Bangladesh Medical Research Council Bulletin (Vol. 47, No. 02, 2021)

Abstract

Background: Weighting of national survey data enables the sample to be more representative of the target population. Weighting procedure is a thorough exercise and yields several types of weights. However, considerable variation exists among authors on which weight to use leaving the researchers baffled. As a result, survey data are often used by researchers without the weights leading to erroneous conclusions. In addition, despite availability of powerful yet costly statistical software•• researchers from developing countries are mostly unable to use those due to high cost. In this article, we share our experience on weighting for recent national surveys in Bangladesh using Microsoft Excel.

Objectives: Overall objective was to perform sample weighting of a national survey of Bangladesh using Excel. As specific objective, the study was aimed at creating different weighting variables, describe their features and identify the appropriate weight to be used for analysis.

Methods: We generated four types of weights: the base weight calculated from probabilities of selection, and non-response adjusted, population calibration adjusted, and trimmed weights. We compared the distribution of the population by sex and age by unweighted and four types of weighted numbers. Finally, we calculated weighted means, medians, ranges, standard errors, confidence intervals, variances, multiplicative effects and design effects with these four weights. In addition, we compared the weighted prevalence of a key variable of the survey using these four weights.

Results: We compared unweighted distribution with weighted ones and identified that weighting makes the sample distribution to conform to the target population. Among the four calculated weights, the trimmed weight had narrow standard error and variance, and smallest design and multiplicative effects. It yielded an acceptable prevalence and distribution of prevalence of mental disorder.

Conclusion: Among the four weights, we show that the trimmed weight met all parameters of good quality and precision. We performed this complex exercise using Microsoft Excel which is largely available to researchers in Bangladesh. Therefore, we recommend using the trimmed weight for national level surveys in Bangladesh in a similar context.

Keywords: Weighting, Base weight, Population calibration, Trimming

Abstract

Background: Malnutrition among under-five children is one of the paramount public health concerns in the country.

Objectives: This study aimed to determine the relationship between under-five nutritional status and household dietary diversity (HDD) and household food security (HFS).

Methods: In this cross-sectional study analysed 808 under-five children’s data from 50 villages in five divisions of Sarawak using a multistage cluster sampling technique. Data were collected by face-to-face interview using interviewer-administered questionnaires. WHO Anthro version 3.2.2 was used for anthropometric, and IBM SPSS version 22.0 was used for multivariate data analysis.

Results: Multivariate analysis showed that children with low HDD were 1.68 times more likely to be stunted than those with high HDD. Children from households with food insecurity but without hunger were 3.86 times and with hunger were 4.02 times likely to be wasted in the last three months and were almost six times more likely to stunted at the same time. The likelihood of being underweight was 2.86 times more likely to occur in households with food insecurity without hunger and 4.89 times in food insecurity with hunger households. In the past 12 months, children from households with food insecurity with hunger were 8.56 times and four times more likely to be stunted with food insecurity without hunger. Underweight children had twice the odds of occurring in households with food insecurity without hunger compared with food secured households. HFS in the last three months had a significant association with wasting, stunting and underweight of the children, while HFS in the last 12 months was associated with stunting and underweight children.

Conclusion: Low HDD had resulted in stunting, and food insecurity had resulted in wasting, stunting and underweight in under-five Dayak children in rural areas of Sarawak. A food-based intervention programme should be undertaken for malnourished children.

Keywords: Stunting, Dietary diversity, Food security, Sarawak

Abstract

Background: Diagnosis is a key determinant for any disease outcome. For that, we want to find out in which stage a breast cancer patient got admitted in hospital including various methods of laboratory investigations were done at different visits.

Objectives: This study was aimed to generate information on the stages that a breast cancer patient got admitted including various methods of laboratory investigations were done at different visits.

Methodology: We conducted a cross sectional study at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2017-June 2018. We randomly selected a total of 200 patients who came to that hospital through face-to-face interview by using pretested semi-structured questionnaire.

Results: A total 77.0% (154) patients investigated Fine Needle Aspiration Cytology (FNAC) at first visit and mean duration for diagnosis was 11 months. Maximum patients came for diagnosis at stage II, III or IV; nobody came at stage I. As consequences, we found that stage of cancer had 7 times more likely to cause diagnostic delay (OR=7.957; 95% CI 3.206-19.749) p <0.0001. Number of consultations was one of the cause for diagnostic delay (c2= 12.825, p<0.0001). Diagnostic delay had strong association between first consultation with physician versus other health care providers (c2= 17.645, p<0.0001). Excluding physicians, first consultation with health care providers also had 3 times more likely to cause delay in diagnosis (OR-3.862; 95% CI1.877-7.944) p<0.0001.

Conclusion: Breast cancer patients attended to health care provider at advanced stage. Knowledge, negative perception, social support were the contributing factor for delay in breast cancer diagnosis.

Keywords: Laboratory diagnosis, Diagnosis delay, Breast cancer, Fine needle aspiration cytology

Abstract

Background: Despite improvement in overall survival, neonatal period is not free of complications. Ventilator associated Pneumonia (VAP) is a serious complication and account for 6.8 - 32.2 % of healthcare associated infections among neonates.

Objective: The objective of the study was to document the effectiveness of an educational programme for neonatal intensive care (NICU) service provider in preventing occurrence of ventilator associated pneumonia in NICU.

Methods: It was a prospective cohort study compared with historical control taken from the hospital records. All neonates admitted to the NICU during 12 months period from May 2019 to April 2020 were enrolled. Prospective enrollment of ventilated baby after educational interventions was subjected to the VAP educational care bundle. Eligible neonates who spent more than 48 h on MV were followed up and monitored closely for the development of VAP. Detail history, thorough clinical examination, relevant investigation including chest radiography were carried out on all enrolled infants.

Results: A total of 54 neonates ventilated newborn, 41 met the inclusion criteria and were enrolled in the current study; 22 cases in pre-intervention phase and 19 cases in the post- intervention phase. Among enrolled mechanically ventilated newborn, 18 patients (18/41, 44%) developed at least single episode of VAP during the ventilated period. Baseline characteristics were comparable in both the groups. The primary indication of mechanical ventilation was sepsis related complications during both the phases (9/22, 41% and 8/19, 42.1%). Next to sepsis, perinatal asphyxia (5/22, 22.7%) was the indication of MV in pre-intervention period whereas respiratory distress syndrome (7/19, 36.8%) was the second leading causes of MV during post-intervention period. Significant reduction in VAP incidence rate was observed after implementation of VAP interventions, as 13/22, 59 % episodes of VAP were diagnosed in pre-intervention period compared to 5/19, 26.3% were diagnosed during implementation period. (p= 0.035). Non-significant reduction in mean duration of MV days was observed in the post-intervention period when compared to pre-intervention counterpart (7.23±4.48 days versus 5.16±2.77 days, p = 0.089). There was no significant reduction in NICU length of stay (13.05±8.16 versus 11.58±7.75 days in pre and post intervention period respectively, p= 0.56). The difference in overall mortality rates between the two phases were 15/22, 68.18% and 10/19, 52.63% respectively and found to be non- significant. Gram negative bacteria were the most commonly isolated micro-organisms, Acinetobacter was the leading causative pathogen.

Conclusion: It demonstrates that an educational program including bundle of infection control practice can reduce the occurrence of VAP during ventilation period. These educational programs for NICU care providers can be expanded to other NICU s of the country to prevent ventilator associated pneumonia.

Keywords: Ventilator associated pneumonia, NICU, Health care associated infection, Educational intervention

Abstract

Background: Extra-pulmonary tuberculosis often requires FNAC or biopsy of lymph node to reach a final diagnosis of tuberculous lymphadenitis, which is invasive, expensive, and needs an advanced setting. Estimation of adenosine deaminase (ADA) in different body fluid and serum has been suggested as a quick, cheap, and reliable test for tuberculosis.

Objective: The study was intended to assess the usefulness of serum ADA in the diagnosis of tuberculous lymphadenitis.

Methods: This was a cross-sectional observational study, conducted in BSMMU over a two year period and included 68 participants, divided equally into two group e.g. tuberculous lymphadenitis and a healthy comparison group. As tuberculous lymphadenitis, only newly diagnosed cases, labeled on the basis of histopathological findings of epithelioid granuloma with caseation necrosis were included. Serum ADA concentrations were estimated by enzymatic method and compared between groups.

Results: The mean serum ADA concentration was found to be 25.52±7.11 U/L in tuberculous lymphadenitis group, which was significantly higher (p=0.000) than that of the healthy comparison group (14.82±3.85 U/L). Three different cut-off values of serum ADA (18.25 U/L, 20.45 U/L, 22.15 U/L) were used to determine the best predictive value for the diagnosis of tuberculous lymphadenitis. Sensitivity and specificity of these cut off values were 91.2% and 82.4%, 79.4% and 88.2%, 67.6% and 97.1% respectively.

Conclusion: It is clearly denoted by the study that, tuberculous lymphadenitis patients has significant higher serum ADA then the healthy comparison group. This result indicates that serum ADA can be used as a useful adjunct in the diagnosis of tuberculous lymphadenitis with conventional investigations.

Keywords: Adenosine deaminase, tuberculous lymphadenitis, FNAC, BCG

Abstract

Background: Since chemical anticancer drugs are found to have adverse effect on body, nowadays people are motivated towards natural agents to treat cancer. Fruits and vegetables are potential source of natural anticancer agents that protect our body against cancer by scavenging and neutralizing free radicals.

Objective: The study was aimed to explore antioxidant and anticancer properties of methanolic extract of leaves of Hibiscus sabdariffa L. (MEHSL).

Methods: In vitro assays were used to examine the different types of phytochemical content and antioxidant properties of MEHSL. In vitro and in vivo assays were performed to study the effects of MEHSL on Ehrlich ascites carcinoma (EAC) cells. Chemical constituents were also analyzed by GC–MS.

Results: Total phenolic and flavonoid contents of MEHSL were found to be 26.23±0.30 and 131.13±1.40 mg/g of extract in terms of gallic acid and catechin equivalent, respectively. The MEHSL exhibited remarkable scavenging effect on DPPH, ABTS, nitric oxide scavenging activity and inhibition of lipid peroxidation with IC₅₀ values 6.768, 11.54, 29.84 and 17.55, respectively, compared to the positive control, catechin. In vitro cytotoxic study shows that MEHSL reduced the viability of Ehrlich ascites carcinoma (EAC) cells in dose dependent manner. In in vivo, significant inhibition of EAC cells growth and proliferation, reduction of tumor weight and increased of survival time of EAC-bearing mice were noted following by intraperitoneal MEHSL treatment at the doses of 5 and 10 mg/ kg/day (p<0.05). Moreover, the MEHSL also altered the depleted hematological parameters like RBC, WBC, and percentage of hemoglobin (Hb %) of EAC bearing mice towards normal. Furthermore, administration of MEHSL induced apoptosis of EAC cells as observed in Hoechst-33342 stained cells under fluorescence microscope. Hexadecanoic acid, methyl ester (2.845%), hexadecanoic acid (9.858%), linolenic acid methyl ester (2.142%), 9,12- -octadecadien -1-Ol (2.063), alpha-glyceryl linolenate (6.138), arachidic acid (23.280%) and phthalic acid, 6-ethyloct-3-yl 2-ethylhexyl ester (74.926%) were identified as the major constituents of MEHSL by GC-MS analysis.

Conclusion: Findings of the present study suggested that the leaves of H. sabdariffa can therefore be considered as a promising resource in cancer chemotherapy.

Keywords: Hibiscus sabdariffa, Antioxidant, Anticancer, Apoptosis

Abstract

Background: In Bangladesh, the poultry industry contributes a significant role in the food sector. A vast amount of antibiotic is used as prophylaxis and growth promotion factors in farms. These unconcerned uses of antibiotics ultimately generate resistant bacteria affecting substantial adverse consequences on human health. Extended-spectrum b-lactamase (ESBL) genes are responsible for inactivation of antibiotics containing b-lactam ring, namely, penicillin, cephalosporins, monobactams, and carbapenems.

Objectives: This study was designed to analyse the distribution of three ESBL genes and associated antimicrobial susceptibility profile of poultry gut bacteria.

Methods: This study was designed to analsze the distribution of three ESBL genes and associated antimicrobial susceptibility profile of poultry gut bacteria. Poultry feces were collected and cultured on cysteine lactose electrolyte deficient (CLED) agar and Salmonella-Shigella (SS) agar to differentiate various isolates based on colony characteristics. Identification of the isolates was made by convention biochemical tests, analytical profile index (API-20E), and 16S rRNA sequence analysis. Antibiotic susceptibility test was done by disc diffusion method using 17 antibiotics from seven groups. Subsequently, polymerase chain reaction (PCR) was employed with a specific primer to identify respective ESBL genes (blaTEM, blaSHV, blaOXA). All data were analysed by SPSS.

Results: A total of 113 isolates were identified from 85 poultry feces tested. Most of the bacteria belonged to Enterobacteriaceae family, notably Proteus spp., E. coli, Klebsiella spp., Salmonella spp., and Enterobacter spp. Different bacteria were detected, namely, Kurthia populi, Cronobactersp, and Eikenella corrodens. Most of the poultry isolates were resistant against more than one group of antibiotics. ESBL gene, blaTEM gene was identified most frequently (53.9%), followed by blaOXA (52.2%), and blaSHV (23%). Higher phenotypic resistance was observed in isolates carrying ESBL genes.

Conclusion: This study revealed a very high frequency of three ESBL genes with their phenotypic resistance- capacities in Bangladeshi poultry gut microbiota. Excess uses of antibiotics in local poultry farms may result in the emergence of antibiotic resistance that is imposing public health threatening in Bangladesh.

Keywords: Antibiotic resistance, ESBL genes, blaTEM, blaOXA, blaSHV.

Abstract

Background: Antimicrobial resistance is a global health problem and the number of organisms developing resistance to commonly used antibiotics is increasing.

Objective: The study was aimed to find out the pattern of common organism isolated from wound swabs and pus with their antibiogram.

Methods: This observational study was conducted from September 2018 to January 2019 in a tertiary care hospital in Dhaka, Bangladesh. Culture and sensitivity tests were done for wound swabs and pus samples. Data regarding information of the patients, isolated organisms and culture and sensitivity reports were collected from the records of the department of microbiology.

Results: Out of 1709 samples, 72.0% yielded growth of organisms of which 86.4% were gram negative and 13.6% were gram positive bacteria. Pseudomonas spp was the most commonly (43.8%) isolated organism from both wound swab and pus samples followed by Escherichia coli (16.6%), Staphylococcus aureus (11.8%), Klebsiella spp (9.8%). Among gram negative bacteria, 14.9% were ESBL producing organisms and Klebsiella spp were the most commonly isolated ESBL producers. Most of the bacteria showed high resistance to commonly used antibiotics. Gram negative bacteria were mostly resistant to amoxicillin followed by fluoroquinolones, co-trimoxazole, and cephalosporins whereas colistin, carbapenems and piperacillin/tazobactum were the most effective drugs against them. Majority of gram positive bacteria were resistant to fluoroquinolones and co-trimoxazole but 100% Staphylococcus aureus were sensitive to vancomycin, followed by linezolid (98.0%) and teicoplanin (86.0%) and 32.0% of them were Methicillin resistant (MRSA).

Conclusion: The susceptibility pattern shows that some common antibiotics, especially antibiotics of oral form have very limited usefulness in treatment of infections and also highlight the need for regular reporting and antibiogram guided antibiotic prescription.

Keywords: Antibiotic susceptibility, Pus, Resistance, Wound swab

Abstract

Background: The extent of damage by ischaemic stroke and the course of illness depend largely on the presence of collateral vessels around the affected area. The Circle of Willis (CoW), which serves as an important potential collateral pathway in maintaining adequate blood flow around the brain, is known to have variable patency. So the completeness of CoW is expected to influence the severity of ischaemic stroke.

Objective: The objective of the study was to determine the association of completeness of Circle of Willis with severity of acute ischaemic stroke.

Methods: It was a cross-sectional study done in Bangabandhu Sheikh Mujib Medical University, Dhaka from March, 2015 to August, 2017. A total of 42 patients of acute ischaemic stroke who were undergoing Digital Subtraction Angiography (DSA) for different reasons were selected by purposive sampling method. Data regarding completeness of Circle of Willis were obtained from DSA. National Institutes of Health Stroke Scale (NIHSS) score were measured to assess the severity of stroke. Then the severities of stroke between the complete and incomplete Circle of Willis groups were compared.

Results: A total of 27 male and 15 female patients were enrolled. Among them, 47.6% (20) had complete CoW and it was incomplete in rest 52.4% (22). Median (range) of NIHSS scores of complete and incomplete CoW group was 4.5 (0-17) and 9.5 (3-21) respectively. Mean NIHSS (±SD) for the complete and incomplete CoW was

6.60 (±4.97) and 9.95 (±5.10) respectively. The difference of mean between the two groups was found to be statistically significant (p=0.037). Odd’s Ratio (OR) for development of more severe stroke in patients with incomplete CoW was 4.5, 95% Confidence Interval (CI) 1.18-18.13 which was statistically significant (p=0.029).

Conclusion: It was concluded that incomplete Circle of Willis is associated with more severe stroke in acute ischaemic stroke patients.

Keywords: Acute ischaemic stroke; Severity of stroke; Circle of Willis; NIHSS score.

Abstract

Background: Parkinson’s disease dementia (PDD) is a common consequence during the course of the disease. It deeply influences patients’ prognosis, quality of life, caregiver burden and economic strain. However, effective treatment for PDD is currently unclear. Clinical and demographic predictors for this comorbidity are not well studied.

Objectives: To investigate putative risk factors for the development of dementia in patients with Parkinson’s disease (PD) attending a tertiary care and teaching hospital in Bangladesh.

Methods: One hundred thirty-one consecutive PD cases were enrolled in this cross-sectional study; whose disease duration was more than a year. Comparison was done between demented and non-demented PD cases. Structural CNS diseases including secondary parkinsonism were excluded by clinically and MRI of brain for all cases. Dementia was evaluated based by DSM-IV and assessed using mini-mental state examination (MMSE) score and Parkinson’s disease dementia short screen (PDD-SS) score. Severity of disease was evaluated by Hoehn and Yahr stage (H-Y I to V). Depression was assessed using DSM-IV. Data were analysed on a logistic regression model using SPSS v 23.

Results: The overall frequency of dementia was 38%. The mean (SD) age of the demented and non-demented PD cases was 73.32(8.86) and 63.98 (6.19) years respectively. On multivariate logistic regression model, age

³70 years [OR=4.25, p=0.031], diabetes [OR=5.37, p=0.019], hypertension [OR=7.63, p=0.011], disease duration

³5 years [OR=10.01, p<0.001], H-Y stage e” 3 [OR= 9.52, p<0.001] and depression [OR=8.79, p<0.001] were significantly associated with PDD.

Conclusion: In this study of PD cases, overall risks of dementia were advancing age, diabetes, hypertension, longer disease duration, higher disease stage and presence of depressive illness.

Keywords: Parkinson’s disease, Dementia, Mini mental state examination, Depression

Abstract

Background: Cement industries are playing a key role in economic growth and infrastructure development. But its production is a dusty process and is a major source of air pollution. Its exposure may affect respiratory system and impairment of pulmonary functions.

Objective: This study was aimed to assess the effects of cement dust on pulmonary functions of workers working in cement factory.

Methods: This case control study was conducted in the department of physiology, Chittagong Medical College, Chattogram in collaboration with Heidelberg Cement Bangladesh Ltd. in Chattogram from January 2018 to December 2018. A total of 88 male workers, aged between 20-45 years were included in this study by consecutive sampling method who met the inclusion criteria. Workers working at least two years in direct contact of cement dust were considered as exposed (case) group. Non exposed (control) group were selected from office workers of same factory those who were not directly exposed to cement. Each group included 44 subjects. A predesigned data collection form containing information regarding general information, job history, present and past disease, drug history was filled up. Individual’s height, weight was measured and BMI was calculated. FVC, FEV1, FEV₁/FVC (%) was recorded by a digital spirometer (Chestgraph HI-101, Japan) in upright sitting posture. After compiling data,statistical analyses were done by using SPSS version Windows 25. Unpaired student’s ‘t’ test was done for statistical analysis.

Results: Exposed (case) group showed significant reduction of FVC and FEV₁ (p<0.001)with unaltered FEV₁/ FVC (%) (p>0.05) in comparison to non exposed (control) group.

Conclusion: The results of this study concluded that occupational exposure to cement dust reduce pulmonary functions of cement workers.

Keywords: Cement, Pulmonary function, Spirometer, Forced vital capacity

Abstract

Background: Open fractures are a frequent occurrence in the in accident and emergency department that requires immediate care. As a pedal bone, the tibia is very prone to accidental injury, easily becomes bare following the trauma and very prone to infection. Updated knowledge about microbial aspects of open tibia fracture infection is essential for proper management.

Objective: This study evaluated the injury characteristics and resistance patterns of microorganisms involved in the infection of open fracture tibia in a single-centred study.

Methods: This was a cross-sectional study on a total of 384 patients presented at the emergency department with open fractures of the tibia (all Gustilo types) from January 2020 to July 2020 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Three successive culture sensitivity tests were carried out-one at the emergency room (surveillance culture), 2nd at the emergency theatre after debridement and third at ward after 1 week (7 to 10 days).

Results: Average age of the patients was 36.2± 15.5 years, with motor vehicle accidents being the predominant cause (72.9%). Gustilo III fractures were most prevalent (54.4%). The maximum infection rate was in Gustilo IIIB Fractures (40.4%). There was a significant difference in contamination rate between on admission culture (37.0%) and post debridement culture (26.3%). The infection rate from the ward samples was 44.5 %, where the postdebidement contamination was less only 26.3%. But from the ward sample, it again increased to 44.5%. Among the patient entering the ward after debridement with no contamination (73.7%) became infected in 34.62% cases, which indicates hospital-acquired infection. The bacterial resistance patterns from the ward samples were more virulent with multidrug resistance, predominantly Pseudomonas spp. and Kliebsiella spp.

Conclusion: The present study provided insight into the injury characteristics and infection patterns of open fractures of the tibia. Early debridement reduced the contamination, but there was still hospital-acquired infection with more virulent multidrug resistance phenotypes.

Keywords: Open fracture tibia, Injury characteristics, Infection, Antibiotic resistance

Abstract

Background: Insulin resistance has evolved as an important metabolic alteration in obese children especially during adolescence. Emerging data suggest that insulin resistance in obesity play the key role in the pathogenesis of hypertension, dyslipidemia, impaired glucose tolerance, type 2 diabetes mellitus, non-alcoholic fatty liver disease and metabolic syndrome.

Objective: The aim of this study was to assess the insulin resistance status of Bangladeshi obese adolescents in hospital settings.

Methods: It was a cross sectional study done in children, aged 10 to 16 years, attending the paediatric endocrine clinic, paediatric outpatient and paediatric inpatient department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 15 months. Homeostasis Model Assessment of Insulin Resistance (HOMA- IR) value was obtained from fasting insulin & fasting blood glucose level to assess insulin resistance in obese and normal weight children.

Results: Among obese adolescents, 78.8% were insulin resistant in comparison to16% in non-obese adolescent. Mean HOMA-IR level of obese group were significantly higher than non-obese group (4.46±1.82 Vs 1.98±1.26, p<0.001). Insulin resistance was observed in 73.8% and 84.2% among grade 1 obese and grade 2 obese adolescents respectively. HOMA-IR showed positive correlation with BMI and waist circumference. Insulin resistance showed significant association with central obesity, puberty and acanthosis nigricans (AN).

Conclusion: In this study, insulin resistance was observed in higher frequency among obese adolescents than normal weight adolescents. Obese adolescents with central obesity, acanthosis nigricans and puberty are at increased risk of insulin resistance.

Keywords: Obesity, Insulin resistance, HOMA-IR, Puberty

Abstract

Background: In Bangladesh, more than 14000 children on are born annually with in thalassaemia – a common congenital disease Hb E trait is 6.1%. Hb E beta thalassaemia is the most common type of thalassaemia, followed by Beta thalassaemia major.

Objectives: To determine the frequency of Xmn1 polymorphism and its association with Beta thalassaemia mutations.

Methods: A total of one hundred and four Bangladeshi thalassaemia patients were analysed. Amplification Refractory Mutation System (ARMS) was utilized for Beta thalassaemia mutations and digestion of the PCR product using Xmn1 restriction enzyme Pdml for Xmn1 polymorphism.

Results: Xmn1 polymorphism was detected in seventy patients of which 60(57.69%) were heterozygous for Xmn1 polymorphism and seventeen (16.35%) were homozygous. The most common genotype found was heterozygous Xmn1(-/+)seen in 57.70%. The age of presentation of thalassaemic patients was delayed in those who had Xm1 polymorphism.The mean age of presentation of Hb E beta thalassaemia was 13.35 years having homozygous Xm1 polymorphism,7.21 years in heterozygous and 6.25 years without Xmn 1 polymorphism. The most common mutation detected was Cd26 (G-A) +IVS 1-5(G-C) in fifty eight patients in which thirty nine (67.24%) were heterozygous for Xmn 1 polymorphism and 8 (13.79%) were homozygous (+/+).The second most common mutation observed was Cd26(G-A)+30(G-C) seen in fourteen patients where 57.14% were homozygous for Xmn 1 polymorphism and 35.71% were heterozygous. In thalassaemia major 9 (90%) were negative for Xmn1 polymorphism. Allele frequency of Xmn 1 polymorphism was 0.45.

Conclusion: The association of Xmn1 polymorphism with two common mutations seen in Hb E beta thalassemia patients may be utilized for hydroxyurea therapy to reduce the requirement of blood transfusion.

Keywords: Beta Thalassemia mutations Xmn1 Polymorphism, Restriction enzyme, Heterozygous, Homozygous

Abstract

Background: Retroperitoneal cyst is a rare event with diagnostic and therapeutic challenges. It may remain asymptomatic or present with vague symptoms such as abdominal distension or pain. In the event of late diagnosis, it might develop complications like infection, perforation, haemorrhage and malignant transformation.

Objective: As there is not a single reported case from Bhutan, this is the first report to sensitise the clinicians so that they are aware about the rare possibility of this lesion.

Case: A 34-year-old woman presented with abdominal pain was diagnosed as ovarian tumour. During laparotomy, the mass was found to be a retroperitoneal cyst which was excised completely with intact capsule. The uterus, bilateral ovaries and fallopian tubes were normal. Histopathology confirmed that it to be benign primary retroperitoneal cyst.

Conclusion: Involvement of multidisciplinary team members would facilitate proper diagnosis and appropriate management of retroperitoneal cysts.

Keywords: Retroperitoneal mucinous cyst; Laparotomy; Histopathology; Ovarian tumour

Abstract

Background: Root canal treatment is the usual management of acute irreversible pulpitis of mature permanent teeth. MTA Pulpotomy can be used to treat acute irreversible pulpitis of an adult HIV-Positive patient alternative to root canal treatment as it is less invasive and one-step endodontic therapy.

Objective: The aim was to evaluate the outcome of MTA Pulpotomy alternative to root canal treatment to manage acute irreversible pulpitis of an adult HIV-positive patient.

Methods: Based on history, clinical and radiological examination the case was diagnosed as acute irreversible pulpitis on the mandibular left 2nd molar tooth in a patient who was HIV-positive and under treatment for 16 years. After anaesthetising and isolation with rubber dam coronal pulp was completely removed and MTA (Angelus, Brazil) was placed over the pulp chamber floor covering the canal orifices, and the rest of the cavity was sealed with glass-ionomer filling over the set MTA. The severity of postoperative pain was assessed by a visual analog scale after 24 hours, 48 hours, 72 hours, and 7 days. The incidence of any clinical symptoms or periapical pathology was determined using clinical and radiographic evaluation after 3-month, 6 months, and 1-year intervals.

Results: Throughout the follow-up period, the patient was asymptomatic and there was no periapical pathology at the radiograph even at the end of one year.

Conclusion: As a less invasive and single sitting short procedure, MTA pulpotomy can be done to treat acute irreversible pulpitis in the HIV-positive patient as an alternative to root canal treatment.

Keywords: MTA pulpotomy, Acute irreversible pulpitis, HIV-positive patient, Root canal treatment