Bone and non-contractile soft tissue changes following open kinetic chain resistance training and testosterone treatment in spinal cord injury: an exploratory study.

Twenty men with spinal cord injury (SCI) were randomized into two 16-week intervention groups receiving testosterone treatment (TT) or TT combined with resistance training (TT + RT). TT + RT appears to hold the potential to reverse or slow down bone loss following SCI if provided over a longer period. INTRODUCTION: Persons with SCI experience bone loss below the level of injury. The combined effects of resistance training and TT on bone quality following SCI remain unknown. METHODS: Men with SCI were randomized into 16-week treatments receiving TT or TT + RT. Magnetic resonance imaging (MRI) of the right lower extremity before participation and post-intervention was used to visualize the proximal, middle, and distal femoral shaft, the quadriceps tendon, and the intermuscular fascia of the quadriceps. For the TT + RT group, MRI microarchitecture techniques were utilized to elucidate trabecular changes around the knee. Individual mixed models were used to estimate effect sizes. RESULTS: Twenty participants completed the pilot trial. A small effect for yellow marrow in the distal femur was indicated as increases following TT and decreases following TT + RT were observed. Another small effect was observed as the TT + RT group displayed greater increases in intermuscular fascia length than the TT arm. Distal femur trabecular changes for the TT + RT group were generally small in effect (decreased trabecular thickness variability, spacing, and spacing variability; increased network area). Medium effects were generally observed in the proximal tibia (increased plate width, trabecular thickness, and network area; decreased trabecular spacing and spacing variability). CONCLUSIONS: This pilot suggests longer TT + RT interventions may be a viable rehabilitation technique to combat bone loss following SCI. CLINICAL TRIAL REGISTRATION: Registered with clinicaltrials.gov : NCT01652040 (07/27/2012).

Biomanagement of rice root-knot nematode Meloidogyne graminicola using five indigenous microbial isolates under pot and field trials.

AIMS: To ascertain the effectiveness of Aspergillus niger, Trichoderma harzianum, Pochonia chlamydosporia, Bacillus subtilis and Pseudomonas fluorescens against rice root-knot nematode, Meloidogyne graminicola, and to optimize their application methods. METHODS AND RESULTS: The relative effectiveness of five indigenous biocontrol agents (BCA) against M. graminicola on rice cv. PS-5 was tested initially in pot culture. The BCAs, A. niger, P. chlamydosporia and P. fluorescens proved more effective, and significantly reduced the nematode disease. It is hypothesized that success of a biocontrol module may vary with the BCA and application methods. Hence, the effectiveness of the above three BCAs as well as seven different treatment schemes were evaluated in naturally infested farmer's fields during 2 consecutive years. In nematode-infested plots without any BCA treatments, terminal galls formed on the roots, and plants suffered a 19-31% decrease in the growth and yield. The treatments with P. chlamydosporia or A. niger through root-dip (RD) plus one soil application (SA) at 15 days after planting were found to be highly effective against the nematode. CONCLUSIONS: Relatively greater nematode control was achieved with RD plus two SAs (15 + 30 DAP) but statistically the effect was on par with RD + one SA at 15 DAP. These treatments significantly reduced galling (22-25%), egg mass production (21-29%) and reproduction factor (63-70%) of M. graminicola, and subsequently increased the grain yield (11-21%). SIGNIFICANCE AND IMPACT OF THE STUDY: Application methods enhanced the effectiveness of BCAs against M. graminicola. The RD plus one SA at 15 DAP proved to be most effective treatment to control root-knot disease in rice. Use of multiple treatments (root dip and SA) appears cumbersome, but in view of effectiveness and limitation of chemical control in rice paddies, farmers may adopt the above module that may lead to 11-21% yield improvement.

Computer aid screening of COVID-19 using X-ray and CT scan images: An inner comparison.

The objective of this study is to conduct a critical analysis to investigate and compare a group of computer aid screening methods of COVID-19 using chest X-ray images and computed tomography (CT) images. The computer aid screening method includes deep feature extraction, transfer learning, and machine learning image classification approach. The deep feature extraction and transfer learning method considered 13 pre-trained CNN models. The machine learning approach includes three sets of handcrafted features and three classifiers. The pre-trained CNN models include AlexNet, GoogleNet, VGG16, VGG19, Densenet201, Resnet18, Resnet50, Resnet101, Inceptionv3, Inceptionresnetv2, Xception, MobileNetv2 and ShuffleNet. The handcrafted features are GLCM, LBP & HOG, and machine learning based classifiers are KNN, SVM & Naive Bayes. In addition, the different paradigms of classifiers are also analyzed. Overall, the comparative analysis is carried out in 65 classification models, i.e., 13 in deep feature extraction, 13 in transfer learning, and 39 in the machine learning approaches. Finally, all classification models perform better when applying to the chest X-ray image set as comparing to the use of CT scan image set. Among 65 classification models, the VGG19 with SVM achieved the highest accuracy of 99.81%when applying to the chest X-ray images. In conclusion, the findings of this analysis study are beneficial for the researchers who are working towards designing computer aid tools for screening COVID-19 infection diseases.

Origin of Groundwater Arsenic in a Rural Pleistocene Aquifer in Bangladesh Depressurized by Distal Municipal Pumping.

Across South Asia, millions of villagers have reduced their exposure to high-arsenic (As) groundwater by switching to low-As wells. Isotopic tracers and flow modeling are used in this study to understand the groundwater flow system of a semi-confined aquifer of Pleistocene (>10 kyr) age in Bangladesh that is generally low in As but has been perturbed by massive pumping at a distance of about 25 km for the municipal water supply of Dhaka. A 10- to 15-m-thick clay aquitard caps much of the intermediate aquifer (>40- to 90-m depth) in the 3-km2 study area, with some interruptions by younger channel sand deposits indicative of river scouring. Hydraulic heads in the intermediate aquifer below the clay-capped areas are 1-2 m lower than in the high-As shallow aquifer above the clay layer. In contrast, similar heads in the shallow and intermediate aquifer are observed where the clay layer is missing. The head distribution suggests a pattern of downward flow through interruptions in the aquitard and lateral advection from the sandy areas to the confined portion of the aquifer. The interpreted flow system is consistent with 3H-3He ages, stable isotope data, and groundwater flow modeling. Lateral flow could explain an association of elevated As with high methane concentrations within layers of gray sand below certain clay-capped portions of the Pleistocene aquifer. An influx of dissolved organic carbon from the clay layer itself leading to a reduction of initially orange sands has also likely contributed to the rise of As.

The Impact of Aquifer Flushing on Groundwater Arsenic Across a 35-km Transect Perpendicular to the Upper Brahmaputra River in Assam, India.

Well testing in the floodplain of the Brahmaputra River in Golaghat and Jorhat districts of Assam, India, shows that groundwater arsenic (As) concentrations increase with distance from the river. To establish the origin of this pattern, an additional 900 wells <60 m deep were tested for As and 9 sites were drilled along a 35-km transect perpendicular to the river. The field data show no relation between groundwater As concentrations ranging from <1 to 660 µg/L along the transect and (a) As concentrations of <1-5 mg/kg in cuttings of aquifer sand recovered while drilling or (b) the degree of reduction of iron oxides in these cuttings. The drilling indicates, however, a marked increase in the thickness of a clay layer capping the aquifer starting from <1-5 m near the river to over 60 m at the most distant site towards the base of the Naga foothills. Organic radiocarbon ages of 18-46 kyr obtained from all but one of 13 clay samples indicate pre-Holocene deposition of the underlying sands across the entire transect. Radiocarbon ages of dissolved inorganic carbon of 0.2, 4.7, and 17.8 kyr were measured in groundwater from 3 monitoring wells installed to 30-60 m depth at distances of 10, 20, and 40 km from the river, respectively. A conceptual groundwater flow model consistent with monitored heads and groundwater ages suggests that thick clay layers capping the aquifer further from the river inhibited flushing of the aquifer and, as a result, preserved higher As levels in groundwater.

A Young Boy with L-asparaginase-Induced Seizure.

L-Asparaginase is a critical component in the treatment of acute lymphoblastic leukemia in children. It is known to cause coagulation abnormalities, thrombosis and hemorrhage in the central nervous system in addition to vasculitis and hypersensitivity reactions. This syndrome generally occurs after a few weeks of therapy and may occur after L-asparaginase therapy is completed. Seizures are uncommon symptoms. We report a case of seizure associated with L-asparaginase therapy but no evidence of hemorrhagic or thrombotic cerebrovascular events, completed in the department of Hematology of Bangabandhu Sheikh Mujib Medical University during March & April 2016.

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.

VULNERABILITY OF LOW-ARSENIC AQUIFERS TO MUNICIPAL PUMPING IN BANGLADESH.

Sandy aquifers deposited >12,000 years ago, some as shallow as 30 m, have provided a reliable supply of low-arsenic (As) drinking water in rural Bangladesh. This study concerns the potential risk of contaminating these aquifers in areas surrounding the city of Dhaka where hydraulic heads in aquifers >150 m deep have dropped by 70 m in a few decades due to municipal pumping. Water levels measured continuously from 2012 to 2014 in 12 deep (>150m), 3 intermediate (90-150 m) and 6 shallow (<90 m) community wells, 1 shallow private well, and 1 river piezometer show that the resulting drawdown cone extends 15-35 km east of Dhaka. Water levels in 4 low-As community wells within the 62-147 m depth range closest to Dhaka were inaccessible by suction for up to a third of the year. Lateral hydraulic gradients in the deep aquifer system ranged from 1.7×10-4 to 3.7×10-4 indicating flow towards Dhaka throughout 2012-2014. Vertical recharge on the edge of the drawdown cone was estimated at 0.21±0.06 m/yr. The data suggest that continued municipal pumping in Dhaka could eventually contaminate some relatively shallow community wells.

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.

Serum Zinc, Copper, Magnesium & Phosphorus Level in Children with Severe Acute Malnutrition (SAM).

Malnutrition is widely prevalent among hospitalized children in most developing countries including Bangladesh. Though malnutrition accounts for the high rate of under 5 mortality sometimes it is overlooked. Keeping in this in mind A comparative cross sectional study was done in Mymensingh Medical College Hospital from 1st October 2009 to 31st May 2011. Children aged 1-5 years with presence of one or more criteria WHM <70%, WHZ-score <-3SD, Bipedal edema & Mid upper arm circumference <110mm were taken as study group and children aged 1-5 years with normal growth allowable normal range of variation is between 3rd and 97th centile curve or median (50th centile) ±2SD of weight for age growth chart (CDC growth chart, USA, 2000) were taken as reference group. Persistent diarrhea, Patients taking medications containing zinc, copper, magnesium, phosphorus & calcium, PEM with shock were excluded from study group. Nutritional assessment was done according to WHO criteria of SAM. Serum Zinc, Copper Magnesium and Phosphorus level were determined by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer, model no. 969, Spain. Total 120 study populations were taken. Ninety Out of 120 were taken as a study group (SAM) & 30 were reference group. In reference group serum Zn, Cu, Mg, P value was 103.80±8.86µg/dl, 135.92±13.57µg/dl, 2.31±0.18mg/dl, 3.96±0.22mg/dl respectively. In study group serum Zn, Cu, Mg, P value was 60.33±11.08µg/dl, 80.60±15.46µg/dl, 1.47±0.22mg/dl, 2.00±0.52mg/dl respectively. All these results show that there is significant difference between study group & reference group. Considering the decreased level of these parameters, close biochemical monitoring and follow up should be emphasized for the children with SAM.

STI/HIV Sexual Risk Behavior and Prevalent STI Among Incarcerated African American Men in Committed Partnerships: The Significance of Poverty, Mood Disorders, and Substance Use.

African Americans face disproportionate sexually transmitted infection including HIV (STI/HIV), with those passing through a correctional facility at heightened risk. There is a need to identify modifiable STI/HIV risk factors among incarcerated African Americans. Project DISRUPT is a cohort study of incarcerated African American men recruited from September 2011 through January 2014 from prisons in North Carolina who were in committed partnerships with women at prison entry (N = 207). During the baseline (in-prison) study visit, participants responded to a risk behavior survey and provided a urine specimen, which was tested for STIs. Substantial proportions reported multiple partnerships (42 %), concurrent partnerships (33 %), and buying sex (11 %) in the 6 months before incarceration, and 9 % tested positive for an STI at baseline (chlamydia: 5.3 %, gonorrhea: 0.5 %, trichomoniasis: 4.9 %). Poverty and depression appeared to be strongly associated with sexual risk behaviors. Substance use was linked to prevalent STI, with binge drinking the strongest independent risk factor (adjusted odds ratio: 3.79, 95 % CI 1.19-12.04). There is a continued need for improved prison-based STI testing, treatment, and prevention education as well as mental health and substance use diagnosis.

Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation.

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC.

Genotypes of hepatitis C virus infection in Bangladeshi population.

Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide also in Bangladesh. Prevalence of Hepatitis C virus infection in rural adult population of Bangladesh is reported to be 0.6% but the exact pattern of existing genotype has not been well studied. Genotyping of HCV is important for the planning of treatment duration and predicting the response to treatment in HCV infection. This study was done to identify the existing HCV genotypes in the diagnosed cases of chronic hepatitis C infection in Bangladesh. This study was a prospective as well as retrospective cross-sectional observational study done in the department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh. Cases were also taken from department of Hepatology of Bangabandhu Sheikh Mujib Medical University and Square General Hospital, Dhaka. The study was from January 2010 to March 2011. In total, 417 patients having chronic HCV confirmed by positive anti-HCV and HCV-RNA tests attending to above mentioned institutions were included in this study. Out of the 417 study subjects, 303 were males (72.66%) and 114 (27.34%) were females between 05 to 78 years of age. Most cases were in the age group 30-50 years (57.06%). The study showed that 209 (50.19%) were infected with Genotype 3. Next common identified genotype of HCV was a combination of type 3 & 4, which accounted for 120 (28.77%) and genotype -1 represented 59 (14.14%) of the cases. Other less common identified genotypes were 2, 4, 5 and mixed genotypes -1 & 3, 5 & 6 and 2 & 3; the figure being 12(2.87%), 8(1.91%), 1(0.23%), 5(1.19%), 2(0.47%) and 1(0.23%) respectively. Several subtypes were also found. Genotype 3 was the commonest HCV genotype among the Bangladeshi population. Different HCV genotypes will give a good idea regarding the plan of treatment and possible response rate as well as prognosis of HCV infection in Bangladesh. This study had some limitation like relatively smaller sample size and shorter period for the study. Further studies over a larger population are needed to draw any conclusive opinion.

Q-factor measurements through injection locking of a semiconductor-glass hybrid laser with unknown intracavity losses.

The injection locking properties of a newly developed waveguide-based external cavity semiconductor laser have been investigated. Using the injection locking properties to measure the Q-factor of complex optical cavities with unknown internal losses, has been demonstrated for the first time.

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.

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.

Efficacy of Probiotics as Adjuvant to the Standard Triple Therapy for the Treatment of Helicobacter Pylori-Associated Peptic Ulcer Disease: A Randomized-Control Trial.

Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD), which needs effective eradication of the organism to heal ulcers and prevent a recurrence. In recent years, increasing resistance of H. pylori to clarithromycin and amoxicillin have decreased peptic ulcer cure rate following treatment with standard triple therapy worldwide. The addition of probiotics with standard triple therapy has shown excellent efficacy in H. pylori eradication and has appeared to be an alternative treatment strategy. This study aimed to assess the efficacy of standard triple therapy plus probiotics for H. pylori eradication and ulcer healing compared to standard triple therapy alone. This double-blind, randomized placebo-controlled clinical trial included 158 with endoscopically proven H. pylori-positive PUD who were randomly allocated equally into two groups; Group A was treated with standard triple therapy plus probiotics, and Group B was treated with standard triple therapy plus placebo for 14 days. The outcome was evaluated at the end of treatment (14th day) (symptoms plus adverse events) and after 60 days of treatment completion (H. pylori eradication and ulcer healing). One hundred forty four (144) study subjects (73 in Group A and 71 in Group B) completed the study. Significantly higher H. pylori eradication rate (82.2%vs. 67.6%, p=0.043) and ulcer healing rate (92.3% vs. 60.0%, p=0.049) were observed in the standard triple therapy plus probiotic group than the standard triple therapy plus placebo group. Early relief of epigastric pain was also seen among patients getting probiotics than the placebo in addition to standard triple therapy (42.3% vs. 15.1%, p<0.001).The addition of probiotics significantly improves the H. pylori eradication rate and ulcer healing rate among the patients getting standard triple therapy. Further large-scale, multi-center studies are needed to recommend routine use of probiotics with standard triple therapy for H. pylori eradication.

Anatomical and congenital anomalies of extra hepatic biliary system encountered during cholecystectomy.

Anomalous biliary anatomy is frequently encountered by surgeons during cholecystectomy. Importance of its recognition lies in avoiding serious biliary injuries. This study was carried out to assess the frequency of anatomical and congenital anomalies of extrahepatic biliary system in patients undergoing cholecystectomy. This is an observational study performed in the Department of Surgery, Combined Military Hospital (CMH) Momenshahi, CMH Ghatail and Mymensingh Medical College Hospital for a period of five years from June 2007 to June 2012. Two hundred and fifty diagnosed patients of cholelithiasis undergoing routine cholecystectomy were assessed for anatomical and congenital anomalies of extra hepatic biliary system as well as vascular anomalies. Structures mainly assessed for anomalies were gall bladder, cystic duct, supraduodenal part of Common Bile Duct (CBD), cystic artery and hepatic artery which are routinely handled during cholecystectomy. However, assessment of variations and anomalies, of hepatic ducts, portal vein, retroduodenal and pancreatic parts of CBD were not done due to possibility of iatrogenic injuries. Two hundred and fifty cases of cholelithiasis comprising 216(86.4%) females and 34(13.6%) males with mean age of 39.15 years were included in the study. Clinical presentation includes mainly pain in right hypochondrium (74.8%), pain in right hypochondrium and epigastrium (18.8%) and pain in epigastrium alone (7.6%). Laparoscopic cholecystectomy was done in 157 patients and 93 patients were treated by open procedure including conversion cases. Operative findings revealed variations in 38 cases (15.2%) mainly involving cystic artery (8%), cystic duct (4.4%) and gall bladder (1.6%). Postoperative complications includes bleeding 3.6%, biliary leak from drain 1.6% and CBD injury 0.8% giving rise to 0.8% morbidity, however, no mortality was seen in this series. Anatomical and congenital anomalies of biliary tree, are not common but may be significant during surgery as failure to recognize them leads to iatrogenic injuries and can increase morbidity and mortality.

Efficacy of Peppermint oil in diarrhea predominant IBS - a double blind randomized placebo - controlled study.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder which is associated with considerable sufferings of patient and Peppermint oil is volatile oil, its active principle is menthol-contain a cyclic monoterpine which has anti-spasmotic properties due to its ability to block calcium channel of intestinal smooth muscles. This study observed the efficacy of peppermint oil for relieving the symptoms and changes of quality of life (QOL) in diarrhea predominant IBS. This was a prospective double blind randomized placebo-controlled study conducted in the Bangabandhu Sheikh Mujib Medical University during July 2008 to September 2009. Patients who fulfilled ROME II were initially selected but those had red flag signs or any organic disease was excluded from the study. Seventy four patients were enrolled in the study and randomly allocated to receive either peppermint oil or placebo three times daily for six weeks. Changes of symptoms were assessed three week interval during treatment and two weeks after the end of treatment. Data were analyzed by paired and unpaired 't' test. Finally sixty five patients completed the trial. It was observed that, at six weeks of therapy abdominal pain is markedly improved (mean±SD) 4.94±1.30 in peppermint oil group compared with 6.15±1.24 in placebo group and the difference was statistically highly significant (p>0.001). But two weeks after end of trials pain score again increased (6.09±1.93). Other symptoms and quality of life did not improve significantly. So the study result concludes that peppermint oil is effective in reliving only abdominal pain in diarrhea predominant IBS transiently.