Respondent or non-respondent comparison post cardiac resynchronisation therapy implantation in patients with dilated cardiomyopathy

Background: Dilated cardiomyopathy can be treated using cardiac resynchronisation therapy (CRT) effectively. In our study, we compared the clinical and biochemical profile of responders and non-responders to CRT device (CRTD) implantation suffering from DCM. Methods: A cross-sectional observational study was performed in 47 patients with dilated cardiomyopathy for CRTD implantation for a period of 18 months. The tools used for the study include electrocardiography 12 lead, echocardiography: 2D, M mode, Doppler, strain echo, Holter monitoring, coronary angiography and CRTD implantation. Statistical analysis was performed using Epi Info (TM) 7.2.2.2. Results: The proportion of responders (68.1%) was significantly higher than non-responder (31.9%). Almost 60% of patients in non-responder group had smoking as a risk factor. Around 60% were suffering from hypertension and 33% from T2DM in non-respondent group. Parameters of dyssynchrony has significantly improved in responder group than in non-responder group. LVEDV, LVESV has shown an increase and EF has decreased considerably in DCM patients. Many patients in non-responder category have shown mitral and tricuspid regurgitation. Strain echocardiography parameters-GLS, GRS and GCS were significantly decreased. Post CRTD echocardiographic parameter has improved considerably and LVESV was reduced in more than 15% of responders. Conclusions: The CRTD implantation improves patients’ clinical and Echocardiographic data which can help in better patient management, improving quality of life and decreased healthcare cost. By this study we can improve patients’ selection and predict accordingly for CRT responders and non-responders and can take necessary measures for better patient’s management.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822) / Análise sazonal de itens e hábitos alimentares de bagres ribeirinhos Rita rita (Hamilton, 1822) ameaçados de extinção

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin’s niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Esta investigação apresenta a alimentação e a atividade alimentar de bagres ribeirinhos Rita rita ameaçados de extinção, no período de fevereiro de 2017 a janeiro de 2018. Um total de 225 peixes foi analisado quanto ao conteúdo do estômago, caracterizando os itens alimentares dominantes e as características morfométricas. Os resultados apresentaram dez principais itens alimentares consumidos, preferencialmente escamas e ovos de peixes, teleósteos, copépodes, cladóceros, rotíferos e moluscos. O comprimento total e o peso corporal dos peixes variaram entre 9-34 cm (20,53 ± 6,90 cm) e 10-400 g (9125,94 ± 102,07 g), respectivamente. O índice de importância relativa (IRI%) mostrou a importância dos rotíferos sobre os demais itens alimentares. O índice de sobreposição de dieta de Morisita indicou variações sazonais nas dietas de bagres no verão e nas monções, exibindo a menor sobreposição, enquanto a sobreposição máxima ocorreu durante as estações das monções e do inverno. A escala multidimensional não métrica (nMDS) indicou a estreita associação entre os itens alimentares disponíveis durante o verão e o inverno, com uma diferença significativa entre as estações (ANOSIM, R = 0,638, P = 0,013). O índice de amplitude de nicho de Levin foi organizado na ordem de 0,88 > 0,81 > 0,78 > 0,63 > 0,43 para as classes de tamanho de V, IV, III, II e I, respectivamente. O PCA explicou 95,39% da variação total entre os itens alimentares e os grupos de tamanho de peixes. Peixes de pequeno porte apresentaram maior correlação com itens alimentares adequados ao tamanho da boca. Em conclusão, a variedade e a frequência dos itens alimentares registrados indicaram plasticidade alimentar considerável e comportamento alimentar oportunista, com uma mudança da natureza carnívora para onívora. Este estudo pode fornecer informações úteis sobre os hábitos alimentares e de alimentação de R. rita e apresentar subsídios para a preparação de sua dieta em futuras práticas de aquicultura.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822)

Abstract This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisitas index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levins niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Resumo Esta investigação apresenta a alimentação e a atividade alimentar de bagres ribeirinhos Rita rita ameaçados de extinção, no período de fevereiro de 2017 a janeiro de 2018. Um total de 225 peixes foi analisado quanto ao conteúdo do estômago, caracterizando os itens alimentares dominantes e as características morfométricas. Os resultados apresentaram dez principais itens alimentares consumidos, preferencialmente escamas e ovos de peixes, teleósteos, copépodes, cladóceros, rotíferos e moluscos. O comprimento total e o peso corporal dos peixes variaram entre 9-34 cm (20,53 ± 6,90 cm) e 10-400 g (9125,94 ± 102,07 g), respectivamente. O índice de importância relativa (IRI%) mostrou a importância dos rotíferos sobre os demais itens alimentares. O índice de sobreposição de dieta de Morisita indicou variações sazonais nas dietas de bagres no verão e nas monções, exibindo a menor sobreposição, enquanto a sobreposição máxima ocorreu durante as estações das monções e do inverno. A escala multidimensional não métrica (nMDS) indicou a estreita associação entre os itens alimentares disponíveis durante o verão e o inverno, com uma diferença significativa entre as estações (ANOSIM, R = 0,638, P = 0,013). O índice de amplitude de nicho de Levin foi organizado na ordem de 0,88 > 0,81 > 0,78 > 0,63 > 0,43 para as classes de tamanho de V, IV, III, II e I, respectivamente. O PCA explicou 95,39% da variação total entre os itens alimentares e os grupos de tamanho de peixes. Peixes de pequeno porte apresentaram maior correlação com itens alimentares adequados ao tamanho da boca. Em conclusão, a variedade e a frequência dos itens alimentares registrados indicaram plasticidade alimentar considerável e comportamento alimentar oportunista, com uma mudança da natureza carnívora para onívora. Este estudo pode fornecer informações úteis sobre os hábitos alimentares e de alimentação de R. rita e apresentar subsídios para a preparação de sua dieta em futuras práticas de aquicultura.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822) / Análise sazonal de itens e hábitos alimentares de bagres ribeirinhos Rita rita (Hamilton, 1822) ameaçados de extinção

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin's niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Esta investigação apresenta a alimentação e a atividade alimentar de bagres ribeirinhos Rita rita ameaçados de extinção, no período de fevereiro de 2017 a janeiro de 2018. Um total de 225 peixes foi analisado quanto ao conteúdo do estômago, caracterizando os itens alimentares dominantes e as características morfométricas. Os resultados apresentaram dez principais itens alimentares consumidos, preferencialmente escamas e ovos de peixes, teleósteos, copépodes, cladóceros, rotíferos e moluscos. O comprimento total e o peso corporal dos peixes variaram entre 9-34 cm (20,53 ± 6,90 cm) e 10-400 g (9125,94 ± 102,07 g), respectivamente. O índice de importância relativa (IRI%) mostrou a importância dos rotíferos sobre os demais itens alimentares. O índice de sobreposição de dieta de Morisita indicou variações sazonais nas dietas de bagres no verão e nas monções, exibindo a menor sobreposição, enquanto a sobreposição máxima ocorreu durante as estações das monções e do inverno. A escala multidimensional não métrica (nMDS) indicou a estreita associação entre os itens alimentares disponíveis durante o verão e o inverno, com uma diferença significativa entre as estações (ANOSIM, R = 0,638, P = 0,013). O índice de amplitude de nicho de Levin foi organizado na ordem de 0,88 > 0,81 > 0,78 > 0,63 > 0,43 para as classes de tamanho de V, IV, III, II e I, respectivamente. O PCA explicou 95,39% da variação total entre os itens alimentares e os grupos de tamanho de peixes. Peixes de pequeno porte apresentaram maior correlação com itens alimentares adequados ao tamanho da boca. Em conclusão, a variedade e a frequência dos itens alimentares registrados indicaram plasticidade alimentar considerável e comportamento alimentar oportunista, com uma mudança da natureza carnívora para onívora. Este estudo pode fornecer informações úteis sobre os hábitos alimentares e de alimentação de R. rita e apresentar subsídios para a preparação de sua dieta em futuras práticas de aquicultura.

Association of biomass fuel smoke exposure and hypertension among rural women of Bangladesh: A cross-sectional study

Exposure to biomass fuel smoke has detrimental health effects causing chronic diseases. This study investigated the relationship between biomass fuel smoke exposure and hypertension among the rural Bangladeshi women. A total of 410 women aged 19–60 years were enrolled in this study during April–May 2017 who regularly cooked with biomass fuel in traditional cook stove for the past ?1 year. Self-reported daily cooking hours and lifetime cooking experience of the participants were recorded, and their blood pressure was measured. Participants' age ?40 years, parental history of hypertension, body mass index ?25 kg/m2, and cumulative exposure to biomass smoke were found to be the significant risk factors of hypertension. Every 1 year increase in cumulative exposure to biomass smoke eventually exacerbated the risk of hypertension by 61% (adjusted odds ratio 1.61, 95% confidence interval: 1.16–2.22; P < 0.01). This study provides evidence that long-term exposure to biomass fuel smoke is associated with hypertension.

Intestinal Perforation as a Complication of Induced Abortion - a Case Report and Review of Literature.

Intestinal perforation is a rare complication of induced abortion but it is not rare in our country. It is most commonly seen in countries in which abortions are performed by people without proper training and with sharp pointed instruments without knowledge of anatomy. Bowel perforation occurs when the posterior vaginal wall or uterus is violated, allowing the instrument to pierce underlying structures. The ileum and sigmoid colon are the most commonly injured portions of bowel due to their anatomic location. Here we discussed a woman who sustained a perforation at anterior rectal wall from abortion and was managed successfully.

Early Risk Assessment In Right Ventricular Infarction By TIMI Risk Score.

Background: Inferior myocardial infarction complicated by right ventricular infarction is associated with a greater risk of in-hospital mortality and cardiovascular related complications. Early risk stratification of patients with right ventricular infarction is crucial for appropriate management and reduction of adverse cardiac events. The development of TIMI risk score has provided a useful tool to quickly and easily stratify patients with right ventricular infarction. We conducted this study to evaluate the prognostic value of TIMI Risk Score analysis in patients with right ventricular infarction. Methods: This observational study was conducted in the department of Cardiology in NICVD, Dhaka, from July 2006 to June 2008. Considering inclusion and exclusion criteria, a total of 60 patients with right ventricular infarction were evaluated. All the patients were evaluated clinically and ECG was done after admission. Patients were categorized into two groups by TIMI risk scoring. Patients with low TIMI risk score(0-3) were in Group-I and patients with high TIMI risk score(4- 14) were in Group-II. Results: The study revealed no statistically significant difference among the patients of two groups (p>0.05) in relation to sex, weight, risk factors and presenting complaints. Analysis revealed statistically significant difference among the patients of two groups (p<0.05) in relation to age, duration of chest pain, clinical parameters, Killip class of heart failure and LVEF. Regarding inhospital outcome, 51.7% patients developed complications during the study period and all the complications were more in group II patients with high TIMI risk score(4-14). Death (18.3%) was the most common complication followed by cardiogenic shock (15.0%), complete heart block(6.6%),cardiac arrest(6.6%),VT(3.3%)and 2nd degree heart block(1.6%). Conclusion: This study indicates that on admission - TIMI risk score analysis can identify patients with right ventricular infarction at higher risk for in-hospital mortality and morbidity.

Field evaluation of ZeroFly® - an insecticide incorporated plastic sheeting against malaria vectors & its impact on malaria transmission in tribal area of northern Orissa.

Background & objectives: Insecticide incorporated plastic sheeting is a new technology to control mosquitoes in emergency shelter places and also temporary habitations in different locations. Therefore, field studies were conducted to assess the efficacy of ZeroFly® plastic sheeting treated with deltamethrin on prevailing disease vectors Anopheles culicifacies and An. fluviatilis and its impact on malaria transmission in one of the highly endemic areas of Orissa. Methods: The study was conducted in Birkera block of Sundargarh district, Orissa state. The study area comprised 3 villages, which were randomized as ZeroFly plastic sheet, untreated plastic sheet and no sheet area. ZeroFly plastic sheets and untreated plastic sheets were fixed in study and control villages respectively covering all the rooms in each household. Longitudinal studies were conducted on the bioefficacy with the help of cone bioassays, monitoring of the mosquito density through hand catch, floor sheet and exit trap collections and fortnightly domiciliary active surveillance in all the study villages. Results: In ZeroFly plastic sheeting area, there was a significant reduction of 84.7 per cent in the entry rate of total mosquitoes in comparison to pre-intervention phase. There was 56.2 per cent immediate mortality in total mosquitoes in houses with ZeroFly sheeting. The overall feeding success rate of mosquitoes in the trial village was only 12.5 per cent in comparison to 49.7 and 51.1 per cent in villages with untreated plastic sheet and no sheet respectively. There was a significant reduction of 65.0 and 70.5 per cent in malaria incidence in ZeroFly plastic sheeting area as compared to untreated plastic sheet and no sheet area respectively. Interpretation & conclusions: Our study showed that introduction of ZeroFly plastic sheets in a community-based intervention programme is operationally feasible to contain malaria especially in the high transmission difficult areas.

Pott's disease in a young child.

A 16-month-old emaciated, immunized child presented with low-grade fever and progressive kyphosis with a right sided para-vertebral abscess for 9 months. During this period of illness the child had marked loss of appetite and progressive weight loss. There was history of contact with sputum smear positive father. A gibbus was present at thoraco-lumbar region with a cold abscess at the right side of the gibbus and signs of upper motor neuron lesion were found on lower limb examination. Diagnosis was supported by relevant investigations including MRI of dorsolumbar spine and treatment was started beforehand with anti-tubercular drugs. The paravertebral abscess was drained several times and antibiotics were used depending upon the results of microbiological study. At the same time the patient was advised to wear a modified chest brace for immobilization and the management for severe malnutrition was also started accordingly. There was significant clinical improvement observed within one month of starting treatment.

Histopathology based cancer pattern in Mymensingh region of Bangladesh.

To our knowledge, population-based published data regarding the cancer profile in Mymensingh region of Bangladesh is not available. This study was designed to provide information regarding the frequencies of cancers through sample data retrieved from histopathology (surgical pathology) laboratory based cancer registry from two laboratories in Mymensingh. All malignant tumours recorded in 2006 in the register of pathology laboratory of Mymensingh Medical College and one private pathology laboratory in Mymensingh town were taken as sample data for analysis in terms of age groups, gender and types of cancer with relation to site. A total of 470 cases diagnosed as cancer were found in the register, of which males were 249(53%) and females were 221(47%) with male to female ratio 1.2: 1. Highest numbers of cases were found in the age group of 51-60 years. In male group frequency of malignant tumours was found in the age group of 51-60 years and the female group it is 41-50 years. Top five sites of cancer, irrespective of sex, were of stomach, uterine cervix, colo-rectum, lymph nodes and breast. According to decreasing order of frequency, in the males, the top five cancers were of stomach, lymph node, oesophagus, urinary bladder and colo-rectum. In the female groups these were of uterine cervix, breast, ovary, colo-rectum and stomach. Cancer cases in the age group of 51-60 years were significantly higher in males than in females (p<0.001). The commonest cancers in males and females were of stomach and cervix, respectively. As the analysis was based only on surgical specimens, the exact incidence of cancer of lung and liver could not be evaluated. Because, majorities of the malignancies in these organs are diagnosed mainly on cytological examination. Population-based cancer registry should be maintained to explore the exact patterns of cancer in the study region. Cervical cancer screening program and eradication of H. pylori infection program may be helpful for the reduction of incidence of cancer in this region.

Histopathological analysis of hysterectomy specimens.

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.

Morphometry of the intercommissural distances and other structures of the aortic valve of bovine heart.

The morphometry of the intercommissural distances and their relation with other structures of the aortic valve of bovine heart was carried out. A total of 32 apparently healthy bovine hearts of indigenous cattle of both sexes (50% male and 50% female), 2-4 years of age, weighing 500 to 800 gms were used in this study. The external intercommissural distances were higher in all cusps of the valve compared to the internal intercommissural distances. The internal intercommissural distance was larger in the RC sinus in case of male animals followed by that of the LC and NC sinus. The mean external intercommissural distances were 34.67+/-3.40, 34.40+/-3.64 and 34.97+/-4.37 mm and the internal intercommissural distances were 21.60+/-4.21, 21.20+/-4.70 and 20.67+/-4.06 mm for LC, RC and NC respectively. Analyzing the internal intercommissural distance, value in the LC sinus was higher followed by the RC and the NC but this variation was non-significant. In regard to the position of the coronary ostia, there were two coronary ostia, the right coronary ostium present in the RC sinus and the left coronary ostium in the LC sinus respectively and the right coronary ostium was supracommissural in position in bovine heart. Data about the morphometrical analysis of intercommissural distances and the position of the coronary ostia of the aortic valve facilitate the knowledge of manufacturing bovine tissue valve as well as those might be involved in valve replacement in human.

A case report on Klinefelter syndrome.

An 18 year old boy presented with small genitalia, failure of eruption of secondary sex hairs, female like voice with eunachoid body habitus, bilateral gynecomastia, infantile external genitalia, small testes and poorly developed musculature. He was diagnosed as a case of 47XXY Klinefelter syndrome on the basis of hormone assay and karyotyping. He has given androgen replacement therapy with the aim to relieve symptoms of androgen deficiency, to reproduce physiological levels of plasma testosterone and to prevent long term consequences of androgen deficiency.

Histopathological types of malignant lesions of esophagus and stomach.

Upper part of gastrointestinal tract is common site of malignancy. Histological types of malignancy of esophagus and stomach may vary in different countries and also in different regions in the same countries. To find out the frequencies of different histological malignancies in Mymensingh region of Bangladesh, we analyzed the histopathological reports of 259 biopsy specimens examined in one pathology laboratory in Mymensingh town during the period from 6th January 2002 to 29th April 2004. Endoscopic biopsies were 234 (90.35%) and surgical biopsy specimens were 25 (9.35%). Male patients were 193 (72.52%) and female patients were 66 (25.48%). Specimens of esophagus were 73 (28.19%) and of stomach were 186 (71.81%). Out of 69 (94.53%) adequate samples of esophagus 46 (74.19%) were squamous cell carcinoma and 16 (25.81%) were adenocarcinoma. Adequate samples of stomach were 177 (95.16%) in which malignancies were found in 119 (67.23%). All the malignant tumor of stomach were in adenocarcinoma of which 82 (68.91%) were intestinal type, 17 (14.29%) were diffuse type and 20 (16.81%) mixed type. Intestinal type of gastric adenocarcinoma was found to be significantly associated with male patients (p < 0.005). From the present study it is suggested that in the Mymensingh region the common form of malignant lesion of esophagus may be squamous cell carcinoma followed by adenocarcinoma. Adenocarcinoma is the most common type of gastric malignancy of which intestinal type is more common

Advances in treatment and prevention of hepatorenal syndrome.

Hepatorenal syndrome (HRS) remains one of the major therapeutic challenges in clinical medicine today. The pathogenesis is complex, but the final common pathway seems to be that sinusoidal portal hypertension, in the presence of severe hepatic decompensation, leads to splanchnic and systemic vasodilatation and decreased effective arterial blood volume. Renal vasoconstriction increases concomitantly, renal haemodynamics worsens, and renal failure occurs. About 15 years ago it was shown that the renal failure is potentially reversible after liver transplantation. This potential reversibility together with increased understanding of the pathogenesis has led to successful preliminary attempts to reverse HRS nonsurgically with combinations of splanchnic vasoconstrictors and colloid volume expansion, insertion of trans-jugular intrahepatic portovenous shunt radiologically, and improved forms of dialysis. The aim of this chapter is to discuss the advances in the therapy of patients with HRS

A case of molluscum contagiosum.

Molluscum contagiosum is a benign contagious disease caused by a poxvirus. The virus proliferates within keratinocytes and forms intracytoplasmic Molluscum bodies. Though it is a common clinical condition, histologically is not yet reported from this region of Mymensingh. We received a skin biopsy specimen in a pathology laboratory for histological examination. The Haematoxylin and Eosin stained sections revealed typical intracytoplasmic Molluscum bodies in keratinocytes. The lesions were in the trunk, which is a common site for Molluscum Contagiosum (MC). As the diagnosis of Molluscum contagiosum is easy by histological examination, every patient suspected to be this disease is recommended to be examined histologically to exclude other similar types of lesions.

Ultrasound guided fine needle aspiration cytology for diagnosis of mass lesions of liver.

The therapeutic and prognostic evaluation of malignant neoplasia of liver depends mostly on morphologic diagnosis. Ultrasound guided fine needle aspiration cytology (FNAC) of liver has been proved to be a rapid, reliable and cost-effective method for cytological diagnosis of hepatic mass lesions. This study was undertaken to find out the frequency of different benign and malignant space occupying lesions (SOL) of liver from patients attending for FNAC in Mymensingh. Ultrasound guided FNAC was performed on 108 patients with hepatic mass lesions from September 2, 2001 to August 19, 2003. There were 67 (62.0%) males and 41 (37.96%) females with a mean age 53 year (SD +/- 14) ranging from 2 to 83 years. Samples were adequate in 101 (93.5%) and inadequate in 7 (6.5%). Out of 101 adequate samples only one was benign (liver abscess) and 100 were malignant. Of the malignant lesions hepatoblastoma was in 1 (1%), hepatocellular carcinomas in 8 (8%), metastatic adenocarcinomas in 73 (73%) and unclassified malignancies were in 18 (18%). Most of the hepatocellular carcinomas occurred in males (7 in 8). The frequency of metastatic adenocarcinoma was more in males (39 vs. 34) but the difference is not significant (p > 0.05). Ultrasound guided FNAC of liver is a rapid, reliable and cost-effective diagnostic method. It can be practice in any centres where ultrasound facility and specialist pathologists are available.

Role of fine needle aspiration cytology in the diagnosis of pulmonary lesions.

Fine needle aspiration cytology (FNAC) is a rapid, reliable and cost-effective method in the diagnosis of lung lesions. Cells are collected from the lesions usually under fluoroscopic or CT-guidance for cytological examination. Due to lack of these highly sophisticated radiologic imaging techniques in our institute we performed this test under X-Ray film guidance. This study was carried out in 59 patients, who underwent FNAC of lung lesions in the department of Pathology, Mymensingh Medical College, Bangladesh to find out the specimen adequacy and frequency of both benign and malignant lesions of the lungs in our areas. Out of 59 cases 54 were males and 5 were females with age ranged from 20 to 82 years. Adequate samples were obtained in 50 (84.75%) cases of which 35 (70%) were malignant, 10 (20%) were benign and 5 (10%) were suspicious for malignancy. Malignant lesions comprised of squamous cell carcinoma in 20 (57.14%), adenocarcinoma in 1(2.86%), large cell carcinoma in 8 (22.86%) and small cell carcinoma in 6 (17.14%) cases. All the benign lesions were inflammatory in nature, which included abscess in 6 (60%), tuberculosis in 3 (30%) and chronic non-specific inflammation in 1 (10%) case. Majority of the malignant lung lesions were encountered in the 6th decade of life. As the method is simple, rapid, cost-effective and without major complications, so it can be practiced in any centres in our country where specialised radiologists and pathologists are available.

Epidemiological characteristics of sixty five cases of Kala-azar attending to a laboratory in Mymensingh.

To find out the epidemiological characteristics of the patients with Kala-azar attending to a pathology laboratory at Mymensingh we studied retrospectively in a total of 65 patients. These patients were suspected to be Kala-azar as they were suffering from usually chronic fever, anaemia and splenomegaly. They were referred for serological detection of anti-k39 Leishmanial antibody by Immunochromatographic test (ICT) method. ICT positive cases were included for study. Majority cases were suffering from fever of more than 3 months (40%). Out of 65 patients 43 (66.15%) were males and 22 (33.85%) were females with a M:F ratio 2:1. Patients of 10 or less then 10 years of age were 17 (26.15%), in 11-20 years 23 (35.38%), in 21-30 years 13 (20.00%), in 31-40 years 5 (7.69%), in 41-50 years (6.15%) and in more than 50 years 3 (4.62%). Distribution of patients in different districts were: Mymensingh 54 (83.08%), Tangail 5 (7.69%), Jamalpur (4.62%), Netrokona 1 (1.54%) and Kishorgonj 1 (1.54%). In Mymensingh district patients were distributed as following Upazilla:Trishal 22 (40.74%), Fulbaria 11 (20.37%), Mymensingh Sadar 7 (12.96%), Gaforgaon 7 (12.96%),Bhaluka 5 (9.96%), Fulpur 1 (1.85%) and Nandail 1 (1.85%). Patients were found to scattered among different Unions of the affected Upazillas. The details addresses of the Kala-azar patients are recorded in authors computer databases. This may help in the further study regarding pathogenesis, reservoir and vectors of Leishmania in endemic areas. It may also helps in the community based study of Kala-azar. Present study supports that Kala-azar is still prevailing in the south-western region of greater Mymensingh in Bangladesh of which males and the adolescents are more affected.