Impact of Climate Change and Land Use on Groundwater Salinization in Southern Bangladesh-Implications for Other Asian Deltas.

Pervasive salinity in soil and water is affecting agricultural yield and the health of millions of delta dwellers in Asia. This is also being exacerbated by climate change through increases in sea level and tropical storm surges. One consequence of this has been a widespread introduction of salt water shrimp farming. Here, we show, using field data and modeling, how changes in climate and land use are likely to result in increased salinization of shallow groundwater in SE Asian mega-deltas. We also explore possible adaptation options. We find that possible future increase of episodic inundation events, combined with salt water shrimp farming, will cause rapid salinization of groundwater in the region making it less suitable for drinking water and irrigation. However, modified land use and water management practices can mitigate the impacts on groundwater, as well as the overlying soil, from future salinization. The study therefore provides guidance for adaptation planning to reduce future salinization in Asian deltas.

Incomplete Pentalogy of Cantrell--A Case Report.

Cantrell's Pentalogy is a rare congenital malformation consists of supraumbilical abdominal wall defect, defect in the lower part of sternum, agenesis of anterior portion of diaphragm, an absence of the diaphragmatic part of the pericardium and intracardiac malformation. This case report presents a female neonate, who was born at 40 weeks of gestation weighing 2400 gm and was admitted 4 hours after delivery with the complaints of something coming out from chest. On physical examination her vital signs were within normal limit, she had a systolic murmur on heart at lower left sternal area and there was a vascular structure present on the upper part of abdomen which was pulsatile and pulsation was synchronized with cardiac pulsation. On investigation chest X-ray lateral view showed absence of lower part of sternum, echocardiography findings were different in different institutes. Echocardiography findings at Mymensingh medical college hospital (MMCH) were large VSD (Ventriculo septal defect), ASD (Atrial septal defect) and rotated heart. On colour Doppler ultrasonogram at MMCH showed there were VSD, ASD, and a small epigastric swelling which was vascular and appears to be attached to the apex of the heart. On the other hand echocardiography findings of LAB AID hospital in Dhaka were Dextrocardia, complete AV (atrio ventricular) canal defect, almost common atrium, almost single ventricle, common AV valve, double outlet right ventricle (DORV), Cortriatriatum, mild A-V valve regurgitation and severe pulmonary hypertension (PAH). Echocardiography was also done at national heart foundation hospital in Dhaka. Findings were situs solitus, mesocardia to dextrocardia, DORV, large VSD, mild mitral inflow, mild TR (triuspid regurgitation), good LV (left ventricle) and RV (right ventricle) systolic function. Cardiologists at Dhaka in Bangladesh were suggested for surgery. Then the patient was consulted at Naryan Institute of Cardiac Science, Chennai in India. Here echocardiography findings were dextroversion/dextrocardia, DILV (Double inlet left ventricle), large inlet VSD with bidirectional shunt, mild TR, severe PAH with good ventricular function. Cardiologists in India were given comment about this patient. This patient was highly risky for surgery. They advised medical treatment and requested to review after one year. By taking medical treatment patient condition is well except failure to thrive and cyanosis develops during feeding and crying according to the statement of guardian of the patient. This case has 3 criterias among the five criteria of Cantrell's Pentalogy. So, it is incomplete Pentalogy of Cantrell.

Serum Zinc, Copper, Magnesium & Phosphorus Level in Children with Severe Acute Malnutrition (SAM).

Malnutrition is widely prevalent among hospitalized children in most developing countries including Bangladesh. Though malnutrition accounts for the high rate of under 5 mortality sometimes it is overlooked. Keeping in this in mind A comparative cross sectional study was done in Mymensingh Medical College Hospital from 1st October 2009 to 31st May 2011. Children aged 1-5 years with presence of one or more criteria WHM <70%, WHZ-score <-3SD, Bipedal edema & Mid upper arm circumference <110mm were taken as study group and children aged 1-5 years with normal growth allowable normal range of variation is between 3rd and 97th centile curve or median (50th centile) ±2SD of weight for age growth chart (CDC growth chart, USA, 2000) were taken as reference group. Persistent diarrhea, Patients taking medications containing zinc, copper, magnesium, phosphorus & calcium, PEM with shock were excluded from study group. Nutritional assessment was done according to WHO criteria of SAM. Serum Zinc, Copper Magnesium and Phosphorus level were determined by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer, model no. 969, Spain. Total 120 study populations were taken. Ninety Out of 120 were taken as a study group (SAM) & 30 were reference group. In reference group serum Zn, Cu, Mg, P value was 103.80±8.86µg/dl, 135.92±13.57µg/dl, 2.31±0.18mg/dl, 3.96±0.22mg/dl respectively. In study group serum Zn, Cu, Mg, P value was 60.33±11.08µg/dl, 80.60±15.46µg/dl, 1.47±0.22mg/dl, 2.00±0.52mg/dl respectively. All these results show that there is significant difference between study group & reference group. Considering the decreased level of these parameters, close biochemical monitoring and follow up should be emphasized for the children with SAM.

Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial.

This study was done to determine the effects and outcome of inhaled budesonide in addition to standard management of asthma exacerbations in pediatric age groups. A randomized, double-blind, placebo controlled trial was done in a tertiary care urban hospital. Sixty six children aged 5 to 15 years with moderate to severe asthma exacerbations were eligible. All patients received a single dose of prednisolone 1mg/kg orally as first dose of systemic corticosteroids and then salbutamol (0.15mg/kg) and ipratropium bromide (500mcg) was nebulized every 20 minutes for 3 doses and then hourly for 2 hours as a part of standard treatment of asthma exacerbations. The intervention was 2mg (4mL) of budesonide or 4mL of normal saline which was nebulized immediately after the 1st dose of nebulized salbutamol and ipratropium bromide. The baseline characteristics of the budesonide group (n=33) and placebo group (n=33) were similar, but at 1 hour, 2 hour and 3 hour PEFR, respiratory rate, pulse rate, SaO2 and asthma score were significantly improved in the budesonide group compared to placebo group (p<0.01). The positive immediate effect of nebulized budesonide added to standard treatment of asthma exacerbations is an encouraging finding for further investigations of its routine use in the treatment of asthma exacerbations in children.

Stroke in Bangladeshi patients and risk factor.

To evaluate comprehensively the distribution of established risk factors of stroke among Bangladeshi patients. This is an observational study. It involved 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years. Common established risk factors of stroke e.g. age, sex, family history, hypertension, diabetes, ischemic heart disease, smoking, obesity, dyslipidaemia, alcoholism, use of oral contraceptive pill, lack of fresh fruit consumption etc. were evaluated in these patients through a preformed questionnaire and data were analyzed. Majority of the stroke events occurred after the age of forty (82.3%) and the ischemic stroke (72%) is the most common. Apart from non modifiable risk factors (advancing age, sex, Family history of stroke) hypertension was the most common modifiable risk factor found in stroke patients (57.6%) followed by smoking (44.6%), tobacco use (24.3%), OCP use in female (40% of female stroke), diabetes (23%), ischemic heart disease (17.1%), obesity (10.6%) and dyslipidaemia (5.3%). Lack of fresh fruit consumption and alcoholism were found in some of the patients. Stroke is common after the age of forty. Ischemic events are commonest type of stroke. Hypertension, smoking, tobacco use, diabetes and ischemic heart disease were five most common risk factors of stroke. Outlining the common stroke risk factors in our settings, may help the physicians and care givers in managing this disabling disease properly.

Symptom Analysis of Early Parkinson's Disease and its Correlation with High Sensitivity C-reactive Protein.

Parkinson's disease is a debilitating neurodegenerative disease for which there is no cure. It is characterized by bradykinesia, resting tremor, rigidity and postural instability, due to impairment of function of the basal ganglia which is involved in the coordination of body movement. Neuro-inflammation is pathogenesis of development in early Parkinson's disease. High-sensitivity C-reactive protein level is a useful non-specific biochemical marker of inflammation. Objective of this study was to analyze the symptoms of Parkinson disease and it's correlation with high sensitive CRP. Seventy-six Parkinson's disease patients were enrolled in this Cross-sectional observational study that was attended in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from September 2014 to March 2016. Analysis of the symptoms of Parkinson disease and it's correlation with high sensitive CRP were done among these patients. This study was performed on 76 Parkinson disease patients with presented early with symptoms. a positive and highly significant correlation were seen in between duration of tremor and High sensitivity CRP (r=0.430, p<0.001) and between duration of bradykinesia and High sensitivity CRP (r=0.426, p<0.001) which indicate increase duration causes increase level of high-sensitivity C-reactive protein value. The neuro-inflammation plays a significant role in the pathogenesis of symptoms development in early Parkinson's disease.

Endovascular management of a young patient of stroke with absent right upper limb pulse.

A 39 years old, right handed, hypertensive non-diabetic smoker presented with ischemic stroke with left sided hemiplegia and absent right upper limb peripheral pulses. Possible causes of young stroke were searched. Cerebral digital subtraction angiography (DSA) revealed 95% stenosis at origin of brachiocephalic trunk with absent flow in right sub-clavian artery and 75% stenosis at osteum of left vertebral artery with flow reversal through right vertebral artery. Subsequently, stents were placed within the stenosed portion Right brachiocephalic trunk and left vertebral artery. The intervention resulted in immediate restoration of right upper limb pulses and cessation of flow reversal in vertebral artery.

Nutritional status among primary school children of Mymensingh.

The school age is a dynamic period of growth and development. During this period physical, mental, social development of child takes place. The purpose of the study is to observe the nutritional status among the school aged children and to compare the urban and rural children. It is a descriptive cross sectional study. Data were collected from 600 children of primary school in Mymensingh district for a period of one year from October 2009 to September 2010. Among the primary school children in Mymensingh, Bangladesh 15.1% were wasted, 22.1% were stunted, 2.3% were both stunted and wasted and 60.4% children were within normal limit. Malnutrition was more in rural area in comparison with urban area. In rural area severely underweight, moderately underweight children were 62.1%, 65.6%, and corresponding result in urban area were 37.9%, 34.4% respectively. In rural area severely stunted, moderately stunted children were 100%, 58.6%, and in urban area they were 0%, 41.4% respectively. Again severely wasted and moderately wasted, children were 62.5%, 59.5% in rural area and 37.5%, 40.5% in urban area respectively. Malnutrition among girls were more then the boys.

Iron status in children with febrile seizure.

This hospital based cross sectional analytic study was carried out in department of Pediatrics Dhaka Medical College Hospital and Combined Military Hospital from July 2009 to June 2010 to find out the relationship of iron status with febrile seizure in children. Sixty children aged 6 months to 5 years having febrile seizure were enrolled as cases after taking proper consent by purposive sampling. Sixty age matched children with fever but no seizures were taken as control after taking proper consent. Children having a febrile seizure, developmental delay, hemorrhagic disorder, severe malnutrition or micronutrient deficiency and abnormal CSF findings were excluded from the study. In cases after control of seizure 2 ml of CSF was taken for cytology, biochemistry, Gram & AFB staining. Two milliliter of blood from cases as well as control was collected, released to EDTA bottle for Hb, MCV and MCHC. Again 2 ml of blood was taken in plain test tube for testing serum iron, TIBC and for serum ferritin. Serum iron, TIBC, serum ferritin was estimated by automated analyzer (PENTRA for serum iron, DADE BEHRING for TIBC, IMMULITE 1000 for serum ferritin). There was no significant difference between two groups regarding age (p>0.05), sex (p>0.05). High fever (p<0.001) and continuous fever (p<0.001) was significantly associated with febrile seizure. Seizure was generalized in all with positive family history in 83.3% cases. The Mean±SD of blood Hb (Case 9.8±1.6; Control 10.7±0.9), MCH (Case 22.1±2.3; Control 24.3±3.6) & serum ferritin (Case 55.1±29.3; Control 99.6±81.9) level were significantly low associated with febrile seizure (p<0.05). No significant difference was found between cases and control regarding MCV, serum iron and serum TIBC.

Peak expiratory flow rate of normal school going children in Mymensingh municipality.

This cross sectional study was conducted to measure the PEFR values of normal school going children of Mymensingh, Bangladesh. Peak expiatory flow rate (PEFR) is a lung function test which is easily measurable and reproducible but the base line values of PEFR have not been studied in large scale among Bangladeshi children. In Mymensingh municipality out of 79 schools 4 schools were selected purposively. A total of 984 (499 boys and 485 girls, nearly equal in ratio) normal children (6-15 years), were selected randomly by using lottery technic in classroom. To obtain peak expiratory flow rate (PEFR) mini Wright peak flow meter was used. The highest of three readings was taken as the correct value. Anthropometric parameters including body weight and height were recorded by bathroom scale and stadiometer respectively and body surface area was calculated. According to age interval (10 months) in boys and girls the mean difference of PEFR values showed that among age categories of 6, 7 & 8 years had no significant (p were <0.18, <0.73 and <0.70 accordingly) and all other age categories the mean difference of PEFR between boys and girls had significant (p<0.01). The correlation coefficient (r values) and the level of significance between different anthropometric parameters and PEFR in case of boys and girls were significant (p<0.001). Correlation of height (boys r=0.961 & girls r=0.954) with PEFR was the highest in comparison to other anthropometric parameters (age, sex and body weight). Boys had significantly higher values of PEFR than the girls at any height.

Study on Blood Pressure Profile in School Children of Mymensingh City.

High blood pressure and its related problems are progressively assuming public health dimensions in developing countries like Bangladesh. There was a suggestion that hypertensive process can be aborted in its early stages. But it is poorly understood in its early stages. So, early natural history of hypertension and its evolution from the youth needs to be investigated. Objective of this study was to determine blood pressure distribution in school children aged 6-15 years. This descriptive cross-sectional study was conducted in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015. The sample was collected by simple random sampling from five different schools of Mymensingh after applying inclusion and exclusion criteria. After taking proper history and doing relevant examination, both systolic and diastolic BP was recorded by auscultatory method. Out of 994 children, 480(48.29%) were boys and 514(51.71%) were girls. In boys, the mean±SD of systolic and diastolic blood pressure (BP) were 105.9±10.8 mm of Hg and 67.4±6.7 mm of Hg and in girls it was 106.1±11.8 and 67.5±6.9 mm of Hg respectively. Systolic BP was found higher in girls belongs to 10-13 years. The study has shown that BP rises linearly with age and both systolic and diastolic BP has a significant positive correlation with age, sex, height and BMI in both sexes. This study also showed, 46(4.6%) children were hypertensive and 89(8.9%) were pre-hypertensive. Hypertension was found more in girls but there was no significant difference between two sexes. Hypertension was found more in relation to overweight, obesity and family history of hypertension. Hypertension is not uncommon in children. Routine blood pressure measurement should be conducted in all children.

H9N2 avian influenza virus dispersal along Bangladeshi poultry trading networks.

Avian influenza virus subtype H9N2 is endemic in Bangladesh's poultry population. The subtype affects poultry production and poses a potential zoonotic risk. Insufficient understanding of how the poultry trading network shapes the dissemination of avian influenza viruses has hindered the design of targeted interventions to reduce their spread. Here, we use phylodynamic analyses of haemagglutinin sequences to investigate the spatial spread and dispersal patterns of H9N2 viruses in Bangladesh's poultry population, focusing on its two largest cities (Dhaka and Chattogram) and their poultry production and distribution networks. Our analyses suggest that H9N2 subtype avian influenza virus lineage movement occurs relatively less frequently between Bangladesh's two largest cities than within each city. H9N2 viruses detected in single markets are often more closely related to viruses from other markets in the same city than to each other, consistent with close epidemiological connectivity between markets. Our analyses also suggest that H9N2 viruses may spread more frequently between chickens of the three most commonly sold types (sunali-a cross-bred of Fayoumi hen and Rhode Island Red cock, deshi-local indigenous, and exotic broiler) in Dhaka than in Chattogram. Overall, this study improves our understanding of how Bangladesh's poultry trading system impacts avian influenza virus spread and should contribute to the design of tailored surveillance that accommodates local heterogeneity in virus dispersal patterns.

Causes of morbidity and mortality of wild aquatic birds at Billabong Sanctuary, Townsville, North Queensland, Australia.

Infectious diseases are common causes of significant morbidity and mortality events of wild aquatic birds (WABs) worldwide. Reports of Australian events are infrequent. A 3-yr passive surveillance program investigating the common causes of morbidity and mortality of WABs was conducted at Billabong Sanctuary near Townsville, North Queensland, from April 2007 to March 2010. Forty-two carcasses were obtained and evaluated by clinico-pathologic, histologic, bacteriologic, and virologic (molecular) examinations. Morbidity and mortality were sporadic and more commonly observed in chicks and juvenile birds in April than other months of the year. Morbid birds were frequently unable to walk. Hemorrhagic lesions and infiltration of lymphocytes in various organs were the most common findings in dead birds. Identified bacterial diseases that could cause bird mortality were colibacillosis, pasteurellosis, and salmonellosis. Salmonella serotypes Virchow and Hvittingfoss were isolated from an Australian white ibis (Threskiornis molucca) chick and two juvenile plumed whistling ducks (Dendrocygna eytoni) in April 2007. These strains have been previously isolated from humans in North Queensland. A multiplex real time reverse transcriptase-PCR (rRT-PCR) detected Newcastle disease viral RNA (class 2 type) in one adult Australian pelican (Pelecanus conspicillatus) and a juvenile plumed whistling duck. No avian influenza viral RNA was detected from any sampled birds by the rRT-PCR for avian influenza. This study identified the public health importance of Salmonella in WABs but did not detect the introduction of the high pathogenicity avian influenza H5N1 virus in the population. A successful network was established between the property owner and the James Cook University research team through which dead birds, with accompanying information, were readily obtained for analysis. There is an opportunity for establishing a long-term passive disease surveillance program for WABs in North Queensland, an important region in Australian biosecurity, thus potentially significantly benefitting public health in the region and the country.

Redox trapping of arsenic during groundwater discharge in sediments from the Meghna riverbank in Bangladesh.

Groundwater arsenic (As) is elevated in the shallow Holocene aquifers of Bangladesh. In the dry season, the shallow groundwater discharges to major rivers. This process may influence the chemistry of the river and the hyporheic zone sediment. To assess the fate of As during discharge, surface (0-5 cm) and subsurface (1-3 m) sediment samples were collected at 9 sites from the bank of the Meghna River along a transect from its northern source (25 degrees N) to the Bay of Bengal (22.5 degrees N). Bulk As concentrations of surface sediment averaged 16 +/- 7 mg/kg (n = 9). Subsurface sediment contained higher mean concentrations of As of 4,000 mg/kg (n = 14), ranging from 1 to 23,000 mg/kg As, with >100 mg/kg As measured at 8 sites. X-ray absorption near-edge structure spectroscopy indicated that As was mainly arsenate and arsenite, not As-bearing sulfides. We hypothesize that the elevated sediment As concentrations form as As-rich groundwater discharges to the river, and enters a more oxidizing environment. A significant portion of dissolved As sorbs to iron-bearing minerals, which form a natural reactive barrier. Recycling of this sediment-bound As to the Ganges-Brahmaputra-Meghna Delta aquifer provides a potential source of As to further contaminate groundwater. Furthermore, chemical fluxes from groundwater discharge from the Ganges-Brahmaputra-Meghna Delta may be less than previous estimates because this barrier can immobilize many elements.

17ß-hydroxysteroid dehydrogenase-3 deficiency in disorder of sex development.

A 29 years old patient, claimed to be a male, presented to us with pubertal gender swing from female to male. Since birth he was reared as a female child. His breasts, axillary hairs and pubic hairs developed at about 11-12 years of age. At that time he also observed the mental and physical changes towards a male. He began to feel sexual attraction towards females due to enlargement of his phallus and he preferred to behave as a male. The patient further noticed deepening of voice as well as appearance of facial hairs at about 15 years of age. He never experienced menstruation. His parents are first degree cousins. On examination, there was facial hairs in upper lip and chin (G3), breasts were in mature stage (B5), pubic hairs were darker, coarser and curlier and spreading sparsely (P3), and stretched dorsal phallic length was 6cm. In perineoscrotal area, there was hypospadias with blind vaginal pouch, partially fused, pigmented & ruggated bilateral labio-scrotal folds and soft palpable ellipsoid gonads measuring about 8 ml (each) in volume within labio-scrotal folds. Ultrasound examination revealed no uterus and karyotyping test found 46XY. Provisionally, he was diagnosed as a case of 46,XY Disorders of Sex Development (DSD). On further investigations, serum testosterone was low, serum LH and DHEA were raised and serum electrolytes were normal. From history, physical examination and investigations we diagnosed the case as 46,XY DSD due to 17ß-hydroxysteroid dehydrogenase-3 deficiency.

Efficacy of Nebulized Hypertonic Saline (3%) Versus Normal Saline and Salbutamol in Treating Acute Bronchiolitis in A Tertiary Hospital: A Randomized Controlled Trial.

Acute bronchiolitis is a viral respiratory illness of infants and young children that occurs in the first two years of life. It is a major cause of hospital admissions in Bangladesh. Management of bronchiolitis is a great challenge for the pediatrician both in the outpatient and inpatient department. Because mainstay of treatment options are usually supportive like cool humidified oxygen, fluids, bronchodilators, epinephrine and corticosteroids. A number of agents have been proposed as adjunctive therapies, but their effects are controversial. Nebulized hypertonic saline (3%) has been reported to have some benefit in recent studies. So the objective of this study was to compare the efficacy of nebulized 3% hypertonic saline (HS) with salbutamol and normal saline (0.9%) nebulization in children with acute bronchiolitis. A double-blind randomized controlled trial was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital, Bangladesh from November 2015 to October 2016. A total of 100 children aged one month to two years with acute bronchiolitis admitted in the Pediatric wards of MMCH were included in the study and were randomly assigned to either 3% nebulized hypertonic saline (n=50) or to 0.9% nebulized isotonic saline with salbutamol solution (n=50). The main outcome variables were clinical severity score, length of hospital stay, duration of oxygen therapy and oxygen saturation (SpO2). The therapy was repeated three times on every hospitalization day and the outcome was evaluated two times daily (12 hourly) for 60 hours. Mean duration of oxygen therapy in study group was 33.6±21.7 hours and in control group was 36.8±22.5 hours. But their difference was not statistically significant (p>0.05). The mean clinical severity score and mean oxygen saturation of the entire study patients in both groups decreased and increased respectively during hospital stay. There was significant difference of mean clinical severity score and oxygen saturation between admission and follow up-5 in each group (p<0.001). But their difference between two groups was not statistically significant (p>0.05). Mean duration of hospital stay was 2.91±1.54 days in study group and 3.09±1.85 days in control group. But their difference between two groups was not statistically significant (p>0.05). So in acute bronchiolitis nebulized hypertonic saline (3%) is as effective as normal saline (0.9%) and salbutamol nebulization.

Comparison of Growth of School Children in Mymensingh City Area, Bangladesh Using the 2000 CDC Standards and 2007 WHO Standards.

Growth assessment is an essential component of child health surveillance. The most influential tool in the growth assessment is the growth chart. Growth parameters of children are usually interpreted in relation to international standards like the NCHS/1977, CDC/2000 and WHO/2007 growth charts. This comparative study was carried out in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015 to compare the growth parameters of children using 2000 CDC standards and 2007 WHO standards. A total of five hundred healthy school children, aged 6 to 10 years were randomly selected proportionately from each class of five government primary schools from Mymensingh city area. Children with physical deformities and acutely ill and those with chronic debilitating diseases were excluded from the study. The mean and median weight, height and BMI were calculated for each age and sex. The median weight, height and BMI were then standardized by converting them to Z-scores (SD) for comparing against known reference values of 2000 CDC and 2007 WHO charts. Among 500 children, 252(50.4%) were boys and 248(49.6%) were girls. The mean age was found 8.0±1.42 years in boys and 8.04±1.42 years in girls. The mean weight was found 24.4±6.36kg in boys and 24.08±6.35kg in girls. The mean height was 125.90±10.16cm in boys and 125.38±10.74cm in girls. The mean weight, height and BMI of boys and girls were found to be lower in all age groups with compared to 2000 CDC standard and 2007 WHO standard but were closer to the WHO standards compared to the CDC standards. According to CDC and WHO in the study it was observed that underweight was found 16.3% and 14.7%, stunting 7.1% and 6.7%, overweight 6.7% and 8.7%, and obese 2.8% and 4.0% respectively in male subjects. On the other hand, in female subjects it was observed that according to CDC chart and WHO chart underweight was found 19.4% and 13.3%, stunting 6.0% and 4.8%, overweight 7.3% and 8.1% and obese 2.0% and 2.0% respectively. The findings in this study imply that growth pattern of Bangladeshi school children is closer with WHO standards and wider from CDC standards.

Clinical Profile of Parkinson's Disease Patients in a Tertiary Hospital.

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. The pathogenesis of PD is yet unknown. Aim of this study was to analyze the clinical profile of patient with early Parkinson disease. A total of seventy-six early Parkinson's disease patients were enrolled in this cross-sectional observational study which was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2014 to March 2016. Analysis of the history and clinical findings were done among these patients. This study was performed with 76 early Parkinson disease patients. Among them, male and female were 69.7% and 30.3% respectively. The mean±SD age of patients was 53.25±11.53 years with an age range of 24 to 77 years. The patients were found in primary level accounted for 42.1% which was followed by secondary 19.7% and illiterate or non-formal education 17.1%. Only 5.3% study population was found in post-graduate. Occupant as 28.9% were service holder, 26.3% as a housewife, 1.3% as business and 43.5% other occupations. Regarding smoking, 28.9% was a current smoker, 59.2% non-smoker and 11.8% ex-smoker. Of them, 11.8% had a family history of Parkinson's disease. Of the total population, 30.3% had dyslipidemia, 21.1% had hypertension, and 7.9% had diabetes mellitus. Males are predominant in affecting this disease. Middle aged people are vulnerable to it. Parkinson's disease is common in nonsmoker and dyslipidaemia. Few patient had family history of Parkinson's disease.

Bilateral, symmetrical and extensive cerebral calcification in pseudohypoparathyroidism.

Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterized by hypocalcemia, hyperphosphatemia, increased serum concentration of parathyroid hormone (PTH), and insensitivity to the biological activity of PTH. Pseudohypoparathyroidism is rare sporadic or autosomal dominant disorder having several subtypes (type Ia, Ib, Ic, type II). We report a case who was 27 years old married lady having two children presented in the summer season 2009. Her trousseau's sign was positive, serum calcium 5.5 mg/dl, PTH 137 pgm/ml and CT scan of brain shows bilateral and symmetrical calcification. She had occasional doubtful seizure and headache for 7 years. Initially clinicians could not reach the diagnosis due to inadequate investigations.

Status of liver enzymes in babies with perinatal asphyxia.

Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. In this study, the functional status of liver of the asphyxiated babies was assessed through estimation of liver enzymes to see any correlation existing between enzyme changes and severity of perinatal asphyxia. A total of 70 full-term asphyxiated newborns (study group) were studied during January'2008 to December'2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrollment these babies were grouped according to Sarnat & Sarnat stages of Hypoxic-ischemic encephalopathy (HIE) as stage I, II & III. Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. Another 50 healthy newborns were also studied as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum AST, ALT & alkaline phosphatase (ALP). Unpaired student's 't' test and Spearman's rank correlation was used for data analysis and P value of <0.05 were considered significant. Mean AST, ALT and ALP of the asphyxiated babies were 76.27±37.44, 82.16±48.08 & 369.59±123.05 U/L and that of normal babies were 23.46±8.45, 26.54±7.76 & 208.20±46.95 U/L respectively and these rise were statistically significant (p<0.001). The levels of transaminases and ALP were positively correlated with the severity of asphyxia and these correlations were also statistically significant (p<0.001). So, this study concludes that AST, ALT & ALP significantly elevated in perinatal asphyxia and this elevation was proportional to the severity of hypoxia.