were changed but not significantly.

Endometriosis association research center.

Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age. Pain syndrome, however, represents the major clinical problem of this disease, manifested as dysmenorrhea, pelvic pain, lower abdominal pain, and dyspareunia. About 32 literatures are reviewed in recent advancement for diagnosis of endometriosis. The magnifications of its managements are understood. In outdoor, the management is only depending on clinical findings and on some non invasive procedures without any definitive diagnosis. So, research activities should be done on the basis of recent advancement of endometriosis.

Calcium binding capacity and calcium sensitive protein content in denervated frog muscles.

Total and ionic calcium content, calcium binding capacity of sarcoplasmic proteins and calcium insensitive proteins were examined in atrophying leg muscles of frog after 1-5 months period of denervation. Different muscles showed different levels of atrophy and the total calcium content varied with reference to the type of muscle. Ionic calcium levels doubled in the gastrocnemius muscle after three months denervation. Calcium binding capacity of proteins and calcium insensitive proteins decreased rapidly up to four months after denervation in the gastrocnemius muscle. However no significant changes in the levels of calcium binding capacity and calcium insensitive proteins were found with reference to the type of muscle. Since total calcium content remains constant and wet muscle mass (expressed as atrophy) decreased markedly, an apparent increase in calcium concentration occurs in each muscle on denervation.

Reactivity of some sugars and sugar phosphates towards gold(III) in sodium acetate-acetic acid buffer medium.

The kinetics of the oxidation of some aldoses and aldose phosphates have been studied spectrophotometrically in sodium acetate-acetic acid buffer medium at different temperatures. The reactions are first order with respect to [Au(III)] and [substrate]. Both H+ and Cl- ions retard the reaction. The reactions appear to involve different gold(III) species, viz. AuCl4-, AuCl3(OH2) and AuCl3(OH)- . The results are interpreted in terms of the probable intermediate formation of free radicals and Au(II). Aldoses react with gold(III) in the order: triose > tetrose > pentose > hexose. The sugar phosphates react with gold(III) at a faster rate than the parent sugars except glucose-1-phosphate, which reacts at slower rates than glucose. A tentative reaction mechanism leading to the formation of products has been suggested.

Pluripotent bone marrow cells in leukemic mice elicit enhanced immune reactivity following sheep erythrocyte administration in-vivo. A possible S-LFA3 interactive immunotherapy.

Reports concerning the compartmentwise immunoreactivity and migratory property of the bone marrow derived stem/progenitor cells have been poorly documented. The present study shows that both in normal and leukemic mice a low density group of bone marrow cells (LDC) are functionally less matured than a high density group of cells (HDC) as revealed from spontaneous E-rosetting, cytotoxic efficacy and phagocytic function against the targets which correlated well with the migratory activity of the cells from LDC to HDC compartment. This is deranged in leukaemic groups of animals. Administration of Sheep Erythrocytes (SRBC) significantly increased the CD34+ cell population as evident through flowcytometric (FACS) analysis and the above immune reactivity in leukemic mice. The results indicated that, (a) bone marrow cells comprising the major fractions of immature cells are capable of eliciting immune-reactivity against the targets in normal and (b) poorly in leukemic mice and that (c) sheep red blood cells could effectively trigger such immunological functions together with enhanced maturation dependent migration in leukemic mice. The study hints at therapeutic potentiality of SRBC or its determinant molecule TIITS or Sheep-leucocyte function antigen 3 (S-LFA3/CD 58) in stimulating the stem and progenitor cells in vivo.

Management of severe malnutrition and diarrhea.

Children with severe malnutrition and diarrhea have high mortality rates that have been attributed to faulty case-management. Health workers are often unaware of the unique treatment requirements of severely malnourished children resulting in improper case-management. Moreover, the lack of prescriptive guidelines promotes the exercise of discretion in case-management that is often detrimental. Appropriate feeding from the start of treatment, routine micronutrient supplementation, broad-spectrum antibiotic therapy, less use of intravenous fluids for rehydration, and careful management of complications are factors that can reduce death, morbidity and cost of treating children with severe malnutrition and acute illnesses including diarrhea. In this paper is discussed a standardized protocol based upon the above mentioned factors for the management of severely malnourished children with acute illnesses including diarrhea. Implementation of the protocol resulted in a 47% reduction in mortality in these children.

A comparative study of body iron status and lipid profile in acute myocardial infarction patients.

This study was carried out to evaluate the relationship between body iron status and lipid profile in hospital admitted clinically diagnosed AMI patients considering the concept that there is a potential association between body iron status and coronary heart disease (CHD). Total 80 subjects were selected, of which 40 were healthy adults and 40 were AMI patients. Fasting blood samples were collected from healthy adults. Blood samples of AMI patients were collected within 24 hours of the attack of myocardial infarction. Body iron status was measured in term of 3 variables serum total iron concentration, TIBC and transferrin saturation. Lipid profile variables measure were total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol. No correlation was found between serum iron and the variables of lipid profile. TIBC was found to maintain negative correlation with total cholesterol, triglyceride and LDL-cholesterol but positive correlation with HDL-cholesterol. Transferrin saturation was found to maintain strongly positive correlation with total cholesterol, triglyceride and LDL-cholesterol but strongly negative correlation with HDL-cholesterol. This correlation of TIBC and transferrin saturation with lipid profile supports the hypothesis that there is a potential association between body iron status and coronary heart disease.