Detection of Oncogenic Human Papillomavirus (HPV-16 and HPV-18) from Bacterial Vaginosis Positive Patient Attending at Tertiary Care Hospital in Mymensingh.

Cervical cancer is the fourth most common cancer in women in the world and is the second leading malignancy among Bangladeshi women. Persistent infection with high risk human papillomavirus (HPV) is an important cause of development of cervical intraepithelial neoplasia (CIN) followed by cancer. Bacterial vaginosis (BV), a common treatable vaginal infection which can disrupt the balanced vaginal ecosystem and its innate protective mechanisms against infection, can play an essential role in the acquisition and persistence of high risk human papillomavirus (HR-HPV) infection. This cross sectional study was conducted to detect the HR-HPV (HPV-16 and HPV-18) infection among bacterial vaginosis positive patient in the Department of Microbiology, Mymensingh Medical College (MMC), Bangladesh, from March 2018 to February 2019. A total of 300 endocervical swabs and high vaginal swabs were collected from the VIA (Visual inspection with acetic acid) outdoor clinic of Obstetrics and Gynaecology Department of Mymensingh Medical college Hospital. HPV DNA was tested among all 300 cases by nested PCR. Typing of HPV 16 and HPV 18 was done among HPV DNA positive cases with BV and intermediate flora by multiplex PCR. BV was diagnosed according to Nugent criteria by using the gram stained smear of high vaginal swab. A total of 57/300 (19.0%) samples were positive for HPV DNA by nested PCR. Of the total 300 cases 78(26.0%) had BV, 38(13.0%) had intermediate flora and 184(61.0%) had normal vaginal flora. HPV DNA was more positive in patients having intermediate flora 08/38 (21.05%) followed by the patients having normal vaginal flora 37/184 (20.11%) and BV 12/78 (15.38%). Among the 12 BV patients who were also HPV DNA positive (83.33%) were belong to high risk HPV (type 16 and 18) group and among them 08(66.67%) were HPV-16 and 02(16.67%) were HPV-18. But among 08 HPV DNA positive intermediate flora containing patients only 01(12.5%) were belong to HR-HPV (type 16 and no type 18 was detected).

Ear Infections by Non albicans Candida Species with Isolation of Rare Drug Resistant Species in a Tertiary Care Hospital of Bangladesh.

Otomycosis, a fungal infection of external ear, is challenging for both patients and otolaryngologist as it requires long term treatment and follow up. Candida spp. is second common organism causing otomycosis with Aspergillus being first. Among Candida species, C. albicans is considered as most common but in recent years there is increasing incidence of Non albicans Candida (NAC) species with greater resistance and recurrence. This descriptive type of observational study was planned to determine the species distribution and antifungal susceptibility of Candida spp. causing otomycosis. From March 2021 to February 2022, 60 patients clinically suspected of Candida associated otomycosis at Mymensingh Medical College Hospital, Bangladesh were enrolled. Specimens were taken by an otorhinolaryngologist. After culture and microscopic examination, isolated Candida species were identified by phenotypic and genotypic method and antifungal susceptibility was determined at Department of Microbiology, Mymensingh Medical College. From 60 samples 18(30.0%) were positive for Candida on microscopy and culture. Of the isolates, C. albicans were 2(11.11%) and Non albicans Candida (NAC) 16(88.89%). Five different NAC species were identified of which C. parapsilosis was predominant 5(27.77%) followed by C. tropicalis 4(22.22%) and C. famata 3(16.67%). Rare species of C. ciferrii 2(11.11)%, Kodamaea ohmeri 2(11.11%) were isolated. Candida spp. showed highest resistance to Clotrimazole 8(44.0%) followed by Itraconazole 6(33.0%), Nystatin 4(22.0%) and Fluconazole 3(17.0%). C. ciferrii and Kodamaea ohmeri showed resistance to all antifungals except Nystatin. Outcomes from this study showed a different picture of species distribution, with isolation of rare and emerging drug resistant threatening species like C. ciferri and Kodamea ohmeri which necessitates more detailed survey.

Observational studies on the efficacy of carbamazepine and ascorbyl palmitate in managing trigeminal neuralgia.

OBJECTIVE: Ascorbyl palmitate is a fat-soluble ester of vitamin C and is used as an antioxidant food additive. While literature reports that ascorbyl palmitate can prevent exacerbation of pain and improve the quality of life of patients suffering from pain, this is not yet supported by clinical trial data. Our study aimed to investigate the effectiveness of ascorbyl palmitate in managing trigeminal neuralgia. PATIENTS AND METHODS: This study was carried out in a single-centre clinical trial in which subjects suffering from trigeminal neuralgia (N=11) were included. All patients were on carbamazepine when first included and, after washout period, received Ascorbyl palmitate. Eligible patients had the most severe trigeminal neuralgia pain in the oral cavity or pain on touching trigger zones, aged 20 years or older, were capable of proper assessment of the severity of pain and their condition, and had experienced multiple episodes of intraoral pain for at least 3 months with a pain intensity of more than 4 points on the numerical rating scale. The Brief Pain Questionnaire was used to evaluate patient's quality of life. RESULTS: A total of 11 patients were included with a mean age 55.36±10.67 years (7 males, 4 females). Most patients had compression by the superior cerebellar artery and vascular loops upon magnetic resonance examination. The mean numerical rating scale score for carbamazepine after one month was 7.9±0.56 (95% CI 7.49, 8.30). Similarly, for ascorbyl palmitate was 5.5±1.50 (95% CI 4.42, 6.57) (p<0.001). CONCLUSIONS: Ascorbyl palmitate can be used as an adjunct intervention in managing trigeminal neuralgia pain. According to the results, ascorbyl palmitate prevents frequent exacerbation of pain and improves patient quality of life.

Detection of Biocide Resistance Genes (qacE and qacΔE1) in Pseudomonas spp Isolated from Patients with CSOM at Mymensingh Medical College Hospital, Bangladesh.

Biocides, including disinfectants and antiseptics, are used for a variety of topical and hard surface applications in health care facilities. Biocides play a significant role for preventing and controlling nosocomial infections. However, failures in the antimicrobial activities of biocides have been reported. The resistance mechanism to disinfectants is usually determined by genes which are related to resistance to quaternary ammonium compounds, namely, qacE, qacΔE1 that are found in Gram-negative bacteria. The aim of this study is to detect the prevalence of Biocides resistance genes, qacE and qacΔE1, in clinical isolates of Pseudomonas spp. It was carried out from March 2017 to July 2018 in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Samples were collected from Outpatient of ENT department, MMCH. In this study, 300 clinical samples of CSOM cases were tested by the PCR method. The present study shows detection of biocide resistance genes (qacE, qacΔE1) among 87 isolated Pseudomonas spp by uniplex PCR. Among 72 clinical isolates of Pseudomonas aeruginosa 67(93.05%) had the gene qacEΔ1 and 25(34.72%) had the gene qacE. In addition other 15 Pseudomonas spp 3(20%) isolates had the qacEΔ1 gene and 2(13.33%) isolates had the qacE gene. In this study there is a marked difference in detection of the qacEΔ1 gene between the MDR and non MDR P. aeruginosa isolates. The qacEΔ1 was identified in 50 of 54(92.59%) MDR isolates and 7 of 18(38.89%) non MDR strains respectively. While gene qacE was detect 25(46.29%) MDR isolates and did not show any qacEΔ1gene in non MDR isolates. This study shows that the genes, qacE, qacΔE1 are widespread among Pseudomonas aeruginosa, they are higher in MDR strains than non MDR strains.

Early and Rapid Detection of Typhoid Fever by Nested PCR in Blood.

Typhoid fever caused by Salmonella typhi is one of the major health problems in developing countries including Bangladesh. Still now blood culture is gold standard method for diagnosing typhoid fever, but this method is laborious, requires several days and detection rate is low. Failure of early laboratory diagnosis often leads to increased morbidity and mortality. This study was intended to apply a nested PCR in blood for early diagnosis of typhoid fever. In this cross sectional study blood samples were collected from 200 suspected typhoid fever patients attending Mymensingh Medical College Hospital, Bangladesh. Nested Polymerase Chain Reaction (n PCR) of flagellin gene was done in all the blood samples. At the same time all blood samples were subjected to culture by lytic centrifugation method. Culture positive isolates were identified as S. typhi by biochemical tests. Among the 200 blood samples, 57 (28.5%) were positive for S. typhi on nested PCR where as blood culture was positive for S. typhi in 16 (8%) samples. Among the 57 PCR positive samples, only 15 (26.3%) samples were culture positive for S. typhi and rest 42 (73.7%) were culture negative. So, in culture negative cases PCR can be used as a rapid diagnostic test for diagnosing typhoid fever. Considering time requirement, PCR takes one day, whereas blood culture takes 3 or more days to confirm diagnosis.

Prevalence of ESBL Encoding Genes in Acinetobacter baumannii Strains Isolated from Various Samples of a Tertiary Care Hospital in Mymensingh.

The aim of this study was to find the prevalence of ESBL genes among A. baumannii isolates. In this cross sectional study, 49 Acinetobacter spp. were isolated from various clinical samples from March 2019 to February 2020 conducted in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Clinical samples including endotracheal aspirates, wound swab/pus, urine and blood. A total of 380 samples were analyzed. Growth was obtained in 34.21% of the samples yielding 130 organisms. Out of 130 organisms, 49(37.69%) were Acinetobacter spp. Among 49 Acinetobacter spp, 39(79.59%) were Acinetobacter baumannii which was identified by PCR targeting OXA-51 like gene. Amplification of the ESBL encoding genes, namely CTX-M, TEM, SHV done by molecular technique PCR. The most antibacterial resistance was against ceftriaxone (79.48%) and lower resistance only showed in colistin (12.82%). All the isolates were sensitive to tigecycline. The distribution of ESBLs genes such as TEM 20(51.28%), CTX-M 16(41.02%) and SHV 0(0%). The high resistance to most of the antibiotics among the studied strains and also a high prevalence of TEM gene in A. baumannii strains found in our study gives alarming sign towards the treatment complexity of these strains.

Bacteriology of Chronic Supporative Otitis Media (CSOM) at a Tertiary Care Hospital, Mymensingh.

Chronic suppurative otitis media (CSOM) is a notorious infection in developing countries causing serious local damage and threatening complications. It was a cross sectional observational study to isolate and identify aerobic bacteria and to analyze the susceptibility pattern of the aerobic bacterial isolates. It was carried out from March 2017 to July 2018 in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Samples were collected from Outpatient of ENT department, MMCH. Out of a total 300 patients with CSOM were enrolled in this study and 209 were culture positive. Among them gram negative organisms were 129(61.72%) and gram positive organisms were 70(33.49%). The most frequently isolated organism in this study was Pseudomonas aeruginosa 72(34.44%), gram positive organisms S. aureus 63(30.14%), E. coli 21(10.04%), other Pseudomonas spp (other than P. aeruginosa) 15(7.17%), mixed bacterial infectios 10(4.78%), Proteus spp 9(4.30%), CoNS 7(3.34%), Klebsiela lspp 7(3.34%), Acinetobactor spp 5(2.39%). P. aeruginosa isolates had least resistant to imipenem and colistin, S. aureus were showed high sensitivity to Vancomycin and Linezolid and E. coli were sensitive to imipenem and amikacin, ciprofloxacin and amikacin respectively. Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Piperacillin-Tazobactum, Ciprofioxacin, Gentamicin and Amikacin were found to be the most suitable drug for Pseudomonas aeruginosa, S. aureus and E. coli. The resistance against ceftriaxone and aztreonam was found to be very high.

Detection of Oncoprotein by a Novel Immunochromatoghaphic Test Depending on Age and Parity of the Patients Attending at Mymensingh Medical College Hospital, Bangladesh.

In world wide cervical cancer is the fourth most common among women, with the majority of cases occurring in developing countries. Some HPV infections persist, and a subset of persistent infections may lead to development of cervical intraepithelial neoplasia (CIN) or invasive cancer. Because neoplastic change typically takes some years to occur and it depends on multiple factors among them age and parity play important role. The objective of the cross sectional observational study was detection of oncoprotein depending on age and parity by immunochromatographic test (OncoE6 cervical test). Informed consent was taken from patients and the protocol was approved by IRB, Mymensingh Medical College, Mymensingh, Bangladesh. From April 2016 to March 2017 following universal safety precautions a total of 280 endocervical swabs were collected from VIA outdoor and Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Laboratory work was done in the department of Microbiology, Mymensingh Medical College. The E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. In this study VIA and OncoE6 cervical test were done on 280 cases and among them 120 were VIA positive and sent for colposcopy. From 120 VIA positive cases 70 were positive for colposcopy test. Afterwards 50 cases were selected for histopathological examination and classified into different grades. The present study showed 21(7.5%) cases were OnE6 cervical test positive by OncoE6 cervical test and most of them were found in advance aged <50 (38.09%) and multi parity (women more than two, 32.5%). Based on the findings of the present study, it may be concluded that age and multi parity plays important factor to cause cervical cancer. Now for prevention of cervical cancer we need screening which is an early detection tool. This is a low cost device, easily performed which can detect this HRHPV (High Risk HPV) and it will be helpful to reduce over treatment and high predictability of the disease.

Highly acidic pH values of carbonated sweet drinks, fruit juices, mineral waters and unregulated fluoride levels in oral care products and drinks in India: a public health concern.

PURPOSE: The objective of this study was to quantify and assess the concentrations of fluoride in commonly used oral care products, fruit juices, bottled waters, soft drinks, favoured bottled milk and milkshakes and to determine the pH of carbonated sweet drinks and drinks marketed in India. MATERIALS AND METHODS: Various commercial brands of dentifrices, toothpowders, mouthwashes, bottled waters, sweet carbonated drinks and fruit juices were collected randomly from different outlets in Mangalore city, Karnataka, India. A fluoride ion-selective electrode was employed to estimate the fluoride concentrations. A standardised pH meter was used to detect pH in the drinks. RESULTS: The fluoride level in toothpastes ranged between 96 and 1397 mg/l, whereas in toothpowder the fluoride content ranged from 35 to 1380 mg/l and mouthwash fluoride concentrations varied from 6 to 228 mg/l. The fluoride level in bottled waters ranged between 0.10 and 0.12 mg/l, and that in fruit juices between 0.09 and 0.21 mg/l. Most of the carbonated sweet drinks and fruit juices had highly acidic pH values which ranged between 2.62 and 4.26. CONCLUSION: Of the wide variety of dentifrices and toothpowders available in India, most brands do not indicate the fluoride levels on their packaging or inserts. Similarly, the unregulated acidic pH values of carbonated sweet drinks are not only potentially contributing to non-carious tooth loss (enamel erosion and dentine erosion), but are also a contributing factor to the weight gain observed in Indian adolescents.

Quantitative study of As (V) and As (III) interaction with mangrove DNA by molecular fluorescence spectroscopy.

This study describes the in vitro study of (1:1) one step nucleophilic displacement ([Formula: see text]) of phosphate by heavier anion arsenate and arsenite in the DNA of arsenic ridden Sundarban mangroves. Mangrove DNA was found to give rise to a broad fluorescence and its integrated fluorescence intensity was enhanced on addition of As (V) and As (III), respectively. Analyses of the fluorescence parameter showed adequacy of 1:1 model to describe substitution of phosphate of mangrove DNA chain exiplex by arsenate and arsenite with equilibrium constant (log Kc) ranging between 4.19 and 4.32 for As (V), and between 3.77 and 3.89 for As (III) at pH 7 and 25°C. In the cases, the melting temperature (Tm) and reassociation rate constant of mangrove DNA was increased on treatment with As (V) and As (III). It is suggested that heavier ion arsenate and arsenite may substitute phosphate in natural DNA.

Implication of organic matter on arsenic and antimony sequestration in sediment: evidence from Sundarban mangrove forest, India.

This study reports the measurement of stability constants for the interaction of As (V and III) and Sb (V and III) with humic substances extracted from aquatic sediments of the Sundarban mangrove forest ecosystem. It was observed that As and Sb formed a slightly more stable association with fulvic acid (FA) than with its humic acid (HA) counterpart. Quenching of fluorescence at increasing As (III and V) or Sb (III and V): FA or HA ratios was obtained that ideally correspond to a 1:1 complexation model. Quite strong complexation of As and Sb by FA and HA occurs at neutral pH, indicating that HA and FA probably markedly affect the mobility of As and Sb in the mangrove environment.

Wood chemistry and density: an analog for response to the change of carbon sequestration in mangroves.

This study aimed to resolve the variations of physical and chemical properties of wood records measured in different mangroves with their annual carbon sequestration. The methods of investigation used were to examine growth rate by monitoring breast height diameter, wood chemistry and density, FTIR spectroscopy and thermogravimetry. Carbon sequestration rate showing an increase with density varied between 0.088 and 0.171 µg C kg(-1) AGB s(-1), and Avicennia marina showed the maximum value and Bruguiera gymnorrhiza, the minimum. The changes in FTIR bands at 4000-2500 cm(-1) and 1700-800 cm(-1) were correlated to the variations in cellulose in mangrove woods and lignin to cellulose ratio ranged between 0.21 and 1.75. Thermal analyses of mangrove wood suggested that the fuel value index (985-3922) exhibited an increase with the decrease in maximum decomposition temperature and density. The seasonal variation of temperature and CO2 were likely to affect chemical properties through changes in wood density.

[4-Bromo-2-[2-(5-bromo-2-oxidobenzylideneaminomethyl)phenyliminomethyl]phenolato-kappa4O,N,N',O']nickel(II).

In the title complex, [Ni(C(21)H(14)Br(2)N(2)O(2))], the Ni(II) atom is coordinated by the two imine N and two phenolate O atoms of the Schiff base ligand in a tetrahedrally distorted square-planar geometry. The Ni-N and Ni-O distances are within the ranges expected for Ni-Schiff base derivatives. Intermolecular C-H...O hydrogen bonds link the molecules into centrosymmetric dimers, forming R(2)(2)(12) (A) and R(2)(2)(10) (B) rings. These dimers combine to form a supramolecular ABAB... aggregate which propagates along the [100] direction.

Enantioselective synthesis of the antiinflammatory agent (-)-acanthoic acid.

An enantioselective synthesis of the potent antiinflammatory agent (-)-acanthoic acid (1) is described. The successful strategy departs from (-)-Wieland-Miescher ketone (10), which is readily available in both enantiomeric forms and constitutes the starting point toward a fully functionalized AB ring system of 1. Conditions were developed for a regioselective double alkylation at the C4 center of the A ring, which produced compound 32 as a single stereoisomer. Construction of the C ring of 1 was accomplished via a Diels-Alder reaction between sulfur-containing diene 43 and methacrolein (36), which after desulfurization and further functionalization yielded synthetic acanthoic acid. The described synthesis confirms the proposed stereochemistry of the natural product and represents a fully stereocontrolled entry into an underexplored class of biologically active diterpenes.

Malignant schwannoma of the lingual nerve : a case report.

Malignant schwannomas of the head and neck are rare tumours that offer various diagnostic and therapeutic challenges encompassing the breadth of modern histupatholagy, radiology and surgery, We describe the only reported case oj a de novo malignant schwannoma affecting the lingual nerve. Presenting a review of the literature and using our case for illustration we discuss some of the pertinent features in the management of patients with this condition.

Penetrating laryngeal injury: two case reports from Bosnia.

Penetrating injury to the larynx is uncommon. We present two cases resulting from the recent Bosnian conflict. It is possible to achieve good laryngeal function by appropriate conservative management once the airway is secured. Progress should be monitored by repeated endoscopic examination and imaging techniques.

Primary amyloidosis of the larynx.

The history, examination and operative findings of primary amyloidosis of the larynx are very suggestive of carcinoma, indicating the need for careful histological examination. Staining with Congo red shows a characteristic birefringence. Systemic amyloidosis may be present.

Experience of day-case ENT surgery in a military hospital.

This paper presents the results of an audit undertaken one year after the introduction of ENT day-case surgery at a military hospital. Day-case surgery was introduced to use spare operating time in order to reduce the ENT waiting list. One year after the introduction of day-case surgery there was no difference in the total operating time (267 vs 268 hours) compared to the previous year. There had been 67 more operations performed and the average number of completed weeks on the waiting list had fallen from 13.76 to 5.67 weeks. The administration of day-case surgery is discussed. The results of a survey of local general practitioners' awareness of day-case surgery is also presented.