Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.

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Introduction: Hs-CRP is a nonspecific marker of the inflammatory response has been associated with development of type 2 diabetes mellitus. Cardiovascular disease is a major consequence of diabetes. DM confers a 2-4 fold rise in cardiovascular risk compared with general population. One of the many modifiable risk factors for both cardiovascular disease and diabetes is diet. Fiber is an important dietary factor that may modify the risk of both diseases. Material & methods: The current study is an attempt to explore the association of dietary fiber on inflammatory marker, hs-CRP in type2 diabetic subjects. Total 80 diabetic subjects were included in this study of which 40 were taking more dietary fiber and 40 were taking relatively low dietary fiber. Serum hs-CRP was measured by chemiluminescent immunometric assay (DPC Biermann Gmbh., Germany). Nutrient information was calculated using a pretested food recall questionnaire prepared by nutritionists for usual Bangladeshi food articles. Results: Hs-CRP was significantly higher in subjects taking low dietary fiber. There was significant negative correlation between CRP of subjects taking high and low intake of dietary fiber. Conclusion: So, low dietary fiber consumption maybe a possible causal factor of raised CRP. Type 2 diabetic patients who took less dietary fiber in their diets had elevated blood CRP levels. DOI: http://dx.doi.org/10.3329/bjms.v11i2.11434 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 117-120

Objective: This study aimed to compare the efficacy of diode laser and coblation tonsillectomy in paediatric patients in relation to operative time, amount of blood loss, post operative pain, healing of tonsillar fossa and returns to normal diet. Methods: A total of 200 patients ,100 for coblaton and 100 for diode laser, aged 3-12 years with recurrent tonsillitis with or without snoring and sleep apnoea were recruited. Participants were prospectively randomised to diode laser and coblation tonsillectomy. Operative time and blood loss were recorded. Pain was recorded by VAS or assessed by using analgesic. Results: The operative time were recorded 07-15 minutes,mean 10 minutes in coblation group and 12-20 minutes ,mean 14 minutes in laser group., Blood loss was recorded 0-15 ml mean 8 ml in coblation group and 10-25 ml mean 13.5 ml in diode laser group . However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with coblationtonsillectomy groups.Coblation group started normal soft diet on day 5 whereas diode laser started on day 8 Conclusion: Coblation tonsillectomy is associated with less operative time and blood loss, early returns to normal diet and less pain score in comparison to Diode laser tonsillectomy Bangladesh J Otorhinolaryngol; October 2017; 23(2): 140-145

Hepatitis C virus is one of the leading causes of liver disease and represents a major public health problem. It is a common cause of cirrhosis and hepatocellular carcinoma (HCC) as well as the most common reason for liver transplantation. This cross sectional study was carried out during the period of April 2007 to April 2008 among thalassemic patients with history of multiple blood transfusion (>20 units). Total 200 thalassemic patients from Thalassemia Samity Hospital, Green Road, Bangladesh Thalassemia Foundation, Dhanmondi, and from Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka were included in the study.After taking detailed history and clinical examination , 0.3 ml of venous blood was collected from each patient and tested for anti HCV by commercial kit. Positive cases were confirmed by ELISA method. Among 200 patients majority (68.5%) were below age of 20 years with a male to female ratio of 1.7:1,16.5% were found to have anti HCV positive. Anti HCV positivity increased with duration of exposure and number of blood transfusion., 22.9% of patients who had duration of exposure for more than 10 years and 36.4% having blood transfusion more than 40 units were positive for anti HCV. Key words: Seroprevalence; hepatitis C virus; thalassemia. DOI: 10.3329/jdmc.v18i2.6269 J Dhaka Med Coll. 2009; 18(2) : 115- 119

Objective: Although Protein Energy Malnutrition (PEM) has been studied extensively; the best criteria for its detection in early stages have not been established. This study was carried out to observe the change in transaminases, alkaline phosphatase levels when compared with control and also to see their relationships with various grades of PEM. Then to see if certain biochemical parameters could be used to detect malnutrition in early stage. Methods: Cross sectional study between Jan 1999-Dec 2000,124 children from 5 months to 5 years were included in the study. Out of 124 children 98 (79%) were cases and 26 (21%) normal age matched healthy controls. Cases were divided into groups as per Gomez classification (Group1-Grade I PEM, 37;Group 2-Grade II PEM, 34; Group 3-Grade III PEM27; and Group 4 26 Healthy controls). Three serum enzymes, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Alkaline Phosphatase (ALP) was analyzed and for statistical analysis student's "t" test was used. It can be concluded that abnormalities in blood levels of these enzymes occur in any form of PEM and these are related to the severity of the disease. Hence this may be helpful in early diagnosis of PEM where clinical features are equivocal.

In chronic bronchial asthma inflammation may be accompanied by intensive air flow limitation. Endogenous oxidants produced by overactive inflammatory cells destroy airway epithelium which slough into bronchial lumen and thus aggravates asthma. When oxidant overwhelm anti-oxidants, tissue injury and disease results. It is observed that decrease level of anti-oxidants in the lungs is a feature of chronic bronchial asthma and that there is a marked decrease of these levels during acute asthmatic attacks. These observations highlight the positive correlation between anti-oxidant therapy in asthmatic patients. The study was carried out to observe the changes in lung function in patients with chronic bronchial asthma both before and after supplementation of anti-oxidant vitamin A. Pulmonary function variables such as FVE, FEV1, FEV1/FVC%and PEFR were measured by spirometer in patients with chronic bronchial asthma both before and three month after supplementation of vitamin A 10,000 I.U orally daily. The mean FVC, FEV1, FEV1/FVC% and PEFR following vitamin A was unchanged significantly (P<0.001) than the pre supplementation values in patients with chronic bronchial asthma. This study reveals that no improvement of pulmonary functions occur after supplementation of anti-oxidant vitamin A in chronic bronchial asthma patients.TAJ 2014; 27(1): 10-13