Efficacy of amitriptyline, pizotifen and propranolol in the prevention of migraine.

This intervention study conducted in the Neurology outpatient Department of Mymensingh Medical College Hospital (MMCH) from January 2006 to December 2007 to compare efficacy of amitriptyline, pizotifen and propranolol in the prophylaxis of migraine. Ninety cases were selected following certain inclusion and exclusion criteria. Result showed that the differences in duration, frequency and severity of attack were reduced in all groups but the differences among the groups were not significant (p>0.05). However, compared with amitriptyline and pizotifen, the propranolol group needed tablet paracetamol as abortive therapy less frequently which was statistically significant (p<0.05). All the drugs were well tolerated with minimum adverse effects.

Assessment of the Relationship between Non-motor features and Severity of Parkinson's Disease Patients in Bangladesh.

Parkinson's disease (PD) is second most common neurodegenerative disorder after Alzheimer's disease that may present with both motor and non-motor symptoms (NMSs). Many of the ignored NMSs may potentiate further deterioration of the patient's quality of life (QoL). But there is scarcity of data regarding NMSs of PD patients and their relationship with the disease severity in Bangladesh. This study was aimed to investigate the frequency of NMSs and assess their debatable impact on the severity of PD patients in Bangladesh. This cross-sectional type of observational study was conducted in neurology department of Dhaka Medical College Hospital, Bangladesh from January 2012 to June 2013 which recruited 60 eligible PD patients. The PD patients and disease severity was demonstrated by UK Parkinson's Disease Society Brain Bank criteria for idiopathic PD and the Hoehn and Yahr scale respectively. Whereas, NMSs were demonstrated by the self-structured questionnaire which had encountered 30 common symptoms of PD. The mean age of our study cohort was found 57.88±10.56 years with male female ration 2:1. According to the Hoehn and Yahr (H & Y) severity scale 38.3%, 38.3%, 20.1% and 3.3% patients had been suffering from stage ?, stage II, stage III and stage ?V Parkinson's disease respectively. Irrespective of the severity of the PD the frequency of NMSs was nocturia (66.7%), sadness or blues (65.0%), memory disturbance (61.7%), anxiety (58.3%), insomnia (56.7%), orthostatic hypotension (55.0%), erectile dysfunction (50.0%), urinary urgency (46.7%), anhedonia (45.0%), olfactory disturbance (38.3%), constipation (38.3%), hyper or hypo sexuality (31.7%) and restless leg syndrome (31.7%). However, after head-to-head NMSs analysis, daytime dribbling of saliva (p=0.024), urinary urgency (p=0.036), nocturia (p=0.001), weight loss (p=0.001), anhedonia (p=0.027), excessive daytime sleepiness (p=0.024), insomnia (p=0.007), vivid dream (p=0.024), REM behavior disorder (p=0.010), restless leg syndrome/ periodic leg movements (p=0.043) had significantly been reported higher among the stage II PD patients than that of stage I patients. Whereas fall (p=0.001), dysphagia or choking (p=0.002), constipation (p=0.003), fecal incontinence (p=0.033), excessive daytime sleepiness (p=0.033), anxiety (p=0.036) and anhedonia (p=0.044) were significantly more prevalent among the advanced stage (III) than stage (II) PD patients. Mean total NMS increased significantly with PD severity based on H and Y staging with a mean NMSQ-T (Non-Motor Symptoms Questionnaire Test) of 5.43 in stage 1, 9.22 in stage 2, 13.75 in stage 3 and 17.0 in stage 4 (p=0.0001). This study revealed that there was high frequency of NMSs among the PD patients and most common symptoms were nocturia, sadness, memory impairment, anxiety, insomnia, orthostatic hypotension, erectile dysfunction, anhedonia, urinary urgency and constipation. Finally, the more advanced disease as indicated by a higher H&Y stage was associated with significantly higher number of reported NMSs.

Demographic and clinical profile of myelopathy patients.

This descriptive type of cross sectional study was aimed to identify the demographic profile, clinical presentations of myelopathy and to find out the etiological factors associated with myelopathy. Total 65 patients having clinical features of myelopathy, admitted in Neurology and Medicine ward of Mymensingh Medical College Hospital from February 2009 to December 2010 were purposively studied. Patients underwent a detailed clinical evaluation followed by laboratory investigations and neuro-imaging studies. Out of 65 cases, 80.0% were male and 20.0% were female with mean age 39.15 ± 16.8 years. Highest number of cases (41.6%) was farmers. Most of the cases (72.3%) hailed from rural area. Mean duration of illness was 7.74 ± 15.8 months. 41.54% patients presented with paraplegia/paraparesis and 58.46% with quadriparesis/quadriplegia. 63.1% patients had sensory disturbance. It is observed that 58.5% had urinary sphincter disturbance and 21.5% had bowel sphincter disturbance. Among the causes of myelopathy found in this study, 29.23% patients had spondylotic myelopathy and 24.62% had transverse myelitis (ATM). In 12.31% patients the cause of myelopathy could not be identified. Myelopathy is more common in males and most of the patients are farmers. Spondylotic and Transverse myelopathy is the main etiology of compressive and non-compressive myelopathy respectively.

Sex differentiation and risk factor evaluation in stroke patients.

This study was conducted to find out the possible influencing factors on stroke in two sexes. It was a descriptive type of cross sectional study, conducted on 177 stroke patients admitted in Mymensingh medical college hospital from February 2009 to March 2010. Patients were selected according to WHO stroke definition and confirmed by CT or MRI. The results of the study showed that Stroke was more common (58.19%) in male than female (41.8%), mean age of male stroke patients was 60.58±12.36 years and that of female was 63.58±13.62 years with no significant statistical sex difference. But after 70 years, females are more sufferer than male. Hypertension, Diabetes mellitus, ischemic heart disease, atrial fibrillation and dyslipidemia in male and female were equally present without significant difference, although male had a higher rate of smoking and previous stroke (p<0.05). Motor weakness was more in male than female and unconsciousness was more in female (p<0.05). Type and sub types of stroke showed no significant difference. Females had more severe stroke in terms of severity score (Scandinavian Stroke Scale) on admission. Duration of hospital stay were similar among male and female but on discharge functional scale (Modified Rankin Scale) score was higher in male (p<0.05) and in hospital mortality was higher in female (p<0.05) which was statistically significant.

Lipid profile among ischemic and haemorrhagic stroke patients.

This study is a prospective cross- sectional study conducted in the Neurology and Medicine department of Mymensingh Medical college Hospital (MMCH) to see the association of different components of serum lipids among ischemic and hemorrhagic stroke patients. Cases were selected following certain inclusion and exclusion criteria. Result showed that both types of stroke were more common after the age of 50 years. Male suffered more than female. M:F in ischemic stroke group was 1.73:1, and in hemorrhagic group was 1.42:1. Both types of stroke belong to middle class people. Smoking, hypertension and diabetes mellitus were equally common in both types of stroke. Low density lipoprotein (LDL) level were more than desired level in both types of stroke and there was no significant difference between two groups (p>0.05). Other components of lipid profile (total cholesterol, HDL, Triglyceride) were within normal range and there was no significant difference between two groups (p>0.05).

Pattern of Infections and Antibiotic Sensitivity in Diabetic Patients Admitted in A Tertiary Care Hospital in Dhaka.

Infections are well recognized cause of morbidity and mortality in people with diabetes. This study was done to observe the pattern of infections and microorganism with sensitivity pattern in patients with diabetes admitted at a specialized referral hospital in Dhaka. This cross-sectional study was carried out in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka from March 2014 to April 2015. It included 309 patients of diabetes (male-169, female-140; age mean±SD- 49.3±14.7 years) admitted in medicine or endocrinology department, who were screened for clinical evidence of infections according to revised McGeer criteria. Culture and sensitivity pattern of responsible microorganisms were sought from clinically appropriate specimen. Among the participants 25.9% (80 out of 309) had evidence of infection. The most common of them were urinary tract infection (53.8%) and respiratory tract infection (30.0%). E. coli and Klebsiella were the most common organisms that were isolated by urine (55.3% and 13.2%) and blood culture (57.1% and 42.9%). Acinetobacter was the most common pathogen in tracheal aspirate (80%) and Klebsiella in sputum (100%). Culture of wound swab exclusively revealed growth of Staphylococcus. E. coli was fairly sensitive to meropenem (100%), amikacin (93.5%) and nitrofurantoin (93.1%), while sensitivity of Klebsiella was almost similar to that of E. coli. Acinetobacter was fully resistant to ceftazidime, nitrofurantoin and meropenem while only modestly sensitive to ciprofloxacin and amikacin (25% and 20% respectively). Pseudomonas was 100% sensitive to ceftazidime, amikacin and meropenem, but 100% resistant to ciprofloxacin and nitrofurantoin. One in four admitted diabetes patient had evidence of infection, most commonly involving urinary and respiratory tracts. E. coli and Klebsiella both fairly sensitive to common antibiotics, were common isolates from urine and blood culture; whereas Acinetobacter isolated from tracheal aspirates and urine, was only modestly sensitive.

Evaluation of socio-economic factors causing discontinuation of epilepsy treatment resulting in seizure recurrence: a study in an urban epilepsy clinic in India.

BACKGROUND AND PURPOSE: The prevalence rate of epilepsy in India ranges between 4.15 and 7.03 per 1000 population. In the developing countries, the major problems of epilepsy are lying in the treatment gap and discontinuation of treatment due to various adverse socio-economic factors. The objective of this study was to evaluate the rate of discontinuation of epilepsy treatment and its related socio-economic factors responsible for discontinuation. MATERIAL AND METHODS: Among 1450 patients with epilepsy who were recurrently followed up at an intervals of 2 months from 05 January to 06 January; 620 patients discontinued their treatment. Among them 88.7% patient had breakthrough seizures for more than in two occasions. Socio-economic factors in respect to the treatment were evaluated during the follow-up period vis-a-vis income and expenditure, unemployment status, negative attitude towards medical treatment, non-availability of drugs locally, co-morbid psychiatric and other illnesses, polytherapy and socialillusional thoughts about epilepsy. RESULTS: Discontinuation of epilepsy treatment was detected in 42.75% (n = 620) of total patients resulting in recurrence of seizures. Reasons for discontinuation were multiple in most of the cases. The discontinued group had an average annual cost of treatment and income of Rs. 5500 ($110) and Rs. 12,800 ($256), respectively, amounting to 40% of their total income being expended for the cost of the treatment, while in continued group annual cost of treatment and income were Rs. 4500 ($ = 90) and Rs. 24,400 ($ = 580) respectively amounting to only 18% of the total income (p < 0.001) for the cost of treatment. Among the discontinued group, 90% of the patients reported the cost factors, 29.09% due to the unemployment, 20% from the frustration and despair, 20.09% due to non-availability of medicines locally, 17.27% spiritual illusional thoughts about epilepsy, 10% for marital disharmony were the causes for discontinuation of treatment. In the discontinued group, 10% got polytherapy against 9.03% in the continued group (p > 0.01), co-morbid psychiatric illnesses were observed in 4.54% against 3.25% in the continued group (p > 0.10). CONCLUSION: The study showed a significant number of patients (42.75%) discontinued epilepsy treatment within 1 year due to poor knowledge regarding the problem of discontinuation, cost and income disparity, unemployment, spiritual illusional thoughts about epilepsy, frustration and mental impairment, lack of uniform availability of drugs in local market. To tide these shortcomings, uniform availability of cheaper antiepileptic drugs with adequate information and communication regarding the disease and upliftment of socio-economic status are to be ensured.

Single dose piperazine therapy for Ascaris lumbricoides: an unsuccessful method of promoting growth.

One-hundred eighty-five Bangladeshi children age 1 1/2 to 8 yr with no Ascaris lumbricoides infection or with light, moderate, or heavy infection were randomly assigned to treatment of placebo groups, with treatment given in a double-blind fashion. The groups were comparable for nutritional and socioeconomic parameters. Treatment consisted of a single dose of piperazine citrate administered twice within a 2-wk period. The cure rates for the low, moderate, and heavy A. lumbricoides infected subgroups were 53, 31, and 36%, respectively. With more severe infections, worm eradication was more difficult and the rate of reinfection after treatment was more rapid. The rate of reinfection was significantly different for the low A. lumbricoides infected treatment and placebo subgroups for 5 months after treatment, for the moderate treatment and placebo subgroups for 3 months after treatment, and for the heavy A. lumbricoides infected treatment and placebo subgroups there was a difference, although not significant, for 1 month after treatment. Anthropometric measurements were obtained for a period of 11 months. Analysis of covariance revealed no significant difference for change of weight, change of height, weight-for age, weight-for-height, height-for-age, triceps skinfold, midarm circumference, and the abdominal girth to chest circumference ratio between the treatment and placebo groups after drug administration. The results of this study do not support single dose worm therapy as a means to enhance growth.

Allelic imbalance at chromosome 11 in head and neck squamous cell carcinoma in an Indian patient population.

BACKGROUND: Genetic instability of chromosome 11 is a frequent event in many solid tumours, including head and neck squamous cell carcinoma (HNSCC). AIMS: To perform allelic imbalance analysis of cytogenetically mapped altered regions of human chromosome 11 in patients with HNSCC from eastern India. METHODS: Genomic alterations were investigated using highly polymorphic microsatellite markers in both HNSCC and leukoplakia tissues. RESULTS: Microsatellite markers D11S1758 from 11p13-15 and D11S925 from 11q23.3-24 had the highest frequency (38% and 32%, respectively) of loss of heterozygosity among all the markers analysed. Allelic loss at the marker D11S925 was seen in both leukoplakia and in all stages of HNSCC tumour tissues suggesting that it is an early event in HNSCC tumorigenesis. Microsatellite size alteration was also found to be high (> 20%) in several markers. In leukoplakia samples microsatellite instability was seen at a higher frequency than loss of the allele, indicating such alterations might initiate the process of tumorigenesis in HNSCC. CONCLUSIONS: The high rate of chromosomal alterations at 11q21-24 in HNSCC suggests the presence of a putative tumour suppressor gene in this region.

Endemic focus of Fasciolopsis buski infection in Bangladesh.

Stool surveys were conducted on children 2--10 years of age in 27 villages within Dacca District and around this index area (1,668 children were sampled), revealing an endemic focus of Fasciolopsis buski infection to the south and the east of Dacca District. In order to determine the seasonal variation in the total snail populations and the natural rate of F. buski infection in the snails, two species of planorbid snails, Segmentina (Trochorbis) trochoideus and Hippeutis (Helicorbis) umbilicalis, were periodically sampled for 12 months from a village endemic for F. buski infection. Gymnocephalous cercariae were found in S. (T.) trochoideus snails during August, September and October. The size of the snail population (n = 1,275) was significantly correlated with inches of rainfall (r = +0.62; P less than 0.05) and water temperature (r = +0.59; P less than 0.05). The natural infection rate of F. buski in the snails ranged from 0.5--2%. Snails from non-endemic areas were exposed to 3--10 miracidia. A total of 13 of 49 (27%) of H. (H.) umbilicalis and 6 of 14 (43%) of S. (T.) trochoideus had gymnocephalous cercariae present 4 to 6 weeks after exposure to miracidia. Thus, snail strain variation is unlikely to be a barrier to F. buski transmission.

Epidemiology and serology of Giardia lamblia in a developing country: Bangladesh.

The age-specific prevalence of Giardia lamblia was determined in two Bangladeshi villages and malnourished children in hospital in Dhaka City. Age-specific acquisition rates, the duration of infection and age-specific sero-positivity to (immunofluorescent assay) G. lamblia trophozoites were determined. Infection was acquired early (less than one year) and in 16% of infected children persisted for longer than three months. Prevalence was higher in 5 to 10-year-old village children (21%) and one to five-year-old malnourished children (51%). Over 40% of the children much less than 7 years acquired G. lamblia within 18 months; acquisition rates did not change with age. Positive antibody titres were acquired between six months and one year and the prevalence of sero-positivity remained high in all age groups No association was found between positive antibody titres and positive stool examinations. In developing countries serum antibodies are useful epidemiologically, but are not diagnostic in the individual patient.

Fungal metabolites from Aspergillus niger AN27 related to plant growth promotion.

Two metabolites have been isolated from Aspergillus niger AN27, a biocontrol agent, and identified as 2-carboxymethyl 3-n-hexyl maleic acid (compound 1) and 2-methylene-3-hexylbutanedioic acid (compound 2). Their biological activities related to crop growth promotion have been assayed. Both the compounds increased germination and improved crop vigour. Compound 1 was more effective for increase in germination and shoot length, whereas compound 2 had relatively greater role in increasing the root length and biomass of cauliflower seedlings.

Neonatal septicaemia among inborn and outborn babies in a referral hospital.

Neonatal sepsis was studied among one hundred neonates (50 hospital born and 50 outborn babies) over one year period. The incidence of neonatal septicaemia was 15.5 per 1000 live births in the hospital. Among outborn babies it accounted for 6.1% of total pediatric admissions and 43.7% of sick neonates referred from outside. Low birth weight and prematurity were important predisposing factors in both the groups. Blood culture was positive among 32% of outborn and 34% of inborn babies. Coagulase-negative Staphylococcus, Klebsiella and Acinetobacter were the common causative organisms. All isolated organisms were sensitive to Gentamicin whereas 75% of them were resistant to Ampicillin. Mortality among outborn neonates (32%) was much higher in comparison to (10%) hospital born babies. Early identification of high risk antenatal cases and neonates and appropriate referral can bring down mortality and morbidity from neonatal sepsis.

Perinatal risk factors in neonatal infections.

Perinatal risk factors were studied among 50 cases of neonatal septicemia and 200 matched normal neonates during one year period. The consanguinity among parents, birth order and sex of the baby did not increase the risk for developing septicemia. There was significant increase in the risk for septicemia when the duration of labour was more than 24 hours (P less than 0.01), time interval between rupture of membrane and delivery of baby was more than 12 hours (P less than 0.001), liquor was meconium stained or foul smelling (P less than 0.001) and delivery was operative (P less than 0.01). The neonatal factors identified with risk for septicemia were preterm delivery (P less than 0.01), low birth weight (P less than 0.01), birth asphyxia (P less than 0.001) assisted ventilation (P less than 0.001) and intravenous alimentation (P less than 0.02). Identification of high risk pregnancies and appropriate management can minimize many of the above risk factors which in turn will reduce the occurrence of neonatal sepsis.

A study of obliquity of femoral shaft in Eastern Indian population.

In the erect posture, femur is not absolute vertical, being separated above from its fellow by a considerable interval, which corresponds to the breadth of the pelvis, and inclines gradually medially and downward, so as to approach its fellow, for the purpose of bringing the knee joints near the line of gravity of the body. In the present study obliquity of femoral shaft measured in 127 dry femora. Mean obliquity of femoral shaft for 62 left sided femora found 8.431 degrees with standard deviation of 2.361 degrees whereas for 65 right sided femora were found to be 7.708 degrees with standard deviation of 2.425 degrees. When total 127 femora considered, mean bicondylar angle of 8.061 +/- 2.412 degrees was obtained. Though statistically insignificant, mean bicondylar angle determined on left side was higher than that on the right side.

True palmar pattern in vitiligo--a case control study.

Characteristic epidermal ridges formed on the finger pad and on the palm by the end of the second trimester and remain unchanged thereafter and those are responsible for the highly specific finger prints of each individual. These ridges are nither influenced by later prenatal period nor they subject to any influence in the postnatal environmental factors because the formation of ridge patterns gets already completed by about the eighteenth week of gestation. Dermatoglyphics is a scientific study of such epidermal ridges. Dermatoglyphic study of both palms of clinically diagnosed vitiligo patients and control subjects were carried out and statisticaltly analysed in respect to sex and side of hands. The study revealed variable number of deviations of this patterns in Vitiligo patients when compared with that of control. Increased number of true palmar patterns in right hypothenar, right thenar and both inter digital areas 2 (ID-2) and decreased TPP in Rt. ID3, Rt. ID4 in vitiligo male patients and increased TPP in Rt. Hypothenar and Rt. ID1 and decreased TPP in Rt. ID2 and Lt. ID 3 in vitiligo female patients while compared with that of the control group. Some of the variations observed were stastically significant.

Discontinuation of secondary preventive treatment of stroke: an unexplored scenario in India.

OBJECTIVE: This prospective study will evaluate the socioeconomic factors responsible for the discontinuation of secondary preventive treatment of stroke in India and its outcome. DESIGNS METHODS: A total of 1212 stroke patients (male=708, mean age 58 ± 2 years; female=504, mean age 56 ± 2 years; intra-cerebral haemorrhage=496; ischaemic=716) were enrolled in the stroke clinic for secondary preventive treatment from 1st January 2006 to 1st January 2008 and were followed up at 4-6-week intervals. Among them, 512 patients were grouped as being below the poverty line. Discontinuation of treatment for more than 2 weeks by a patient placed that patient in a group labelled discontinued. Outcomes of discontinuation of secondary preventive treatment were evaluated with respect to (1) control of risk factors, (2) recurrence of stroke, and (3) mortality rate. Reasons for the discontinuation were comparatively analysed with respect to awareness, education, economy, distance, and daily cost of treatment, types of stroke and disability status. RESULTS AND ANALYSIS: During the study period of 2 years, the following was observed: 420 patients (34.65%) discontinued secondary preventive treatment; 112 patients (9.24%) dropped out; 680 patients (56.10%) continued. Chi-square and null hypothesis procedures were applied for statistical analysis. Distance, economy, poor awareness on stroke, low educational level, types of stroke, cost of treatment and disability status all were significant factors in the discontinuation of treatment. The discontinued group had poor control of risk factors, higher recurrence of both types of stroke and higher mortality. CONCLUSIONS: Discontinuation of secondary preventive treatment due to diverse socioeconomic factors results in greater recurrence and disabilities among stroke survivors, and these findings should be reported to national and international planning authorities to strengthen preventive measures to achieve better outcomes and reductions of the stroke burden globally.

Precipitation chemistry and occurrence of acid rain over Dhanbad, coal city of India.

The present study investigated the chemical composition of wet atmospheric precipitation over Dhanbad, coal city of India. The precipitation samples were collected on event basis for three years (July 2003 to October 2005) at Central Mining Research Institute. The precipitation samples were analyzed for pH, conductivity, major anions (F, Cl, NO(3), SO(4)) and cations (Ca, Mg, Na, K, NH(4)). The pH value varied from 4.01 to 6.92 (avg. 5.37) indicating acidic to alkaline nature of rainwater. The pH of the rainwater was found well above the reference pH (5.6), showing alkalinity during the non-monsoon and early phase of monsoon, but during the late phase of monsoon, pH tendency was towards acidity (<5.6 pH) indicating the non-availability of proper neutralizer for acidic ions. The observed acidic events at this site were 91, (n = 162) accounting 56% for the entire monitoring months. The (NO(3) + Cl)/SO(4) ratio in majority of samples was found below 1.0, indicating that the acidity is greatly influenced by SO(4). The calculated ratio of (Ca + NH(4))/(NO(3) + SO(4)) ranges between 0.42-5.13 (average 1.14), however in most of the samples, the ratio is greater than unity (>1.0) indicating that Ca and NH(4) play an important role in neutralization of acidic ions in rainwater. Ca and SO(4) dominate the bulk ionic deposition and these two ions along with NH(4) accounts 63% of the annual ionic deposition.

Changes in the allergenicity during different preparations of Pomfret, Hilsa, Bhetki and mackerel fish as illustrated by enzyme-linked immunosorbent assay and immunoblotting.

BACKGROUND: Although the identification and characterization of several fish allergens have already been reported, there is almost no data on Indian fish allergens and the effect of thermal processing on their allergenicity. This study aimed at the evaluation of the changes in the level of allergenicity of 4 highly consumed Indian fishes, i.e. pomfret, hilsa, bhetki and mackerel, that occurred after boiling and frying. METHODS: In this study 110 patients with fish hypersensitivity as evidenced by clinical history and symptoms were recruited based on their positive skin prick test results. The raw, boiled and fried muscle extracts of the 4 fishes were prepared, and each extract was tested by ELISA and immunoblotting with patients' sera. RESULTS: ELISA and immunoblotting studies demonstrated that the raw muscle extracts of pomfret, hilsa, bhetki and mackerel were allergenic. While the allergenicity of boiled and fried extracts of pomfret and hilsa was considerably reduced, maximum allergenicity of bhetki was demonstrated in the fried extract. The degree of allergenicity of bhetki was demonstrated in the order fried>boiled>raw while that of mackerel followed the order raw>boiled approximately fried. CONCLUSION: The specific IgE-binding activity and immunoblot profile clearly showed that pomfret and hilsa fish allergens are heat-labile, while allergens of bhetki and mackerel maintained strong reactivity even after thermal treatment.