Oral health assessment of epilepsy patients from a tertiary hospital in Asia.

INTRODUCTION: Oral health problems are frequently overlooked in patients with epilepsy. We evaluate the oral health status of epilepsy patients from a tertiary teaching hospital. MATERIALS AND METHODS: We conducted a cross-sectional study of epilepsy patients from the neurology clinic, Hospital Canselor Tuanku Muhriz, Kuala Lumpur. The dental assessment included the decayed, missing and filled teeth (DMFT) criteria, as well as the plaque and periodontal status by dentists. RESULTS: A total of 151 patients were recruited. The median age of onset of epilepsy was 16 (IQR 7-30) years, with generalised seizures at 59.6% and focal seizures in 40.4% of patients. Fair or poor oral health was present in 59 (39.1%) and gingivitis was seen in 65 (43%). The median DMFT decayed (D), missing (M) and filled teeth (FT) was 3 (IQR 1- 7). The median age of patients with fair or poor oral health was older (40 years, IQR 31-51) than the patients with excellent or good oral health (33 years, IQR 26-45), (p=0.014). Multivariate logistic regression analysis showed that carbamazepine (Odds Ratios, OR: 3.694; 95% Confidence Intervals, 95%CI: 1.314, 10.384) and hypertension (OR 6.484; 95%CI: 1.011, 41.594) are the risk factors for fair or poor oral health. Phenytoin use is 4.271 times more likely to develop gingivitis (OR 4.271; 95% CI: 1.252, 14.573). CONCLUSION: Factors that contribute to fair or poor oral health include age, antiseizure medications like phenytoin and carbamazepine, and hypertension. Effective preventive strategies should be implemented to maintain oral health in epilepsy patients.

Molecular regulation of mitochondrial dynamics in cardiac disease.

Mitochondrial homeostasis is critical for keeping functional heart in response to metabolic or environmental stresses. Mitochondrial fission and fusion (mitochondrial dynamics) play essential roles in maintaining mitochondrial homeostasis, defects in mitochondrial dynamics lead to cardiac diseases such as ischemia-reperfusion injury (IRI), heart failure and diabetic cardiomyopathy. Mitochondrial dynamics is determined by mitochondrial fission and fusion proteins, including OPA1, mitofusins and Drp1. These proteins are tightly regulated by a series of signaling pathways through different aspects such as transcription, post translation modifications (PTMs) and proteasome-dependent protein degradation. By modulating these mitochondrial fission and fusion proteins, mitochondria fine-tune their metabolic status to meet the energy demands of the heart. Moreover, these mitochondrial fission and fusion proteins are essential for mediating mitochondrial autophagy (mitophagy), leading to clearance of damaged mitochondria to maintain a healthy population of mitochondria in heart under stressed conditions. Mitochondrial dynamics dependent improvement in mitochondrial metabolism and quality could partially reverse the pathological conditions of heart. This review describes an overview of mechanisms on mitochondrial dynamics regulation and provides potential therapeutic targets for treating cardiovascular diseases.

Processable dodecylbenzene sulfonic acid (DBSA) doped poly(N-vinyl carbazole)-poly(pyrrole) for optoelectronic applications.

A soluble poly (n-vinyl carbazole)-polypyrrole (PNVC-Ppy) copolymer was prepared through oxidative chemical polymerization wherein dodecyl benzene sulfonic acid (DBSA) was used as a dopant to facilitate polymer-organic solvent interaction and ammonium persulfate (APS) was used as an oxidant. Compared with undoped PNVC-Ppy, the DBSA-doped PNVC-Ppy copolymer showed higher solubility in some selected organic solvents. The composition and structural characteristics of the DBSA-doped PNVC-Ppy were determined by Fourier transform infrared, ultraviolet-visible, and X-ray diffraction spectroscopic methods. Field emission scanning electron microscopic method was employed to observe the morphology of the DBSA-doped PNVC-Ppy copolymer. The electrical conductivity of the DBSA-doped PNVC-Ppy copolymer was measured at room temperature. The conductivity increased with increasing concentration of APS oxidant, and the highest conductivity was recorded at 0.004 mol/dm3 APS at a polymerization temperature of -5 °C. The increased conductivity can be explained by the extended half-life of pyrrole free radical at a lower temperature and a gradual increase in chain length over a prolonged time due to the slow addition of APS. Furthermore, the obtained soluble copolymer exhibits unique optical and thermal properties different from those of PNVC and Ppy.

Comparative Efficacy of Local Steroid and Therapeutic Ultrasound for Quicker Functional Improvement in Tennis Elbow.

Lateral epicondylitis or Tennis elbow is very common repetitive stress injury or cumulative trauma disorder among active professionals and tennis players. Local steroid injection can provide quick functional improvement as sought by most of the patients. Therapeutic ultrasound and eccentric exercises can also improve the function. This study was carried out to see the comparative efficacy of these two modalities of treatments in terms of quicker functional improvement and this randomized interventional clinical trial was carried out in a private rehabilitation hospital in Dhaka. Patients attended the authors private chamber from January 2013 to December 2013 with clinical diagnosis of tennis elbow were included. Eighty adult patients diagnosed as lateral epicondylitis or tennis elbow were randomly divided into two groups. Group A received local steroid injection (triamcinolone acetate) and group B received therapeutic ultrasound for two weeks. Both the groups received eccentric exercises and advised to avoid provocative activities like twisting and lifting activities. Pain, tenderness and functional improvements were measured in traditional methods like visual analogue scale (VAS) and tenderness grade 0 to 4. Data were analyzed by SPSS. Most of the patients were female. None of them were tennis player. Younger housewives were common sufferer. Almost all patients in group A had very little or no pain or tenderness and no difficulty in lifting object at one week and two weeks. VAS was 13.62±6.503 and 4.15±5.517 respectively. Group B patients had mild improvement of pain and function at one week and moderate improvement at two weeks. VAS was 52.57±7.80 and 25.57±5.392 respectively. Similarly tenderness' were markedly improved in Group A at one and two weeks. They were 0.68±0.616 and 0.02±0.405 respectively for Group A and 1.60±0.553 and 1.14±0.335 respectively for Group B. Results were statistically significant in both groups at the end of two weeks. Local corticosteroid injections at extensor origin in tennis elbow patients are found to have better relief of pain and tenderness and quicker functional improvement than therapeutic ultrasound treatment. None of the patients were followed up for long term efficacy in either group.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome.

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

Large adrenal leiomyoma presented as adrenal incidentaloma in an AIDS patient: A rare entity.

The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.

Assessing the Rehabilitation of Achilles Tendon Ruptures using Modified Teuffer and Lindholm Technique.

The aim of this study is to assess the optimum rehabilitation and the functional outcome of open repaired Achilles tendon ruptures. This study was conducted for the 18 consecutive patients of complete ruptures at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 2012 to 2013. Two groups were considered during 6 to 18 months post-operative observation and each group consist 9 patients. In the Group I, modified Teuffer's and in Group II, Lindholm operative methods were employed for the open repair of Achille tendon. The post operative outcomes were assessed for both of the groups through the modified Thermann's scores. In this study the patients median age was seen 39 years with 72.2% male and 27.8% female. The Thompson test was found positive in pre-operative and negative in post-operative outcome. The results shown that Achilles tendon ruptures occurred in 4 to 6cm rupture site, where the rupture side was 61.1% left and 38.9% right. The subjective overall assessment of total Thermann's scores were found very good (91 to 96) in 4 cases and (90 to 98) in 3 cases for Group I and Group II, respectively. Both of the operative techniques were found accountable results for rehabilitation. Therefore, based on the further statistical evidence of higher correlations and errors it may be concluded that Achilles tendon ruptures can be treated by modified Teuffer's or Lindholm technique.

Klippel Trenaunay Syndrome: A Case Report.

Klippel Trenaunay syndrome refers to a rare congenital anomaly which is characterized by capillary malformation, venous malformation and sometimes lymphatic malformation associated with overgrowth of a limb, with soft tissue hypertrophy and/or bony hypertrophy. The anomaly, if present, is present at birth and usually involves the lower limbs as well as portion of trunk, face, uppper limb or head. Our reporting case is a preterm male neonate having port wine stain, varicose veins and excessive growth of soft tissue of left lower limb clinically consistent with Klippel Trenaunay Syndrome.

Mesoblastic Nephroma in a 22 Years Old Woman.

Mesoblastic nephroma is an uncommon renal tumor of infancy and rarely occurs in adults. We report a case of mesoblastic nephroma in adult. A 22-year-old woman, who presented with left flank pain, was found to have a left renal mass by abdominal ultrasonography. Computed tomography revealed a heterogeneous tumor. Left radical nephrectomy was performed. The tumor was a creamy white solid mass. Microscopically, the tumor was composed of spindle cell proliferation. Atypia and mitoses were not identified. Among the tumor cells, there were tubular arranged epithelial elements. The patient was free of recurrence 18 months postoperatively. Mesoblastic nephroma is classified as a benign tumor but recurrence and malignant transformation of this tumor have been reported, so regular postoperative follow up is required.

Genetic testing for spinocerebellar ataxias in patients diagnosed as Parkinson's disease in Bangladesh.

This study was conducted to find out Spinocerebellar Ataxias (SCA) by genetic analysis from those patients presenting with Parkinsonism in the Neurology department of Mymensingh Medical College Hospital, Bangladesh. A sample of about 5ml blood was collected by venipuncture in EDTA tube after having informed consent from each patients and healthy individual, with due Institutional Ethical committee approval for genetic study of 7 healthy people and 9 patients. The neurological disorder along with a complete physical and/or psychological, as well as family history and demographic data was recorded with a prescribed questionnaire by the neurologists of Mymensingh Medical College Hospital. Extraction of genomic DNA from the venous blood using Flexi Gene DNA kit (Qiagen, Japan) was performed in Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh. The extracted DNA was stored, accumulated and then were sent to Division of Clinical Genetics, Department of Medical Genetics, Osaka University Medical School, Suita, Osaka 565 0871, Japan for PCR and further analysis. PCR amplification of the CAG repeat was performed for the SCA1, SCA2, SCA3, SCA6 loci using primers SCA1N-F1 and SCA1N-R1, SCA2-F1 and SCA2-R1, MJDF1 and MJDR1, SCA6-F1 and SCA6-R1, respectively. SCA1 PCR of both healthy individual and suspected Parkinsons Disease (PD) patients DNA was found 250 bp (no. of CAG repeats=36). SCA2 PCR products reveal the DNA products of about 150 bp (no. of CAG repeats=23) except one patient that was suspected and it was sequenced and revealed 175bp (no. of CAG repeats=30). SCA3 PCR product size of both healthy individual and patient DNA was within 250 (no. of CAG repeats=11) to 300 bp (no. of CAG repeats=28) except one patient which was about 320 bp and its CAG repeats was about 34. SCA6 PCR product size of both healthy individual and patient DNA was about 150 bp (no. of CAG repeats=16).

Analgesic and antidepressant activities of Brassica rapa subspecies chinensis (L.) Hanelt on Swiss-albino mice model.

Bangladesh being a subtropical country provides varieties of herbs and vegetables. Brassica is a broad genus available in Bangladesh and it encompasses a lot of nutritive herbs. Among these, Brassica rapa subspecies chinensis (L.) Hanelt (Family-Brassicaceae) is popular in many parts of the world. In the quest of medicinal property, this plant was investigated here for observing analgesic and antidepressant activities in Swiss-albino mice model. The herb was extracted well with methanol and then assayed by acetic acid-induced writhing and tail immersion methods for analgesic action. Besides, thiopental sodium induced sleeping time test, tail suspension test and forced swim test were conducted for the evaluation of its antidepressant activity. The plant extract was orally administered to the mice at 200 and 400 mg/kg body weight and it exhibited significant analgesic and antidepressant activities in compare to the controlled groups. This is the first time comprehensive report for analgesic and antidepressant activities of this plant.

Defending the fort: a role for defensin-2 in limiting Rickettsia montanensis infection of Dermacentor variabilis.

The importance of tick defensins is evidenced by their expression in a wide variety of tick tissues and prevalence across many tick genera. To date, the functional and biological significance of defensin-2 as a rickettsiastatic or rickettsiacidal antimicrobial peptide has not been addressed. In a previous study, defensin-2 transcription was shown to increase in Dermacentor variabilis ticks challenged with Rickettsia montanensis. In the present study, the hypothesis that defensin-2 is functional as a rickettsiastatic and/or rickettsiacidal antimicrobial peptide is tested. We show that defensin-2 plays a role in reducing burden after acquisition of Rickettsia montanensis through capillary feeding. Moreover, defensin-2 is shown to associate with R. montanensis in vitro and in vivo, causing cytoplasmic leakiness.

Comparative efficacy of pregabalin and therapeutic ultrasound versus therapeutic ultrasound alone on patients with post stroke shoulder pain.

The study was designed to compare the efficacy of pregabalin, an anticonvulsant on pain behavior of stroke patients with shoulder pain in a comparative study with ultrasound therapy and ultimately to recommend a better treatment option to improve pain and function in post stroke shoulder pain. This study was carried out in a private neurology Hospital in Dhaka during January to December 2010. Data were collected from 70 post stroke patients with shoulder pain and were divided into two groups. The patients in Group A were treated with pregabalin 100mg twice daily along with therapeutic ultrasound 10 minutes daily and group B were treated with therapeutic ultrasound alone for the same dose and duration. Pain free range of motion exercise was given to both groups as the therapeutic exercise. Pain parameters in the form of VAS were measured at one and two weeks and were compared. Seventy one percent of the patients were male with 80% were above 60 years old. Pain scoring in VAS of 100 was 21.32±6.01 in group A and 41±4.58 in groups B at the end of two weeks assuming the pretreatment VAS of all patients as 100. Marked improvement in shoulder pain were observed in both groups and Group A had better improvement in pain than group B. Therapeutic ultrasound when given with pregabalin found to have added benefit over therapeutic ultrasound alone in post stroke shoulder pain. Differences were statistically significant.

Modification of structural, morphological, and dielectric properties of barium calcium titanate ceramics with yttrium addition.

Barium calcium titanate (BCT) ceramics with varying yttrium doping concentrations were fabricated using the solid-state compaction process to explore the attributes of dopants. (Ba0.75Ca0.25) TiO3 and (Ba0.75Ca0.25) (YyTi(1-y)) O3 where, y = 0.00, 0.10, 0.15, and 0.20 ceramics were synthesized by pressing isostatically in pellet press apparatus, then sintered at 1250 °C with consequent cooling in furnace ambient. The structural, morphological, and dielectric properties were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), and impedance spectroscopy interpretations, respectively. The XRD analysis revealed that the cubic BCT lattice was transformed into a tetragonal structure with Yttrium doping. Scanning electron microscopy (SEM) disclosed that yttrium doping countered the liquid phase formation of BCT as well as influenced grain development and microstructure, leading to the formation of distinct grain boundaries and improved densification. The average grain size (18-29 nm) of the Y-BCT increases as the doping level rises. At 60 Hz, it was reported that the dielectric constant obtained a maximum value of 70000 with a resistivity of 5 × 108 Ώ-cm for y = 0.15. The manifestation of the secondary phase confirmed from XRD, allocating an easy path for oxygen migration, might be responsible for the rise in oxygen vacancy, higher leakage current, and dielectric loss for y = 0.01. Co-doping of calcium and yttrium in BCT ceramics has modified the basic structure and ameliorated composites' structural stability and dielectric characteristics. The optimized sample, upon demonstrating outstanding efficiency, ought to be employed for specific uses such as energy storage devices and capacitors.

Innovative approaches for augmenting dielectric properties in cross-linked polyethylene (XLPE): A review.

Throughout the history of power systems, power cables have been used to securely and efficiently distribute electrical energy to the destined locations. Cross-linked polyethylene (XLPE), a commonly used insulator in high-voltage cables, have several desirable properties, such as low dielectric loss, high dielectric constant, high thermal conductivity, enhanced thermal stability, and superior resistance against electrical stress. However, further improvements of XLPE's performance are needed. The incorporation of large specific surface area nanoparticles, such as boron nitride nanosheets and graphene oxide, exhibited a great potential in enhancing XLPE's properties. These nanoparticles create numerous trapping sites, even at small loading levels, due to their large interfacial regions. In addition, voltage stabilisers with polar groups can scavenge high-energy electrons generated by local electric fields, thereby inhibiting the electrical tree growth. Another important aspect of enhancing XLPE's dielectric performance is the inclusion of antioxidants with phenolic groups. These antioxidants react with peroxyl radicals, mitigating their harmful effects. This review summarises the effects of nanoparticles, voltage stabilisers, antioxidants, and polymer amalgamation on dielectric performance of XLPE as an insulation material. The major challenges in dielectric insulation such as breakdown voltage strength, electrical tree growth, structural defect, space charge accumulation, and thermal aging are addressed.

Long-term exposure to particulate matter and all-cause and cause-specific mortality in an analysis of multiple Asian cohorts.

BACKGROUND: Exposure to ambient air pollution is associated with a significant number of deaths. Much of the evidence associating air pollution with adverse effects is from North American and Europe, partially due to incomplete data in other regions limiting location specific examinations. The aim of the current paper is to leverage satellite derived air quality data to examine the relationship between ambient particulate matter and all-cause and cause-specific mortality in Asia. METHODS: Six cohorts from the Asia Cohort Consortium provided residential information for participants, recruited between 1991 and 2008, across six countries (Bangladesh, India, Iran, Japan, South Korea, and Taiwan). Ambient particulate material (PM2·5) levels for the year of enrolment (or 1998 if enrolled earlier) were assigned utilizing satellite and sensor-based maps. Cox proportional models were used to examine the association between ambient air pollution and all-cause and cause-specific mortality (all cancer, lung cancer, cardiovascular and lung disease). Models were additionally adjusted for urbanicity (representing urban and built characteristics) and stratified by smoking status in secondary analyses. Country-specific findings were pooled via random-effects meta-analysis. FINDINGS: More than 300,000 participants across six cohorts were included, representing more than 4-million-person years. A positive relationship was observed between a 5 µg/m (Dockery et al., 1993) increase in PM2·5 and cardiovascular mortality (HR: 1·06, 95 % CI: 0.99, 1·13). The additional adjustment for urbanicity resulted in increased associations between PM2.5 and mortality outcomes, including all-cause mortality (1·04, 95 % CI: 0·97, 1·11). Results were generally similar regardless of whether one was a current, never, or ex-smoker. INTERPRETATION: Using satellite and remote sensing technology we showed that associations between PM2.5 and all-cause and cause-specific Hazard Ratios estimated are similar to those reported for U.S. and European cohorts. FUNDING: This project was supported by the Health Effects Institute. Grant number #4963-RFA/18-5. Specific funding support for individual cohorts is described in the Acknowledgements.

Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study.

BACKGROUND: Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time. METHOD: A prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data. RESULTS: Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100,000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15-44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually. CONCLUSIONS: The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.

Sexual and urinary outcome after surgical treatment for low rectal cancer.

Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. This study was designed to observe the sexual and urinary dysfunction in both sexes of the patients suffering from cancer of the lower third of the rectum managed by surgical intervention with preservation of sphincter. A comparative study was carried out on 54 patients with low rectal cancer who underwent ultra-low anterior resection in the department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January, 2009 to December, 2010. Patients were divided into two groups depending on the tumor distance from anal verge. Thirty one (57%) patients were in Group A (Experimental) where tumor distance was 5cm from anal verge and upper 1cm of anal sphincter was sacrificed during surgical intervention. Twenty three (43%) patients were in Group B (Control) where tumor distance was 6cm from anal verge and whole length (4cm) of anal sphincter was preserved during surgical intervention. The mean±SD age of the patients was 45.96±14.41 years. During surgery, ultra low anterior resection was performed to remove the tumor in all patients and for anastomosis double stapling technique was performed in 52(96%) patients and hand sewn technique was performed in 2(4%) patients irrespective of tumor distance from anal verge. Covering ileostomy was fashioned in all but one patient. During post-operative follow up Sexual activity in both groups of male patients (Potency, P=0.17; ejaculation; satisfaction and loss of libido, P=0.15) and in female patients (Satisfaction and loss of libido, P=0.15) was not significantly hampered following surgery. Urinary function was assessed by incontinence, increased frequency (P=0.54) and retention (n=0) which were not impaired significantly following surgery. Sexual and urinary function was not significantly impaired in both sexes after low rectal cancer surgery. Sphincter saving surgery can be performed in a very low rectal cancer with preservation of anal sphincter.

Sphincter saving surgery is the standard procedure for treatment of low rectal cancer.

Carcinoma rectum is a challenging problem both for the developed and underdeveloped countries. Colorectal cancer accounts for 9% of all cancer deaths (49,920) in 2009 in USA. Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. To observe the objective, subjective and functional outcome of the patients suffering from cancer of the lower third of the rectum managed by surgical intervention with preservation of sphincter. A comparative study was carried out on 54 patients with low rectal cancer who underwent ultra-low anterior resection in the department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2009 to December 2010. Patients were divided into two groups depending on the tumor distance from anal verge. Thirty one (57%) patients were in Group A (Experimental) where tumor distance was 5cm from anal verge and upper 1cm of anal sphincter was sacrificed during surgical intervention. Twenty three (43%) patients were in Group B (Control) where tumor distance was 6cm from anal verge and whole length (4cm) of anal sphincter was preserved during surgical intervention. Functional integrity of anal sphincter was assessed between these two groups of patients following surgery. The mean age of the patients was 45.96±14.41 years. During surgery, ultra low anterior resection was performed to remove the tumor in all patients and for anastomosis double stapling technique was performed in 52(96%) patients and hand sewn technique was performed in 2(4%) patients irrespective of tumor distance from anal verge. Covering ileostomy was fashioned in all but one patient. During post-operative follow up anal sphincter muscle tone, anal sphincter function (Anal continence, p = 0.54), Quality of life (Social life, p = 0.54; Professional life, p = 0.23; House work and Need a diaper, p = 0.54) were not significantly impaired in both groups. Functional outcome of anal sphincter muscle and quality of life was not impaired in comparison to general population after low rectal cancer surgery.

Traumatic gut injury: a study of 100 cases in Mymensingh Medical College Hospital.

This study was done to find out the mode of presentations, management options and the factors which dictate the out-come of the patients with traumatic gut injury. It has been carried out in the department of Surgery, Mymensingh Medical College Hospital in 100 patients with traumatic gut injury from January 2009 to December 2010. Most of the patients were within 21-30 years (47%) and male patients were the predominant group (90%). In this study penetrating injury was more common (57%) than non-penetrating (43%) injury as a cause of gut injury. Stab (64.91%) was the main mechanism of penetrating abdominal trauma; while road traffic (58.14%) was the main mechanism of non-penetrating abdominal trauma. Diagnosis was made on clinical presentation, physical examination and some investigations. Abdominal pain (98%) was the chief complain and chief sign was abdominal tenderness (98%) and absent bowel sound (91%). Small gut injury was present in 71% patients, 20% patients had large gut injury and 9% had both gut injury. In small gut, jejunum (49.29%) was the most vulnerable portion and right sided colon (55%) was the most affected portion in large gut trauma. Spectrum of injury in small gut included single perforation (63%), multiple perforations (23%), laceration (11%) and devascularization (3%) injury. Primary repair in 60.87%, resection & anastomosis in 27.54% and resection anastomosis with proximal diversion in 11.59% patients were done in small gut injury. Injuries in the large gut were classified into three categories according to Flint Colon Injury Severity Scoring. Highest incidence was in Grade I (60%) category, second in Grade II (35%) and Grade III (5%) was the third one. Simple primary repair in 40%, primary repair or resection anastomosis with proximal diversion in 30%, loop ileostomy in 20% and Hartman's procedure in 10% were done in patients of large gut injury. Resection anastomosis with proximal diversion was performed in patients of both small and large gut injury. Outcome of management was quiet acceptable with 47% of patients having uneventful recovery. Delayed presentation, delayed definitive management, haemodynamically unstable patient, site and number of injuries in the gut were the crucial factor for the overall 44% morbidities of this series. Morbidity rate was 9%. More than half of the patients (56.04%) discharged from the hospital within 10 days. Only a few patients could be followed up for a few months after surgery, who reported to have a satisfactory outcome with no morbidity.