Different RT-PCR Protocol used in SARS-Cov2 PCR Laboratory of Mymensingh Medical College, Bangladesh.

The novel corona virus (SARS CoV-2) was first detected on Wuhan, China. After that it spread worldwide and has caused many deaths till now. This virus is also known as novel corona virus because of being newly discovered. Scientifically it is named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has positive-single stranded RNA and several proteins such as spike (S), envelope (E), membrane (M), nucleocapsid (N) and the other helper proteins. On the basis of phylogenic evidence, it is the new member of beta corona viruses and this group of viruses causes respiratory illness in human. This virus is detected in laboratory by using RT-PCR, by which different target gene such as E gene, S gene, N gene and RdRP (ORF1a-ORF1b) etc. are detected. This study was carried out at Mymensingh Medical College from April 2020 to December 2020. Around 65000 samples (nasopharyngeal swab) were tested during this period by three PCR protocols. By Sansure PCR kit N and ORF1a target genes were detected, Basphore's target genes were E and ORF and by Neoplex PCR kit N and RdRp genes were detected. Most of samples were tested by Sansure kit (62500), 2000 samples were screened by Bosphore kit and 500 samples by Neoplex. Among them, 6876(11.0%) samples were positive by Sansure, 120(6.0%) by Bosphore and 66(13.2%) by Neoplex. Among the positive samples, N gene 6188(90.0%) was mostly found by Sansure kit, whereas ORF was 120(100.0%) mostly found by Bosphore.

Conducting polymer composite-based biosensing materials for the diagnosis of lung cancer: A review.

The development of a simple and fast cancer detection method is crucial since early diagnosis is a key factor in increasing survival rates for lung cancer patients. Among several diagnosis methods, the electrochemical sensor is the most promising one due to its outstanding performance, portability, real-time analysis, robustness, amenability, and cost-effectiveness. Conducting polymer (CP) composites have been frequently used to fabricate a robust sensor device, owing to their excellent physical and electrochemical properties as well as biocompatibility with nontoxic effects on the biological system. This review brings up a brief overview of the importance of electrochemical biosensors for the early detection of lung cancer, with a detailed discussion on the design and development of CP composite materials for biosensor applications. The review covers the electrochemical sensing of numerous lung cancer markers employing composite electrodes based on the conducting polyterthiophene, poly(3,4-ethylenedioxythiophene), polyaniline, polypyrrole, molecularly imprinted polymers, and others. In addition, a hybrid of the electrochemical biosensors and other techniques was highlighted. The outlook was also briefly discussed for the development of CP composite-based electrochemical biosensors for POC diagnostic devices.

Psychiatric Manifestations of COVID-19: A Literature Review.

BACKGROUND: COVID-19 (coronavirus disease of 2019) occurs due to the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It uses angiotensin-converting enzyme- 2 (ACE-2) as its primary receptor to enter the host cell. Recent reports suggest that this pathogen also has a large impact on the CNS alongside other organs. Various inflammatory mediators, such as cytokines, chemokines, and numerous metabolites, are poorly regulated during infection as well as in several psychiatric diseases, which leads to conditions of hypoxia and cytokine storm. The persistence of COVID-19 infection may also result in aggravation of the already present neuro-psychiatric symptoms in patients. METHODS: We systematically searched various sources of journals and assessed the varied neurological routes of propagation and pathogenesis of SARS-CoV-2 neurotoxicity, like ACE2-mediated neuroinvasion induced hypoxia and the cytokine storm syndrome. Several case studies were also referred to obtain a better idea of the current mental health scenario as a consequence of infection and inflammation due to SARS-CoV-2. CONCLUSION: Several risk factors for the causation of mental health issues during as well as after the infection include female gender, presence of necrosis, and pain in avascular regions. Most psychiatric disorders are directly associated with the socioeconomic and psychosocial changes that have occurred as a consequence of the pandemic. These psychiatric manifestations have only started to unravel, which calls for the development of faster means of diagnosis and integrated pharmacological and epidemiological studies to curb the growing rate of neuronal complications as well as mortality.

Catalytic SrMoO4 nanoparticles and conducting polymer composite sensor for monitoring of K+-induced dopamine release from neuronal cells.

Octahedral SrMoO4 nanoparticles (NPs) with a high degree of crystallinity and controlled size (250-350 nm) were synthesized for the first time by employing a facile hydrothermal method. The prepared NPs were composited with a carboxyl group bearing conducting polymer (2,2:5,2-terthiophene-3-(p-benzoic acid, TBA)) to attain a stable sensor probe (pTBA/SrMoO4) which was analyzed using various surface analysis methods. The catalytic performance of the composite electrode was explored as an oxidation catalyst for biological molecules through anchoring on the conducting polymer layer, which functioned as a matrix to enhance the stability and selectivity of the sensor probe. The pTBA/SrMoO4 coated on glassy carbon displayed excellent electrocatalytic performance for the oxidation of some biologically important molecules, including dopamine (DA) in neuronal cells. The sensor immobilized with the catalyst showed an excellent response for DA with a dynamic range between 0.2 and 500 µM and a detection limit of 5 nM. The proposed sensor demonstrates the detection of trace DA released from PC12 cells under K+ stimulation, followed by inhibition of the release of exogenic DA by a Ca2+ channel blocker (nifedipine). The developed method provides an interesting way to monitor the effect of extracellular substances on living cells and the drug potency test.

Can honey improve the quality of cryopreserved cross bred ram semen added to tris egg yolk extender?

BACKGROUND: Honey can improve the quality of cryopreserved ram semen because of its multinutrient and cryoprotective nature added to standard tris egg yolk extender. OBJECTIVE: Different concentrations of honey were added to the standard tris egg yolk extender to improve the post-thaw quality of crossbred ram semen. METHOD: Thirty six (36) ejaculates from eight healthy cross bred rams were pooled and divided into four aliquots. Standard tris egg yolk extender without any alteration acted as Control (C) and was supplemented with different concentrations of honey, viz. T1 (honey 1.5%), T2 (2.5%), and T3 (3.5%). RESULTS: The percent (mean ± S.E.M) sperm motility at pre-freeze was significantly (P < 0.05) higher in Group T2 and at post-thaw in Group T3 in comparison to T1 and C treatment groups. The percent (mean ± S.E.M) HOST reacted spermatozoa at post-thaw was significantly (P < 0.05) higher in Group C and at pre-freeze the value was significantly (P < 0.05) higher in the same treatment group than Group T1. The mean MDA level (mean ± S.E.M) at post thaw was significantly (P < 0.05) lower in Group T3 than the treatment groups C and Group T1. CONCLUSION: From this study it is concluded that the addition of 3.5% honey to the standard tris egg yolk extender provides better protection to ram semen than the addition of 1.5% honey (i.e., Control). doi.org/10.54680/fr22610110212.

Recent advancements in vitrification cryodevices for gamete and gonadal tissue.

Cryopreservation of gametes and gonadal tissue is nowadays primarily accomplished through vitrification. Variables such as cooling rate, viscosity and volume of vitrification solution are critical in gamete vitrification. In addition, sample size and stepwise exposure are also crucial for gonadal tissue vitrification. Recently a class of cryodevices has been developed to reduce the volume of vitrification solution so as to achieve higher cooling rates. Vitrification devices are classified as "open" or "closed" depending on whether the medium comes into direct contact with liquid nitrogen during the process. Examples of the open cryodevices for gamete vitrification are Cryotop, Cryolock, open pulled straw (OPS), etc., and closed devices are Vitrisafe, CryoTip, and high security vitrification kit. Similarly, for tissue vitrification open cryodevices used are needles, cryovials and closed devices used are Cryotissue, ovarian tissue cryosystem, etc. Among all the gamete cryodevices, Cryotop is unique and the best-selling micro-volume storage device. Use of this device has resulted in the highest number of babies born after embryo or oocyte vitrification. Another novel device, Kitasato vitrification system, is a vitrification solution absorber, which is similar to Cryotop but differs in one way, as it possesses a porous membrane that absorbs extra solution from the gamete. This review provides an update on the recent use of cryodevices for gamete and gonadal tissue vitrification. doi.org/10.54680/fr22310110112.

Milestones of Development in Infancy: A Prospective Study in a Tertiary Level Hospital of Bangladesh.

The timing of milestone is influenced by many factors. Sex and socioeconomic status has significant effect to some psycomotor milestones. The study was conducted to determine the pattern of milestones of development of infants in our country and to compare it in different sex and socioeconomic condition. It was a hospital based prospective study done in Sir Sallimullah Medical College and Mitford Hospital, Dhaka, Bangladesh from October 2014 to November 2015. Healthy term newborn infants with average birth weight were included in this study and milestones of this birth cohort were assessed monthly from birth to 12 months of age by using a set of 60 milestones. Total number of 217 babies was enrolled but during follow up 0.9% developed meningitis, 43.7% was lost to follow up and 55.2% of the cohort was followed up to 12 months of age. Among 120 babies 51.7% were male, 48.3% were female babies and 51.7% belong to lower, 32.5% middle and 15.8% upper socioeconomic group. There was no significant difference between male and female infants achieving most of the milestones of development except in language development in which female infants were little bit higher than male infants.

In vitro Assessment of Tris Egg Yolk and Soybean Lecithin Based Extenders for Cryopreservation of Crossbred Ram Semen.

BACKGROUND: The replacement of egg yolk with alternative plant-derived soybean lecithin is gaining interest in both animal and human sperm cryopreservation owing to biosecurity issues with egg yolk based extenders. OBJECTIVE: To evaluate the comparative effect of egg yolk and soyabean lecithin based extenders on the quality of cryopreserved crossbred ram semen. METHODS: Pooled ejaculates (total ejaculates = 36) were divided into two aliquots and extended with Tris egg yolk extender (Tris extender) and soybean lecithin based commercial extender (Ovixcell) RESULTS: Among the two extenders, Ovixcell showed better sperm quality both at the pre-freeze (Sperm motility) and post-thaw stages. Lower malondialdehyde (MDA) level (nmol/mL) was observed in Ovixcell as compared to Tris extender. Both sperm quality and MDA level decreased significantly (P < 0.05) from pre-freeze to post-thaw in both the extenders. CONCLUSION: The findings of the present study indicate that Ovixcell is a comparable alternative to Tris extender for the cryopreservation of crossbred ram semen.

Effects of stem cell factor on in vitro growth of buffalo oocytes.

Stem cell factor (SCF) plays important roles in primordial follicle activation, oocyte growth and survival, granulosa cell proliferation, theca cell recruitment, and ovarian steroidogenesis. The aim of this study was to investigate the effect of SCF on in vitro growth of buffalo oocytes. Oocyte-granulosa cell complexes (OGCs) were dissected from early antral follicles of slaughtered buffalo ovaries and cultured for 6 days in media supplemented with 0, 50 or 100 ng/mL SCF. In vitro grown oocytes were further cultured for in vitro maturation for 24 h. The results showed that SCF significantly (P < 0.05) increased oocyte diameter in vitro. The percentages of surviving oocytes were 60, 81 and 92 in 0, 50 and 100 ng/mL SCF supplemented group, respectively. SCF promoted formation of antrum-like structures in culture. The results also showed that SCF enhanced the maturation of in vitro grown buffalo oocytes. Here, 14% in vitro grown oocytes reached metaphase II (MII) stage in 50 ng/mL SCF supplemented group, whereas the percentage was increased to 26% in 100 ng/mL SCF treated group. These results show that SCF supports the growth, viability and nuclear maturation of buffalo oocytes in vitro.

Detection of Tubercular Pleural Effusion by Molecular Technique PCR.

Tuberculosis is a common cause of death in developing countries like Bangladesh. About 30% of pulmonary tubercular infected patients developed tubercular pleural effusion. Tubercular pleural effusion was diagnosed by cytological, biochemical and bacteriological methods. But these methods showed low sensitivity. In some cases pleural biopsy showed also negative results. Now a days molecular technique like Polymerase chain reaction (PCR) is promising method for diagnosis of pleural TB. PCR was done in 100 pleural fluid collected from suspected tubercular pleural effusion cases admitted in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2011 to January 2013. Among the 100 samples 3% were culture positive and PCR positive was 6%. Sensitivity and Specificity of PCR considering culture as a gold standard method was 100% and 96.71% respectively in this cross sectional study. Among them Adenosine deaminase (ADA) level is >40IU/L in all PCR positive sample. Where PCR is available, measurement of ADA activity as well as PCR can be done simultaneously.

Adherence Pattern of Lipid Lowering Drugs in a Tertiary Care Hospital.

Dyslipidemia is one of the major risk factors of cardiovascular diseases. Worldwide, dyslipidemia is estimated to cause about 2.6 million deaths annually. Low drug adherence has been found to be a significant problem leading to poor health outcome. Medication non-adherence in chronic conditions is a recognized, but understudied public health problem. The present study was conducted to observe pattern of adherence to lipid lowering drugs, to find out the causes of non-adherence to medication and see the medication adherence in relation to various factor. The study was performed among 125 cardiovascular disease patients (both indoor and outdoor) of Cardiology department in Mymensingh Medical College Hospital (MMCH) who received lipid lowering drugs at least 6 months.Among them 21.6% patients were highly adherent, 34.4% patient showed medium adherent and 44% patients were low adherence to their treatment plan. Most important cause of non-adherence was financial problem (52.04%). Among them 46-55 years age group were highly adherent, male were more adherent to medication than female. Rich patient were highly adherent. Patient with above higher secondary level of education were highly adherent than others. Patients lived in urban area were more adherent than rural patients. Immediate efforts are required to tackle this situation. Multiple kinds of processes are required to improve the drug adherence such as to provide proper health education focusing on preventive aspect as well as financial support for the care. Such acts might prevent future complication thereby reducing costs of health care and eventually turns out to be reducing morbidity and mortality in the long run.

Comparison of markers predicting litter size in different pig breeds.

To overcome the limitations of conventional analysis of male fertility in animals and humans, proteomic studies have been performed to develop fertility-related biomarkers for prognosis and diagnosis of male fertility. However, the studies were focused on specific species or breeds. Therefore, a study is required to validate whether fertility-related markers would apply to other breeds in pigs. In this study, previously developed fertility-related biomarkers from Landrace were validated to use for prognosis of male fertility in commercially available breeds. Expression level of eight biomarkers in non-capacitated and capacitated (C) spermatozoa from Yorkshire and Duroc boars was analyzed. And then, to explore the validity of these markers for prognosis of male fertility, i.e. litter size, artificial insemination was performed. Among them, RAB2A (NC) and UQCRC1 (NC) turned out to be highest efficient markers for Yorkshire. RAB2A (C) was most efficient marker for Duroc. Average litter size has increased as much as 1.41 live born after prediction using eight fertility-related biomarkers in Yorkshire. In addition, average 2.52 litter size was increased after prediction using eight fertility-related biomarkers in Duroc. Average litter sizes were especially highly increased after prediction of fertility using RAB2A (NC) in Yorkshire (1.57 piglets) and TPI (NC) in Duroc (3.14 piglets), respectively. As a result, all biomarkers were significantly correlated with litter size. However, overall accuracy to predict litter size in three breeds was different in response with each marker. Average litter size after artificial insemination was also significantly affected by marker selection. Therefore, this study suggests that developed fertility-related markers may be used for prognosis and diagnosis of male fertility irrespective of breed. However, selection of efficient markers for breeds should be considered to obtain more accurate and efficient outcomes.

Pattern of Anti-hypertensives Usage in Hypertension with or without Comorbidities in a Tertiary Care Hospital.

Hypertension is a chronic illness associated with high morbidity & mortality. A large number of antihypertensive drugs alone or in various combinations are available and physicians need to choose the most appropriate drug for a particular patient. The standard treatment guidelines and drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to evaluate the use of antihypertensive in hypertension with or without ischemic heart disease and diabetes mellitus at Department of Cardiology in Mymensingh Medical College Hospital, Mymensingh from July 2015 to October 2015. It was an observational type of descriptive cross sectional study. The study was performed among 400 hypertensive patients in Cardiology department in MMCH who received antihypertensive drug. Out of 400 hypertensive patients 67% were male and 33% were female. Maximum patients (54%) found in 40 - <60 years age group and ≤60 years age group (37.5%). Mean age of the patients was 55.02±12.47 years. Mean systolic BP was 146.74±28.28 and diastolic BP was 90.60±14.27mmHg. In overall prescription combination therapy (63.25%) was prescribed more frequently than mono-therapy (36.75%). In monotherapy ramipril was the most commonly prescribed (27.89%) antihypertensive drug and ARB was the most commonly prescribed group (37.41%). In our study 5 groups of antihypertensive were found (ARB, ACEI, BB, Diuretics, and CCB). In combination therapy 2-drugs combination were found most frequently (37.50%) and ACEI + Diuretics (23.72%) was the most common combination followed by ARB + Diuretics (12.25%), ACEI + BB (11.86%). Average number of antihypertensive drug per prescription was 1.9.

Blood Pressure in Third Trimester of Pregnancy.

Pregnancy is a great stressful physiological condition in women during their reproductive period. During pregnancy several hemodynamic, biochemical and hematological modifications occur as a part of the physiological adaptation of the body. Changes in blood pressure occur in third trimester of pregnancy, which may be associated with increased maternal and infant mortality and morbidity. This cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, from July 2013 to June 2014. Study subjects were selected by following purposive sampling procedure and the protocol of this study was approved by Institutional Ethics Committee (IEC) of Mymensingh. This study enrolled 100 pregnant women of third trimester of pregnancy and 100 aged matched non-pregnant women from Mymensingh district. Mean systolic blood pressure in study group were 124.8±14.51 mm of Hg and in control group were 106.50±10.67 mm of Hg, which was statistically increased. Diastolic blood pressure in study group was 83.00±13.37 mm of Hg and in control group 71.05±7.12 mm of Hg, which was also statistically significant. The changes in blood pressure in third trimester of pregnancy is the major concern of developing the risk of pre-eclampsia & eclampsia, and increased prevalence of IUGR, pre-maturity and perinatal mortality. This study reveals significant changes of blood pressure during third trimester of pregnancy.

Retrobulbar abscess in a child.

A 14 months old male child was admitted into Mymensingh Medical College Hospital (MMCH), Bangladesh, with fever, watering, swelling, redness of right eye and running nose. On initial examination, patient was febrile, toxic, right-sided severe proptosis, restricted ocular movement, conjunctival chemosis and exposure keratitis of right eye. A sluggish pupillary light reaction was present in the right eye. Visual acuity was not recordable. CT scan of Brain and Orbit revealed, retrobulbar abscess of right orbit. The left eye was normal. The abscess was drained through a wide bore needle. The extraocular motility improved and pupil became brisk with a reduction in the temperature and toxic signs within 48 hours following surgery. Proptosis at the time of discharge from the hospital was absent in the right eye with no other complication. Post operative 8 months follow up period was excellent.

Comparison between azithromycin and cefixime in the treatment of typhoid fever in children.

An intervention study was carried out in the department of paediatrics of Mymensingh Medical College Hospital, Mymensingh to compare the clinical efficacy of Azithromycin in the treatment of childhood typhoid fever with that of cefixime for a period of one year from January 2011 to December 2011. A total of 60 cases of typhoid fever were enrolled in to a randomized clinical trial and was divided into two groups. The inclusion criteria of the cases were: Documented fever for more than 4 days plus two or more of the following clinical features: toxic physical appearance, intestinal complaints, coated tongue, ceacal gurgling, hepatomegaly and splenomegaly, diarrhoea and constipation plus positive Widal test and/or blood culture positivity. Patients who had complication like GIT heamorrhage; intestinal perforaion and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg/day for a period of 07 days Cefixime was given at a dose of 20mg/kg/day in two divided dose for 14 days. The mean time of defervesence was 4.05+1.14 days with azithromycin and 3.41+0.95 with cefixime respectively. The minimum defervesence time was 02 days and maximum defervesence time was 07 days. Clinical cure rate was 87% in azithromycin group and 93% in cefixime group. No serious adverse effect was noted related to azithromycin and cefixime therapy except nausea, vomiting, diarrhoea and jaundice. It was found that azithromycin is almost as effective as cefixime in the treatment of typhoid fever.

Role of adenosine deaminase in diagnosis of tubercular pleural effusion.

The diagnosis of pleural tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. It is produced during the inflammatory process triggered by the M. tuberculosis. Usefulness of adenosine deaminase (ADA) estimation in pleural fluid has been shown as a reliable chemical bio-marker specially when there is suspicion of tuberculosis in endemic areas. ADA level was determined in the pleural fluid of 100 patients present with pleural effusion admitted at Mymensingh Medical College Hospital during the period of March 2012 to September 2012. ADA level was >40IU/L among the 52 tubercular pleural effusion patients with sensitivity & specificity is 100% and 66% respectively. Thus is evident that ADA level can be used along with conventional methods for diagnosis of pleural TB.

Comparison of transvaginal and transabdominal ultrasonography in the diagnosis of ectopic pregnancy.

This cross sectional study was carried out in the department of Radiology and Imaging, Dhaka Medical College Hospital from July 2008 to June 2010 to compare the accuracy of transvaginal ultrasonography and transabdominal ultrasonography in the diagnosis of clinically suspected cases of ectopic pregnancy. Initially 60 patients with clinical suspicion of ectopic pregnancy were included in this study after analyzing selection criteria 30 patients underwent both transvaginal and transabdominal ultrasonography. 'Histopathological diagnosis' was considered gold standard against which accuracies of two diagnostic modalities were compared. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of transabdominal ultrasonography as a diagnostic modality in evaluation of suspected ectopic pregnancy were 73.1%, 75%, 95%, 30% and 73.3% respectively where as transvaginal ultrasonography was found to have 92.3% sensitivity, 75% specificity, 96% positive predictive value, 60% negative predictive value and 90% accuracy. Transvaginal ultrasonography was superior to transabdominal ultrasonography in the evaluation of suspected ectopic pregnancies so, transvaginal ultrasonography is important for early and accurate diagnosis of ectopic pregnancy.

Nonspirometric aspects of pulmonary function in subjects with dust industries.

Bangladesh is a developing country. Many workers are involved in different industries which are polluted with dust e.g. saw mill, rice mill, jarda factory etc. The present study may give a preliminary idea about the lung function status of those workers. The study has been designed to analyze the lung function status of those workers by measuring TCO2 aiming to recommend necessary steps to improved the quality of life of workers of dust industry in our socioeconomic context. This study was to evaluate pulmonary functional status of those workers who are exposed to dust in industries like saw mill 26.00 mmol/l, rice mill 31.10 mmol/l and jarda factory 22.11 mmol/l. In all groups p values were >0.1 which was not significant except jarda factory worker in which p value was <0.001 and it was highly significant. This study was carried out to increase the awareness of the workers and to reduce the cost of employment.

Outcome of endoscopic fulguration of posterior urethral valves in children.

Posterior urethral valves are the most common cause of congenital obstructive uropathy leading to renal failure in childhood. This study was undertaken to assess the outcome of endoscopic fulguration of posterior urethral valves based upon the clinical, radiological and laboratory findings. This prospective study was carried out on 50 male children with posterior urethral valves who were treated by endoscopic fulguration and came for routine follow-up. Diagnosis of posterior urethral valves (PUV) was confirmed by voiding cystourethrogram (VCUG). After valve ablation, urine R/M/E, urine for culture and sensitivity test, serum creatinine level, USG of KUB including PVR were done in all cases at 1,3,6,12 months and then at six months interval maximum up to 3 years. Mean age of the patients was 2 years ranging from 1 to 12 years old. Mean follow-up period was 30.48 months after valve ablation. At diagnosis mean serum creatinine +/-SD was 90.4+/-44.8 mumol/lit and it decreased to 56.3+/-11.1micromol/lit at the end of 3-years follow-up. Hydronephrotic changes decreased from 84% to 4%. Proteinuria decreased from 38% to 6% and urinary tract infections decreased from 58% to 4% at the end of final follow up. Although the techniques for posterior urethral valves ablation have been refined and the short-term management of patients with posterior urethral valves has improved remarkably, there is growing concern about the long-term outcome. At present endoscopic fulguration with observation is the treatment of choice for posterior urethral valves. In this study patients improved dramatically following fulguration of posterior urethral valves. Early diagnosis and appropriate therapy may arrest progressive damage and facilitate recovery. Further follow-up studies of longer duration are needed.