An Imaging Assessment of the Femoral Neck-shaft Angle in Adult Bengali Bangladeshi Population.

Most orthopaedics implants were designed and manufactured based on data from the Western population whose skeletal dimensions are different from the Bengali Bangladeshi population. This study aims to determine the value of the femoral neck-shaft angle of the adult Bengali Bangladeshi population for adequate planning, preparation and pre-operative selection of orthopaedic implants for surgeries involving the femoral neck and stocking of orthopaedic implants. This was a cross-sectional analytical study which involved measuring the femoral neck-shaft angle (NSA) from the pelvic radiographs anterior-posterior view of adult patients reported "normal study" by the registered radiologist. This study was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from March 2019 to February 2020. A total of 200 femoral neck-shaft angles were analyzed from 100 patients' radiographs comprising 50 males and 50 females. The average NSA of adult Bengali Bangladeshi is 128.74°±5.83° with a mean value of 128.68°±6.20° for the right and 128.81°±5.66° for the left. The mean value of NSA is 129.64°±5.90° and 127.85°±5.64° in adult males and females respectively. The femoral neck-shaft angle in adult Bengali Bangladeshi males was significantly higher than the females.

Correlation of Vascular Changes in Skin Tissue of Diabetic Patients with Glycosylated Hb and duration of Disease.

Skin is the largest organ and outer covering of human body. It plays a great role in our visible appearance. Humans are more conscious about skin disease because it has a cosmetic priority. The cases that fulfil the selection criteria will be enrolled as study samples with a view to see correlation with glycosylated Hb, vascular changes and duration of DM. This cross-sectional study was performed in the Department of Skin and VD and the Department of Pathology of BIRDEM, Dhaka, Bangladesh from March 2017 to February 2019. Study population was all diabetic patients with skin diseases attending dermatology department of BIRDEM hospital. Among them 90 patients were selected who will do skin biopsy with diabetes mellitus. Skin biopsy tissue and blood sample were taken as materials to determine the type of skin lesion in patients with satisfactory and unsatisfactory glycaemic control; the relationship of diabetic skin lesions with duration of diabetes; and assessing the cutaneous or dermal capillary vascular changes was in Diabetes Mellitus and its correlation with HbA1c level and duration of Diabetes Mellitus. Among 90 cases age ranged from 31 to 85 years with mean age of the patients 55.06 ± 12.10 years. Maximum patients were in age group 41-50 years (32.2%). Skin disorders in Diabetes mellitus are more common in female in this study. Almost three fourth of the patients glycemic status was unsatisfactory. Satisfactory glycemic patients were 17 cases (18.9%) and unsatisfactory glycemic patients were 73 cases (81.1%). Mean HbA1c shows unsatisfactory glycemic status among 90 cases in this study. Mean HbA1c is more unsatisfactory in female patients in this study. Most common group of lesion was 37.7 % belong to miscellaneous group followed by skin diseases with strong to weak association with DM. There were no significant differences in different types of skin lesions between satisfactory and unsatisfactory blood glucose patients. Majority of the cases (37.8%) occurred after 10 years of diagnosis of DM. Mean duration of DM was highest among the patients with skin reaction to diabetic treatment (10.04±6.19). There is marked variation in thickness of dermal capillary basement membrane with duration of diabetes. There was a significant inverse correlation between perivascular infiltration and capillary basement membrane thickness.

Association of Modified Sequential Organ Failure Assessment (MSOFA) Score and C-reactive protein (CRP) With the Outcome of Patients under Mechanical Ventilation.

Different scoring systems has been discovered in medical practice, more specifically for ICU treatment, are designed to objectively quantify physiologic derangements and comorbid conditions for estimating mortality, length of stay and ICU resource use. This observational and descriptive study was carried out in the ICU, BSMMU, Dhaka, during March 2014 to May 2016, to determine the association of MSOFA score, CRP level with the outcome of patients on mechanical ventilation as well as compare the MSOFA and CRP combined with MSOFA alone. For this purpose, a total of 60 critically ill patients admitted in the above hospital were included in this study. Patients with an ICU stay of less than 48 hours, readmissions not considered, known case of neuromuscular disease, connective tissue disorder, renal disease and pregnancy and Patients refused to give written consent were excluded from the study. Patients who had MSOFA ≥7, their mean duration of ICU stay were 10.9±6.7 days and mean duration of mechanical ventilation 7.63±5.2 days. Patients who had CRP >11mg/L, their mean duration of ICU stay was 10.8±7.2 days and mean duration of mechanical ventilation was 7.35±5.1 days. Patients who had MSOFA score ≥7 and CRP ≥11mg/L with mean duration of ICU stay was 10.82±7.2 days and mean duration of mechanical ventilation was 7.12±5.2 days. 69.2% patients were CRP status positive (≥11) in death group and 33.3% had alive group. 92.3% patients were Positive (CRP ≥7 or MSOFA ≥11) in death group and 14.3% had alive group. MSOFA identified true positive 32 cases for death, false positive 5 cases, false negative 7 cases and true negative 16 cases confirmed by patient's outcome. CRP level identified true positive 27 cases for death, false positive 7 cases, false negative 12 cases and true negative 14 cases confirmed by patients outcome. Combined (CRP ≥11mg/L and MSOFA score ≥7) identified true positive 33 cases for death, false positive 1 case, false negative 6 cases and true negative 20 cases confirmed by patient's outcome. We concluded that there is a positive correlation (r=0.323; p=0.014) between CRP status with MSOFA score, positive correlation (r=0.402; p=0.002) between MSOFA score with MSOFA score and CRP combined and a positive correlation (r=0.999; p=0.001) between CRP level with MSOFA score and CRP combined.

Association of Low Serum Free Testosterone with Carotid Atherosclerosis in Male.

The cross sectional descriptive type of observational study was aimed to evaluate the association of serum free testosterone in 59 patients of carotid atherosclerotic male {<50% stenosis (n=26); >50% stenosis (n=33) } from March 2015 to February 2016 in the Department of Radiology & Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU) & National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Twenty seven patients who had normal carotid doppler findings were taken as control. Serum total testosterone and sex hormone binding globulin was measured by chemiluminescence micro particle immunoassay and free testosterone was done by using Vermeulen formula. Concentration of free testosterone differed significantly among groups (p=0.004) and it was significantly lower in <50% stenosed group. Logistic regression analysis revealed that low free testosterone (free testosterone ≤0.24 nmol/L) was independently associated with development of carotid atherosclerosis (p=0.04, OR 3.07, 95% CI 1.14-9.30). In conclusion low serum free testosterone was associated with carotid atherosclerosis in male.

Short Segment Pedicle Screw Fixation Including Fracture Vertebrae for the Management of Unstable Thoracolumbar Burst Fracture.

Stabilization procedures for the treatment of thoracolumbar burst fractures remain controversial. Traditional stabilization procedures include short and long segment stabilization. Nowadays short-segment including fracture vertebrae stabilization is one of the modalities of treatment. This study aimed to analyze the radiological and functional outcome of the Short-segment fixation with the inclusion of the fracture level (SSFIFL) for the treatment of unstable thoracolumbar fractures. In this prospective study, 40 cases of thoracolumbar burst fractures with incomplete spinal cord injury were operated by SSFIFL from Jan 2016 to Jan 2019 in NITOR, Dhaka, Bangladesh. The mean follow-up period was 18 months. Pre-operative and post-operative radiological parameters were the kyphotic angle, kyphotic deformation, Beck index, and clinical parameters include ASIA impairment scale, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Mean age was 32.30±11.85 years, among whom 80% (32) were male in this study. Fall from height (85%) was the main cause and occurs mostly in day labors (45%). Most common skeletal level was L1 (52.5%) followed by L2 (32.5%). Most cases operated between 10-15 days with mean duration of 119.58±19.93 minutes and mean blood loss of 350.38±31.26ml. The pre-operative kyphotic angle was 22.75±4.53° and 9.13±3.04° at final follow-up with correction loss of 5.15±2.54° (p<0.05). Most of the patients were in ASIA-C grade (57.5%) pre-operatively and ASIA-E (67.5%) at final follow-up after surgery (p=0.001). ODI improved from 67.20±12.90 to 25.08±11.36 and VAS form 60.25±8.91 to 21.50±8.33 (p<0.05). Main complication was superficial infection (5 cases) followed by bent rod and CSF leakage in 2 cases each. Good radiological and clinical outcome can be achieved by inclusion of fracture level in a short-segment fixation for unstable thoracolumbar fractures. Finally, this technique may allow us to save two or more segments of vertebral motion.

Level of Serum Vitamin D, To Which People Are at Risk of Developing Acute Myocardial Infarction in Bangladesh.

Incidence of Myocardial Infarction is increasing day by day in developing countries. Most of the patients who sustain myocardial infarction have coronary atherosclerosis. There are several risk factors for the development of atherosclerosis. Among all the risk factors, vitamin D deficiency has been proposed to play an important role in the development of atherosclerosis. With this aim, a case-control study was carried out to explore the association of serum vitamin D with acute myocardial infarction. The enrolled study subjects were categorized into Group A which comprised of STEMI, Group B, comprised of NSTEMI and Group C comprised of age and sex matched individuals free from acute myocardial infarction. The mean values of serum vitamin D (in ng/ml) were 20.17, 20.8 and 24.77 respectively in STEMI, NSTEMI and control groups. It differed significantly among groups (p<0.001) and it was significantly low in STEMI and NSTEMI groups compared to control group (p<0.001 and p=0.004). From this study it can be concluded that low serum vitamin D is an independent risk factor for developing acute myocardial infarction. Individuals with serum vitamin D <20ng/ml have higher chance of developing acute myocardial infarction compared to those with serum vitamin D >20ng/ml.

Special AT-rich sequence-binding protein 2 suppresses invadopodia formation in HCT116 cells via palladin inhibition.

Invadopodia are specialized actin-based microdomains of the plasma membrane that combine adhesive properties with matrix degrading activities. Proper functioning of the bone, immune, and vascular systems depend on these organelles, and their relevance in cancer cells is linked to tumor metastasis. The elucidation of the mechanisms driving invadopodia formation is a prerequisite to understanding their role and ultimately to controlling their functions. Special AT-rich sequence-binding protein 2 (SATB2) was reported to suppress tumor cell migration and metastasis. However, the mechanism of action of SATB2 is unknown. Here, we show that SATB2 inhibits invadopodia formation in HCT116 cells and that the molecular scaffold palladin is inhibited by exogenous expression of SATB2. To confirm this association, we elucidated the function of palladin in HCT116 using a knock down strategy. Palladin knock down reduced cell migration and invasion and inhibited invadopodia formation. This phenotype was confirmed by a rescue experiment. We then demonstrated that palladin expression in SATB2-expressing cells restored invasion and invadopodia formation. Our results showed that SATB2 action is mediated by palladin inhibition and the SATB2/palladin pathway is associated with invadopodia formation in colorectal cancer cells.

Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures.

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.

A review of the possible role of the essential fatty acids and fish oils in the aetiology, prevention or pharmacotherapy of schizophrenia.

WHAT IS KNOWN AND OBJECTIVE: Fish oils and other essential fatty acids have been purported to ameliorate the symptoms of schizophrenia or the adverse effects of the drugs that are used to manage it. Our objective is to review the basic and clinical evidence regarding replenishment of the reported decreased levels of polyunsaturated essential fatty acids, such as the omega-3 docosahexaenoic acid, the omega-6 linoleic and arachidonic acids, in brains of patients with schizophrenia. METHODS: We summarize the literature related to the postulated mechanistic connection between essential fatty acids and schizophrenia and the clinical trials testing fatty acids in patients with schizophrenia. RESULTS AND DISCUSSION: Fatty acids play critical roles in cell membranes of neurons, and certain fatty acids appear to be abnormally low in brains of patients with schizophrenia. The attempt to enhance endogenous levels thus seems a rational and worthwhile goal. The value of such intervention awaits the results of ongoing trials. WHAT IS NEW AND CONCLUSION: Despite the limited evidence that supplements ameliorate symptoms of schizophrenia, given the low risk of harm, some clinicians might opt to add omega-3 polyunsaturated fatty acid to current drug regimens in hope of better symptomatic control in schizophrenia.

Relation between insulin secretory capacity and microangiopathy in young diabetic patients in Bangladesh.

The pathogenesis of diabetic retinopathy is still unclear. The relative role of duration of diabetes, glycemic and insulinemic status in the etiopathogenesis of retinopathy is to be clearly understood. Hypertension, hyperlipidemia, pregnancy and age at diagnosis have been thought to be factors associated with diabetic retinopathy. Taking advantage of the availability of a group of young lean, normotensive and generally normolipidemic subjects in Bangladeshi population, the present study was undertaken to investigate the relationship between insulin secretory capacity and microvascular damage in the pathogenesis of diabetic retinopathy. A total number of 91 diabetic subjects, diabetes diagnosed before the age of 30 years, were recruited form the out-patient Department, BIRDEM Hospital. Diabetic subjects recruited were new- to previously diagnosed cases with duration of diabetes around 8 years. Insulin secretory capacity was assessed by C-peptide and C-peptide was estimated by ELISA method. Urinary albumin was measured by Immunoturbidetric methods. The subjects were grouped on the basis of duration of diabetes and presence (DR) and absence (NDR) of diabetic retinopathy. Subjects were also divided on the basis of albumin-creatinine ratio (ACR) level. ACR level was observed sharply increased with the duration of diabetes and showed a peak after 8 years. In the ACR positive cases 95.25% of diabetic patient had retinopathy. Both retinopathic and ACR positive subjects had low insulin secretory capacity as evident by absolute C-peptide level and C-peptide glucose ratio. Retinopathy was found increased with generalized vasculopathy. Both microvasculopathy and retinopathy seemed to occur at around 8 years. Insulin secretory capacity in particular seemed to have predominant determinant effect in the etiopathogenesis of diabetic retinopathy.