Bone architecture, bone material properties, and bone turnover in non-osteoporotic post-menopausal women with fragility fracture.

Macro- and microarchitectural, bone material property, dynamic histomorphometric, and bone turnover marker data were studied in normal bone mineral density (BMD) post-menopausal women with fragility fracture. Women with fracture had thinner iliac cortices and more homogeneous bone material properties in cortical bone than age/BMD-matched non-fracture women. Low cortical thickness and bone tissue heterogeneity in normal BMD women are associated with prevalent fragility fracture. INTRODUCTION: Bone mass (bone mineral density, (BMD)) of the spine and hip is today's best single measurement for evaluating future fragility fracture risk. However, the majority of fragility fractures occur in women with BMD T-score above the WHO osteoporotic BMD threshold of - 2.5, indicating that non-BMD endpoints may play a role in their fragility fractures. We hypothesize that in non-osteoporotic women, bone micoarchitecture, bone material properties, dynamic histomorphometric endpoints, and bone turnover markers are related to fragility fracture. METHODS: Two groups (N = 60 each) of post-menopausal women with total hip BMD T-score ranging from + 0.3 to -2.49 were recruited: fragility fracture and age/BMD-matched, non-fragility fracture women. Normal (T-score > - 0.99) and osteopenic (T-score ≤ - 1.0) BMD cohorts were designated within both the fracture and non-fracture groups. Transiliac biopsy specimens were obtained to evaluate dynamic histomorphometric and microarchitectural endpoints and bone material properties by static and dynamic nanoindentation testing. All variables for fracture and non-fracture women within each BMD cohort were compared by the Wilcoxon signed-rank test (P < 0.01). RESULTS: Compared to non-fracture/normal BMD women, fracture/normal BMD women display lower iliac cortical thickness (- 12%, P = 0.0041) and lower heterogeneity of hardness (- 27%, P = 0.0068), elastic modulus (- 35%, P = 0.0009), and storage modulus (- 23%, P = 0.0054) in the cortical bone tissue, and lower heterogeneity of hardness (- 13%, P = 0.0088) in the trabecular bone tissue. Osteopenic women had no abnormalities related to fracture status. CONCLUSION: Post-menopausal women with normal BMD and fragility fracture have low cortical thickness and heterogeneity of several bone material properties in cortical and trabecular mineralized bone tissue. These differences may explain a portion of the excess bone fragility in women with normal BMD and fragility fracture.

Incidence of surgical site infection in postoperative patients at a tertiary care centre in India.

OBJECTIVE: A prospective observational was carried out to calculate the incidence of surgical site infections (SSI) along with the main risk factors and causative organisms in postoperative patients at a tertiary care setting in Mumbai. METHOD: A total number of 1196 patients between June 2011 to March 2013 admitted to the general surgical ward or surgical ICU of our hospital were included in the study. Post laproscopy patients and organ space SSIs were excluded. Patient data were collected using a preformed pro forma and a wound Southampton score tabulated and checked repeatedly until suture removal of patient. Regular follow-up was maintained until at least 30 days postoperatively. RESULTS: The study showed a SSI rate of 11%. Risk factors associated with a higher incidence of SSI were found to be age (>55 years), diabetes mellitus (especially uncontrolled sugar in the perioperative period), immunocompromised patients (mainly HIV and immunosuppressive therapy patients), surgeon skill (higher in senior professors compared with junior residents), nature of the cases, (emergency surgeries), placement of drains, wound class (highest in dirty wounds), type of closure (multilayer closure), prolonged duration of hospital stay, longer duration of surgery (>2 hours), type of surgery (highest in cholecystectomy). The highest rates of causative organisms for SSIs found were Staphylococcus aureus, Escherichia coli and Klebsiella ssp. CONCLUSION: Prevention of SSIs requires a multipronged approach with particular emphasis on optimising preoperative issues, adhering religiously to strict protocols during the intraoperative period and addressing and optimising metabolic and nutritional status in postoperative period.

Study on Neurological Consequence of Eclampsia.

The present study was carried out in the Department of Obstetrics and Gynecology at Mymensingh Medical College Hospital, Mymensingh, Bangladesh for a period of one year from 1st June 2009 to 30th June 2010 to see the Neurological Consequence of Eclampsia. A total number of 37 patients were enrolled in this study. Among 37 patients majority are in the age group of 21-30 years which is 19(51.4%) cases followed by less than or equal to 20 years and more than 30 years which are 13(35.1%) cases and 5(13.5%) cases respectively. Knee jerk is present in 28(75.7%) cases and absent in 8(21.6%) cases. The exaggerated knee jerk is present in only in 1(2.7%) case. The rate of Glasgow coma scale is less than 5 in 21(56.8%) cases, 14(37.8%) cases in 5-10 and 2(5.4%) cases is in more than 10. Focal sign is absent in 22(59.5%) cases and present in 15(40.5%) cases. Majority of the patients is presented with absence of neck stiffness which is 35(94.6%) cases and the rest 2(5.4%) cases are presented with neck stiffness. Flexor planter response is found in 20(54.1%) cases which is the highest in number followed by extensor which is 15(40.5%) cases. In only 2(5.4%) cases the planter reflex is not elicitable. Presence of infarct is found in 15(40.5%) cases which is the highest number. Cerebral edema and Presence of haemorrhage is found in 3(8.1%) cases in each. Leuko-encephalopathy is found in 2(5.4%) cases. Encephalopathy and Both infarct & haemorrhage is found in 1(2.7%) case of each. Normal CT scan findings of brain are found in 12(32.4%) cases.

Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus.

Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups.

Radiologic evaluation of hyperacute brain infarction: a review.

Imaging cerebral infarction in first few hours after the onset of clinical symptoms is a challenge. The role of stroke imaging underwent a paradigm shift from confirmation of infarction from and exclusion of hemorrhage to the detection of the tissue at risk that may be rescued with restoration of circulation. Computed tomography (CT) is generally performed before starting the therapy in order to exclude the presence of bleeding and tumors. Although CT may show findings of infarction as early as 3-6 hours after ictus 30% of CT scans are normal in the first few hours after ischemic insult. Conventional spin-echo MR imaging is more sensitive and specific than CT in the detection of cerebral ischemia during the 1st few hours symptom onset. Lesion conspicuity can be further optimized by using an FLAIR sequence. Diffusion-weighted MR imaging is a technique that is more sensitive than conventional MR imaging for detection of hyperacute cerebral ischemia, within minutes after the onset of ischemia, a profound restriction in water diffusion occurs in affected brain tissue and DWI is sensitive to diffusion restriction. But DWI only shows areas that are already irreversibly damaged. Around this core, there is believed to be a region of ischemic penumbra where reversible cell death occurred. An imaging technique that accurately identifies this tissue at risk could have a tremendous impact on patient management by thrombolysis. Perfusion imaging allows depiction of both areas of irreversible ischemia and areas of reversible ischemia. Both MR and CT Perfusion imaging help define the tissue at risk. The introduction of intravenous thrombolysis with tPA has radically changed the role of neuroimaging for stroke evaluation. The ECASS trial prescribed for treatment with intravenous tPA with stroke symptoms of less than 6 hours in duration and who did not have identifiable infarction of greater than one- third of the middle cerebral artery (MCA) territory on CT images. The NINDS trial established that intravenous tPA treatment is efficacious if administered less than 3 hours after symptom onset. The experience of interventional cardiologists in treating acute myocardial infarction may predict the future of intervention neuro in treating ischemic stroke.

Malignant paraganglioma: a case report.

A paraganglioma is a rare tumour composed of chromaffin cells. The malignant paraganglioma is a very rare presentation, diagnosed by local recurrence after total resection of primary mass or findings of distant metastasis. Recurrent paraganglioma developed in a 60 years old lady 10 years after first surgical resection. This time the patient presented with neck swelling as well as with vertebral metastases. The patient underwent radiotherapy and symptomatic improvement was there. We present the case to emphasize the role of imaging in early diagnosis, avoidance of complications of advanced disease and to make awareness among the physicians.

Identification of bacterial isolates in neonatal sepsis and their antimicrobial susceptibility.

A cross-sectional descriptive study was conducted in the Neonatal Intensive Care Unit (NICU) of Ad-din Medical College Hospital during the period of January to December 2011 to determine the pattern of bacterial agents causing neonatal sepsis and their susceptibility pattern to various antimicrobial agents. Blood cultures were performed on admitted newborn babies (0-28 days) to rule out sepsis. Antimicrobial susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Out of 1000 screened blood cultures, 87(8.7%) reported as positive and the gram positive and gram negative bacteria accounted for 21(24.1%) and 66(75.9%) respectively. The most common gram positive organisms were Coagulase Negative Staphylococcus Aureus (CONS) (18.4%) and Staphylococcus Aureus (4.6%) and gram negative organisms were Acinetobacter (34.4%), Pseudomonas (21.8%) and Klebsiella spp. (6.9%). The susceptibilities were remarkably low to Ampicillin (20%) and Cefotaxim (29.6%) for both gram positive & gram negative isolates. Gram positive group had susceptibilities of 71.1% to Gentamicin, 85.7% to Imipenem & 100% to Amikacin & Vancomycin. Gram negative isolates showed higher sensitivities to Colistin (96.9%), Piperacillin-Tazobactum (78.7%), Imipenem (74.2%), Levofloxacillin (71.2%), respectively. Gram-negative bacteria showed high level of resistance to commonly used antibiotics (Ampicillin, Ceftazidim and Cefotaxim). Gentamicin, Amikacin, Imipenem and Levofloxacin were the most effective drugs compared to others. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care.

Color Doppler sonography and resistivity index in the differential diagnosis of hepatic neoplasm.

The purpose of this study was to determine the usefulness of color doppler sonography and resistivity index (RI) in differentiating liver tumors. The study was carried out in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, and Institute of Nuclear Medicine and Allied Sciences (INMAS), Mymensingh, Bangladesh, during the period of July 2009 to June 2011. Total 50 consecutive cases were studied. Among them 27 were hepatocellular carcinomas, 19 were metastatic tumors, 03 were hemangiomas and 01 was hepatic adenoma. Doppler sonographic findings were then correlated, case by case, with final diagnosis- either pathologically by USG guided Fine-needle aspiration or by other imaging modalities (e.g., CT scan and RBC liver scan for hepatic hemangioma). The RI value of hepatocellular carcinoma was 0.69±0.096 and in metastatic tumors 0.73±0.079. The results showed no significant difference between the RI of hepatocellular carcinomas and metastatic liver tumors but it was significantly higher than benign lesions (p<0.05). RI of hemangiomas was 0.49±0.64 and in one hepatic adenoma was 0.65. When RI was <0.6 for benign liver tumors and ≥0.6 for malignant tumors we calculated a sensitivity of 89.14%, specificity of 66.7%, accuracy of 85.71% positive predictive value of 97.62% and negative predictive value of 28.57% in differentiating benign and malignant tumors. Thirty four of 46(73.9%) malignant lesions had intratumoral flow and 25% of benign lesions also showed intratumoral flow. The difference of intratumoral flow between malignant and benign lesions was significant (p<0.01). Two of 4 benign lesions (50%) had peritumoral vascularity where 6% of the malignant tumors showed peritumoral vascularity. In conclusion, combined studies of the type of intra-and peri-tumoral flow signals in CDFI and the parameter of RI would be more helpful in the differential diagnosis of benign and malignant liver tumors.

Serum Lipid Profile and Its Association with Newly Diagnosed Hypertensive Patients in Bangladesh.

Clustering of hypertension, dyslipidemia, and other metabolic abnormalities is increasing the burden of non-communicable diseases, especially cardiovascular disease. The objective of this study was to explore the pattern of lipid profiles in newly diagnosed hypertensive patients attending Shaheed Mansur Ali Medical College, Dhaka, Bangladesh from August 2020 to December 2020. A total of 59 newly diagnosed hypertensive patients were studied through a cross-sectional approach. Prior to the study, ethical clearance was ensured, and informed written consent was obtained. A pre-structured questionnaire was used for data collection. Collected data were analyzed using SPSS 24.0 version. Slight male preponderance (54.2%) was observed along with an average age of 45 years among studied patients. Raised levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) were observed in 91.5%, 98.3%, and 88.1% of patients accordingly. Low level of high-density lipoprotein (HDL) was observed in 47.5% of the patients. Mean TC, TG, LDL, HDL were 286.11±347.37, 311.74±122.76, 163.27±33.67 and 38.29±6.66 mg/dl, respectively. Almost all patients were obese. There is no correlation between the serum lipid profile and blood pressure of the patients. Dyslipidemia was highly prevalent among newly diagnosed hypertensive patients.

Wandering spleen associated with ß-Thalassemia: a case report.

The clinical entity 'Wandering spleen' is an uncommon presentation and it is more often diagnosed in children than in adults, mostly women of reproductive age. Here is a case of a young woman who presented with generalized weakness and fever, and a painless mobile lump in her central abdomen. The laboratory evaluation revealed a haemolytic state and Haemoglobin electrophoresis showed ß-Thalassemia trait (Hb A2 5.1%). Ultrasonography and Computerized Tomography (CT) scan confirmed that the mass is spleen and spleen is not present in its normal anatomical location. Abdominal CT described a well-defined, homogenous pediculated mass with echo texture comparable to spleen. Radioisotope scanning could be used as an alternative for confirmation of diagnosis of this rare condition, but was not done in our case. Colour Doppler sonography of the splenic circulation revealed no infarction and intact splenic vasculature. Wandering spleen should be considered in the differential diagnosis of idiopathic abdominal or pelvic lumps. The authoritative opinion for the treatment of such a case is splenectomy or splenopexy especially in children and here, in this case splenectomy was done.

Effectiveness of radioiodine therapy in treatment of hyperthyroidism.

The present non randomized clinical trial was conducted in the Center for Nuclear Medicine and Ultrasound, Mymensingh, Bangladesh for duration of one year. Total 30 patients with hyperthyroidism diagnosed by clinical and biochemical profile were included in the study. All patients received radioiodine treatment and regular follow up at 1st month, 3rd month, 6th month & 9th month were done to evaluate clinical and biochemical status and complications. Data were analyzed by computer with SPSS programme using 't' test and chi-square test. In the present study, out of 30 respondents more than three fourth of the respondents (76.6%) were in the age group of 31-50 years followed by less than 30 years are group (16.7%) and rest of respondents were in the age group of more than 50 years (06.7%). Mean±SD and range of age of the respondents were 39.80±10.02 years and 17-65 years respectively. Among the 30 respondents 11(36.7%) were male and 19(63.3%) were female. Male to female ratio was 1:1.73. Out of 30 patients 26(86.7%) presented with goiter and among them 21(80.8%) has diffused goiter and five (19.2%) had nodular goiter. Baseline mean±SD, median, range of serum T3 level were 5.24±3.62, 4.34, 1.48-14.65nmol/L respectively. Base line mean±SD, median range of serum T4 level were 192.25±99.17, 201.77, 1.75-336.25nmol/L respectively. Baseline mean±SD, median range of serum TSH level were 6.33±23.93, 0.15-0.07, 130.46nmol/L respectively. In the present study serum T3, T4 level among the respondents sharply decrease from baseline to 2nd follow up then gradually decrease from 2nd to 4th follow up. Serum TSH level gradually increases from baseline to 3rd follow up and then gradually decreases from 3rd to 4th follow up. The result showed radioiodine is an effective option for the treatment of thyrotoxicosis.

Prevalence of Diarrhea and its Relation with Severity of the Disease among Covid-19 Positive Patient in a Selected Covid Dedicated Hospital.

Covid-19 has become a pandemic since its emergence in Wuhan, China. It involves Gastro intestinal (GI) system and diarrhea is recognized as an important symptom. Diarrhea is also associated with disease severity. This study was conducted to see the prevalence of diarrhea in Covid-19 positive patient and its relation with disease severity. Prospective observational study done among consecutive Covid-19 positive patient of both sex admitted in Mugda Medical College Hospital in Dhaka from February 2021 to April 2021. Informations were collected by face to face interview and severity was assessed on bedside. Among 166 Covid-19 positive patient 40.0% developed diarrhea. Mean age of the diarrheal patients was 44.21±14.40. Women affected more than men (51.0% versus 49.0%). In majority patient (62.0%) diarrhea persist for 3-7 days and majority had frequency of bowel movement 3-5 times per day. Regarding Bristol stool type 47.0% had stool type 6 followed by stool type 7(43.0%) and stool type 5(10.0%). Half of the diarrheal patient (48.0%) had severe pneumonia. Severe pneumonia is significantly more common in non-diarrheal patients (65.0%) than in diarrheal patient (35.0%) (p=0.007). This study reflects that a large number of Covid-19 positive patients developed diarrhea. Half of the diarrheal patients had severe pneumonia. But severe pneumonia is significantly common in non-diarrheal patient than diarrheal patients.

Enhanced alveolar bone loss in a model of non-invasive periodontitis in rice rats.

OBJECTIVE: The rice rat (Oryzomys palustris) develops periodontitis-like lesions when fed a diet rich in sucrose and casein (H-SC). We aimed to establish whether this model can accurately mimic the development of human periodontitis. MATERIALS AND METHODS: For this purpose, 28-day-old rice rats (15/group) were assigned to standard (STD) or H-SC diets and sacrificed after 6, 12, and 18 weeks. Jaws were processed for morphometric, histometric, histologic, histomorphometric, and micro-CT analyses. RESULTS: We found a progressive increase in horizontal alveolar bone loss (ABL) with age in maxillae of rats fed the STD diet as determined by morphometry. The H-SC diet exacerbated horizontal ABL at the palatal surface at 12 and 18 weeks. Furthermore, increased vertical ABL was detected in mandibles and maxillae of rats fed the H-SC diet for 12 and/or 18 weeks by histometry and micro-CT. Remarkably, the H-SC diet significantly increased bone remodeling at the interproximal alveolar bone of mandibles from rats fed for 6 weeks, but not in those fed for longer periods. CONCLUSIONS: These findings indicate that the H-SC diet induced a transient increase in alveolar bone remodeling, which is followed by ABL characteristic of moderate periodontitis.

Detection of bacterial blight resistance genes in basmati rice landraces.

Aromatic basmati rice is vulnerable to bacterial blight disease. Genes conferring resistance to bacterial blight have been identified in coarse rice; however, their incorporation into basmati varieties compromises the prized basmati aroma. We identified bacterial blight resistance genes Xa4, xa5, Xa7, and xa13 in 52 basmati landraces and five basmati cultivars using PCR markers. The Xa7 gene was found to be the most prevalent among the cultivars and landraces. The cultivars Basmati-385 and Basmati-2000 also contained the Xa4 gene; however, xa5 and xa13 were confined to landraces only. Ten landraces were found to have multiple resistance genes. Landraces Basmati-106, Basmati-189 and Basmati-208 contained Xa4 and Xa7 genes. Whereas, landraces Basmati-122, Basmati-427, Basmati-433 were observed to have xa5 and Xa7 genes. Landraces Basmati-48, Basmati-51A, Basmati-334, and Basmati-370A possessed Xa7 and xa13 genes. The use of landraces containing recessive genes xa5 and xa13 as donor parents in hybridization with cultivars Basmati-385 and Basmati-2000, which contain the genes Xa4 and Xa7, will expedite efforts to develop bacterial blight-resistant basmati rice cultivars through marker assisted selection, based on a pyramiding approach, without compromising aroma and grain quality.

First Report of Groundnut bud necrosis virus in Tomato in Bangladesh.

An unusual disease of tomato characterized by leaf mottling and necrotic streaks on veins, shortened internodes, necrosis of terminal buds, and concentric rings on fruits was observed during 2010 to 2011 surveys in tomato growing regions of Godagari Upzila, Rajshahi district, Bangladesh. Disease incidence in popularly grown F1 hybrid cultivars, which include Sobal, Abhiruchi, Salamat, Bangobir, and BARI hybrid tomato-5 and -6 in about 40 commercial fields, ranged from 40 to 90%. Extracts from the field samples (n = 10) reacted with polyclonal antiserum to Groundnut bud necrosis virus (GBNV) in direct antigen coated ELISA, suggesting the association of a tospovirus antigenically related to serogroup IV topsovirus (1). To identify whether the tospovirus was a distinct virus species, ELISA-positive samples were subjected to total RNA extraction with an RNeasy Plant Mini Kit (Qiagen, Chatsworth, CA) followed by reverse transcription (RT)-PCR with tospovirus-specific primers (5'-ATGGTTGAAAAGAGCAAGAATGATGC-3') and degenerate primer (5'-CTTCTTATGAAGTGTACTCACCATAAGTCATCC-3') derived from the conserved sequences of GBNV, Watermelon bud necrosis virus (WBNV), and Capsicum chlorosis virus (CaCV) (2). The RT-PCR product was cloned into pGEM-T Easy vector (Promega, Madison, WI) and sequenced at Department of Biochemistry, University of Delhi, South Campus, Delhi, India (GenBank Accession No. JQ692083). The sequences of cloned fragments were assembled. Analysis of the 477-bp region of the nucleocapsid protein (N) gene revealed that the tomato tospovirus shared maximum identity both at the nucleotide (96%) and amino acid (97%) levels with the corresponding region of GBNV. In contrast, only 78 to 81% and 85 to 87% identity at nucleotide and amino acid levels, respectively, was observed with the corresponding region of the N genes of CaCV, WBNV, and Watermelon silver mottle virus. These results suggested the association of GBNV with the diseased tomato samples. To our knowledge, this is the first report of GBNV infecting tomato in Bangladesh and regular surveys are necessary to ascertain the prevalence and incidence of GBNV in other crops. References: (1) R. K. Jain et al. J. Virol. Methods 130:162, 2005. (2) M. Tsompana and J. W. Moyer. Tospovirus. Page 157 in: Encyclopedia of Virology. Academic Press, New York, 2009.

Electrolyte changes in stroke.

The present study was carried out in the department of Neurology and Medicine, Mymensingh Medical College Hospital, Bangladesh during the period of January 2009 to December 2010 to see the electrolyte changes in stroke. The serum concentration of Na⁺, K⁺, and Cl⁻ were measured in 110 cases during acute period of stroke (55 ischemic and 55 haemorrhagic strokes). Data were analyzed by computer with SPSS programme using 't' test and chi square test. In haemorrhagic stroke, out of 55 patients 29(52.72%) had abnormal sodium level, of them 23(41.8%) had hyponatremia, 6(10.9%) had hypernatremia. In contrast in ischemic stroke 23(41.80%) out of 55 had abnormal sodium level, of them 21(38%) had hyponatremia. The result showed that hyponatremia is almost equally common in both haemorrhagic and ischaemic group without significant difference (p>0.05). The study also revealed that hyponatremia is more common than hypernatremia in both groups. Mean ± SD of age of the haemorrhagic group was 60.80 ± 15.97 while the age of ischaemic group was 59.89 ± 15.84 years. Male, female ratio in haemorrhagic and ischaemic group 1:0.62 and 1:0.89 respectively. Mean ± SD of serum Na⁺, K⁺, Cl⁻ in haemorrhagic group were 136.18 ± 10.5, 3.83 ± 0.65, 97.96 ± 16.74 mmol/L, in ischaemic group 135.08 ± 9.08, 4.00 ± 0.75, 100.27 ± 8.39 mmol/L. The result showed no significant difference in haemorrhagic and ischemic stroke. Hyponatremia, hypokalamia and hyperchloredemia were more common than hypernatremia, hyperkalamia and hyperchloredemia. In haemorrhagic stroke, out of 55 patients, 21(38.18%) had abnormal potassium level, of them 19(34.55%) had hypokalemia, 2(3.63%) had hyperkalemia. In contrasts, in ischemic stroke, 15 out of 55(27.22%) had abnormal potassium level. Of them 12(21.81%) had hypokalemia and 3(5.45%) had hyperkalemia. The finding showed that hypokalemia is almost equally common in both haemorrhagic and ischaemic group without significant difference. The study also revealed that hypokalemia is more common than hyperkalemia in both groups. In haemorrhagic stroke, out of 55 patients 33(60%) had abnormal chloride level. Of them 20(36.4%) had hypochrloridemia, 13(23%) had hyperchrloridemia, in contrast, in ischemic stroke, 40 out of 55(60%) had abnormal chloride level, of them 22(40%) had hypochrloridemia and 18(32.7%) had hyperchrloridemia. The result showed that changes in chloride level after haemorrhagic and ischemic stroke are similar. The result showed hypochrloridemia is more common than hyperchrloridemia in both groups.

Telemedicine-based new patient consultations for hernia repair and advanced abdominal wall reconstruction.

PURPOSE: Telemedicine has emerged as a viable option to in-person visits for the evaluation and management of surgical patients. Increased integration of telemedicine has allowed for greater access to care for specific patient populations but relative outcomes are unstudied. Given these limitations, we sought to evaluate the efficacy of telemedicine-based new patient preoperative encounters in comparison to in-person encounters. METHODS: We performed a retrospective analysis of adult patients undergoing new patient evaluations from April 2020 to October 2021. Telemedicine visits consist of both video and telephone-based encounters. Visit types, patient demographics, preoperative diagnosis, travel time to the hospital, and prior imaging availability were reviewed. RESULTS: A total of 276 new patient encounters were conducted (n = 108, 39% telemedicine). Indications for evaluation included inguinal hernia (n = 81, 30%), ventral hernia (n = 149, 54%) and groin or abdominal pain (n = 30, 11%). Patients undergoing telehealth evaluations were more likely to have greater travel distance to the hospital (91 km vs 29 km, p = 0.002) and have CT image-confirmed diagnoses at the initial visit (73 vs 47%, p < 0.001). Patients who were evaluated for a recurrent or incisional hernia were more likely to be seen through a telemedicine encounter (69 vs 45%, p < 0.001). CONCLUSIONS: We report the efficacy of telemedicine-based consultations for new patient preoperative evaluations related to hernia repair and abdominal wall reconstruction. Telemedicine is a useful modality for preoperative evaluation of new patients with hernia and advanced abdominal wall reconstruction needs. Understanding this patient population will allow us to optimize telemedicine encounters for new patients and improve access to care for patients in remote locations.

Heavy metals as risk factors for human diseases - a Bayesian network approach.

Modern industrial agricultural processes expose human beings to multifactorial environmental pollution including heightened levels of heavy metals. The effects of acute heavy metal exposures at toxic levels are usually known; they are tested for and treated promptly. The effects of low/moderate-level chronic heavy metal exposures are less known as they may be subclinical, and pathogenic effects may only manifest clinically over time under the disguise of a diagnosable disease or miscellaneous symptoms attributed to aging. Consequently, the health impact of low-moderate heavy metal exposure is unlikely to be identified. Furthermore, established heavy metal safety levels often fail to recognize the potential toxic effects on humans. We report in this review what is known about the sub-chronic and chronic effects of exposure to heavy metals, particularly lead, mercury, cadmium, arsenic, and nickel, and we highlight their possible effects in the brain, cardiovascular and endocrine-metabolic systems, and on reproduction.

High resolution imaging in bone tissue research-review.

This review article focuses on imaging of bone tissue to understand skeletal health with regards to bone quality. Skeletal fragility fractures are due to bone diseases such as osteoporosis which result in low bone mass and bone mineral density (BMD) leading to high risk of fragility fractures. Recent advances in imaging and analysis technologies have highly benefitted the field of biological sciences. In particular, their application in skeletal health has been of significant importance in understanding bone mechanical behavior (structure and properties) at the tissue level. While synchrotron based microCT technique has remained the gold standard for non-destructive evaluation of structure in material and biological sciences, several lab based microCT systems have been developed to provide high resolution imaging of specimens with greater access, and ease of use in laboratory settings. Lab based microCT scanners are widely used in the bone field as a standard tool to evaluate three-dimensional (3D) morphologies of bone structure at image resolutions appropriate for bone samples from small animals to bone biopsy specimens from humans. Both synchrotron and standard lab based microCT systems provide high resolution imaging ex vivo for a small sized specimen. A few X-ray based systems are also commercially available for in vivo scanning at relatively low image resolutions. Synchrotron-based CT microscopy is being used for various ultra-high-resolution image analyses using complex 3D software. However, the synchrotron-based CT technology is in high demand, allows only limited numbers of specimens, expensive, requires complex additional instrumentation, and is not easily available to researchers as it requires access to a synchrotron source which is always limited. Therefore, desktop laboratory scanners (microXCT, Zeiss/Xradia, Scanco, SkyScan. etc.), mimicking the synchrotron based CT technology or image resolution, have been developed to solve the accessibility issues. These lab based scanners have helped both material science, and the bone field to investigate bone tissue morphologies at submicron mage resolutions. Considerable progress has been made in both in vivo and ex vivo imaging towards providing high resolution images of bone tissue. Both clinical and research imaging technologies will continue to improve and help understand osteoporosis and other related skeletal issues in order to develop targeted treatments for bone fragility. This review summarizes the high resolution imaging work in bone research.

Neonatal COVID-19 Infection: Is Neonate Safe?

No Abstract.