Association between Metabolic Syndrome and Acute Myocardial Infarction (AMI).

To evaluate the biochemical parameters of metabolic syndrome in case of acute myocardial infarction (AMI) patients this case control study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013. To assess of serum total cholesterol, triacylglycerol, HDL-cholesterol, LDL-cholesterol, to estimate of serum glucose and to establish the association of age, sex, BMI, waist circumference, waist hip ratio and blood pressure of myocardial infarction patients. A total of 120 subjects were included in the study. Among them 60 were subjects of AMI cases and another 60 subjects of non AMI patients as controls. Serum total cholesterol, serum triacylglycerol, serum LDL-Cholesterol & serum HDL-Cholesterol were estimated in each sample. All values were expressed as Mean±SD. Statistical significance of difference between case and control were evaluated by using student's unpaired 't' test. All statistical analysis was done by using SPSS windows package. Past history of diabetes Mellitus and hypertension were more common in cases compared to those in control (p<0.001) which was statistically highly significant. There was no significant difference in the history of smoking between case and control. Statistical mean values of serum triacylglycerol, serum FBS, serum total cholesterol were highly significant in AMI patients in comparison to control (p<0.001). Statistical mean value of HDL-C was significantly decreased in AMI patients in contrast to control (p<0.001). In this study systolic blood pressure and diastolic blood pressure were significantly increased in AMI patients in comparison to control (p<0.05). Waist circumference was highly significant in AMI patients in comparison to control (p<0.001). Analyzing the findings of the present study there were significant alteration in lipid profile, blood pressure, fasting blood sugar & WC. These findings reaffirm the clinical importance of the metabolic syndrome as a significant risk factor for AMI. So it may be recommended that estimation of these parameters may help pivotal for better management of AMI.

Copper and Zinc Status in Patients with Preeclampsia in Bangladesh.

This study assessed maternal serum copper and zinc levels in preeclampsia to find out the role of trace element disorder in the aetiology of preeclampsia. This cross sectional study was conducted in the dept of Physiology of BSMMU during 2009. Sixty patients of Preeclampsia (BP--140/90 aged 18-39 years, with >20th weeks of pregnancy with proteinuria and edema) participated. Thirty normotensive gravida was control. All subjects were collected from in and out patient department of Obstetric and Gynecology of BSMMU and Dhaka medical college hospital. Serum copper and zinc levels were measured by auto analyzer and atomic absorption sprectrophotometric method respectively. Data were compared between preeclampsia and normotensive pregnant women. Data were expressed as mean and SD and independent sample 't' test and two proportion 'z' test was used for statistical analysis. Mean value of maternal serum zinc (p<0.001) and copper (<0.01) levels were significantly decreased in preeclampsia. In addition Cu/Zn ratio was significantly higher (<0.01) in preeclampsia. Hypozincemia was found in 13% and hypocupremia was found in 38% of preeclampsia. The result of this study concludes that trace element disorders may be involved in the etiology of preeclampsia.

Correlation of hyperinsulinemia with hyperandrogenemia in primary infertile women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of the reproductive age and is the most common form of anovulatory infertility. Hyperinsulinemia and hyperandrogenemia are the characteristic features of PCOS, but the association between hyperinsulinemia and hyperandrogenemia is not well established. To find out any causal association between Hyperinsulinemia and hyperandrogenemia, a retrospective study was done on primary infertile women suffering from PCOS in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University. A total of 80 subjects were selected, among them 60 were cases and 20 were controls. Depending on their body mass index, the cases were divide into two groups, obese (n=30) and non-obese (n=30). Age and BMI matched controls were taken for both age groups. Observations derived from the study suggested that hyperinsulinemia and hyperandrogenemia are characteristic features of PCOS but significant correlation was not found between hyperinsulinemia and hyperandrogenemia. However, we cannot negate any possible association between the two and thereby we recommend further study to be done with a larger sample size.

Comparative Study of Adenosine Deaminase and Other Conventional Diagnostic Parameters in Diagnosis of Tuberculous Pleural Effusion.

Though pulmonary tuberculosis is the common presentation of Mycobacterium tuberculosis infection, extra-pulmonary tuberculosis is also a growing problem worldwide. Tuberculous pleural effusion is the second frequent form of extra-pulmonary presentation after tuberculous lymphadenitis and if untreated up to 65% of patients with tubercular pleural effusions will eventually develop active TB. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. So,the aim of this study was to evaluate the diagnostic value of ADA level in plural fluid and other conventional methods for diagnosis of tubercular plural effusion. This was a cross sectional study. This study was carried out in 64 Patients suffering from plural effusion and were consecutively selected and divided into two groups: tuberculous (n=40) and non tuberculous (n=24), depending upon etiology. Details clinical history, physical examination, routine and other relevant investigations including ADA estimation was measured. The mean value of ADA in the tuberculous group was 64.11 ± 19.50 U/L which was significantly higher (p<0.05). Cut off value of ADA was ≥ 40 U/L with 97% sensitivity and 93%specificity. In this study, sensitivity, specificity, PPV and NPV of ADA level in pleural effusion were more significant than other conventional parameters.

Comparison of Serum CA72-4 and CEA Levels in Patient with Endoscopically Suspected Gastric Carcinoma.

Several serum tumour markers have been described for gastric cancer. Preoperative level of tumor marker helps to predict the diagnosis of gastric carcinoma. CA72-4 as a serum tumour marker for gastric cancer is evaluated, and compared its utility in this regard with that of carcinoembryonic antigen (CEA). Analysis of gastric carcinoma by serum levels of CEA and CA72-4 and their correlation with histopathology help the clinician to develop his management strategies for gastric carcinoma. A prospective observational study was carried out in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with Department of Surgery BSMMU, DMCH, Delta Hospital Limited, Dhaka, during the period of October 2010 to September 2011. Serum CA72-4 and CEA were analyzed in 71 endoscopically suspected patients for gastric carcinoma. Among them 58 cases were diagnosed as malignant gastric disease and 13 cases were nonmalignant gastric disease. Sensitivity of CA 72-4 and CEA were 48.3% and 31% respectively and specificity were 92.3% and 76.9% respectively. In poorly differentiated carcinoma, positivity for CA72-4 and CEA were 55.6% and 36.1% respectively. Because of the high positivity of CA72-4 in poorly differentiated carcinoma, CA72-4 is reliable tumour marker in advanced cases. As the sensitivity of CA72-4 was more than that of CEA in diagnosis of gastric cancer, CA72-4 can be used in conjunction with other diagnostic tests like endoscopy that would be more helpful for the patients.

Serum zinc and magnesium level in newly diagnosed type-2 diabetic subjects.

This cross sectional study aimed to determine serum levels of zinc and magnesium in 80 newly diagnosed type 2 diabetic (Group I) and 80 healthy non-diabetic subjects (Group II). Diabetic patients without any complications were studied. It was carried out in the Department of Biochemistry, Mymensingh Medical College in cooperation with the out patient Department of Endocrinology of Mymensingh Medical College, Bangabandhu Sheikh Mujib Medical University and BIRDEM Hospital, Dhaka during the period from July 2008 to June 2009. A total of 160 subjects aged 55-65 years were enrolled for this study. Of them 80 were newly diagnosed type 2 diabetic (Group I) and 80 were apparently healthy non-diabetic (Group II) subjects. For both case and control, persons having no current medication, intercurrent illness, macro or microvascular complications and history of renal failure were selected. Atomic Absorption Spectrophotometer (AAS) was used to estimate the serum levels of zinc and magnesium. The Plasma zinc (72.07±6.84µg/dl) and magnesium (1.86±0.17mg/dl) significantly decreased in type 2 diabetic patients when compared with control (76.59±6.10µg/dl, 1.99±0.17mg/dl). It is concluded that type 2 diabetes mellitus can result in changes in zinc and magnesium levels. As the present study sample was small so it is difficult to draw any definite conclusion. However, the estimation and supplementation of both zinc and magnesium may be suggested in those cases.

Controlled Degradation of Polycaprolactone Polymers through Ultrasound Stimulation.

This study describes the development of an ultrasound-responsive polymer system that provides on-demand degradation when exposed to high-intensity focused ultrasound (HIFU). Diels-Alder cycloadducts were used to crosslink polycaprolactone (PCL) polymers and underwent a retro Diels-Alder reaction when stimulated with HIFU. Two Diels-Alder polymer compositions were explored to evaluate the link between reverse reaction energy barriers and polymer degradation rates. PCL crosslinked with isosorbide was also used as a non-Diels-Alder-based control polymer. An increase of HIFU exposure time and amplitude correlated with an increase of PCL degradation for Diels-Alder-based polymers. Ultrasound imaging during HIFU allowed for real-time visualization of the on-demand degradation through cavitation-based mechanisms. The temperature surrounding the sample was monitored with a thermocouple during HIFU stimulation; a minimal increase in temperature was observed. PCL polymers were characterized using Fourier transform infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR), differential scanning calorimetry (DSC), optical profilometry, and mechanical testing. PCL degradation byproducts were identified by mass spectrometry, and their cytocompatibility was evaluated in vitro. Overall, this study demonstrated that HIFU is an effective image-guided, external stimulus to control the degradation of Diels-Alder-based PCL polymers on-demand.

Serum levels of copper and zinc in newly diagnosed type-2 diabetic subjects.

Diabetes mellitus is a chronic metabolic disorder which affects carbohydrate, lipid and protein metabolism. There is a strong relation between some specific oligoelements and diabetes mellitus. The study was undertaken to determine serum levels of copper and zinc in 60 type 2 diabetic (Group I) and 60 healthy non-diabetic subjects (Group II). Diabetic patients studied were without any complications. Serum copper and zinc were estimated by Atomic Absorption Spectrophotometer (AAS). The serum copper levels (144.00±12.87µg/dl) significantly increased in Group I compared to Group II (138.50±11.00µg/dl). On the other hand, the Plasma zinc (72.70±8.43µg/dl) levels significantly decreased in type 2 diabetic patients compared to control group (75.92±8.20µg/dl). It is concluded that type 2 diabetes mellitus can result in changes in copper and zinc levels. However, it is difficult to draw any definite conclusion from this small study sample but may be suggested that estimation of both copper and zinc is better to be considered in those cases.

Comparative Effect of Losartan and Atenolol on Heart Rate Variability in Untreated Essential Hypertensive Patients by Power Spectral Analysis.

Autonomic balance in untreated essential hypertension is altered and antihypertensive drugs may improve autonomic balance. Losartan and atenolol is drug of choice to treat essential hypertension. Power spectral analysis of Heart Rate Variability (HRV) is a tool for detecting autonomic balance. This study aimed to compare the effect of losartan and atenolol on autonomic balance in essential hypertensive patients. This longitudinal study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2012 to June 2013. For this study, 120 diagnosed male hypertensive patients without any treatment (age 30-55 years) were selected from the Out Patients Department of Cardiology, BSMMU, Dhaka on their first day of visit. Sixty apparently healthy normotensive male subjects with similar age were also studied as control. Patients were divided into two equal groups. Sixty (60) patients received 50 mg losartan (oral) and 60 patients received 50 mg atenolol (oral) daily. Autonomic balance was assessed by power spectral analysis of HRV and HRV data were recorded by a polyrite D. HRV data of the patients were measured at baseline, after 3 months and 6 months of medication and data of control were recorded at baseline. For statistical analysis ANOVA, independent sample 't' test and paired sample 't' were performed. High frequency normalized units (HF n.u), total power (TP) were significantly lower (p<0.001) and low frequency normalized unit (LF n.u), LF/HF ratio were significantly higher (p<0.001) in all patients before treatment compared to control. In both drug groups HF n.u and total power were found significantly higher (p<0.001) whereas LF n.u and LF/HF ratio were found significantly lower (p<0.001) after 3 months of treatment compared to their baseline values. After 6 months of treatment, data demonstrated significant further increase (p<0.001) in HF n.u and total power compared to their values after 3 months of treatment. Again these values were found significantly higher in atenolol treated patients compared to losartan group at the end of 6 months of treatment. These result concluded that cardiac autonomic nerve functions may be impaired in essential hypertensive patients before treatment which may improve by treatment with both drugs but the effect is more pronounced in atenolol treatment after longer duration.

Effect of Slow Breathing Exercise on Glycaemic Status in Type 2 Diabetic Male Patients.

Slow breathing exercise (SBE) improves the chronic disease conditions. This study aimed to observe the effects of slow breathing exercise on glycaemic status in male patients with type 2 diabetes mellitus (DM). This prospective interventional study recruited sixty (60) diagnosed male type 2 diabetes mellitus (T2DM) patients aged 45-55 years with disease history 5-10 years, from Out Patients Department (OPD) of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2015 to December 2015. Thirty patients performed SBE for 30 minutes 2 times daily for 3 months (study group) and 30 patients did not perform any breathing exercise (Control) and were under follow up for similar duration. Fasting plasma Glucose (FPG), 2 hours Post prandial plasma glucose (PPPG) and glycosylated haemoglobin (HbA1c%) of all patients were assessed both at baseline and after3 months of study. Independent sample and paired sample t-test were used for statistical analysis. In this study the mean FPG, 2 hrs PPPG and HbA1c significantly (p<0.05) reduced in patients with SBE after 3 months whereas no significant changes in FPG, 2 hours PPPG were observed, moreover HbA1c significantly increased (p<0.01) after 3 months in patients who were not under SBE. This study reveals that slow breathing exercise significantly improves glycagemic status in type 2 diabetic patients.

Short-term Heart Rate Variability: A Technique to Detect Subclinical Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus.

Type 2 diabetic mellitus (T2DM) patients with sub-clinical cardiac autonomic neuropathy (CAN), which precedes clinically apparent CAN, may have reduced heart rate variability (HRV); yet may remain undetected by conventional autonomic test. The objective of this study was to explore the short-term HRV by power spectral analysis as a tool to detect sub-clinical diabetic cardiac autonomic neuropathy (CAN). This cross -sectional study included 30 recently diagnosed and 54 long-term T2DM male patients (aged 45 to 55 years and without any symptoms of CAN) and 30 age and body mass index (BMI) matched healthy male subjects as controls. This study was done from January 2015 to January 2016 in Endocrinology OPD, BSMMU, who were previously or then diagnosed by the physician at this very OPD following the diagnostic criteria set by the American Diabetes Association Ewing battery of cardiovascular reflex tests (CARTs) was performed to rule out signs of autonomic neuropathy in enrolled patients. Power spectral analysis of frequency domain signals of short term HRV were done by digital data acquisition device RMS Polyrite-D. For statistical analysis, One way ANOVA and independent sample 't' test were used. LF power, HF power and HF normalized units (nu) were significantly lower, and LF nu and LF/HF were significantly higher in long-term T2DM compared to recently diagnosed T2DM (p<0.05) and control (p<0.001). LF power (p<0.01) and HF power (p<0.001) were significantly lower in recently diagnosed T2DM compared to control. Results from this study demonstrate the presence of autonomic dysfunction in CAN asymptomatic long-term T2DM patients. Short-term HRV, thus, seems to be an invaluable tool to detect sub-clinical diabetic CAN.

Skin biopsy and psoriasis.

A total of 33 skin biopsies were sent to Bangladesh institute of health Science (BIHS) hospital at Mirpur, Dhaka by Consultant skin for histopathological diagnosis between a period of one year and three months. Out of these 33 skin biopsies histopathological diagnosis of psoriasis was made for 13(39.39%), chronic non specific dermatitis (eczema) in 4(12.12%), lichenoid lesion 4(12.12%). Ashy dermatosis 3(9.09%), Nevus 2(6.06%) and corn, hemangioma, prurigo simplex, pityriasis rubra pilaris (PRP), dermatofibroma, 1(3.03%) each. The main presenting feature of these patients were erythematous, prurituc, silvery, scale, plaques or papules for a period between 2 months to 15 years. It is evident from the present study that among different skin lesions sent for histological diagnosis, Psoriasis is common skin pathology in dermatological practice.

Role of vitamin E supplementation on serum levels of copper and zinc in hemolytic anemic patients with G6PD deficiency.

Vitamin E scavenges free radicals and may prevent destruction of RBC in Glucose6-phosphate dehydrogenase (G6PD) deficient hemolytic anemia, where changes in copper (Cu) and zinc (Zn) may act as additional contributory factors for hemolysis. In the present study changes in serum Cu and Zn and role of vitamin E supplementation on these changes were observed in hemolytic anemic patients with G6PD deficiency. This study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during July 2005-June 2006. For this, 102 subjects with age ranged 5-40 years of both sexes were included in the study. Among them 68 were G6PD deficient patients, of whom 34 were in supplemented group and 34 were non-supplemented group. The supplemented group received vitamin E for 60 consecutive days at a dose of 800 IU/day for adult and 400 IU/day for children < or =12 years (4 times daily). Age and sex matched 34 apparently healthy subjects with normal G6PD level were taken to observe the base line data (healthy control) and also for comparison. All the G6PD deficient patients were selected from the Out Patient Department (OPD) of Hematology, BSMMU, Dhaka, and all the healthy subjects from personal contact. Blood G6PD level was done by spectrophotometric method and serum Cu, Zn levels by atomic absorption spectrophotometric method. To observe the availability of binding proteins serum total protein, albumin, globulin and A:G ratio were done by standard laboratory techniques. All parameters were measured on day 1 of their 1st visit and also on day 60 in deficient groups. Data analysis was done by appropriate statistical method. Serum Cu was significantly (p<0.001) higher but serum Zn, total protein, albumin, A/G ratio were significantly (p<0.001) lower in G6PD deficient groups in comparison to those of healthy control on day 1. After vitamin E supplementation, values of these parameters were comparable with those of healthy control in supplemented group in comparison to those of their pre-supplemented and non-supplemented groups both on day 1 and day 60. So, vitamin E supplementation has got its effective role in restoration of normal serum concentration of Cu and Zn in this group of patients.

Evaluation of objective structured practical examination and traditional practical examination.

To evaluate the competency of Objective Structured Practical Examination (OSPE) as an assessment technique compared to Traditional Practical Examination (TDPE) in assessment of laboratory component of physiology, the results of Physiology practical examination of 400 students from 4 Medical Colleges, two Government and two non Government (Dhaka Medical College, Mymensingh Medical College, Bangladesh Medical College, Uttara Women's Medical College) under Dhaka University were studied. Students' performance in OSPE and TDPE was compared. Mean score obtained in OSPE was 77.72+/-0.66 and found significantly higher than that for TDPE (64.44+/-0.61). Again mean scores achieved in OSPE were compared among different Medical Colleges and significant difference was noted. In OSPE, male students achieved significantly higher score than that of female students, especially in responding question station. The outcome of the present study thus indicates that OSPE is a better choice as an assessment technique over the Traditional method measuring wide range of practical skill. It may be concluded that it is important for competency based performance discrimination and it also helps improving students performance quality in laboratory exercise.

Summative assessment of under graduate medical student's performance in physiology by structured oral examination.

To evaluate the importance and efficiency of structured oral examination (SOE). This is a retrospective study, has been designed to compare the newly adopted structured oral examination (SOE) with that of the traditional oral examination (TOE). This study was conducted at the department of physiology during the year 2006, on 607 2nd year medical students of Mymensingh Medical College and 106 students from some other medical colleges who appeared in the first professional examination under Dhaka University from 2003-2006. For this purpose, scores achieved by the students in physiology in first professional examination for 4 successive years (2003-2006) were analyzed. The examinations in (2003-2004) and (2005-2006) were conducted under TOE and SOE respectively. Mean score achieved in SOE and TOE was 67+/-.02 and 57+/-.003 respectively. The difference is statistically significant. The pass percentage in SOE is 94.70% and 90.3% in TOE and the difference is significant. Maximum number of students in SOE attained score in the range of 60-69 but in TOE scores attained by maximum frequency fall in the range of 50-59. This observation indicates improvement in student's performance by quality and success rate in SOE. Therefore SOE is a more effective, skill full technique and superior to TOE in assessing student's competency and cognitive ability. The need and skill of SOE over the TOE in assessing oral part of examination has been proved.

Studies on serum lipid profile in hypertensive patient.

UNLABELLED: The study was carried out to appraise the serum total cholesterol, triglyceride, HDL-C and LDL-C values in hypertensive patients for providing information to the health-policy planners and also to the clinical practitioners about the importance of routine monitoring of lipid profile in hypertensive patients for prevention of coronary heart disease and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. It was a cross-sectional study. The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital and in the community of Sadar, Mymensingh District. The period of the study was January 2005 to December 2005. A total number of seventy subjects were included in this study. Out of them 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Most of the hypertensive patients (65%) were taking treatment irregularly. Serum total cholesterol, serum triglyceride and serum LDL cholesterol were greater in hypertensive than those of normotensive . The differences of mean of serum total cholesterol, serum LDL cholesterol in between two groups were statistically significant and in case of serum triglyceride it was statistically highly significant. Serum HDL cholesterol was less in hypertensive than those of normotensive. The differences of mean of serum HDL cholesterol in between two groups were statistically highly significant. Among 40 hypertensives the number of "Getting treatment- regular" & "Getting treatment-irregular" was 14 (35%) & 26 (65%) respectively and the values are not statistically significant. Similarly in patients "suffering less than 5 years" and "suffering 5 years & above" the differences are also not statistically significant. CONCLUSION: The observations of this study has revealed that most of the hypertensive patients are taking treatment irregularly and there was significant alteration of serum cholesterol, triglyceride, HDL-C and LDL-C in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the coronary heart disease (CHD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.