Association of Triglyceride and C-reactive Protein Level with Severity of Angiographically Defined Coronary Artery Disease.

Coronary artery disease (CAD) is considered as a major cause of morbidity and mortality worldwide. Inflammatory cytokines play an important role in the pathogenesis and progression of atherosclerosis. The aim of the study was to find out the association of C-reactive protein (CRP) and triglyceride (TG) level on the severity of CAD in patients with ischemic heart disease (IHD). This cross-sectional study was performed in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh during the period of March 2018 to February 2021. Total 431 patients with ischemic heart disease were enrolled after taking informed written consent. CRP values were categorized into normal (<6 mg/L), borderline (6-10 mg/L) and high (>10mg/L) and TG level were categorized into normal (<150 mg/dl), borderline (150-199mg/dl) and high (≥200 mg/dl). Patients with ischemic heart disease (IHD) were stratified according to CRP value and TG level. Severity of CAD was assessed by the Gensini score. Most of the patients (33.4%) belonged to age 51-60 years. The mean age was 51.31±10.30 years. The majority (74.5%) of patients were male. Among risk factors, the highest 205(47.6%) patients were smokers followed by hypertension 190(44.1%) and diabetes mellitus 175(40.5%). The association of TG and CRP with the whole spectrum of IHD was found statistically significant (p<0.05). Severe CAD was found higher in high TG and high CRP level group compared with the other groups and was statistically significant. Inflammation assessed by high CRP and hypertriglyceridemia associated with the risk and severity of CAD.

Chemometric approach based characterization and selection of mid-early cauliflower for bioactive compounds and antioxidant activity.

The present study was aimed to analyse bioactive compounds (total phenolics, ascorbic acid and sinigrin) and antioxidant activity in 14 mid-early cauliflower genotypes. Significant differences (pb 0.05) were observed among the genotypes for all bioactive compounds and antioxidant activity. Total phenolics content of curd were ranged from 20.36 to 48.93 mg gallic acid equivalent (GAE) 100 g-1 fresh weight (FW) which showed 2.5 times variation. The ascorbic acid content was maximum in DC522 (88.53 mg 100 g-1 FW) followed by Pusa Sharad (65.64 mg 100 g-1 FW) while minimum in DC310 (39.62 65.64 mg 100 g-1 FW). Wide variation was observed for cupric reducing antioxidant capacity and ferric reducing antioxidant power ranging from 9.04 to 20.83 mg GAE 100 g-1 FW and 13.11 to 26.31 mg GAE 100 g-1 FW, respectively. Sinigrin was found to be highest in DC306 (39.50 µmol 100 g-1 FW) for leaf and in DC326 (36.93 µmol 100 g-1 FW) for curd sample. The cauliflower genotypes were classified based on chemometric approaches namely principal component analysis (PCA) and agglomerative hierarchical clustering (AHC). The first two principal components (PC1 and PC2) explained 50.62% and 23.28% of total variance, respectively. The AHC as revealed by heat map classified cauliflower genotypes into four main groups based on measured traits. The information is useful for developing varieties and/or hybrids rich in bioactive compounds and antioxidant activity.

Silver nanoparticles (AgNPs) induced impairment of in vitro pollen performance of Peltophorum pterocarpum (DC.) K. Heyne.

Increasing use of silver nanoparticles (AgNPs) in myriad applications including electronics, medicines and agriculture has led to serious concerns regarding its release to plant ecosystems. Over the years, numerous studies have demonstrated the toxic impact of AgNPs in a variety of cell and tissue systems involved in vegetative growth across a wide range of plant species. However, assessing their impact on haploid phase of plant life cycle was restricted only to a study with Kiwifruit. In this study, in vitro pollen performance of Peltophorum pterocarpum at two endpoints i.e., germination and tube growth was assessed to evaluate the impact of nanoparticulate or ionic form of silver. Increasing concentrations of AgNO3/AgNPs significantly reduced the pollen germination and retarded the tube growth. The EC 50 values indicated a more potent toxic effect of AgNPs than AgNO3 on pollen germination as well as tube growth. Impairment of pollen performance was more pronounced at the stage of emergence of pollen tube. Extensive alterations in the muri and lumen of exine as revealed through SEM analysis and subsequent blockage of germpore might disrupt the emergence of pollen tube. The dynamics of pollen tube growth was analyzed with polynomial models of different degrees. A high degree of polynomial, the quintic model was able to approximate the real data points with highest coefficient of determination and smallest RMSE, compared to other models. An oscillating pattern of tube growth was portrayed with the passage of time in all the treatments that fits well with the established mechanistic oscillatory model of tube growth. It appears that exposure to AgNO3/AgNPs inhibited pollen germination and retarded tube growth without affecting the oscillatory behavior of tip-growth.

Combining molecular docking and molecular dynamics studies for modelling Staphylococcus aureus MurD inhibitory activity.

The ATP-dependent bacterial MurD enzyme catalyses the formation of the peptide bond between cytoplasmic intermediate UDP-N-acetylmuramoyl-L-alanine and D-glutamic acid. This is essential for bacterial cell wall peptidoglycan synthesis in both Gram-positive and Gram-negative bacteria. MurD is recognized as an important target for the development of new antibacterial agents. In the present study we prepared the 3D-stucture of the catalytic pocket of the Staphylococcus aureus MurD enzyme by homology modelling. Extra-precision docking, binding free energy calculation by the MM-GBSA approach and a 40 ns molecular dynamics (MD) simulation of 2-thioxothiazolidin-4-one based inhibitor $1 was carried out to elucidate its inhibition potential for the S. aureus MurD enzyme. Molecular docking results showed that Lys19, Gly147, Tyr148, Lys328, Thr330 and Phe431 residues are responsible for the inhibitor-protein complex stabilization. Binding free energy calculation revealed electrostatic solvation and van der Waals energy components as major contributors for the inhibitor binding. The inhibitor-modelled S. aureus protein complex had a stable conformation in response to the atomic flexibility and interaction, when subjected to MD simulation at 40 ns in aqueous solution. We designed some molecules as potent inhibitors of S. aureus MurD, and to validate the stability of the designed molecule D1-modelled protein complex we performed a 20 ns MD simulation. Results obtained from this study can be utilized for the design of potent S. aureus MurD inhibitors.

The PAF complex regulation of Prmt5 facilitates the progression and maintenance of MLL fusion leukemia.

Acute myeloid leukemia (AML) is a disease associated with epigenetic dysregulation. 11q23 translocations involving the H3K4 methyltransferase MLL1 (KMT2A) generate oncogenic fusion proteins with deregulated transcriptional potential. The polymerase-associated factor complex (PAFc) is an epigenetic co-activator complex that makes direct contact with MLL fusion proteins and is involved in AML, however, its functions are not well understood. Here, we explored the transcriptional targets regulated by the PAFc that facilitate leukemia by performing RNA-sequencing after conditional loss of the PAFc subunit Cdc73. We found Cdc73 promotes expression of an early hematopoietic progenitor gene program that prevents differentiation. Among the target genes, we confirmed the protein arginine methyltransferase Prmt5 is a direct target that is positively regulated by a transcriptional unit that includes the PAFc, MLL1, HOXA9 and STAT5 in leukemic cells. We observed reduced PRMT5-mediated H4R3me2s following excision of Cdc73 placing this histone modification downstream of the PAFc and revealing a novel mechanism between the PAFc and Prmt5. Knockdown or pharmacologic inhibition of Prmt5 causes a G1 arrest and reduced proliferation resulting in extended leukemic disease latency in vivo. Overall, we demonstrate the PAFc regulates Prmt5 to facilitate leukemic progression and is a potential therapeutic target for AMLs.

Age and Gender-dependent Correlates as Risk Factors of Recurrent Headache among Bangladeshi Secondary School Children.

Magnitude of recurrent headache (RHA) is not well explored among school-children (schoolers) particularly in developing countries like Bangladesh, though recent literature reveals that RHA connotes serious public health implication(s) particularly in schoolers in resource constraint countries. To study age and gender-dependent correlates of RHA among secondary-level schoolers and to determine if these remains its risk-factors. Cross-sectional population based respondent-dependent study employing direct interviews using pre-tested open and closed-ended questionnaire following ICHD-II (2004) diagnostic criteria. Overall, 17% RHA was observed among 1499 schoolers surveyed initially, being more in pubertal/adolescents (13-15 years) than pre-pubertal (11-12 years) ones. Of screened-out 255 RHA positive cases, migraine (MHA) was observed in 55.3% while tension-type-headache (TTH) in 19.6% schoolers. RHA demonstrated a steady-inclining trend with schooler's age. Gender difference was obvious in MHA (p<0.001) but not in TTH (p<0.31). Pubertal schoolers (OR=8.75) and boys (OR=1.8) remained at greater risk for migraine but less risky for TTH. Mass-awareness program is imperative to prevent RHA among schoolers towards progressing it into chronicity, psycho-socially handicapped and economically burdened. Further in-depth studies warrant prudent data to examine its long-term risks/underlying factors involving more diverse population (school-children) from different geographical areas and cultural contexts.

Role of Oral Clonidine Premedication on Intra-operative Haemodynamics and PONV in Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy is a gold standard surgical procedure for gallbladder operation. It causes altered haemodynamic responses due to pneumoperitoneum and surgical procedure also causes high incidence of postoperative nausea &vomiting. Clonidine has been shown to reduce intraoperative haemodynamic instability. This randomized prospective single blind clinical study was designed to evaluate the efficacy of oral clonidine premedication for attenuation of haemodynamic responses associated with pneumoperitoneum & also reduce the incidence of postoperative nausea & vomiting and carried out in the department of Anaesthesia Analgesia and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to June 2010. Sixty adult patients of ASA physical status I & II scheduled for elective laparoscopic cholecystecomy were recruited for a prospective randomized single blind study. They were selected randomized into two equal groups, thirty in each group. Group A received no premedication & Group B (Clonidine) received clonidine (100µgm) orally 60 minutes before induction of anaesthesia. Pulse rate, mean arterial pressure were recorded prior to induction, 2 minutes after endotracheal intubation, before pneumoperitoneum, 10 minutes & 20 minutes after pneumoperitoneum, 10 minutes after release of carbon dioxide & 10 minutes after extubation. Patients in Group B (Clonidine) maintained greater haemodynamic stability intraoperatively compare to Group A after intubation, during pneumoperitoneum and also extubation. Pulse rate & mean arterial pressure significantly varies in Group A compare with Group B (Clonidine) at different times of intraoperative period (p<0.05). Postoperative nausea & vomiting was significantly less in Group B (Clonidine). Premedication with oral clonidine attenuates the haemodynamic responses produced by pneumoperitoneum during laparoscopic cholecystectomy and also significantly nausea and vomiting, results better patient satisfaction and cost effective.

Enzymatic hydrolysis of whey and its analysis.

An attempt was made to hydrolyze proteins and lactose in whey to improve the nutritive value of this byproduct, and extend its application as an ingredient to healthy beverages. Flavourzyme in different concentrations was used at pH 7.0 to hydrolyze protein at 50 °C. pH stat method, SDS-PAGE and RP HPLC-MS were used to evaluate degree of protein hydrolysis, pattern of peptide formation and characterize smaller peptides in hydrolysate, respectively. Higher concentration of enzymes produced more number of small peptides. Protein hydrolysate was again hydrolyzed at 30 °C with ß-galactosidase at pH 5.5 to hydrolyze lactose. HPLC analysis indicated the degree of lactose hydrolysis and number of tri/poly saccharides formed due to varied enzyme concentration. Results from the experiment can be utilized to formulate healthy whey beverages for specific purpose.

Plant Pathogenic Microbial Communication Affected by Elevated Temperature in Pectobacterium carotovorum subsp. carotovorum.

Gram-negative plant pathogenic bacteria regulate specific gene expression in a population density-dependent manner by sensing level of Acyl-Homoserine Lactone (HSL) molecules which they produce and liberate to the environment, called Quorum Sensing (QS). The production of virulence factors (extracellular enzyme viz. cellulase, pectinase, etc.) in Pectobacterium carotovorum subsp. carotovorum (Pcc) is under strong regulation of QS. The QS signal molecule, N-(3-oxohexanoyl)-L-Homoserine Lactone (OHHL) was found as the central regulatory system for the virulence factor production in Pcc and is also under strict regulation of external environmental temperature. Under seven different incubation temperatures (24, 26, 28, 30, 33, 35, and 37 °C) in laboratory condition, highest amount of OHHL (804 violacein unit) and highest (79 %) Disease Severity Index (DSI) were measured at 33 °C. The OHHL production kinetics showed accumulation of highest concentration of OHHL at late log phase of the growth but diminution in the concentration occurred during stationary phase onwards to death phase. At higher temperature (35 and 37 °C) exposure, OHHL was not at detectable range. The effect of temperature on virulence factor production is the concomitant effect of HSL production and degradation which justifies less disease severity index in cross-inoculated tomato fruits incubated at 35 and 37 °C. The nondetection of the OHHL in the elevated temperature may because of degradation as these signal molecules are quite sensitive and prone to get degraded under different physical factors. This result provides the rationale behind the highest disease severity up to certain elevated temperature and leaves opportunities for investigation on mutation, co-evolution of superior plant pathogen with more stable HSL signals-mediated pathogenesis under global warming context.

Intraguild Predation in Heteroptera: Effects of Density and Predator Identity on Dipteran Prey.

In tropical freshwaters, different species of water bugs (Heteroptera) constitute a guild sharing similar prey resources including chironomid and mosquito larvae. Assuming possibilities of intraguild predation (IGP) among the constituent members, an attempt was made to evaluate the effects of prey and predator density on the mortality of mosquito and chironomid larvae (shared prey), using Laccotrephes griseus Guérin-Méneville (Hemiptera: Nepidae) and Ranatra filiformis Fabricius (Hemiptera: Nepidae) as IG predators and Anisops bouvieri Kirkaldy (Hemiptera: Notonectidae) as IG prey. The predation on mosquito and chironomid larvae varied with the density and combinations of the predators. When present as conspecific IG predators, L. griseus exhibited greater effect on the prey mortality than R. filiformis. The effects on shared prey suggest that the two predators are not substitutable in terms of the effect on the shared prey mortality. The mortality of A. bouvieri (IG prey) at low shared prey density was significantly different (p < 0.05) from high shared prey density. In view of predatory effect of the heteropteran predators on the dipteran larvae, the results suggest possible interference by the presence of A. bouvieri as an intermediate predator. It seems that the presence of heteropteran predators including A. bouvieri as IG prey may benefit the dipteran prey under situations when the density is low in tropical waters. The intensity of the predatory effect may differ based on the species composition at IG predator level. For mosquito biological control, the interactions between the predators may not be substitutable and are independent in their effects.

PRIMA-1Met induces apoptosis in Waldenström's Macroglobulinemia cells independent of p53.

PRIMA-1Met has shown promising preclinical activity in various cancer types. However, its effect on Waldenström's Macroglobulinemia (WM) cells as well as its exact mechanism of action is still elusive. In this study, we evaluated the anti- tumor activity of PRIMA-1Met alone and in combination with dexamethasone or bortezomib in WM cell lines and primary samples. Treatment of WM cells with PRIMA-1Met resulted in induction of apoptosis, inhibition of migration and suppression of colony formation. Upon PRIMA-1Met treatment, p73 was upregulated and Bcl-xL was down-regulated while no significant change in expression of p53 was observed. Furthermore, siRNA knockdown of p53 in WM cell line did not influence the PRIMA-1Met-induced apoptotic response whereas silencing of p73 inhibited latter response in WM cells. Importantly, combined treatment of BCWM-1 cells with PRIMA-1Met and dexamethasone or bortezomib induced synergistic reduction in cell survival. Our study provides insights into the mechanisms of anti-WM activity of PRIMA-1Met and supports further clinical evaluation of PRIMA-1Met as a potential novel therapeutic intervention in WM.

Urinary tuberculosis presented as isolated bladder lesion - a case report.

Extra-pulmonary Tuberculosis (EPTB) may affect all organs of the body with varied presentations. Genitourinary tuberculosis (GUTB) carries importance for its morbidity, though it is an uncommon form of TB. A widow of 45 years was admitted with several episodes of painless haematuria and recently developed urinary incontinence. Diagnosis of urinary bladder tuberculosis was made only by histopathology from bladder lesion with supportive evidence of few nonspecific constitutional symptoms and positive family history of pulmonary tuberculosis (PTB) and persistent sterile pyuria. Upper urinary tract involvement was not found. Category 1 anti-TB treatment was started. With this treatment recovery of the patient is satisfactory and symptoms are disappearing except for the incontinence. Urinary tuberculosis should be ruled out in a case of painless haematuria, repeated sterile pyuria.

Prey preferences of aquatic insects: potential implications for the regulation of wetland mosquitoes.

Wetlands are potential sites for mosquito breeding and are thus important in the context of public health. The use of chemical and microbial controls is constrained in wetlands in view of their potential impact on the diverse biota. Biological control using generalist aquatic insects can be effective, provided a preference for mosquito larvae is exhibited. The mosquito prey preferences of water bugs and larvae of odonate species were evaluated using chironomid larvae, fish fingerlings and tadpoles as alternative prey. Manly's selectivity (αi ) values with 95% confidence intervals (CIs) were estimated to judge prey preference patterns. Multivariate analysis of variance (manova) and standardized canonical coefficients were used to test the effects of density on prey selectivity. The αi values indicated a significant preference (P < 0.05) in all of the insect predators tested for mosquito larvae over the alternative prey as a density-dependent function. On a comparative scale, chironomid larvae had the highest impact as alternative prey. In a multiple-prey experiment, predators showed a similar pattern of preference for mosquito larvae over alternative prey, reflecting a significant (P < 0.05) niche overlap. The results suggest that, in a laboratory setting, these insect predators can effectively reduce mosquito density in the presence of multiple alternative prey.

Congenital stenosis in the descending colon causing intestinal obstruction in a one and half years male child.

A one and half years male child presented with constipation with severe colicky abdominal pain, bilious vomiting & abdominal distension. He had history of recurrent bouts of constipation followed by gastroenteritis since birth for which he had taken symptomatic treatment & sometimes remained symptom free but he had no other significant history or associated condition. In laboratory investigations, barium enema study of large gut result simulates to Hirschsprung's disease but suction rectal biopsy revealed normal rectal tissue texture. So, consideration of diagnostic tools along with patient's general condition decision was taken for diagnostic laparotomy & peroperatively the child was diagnosed as a case of intestinal obstruction due to congenital colonic stenosis in the descending colon. After resection of stenotic segment and end to end anastomosis, histopathologycal examination of resected stenosed colon was done & it was finally proved as congenital stenosis in the descending colon. The post operative period of the patient was uneventful and he was discharged on 7th postoperative day & followed up upto 6 months. He had been found alright without any complain. Here we tried to high light that the congenital colonic stenosis as a rare, but might be a possible cause of partial/complete intestinal obstruction from newborn to older children in any part of the colon & that should kept in mind for avoiding diagnostic dilemma & proper management of patient.

Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia.

Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ≥2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial.

Congenital duodenal web (wind-soak variety) in the fourth part of the duodenum causing obstruction in a female child.

Delayed presentation of Duodenal Obstruction is a great diagnostic dilemma due to non-specific, varied & wide spectrum presentation. In this study, a 6 years female child presented with recurrent, intermittent, colicky abdominal pain with bilious vomiting, and occasional constipation from 9 months of her age, without having any significant family history or associated condition. She was initially diagnosed as a case of recurrent small bowel obstruction due to atypical variant of malrotation. But, after laparotomy, she was finally diagnosed as a case of recurrent duodenal obstruction due to Congenital Duodenal Web (Wind-Soak Variety) with a central hole in the fourth part of the duodenum. After uneventful recovery of post operative period the patient was discharged at 7th postoperative day & followed up upto 3 months. She had been found alright without any complication.

Congenital urogenital sinus anomaly without Adrenal Hyperplasia.

Urogenital sinus anomaly is a mal-development of female urogenital system, usually associated with Congenital Adrenal Hyperplasia and may varied in presentation according to embryologic separation and length of sharing of common channel between vagina and urethra. We report a case of pure urogenital sinus anomaly of 2.5 years female child without any feature of Congenital Adrenal Hyperplasia or any other associated anomalies which is quite uncommon. The patient was diagnosed with thorough physical, biochemical, radiological and endoscopic evaluation. She had clitiromegaly, very poorly developed fused Labia minoras with a central hole, the length of common channel was about 2.5 cm and the level of vaginal confluence was at the mid portion of common channel. After in general counseling to parents, according to their desire she was operated. We performed Labialo-clitoro-vagino-urothroplasty and from post operative period to till now (after 3 months of operation) she is uneventful. Both functionally and cosmetically she is sound and her parents are also happy.

Laparoscopic versus open pyloromyotomy for infantile hypertropic pyloric stenosis: an early experience.

This prospective comparative study was conducted with an initial experience in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital during the period of December 2007 to January 2009, with the infants of 2-12 weeks age, diagnosed as Hypertrophic pyloric stenosis. Patients selection was done by simple random technique by means of lottery. For open pyloromyotomy conventional method & for laparoscopic pyloromyotomy three trocher techniques was applied. In this study, among 60 cases with infantile hypertrophic pyloric stenosis, 30 cases were finally selected for analysis irrespectively both in laparoscopic (Group A) & in open pyloromyotomy (Group B) group. Patients were studied under variables of operative time, required time of full feeds after operation, post operative hospital stay & both per and post operative complications. Regarding operative time, in Group A, mean±SD operating time (in minutes) was 61.59±51.73 whereas in Group B it was 28.33±8.40 & P value was 0.001. The result was statistically significant. The mean±SD time (in hours) of full feeds (ad libitum) was 35.00±31.70 hours in Group A compared to 28.95±10.99 hours in Group B and P value was found 0.342ns which was not statistically significant. On study of total length (in days) of post operative hospital stay, mean±SD was 3.09±2.25 & 2.58±1.15days in laparoscopic group & open pyloromyotomy group respectively. The p value was 0.355ns, which was statistically insignificant. Again, on study of complications, per operatively 6(19.5%) patients had developed haemorrage, 1(3.33%) had mucosal perforation & 4(13.36%) had developed duodenal serosal injury in laparoscopic group whereas only 1(3.33%) patient in open pyloromyotomy group had nothing else except simple hemorrhage. The p value (0.051ns) was also statistically insignificant. In regard to post operative complications, 2(6.6%) patients had developed wound hematoma, 2(6.6%) had wound infection, 1(3.33 %) had developed wound dehiscence and incisional hernia respectively in Group A. But in group B there was no subject with any complication. This result was also statistically insignificant. So, the overall study results denote that, laparoscopic pyloromyotomy would not be considered as a superior procedure or as safe as that of traditional open pyloromyotomy for the beginners.

Non-Hodgkin's lymphoma is a pathological lead point causing large gut (colo-colic varity) intussusception.

Intussusception secondary to Primary Non-Hodgkin lymphoma presenting colo-colic variety is a very rare clinical entity and sometimes causing diagnostic dilemma due to non-specific, varied & wide spectrum presentation. In this study, a 9 years female child presented with recurrent, intermittent, colicky abdominal pain with occasional bilious vomiting, along with a left illiac fossa swelling & occasional per rectal bleeding and constipation for 3 months was clinically diagnosed as a case of recurrent obstructing intussusception. At laparotomy, a colo-colic intussusception with prolapsed intussusception was marked & finally on histopathology, she was diagnosed as a case of colo-colic variety of intussusception due to primary Non-Hodgkin lymphoma- a pathological lead point in mid transverse colon. After uneventful recovery of post operative period she was treated with combination chemotherapy accordingly & follow up was given up to 5 years. She had been found alright without any recurrence or organ involvement. The study focused on the avoidance of unusual delay in diagnosis as well as in proper management of rare variants of intussusception.