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1.  Effect of Wiihabilitation on strength ratio of ankle muscles in adults 
Journal of Physical Therapy Science  2016;28(10):2862-2866.
[Purpose] This study was conducted to investigate the effect of Wiihabilitation on the ankle dorsiflexion/plantar flexion strength ratio in adults. [Subjects and Methods] Thirty-two healthy male volunteers were randomly assigned to two equal groups (experimental and control). Participants in the experimental group received a Wiihabilitation training program for six weeks. Data were collected using a Biodex system 3 Isokinetic dynamometer. Peak torques of the dorsiflexors and plantar flexors were measured at an angular velocity of 60°/sec which in turn were used to derive the ankle dorsiflexion/plantar flexion strength ratio. [Results] The mean values of the ankle dorsiflexion/plantar flexion strength ratio decreased significantly between before and after the training in the experimental group, meanwhile there was no significant difference between before and after the training period in the control group . [Conclusion] Wiihabilitation has an impact on the ankle dorsiflexion/plantar flexion strength ratio, so it can be considered an effective training tool in terms of the ankle strength ratio. Thus, it could be recommended for both prevention and rehabilitation of ankle instability patients.
PMCID: PMC5088142  PMID: 27821951
Wiihabilitation; Strength ratio; Ankle instability
2.  Spatial Variation of Arsenic in Soil, Irrigation Water, and Plant Parts: A Microlevel Study 
The Scientific World Journal  2016;2016:2186069.
Arsenic pollution became a great problem in the recent past in different countries including Bangladesh. The microlevel studies were conducted to see the spatial variation of arsenic in soils and plant parts contaminated through ground water irrigation. The study was performed in shallow tube well command areas in Sadar Upazila (subdistrict), Faridpur, Bangladesh, where both soil and irrigation water arsenic are high. Semivariogram models were computed to determine the spatial dependency of soil, water, grain, straw, and husk arsenic (As). An arsenic concentration surface was created spatially to describe the distribution of arsenic in soil, water, grain, straw, and husk. Command area map was digitized using Arcview GIS from the “mouza” map. Both arsenic contaminated irrigation water and the soils were responsible for accumulation of arsenic in rice straw, husk, and grain. The accumulation of arsenic was higher in water followed by soil, straw, husk, and grain. Arsenic concentration varied widely within command areas. The extent and propensity of arsenic concentration were higher in areas where high concentration of arsenic existed in groundwater and soils. Spherical model was a relatively better and appropriate model. Kriging method appeared to be more suitable in creating interpolated surface. The average arsenic content in grain was 0.08–0.45 mg/kg while in groundwater arsenic level it ranged from 138.0 to 191.3 ppb.
PMCID: PMC5056312  PMID: 27747271
3.  Efficacy of virtual reality-based balance training versus the Biodex balance system training on the body balance of adults 
[Purpose] This study investigated efficacy of virtual reality (VR)-based balance training on enhancing balance and postural reactions of adults as a low-cost new modality compared to the established Biodex Balance System (BBS). [Subjects] Thirty normal adults of both genders were divided randomly into two equal-sized experimental groups of 15: BBS balance training and VR balance training. [Methods] The training programmes were conducted in 12 sessions, three 15-min sessions per week. The Nintendo® Wii Fit Plus (NWFP) and its balance board were used to train of the VR group. Each participant answered a questionnaire concerning usability, enjoyment, balance improvement, and fatigue at the end of the training programs. [Results] The study found a significant increase the measure of mean overall balance (OLB) in both groups. No significant difference was found between the groups, but a significant decrease in the mean balance-test time was found for both groups, with no significant difference between the two training methods. The VR programme was rated highly enjoyable by 81.8% of the group. [Conclusion] The Wii Fit Plus system with the balance board as a new VR balance-training technique, can be considered an effective and enjoyable tool for the training of adults’ body balance.
PMCID: PMC4755968  PMID: 26957722
Virtual reality; Biodex balance training; Adults
4.  Status of Superoxide Dismutase in Transfusion Dependent Thalassaemia 
Thalassemia is a collection of genetic impairments in beta and alpha genes causing various states of anemia. Severe types of the disease need lifelong transfusions, leading to oxidant-antioxidant disturbance due to massive iron deposits.
The aim of this study was to assess the antioxidant enzyme Superoxide Dismutase (SOD) and ferritin levels of thalassemia major patients in a peripheral health facility.
Materials and Methods:
Two hundred and nine probands were recruited and performed laboratory experiments for SOD and Ferritin levels. Chelation administration and clinical score were taken from interviewing the family and from medical report data.
The study showed that SOD intensity was lower (162.41 u/ml) compared to the normal cutoff point (P = 0.001), while the mean of Ferritin levels was ten times over the normal value (4226,67 ng/dl). Observations also reported that chelation medicine was not administrated properly.
The data indicates that thalassemic patients have oxidant-antioxidant uproar due to oxidative stress. Monitored chelating administration, selective antioxidant, and a well-balanced diet may prevent oxidative injury.
PMCID: PMC4462814  PMID: 26110130
Oxidant-antioxidant; superoxide dismutase; thalassaemia
5.  Crystal structure of a new monoclinic polymorph of 2,4-di­hydroxy­benzaldehyde 4-methyl­thio­semi­carbazone 
A new monoclinic (P21/c) polymorph of the title compound has the same overall conformation as a previously reported (Cc) form with the exception of the conformation of the outer hy­droxy H atom. This difference results in very different crystal packing based on hydrogen bonding, i.e. supra­molecular tubes in the new form as opposed to a three-dimensional architecture in the Cc form.
The title compound, C9H11N3O2S, is a second monoclinic (P21/c) polymorph of the previously reported Cc form [Tan et al. (2008b ▶). Acta Cryst. E64, o2224]. The mol­ecule is non-planar, with the dihedral angle between the N3CS residue (r.m.s. deviation = 0.0816 Å) and the benzene ring being 21.36 (4)°. The conformation about the C=N bond [1.292 (2) Å] is E, the two N-bound H atoms are anti, and the inner hy­droxy O-bound and outer amide N-bound H atoms form intra­molecular hydrogen bonds to the imine N atom. Crucially, the H atom of the outer hy­droxy group is approximately syn to the H atom of the benzene C atom connecting the two C atoms bearing the hy­droxy substituents. This arrangement enables the formation of supra­molecular tubes aligned along [010] and sustained by N—H⋯O, O—H⋯S and N—H⋯S hydrogen bonds; the tubes pack with no specific inter­actions between them. While the mol­ecular structure in the Cc form is comparable, the H atom of the outer hy­droxy group is approximately anti, rather than syn. This different orientation leads to the formation a three-dimensional architecture based on N—H⋯O and O—H⋯S hydrogen bonds.
PMCID: PMC4331891  PMID: 25705451
crystal structure; thio­semicarbazone; polymorph; conformation; hydrogen bonding
6.  Integrated genome-wide association, coexpression network, and expression single nucleotide polymorphism analysis identifies novel pathway in allergic rhinitis 
BMC Medical Genomics  2014;7:48.
Allergic rhinitis is a common disease whose genetic basis is incompletely explained. We report an integrated genomic analysis of allergic rhinitis.
We performed genome wide association studies (GWAS) of allergic rhinitis in 5633 ethnically diverse North American subjects. Next, we profiled gene expression in disease-relevant tissue (peripheral blood CD4+ lymphocytes) collected from subjects who had been genotyped. We then integrated the GWAS and gene expression data using expression single nucleotide (eSNP), coexpression network, and pathway approaches to identify the biologic relevance of our GWAS.
GWAS revealed ethnicity-specific findings, with 4 genome-wide significant loci among Latinos and 1 genome-wide significant locus in the GWAS meta-analysis across ethnic groups. To identify biologic context for these results, we constructed a coexpression network to define modules of genes with similar patterns of CD4+ gene expression (coexpression modules) that could serve as constructs of broader gene expression. 6 of the 22 GWAS loci with P-value ≤ 1x10−6 tagged one particular coexpression module (4.0-fold enrichment, P-value 0.0029), and this module also had the greatest enrichment (3.4-fold enrichment, P-value 2.6 × 10−24) for allergic rhinitis-associated eSNPs (genetic variants associated with both gene expression and allergic rhinitis). The integrated GWAS, coexpression network, and eSNP results therefore supported this coexpression module as an allergic rhinitis module. Pathway analysis revealed that the module was enriched for mitochondrial pathways (8.6-fold enrichment, P-value 4.5 × 10−72).
Our results highlight mitochondrial pathways as a target for further investigation of allergic rhinitis mechanism and treatment. Our integrated approach can be applied to provide biologic context for GWAS of other diseases.
PMCID: PMC4127082  PMID: 25085501
Genome-wide association study; Allergic rhinitis; Coexpression network; Expression single-nucleotide polymorphism; Coexpression module; Pathway; Mitochondria; Hay fever; Allergy
7.  Comparative Study of Popular Objective Functions for Damping Power System Oscillations in Multimachine System 
The Scientific World Journal  2014;2014:549094.
Power oscillation damping controller is designed in linearized model with heuristic optimization techniques. Selection of the objective function is very crucial for damping controller design by optimization algorithms. In this research, comparative analysis has been carried out to evaluate the effectiveness of popular objective functions used in power system oscillation damping. Two-stage lead-lag damping controller by means of power system stabilizers is optimized using differential search algorithm for different objective functions. Linearized model simulations are performed to compare the dominant mode's performance and then the nonlinear model is continued to evaluate the damping performance over power system oscillations. All the simulations are conducted in two-area four-machine power system to bring a detailed analysis. Investigated results proved that multiobjective D-shaped function is an effective objective function in terms of moving unstable and lightly damped electromechanical modes into stable region. Thus, D-shape function ultimately improves overall system damping and concurrently enhances power system reliability.
PMCID: PMC3997879  PMID: 24977210
8.  Modified-orientation log to assess hepatic encephalopathy 
The subjectivity of the West-Haven criteria (WHC) hinders hepatic encephalopathy (HE) evaluation. The new HE classification has emphasised assessment of orientation. The modified-orientation log (MO-log, eight questions, scores 0–24; 24 normal) is adapted from a validated brain injury measure.
To validate MO-log for HE assessment in cirrhosis.
Cirrhotics admitted with/without HE were administered MO-log. We collected cirrhosis/HE details, admission/daily MO-logs and WHC (performed by different examiners), time to reach normal mentation (MO-log ≥23) and MO-log/WHC change (Δ) over day 1. Outcomes were in-hospital mortality, duration to normal mentation and length-of-stay (LOS). Regressions were performed for each outcome. MO-log inter-rater reliability was measured.
Ninety-six HE (55 ± 8 years, MELD 21) and 20 non-HE (54 ± 5 years, MELD 19) in-patients were included. In HE patients, median admission WHC was 3 (range 1–4). Mean MO-log was 12 ± 8 (range 0–22). Their LOS was 6 ± 5 days and 13% died. Time to reach normal mentation was 2.4 ± 1.7 days. Concurrent validity: there was a significant negative correlation between admission MO-log and WHC (r = −0.79, P < 0.0001). Discriminant validity: admission MO-logs were significantly lower in those who died (7 vs. 12, P = 0.03) and higher in those admitted without HE (23.6 vs. 12, P < 0.0001). MO-log improved in 69% on day 1 (ΔMO-log 4 ± 8) which was associated with lower duration to normal mentation (2 vs. 3.5 days, P = 0.03) and mortality (3% vs.43%, P < 0.0001), not ΔWHC. Regression models for all outcomes included admission/ΔMO-log but not WHC as a predictor. Inter-rater reliability: ICC for MO-log inter-rater observations was 0.991.
Modified-orientation log is a valid tool for assessing severity and is better than West-Haven criteria in predicting outcomes in hospitalised hepatic encephalopathy patients.
PMCID: PMC3616137  PMID: 22348593
9.  Learning from negative feedback in patients with major depressive disorder is attenuated by SSRI antidepressants 
One barrier to interpreting past studies of cognition and major depressive disorder (MDD) has been the failure in many studies to adequately dissociate the effects of MDD from the potential cognitive side effects of selective serotonin reuptake inhibitors (SSRIs) use. To better understand how remediation of depressive symptoms affects cognitive function in MDD, we evaluated three groups of subjects: medication-naïve patients with MDD, medicated patients with MDD receiving the SSRI paroxetine, and healthy control (HC) subjects. All were administered a category-learning task that allows for dissociation between learning from positive feedback (reward) vs. learning from negative feedback (punishment). Healthy subjects learned significantly better from positive feedback than medication-naïve and medicated MDD groups, whose learning accuracy did not differ significantly. In contrast, medicated patients with MDD learned significantly less from negative feedback than medication-naïve patients with MDD and healthy subjects, whose learning accuracy was comparable. A comparison of subject’s relative sensitivity to positive vs. negative feedback showed that both the medicated MDD and HC groups conform to Kahneman and Tversky’s (1979) Prospect Theory, which expects losses (negative feedback) to loom psychologically slightly larger than gains (positive feedback). However, medicated MDD and HC profiles are not similar, which indicates that the state of medicated MDD is not “normal” when compared to HC, but rather balanced with less learning from both positive and negative feedback. On the other hand, medication-naïve patients with MDD violate Prospect Theory by having significantly exaggerated learning from negative feedback. This suggests that SSRI antidepressants impair learning from negative feedback, while having negligible effect on learning from positive feedback. Overall, these findings shed light on the importance of dissociating the cognitive consequences of MDD from those of SSRI treatment, and from cognitive evaluation of MDD subjects in a medication-naïve state before the administration of antidepressants. Future research is needed to correlate the mood-elevating effects and the cognitive balance between reward- and punishment-based learning related to SSRIs.
PMCID: PMC3779792  PMID: 24065894
major depressive disorder; selective serotonin reuptake inhibitor; basal ganglia; reward; punishment
10.  Peripheral Blood Buffy Coat Smear: a Promising Tool for Diagnosis of Visceral Leishmaniasis 
Journal of Clinical Microbiology  2012;50(3):837-840.
Confirmative diagnosis of visceral leishmaniasis (VL) is still a challenge at the primary health care facilities in most of the rural areas of endemicity in the Indian subcontinent. Conventional methods for parasitological confirmation are risky and require skilled personnel, and hence they are unavailable to the poor people in the regions of endemicity. Buffy coat smear microscopy, as a minimally invasive, simple alternative for the parasitological diagnosis of VL, was evaluated in this prospective study. One hundred twelve VL patients were enrolled in this study. The buffy coat was separated from peripheral blood of all enrolled subjects using Histopaque-1119 solution. Leishman-stained buffy coat smears were examined for Leishmania donovani bodies, and buffy coat was also utilized for detection of parasite DNA by Leishmania nested PCR (LnPCR) for all cases. Concomitant splenic smears could be examined for L. donovani bodies in 66 cases, and the parasite load was graded on a scale of 1+ to 6+ for L. donovani-positive smears. All splenic smear-positive cases were also found to be positive by LnPCR. Of 112 enrolled VL cases, 103 (92%) were found to be positive for L. donovani bodies in buffy coat smear microscopy, which is promising as a confirmative diagnosis tool. We have also found a significant association of the buffy coat smear positivity with parasitic burden in the spleen smear. In this preliminary observation in Bangladesh, buffy coat smear microscopy has been found to be very simple, minimally invasive, and risk-free method of parasitological diagnosis of VL with a good diagnostic accuracy and potential for field use.
PMCID: PMC3295093  PMID: 22205790
11.  Synthesis, Characterization and In Vitro Antibacterial Studies of Organotin(IV) Complexes with 2-Hydroxyacetophenone-2-methylphenylthiosemicarbazone (H2dampt) 
Five new organotin(IV) complexes of 2-hydroxyacetophenone-2-methylphenylthiosemicarbazone [H2dampt, (1)] with formula [RSnCln-1(dampt)] (where R = Me, n = 2 (2); R = Bu, n = 2 (3); R = Ph, n = 2 (4); R = Me2, n = 1 (5); R = Ph2, n = 1 (6)) have been synthesized by direct reaction of H2dampt (1) with organotin(IV) chloride(s) in absolute methanol. The ligand (1) and its organotin(IV) complexes (2–6) were characterized by CHN analyses, molar conductivity, UV-Vis, FT-IR, 1H, 13C, and 119Sn NMR spectral studies. H2dampt (1) is newly synthesized and has been structurally characterized by X-ray crystallography. Spectroscopic data suggested that H2dampt (1) is coordinated to the tin(IV) atom through the thiolate-S, azomethine-N, and phenoxide-O atoms; the coordination number of tin is five. The in vitro antibacterial activity has been evaluated against Staphylococcus aureus, Enterobacter aerogenes, Escherichia coli, and Salmonella typhi. The screening results have shown that the organotin(IV) complexes (2–6) have better antibacterial activities and have potential as drugs. Furthermore, it has been shown that diphenyltin(IV) derivative (6) exhibits significantly better activity than the other organotin(IV) derivatives (2–5).
PMCID: PMC3352140  PMID: 22611347
12.  Prediction of steroid response in nephrotic syndrome by humoral immunity assessment 
Indian Journal of Nephrology  2011;21(3):186-190.
The purpose of this study was to estimate the serum levels of IgG, IgM, and IgA in nephrotic syndrome (NS) cases, in activity or in remission, and to detect their levels in relation to steroid response by evelautingthe relationship between IgG/IgM ratio and response to steroids. We investigated 27 cases with NS in activity and in remission and 20 healthy children as controls. Group A included 16 NS patients (12.3±1.4 years) who were steroid-resistant, frequent relapsers, or steroid dependent. Group B included 11 steroid-sensitive NS patients with a mean age of 11.6±2.1 years. Group C included 20 healthy children with a mean age of 12.1±2.3 years who were the control group. We found lower serum IgG level in NS cases compared with the control group; and it was lower in activity than in remission. The levels were lower in Group A compared with those of Group B. Serum IgG levels in Group A were as follows: in activity, 2.29±1.13 g/L and in remission, 4.3±2 g/L. In Group B, they were 6.2±1.2 g/L and 6.5±1.15 g/L in activity and in remission, respectively, and 11.8±2.5 g/L in the healthy control group (P<0.05). There was a direct correlation between serum albumin and serum IgG. We found no significant difference in serum IgM and IgA levels among studied groups whether in activity or in remission. Serum IgG/IgM ratio was lower in activity and in remission in the patient groups than in the control group as it was 9.3±4.7 in healthy subjects. It was 1.8±1.5 in Group A in activity and 3.2±2 in remission, and in Group B 4.8±2.39 in activity and 4.8±2.4 in remission. We conclude that IgM and IgA show no significant difference in NS patients. Serum IgG is lower in NS than in the control group and is much lower in activity than in remission. It is lower in patients with poor steroid response. We propose a predictive value of IgG/IgM ratio in activity, that is, the higher the IgG/IgM ratio in activity, the better the prognosis.
PMCID: PMC3161437  PMID: 21886979
Humoral immunity; nephrotic syndrome; steroids
13.  L-isoleucine-supplemented Oral Rehydration Solution in the Treatment of Acute Diarrhoea in Children: A Randomized Controlled Trial 
Antimicrobial peptides represent an important component of the innate immune defenses of living organisms, including humans. They are broad-spectrum surface-acting agents secreted by the epithelial cells of the body in response to infection. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides. The objectives of the study were to examine if addition of L-isoleucine to oral rehydration salts (ORS) solution would reduce stool output and/or duration of acute diarrhoea in children and induce antimicrobial peptides in intestine. This double-blind randomized controlled trial was conducted at the Dhaka Hospital of ICDDR,B. Fifty male children, aged 6-36 months, with acute diarrhoea and some dehydration, attending the hospital, were included in the study. Twenty-five children received L-isoleucine (2 g/L)-added ORS (study), and 25 received ORS without L-isoleucine (control). Stool weight, ORS intake, and duration of diarrhoea were the primary outcomes. There was a trend in reduction in mean±standard deviation (SD) daily stool output (g) of children in the L-isoleucine group from day 2 but it was significant on day 3 (388±261 vs 653±446; the difference between mean [95% confidence interval (CI) (-)265 (−509, −20); p=0.035]. Although the cumulative stool output from day 1 to day 3 reduced by 26% in the isoleucine group, it was not significant. Also, there was a trend in reduction in the mean±SD intake of ORS solution (mL) in the L-isoleucine group but it was significant only on day 1 (410±169 vs 564±301), the difference between mean (95% CI) (-)154 (-288, −18); p=0.04. The duration (hours) of diarrhoea was similar in both the groups. A gradual increase in stool concentrations of ß-defensin 2 and 3 was noted but they were not significantly different between the groups. L-isoleucine-supplemented ORS might be beneficial in reducing stool output and ORS intake in children with acute watery diarrhoea. A further study is warranted to substantiate the therapeutic effect of L-isoleucine.
PMCID: PMC3131118  PMID: 21766553
Dehydration; Diarrhoea, Acute; Diarrhoea, Infantile; Double-blind method; Oral rehydration solutions; Randomized controlled trials; Bangladesh
14.  (2E)-2-(2-Phenyl­hydrazin-1-yl­idene)propanoic acid 
The 13 non-H atoms comprising the title compound, C9H10N2O2, are close to planar (r.m.s. deviation = 0.140 Å), with maximum deviations of 0.292 (1) and 0.210 (1) Å to either side of the least-squares plane exhibited by the hy­droxy and carbonyl O atoms, respectively. The observed conformation is stabilized by an intra­molecular O—H⋯N hydrogen bond. The conformation about the N=C double bond [1.2909 (16) Å] is E. The hy­droxy OH group also forms an inter­molecular hydrogen bond to a carbonyl O atom, and the amine H atom similarly forms an N—H⋯O hydrogen bond to a second carbonyl O atom. The result is the formation of a double layer with a flat topology. Layers stack along the a-axis direction connected by C—H⋯π inter­actions.
PMCID: PMC3089133  PMID: 21754470
15.  Association of Enterotoxigenic Bacteroides fragilis Infection with Inflammatory Diarrhea 
Diarrheal illnesses remain a leading cause of morbidity and mortality globally, with increasing recognition of long-term sequelae, including postinfectious irritable bowel syndrome and growth faltering, as well as cognitive deficits in children. Identification of specific etiologic agents is often lacking. In vitro and in vivo data suggest that enterotoxigenic Bacteroides fragilis (ETBF) may contribute to the burden of colonic inflammatory diarrheal disease. The study goal was to investigate the pathogenesis of ETBF diarrheal illnesses.
We performed an observational study of children and adults with acute diarrheal illnesses in Dhaka, Bangladesh, from January 2004 through November 2005, to define the clinical presentation, intestinal inflammatory responses, and systemic and intestinal antibody responses to ETBF. Other enteric pathogens were also evaluated.
ETBF was identified to cause a clinical syndrome with marked abdominal pain and nonfebrile inflammatory diarrhea in both children (age, >1 year) and adults. Fecal leukocytes, lactoferrin, and proinflammatory cytokines (interleukin 8, tumor necrosis factor–α)—as well as B. fragilis toxin systemic antitoxin responses—increased rapidly in ETBF-infected patients. Evidence of intestinal inflammation often persisted for at least 3 weeks, despite antibiotic therapy.
ETBF infection is a newly recognized cause of inflammatory diarrhea in children and adults. Future studies are needed to evaluate the role of ETBF in persistent colonic inflammation and other morbid sequelae of acute diarrheal disease.
PMCID: PMC3045827  PMID: 18680416
16.  Cloning, characterization and expression of the chitinase gene of Enterobacter sp. NRG4 
Indian Journal of Microbiology  2009;48(3):358-364.
A chitinase producing bacterium Enterobacter sp. NRG4, previously isolated in our laboratory, has been reported to have a wide range of applications such as anti-fungal activity, generation of fungal protoplasts and production of chitobiose and N-acetyl D-glucosamine from swollen chitin. In this paper, the gene coding for Enterobacter chitinase has been cloned and expressed in Escherichia coli BL21(DE3). The structural portion of the chitinase gene comprised of 1686 bp. The deduced amino acid sequence of chitinase has high degree of homology (99.0%) with chitinase from Serratia marcescens. The recombinant chitinase was purified to near homogeneity using His-Tag affinity chromatography. The purified recombinant chitinase had a specific activity of 2041.6 U mg−1. It exhibited similar properties pH and temperature optima of 5.5 and 45°C respectively as that of native chitinase. Using swollen chitin as a substrate, the Km, kcat and catalytic efficiency (kcat/Km) values of recombinant chitinase were found to be 1.27 mg ml−1, 0.69 s−1 and 0.54 s−1M−1 respectively. Like native chitinase, the recombinant chitinase produced medicinally important N-acetyl D-glucosamine and chitobiose from swollen chitin and also inhibited the growth of many fungi.
PMCID: PMC3476779  PMID: 23100735
Chi gene; Enterobacter sp. NRG4; Expression; His-Tag affinity chromatography; Recombinant chitinase
17.  Typhus Fever: An Overlooked Diagnosis 
A case of typhus fever is presented. On admission, the clinical diagnosis was typhoid fever. Forty-eight hours after admission, the presence of subconjunctival haemorrhage, malena, and jaundice raised the possibility of a different aetiology, the two most likely differentials being dengue and typhus. Finally, a co-infection of typhoid and typhus was discovered. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission being treated as a case of typhoid fever.
PMCID: PMC2761786  PMID: 19507758
Co-infections; Morbidity; Typhoid; Typhus; Bangladesh
18.  Cigarettes & waterpipe smoking among medical students in Syria: a cross-sectional study 
To investigate tobacco use practices, beliefs and attitude among medical students in Syria.
This is a cross-sectional study among a random sample of 570 medical students (1st and 5th year) registered at Damascus Faculty of Medicine, 2006–07. We used a self-administered questionnaire inquiring about demographic information, smoking behaviour (cigarette, waterpipe), family and peer smoking, attitudes and beliefs about smoking and future role in advising patients to quit smoking.
The overall prevalence of tobacco use was 10.9% for cigarette (15.8% men, 3.3% women), 23.5% for waterpipe (30.3% men, 13.4% women), and 7.3% for both (10.1% men, 3.1% women). Both smoking methods were more popular among 5th year students (15.4% and 27%) compared to their younger counterparts (6.6% and 19.7%). Regular smoking patterns predominated for cigarettes (62%), while occasional use patterns predominated for waterpipe (83%). More than two thirds of students (69%) think they may not or have difficulty addressing smoking in their future patients.
The level of tobacco use among Syrian medical students is alarming and point at the rapidly changing patterns towards waterpipe use, especially among female students. Medical schools should work harder to tackle this phenomenon and address it more efficiently in their curricula.
PMCID: PMC2553239  PMID: 18713509
Cigarette smoking; waterpipe smoking; medical students; prevalence; Syria
19.  A population based study of Ramadan fasting and acute coronary syndromes 
Heart  2004;90(6):695-696.
PMCID: PMC1768280  PMID: 15145888
coronary heart disease; myocardial infarction; unstable angina
20.  Introduction of Routine Zinc Therapy for Children with Diarrhoea: Evaluation of Safety 
On 8 May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommended routine administration of zinc in the management of children, aged less than five years, with acute diarrhoea. In making the recommendation, WHO and UNICEF also suggested careful monitoring for adverse events associated with routine administration of zinc, particularly unusual or excess vomiting. The study assessed, in a phase IV trial, i.e. post-marketing surveillance of zinc, the occurrence of adverse events during the first hour after the administration of the first dose of zinc in children with acute or persistent diarrhoea. The study was conducted at the Dhaka Hospital of ICDDR,B and at an outpatient clinic operated by a local health NGO—Progoti Samaj Kallyan Protisthan (PSKP), Dhaka, Bangladesh. Eligible children, aged 3-59 months, were treated with 20 mg of zinc sulphate provided in a dispersible tablet formulation. The children were observed for 60 minutes following the initial treatment with zinc for adverse events, with particular attention given to vomiting or regurgitation. During the one-year observation period, 42,440 children (male 57% and female 43%) received zinc, and 20,246 (47.8%) of them were observed. Regurgitation and/or vomiting occurred in 4,392 (21.8%) of the children; 90.8% of these children had vomiting only once, 8.7% twice, and 0.5% more than twice. No children revisited the hospital for recurrent vomiting following their discharge. A significant proportion of infants and children may experience vomiting or regurgitation, usually once, following the administration of the first dose of zinc. This is a transient phenomenon that did not impact on continuation of treatment with zinc.
PMCID: PMC2754002  PMID: 17985814
Diarrhoea; Diarrhoea, Infantile; Evaluation studies; Safety; Zinc therapy; Bangladesh
21.  Maternal and child health: is South Asia ready for change? 
BMJ : British Medical Journal  2004;328(7443):816-819.
South Asia still has a long way to go to meet the United Nations' millennium development goals for maternal and child mortality
PMCID: PMC383381  PMID: 15070640
22.  Reemergence of Epidemic Vibrio cholerae O139, Bangladesh 
Emerging Infectious Diseases  2003;9(9):1116-1122.
During March and April 2002, a resurgence of Vibrio cholerae O139 occurred in Dhaka and adjoining areas of Bangladesh with an estimated 30,000 cases of cholera. Patients infected with O139 strains were much older than those infected with O1 strains (p<0.001). The reemerged O139 strains belong to a single ribotype corresponding to one of two ribotypes that caused the initial O139 outbreak in 1993. Unlike the strains of 1993, the recent strains are susceptible to trimethoprim, sulphamethoxazole, and streptomycin but resistant to nalidixic acid. The new O139 strains carry a copy of the Calcutta type CTXCalc prophage in addition to the CTXET prophage carried by the previous strains. Thus, the O139 strains continue to evolve, and the adult population continues to be more susceptible to O139 cholera, which suggests a lack of adequate immunity against this serogroup. These findings emphasize the need for continuous monitoring of the new epidemic strains.
PMCID: PMC3016788  PMID: 14519249
Cholera epidemic; Vibrio cholerae O139; CTX phage; drug resistance; Bangladesh
23.  Use of Dipsticks for Rapid Diagnosis of Cholera Caused by Vibrio cholerae O1 and O139 from Rectal Swabs 
Journal of Clinical Microbiology  2003;41(8):3939-3941.
We evaluated the recently developed dipsticks for the rapid detection of Vibrio cholerae serotypes O1 and O139 from rectal swabs of hospitalized diarrheal patients after enrichment for 4 h in alkaline peptone water. The sensitivity and specificity of the dipsticks were above 92 and 91%, respectively. The dipsticks represent the first rapid test which has been successfully used to diagnose cholera from rectal swabs, and this would immensely improve surveillance for cholera, especially in remote settings.
PMCID: PMC179818  PMID: 12904424
24.  Status of antithyroid antibodies in Bangladesh 
Postgraduate Medical Journal  2000;76(896):345-349.
To study autoimmunity among thyroid diseases, 397 thyroid patients (age 30 (13) years; M/F 75/322) from two referral centres in Bangladesh and 94 healthy controls (age 30 (13) years; M/F 24/70) were studied for antimicrosomal and antithyroglobulin antibodies. Thyroid patients were clinically grouped as suspected autoimmune thyroid disease (AITD), non-autoimmune, or indeterminate groups (where no decision could be reached). Antimicrosomal antibody was strongly positive in 19.4% and weakly positive in 7.3% of patients but only 4.3% and 2.1% respectively in the controls (χ2 = 17.852; p = 0.000) whereas strong and weak positivity were 27.2% and 6.8% in patients compared with 8.5% and 4.3% respectively in the controls (χ2 = 16.916; p = 0.000) for antithyroglobulin antibody. Antibodies were positive in 63.0% with Hashimoto's thyroiditis, 36.4% with Graves' disease, and 44.7% with atrophic thyroiditis among the autoimmune group. In the non-autoimmune group antibodies were positive in 100% with multinodular hypothyroidism, 46.7% with subacute thyroiditis, 40.0% with suspected iodine deficiency goitre, 31.3% with toxic multinodular goitre, 30.8% with non-toxic solitary nodules, and 19.4% with simple diffuse goitre. None was positive for antimicrosomal antibody without being positive for antithyroglobulin antibody. The two antibodies strongly correlated in both patients (r = 0.977, p = 0.000) and controls (r = 0.986, p = 0.000). About 9% (36/397) of patients were mismatched with the final diagnosis on antibody measurement; most of them had Hashimoto's thyroiditis (33/36). Prevalence of AITD among thyroid patients was 48.36%. Specificity of antimicrosomal and antithyroglobulin antibodies were 93% and 87%. It was concluded that AITD is not uncommon in Bangladesh; antimicrosomal antibody is a useful marker for AITD and unless antibodies are checked, an appreciable number of patients with AITDs will remain undetected.

Keywords: thyroid autoimmunity; diagnostic dilemma
PMCID: PMC1741600  PMID: 10824048
25.  Comparison of immune responses in patients infected with Vibrio cholerae O139 and O1. 
Infection and Immunity  1997;65(9):3571-3576.
Vibrio cholerae O139 has recently emerged as the second etiologic agent of cholera in Asia. A study was carried out to evaluate the induction of specific immune responses to the organism in V. cholerae O139-infected patients. The immune responses to V. cholerae O139 Bengal were studied in patients by measuring antibody-secreting cells (ASC), as well as vibriocidal and antitoxic antibodies in the circulation. These responses were compared with those in patients with V. cholerae O1 disease. Strong immunoglobulin A (IgA) and IgM ASC responses were seen against the homologous lipopolysaccharide or serogroup of V. cholerae. The magnitude and isotype of the responses were similar in O139- and O1-infected patients. Vibriocidal antibody responses were seen against bacteria of the homologous but not heterologous serogroup, and these responses reflect the lack of cross-protection between the infections caused by the two serogroups. The two groups of patients showed comparable cholera toxin-specific ASC responses, with the IgG isotype dominating over the IgA isotype, as well as comparable antitoxic immune responses in plasma. These results suggest that despite having a polysaccharide capsule, V. cholerae O139 induces systemic and intestine-derived ASC responses in peripheral blood comparable to those seen in patients with V. cholerae O1 disease.
PMCID: PMC175508  PMID: 9284121

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