Nucleic acid-based electrochemical biosensors for rapid clinical diagnosis: advances, challenges, and opportunities.

Clinical diagnostic tests should be quick, reliable, simple to perform, and affordable for diagnosis and treatment of diseases. In this regard, owing to their novel properties, biosensors have attracted the attention of scientists as well as end-users. They are efficient, stable, and relatively cheap. Biosensors have broad applications in medical diagnosis, including point-of-care (POC) monitoring, forensics, and biomedical research. The electrochemical nucleic acid (NA) biosensor, the latest invention in this field, combines the sensitivity of electroanalytical methods with the inherent bioselectivity of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). The NA biosensor exploits the affinity of single-stranded DNA/RNA for its complementary strand and is used to detect complementary sequences of NA based on hybridization. After the NA component in the sensor detects the analyte, a catalytic reaction or binding event that generates an electrical signal in the transducer ensues. Since 2000, much progress has been made in this field, but there are still numerous challenges. This critical review describes the advances, challenges, and prospects of NA-based electrochemical biosensors for clinical diagnosis. It includes the basic principles, classification, sensing enhancement strategies, and applications of biosensors as well as their advantages, limitations, and future prospects, and thus it should be useful to academics as well as industry in the improvement and application of EC NA biosensors.

Current trends in polymerase chain reaction based detection of three major human pathogenic vibrios.

Vibrio parahaemolyticus, Vibrio cholerae and Vibrio vulnificus are the most significant aquatic pathogens of the genera Vibrio, account for most Vibrio-associated outbreaks worldwide. Rapid identification of these pathogens is of great importance for disease surveillance, outbreak investigations and food safety maintenance. Traditional culture dependent methods are time-consuming and labor-intensive whereas culture-independent polymerase chain reaction (PCR) based assays are reliable, consistent, rapid and reproducible. This review covers the recent development and applications of PCR based techniques, which have accelerated advances in the analysis of nucleic acids to identify three major pathogenic vibrios. Emphasis has been given to analytical approaches as well as advantages and limits of the available methods. Overall, this review article possesses the substantial merit to be used as a reference guide for the researchers to develop improved PCR based techniques for the differential detection and quantification of Vibrio species.

Authentication of Halal and Kosher meat and meat products: Analytical approaches, current progresses and future prospects.

Meat and meat products are widely consumed worldwide as a source of high-quality proteins, essential amino acids, vitamins, and necessary minerals. The acceptability of Halal and Kosher meat products relies not only on the species origin but also on the manner of slaughtering of animals. Both Islam and Judaism have their own dietary laws in their holy books regarding acceptance and forbiddance of dietary items particularly meat and meat products. They also include many strictures to follow for ritual cleanliness of foods. Since the authenticity of Halal and Kosher food created increased concerns among consumers, the integrity of Halal and Kosher meat and meat products must be assured so that consumers can be accomplished with the originality of products. There is an increasing demand for reliable and sensitive techniques for the authentication of various Halal and Kosher meat products. This up-to-date review intends to provide an updated and extensive overview critically on the present situation, progress, and challenges of analytical techniques to authenticate animal species in meat items. It also addresses slaughtering procedure with brief discussion on Halal and Kosher laws with a view to creating consumer awareness against fraudulent practices. The available methods are schematically presented, and their salient features are comparatively elucidated in tables. Potential future technologies are predicted, and probable challenges are summarized. Overall, the present review article possesses substantial merits to be served as a reference guide in the field of academia and industry for the preparation/processing and identification of Halal and Kosher meat and meat products as well as may act as a platform to help improve existing authentication methods.

Advancements in Detection Approaches of Severe Acute Respiratory Syndrome Coronavirus 2.

Diagnostic testing to identify individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a key role in selecting appropriate treatments, saving people's lives and preventing the global pandemic of COVID-19. By testing on a massive scale, some countries could successfully contain the disease spread. Since early viral detection may provide the best approach to curb the disease outbreak, the rapid and reliable detection of coronavirus (CoV) is therefore becoming increasingly important. Nucleic acid detection methods, especially real-time reverse transcription polymerase chain reaction (RT-PCR)-based assays are considered the gold standard for COVID-19 diagnostics. Some non-PCR-based molecular methods without thermocycler operation, such as isothermal nucleic acid amplification have been proved promising. Serologic immunoassays are also available. A variety of novel and improved methods based on biosensors, Clustered-Regularly Interspaced Short Palindromic Repeats (CRISPR) technology, lateral flow assay (LFA), microarray, aptamer etc. have also been developed. Several integrated, random-access, point-of-care (POC) molecular devices are rapidly emerging for quick and accurate detection of SARS-CoV-2 that can be used in the local hospitals and clinics. This review intends to summarize the currently available detection approaches of SARS-CoV-2, highlight gaps in existing diagnostic capacity, and propose potential solutions and thus may assist clinicians and researchers develop better technologies for rapid and authentic diagnosis of CoV infection.

Rapid in-situ detection kit (RisK): Development of loop-mediated isothermal amplification (LAMP) assay for the rapid identification of selected invasive alien fish in Malaysian freshwaters.

Invasive alien fish species have become a silent treat towards the ecosystem especially the native fish population in Malaysia. There has been a need to develop rapid identification methods that can aid management teams in identifying fish species that are not native to our ecosystem. Current visual identification methods are highly tedious and require time, delaying action towards curbing the invasion. The LAMP assay successfully identified six popular invasive fish species in Malaysia. None of the LAMP assays showed false positives and the Limit of Detection of the LAMP primers were highly sensitive and could detect DNA samples up to 1 × 10-15 ng/µl. The LAMP primers designed were highly specific to the target species and did not amplify non target species. DNA sequencing was done to ensure the accuracy of LAMP assay results. This study demonstrates that LAMP is a suitable tool in species identification efforts of invasive fish species in Malaysia.

Bone tissue engineering potentials of 3D printed magnesium-hydroxyapatite in polylactic acid composite scaffolds.

The primary role of bone tissue engineering is to reconcile the damaged bones and facilitate the speedy recovery of the injured bones. However, some of the investigated metallic implants suffer from stress-shielding, palpability, biocompatibility, etc. Consequently, the biodegradable scaffolds fabricated from polymers have gathered much attention from researchers and thus helped the tissue engineering sector by providing many alternative materials whose functionality is similar to that of natural bones. Herein, we present the fabrication and testing of a novel composite, magnesium (Mg)-doped hydroxyapatite (HAp) glazed onto polylactic acid (PLA) scaffolds where polyvinyl alcohol (PVA) used as a binder. For the composite formation, Creality Ender-3 pro High Precision 3D Printer with Shape tool 3D Technology on an FSD machine operated by Catia design software was employed. The composite has been characterized for the crystallinity (XRD), surface functionality (FTIR), morphology (FESEM), biocompatibility (hemolytic and protein absorption), and mechanical properties (stress-strain and maximum compressive strength). The powder XRD analysis confirmed the semicrystalline nature and intact structure of HAp even after doping with Mg, while FTIR studies for the successful formation of Mg-HAp/PVA@PLA composite. The FESEM provided analysis indicated for the 3D porous architecture and well-defined morphology to efficiently transport the nutrients, and the biocompatibility studies are supporting that the composite for blood compatible with the surface being suitable enough for the protein absorption. Finally, the composite's antibacterial activity (against Staphylococcus aureus and Escherichia coli) and the test of mechanical properties supported for the enhanced inhibition of active growth of microorganisms and maximum compressive strength, respectively. Based on the research outcomes of biocompatibility, antibacterial activity, and mechanical resistance, the fabricated Mg-HAp/PVA@PLA composite suits well as a promising biomaterial platform for orthopedic applications by functioning towards the open reduction internal fixation of bone fractures and internal repairs.

Deep Vein Thrombosis in A Post-Coronary Artery Bypass Grafting Patient: Successful Conservative Management.

Deep vein thrombosis is an alarming medical emergency. Deep vein thrombosis or deep venous thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein predominantly in the legs. Post-Coronary Artery Bypass Grafting deep vein thrombosis is a very rare medical condition relatively in Asian. Approximately 80% of deep vein thrombosis (DVTs) is clinically asymptomatic, 20% of those that actually demonstrate signs and symptoms can be easily confused with symptoms of other commonly presenting musculoskeletal disorders. Proper medical management can reduce patient's morbidity and further burden. A 50 years old diabetic Post-Coronary Artery Bypass Grafting gentleman had been suffering for left leg swelling, high grade fever and calf muscle pain for 5 days. He had absent Arteria Dorsalis Paedis pulse on left foot, Positive Homan sign and Wells score is 7. His left leg was hugely swelled. He had normal leg hair distribution. Duplex study of Left Leg-Deep Vein Thrombosis in left lower limb (Popliteal segment) with sign of recanalization. He is also a patient of anemia of chronic disease due to hemorrhoid. Several investigations have done to find the cause of his chronic anemia. His treatment was meticulous with complete bed rest, elevation of left lower limb, heparinization, oralrivaroxaban. He had rapid recovery following treatment. Post-Coronary Artery Bypass Grafting patient should be given post-operative enoxaparin (Low molecular weight Heparin) or Heparin for 3-5 days. Early diagnosis of the disease condition reduces morbidity. Combined treatment with Rivaroxaban and Heparin is of great clinical value and outcome in a case of Post-Coronary Artery Bypass Grafting Deep Vein Thrombosis patient.

Right Atrial Myxoma: An Uncommon Presentation.

There are two types of tumors found in the cardiac chamber. These are divided into primary intra-cardiac tumors and secondary intra-cardiac tumors. Primary intra cardiac tumors are rare and among them 29% are myxomas. Majority of them are found in the left atrium. Here, we report a case of a myxoma in the right atrium with hepatomegaly and Hepatitis B virus infection. The coexistence of all these conditions is very rare. A 52 years old patient presented with history of shortness of breath on exertion along with fever and generalized weakness for 6 months which aggravated lately for last 2 months. He was then taken for better medical care and hospitalization. On cardiac evaluation he had soft S1 and S2 over the tricuspid region on the right lower parasternal region. He had bilateral mild pitting pedal edema. On further examination, it was revealed that he had mild tender hepatomegaly with jaundice. His blood analysis for HBsAg was positive. Echocardiogram showed right atrial myxoma of 14.3cm² almost completely occupying the right atrium and even protruding into the Inferior Venacava however not fully obstructing it. The inferior vena cava size was mildly dilated (22mm). Abdominal ultrasound report showed hepatomegaly (17.6cm) with coarse hepatic parenchyma. In this report, we emphasize the rarity of myxoma in the Right Atrium, its difficult diagnosis because of the location and the atypical presentation in the echocardiograph.

Clinical Evaluation of Bucco-lingual Crestal Bone Remodeling in Mandibular Posterior Implants placed immediately and Delayed into Extraction Sites.

The objective of this cross sectional study was to evaluate the bucco-lingual crestal bone remodeling in mandibular posterior implants placed immediately and delayed into extraction sites and carried out in the department of Prosthodontics of Dhaka Dental College and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2010 to July 2014. Forty patients were evaluated in this study; of them 25(62.5%) patients were males and 15(37.5%) were females with age range from 24 to 70 years. At first surgery during implant placement the mean distance from buccal bone to lingual bone was 11.11mm for immediate implants and 9.265mm for delayed implants. At second-stage surgery the mean distance from buccal bone to lingual bone was 9.765mm for immediate implants and 6.25mm for delayed implants. The mean±SD change of bone reduction at second surgery was 1.28±0.31 for immediate implants and 3.01±0.33 for delayed implants. Unpaired t test was done for statistical analysis and p value was less than 0.05. So, the changes were statistically significant.

Clinical Presentation of Adult Pulmonary Tuberculosis (PTB): A Study of 103 Cases from a Tertiary Care Hospital.

Tuberculosis, one of the oldest diseases known to affect humans, is a major cause of death worldwide. The disease, which is caused by the bacteria Mycobacterium tuberculosis complex, usually affects the lungs, although other organs are involved in up to one-third of causes. If properly treated, tuberculosis caused by drug-susceptible strains is curable in virtually all cases. If untreated, the disease may be fatal within five years in 50-65% of cases. Transmission usually takes place through the airborne spread of droplet nuclei produced by patients with infectious pulmonary tuberculosis. This cross sectional observational study was conducted to detect various clinical presentations of pulmonary tuberculosis patients in the Department of Medicine, Sir Salimullah Medical College and Hospital from January 2009 to December 2009. Sample was selected through inclusion methods from patients who was admitted in to hospital and confirmed as pulmonary tuberculosis after appropriate investigations and who gave informed written consent was finally enrolled in this study. A total 103 patients were selected for the study. Out of 103 cases 34.9% were above 50 years old, followed by 26.2% between 30-40 years old, 22.3% between 40-50 years old and remaining 16.5% bellow 30 years old. The male to female ratio was roughly 1.2:1. The most of the patients were housewife and farmer which were 31% and 28.1% respectively. The most of the patients came from low socio-economic group. About 55.3% cases were smoker and 43.7 were non smoker. Among the frequency of symptoms 73.7% were chronic cough for above one month followed by 70.8% were low grade fever, 41.8% were night sweats and the 2% were admitted in hospital for other complaints and after evaluation diagnosed as PTB. The most of the patients about 67% were suffering from less than six weeks duration. Among the physical findings the 67% cases were lost significant weight, 56.3% had fever and 56.3% had apical crepitation over chest. There was sputum positive for acid fast bacilli about 64.7%. The traditional TB diagnosis methods are time consuming and the most of the patients are poor in our country, they are unable to afford the modern costly investigations. Therefore we should more emphasis on clinical examinations, so that we can diagnosis pulmonary TB rapidly and can start treatment as early as possible.

Diagnosis of Dermatophytosis by Conventional Methods and Comparatative analysis of Sabouraud Dextrose Agar and Dermatophyte Test Medium for Isolation of Dermatophytes.

Dermatophytosis is a fungal disease which ranked as one of the most common cutaneous condition in all over the world. The aim of this cross sectional observational study is to identify the etiological agent of dermatophytosis and comparison of Sabouraud dextrose agar (SDA) and Dermatophyte test medium (DTM) for the primary isolation of dermatophytes among the clinically suspected cases of dermatophytosis from the outpatient Department of Dermatology and Venereology, Mymensingh Medical College Hospital from July 2013 to December 2015. Two hundred thirty clinically suspected cases of dermatophytosis were subjected in this study. Sixty three cases (27.4%) were positive for fungus in direct microscopy while 53(23%) were culture positive. Trichophyton rubrum (83%) was found common etiological dermatophyte species followed by Trichophyton mentagrophytes 5(9.4%) and Epidermophyton floccosum 4(7.5%). There was no statistically significant difference between the SDA and DTM (p<0.01) in primary isolation of dermatophytes.

Risk Factors and Immediate Outcome of Very Low Birth Weight Babies (Appropriate For Gestational Age) In Newly Established SCANU, Mymensingh Medical College Hospital.

Low birth weight (LBW) is the most important preventable cause in the neonatal period leading to very high neonatal mortality and morbidity in developing countries like Bangladesh. A cross sectional study was conducted in the neonatology ward, Mymensingh Medical College Hospital, Mymensingh from July 2014 to December 2014 to identify the risk factors and immediate hospital outcome of Very Low Birth Weight (VLBW) Appropriate for Gestational Age (AGA) babies in context of present neonatal hospital care standard. Total 100 preterm very low birth weight babies were enrolled and selected by weight, intra uterine growth chart and new ballad score. There is slight preponderance of male babies (64%) over female babies (36%). The overall survival and mortality rate was 50% and 50% respectively in the present study. Mortality is highest (76.47%) in babies whose gestational age 28 weeks and the mortality rate gradually decrease as gestational age increases. Correlation co-efficient (r) between gestational age and number of died is -0.85. It indicates highly opposite relation between the variables, p value (<0.069) which is strong opposite relation. Mortality is highest (66.66%) in babies whose birth weight below1100gm, in comparison to those whose birth weight above 1100gm and correlation co-efficient (CC) r = -0.433 (p<0.466) which is not significant. That means not only birth weight but also other factors are responsible for mortality of very low birth weight baby. Neonatal mortality bears inverse relationship with birth weight and gestational age. This emphasized the need for large scale study which will provide the guideline for appropriate measures to be taken to combat the situation.

Use of Acute Physiology and Chronic Health Evaluation (APACHE)-II and Red Cell Distribution Width (RDW) for Assessment of Mortality of Patients with Sepsis in ICU.

Critically ill patients of Intensive Care Unit (ICU) need highest level of monitoring, intense nursing care and integrated management which are very expensive and consume significant part of hospital resources. Prediction of outcome from disease has become an essential component of health science. So, various scoring systems have been developed to predict outcome of critically ill patients in ICU. There is no perfect model of severity score to predict ICU mortality. Search for new system is still remaining as continuous efforts to find the best model to get accurate information about the prognosis and outcome of critically ill patients. This observational prospective cohort study was carried out in ICU of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2015 to evaluate the ability of mortality prediction of Acute Physiology and Chronic Health Evaluation (APACHE)-II after adding RDW. Total 62 patients, clinically diagnosed as sepsis with positive culture were included in this study after analyzing selection criteria. APACHE II score model was compared with APACHE II plus RDW score model in relation to mortality outcome assessment. Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Receiver Operating Characteristic (ROC) curve were used as parameter to compare the predictive ability of the two models. The derived model APACHE II- RDW was found with higher predictive power (Pearson's correlation coefficient - 0.915) than APACHE II (Pearson's correlation coefficient - 0.885) in relation to mortality (p<0.01). Accuracy was compared by using Receiver Operating Characteristic (ROC) curve between the two models and AUROC was found higher (AUC-0.87) in case of new model compared with conventional model (AUC-0.85). So combination of RDW with APACHE-II increases the predictive ability of the scoring model in relation to mortality.

Van Wyk and Grumbach Syndrome: An Unusual Presentation of Hypothyroism.

An 18 years-old-girl presented one and half years back with the complaints of short stature, retarded growth, and menorrhagia with sudden severe lower abdominal pain; was diagnosed as bilateral ovarian cysts and underwent bilateral ovarian cystectomy. Later on she was incidentally diagnosed as a case of hypothyroidism when she had been experiencing slowly enlarging left lower abdominal mass with dull ache for the 5 month and then was transferred to the department of Endocrinology for further evaluation. Detailed work up revealed her short stature with obesity, delayed bone age and other features of hypothyroidism which was confirmed by thyroid function testing. She had enlarged left ovary with multiple follicles as shown in ultrasonography. Magnetic resonance imaging (MRI) showed sellar mass which was suspicious of macroadenoma. Levothyroxine replacement was started and she had a dramatic improvement of her problems with disappearance of the ovarian cysts and sellar mass.

Molecular-Characterization of Methicillin-Resistance Staphylococcus aureus (MRSA) from Different Tertiary Care Hospitals in Bangladesh.

Infections caused by Staphylococcus aureus were treated by methicillin, but about 95% of S. aureus has been resistance to methicillin, both in the community and hospitals and are increasing day by day. MRSA produces altered penicillin binding protein, PBP2a, due to the expression of mecA gene. Some strains of both the MRSA and MSSA carry PVL gene. This cross sectional observational study was conducted to detect the molecular-characterization of methicillin resistant Staphylococcus aureus (MRSA) and carried out in the Department of Microbiology, Mymensingh Medical College from July 2014 to December 2015. Clinical samples for this study were wound swab, pus, exudates from diabetic ulcer and burn ulcer, aural swab, blood and urine which were collected from three tertiary care hospitals such as from MMCH, BIRDEM hospital and SSMCH. Standard microbiological procedure & biochemical tests were carried out to detect S. aureus. Oxacillin disk diffusion method (ODDM) was done by Kirby-Bauer disk diffusion method. Out of a total 109 culture positive samples 69 isolates of S. aureus were selected for the study. Among the 69 isolates 33, 27 and 09 were from MMCH, BIRDEM hospital and SSMCH respectively. Among the 69 isolates, 17(24.6%) and 52(75.3%) were distinguished as MRSA and MSSA respectively by ODDM. In contrast, detection of presence and absence of mecA gene by PCR identified 20(28.9%) and 49(71.01%) isolates as MRSA and MSSA respectively. Multiplex PCR was performed by standard protocol with specific primers for detection of 16S rRNA gene for Staphylococcus, nuc gene for Staphylococcus aureus, mecA gene for MRSA, PVL gene as a virulence factor and ACME-arc gene for worldwide spreading USA 300 MRSA clone. The PVL gene were detected in 3 out of 20 MRSA (15%) and 19 out of 49 MSSA (38.7%) and the ACME- arc gene was not found in any isolates. All of the S. aureus (MRSA and MSSA) isolates were sensitive to Vancomycin and Gentamicin. All MRSA isolates (100%) showed resistance to Penicillin and Oxacillin. Of the MRSA isolates about 88.2% were resistance to Ceftazidime, 64.7% were resistance to Erythromycin and Ciprofloxacin, 11.7% were resistance to Tetracycline. Among the MSSA isolates 94.2% were resistance to Penicillin and 9.6% resistance to Ciprofloxacin. The MSSA were less resistance for non-beta lactam drugs than MRSA.

Helicobacter Pylori Stool Antigen Assay in Hyperemesis Gravidarum.

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy that seriously affects the pregnancy outcome. It is a disease with unknown etiology and varieties of contributing factors like hormonal changes, psychological and immunological factors. A significantly high prevalence of Helicobacter pylori among pregnant women with Hyperemesis gravidarum has been revealed recently. A descriptive, cross-sectional study was carried out at antenatal ward, Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Mymensingh for a period of twenty-one months among purposively selected thirty-six patients with Hyperemesis gravidarum with a view to assess the involvement of H. pylori in Hyperemesis gravidarum. Data were collected through interview, physical examinations and laboratory investigations by using case record form. Statistical analysis was performed using SPSS version 20.0 for Windows. Highest number 16(44.44%) of respondents were in age group 20 to 24 years with a mean of 23.81 years and a standard deviation (SD) of 4.55 years. Majority 29(80.56%) of the women had education less than 12 years, as many as 28(77.78%) women were housewives, and at least 14(38.89%) women had unplanned pregnancies. An overwhelming majority 29(80.56%) of women had their pregnancy duration between 8 to 12 weeks with a mean duration of 10.64 weeks and a standard deviation of 2.35 weeks. Majority 20(55.56%) of women were pregnant for first time, as many as 19(52.78%) women had duration of illness for 5 to 9 weeks. Of 16 multi-gravid women, 7(43.75%) had history of similar condition in their previous pregnancies. As many as 9 (25.00%) women had family history of similar condition in their mothers and sisters. First trimester was time of manifestation of the condition.At least 11 (30.56%) stool samples were positive for H. pylori stool antigen. Family history of Hyperemesis gravidarum and presence of H. pylori stool antigen are statistically associated (p<0.05). Pregnancy at young age, low educational status of women, nulliparity, unplanned pregnancy, past history, family history and H. pylori infection are the identified risk factors of Hyperemesis gravidarum.

Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) Study.

Ramadan fasting is one of the five pillars of Islam and is obligatory for all healthy adult and adolescent Muslims. A significant number of patients with diabetes observe fasting during Ramadan. The objectives of this Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) study were to find out the current knowledge, attitude, and practices about Ramadan fasting among people with diabetes in Bangladesh. This retrospective cross-sectional study recruited 648 subjects with diabetes mellitus attending the Endocrinology outpatient department of a tertiary level hospital of Bangladesh within two months of the end of Ramadan in 2016. Socio-demographic data, data related to diabetes treatment, complications and co-morbidities; changes in lifestyle and diabetes treatment during Ramadan and frequency of hypoglycemia were collected from all. The mean age of the study population was 50.32±12.1 years and the majority (98.6%) had type 2 diabetes and 63.9% were overweight or obese. The majority (89.35%) of the patients fasted in Ramadan and among them, more than half of the fasters received physicians' advice for Ramadan fasting (60.6%) and changed diabetes medication (69.90%) during Ramadan. Although the amount of total food consumption was unchanged in more than one half (60.6%) of the fasters, majority of them reduced sugar-sweet intake (75.5%), increased fluid drinking (75.8%) and decreased physical activity (75.8%) during the month. A large portion (37.48%) of them did not check blood glucose and more than half (54.06%) of fasters failed to visit their physicians during Ramadan. Among them 14.85% experienced mild to moderate episodes of hypoglycemia and none had severe hypoglycemia and the most (61.6%) episodes of hypoglycemia occurred in the late evening. Hypoglycemic episodes were more frequent among insulin users, patients who had received fasting advice from physicians and in those who had adjusted diabetes drugs before Ramadan fasting. Safe Ramadan fasting is a great challenge not only for the patients but also the consulting physicians. Current study reflects the necessity of both physicians' expertise and patients' awareness for safe fasting.

Detection of Human Papilloma virus by Molecular method from Patients Attending at Colposcopy Clinic of Mymensingh Medical College Hospital, Mymensingh.

Cervical cancer is the second most common cancer in women worldwide. Human papillomavirus (HPV) is considered as the main cause of invasive cervical cancer and cervical intra-epithelial neoplasia. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers. So HPV DNA testing for screening of cervical cancers may play a potential role in early detection and management of cervical cancer. With above background a cross sectional study was undertaken to estimate the prevalence and to identify the associated risk factors of human Papillomavirus infection among Visual Inspection with Acetic acid (VIA) positive women attending at colposcopy clinic of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2013 to December 2014. One hundred and forty three cervical swabs for nested PCR were collected from the patients attending colposcopy clinic of MMCH, for detecting target gene of L1 region of the HPV genome. Among the 143 VIA positive patient nested PCR showed 49.6% (71/143) positive. Biopsy of 54 colposcopy positive women revealed that 16 (29.6%) cases were chronic cervicitis, 33 (61.1%) cases were mild dysplasia (C1NI), 01 (1.9%) were having moderate dysplasia (C1NII) and 04(7.4%) patients were diagnosed as invasive squamous cell carcinoma. So, high grade cervical lesions were 100% positive by nested PCR for HPV.

Specific gyrA gene mutations predict poor treatment outcome in MDR-TB.

OBJECTIVES: Mutations in the gyrase genes cause fluoroquinolone resistance in Mycobacterium tuberculosis. However, the predictive value of these markers for clinical outcomes in patients with MDR-TB is unknown to date. The objective of this study was to determine molecular markers and breakpoints predicting second-line treatment outcomes in M. tuberculosis patients treated with fourth-generation fluoroquinolones. METHODS: We analysed treatment outcome data in relation to the gyrA and gyrB sequences and MICs of ofloxacin, gatifloxacin and moxifloxacin for pretreatment M. tuberculosis isolates from 181 MDR-TB patients in Bangladesh whose isolates were susceptible to injectable drugs. RESULTS: The gyrA 90Val, 94Gly and 94Ala mutations were most frequent, with the highest resistance levels for 94Gly mutants. Increased pretreatment resistance levels (>2 mg/L), related to specific mutations, were associated with lower cure percentages, with no cure in patients whose isolates were resistant to gatifloxacin at 4 mg/L. Any gyrA 94 mutation, except 94Ala, predicted a significantly lower proportion of cure compared with all other gyrA mutations taken together (all non-94 mutants + 94Ala) [OR = 4.3 (95% CI 1.4-13.0)]. The difference in treatment outcome was not explained by resistance to the other drugs. CONCLUSIONS: Our study suggests that gyrA mutations at position 94, other than Ala, predict high-level resistance to gatifloxacin and moxifloxacin, as well as poor treatment outcome, in MDR-TB patients in whom an injectable agent is still effective.

Step-index optical fiber drawn from 3D printed preforms.

Optical fiber is drawn from a dual-head 3D printer fabricated preform made of two optically transparent plastics with a high-index core (NA∼0.25, V>60). The asymmetry observed in the fiber arises from asymmetry in the 3D printing process. The highly multimode optical fiber has losses measured by cut-back as low as α∼0.44 dB/cm in the near IR.