volume 1 december 2009 for pdf.pmd introduction extent of mesoappendix of vermiform appendix in bangladeshi people rahman mm1 khalil m2 khalil m3 sultana sz4 mannan s5 nessa a6 ahamed ms7 parvin b8 islam mt9, siddiquee fs10 background: the mesentery of the appendix extends almost to the appendicular tip along the whole tube or may not be to the tip. the mesoappendix has a free border which carries the blood supply to the organ. failure of the mesoappendix to reach the tip probably reduces the vascularization of the tip of the organ making it more liable to become gangrenous and hence early perforation occurs during inflammation. objective: this cross sectional study was carried out to advance our knowledge regarding the extent of mesoappendix in bangladeshi people and also to find out the variations in the anatomical positions of the vermiform appendix in bangladeshi population and their distribution according to the sex. methods: a total of 100 (60 male and 40 female) specimens of vermiform appendix were collected of different age and sex during postmortem examination in the morgue of mymensingh medical college from july 2006 to june 2007. data was collected by convenient sampling technique. results: in this study pelvic position of the vermiform appendix were common in both sexes. the two thirds extension of mesoappendix was found in 45% cases where as in pelvic position it was 26 (14 male and 12 female) cases. half and whole extension of mesoappendix were found in 31% and 24% cases respectively. among half extension of mesoappendix, retrocaecal position were found to be more (12) than other positions. in whole extension of vermiform appendix pelvic position were found to be common (16) than others. conclusion: this study provides certain basic information of extent of mesoappendix of vermiform appendix of bangladeshi population which is responsible for vascularization of the organ and severity during inflammation. key words: vermiform appendix, mesoappendix j bangladesh soc physiol. 2009 june; 4(1): 20-23 for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp he appendix is a caecal diberticulum appears 8th week of intrauterine life and increases rapidly in length, so that at the mesentery of vermiform appendix hangs from the terminal part of the ilium. the mesentery of the appendix extends almost to the appendicular tip along the whole tube or may not be to the tip2. a small fold of peritoneum extends from the terminal ileum to the front of the mesoappendix, called ileocaecal fold or bloodless fold of treveres, although it sometimes contains blood vessels and the space between it and mesoappendix is the inferior ileocaecal recess. birth it is a long blind tube. the appendix has short mesentery called the mesoappendix1. the mesoappendix is a triangular peritoneal fold which invests the entire appendix and is derived from the posterior (left) layer of the mesentery of the ileum. appendix is connected by a short mesoappendix to the lower part of ileal mesentery. t 20 j bangladesh soc physiol. 2009 june; 4(1): 20-23 article another fold lies in front of the teminal ileum, between of the base of the mesentery and the anterior wall of the caecum. the fold is raised up by the contained anterior caecal artery and is called the vascular fold of the caecum. the space behind it is the superior ileocaecal recess. the mesoappendix has a free border which carries the blood supply to the organ. failure of the mesoappendix to reach the tip probably reduces the vascularization of the tip of the organ making it more liable to become gangrenous and hence early perforation occurs during inflammation. in childhood, the mesoappendix is so transparent that the contained blood vessels can be seen. in many adults it becomes laden with fat, which obscure these vessels. its layers enclose blood vessels, lymph vessels, nerves and a single lymph node2. mesoappendix appear at 8th week of intrauterine life with the appearance of appendix and its extension occur after birth by differential growth of caecum3. the extent of mesoappendix not related with age, height and weight of the person4. with these in mind, the present study was done to establish a bangladeshi standard regarding extent of mesoappendix of vermiform appendix and anatomical position of vermiform appendix. methods this cross sectional study was conducted on dead bodies received in the morgue of mymensingh medical college from july 2006 to june 2007. data were collected during postmortem examination using a structured format by convenient sampling technique. in this study one hundred vermiform appendix of both sexes(male60, female-40) were observed in situ dead bodies during post mortem examination. vermiform appendix of the decomposed dead bodies & bodies with lacerated wounds involving appendix were not included in the study. the abdomen was opened by midline incision and the position of the vermiform appendix was observed in situ and the anatomical position was noted on the format. the caecum along with the vermiform appendix was excised. the specimens were than cleaned and washed and the extent of mesoappendix was studied and recorded on the format. results a total of 100 cases in order to observe the changes in vermiform appendix due to age, collected specimens were grouped according to the age. age and sex distribution of cases are given in the table i. table i: age and sex distribution of subjects age (yrs) no. of sex total male female upto 20 13 15 28 21 – 35 28 11 39 36-55 9 8 17 56-70 9 7 16 total 59 41 100 in both sexes pelvic position of the vermiform appendix were found to be common, shows in table ii. table ii: distribution of the subjects by sex and anatomical position of the appendix position of appendix male female retrocaecal 13 8 retrocolic 6 5 pelvic 29 22 post-ileal 9 1 pre-ileal 2 5 the two-thirds extension of mesoappendix was found in 45% cases where as it was 26 (14 male and 12 female) in pelvic position. half and whole extension of mesoappendix were found in 31% and 24% cases respectively. among half extension of mesoappendix, retroceacel position were found to be more (12) than other positions. the whole extension of vermiform appendix in pelvic position was found to be common (16) than others (table iii). j bangladesh soc physiol. 2009 june; 4(1): 20-23 21 extent of mesoappendix of vermiform appendix in bangladeshi people article discussion the appendix is supplied by a small artery that doses not anastomose with other arteries. the blind end of the appendix is supplied by the terminal branches of the appendicular artery. inflammatory oedema of the appendicular wall compresses the blood supply to the appendix and often leads to thrombosis of the appendicular artery. these conditions commonly result in necrosis or gangrene of the appendicular wall, with perforation5 in this study pelvic position of the vermiform appendix were found to be common in both sexes. the present study, observed that two-thirds and whole extension of the mesoappendix were more common in male and it was also common in pelvic variety. in this study the extent of mesoappendix to twothirds length of vermiform appendix was 45% and most common in pelvic variety positions. the extent of mesoappendix to ½ length of vermiform appendix was 31% and common in retrocaecal positions. whole extension of mesoappendix in the vermiform appendix was 24% and it was common in pelvic variety. these findings are in consistent with the study of bakheit and bergmann where 2/3 extension of mesoappendix were found to be more (43%) common in pelvic variety and ½ extension mesoappendix were more (40%) common retrocaecal position of vermiform appendix6,7. the present study also found that 2/3 extension is more than ½ and whole extension of mesoappendix. failure of the mesoappendix to reach the tip probably reduces the vascularization of the tip of the organ making it more liable to become gangrenous and hence early perforation during inflammation8. conclusion by reviewing the findings of the study, pelvic variety of the appendix were found to be common. pelvic position was common in 2/3 and whole extension of the mesoappendix where as the recto-caecal was common in ½ extension of mesoappendix. it was also found that 2/3 extension is more that ½ and whole extension of mesoappendix. as extension of mesoappendix is responsible for vascularization of the vermiform appendix and severity during inflammation, so the finding of the study e.g. 2/3 extension was more than others provide an important information. table iii: distribution of the extent of mesoappendix by sex and by anatomical position of the vermiform appendix position of va 2/3 extension ½ extension whole extension m f t m f t m f t r. caecal 6 1 7 6 6 12 1 1 2 r. colic 1 1 2 1 2 3 4 2 6 pelvic 14 12 26 5 4 9 10 6 16 post ileal 6 0 6 3 1 4 0 0 0 pre ileal 2 2 4 0 3 3 0 0 0 total 29 16 45 15 16 31 15 9 24 22 j bangladesh soc physiol. 2009 june; 4(1): 20-23 article extent of mesoappendix of vermiform appendix in bangladeshi people authors affiliations 1 . *dr. md. mahbubur rahman, assistant professor (cc), department of anatomy, mymensingh medical college 2 . professor dr. mohsin khalil, professor & head of the department of anatomy, mymensingh medical college. 3 . professor dr. mansur khalil , professor & head of the department of anatomy, chittagong medical college. 4 . dr. seheli zannat sultana, associate professor, department of anatomy, mymensingh medical college. 5 . dr. sabina mannan, assistant professor, department of anatomy, mymensingh medical college. 6 . dr. akhtarun nessa, assistant professor department of physiology, mymensingh medical college. 7 . dr. m. shibbir ahamed, lecturer, department of anatomy, mymensingh medical college. 8 . dr. bilkis parvin, medical officer, mymensingh medical college hospital 9 . dr. md. tarequl islam, medical officer, jamalpur sadar hospital 1 0 . dr. fayela sabrun siddiquee , assistant registrar, gynae & obs 1 * for correspondence references 1 . sinnatamby cs, last’s anatomy regional and applied, 10th ed. churchill living stone: edinburgh; 1999 p – 249-50. 2 . schwartz si, principles of surgery, 7th ed, mcgrawhill, international edition health profession division: 1998, p. 1383-93. 3 . ross mh, koye gi, pawlina w, editors. histology: a text and atlas, 5th ed. baltimore: willims and wilkins; 2005. p. 528-574. 4 . snell rs. clinical anatomy. 7th ed. baltimore: lippincott william and wilkins; 2004. p. 215 – 7. 5 . borley nr. editor, microstructure of the large intestine. in: berkovitz kbb, borley nr, crossman ar, davis ms, fitzgerald mjt, glass j, et. al editors. grays anatomy: the anatomical basis of clinical practice. 39th edi, edinburgh: elsevier churchill livingstone; 2005, p. 1173-86. 6 . bakheit ma, warille aa. anomalies of the vermiform appendix and prevalence of the acute appendicitis in khartoum. king faisal university, dammam, saudi arabia. east afr med j, 1999; june; 76 (6): 338-40. 7 . bergmann j. do any vestigial structures exists in humans? cen technical journal 14 (2) 2000. 8 . das s. a concise text book of surgery. 1st ed. calcutta; s.d. publishers; 1996, p.966. j bangladesh soc physiol. 2009 june; 4(1): 20-23 23 extent of mesoappendix of vermiform appendix in bangladeshi people article volume 1 december 2009.pmd with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion or insulin action or both 1. it is a leading public health problem with increasing incidence and long term complications of various organs such as kidney, neuron, eye, heart etc. these compli-cations are mainly a consequence of macro and micro vascular damages of the target organs2. like other target organs lung is also affected in diabetes3. hyperglycemia causes micro vascular fvc, fev1 and fev1/fvc% in type 2 diabetes and their relationships with duration of the disease ali mo1, begum s2, begum n3, ali t4, ferdousi s5, begum a6 abstract background: diabetes mellitus is a chronic debilitating disease affecting various organs including lungs. the magnitude of the complications of this disease is related to its duration. objective: to observe fvc, fev1 and fev1/fvc% in type 2 diabetic patients and their relationship with duration of the disease. methods: this cross-sectional study was carried out in the department of physiology, bsmmu, dhaka, from july 2007 to june 2008 on 60 type 2 diabetic male patients of age 40-60 years (group b). for comparison, 30 age and bmi matched apparently healthy non diabetic subjects (group a) were also studied. patients were selected from the out patient department of bangladesh institute of research on diabetes, endocrine and metabolic diseases. based on duration of diabetes, diabetic patients were divided into b1 (5-10 years) and b2 (10-20 years). fvc, fev1 and fev1/fvc% of all the subjects were measured by a digital microspirometer . data were analyzed by one way anova test, unpaired student’s ‘t’ test and pearson’s correlation coefficient test as applicable. results: mean of the percentage of the predicted values of fvc and fev1, were significantly (p<0.001) lower in both those of gr. b1and b2 than that in a and were also significantly (p<0.001) lower in gr. b2 when compared with gr. b1. again, fev1/fvc% was significantly (p<0.01)higher in gr. b2 than those in gr. b1 and a whereas this value was lower in gr. b1than those of group a but it was not statistically significant. however, fvc and fev1 showed negative and fev1/fvc% showed positive correlations with duration of diabetes. all these correlations were statistically non significant. conclusion: from the result of this study it can be concluded that the ventilatory function of lung may be reduced in type 2 diabetes which may be related to the duration of the disease. key words: fvc, fev1, diabetes mellitus j bangladesh soc physiol. 2009 dec;4(2): 81-87 for author affiliations, see end of text. http//www.banglajol.info/index.php/jbsp changes such as thickening of basal lamina in the smaller vessels of the lungs, which causes reduction of its diffusing capacity of them. hyperglycemia also causes some mechanical changes in the lungs. in this chronic disease, the susceptibility and severity of systemic inflammation increases which may cause peripheral airway obstruction 4 as well as fibrosis of lung tissue 5. it was also observed that hyperglycemia affects the lung by non enzymatic glycation of chest wall and bronchial tree protein which prevents easy expansion 6. the duration of dm is an important factor affecting the lungs. chronic hyperglycemia is introduction he term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycemiat article 81 j bangladesh soc physiol. 2009 dec;4(2): 81-87 strongly associated with progressive neurogenic damage. its severity and extent increases with the duration of diabetes. in 2000, davis et al. observed that some pulmonary functions were decreased in type 2 diabetes and the reduction was directly proportionate to the duration of the disease 6. in 2007, meo et al. also observed that some spirometric lung function parameters were decreased in this group of patients and the decline was more in patients with longer duration of diabetes 2. the prevalence of diabetes is increasing day by day 7. the number of diabetic patients in the world may be raised from 150 million to 220 million by the year 2010 8. in our country, the number of diabetic patients is also increasing day by day. in 1966, about 1% people were affected by diabetes. but in 2003, it was about 15% 9. it is surprising that there is no age limitation for presentation of type 2 diabetes. many of the patients are diagnosed after development of one or more complications including nephropathy, neuropathy, retinopathy, and cardiovascular diseases. they also suffer from pulmonary complications. many studies on pulmonary functions in type 2 diabetic patients have been done in other countries. with the best of our knowledge no data is available in bangladesh. therefore, the present study was conducted to observe some aspects of lung functions in type 2 diabetic male to evaluate their lung function status and its association with duration of the disease. methods this cross-sectional study was carried out in the department of physiology, bsmmu, dhaka, from july 2007 to june 2008 on 60 type 2 diabetic patients of 40-60 years old. for comparison, 30 age and bmi matched apparently healthy non diabetic subjects were (group a) also studied. the patients were also matched with healthy subjects in terms of socioeconomic status. based on duration of diabetes, diabetic patients were divided into b1 (5-10 years) and b2 (10-20 years). the study group was selected from the out patients department of birdem. subjects with history of copd, asthma, smoking, heart disease, renal insufficiency, obesity, chest deformity and lung infections were excluded from the study. after selection of the subjects the purpose of the study was explained to each subject with a cordial attitude giving emphasis on the benefits they would obtain from this study. they were encouraged for voluntary participation. they were also allowed to withdraw themselves as soon as they need. to avoid the diurnal variation all the subjects were requested to attend at department of physiology bsmmu within 9 a.m. (after taking breakfast at 7 a.m) on the day of examination. before examination an informed written consent was taken from each subject. a detail personal, medical, family, socio economic, occupational and drug history were recorded in a preformed questionnaire. thorough physical examinations were done. height and weight of the subjects were measured for calculation of bmi. 5 ml of venous blood was collected at 9 am from every patient for estimation of serum glucose, serum creatinine and hba1c level in the blood as applicable. then fvc, fev1, fev1/ fvc% of all the subjects were measured by an electronic spirometer in the respiratory laboratory, department of physiology, bsmmu. glycosylated hemoglobin (hba1c) of diabetic patients was estimated by ion-exchange highperformance liquid chromatography (hplc) method. data were analyzed by one way anova test, unpaired student’s‘t’ test, and pearson’s correlation coefficient test as applicable. results the demographic variables of the study subjects are presented in table-i. the groups were matched for age and bmi. mean glycosylated hemoglobin (hba1c) levels in different duration of diabetes are shown in figure 1. the mean (±sd) hba1c level was significantly higher (p<0.01)in group b2 when compared to b1. fvc, fev 1 and fev 1 /fvc% in type 2 diabetes and their relationships article j bangladesh soc physiol. 2009 dec;4(2): 81-87 82 83 j bangladesh soc physiol. 2009 dec;4(2): 81-87 article fvc, fev1 and fev1/fvc% in type 2 diabetes and their relationships table i: age and bmi in different groups (n=90) groups n age bmi (years) (kg/m2) a 30 49.56 ± 5.59 20.63 ± 1.42 (40 60) (18.5-22.9) b1 30 51.70 ± 4.69 21.40 ± 1.70 (42 60) (18.5 – 22.9) b2 30 51.90 ± 5.82 21.30 ± 1.60 (40 60) (18.5 – 22.9) statistical analysis: groups p value p value a vs b1 vs b2 0.184 ns 0.13 ns a vs b1 0.115 ns 0.06 ns a vs b2 0.119 ns 0.10 ns b1 vs b2 0.884 ns 0.80 ns data are expressed as mean ± sd. for test of significance, one way anova were performed for comparison among the groups. independent ‘t’ test was done to compare between the groups.. group a = apparently healthy non diabetic male for control. group b1 = diabetic male with duration 5-10 years. group b2 = diabetic male with duration 10-20 years. ns = not significant. n = number of subjects. the results of fvc, fev1 and fev1/fvc (%) are shown in table ii. figure 1: mean glycosylated hb level in different duration of diabetes (n=60) group b1 = diabetic male with duration 5-10 years. group b2 = diabetic male with duration 10-20 years. n = number of subjects. table ii: mean percentage predicted values of fvc, fev1 and fev1/fvc (%) in different groups (n=90) groups n fvc (litres) fev1 (litres) fev1/fvc (%) a 30 112.86 ± 11.97 130.13 ± 12.84 116.06 ± 6.31 b1 30 83.30 ± 7.69 101.30 ± 8.78 115.53 ± 6.77 b2 30 75.10 ± 8.95 85.51 ± 9.84 121.60 ± 6.78 statistical analysis: p value groups a vs b1 vs b2 0.000*** 0.000*** 0.001*** a vs b1 0.000*** 0.000*** 0.753 ns a vs b2 0.000*** 0.000*** 0.001*** b1 vs b2 0.000*** 0.000*** 0.001*** data are expressed as mean ± sd. for test of significance, one way anova were performed for comparison among the groups. independent ‘t’ test was done to compare between the groups. group a = apparently healthy non diabetic male for control. group b1 = diabetic male with duration 5-10 years. group b2 = diabetic male with duration 10-20 years. *** = p <0.001., ns = nonsignificant, n = number of subjects. j bangladesh soc physiol. 2009 dec;4(2): 81-87 84 fvc, fev1 and fev1/fvc% in type 2 diabetes and their relationships article the mean percentage of predicted values of fvc and fev1 in group b1 and b2 were significantly (p<0.001) lower than those of group a, similarly, the values of fvc and fev1 in group b2 were significantly (p<0.001) lower than b1. but the mean percentage of predicted values of fev1/ fvc (%) were significantly higher (p<0.001) in group b 2 compared to b1. no significant difference was found when this value was compared between group b1 and group a. relationship of fvc, fev1 and fev1/fvc (%) with duration of diabetes in the study groups were observed. the results are shown in figure 2, 3 and 4. fvc and fev1 were negatively and fev1/fvc was positively correlated with duration of diabetes in both group b1 and b2. but these relationships were not statistically significant. figure 2: correlation of percentage predicted value of fvc with duration of diabetes in study groups (n=60) group b1 = diabetic male with duration 5-10 years group b2 = diabetic male with duration 10-20 years 4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00 70.00 80.00 90.00 100.00 110.00 120.00 figure 3: correlation of percentage predicted values of fev1 with duration of diabetes in study groups (n = 60) group b1 = diabetic male with duration 5-10 years group b2 = diabetic male with duration 10-20 years figure 4: correlation of percentage predicted value of fev1/fvc (%) with duration of diabetes in study groups (n = 60). group b1 = diabetic male with duration 5-10 years group b2 = diabetic male with duration 10-20 years hba1c (%) 85 j bangladesh soc physiol. 2009 dec;4(2): 81-87 article fvc, fev1 and fev1/fvc% in type 2 diabetes and their relationships discussion the present study was undertaken to observe some of the spirometric lung function variables in type 2 diabetic male subjects. most of the values of lung function parameters in non diabetic subjects were within normal range and almost similar to the findings reported by different investigators of other countries 10, 11 as well as in our country12. in this study, the mean of the percentage of predicted values of fvc and fev1 in type 2 diabetic patients of different duration were significantly lower than those of non diabetic subjects. these findings are consistent with findings of some investigators of different countries 2, 3, 11. again, these parameters in diabetic patients of 10-20 years duration was significantly lower when it was compared to that of 5-10 years duration of the disease. these findings are also in agreement with those of different investigators of other countries 2, 6, 13. fev1/fvc (%) in the diabetic patients with 5-10 years duration was lower than that of the control group though the difference was not statistically significant. sreeja et al. reported almost similar type of finding 14. on the other hand, this parameter in the patients with 10-20 years of diabetes was significantly higher than those of the diabetic patients with 5-10 years duration and also the control group. however, almost similar type of finding was reported by different researchers although the differences were not statistically significant 11. the data of our study showed that fvc and fev1 were negatively but fev1/fvc (%) was positively correlated with the duration of diabetes of both groups. all these relationships were statistically nonsignificant. these observations are in partial agreement with those of meo et al. (2007). they found significant negative correlation with fvc and fev1 2. on the other hand, benbassat et al. observed no correlation between lung function parameters and duration of the disease or glycemic control subjects 15. various studies suggested that diabetes mellitus may cause irreversible collagen cross linking in thoracic as well as lung tissue in addition, chronic hyperglycemia causes fibrous tissue formation in the chest wall and bronchial tree protein (specially collagen) by non enzymatic glycation. this fibrous tissue may cause reduced compliance of lung and subsequent chronic airflow obstruction 16. long standing hyperglycemia may also cause autonomic as well as somatic (phrenic) neuropathy, which alters respiratory muscle function17. moreover, hyperglycemia causes over production of mitochondrial super oxides and ultimately a secondary reduction in antioxidant defense of the lungs. so there is increased susceptibility to environmental oxidative insults and subsequent loss of respiratory function 18-19. diabetes mellitus is also associated with poor skeletal muscle strength due to increased protein catabolism 20. for this reason respiratory muscle endurance also decreases in diabetes mellitus 21. in this study, comparatively reduced fvc and fev1 in diabetic patients of both group and its subnormal value in patients with longer duration denotes decreased lung compliance and air flow obstruction. again, the increased ratio of fev1/ fvc (%) in diabetic patients of longer duration is due to disproportionate reduction of fvc and fev 1, which indicate that long-standing hyperglycemia may cause predominantly restrictive type of lung disorder. all these changes may be due to glycation of the chest wall and bronchial tree protein. this is further supported by negative correlation of fvc and fev1 and positive correlation of fev1/fvc% with longer duration of diabetes. the negative correlation of fvc and fev1 with duration of diabetes indicate that long standing hyperglycemia may intensify the devastating effect of the disease. conclusion from this study it may be concluded that lung functions decreases in type 2 diabetic male and j bangladesh soc physiol. 2009 dec;4(2): 81-87 86 fvc, fev1 and fev1/fvc% in type 2 diabetes and their relationships article the reduction is directly proportionate to the duration of the disease. acknowledgement the authors of this article are thankful to the authority of bangladesh institute of research on diabetes, endocrine and metabolism (birdem) for granting permission for sample collection. author affiliations * 1 . md. omar ali, assistant professor, department of physiology, jahurul islam medical college. email: omar ali dr@ gmail.com 2 . shelina begum, professor,chairman, department of physiology, bangabandhu sheikh mujib medical university (bsmmu), bangladesh. 3 . noorzahan begum, professor & chairman of the department of physiology, bangabandhu sheikh mujib medical university (bsmmu), bangladesh. email: noorzahanbeg@ yahoo.com 4 . taskina ali, assistant professor, department of physiology, bangabandhu sheikh mujib medical university (bsmmu), bangladesh. email: taskinadr@ gmail.com 5 . sultana ferdousi, assistant professor, department of physiology, bangabandhu sheikh mujib medical university (bsmmu), bangladesh. email: sferdousiratna@ gmail.com 6 . afroza begum assistant professor,(cc) department of community medicine, shahid sohrawardy medical college, dhaka * for correspondence references 1 . who definition diagnosis and classification of diabetes mellitus and its complications. report of a who consultation.geneva. who; 1999. 2 . meo sa, ahmed j, shah sfa, al-regaiey k, hussain a, al-rubean k. effect of duration of disease on ventilatory function in an ethic saudi group of diabetic patients. j diabetes sci technol 2007;1(5):711-717. 3 . davis wa, knuiman m, kendall p, grange v, davis tme. glycemic exposure is associated with reduced pulmonary function in type 2 diabetes.diabetes care. 2004; 27:752-757). 4 . ford es. body mass index, diabetes and creactive protein amonng u. s. adults. diabetes care. 1999; 22:1971-1977. 5 . weynand b, jonckheere a, frans a, rahier j. diabetes mellitus induces a thickening of pulmonary basal lamina. respiration. 1999; 66(1): 14-19. 6 . davis tme, knuiman m, kendall p, hien vu, davis wa. reduced pulmonary function and its assoc iations in type 2 diabetes: the fremantle diabetes study. diabet research clin pract 2000;50:153-159. 7 . europian diabetes epidemiology study group. will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? br med j. 1998; 317: 371-375. 8 . zimmet p, alberti kg, shaw j. global and societal implications of the diabetes epidemic. nature. 2001; 414: 782-7. 9 . khan aka, mahtab h, grant j, stewart m, ahmed t, haq a. diabetes mellitus. dibetic association of bangladesh. 2005; 1(1): 21-22. 1 0 . sinha s, guleria r, mirsa a, pandy rm, yadav r, tiwari s. pulmonary functions in patients with type 2 diabetes mellitus. inian j med res 2004; 119: 66-71. 1 1 . yen hc, punjabi nm, wang n, pankow js, duncan bb, brancati fl. cross-sectional and prospective study of lung function in adults with type 2 diabetes. the atherosclerosis risk in communities (aric) study. diabetes care. 2008; 31: 741-746. 1 2 . mostafa cgme. effects of vitamine a, c and e on some aspects of lung function in smoker. (m. phil. thesis) [dhaka(bangladesh)]bsmmu; 2003. p86. 1 3 . bell d, collier a, matthews dm, cooksey ej, mchardy gj, clarke bf. are reduced lung volumes in iddm due to defect in connective tissue? diabetes. 1988; 37(6): 829-31. 1 4 . sreeja ck, samuel e, kesavachandran c, shashidhar s. pulmonary function in patients with diabetes mellitus. indian j physiol pharmacol. 2003; 47(1):87-93. 1 5 . benbassat ca, evin s, mordechai k, joseph l, iiana b, gershon md. pulmonary function in patients with diabetes mellitus. am j med sci. 2001; 322(3): 127-132. 1 6 . schuyler mr, niewoehner de, inkley sr, kohn r. abnormal lung elasticity in juvenile diabetes mellitus. am rev respir dis. 1976; 113(1): 37-41. 1 7 . villa mp, cacciari e, bernardi f, cicognani a, salardi s, zapulla f. bronchial reactivity in diabetic 87 j bangladesh soc physiol. 2009 dec;4(2): 81-87 article fvc, fev1 and fev1/fvc% in type 2 diabetes and their relationships patients. relationship to duration of diabetes and degree of glycemic control. arch ped adoles med. 1988; 142(7). 1708-1718. 1 8 . brownlee m, vlassara h, cerami a. nonenzymatic glycosylation and pathogenesis of diabetic complications. ann intern med. 1984; 101(4): 527-537. 1 9 . brownlee m, vlassara h, cerami a. nonenzymatic glycosylation: role in the pathogenesis of diabetic complications. clin med. 1986; 32(10 suppl): b374 1 . 2 0 . p a r k sw, goodpaster bh, strotmeyer es, rekeneire n, harris tb, schwartz an, tylavsky fa, newman ab. decreased muscle strength and quality in older adults with type 2 diabetes. the health, aging and body composition study. diabetes 2006; 55:1813-1818. 2 1 . meo sa, al-drees am, arif m, shah sfa, alrubean k. assessment of respiratory muscle endurance in diabetic patients. saudi med j. 2006; 27(2):223-6 . phys. journal no. 3, december 2008.pmd relationship between obesity and parasympathetic nerve function shahin akhter1,noorzahan begum2, sultana ferdousi3, shelina begum4,taskina ali5 back ground: obesity is a potential risk factor for cardiovascular morbidity and mortality. as certain cardiovascular disorders associated with autonomic nerve which dysfunction often coexist in obese persons, investigations of autonomic nerve function especially parasympathetic nerve function in obese, for detection of early autonomic impairment can be potentially important to prevent complications. objective: the present study was done to observe the parasympathetic nerve function status in obese persons in order to investigate the relationship of autonomic nerve function with obesity. study design: this study was conducted in the department of physiology of bangabandhu sheikh mujib medical university, dhaka, bangladesh during july 2006-june 2007. for these 40 apparently healthy obese subjects of both sexes with bmi > 25 kg/sqm. were included in study group. age and sex matched 40 apparently healthy non obese subjects with bmi range 18.5-22.9 kg/ sqm. were taken as control for comparison. methods: to assess parasympathetic nerve function status, heart rate response to valsalva(valsalva ratio), heart rate response to deep breathing and heart rate response to standing (30th:15th ratio) were determined by 3 noninvasive cardiovascular reflex tests . data were collected by recording ecg of all subjects under test condition. the correlations of these parasympathetic nerve function parameters with bmi were also studied. unpaired student‘t’ test and pearson correlation coefficient test were used for statistical analysis. results: valsalva ratio (1.47±0.24 vs 1.67±0.31), hr response to deep breathing (19.62±5.55 vs 27.59±6.51) and hr response to standing (1.07±0.07 vs 1.13±0.018) were significantly decreased in obese subjects than those of non obese control. all these parameters were negatively correlated with bmi. and these relatioship were statistically significant. conclusion: the results of this study indicate that parasympathetic nerve function may be reduced in apparently healthy obese subjects. key words: obesity; valsalva; parasympathetic; deep breathing. j bangladesh soc physiol.2008 dec;(3):50-54. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp reported that globally, approximately 1.6 billion adults (age15+) were overweight and at least 400 million adults were obese. overweight population will reach approximately to 2.3 billion and obese population to 700 million by 20153. obesity is a condition of excess fat deposition in the body4. body mass index (bmi) is commonly used to identify and classify overweight and obesity in adult individuals4. o article introduction: besity is a nutritional health problem which is gradually rising and affecting a major section of adult population1. obese people have greater risk of developing both cardiovascular and metabolic diseases like hypertension, atherosclerosis, diabetes mellitus and gallbladder diseases2. in the mid 1990s who expressed concern to the growing obesity epidemic throughout the world1. in 2005, who 50 j bangladesh soc physiol. 2008 dec;(3):50-54 according to who standards, overweight and obesity are indicated by bmi > 25 and > 30 respectively. but for asians, the cut off point for overweight (23 to 24.9) and obese 25 are lower than the who standard5. obesity usually results from an imbalance between energy intake and energy expenditure which is under a feedback regulation involving a complex interaction among endocrine, nervous, metabolic and psychological factors6. hypothalamus plays an important role in the regulation of body weight2. the importance of hypothalamus and autonomic nerve activity for maintaining energy storage is supported by some experimental observations from animal model study7. more studies on autonomic nervous activity in human obese persons have reported controversial findings; these include hypoactivity of parasympathetic and associated hyperactivity of sympathetic nerve function8; both reduced sympathetic and parasympathetic nerve activity9-10 and increased parasympathetic activity with a decreased sympathetic nerve activity7. sometimes, obesity is associated with minor impairments of autonomic nerve function and in most of the cases, changes were found in parasympathetic division of autonomic nervous system which is analogous to the early stage of autonomic neuropathy in diabetes mellitus11. obesity related health problems including various cardiovascular and metabolic diseases are not uncommon in our community. in addition to recognized complications of obesity, autonomic nerve dysfunction may also coexist with certain cardiovascular disorders in obese person. in obese persons, investigations of autonomic nerve functions especially parasympathetic one can be potentially important for detection of early autonomic nerve function impairment which there by may be helpful to prevent its complications. but no published data on parasympathetic nerve function status in obese people is available in bangladesh. therefore, this study was aimed to observe the parasympathetic nerve function status in obese subjects and also to find out any relationship between parasympathetic nerve activity and obesity. methods: this cross sectional study was conducted in department of physiology of bangabandhu sheikh mujib medical university, dhaka, bangladesh. for this, 80 apparently healthy subjects of both sexes with age range from18-40 years were selected from the different areas of dhaka city. on the basis of their body mass index, all the subjects were divided into two groups. group a(control) consisted of 40 nonobese subjects with bmi between 18.50 22.90 kg/sqm. group b (study)consisted of obese subjects with bmi > 25 kg/sqm.. the subjects with age >40 years, overweight (bmi 23 24.9 kg/sqm.), diabetes mellitus, chronic renal failure, suffering from any obvious cardiovascular diseases, chronic obstructive lung diseases, previous history of head injury and smokers were excluded from this study. the purpose and expected outcome of the study were explained to each subject. they were encouraged for voluntary participation. written informed consent was obtained from each subject. detailed medical and family history was taken and thorough clinical examination was done. all information were recorded in a preformed questionnaire. height and weight of the subjects were recorded and bmi was calculated. random blood sample was collected to determine blood glucose and serum creatinine to exclude diabetes mellitus and chronic renal failure. blood glucose and serum creatinine level were measured by auto analyzer in the hematology laboratory of the physiology department. then the autonomic nerve function parameters like valsava ratio, heart rate response to deep breathing and heart rate response to standing (30th:15th ratio) were determined by performing valsalva maneuver, deep breathing and orthostatic test using an ecg machine and a parasympathetic nerve function and obesity article j bangladesh soc physiol. 2008 dec;(3):50-54 51 mercury column attached to a mouthpiece by a rubber tube. each of the subject was briefed about the procedure in detail and encouraged to obtain maximum efficient performance. cardiovascular reflex tests were conducted in the neurophysiology laboratory from 9.00am2.30pm in a comfortable environment. the subjects were allowed to rest and relax for at least 10 minutes upon arrival. in all subjects, valsalva maneuver, deep breathing and orthostatic test (30th:15thratio) were performed sequentially. before the tests, all the subjects took rest in supine position in a bed for a minimum of 10 minutes and then their basal heart rate was recorded. results were compared between the groups. relationship of all the parameters with bmi were observed. data were entered in computerized spss program version-12. all the data were expressed as mean ± sd (standard deviation). statistical analysis were done by unpaired student’s ‘t’ test and pearson’s correlation-coefficient test as applicable. results: anthropometric details of the subjects are given in table-i. both groups are matched for age and sex. mean weight and bmi were significantly higher (p<0.001) in obese subjects compared to that of nonobese control subjects. all the parasympathetic nerve function parameters were analyzed separately in male and female. but no significant differences were observed between male and female. the results of the parasympathetic nerve function tests are shown in table-ii. obese subjects(group b) had significantly lower valsalva ratio, hr response to deep breathing and 30th :15th than those of control(group a). the results of correlations are presented in figure 1,2,3. all the parasympathetic nerve function parameters showed statistically significant negative correlation with bmi. table-i mean + sd, age, height, weight and body mass index in the study groups (n=80) parameters group-a group-b (n=40) ( n=40) age(years) 31.02±5.04 31.77±4.66ns (20-40) (19-40) height(cm) 165.02±7.64 163.37±8.69ns (154-180) (152-180) weight(kg) 57.6±6.49 76.05±9.18*** (48-72) (58-98) bmi(kg/m2) 21.44±1.24 28.45±1.78*** (18.75-22.90) (26.17-33.96) group a : nonobese subjects having bmi between 18.50 to 22.90 kg/m2 group b : obese subjects having bmi >25 kg/m2 values in parenthesis indicate range.n = total number of subjects.ns= not significant. ***= significant at <0.001 level. table-ii parasympathetic nerve function parameters in the study groups (n=80) parameters group-a group-b n=40 n=40 valsalva ratio 1.67±0.31 1.47±0.24** (1.21-2.34) (1.07-1.98) heart rate response 27.57±6.51 19.62±5.55*** to deep breathing (16.18-39.83) (9.28-31.89) (beats/min) heart rate response 1.13±0.08 1.07±0.07** to standing (1.04-1.34) (0.9-1.25) (30th:15th ratio) group a : nonobese subjects having bmi between 18.50 to 22.90 kg/m2 group b : obese subjects having bmi ≥25 kg/m2 values in parenthesis indicate range. n = total number of subjects.**= significant at <0.01 level. ***= significant at <0.001 level. article parasympathetic nerve function and obesity 52 j bangladesh soc physiol. 2008 dec;(3):50-54 discussion: the results in the present study have shown that hr response to valsalva maneuver, to deep breathing and standing were significantly lower in obese subjects than in non obese control which is similar to the findings observed by some other investigators of different countries12-15. but relatively higher valsalalva ratio and lower deep breathing and standing test in obese subject compared to control subjects but not statistically significant were also found by some other group of observers 6. in this study, all the parasympathetic nerve function parameters showed negative correlation with bmi and it was statistically significant. therefore, the present study has shown that parasympathetic nerve dysfunction may occur in obese people. however,the exact mechanism that may cause impairment of parasympathetic nerve function has not yet been clearly established. some researchers suggested that gradual development of insulin resistance in target tissues with the beginning of excess weight gain in obesity is responsible for subsequent development of hyperinsulinaemia 4. this hyperinsulinaemia has got a role in low cardiac vagal activity in obese person16. though the relationship between insulin resistance and parasympathetic dysfunction is not clear, but several researchers made various suggestions such as high insulin level or insulin resistance may cause damage to autonomic nerves at any level of their reflex arc17, insulin resistance may cause a deterioration of microcirculation in many tissues including nerves which may lead to neural ischemia17 and thereby damage of cardiac parasympathetic nerve terminals occur at the level of cardiac muscle or vascular wall18. figure 1: relationship between bmi and valsalva ratio in the obese groups (n=80) figure 2: relationship between bmi and hr response to deep breathing in the obese groups (n=80) figure 3: relationship between bmi and 30th:15thratio in the obese groups (n=80) parasympathetic nerve function and obesity article j bangladesh soc physiol. 2008 dec;(3):50-54 53 therefore, this study concludes that obesity may reduce parasympathetic nerve function. authors affiliations: *1. shahin akhtar,lecturer, physiology, chittagong medical college, chittagong bangladesh. 2. noorzahanbegum, professor and chairman, department of physiology, bsmmu. email:noorzahanbeg@ yahoo.com 3. sultana ferdousi,assistant professor, department of physiology, bsmmu.email:sferdousiratna @yahoo.com 4. shelina begum, professor, department of physiology, bsmmu. 5. taskina ali, assistant professor, department of physiology, bsmmu. email:taskinadr @gmail.com *for correspondance references: 1. weisell rc. body mass index as an indicator of obesity. asia pacific j clin nutr. 2002; 11:s681-s684 2. ganong wf. review of medical phisiology. 22nd ed. usa: mc grawhill company; 2005. 3. guyton ac, hall je. text book of medical physiology. 11th ed. singapore: w.b.saunders; 2006. 4. steering committee. the asia-pacific perspective: redefining obesity and its treatment. melbourne: international diabetes institute, 2000. 5. colak r, donder e, karaoglu a, ayhan o, yalniz a. obesity and the activity of autonomic nervous system. turk j med sci. 2000; 30: 173-176. 6. bray ga. auotonomic and endocrine balance in the regulation of energy balance. fed proc. 1986; 45: 1404-1410. 7 arrone lj, mackintosh r, rosenbaum m, liebel rl, hirsch j. autonomic nervous system activity in weight gain and weight loss. am j physiol. 1995; 269: r222r225. 8. hofmann kl, mussgay l, and ruddel h. autonomic cardiovascular regulation in obesity. j endocrinol. 2000;164: 59-66. 19. peterson hr, rothschild m, weingberg cr, fell rd, meleish kr, pfeifer ma. body fat and the activity of autonomic nervous system. n eng j med. 1988; 28:1077-1083. 10. mathias cj and bannister r. autonomic failure. a textbook of clinical disorders of the autonomic nervous system. 3rd ed. newyork: oxford university press; 1992. 11. rossi m, marti g, ricordi l, fornasari g, finardi g, fratino p, and bernardi l. cardiac autonomic dysfunction in obese subjects. clin sci. 1989; 76: 567-572. 12. v alensi p, bich ngoc pt, idriss s, paries j, cazes p, lormeau b and attali jr. haemodynamic response to an isometric exercise test in obese patients: influence of autonomic dysfunction. int j obes. 1999; 23:543-549. 13. emdin m, gastaldelli a, muscelli e, macerata a, natali a, camastra s and ferrannini e. hyperinsulinemia and autonomic nervous system dysfunction in obesity: effects of weight loss. circulation. 2001; 103: 513-519. 14. valensi p, lormeau b, dabbech m, miossec p, paries j, dauchy f et al., glucose induced thermogenesis, inhibition of lipid oxidation rate and autonomic dysfunction in nondiabetic obese women. int j obes. 1998, 22:494-499. 15. borne pvd, hausberg m, hoffman rp, mark al and anderson ea. hyperinsulinaemia produces cardiac vagal withdrawl and nonuniform sympathetic activation in normal subjects. am j physiol regul integr comp physiol. 1999; 276:178-183. 16. valensi p, paries j, lormeau b, attia s, attali jr. influence of nutrients on cardiac autonomic function in nondiabetic overweight subjects. metabolism. 2005; 54: 1290-1296. 18. valensi p, nguyen tn, idriss s, cazes p, karam g, paries j, miossec p and attali jr. influence of parasympathetic dysfunction and hyperinsulinaemia on the haemodynamic response to an isometric exercise in non ins ulin dependent diabetes mellitus. metabolism. 1998; 47: 934-939. article parasympathetic nerve function and obesity 54 j bangladesh soc physiol. 2008 dec;(3):50-54 number 2 december 2007 final.pmd introduction morphological study of length, breadth and thickness of the ovary at different age group in bangladeshi people ahmed sm1, khalil m2, rahman mh3, mannan s4, sultana sz5, ara zg6, rahman mm7 the morphological study was done to see length, breadth and thickness of the ovary in different age group of bangladeshi people to increase the knowledge regarding variational anatomy in our population. sixty two postmortem tissue block containing ovary and fallopian tube along with surrounding structures were collected from 62 female cadavers of different age groups and fixed in 10% formol saline solution. gross & fine dissections were carried out to study these morphological parameters of ovary in different age group. in the present study, findings were compared with the finding of other researchers. in this study the mean length of ovary was maximum in found in group c (46-80 years) 4.32cm and minimum was found in group a (2-13 years) 2.81cm of both side. the mean breadth of ovary was maximum in group c 2.01cm and minimum was in group a 1.38cm. the mean thickness of ovary maximum was in group c 0.971cm and minimum was in group a 0.682cm of both sides. in statistical analyses significant difference between two groups was calculated by using students “t” test. a difference between two groups was considered to be significant when p<0.05. in the present study it is observed that the size of the ovary is not equal on both side of same individual. key words: ovary; morphology; bangladesh j bangladesh soc physiol. 2007 dec;(2):24-27. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp he ovaries are a pair of female reproductive and endocrine glands1. the ovaries of the female are homologous with the testis of the male. they are solid, nodular bodies, with the proportions of a large unshelled almond. situated on either side of the uterus, behind and below the uterine tubes. they are attached to the back of the broad ligament and to the lateral wall of the lesser pelvis by peritoneal folds. the ovaries contains numerous ova, which are discharged during ovulation by periodic rupture of the follicles; in addition to being cytogenic glands, the ovaries produce hormones regulatory of the development and activity of the female reproductive organs 2. reproduction is basic part of human life cycle to maintain its own species. the ovaries are the organs responsible for the production of the female germ cells, the ova and the female sex hormones, estrogen and progesterone in the sexually mature female 3. without maintaining these functions properly by ovaries, life will be burdensome. for these reason, ovary is one of the essential sexual organ in human being. to understand the basic mechanism of these important functions of human body has an immerse value. now a day, large numbers of people are suffering from ovarian disease and also importance for diagnostic as well as surgical purposes. so a research work on detailed anatomical parameters such as length, breadth and thickness of ovary is an un-debatable t j bangladesh soc physiol. 2007 dec;(2): 24-27 24 article requirement for the successful treatment of ovarian disease. methods the present study was performed on 62 post mortem human ovaries from bangladeshi female cadaver’s age ranging from 02 to 80 years. all specimens were studied by careful gross dissection. specimens containing ovaries with ligament, uterus and fallopian tube were collected from dead bodies autopsied on different dates from october 2006 to may 2007 at the autopsy laboratory of department of forensic medicine of mymensingh medical college, mymensingh, bangladesh. all the collected specimens were from medicolegal cases. only fresh specimen of ovaries was selected from the dead bodies which were collected within 24 hours after death. ovaries of decomposed body grossly injured and poisonous cases were excluded from the study. the collected specimens were tagged with an identifying number representing individual serial number. the particulars of the body (age and cause of death) were the respective specimen number. undergoing the study 62 ovaries were divided into three categories e.g. 2-13 years in group a, 14-45 years in group b and 46-80 years in group c. the study was carried out in the department of anatomy, mymensingh medical college, mymensingh, bangladesh between july 2006 to june 2007. from each cadaver the ovary and fallopian tubes and related neighboring structures were collected by “block dissection” during routine post mortem examination. then the collected specimens were washed gently with tap water to remove the blood and blood clots as per as possible. the specimens were fixed and preserved in 10% formol saline solution. gross and fine dissection was carried out to study the length, breadth and thickness of the ovary after removing the ligament of the ovary. the length, breadth and thickness of ovary were measured with the help of a slide caliper. the lengths of ovaries were measured from its upper pole to lower pole. the breadth and thickness were measured in the middle portion of the ovaries. all the data were recorded in pre-designed data sheet from specimen of each cadaver. the collected data were processed and analyzed statistically by anova to find out the significance difference in different age groups. results comparison of length of ovary in three age groups. are shown in table i. in this study difference of mean length of ovaries between group a vs. group b and group b vs. group c were statistically significant on both side but the difference between group a vs. c of right ovary highly significant and left ovary moderately significant only. table i : depicts length of ovary in different age groups groups length of length of right ovary (cm) left ovary (cm) mean ± se mean ± se a(2-13 years) 2.81 ±0.52 2.50 ± 0.42 b(14-45 years) 3.64 ± 0.92 3.50 ± 0.78 c(46-80 years) 4.15 ± 0.53 4.32 ± 0.83 statistical analysis groups level of significance right ovary left ovary a vs. b significant significant b vs. c significant significant a vs. c highly moderately significant significant j bangladesh soc physiol. 2007 dec;(2): 24-27 25 morphology of ovary article table – ii: shows morphological characters of ovaries in different age groups groups breadth breadth (mean) ± se (mean) ± se of right ovary of left ovary in cm in cm a(2-13 years) 1.45 ± 0.42 1.38 ± 0.35 b(14-45 years) 1.88 ± 0.46 1.88 ± 0.51 c(46-80 years) 2.01 ± 0.46 1.67 ± 0.47 statistical analysis groups level of significance right ovary left ovary a vs. b significant significant b vs. c significant not significant a vs. c highly significant significant comparison of breadth of ovary in there age groups a, b & c are shown in table-ii. the average breadth of right ovary was maximum in group c and minimum in group b. the average breadth of left ovary was maximum in group b and minim in group a. in statistical analysis the difference mean breadth of ovary between a vs. b was only significant on both side but difference between a vs. c was highly significant on right side and significant only on the left side. thickness of ovaries in different age groups is shown in table iii. in present study maximum thickness of right ovary was in group c and minimum was found in group a but in case of left ovary maximum thickness of ovary was found in group b and minimum in group a. in statistical analysis the mean thickness of difference between group a vs. b was highly significant on both sides. in case of b vs. c was significant only on right side. the thickness difference between group a vs. c was significant on both sides. table – iii: thickness of ovaries in different age groups groups thickness thickness (mean) ± se (mean) ± se of right ovary of left ovary in cm in cm a(2-13 years) 0.682 ± 0.15 0.709 ±0.08 b(14-45 years) 0.877 ± 0.29 0.951 ± 0.28 c(46-80 years) 0.971 ± 0.17 0.814 ± 0.23 statistical analysis groups level of significance right ovary left ovary a vs. b highly highly significant significant b vs. c significant not significant a vs. c significant significant discussion the ovary shows considerable individual variation in size and the right is considerable, some what larger than the left. the mean length, breadth and thickness were more on right side than left which was confirmed to the findings of mcvay. he found the length, breadth and thickness of the ovary were 3.6 mm in length, 1.8 cm in breadth and 1.2 cm in thickness2 which is less than my finding. where as thomas ind. 4 found length, breadth and thickness were 2.0cm, 1.5cm, and 0.5cm in early menopause and 1.5 x 7.5 x 0.5cm which is very less than my finding. sinnatambly 5 states that the ovaries are somewhat flattened, ovoid bodies, measuring about 3 cm in length, 2 cm in width and 1 cm in thickness 5, which is less than my findings. copenhaver 6 found that the length, breadth and thickness were 4.0cm, 2.0cm and 1.0cm which are similar with my findings in c group. in this study it is observed that the size of the ovary is not equal in both side of the same individual. our present finding indicates that length, breadth and thickness of ovary are more than the other researchers. 26 j bangladesh soc physiol. 2007 dec;(2): 24-27 article morphology of ovary it is expected that, the findings of the present study will enrich the information pool on the morphology of ovary in different age group in bangladeshi people. author affiliation 1. *dr md shibbir ahmed, lecturer of anatomy, mymensingh medical college, mymensingh, bangladesh 2. prof. mohsin khalil, professor and head of anatomy, mymensingh medical college, mymensingh, bangladesh 3. dr md habibur rahman, assistant professor, anatomy department, mymensingh medical college, mymensingh, bangladesh 4. dr sabina mannan, assistant professor (cc) of anatomy, mymensingh medical college, mymensingh, bangladesh 5. dr seheli zannat sultana, assistant professor of anatomy, mymensingh medical college, mymensingh, bangladesh 6. dr zubaida gulshan ara, assistant professor, department of anatomy, cbmcb, mymensingh, bangladesh 7. dr m mahbubur rahman, mbbs, m phil, lecturer of anatomy, mymensingh medical college, mymensingh, bangladesh * for correspondence references 1. datta ak. essential of human anatomy part ii. 6th ed. calcutta current book international; 2003. p. 315-31. 2. mcvay a. surgical anatomy (volume-2). 5th ed. philadelphia: wb saunders company; 1971. p. 805-06. 3. snell rs. clinical anatomy. 7th ed. baltimore: lippincott william and wilkins; 2004. p. 386-90. 4. thomas ind. editor. female reproductive system. in: standring s, ellis h, healy jc, tohnson d, williams a, collins p, wigley c. editors. gray’s anatomy: the anatomical basis of clinical practice. 39 th ed. edinburgh: elsevier churchill livingstone; 2005. p. 1332-38. 5. sinnatambly cs. last’s anatomy. regional and applied. 10 th ed. churchill, livingstone. 1999. p. 296-98. 6. copenhaver mw, bunge rp, bunge md. bailey’s text book of histology. 16th ed. baltimore: the william and wilkins company; 1971. p. 581-92. j bangladesh soc physiol. 2007 dec;(2): 24-27 27 morphology of ovary article 403 forbidden forbidden you don't have permission to access this resource. apache/2.4.54 (ubuntu) server at www.banglajol.info port 443 403 forbidden forbidden you don't have permission to access this resource. apache/2.4.54 (ubuntu) server at www.banglajol.info port 443 volume 1 december 2006.pmd primarily with the nutrition of growing fetus and with the maternal adaptation needed for this purpose. lipid changes during pregnancy are a result of phyhysiological adaptation to the state pregnancy. there are increases in the blood concentration of cholesterol, triglyceride and phospholipids2. toward the end of pregnancy, the daily production of placental estrogen and progesterone increases about 30 and 10 times the mother ’s normal level of production respectively1. estrogen generally tends to increase serum triglyceride and hdl-cholesterol and decreases serum ldl-cholesterol and total cholesterol. whereas progesterone tends to studies on serum total cholesterol, in second and third trimester of pregnancy husain f 1, latif sa 2, uddin mm 3 study was carried out in the department of physiology, mymensingh medical college, mymensingh, bangladesh during the period of july 2006 to june 2007 to investigate the effect of pregnancy on serum total cholesterol. the serum concentrations of total cholesterol was measured in 100 cases of 2nd and 3rd trimester of pregnancy and in a control group of 100 cases of non pregnant women which was matched on reproductive age. data were analyzed by computer with spss program using unpaired student‘t’ test. the results showed that the pregnant women had significantly higher concentrations of serum total cholesterol. higher concentration of total cholesterol was more common in pregnant than control and reaching maximum at 3rd trimester of pregnancy. this may be a purely physiological response to pregnancy or it may be indication of pathology in some women. these results deserve a follow up study to investigate whether the hypercholesterolemia persists after parturition. key words: total cholesterol, pregnancy, parturition, hypercholesterolemia j bangladesh soc physiol. 2006 dec;(1):1-4. for author affiliations, see end of text. produce, the opposite effects and thus counteract the action of the estrogen3. hormonal change during pregnancy induces changes in composition of lipid, making it more atherogenic as pregnancy progress4. hyperlipidaemia is defined as excess concentration of cholesterol or triglyceride or both in plasma5. increased serum lipid and lipoprotein concentrations are recognized risk factor for atheromatous cardiovascular diseases6. effective control the blood lipid level reduces cardiovascular morbidity and mortality both in patient with established chd and those at risk of developing chd7. although pregnancy has been shown to increase serum total cholesterol and triglyceride, its effect on apolipoprotein and lipoprotein has not been adequately characterized .more over the prevalence, extent of these alteration, the duration of changing concentration of lipid & j bangladesh soc physiol. 2006 dec;(1):1-4. 1 article p introduction regnancy is a new sequence of events after fertilization of ovum 1. the physiology of pregnancy is concerned lipoprotein, and underlying mechanism where by pregnancy induces hyperlipidaemia have not been fully documented. therefore, in women with 2nd and 3rd trimester of pregnancy, what changes occur in total cholesterol concentration in our socio economic context? the main objective in this study is to investigate whether the total cholesterol during pregnancy differs from non-pregnant women of similar reproductive life. the rationale of this study is based upon the effect of pregnancy on serum cholesterol metabolism so that steps may be taken to minimize any cardiovascular and other complications, which may help to promote and preserve women’s reproductive health. however, attempt is made to asses and evaluates which type of change occurs in the cholesterol metabolism during pregnancy. in this preliminary report, we present the result of total cholesterol measurements perform on 100 healthy women in 2nd and 3rd trimester of pregnancy and compare these with those of non-pregnant women of similar age. methods a cross sectional study was carried out in the department of physiology, mymensingh medical college, mymensingh, bangladesh during the period of july 2006 to june 2007. a total number of 100 cases of 2nd and 3rd trimester of pregnancy were participated as study group. this group again subdivided into group 1(a) and 1(b). 1a consist of 50 cases of 2nd trimester of pregnancy and gestational period were 12-28 weeks. 1b consist of 50 cases of 3rd trimester of pregnancy and gestational period were 29-40 weeks. hundred cases of non-pregnant women matched on reproductive age were considered as control group. participants those who were suffering from diabetes mellitus (random blood sugar>11 mmol/l)8, hypertension (blood pressure>140/ 90 mm of hg)9, obesity (bmi>30kg/m2 )1, contraceptive user in control group were excluded from this study. we also exclude 1st trimester of pregnancy because there is no significance change in concentration of serum lipid and lipoprotein between study and control group 10,11. the sampling technique was convenience type. during visit the available pregnant women and controls those who were present were interviewed and examined. under strict aseptic precaution, venous blood sample was collected from all subjects biochemical analysis of serum was carried out for estimation of total cholesterol by chod-pod enzymatic method using lipid profile kit, spinreact sa ctra. santa coloma , 7-e-17176 sant esteve de bas (goriona) spain12. statistical analysis was calculated by spss program using unpaired student t test between two groups. results the 100 subjects with 2nd and 3rd trimester of pregnancy and 100 control matched on reproductive age were participated. data were expressed as mean ( ± se) in tables. all the results were expressed in mmol/l. table i shows the concentration of total cholesterol in group i (pregnant) and in group ii (control), was 5.898(±0.013) vs. 4.276(±0.038), p<0.001. the pregnant women had significantly higher concentration of total cholesterol than control. table i: comparative analysis of serum total cholesterol in group i (pregnant) and group ii (control) by spss parameters groups mean t value p value ±sem serum total i 5.898 cholesterol n = 99 ±0.103 (mmol/l) 14.747 <0.001 ii 4.276 n = 100 ±0.038 n = number of subjects, sem = standard error of mean, p<0.001 = highly significant table ii shows the relative analysis of serum total cholesterol in group 1a (2nd trimester) and group ii (control). the mean (se) serum total cholesterol was significantly higher in pregnant than in control. 2 j bangladesh soc physiol. 2006 dec;(1):1-4. article table ii: relative analysis of serum total cholesterol in group ia (2nd trimester) and group ii (control) by spss parameters groups mean± t value p value sem serum total 1a 5.373 cholesterol n = 50 ±0.131 (mmol/l) 7.985 <0.001 ii 4.276 n = 100 ±0.038 n = number of subjects, sem = standard error of mean, p<0.001 = highly significant table-iii shows the proportional analysis of serum total cholesterol, in group1b (3rd trimester) and group ii control. the mean total cholesterol concentration was significantly higher in pregnant women of 3rd trimester than in control (p<0.001). table iii: proportional analysis of serum total cholesterol in group ib (3rd trimester) and group ii (control) by spss parameters groups mean± t value p value sem serum total 1b 6.434 cholesterol n = 49 ±0.117 17.427 <0.001 (mmol/l) ii 4.276± n = 100 0.038 n = number of subjects, sem = standard error of mean, p<0.001 = highly significant discussion the finding of this study shows that there is progressive increase in concentrations of total cholesterol, during the course of 2nd and 3rd trimester of pregnancy than controls. this study documents total cholesterol shows about, 70% increase during pregnancy and reaching maximum 50% at 3rd trimester of pregnancy in comparison to control. in comparison to other study, the majority of similar study was agreed with this results13,15,16,17. in this study, it is difficult to explain how pregnancy hormones increased the serum total cholesterol level. the mechanism whereby pregnancy induces hyperlipidaemia has not been fully documented. estrogen seems to be responsible for most of the alterations in lipoprotein metabolism during pregnancy, but its action are complemented and opposed by the other pregnancy hormones and in late pregnancy by increasing insulin resistance. the role of progesterone in pregnancy associated hyperlipidaemia is questionable. progesterone has been to shown to oppose the action estrogens on lipoprotein metabolism, leading to increased concentrations of ldl cholesterol and decreased concentrations of hdl cholesterol. some authors have suggested that the estrogen progesterone ratio, which is low in early and in very late pregnancy, is important in the balance of the alteration in lipoprotein metabolism throughout pregnancy 18 . this study has certain limitations. firstly, the subjects were not observed longitudinally. secondly, the pregnant group was highly selected, the subjects being recruited from women presenting for medical checkups. the results may therefore not be representative of the general population. thirdly, both study and control groups were non-fasting. based on a research work it can be concluded that higher concentration of total cholesterol is more common in pregnant than control and reaching maximum at 3rd trimester of pregnancy. however, when determining the need for diagnostic evaluation of hyperlipidaemia, we should consider at list two or three measurement of total cholesterol during pregnancy and follow up measurement would be required after delivery. author affiliations *1. dr m farhad husain, mbbs, m phil, lecturer of physiology, mymensingh medical college, mymensingh, bangladesh, email: drfarhadmmc @yahoo.com 2. professor shah abdul latif, mbbs, m phil, facp, frcp edin, professor and head of physiology, mymensingh medical college, mymensingh, bangladesh. e-mail: salatif@bttb.net.bd 3. dr m murshed uddin, mbbs, m phil, associate professor of physiology, mymensingh medical college, mymensingh, bangladesh * for correspondence j bangladesh soc physiol. 2006 dec;(1):1-4. 3 article references 1. guyton ac, hall je. text book of medical physiology. 11th ed. philadelphia: elsevier; 2006. p. 872,1017,1027-1033. 2. keele ca, neil e, joels n. samson wright’s applied physiology. 13th ed. new york: oxford; 2000. p. 574582. 3. nessa a, latif sa, uddin m. effects of low dose oral contraceptives on serum total cholesterol, tag, hdlc & ldl-c levels in contraceptives users. mymensingh med j. 2004;14(1):26-28. 4. fernandez ju, hoyos am, carballo am, prieto ap, ruiz av, cosano cr, monila-font ja. lipoproteins in pregnant women before and during delivery influence on neonatal haemorheology. j clin pathol. 1996;49:120-123. 5. murchison le. hyperlipidaemia. british medical journal. 1985;290:535-538. 6. koukkou e, watts gf, mazurkiewicz j, lowy c. ethnic differences in lipid and lipoprotein metabolism in pregnant women of african and caucasian origin. j clin pathol. 1994;47:1105-1107. 7. sarker d. studies on serum total cholesterol, triglyceride, hdl-cholesterol, ldl-cholesterol, creatinine & creatinine clearance values in hypertensive patients (thesis). mymensingh: university of dhaka; 2006:4-5. 8. haslett c, chilvers er, boon na, colledge nr. davidson’s principles and practice of medicine. 19th ed. edinburgh: churchill livingstone; 2002. p. 649. 9. sarkar d, latif sa, uddin mm, aich j, sutradhar sr, ferdousi s, ganguly kc, wahed f. studies on serum lipid profile in hypertensive patient. mymensingh med j. 2007 jan;16(1):70-76. 10. alvarez jj, montelongo a, iglesias a, lasuncion ma, herrera e. longitudinal study on lipoprotein profile, high density lipoprotein subclass and post heparin lipases during gestation in women. j lipid res.1996;37:299-308. 11. sattar n, greer ia, louden j, lindsay g, mcconnell m, chepherd j et al. lipoprotein sub fraction changes in normal pregnancy: threshold effect of plasma triglyceride on appearance of small, dense low density lipoprotein. j clin endocrinol metab. 1997;82:24832491. available from: www.jcem.endojounals.org 12. spinreact, sa. ctra. santa coloma, 7 e-17176 sant esteve de bas (gi) spain. 13. saarelainen h, laitinen t, raitakari ot, juonala m, heirskanen n, laitine tl et al. pregnancy-related hypelipidemia and endothelial function in healthy women. circ j. 2006;70:768-772. 14. sattar n, greer ia, louden j, lindsay g, mcconnell m, chepherd j et al. lipoprotein sub fraction changes in normal pregnancy: threshold effect of plasma triglyceride on appearance of small, dense low density lipoprotein. j clin endocrinol metab. 1997;82:24832491. available from: www.jcem.endojounals.org 15. winkler k, wetzka b, hoffman mm, friedrich i, kinner m, baumstark mw et al. low density lipoprotein (ldl) sub fractions during pregnancy: accumulation of buoyant ldl with advancing gestation. j clin endocrinol metab. 2000;85:45434550. available from: www.jcem.endojounals.org 16. sttar na, lindsay g, greer ia, packard cj, shepherd j. the hyperlipidaemia of normal pregnancy. atherosclerosis, supplement. 64, 1995:17. available from: http://www.ingentaconnect.com/content/els/ 00219150/1995/00000115/90000064/art96321. 17. potter jm, nestel pj. the hyperlipidemia of pregnancy in normal and complicated pregnancies. am j obstet gynecol. 1979 jan 15;133(2):165-70. available from: h t t p : / / w w w . n c b i . n l m . g o v / e n t r e z / query.fcgi?it00l=abstractplus&db=pubmed&cmd=ret 18. masurkiewiez jc, watts gf, warburton fg, slavin bm, lowy c, koukkou e. serum lipid, lipoproteins and apoliproteins in pregnant non-diabetic patients. j clin pathol. 1994;47:728-731. 19. young ds. implementation of si units for clinical laboratory data. ann intern med. 1987;106:114; jama instructions for authors, jama. 1997;278:74. 4 j bangladesh soc physiol. 2006 dec;(1):1-4. article volume 1 december 2006.pmd artery and sub-mucosal follicles, it is prone to infection. besides these factors, its variable position also hampers the early diagnosis of any appendicular pathology 1. according to the many authors, the vermiform appendix is the only organ in the human body which has no single definitive anatomical position. its position varies from individual to individual. the position of the vermiform appendix was of great interest not only because of its evolutionary significance but also because of its pathological and surgical importance. appendicitis was a common medical problem in man at all ages from childhood to old age. the position of the organ was important in the pathogenesis, presentation, j bangladesh soc physiol. 2006 dec;(1): 5-9 5 article anatomical positions of vermiform appendix in bangladeshi people rahman mm 1, khalil m 2, rahman h 3, mannan s 4, sultana sz 5, ahmed s 6 the study was done to see the incidences of different anatomical positions of vermiform appendix in bangladeshi people to increase the knowledge regarding variational anatomy in our population. a total 100 vermiform appendix (male-60, female-40) were observed in situ on cadaver of different age and sex during routine post mortem examination in the autopsy laboratory of forensic department of mymensingh medical college. this cross-sectional descriptive study was done by convenient sampling technique. for convenience of differentiating the incidences of different positions of vermiform appendix in relation to age and sex findings were classified and analyzed in four age groups (up to 20 year, 21 35 years, 36 55 years, 56 70 years) and in different sex. in the present study, the pelvic position of vermiform appendix was the most common position in all age groups and pelvic positions were found in 47% cases. the retrocaecal position was the second highest position (22%) and pre ileal position was the lowest (10%) in number. in respect to sex, incidences of pelvic variety of vermiform appendix were more in male than female. key words: vermiform appendix, anatomy, position j bangladesh soc physiol. 2006 dec;(1):5-9. for author affiliations, see end of text. surgical approach and prognosis of the appendix related diseases2. identification of the normal position of the appendix is important because in appendicitis, variable positions may produce symptoms and signs related to their position and hence can mimic other diseases3. acute inflammatory changes are the most frequent cause of surgical abdominal interventions. inflammation of atypically located vermiform appendix may initiate inflammation of other organs which leads to diagnostic errors and life threatening complications that it can cause. deadly infection of the appendix at youthful age is common4. the only thing constant about the position of the appendix was its inconstancy. no useful purpose was served by elaborate statistics of appendicular a introduction ppendicular pathology are gradually increasing in our country. as it is a blind end tube and has muscularis hiatus, end 6 j bangladesh soc physiol. 2006 dec;(1): 5-9 article topography in view of its great variability. although it can not be sufficiently stressed that the position of the appendix may vary even with the posture of the individual as well as the degree of distention of the adjacent bowel. there are nevertheless two categories of surgical importance, one concerns the frequency of appendix in fixed position by adherence to the posterior abdominal wall or adjacent organs and the other with the incidence of retro caecal and retro-colic positions.5 the knowledge of variational anatomy regarding the position of appendix is very much essential when attempting to diagnose a case as appendicitis. in retrocaecal appendicitis it is difficult to found tenderness on palpation in the right iliac region. irritation of the psoas muscle occurs in retrocaecal or para caecal appendicitis. retrocolic appendicitis confuse with cholecystitis. in pelvic variety appendicitis, tenderness mainly elicit in the suprapubic region. post ileal appendicitis called missed appendix and common in children and in early adult life. perforation of preileal appendix causes more diffuse peritonitis than others. in retrocaecal and retrocolic variety of appendix, the chances of gangrenous complication are more common because their blood supply more prone to kinked 5. pelvic variety appendix principally cause is suprapubic pain from irritation of urinary bladder. long retro-colic inflamed appendix also called sub hepatic and it causes confusions with cholecystitis. a retrocaecal appendix may cause principally right flank or back pain. whereas preileal directs towards the spleen and if it becomes inflamed it is liable to result in general peritonitis and is the most dangerous positions 5. with this rationale in mind, present study was done to establish a bangladeshi standard regarding various positions of vermiform appendix which is the basic and essential for easy diagnosis and to prevent complications of appendicular pathology. methods in this study, one hundred normal vermiform appendixes of both sexes(male-60, female-40) were observed in dead bodies during routine postmortem examination due to accidental and unnatural death. vermiform appendix of the decomposed bodies & lacerated injured cases involving appendix or its adjacent structures were excluded from the study. in the morgue of mymensingh medical college, during routine postmortem examination when the abdomen was opened by classical midline incision, the position of the vermiform appendix were observed in situ and noted in the prepared format. in this study the cadaver ages were from up to 70 years (table i). table i. number of specimen in different age groups group a group b group c group d up to 20 21 – 35 36 – 50 51 – 70 years years years years n =28 n =39 n =18 n =15 male =13 male =28 male =10 male =09 & & & & female female female female =15 = 11 = 08 = 06 ‘n’ represents the number of specimens examined in each group for convenience of differentiating the changes of vermiform appendix in relation to age, collected specimens were grouped in a group (up to 20 years), group b (21 year 35 years), group c (36 year 55 years) & group d ( 56 yeas 70 years). results positions of vermiform appendix in respect of groups (table ii and table iii): in group a pelvic variety was highest in percentages, 35.71%, total number of observation was 28, preileal and postileal was the minimum in number of variety (10.71%) in each. in group b pelvic variety was maximum, in percentages 48.71%, post ileal was the minimum preileal variety (5.12%) and total number of observation was 39. in group c pelvic variety was 52.94%. retrocolic position was nil in position total number of observation were 17. j bangladesh soc physiol. 2006 dec;(1): 5-9 7 article table ii. positions of vermiform appendix in different age groups group a group b group c group d retro caecal 3.5 7 29.62 3.5 7 17.94 2.5 5 29.41 1.5 3 20.00 retro colic 2.0 4 14.28 2.0 2 10.25 0 2 0 1.0 2 13.33 pelvic 5.0 11 35.71 9.5 19 48.71 4.5 9 52.94 4.5 9 60.0 post ileal 1.5 3 10.71 1.5 6 15.38 0.5 2 5.88 0.5 1 6.66 pre ileal 1.0 3 10.71 4.5 2 5.12 0.5 3 29.41 0 0 0 total 28 36 21 15 mean 2.80 4.20 1.60 1.50 level of significance p<0.001 p<0.001 p<0.001 p<0.001 ‘n’ represents the number of specimens examined in each group. group ab ms than cd, group a ms than b, group a s than b, group b s than c, group c s than d, group a hs than d, here hs means highly significant, ms means moderately significant, s means significant *** p < 0.001 (hs), ** p < 0.01 (ms), * p < 0.05 (s) table iii. position of vermiform appendix in male and female position of va number of male female percentage (%) observation (n) mean mean r. caecal 22 4.00 2.25 22 r. colic 10 2.00 0.50 10 pelvic 47 6.75 4.75 47 post ileal 12 2.00 0.25 12 pre ileal 9 2.25 1.00 9 level of significance p<0.001 p<0.001 ‘n’ represents the number of specimens examined in each group. pelvic variety hs than r. cacal, r. cacal ms than pre ileal, pre ileal s than r. colic, r. colic s than post ileal pelvic and r. colic and pre ileal hs than post ileal and r. colic, pelvic hs than r. cacal and pre ileal pelvic hs than post ileal , here hs means highly significant, ms means moderately significant, s means significant *** p < 0.001 (hs), ** p < 0.01 (ms), * p < 0.05 (s) percentage (%) po si tio n o f v a o bs er va tio n n o. ( n) m ea n o bs er va tio n no . ( n) pe rc en ta ge ( % ) m ea n pe rc en ta ge ( % ) m ea n o bs er va tio n (n ) pe rc en ta ge ( % ) m ea n o bs er va tio n no . ( n) pe rc en ta ge ( % ) in group d pelvic variety were 60%, pre ileal position were nil in position. total number of observation was 15. in all groups pelvic position was the most common position (47%), retrocaecal (22%) position was the second highest position in number and preileal (10%) position was the lowest in number. positions of vermiform appendix in respect of age group and sex: (table ii and table iii): 8 j bangladesh soc physiol. 2006 dec;(1): 5-9 article here shows, 47 pelvic varieties were found in 100 specimens. the pelvic position was maximum in respect of group and sex 47% and its mean value was 5.75 in male its mean was 6.75 and in female its mean was 4.75. lowest number of positional variety was pre ileal 10%. its mean was in respect to sex and group 1.62. in male its mean was 2.00 and female it was 0.25. in all groups and sex observed that pelvic variety in male sex was maximum in number. discussion in the uk on 1959 and in ghana on 1988, at surgical removal it was found that the commonest position of the vermiform appendix was retrocaecal. in their series, found the retro-caecal position in 74% cases followed by pelvic 21%, post ileal 5%, para-caecal 2%, sub-caecal 1.5% and preileal 1%. kartzarski during a postmortem study found that the pelvic position was the commonest (43.2%) in the indigineous population of ghana 13. a study in the relative position of the vermiform appendix found that in american infants, the retro-ileal was the commonest followed by retrocaecal, pelvic, sub-caecal and ectopic 14. in 1945, shah and shah studies 405 cases and found 45.5% retro-caecal and retro-colic, 27.4% ileio caecal, 21.5% pelvic and 5.4% sub-caecal positions 4. the position and relation between intestinum caecum and vermiform appendix are variable. vermiform is a variable organ as for position and the place of origin from the wall of intestinum caecum. it is found that predominantly placed in the middle of the lower pole of the intestinum, caecum (58%), in medial wall it is present in (32%) and lateral wall in the least number cases (10%) 15 the vermiform appendix is subject to considerable variation in position. as the ascending colon elongates the appendix may pass posterior to the caecum (retrocaecal appendix) or colon (retrocolic appendix). it may also descend over the brim of the pelvis (pelvic appendix) 5 wakeley 1933, who claimed retrocaecal position to be the commonest 65%, but other investigators claimed that rectrocaecal and retrocolic position are the 5. the frequency of different position of the adult’s vermiform appendix followed the above mentioned trend excepting those of wakeley (1933) and shah and shah (1945). these authors recorded a high incidence of retro-caecal and retro-colic positions. it was interesting to note that shah and shah (1945) noted a much higher incidence of these positions in operative cases (62%) than in cadeveric specimens (30.1%). it was suggested that the vermiform appendix might be more liable to inflammation when fixed retro-caecally, and thus accounted for its high incidence at operation 5 in ajmani and ajmni (1983) series, the retrocaecal and retro-colic position was the most common (58%) followed by pelvic (23%), post ileal (10%), sub-caecal (5%), pre-ileal (2%) and para-caecal (2%). it was possible that the frequency of the retro-caecal and retro-colic positions among the indians might be one of the factors responsible for acute appendicitis. this was because in the retro-caecal and retro-colic positions, the blood vessels could be compressed or kinked by the caecum or ascending colon. so when the appendix was inflamed, the surgeons most commonly found it in the retro-caecal and retro-colic positions which might give it and inadequate blood supply 7. kartzarski (1971) during a postmortem study found that the pelvic position was the commonest 43.2% in the indigenous population of ghana. this figure was almost similar to kartzarski and bary, 1979 found in their series in zambia 14 . there are no explainable roles concerning the position occupied by the vermiform appendix. wakeley (1933) studied 1000 cases and found the retrocaecal and retrocolic positions the most commonest (65.28%), followed by the pelvic (31.1%), sub-caecal (2.26%), preileal (1.00%), postileal (0.4%) and ectopic (0.05%) 5 the present study (table number ii.) shows that in all groups, pelvic position was the most common position. j bangladesh soc physiol. 2006 dec;(1): 5-9 9 article retrocaecal was the second highest position in number, pre-ileal was the lowest in number and, pelvic variety was maximum in number. it is thought that in the pelvic position, the blood vessels of the appendix are free from pressure, whereas in the retrocaecal and retro colic position the vessels are compressed or kinked by the loaded caecum or the ascending colon.4 in this study incidence of common positions of appendix did not agree with the findings of the above mentioned authors. here, pelvic variety was found to be the most common variety instead of retrocaecal variety. appendicitis is a general surgeon and practitioner diagnostic reflection. for early and easy diagnosis it is very important to know about variable position of vermiform appendix in bangladeshi people to minimize the morbidity and mortality in appendicular pathology. if we can study in living body, larger scale in different regions of bangladesh, we shall get better information about appendix for bangladeshi people. author affiliations *1. curator of anatomy, mymensingh medical college, bangladesh 2. professor of anatomy, mymensingh medical college, mymensingh, bangladesh 3,4,5. assistant professor of anatomy, mymensingh medical college, mymensingh, bangladesh 6. lecturer of anatomy, mymensingh medical college, mymensingh, bangladesh * for correspondence references 1. datta ak. essentials of human anatomy. part – i. 6th ed. calcutta: current books international; 2007, p. 228 – 30. 2. normann lb. an introduction to the symptoms and signs of surgical disease. 3rd ed. england: elst; 1997. p – 406 – 9. 3. bakheit ma, warille aa. anomalies of the vermiform appendix and prevalence of the acute appendicitis in khartoum. king faisal university, dammam, saudi arabia. east afr med j, 1999; june; 76 (6): 338 – 40. 4. schwartz si, principles of surgery, 7th ed, mcgrawhill, international edition health profession division: 1998, p. 1383 – 93. 5. o’connel pr. the vermiform appendix. in: russel rcg, norman sw, christopher jkb; editors bailey’s and loves short practice of surgery. 24th ed. london: international student ed; 2004, p.1203 – 18. 6. woodburne ri. essential’s human anatomy. 5th ed. london: oxford university: 1973. p 430 – 33. 7. borley nr. editor, microstructure of the large intestine. in: berkovitz kbb, borley nr, crossman ar, davis ms, fitzgerald mjt, glass j, et. al editors. grays anatomy: the anatomical basis of clinical practice. 39th edi, edinburgh: elsevier churchill livingstone; 2005, p. 1173 – 86. 8. snell rs. clinical anatomy. 7th ed. baltimore: lippincott william and wilkins; 2004. p. 215 – 7. 9. plesis dudj. a synopsis of surgical snatomy. 11th ed. bristol: john wright and sons ltd.; 1995. p. 184 10. moore kl, dalley af, editors. clinically orientated anatomy. 4th ed. philadelphia: lipincott williams and wilkins; 1999. p. 250 – 3. 11. karim om, borthroyd ae, wyllic jh. mc burney’s point-fact or friction? ann r coll surg engl. 1990 sep; 72(5): 304 – 8. 12. shen gk, wong r, daller j. does the retrocaecal position of the vermiform appendix alter the clinical course of acute appendicitis. arch surg, 1991 may; 126 (5): 569 – 70. 13. chowdhury gmi, anatomical study of vermiform appendix in bd,1993. department of anatomy, ipgmr, dhaka, bd, 1993. 14. das s. a concise text book of surgery. 1st ed. calcutta; s.d. publishers; 1996, p.966. 15. delic j, savkovic a, isakovic e. variations in the position and point of origin of the vermiform appendix. med art. 2002; 56(1): 5 – 8. 16. lally kp, cox cs, andrasy rj editor. appendix. in: townsend, beauchmp, everts, mattox sabiston text book of surgery, vol. ii. 7th ed. saunders; 2004. p. 1381 – 99. 17. ndoye jm, ndiaye a, dia a, fall b. cadaveric topography and morphometry of the vermiform appendix. (article of french) faculty of medicine, dakar senegal. 2005 jun; 89(285): 59 – 63. 18. oto a, srinivasan pn, ernst rd. revisiting mri foe appendix location during pregnancy. 2006 mar; 186(3): 883 – 7. 403 forbidden forbidden you don't have permission to access this resource. apache/2.4.54 (ubuntu) server at www.banglajol.info port 443 phys. journal no. 3, december 2008.pmd article introduction serum total protein and albumin levels in different grades of protein energy malnutrition chowdhury msi 1, akhter n 2, haque m 3, aziz r 4, nahar n 5 the present study has been designed to estimate serum total protein and albumin levels in different grades of protein energy malnutrition and this will be helpful in early diagnosis, management and rehabilitation of pem. the serum total protein and albumin levels were studied on 20 healthy children and 30 children suffering from protein energy malnutrition of different grades. serum total protein and albumin levels of different grades of protein energy malnutrition were significantly lowered than that of control. lowering being maximum in grade iii pem. this lowering of total protein and albumin occur in any form of pem and related to severity of the disease. key words: serum, protein, malnutrition j bangladesh soc physiol.2008 dec;(3):58-60. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp and thus help in reducing problem created by pem5. methods the study was carried out in a total number of 50 children of 06 months to 05 years of age of both sexes and out of them twenty of apparently healthy children with no systemic disorder and in terms of median harvard standard weight/ height ratio more than 80% were taken as control group. thirty children suffering from various grades of pem of same age and both sexes were selected as experimental group and excludes hepatobiliary and other disease by history and physical examination 30 children with pem of both sexes in the age group of 6 month to 5 years were selected for the study the attendant parents of the patients was put through a questioners to collect data related to the study and verbal consent were taken from them for alnutrition is one of the common public health problem and observe a leading cause of mortality in bangladesh. children under 06 years are victims of different grades of malnutrition1. children with pem have greater deficient of total protein and in severe cases the total protein may be reduced to around 50%2. the reductions of total serum protein and albumin were more marked in kwashiorkor than in marasmus. physical findings generally help in the diagnosis of advanced malnutrition but is not frequently positive in children in mild and moderated degree of malnutrition. early diagnosis of these cases is very useful, as they are amenable to early rehabilitation, have better prognosis.3, 4 the assay of total protein and albumin will prove very useful in the diagnosis of pem before clinical manifestations are established m 58 j bangladesh soc physiol. 2008 dec;(3):58-60 participation his/her child in the study. experimental groups were collected from bsmmu, child nutrition unit of dhaka shisu hospital and dhaka medical college hospital, dhaka. grade – i, ii and iii pem cases were selected according to classification set by gomez, shown in tablei. table – i gomez classification of pem degree of pem % of desired body wt. for age & sex normal 90%-100% grade –i. mild malnutrition 75% 89% grade – ii. moderate malnutrition 60%-74% grade –iii, severe malnutrition <60% another classification of pem based on height for age and weight for height called water low classification is shown in table – ii. table – ii waterlow classification of pem degree of stunting (%) wasting (%) pem height for age weight for height normal 90% 90% mild 87.5-95% 80-90% moderate 80-87.5% 70-80% severe <80% <70% blood was drawn with all aseptic precaution and serum total protein was determined by colorimetric biuret method. albumin was determined by colorimetric bromcresolgreen method. statistical analysis of the result was done by unpaired student “t”test. results serum total protein and albumin levels in grade i, grade – ii and grade iii. pem are significantly lowered (p<0.001) than that of control (table – iii). serum total protein and albumin levels in grade iii, pem are significantly lowered (p<0.001) than that of grade ii and grade i, pem. when comparison was done between grade ii pem and grade i pem, it was found that serum total protein and albumin levels in grade ii pem was significantly lower that of grade i pem. table – iii mean (±se) serum total protein and albumin levels in control and different grades of pem. parameters control grade-i pem grade-ii pem grade-iii pem n=20 n=10 n=10 n=10 total protein (gm/dl) 7.02±0.14 5.15±0.26*** 4.6±0.09*** 4.0±0.08*** albumin(gm/dl) 4.46±0.06 3.38±0.13*** 3.12±0.12*** 2.6±0.11*** *** p<0.001= highly significant discussion in this study serum total protein and albumin values in all grades of pem are significantly lowered than control. lowering of these serum total protein and albumin values in pem could be explained on the basis of generalized p r o t e i n d e f i c i e n c y l e a d i n g t o i m p a i r e d synthesis. these results are in agreement to that of other workers. 2, 4, 5, 6, 7 in the final stage of wasting low plasma albumin concentration can appear because of feature of adaptation of protein deficient diet5. protein energy malnutrition article j bangladesh soc physiol. 2008 dec;(3):58-60 59 in the development of mararasmus, there occur deficiencies of energy in the diet reselling in the change of normal pattern4. it is also observed that reduction in serum albumin and total protein in pem was due to reduced synthesis of protein because of inadequate intake of dietary protein9. conclusion it may conclude that serum total protein and albumin were significantly lowered in protein energy malnutrition and this varies according to its severity. the result may help physician to diagnose pem and could help to detect its severity. author affiliations 1. * md serajul islam chowdhury, assistant professor of biochemistry, chittagong medical college, chittagong, bangladesh 2. nayeema akhter, professor of physiology, chittagong medical college, chittagong, bangladesh 3. mahmudul haque, professor of biochemistry, chittagong medical college, chittagong, bangladesh 4. rehana aziz , assistant professor of biochemistry, chittagong medical college, chittagong, bangladesh 5. nazibun nahar, lecturer of biochemistry, chittagong medical college, chittagong, bangladesh * for correspondence references 1. bangladesh bureaus of statistics. report of the child nutrition status survey, 1995-96. dhaka. bangladesh bureau of statistics, 1996-:22-39. 2. montogomery rd. muscle morphology in infantile protein energy malnutrition. j clin path 1962;15:511-21. 3. bengoa jm. recent trends in the public health aspects of protein calorie malnutrition who chron 1979;24:552-61. 4. coward wa & lunn pg. the biochemistry and physiology of kwashiorkor and marasmus. br med bulletin 1981;37(1):19-24. 5. coward bwa, whitehead rg & lunn pg. reasons why hypoalbuninaemia mayor may not appear in protein energy malnutrition. br j nutr 1977;38:115-26. 6. coward bwa, whitehead rg & coward dg. quantitative changes in serum protein fractions during the development of kwashiorkor and in recovery. br j nutr 1972;28: 433-41. 7. kumer v, chandrasckharan r, belavalgidad m.i. blood biochemical tests in the diagnosis of malnutrition. indian pediatrics 1975;12(10):955-60. 8. bhattacharya ak. studies on kwashiorkor and marasmus in calcutta (1957-74): pathological, biochemical and metabolic studies. indian j pediatrics 1975;12:1115-21. 9. osifo boa & bloodekujo. serum aspartate and alanine aminotransferase activities in protein energ y malnutrition. enzymes 1982;28:300-4. article protein energy malnutrition 60 j bangladesh soc physiol. 2008 dec;(3):58-60 volume 1 december 2006.pmd j bangladesh soc physiol. 2006 dec;(1):40-41 40 letter problem in developing countries like bangladesh. atherosclerosis –this extremely widespread disease predisposes to myocardial infarction, cerebral thrombosis, ischemic gangrene of the extremities and other illness. myocardial infarction is a very common cause of death due to sequele of atherosclerosis. 1, 2 in the uk (population 59 million) 1 in 3 in men and 1 in 4 in women die from chd (coronary heart disease), an estimated 330000 people have myocardial infarct each year and approximately1.3 million people have angina 2. although great advances have been made in prevention and treatment of chd through drug therapies and procedures, diet and lifestyle modification remain the foundation of clinical intervention for prevention. unfortunately, above mention are commonly neglected, to the detriment of patients. the rationality of this scientific writing is to promote the healthy behaviors and increases public awareness of blood cholesterol level, there by reduce populationwide lipid levels and reduce the need for drug therapy. in affluent societies dietary cholesterol is derived mainly from egg yolk (the richest source), dairy products and red meat; the daily intake is about11.5 to 2.0 mmol (600 to 800mg). inhibition of hepatic cholesterol synthesis, by suppression of the enzyme hmg coa reductase, may not prevent intracellular accumulation of lipid if dietary intake is excessive 3, 5. diet and life style modification be able to reduce the risk of coronary heart diseases nessa a 1, uddin mm 2, ferdousi s 3, hussain ma 4 j bangladesh soc physiol. 2006 dec;(1):40-41. for author affiliations, see end of text. to the editor n the developed societies the major cause of death and premature disability is atherosclerosis. it is also an emerging healthi dyslipidemia plays a vital role in atheroscleroticcardiovascular diseases. dyslipidemia is adisorder of lipid metabolism including lipoprotein over production or deficiency. 2, 3, 5, 6 low hdl-cholesterol is a strong independent predictor of coronary heart disease (chd). hdl-cholesterol has been identified as a lipoprotein that protects against atherosclerosis and its levels are inversely proportional to the risk for developing ischemic coronary heart disease. hdlc physiologically removes excess cholesterol from arterial walls and transports it to the liver, where it is re-metabolized and excreted in the form of biliary acids. 3-6 ldl–cholesterol is a strong risk factor for atherosclerosis. when serum ldl-cholesterol exceeds physiological limit it then taken up by macrophages and some other cells. when the macrophages become overloaded with oxidized ldl, they become “foam cells” that are seen in early atherosclerotic lesions of the arterial walls.5-6 research studies suggest that the protector effect of “good” cholesterol (hdl-c) is stronger than the atherogenic effect of “bad” cholesterol (ldlc). 3, 4, 6 elevated tg frequently associated with low hdl and increased ‘small dense’ ldl.1, 5 ldl cholesterol and triglyceride measurements are useful for guiding the treatment, but do not improve chd risk prediction better than measurement of total and hdl cholesterol only. 5, 8, 9 the national cholesterol education program adult treatment panel iii (ncep-atp iii) recommends beginning screening of all adults at age 20, regardless of cardiovascular risk profile. 3 lifestyle changes can favorably affect total cholesterol, hdl cholesterol, ldl cholesterol and triglyceride levels. a reduction on total cholesterol by 1 percent may decrease a person’s risk of developing coronary heart disease by 2 percent. 3, 4, 7, 9 diet and preventive life style measures – that help to control lipid level 1, 3, 4, 7, 10 • aim for a healthy body weight attain and maintain normal body weight. • consume an overall healthy diet-follow a diet containing less than25%-35%of calories from fat, less than 7% of calories from saturated fat, and fewer than 200 mg of cholesterol per day. • emphasize a plant based diet. • consume a diet rich in vegetable and fruits. • choose whole-grain, high-fiber foods. • minimize your intake of beverages and foods with added sugars. • if one consumes alcohol, consume no more than1 to 2 alcoholic beverages per day. • avoid use of and exposure to all forms of tobacco products. • be physically active. exercise aerobically for at least 30 minutes on most and preferably all days of the week. regardless of the presence of preexisting chd, patients who adopt these habits will have healthier lipid profiles, placing them in lower risk strata for cardiovascular events. preventive management of dyslipidemia can markedly alter lipid levels thereby decrease cardiovascular morbidity and mortality. author affiliations *1. dr akhtarun nessa, assistant professor, (c.c) physiology department of physiology, mymensingh medical college, mymensingh, bangladesh, email: nessa_akhtarun@yahoo.com 2. dr m murshed uddin, associate professor (cc), department of physiology, mymensingh medical college, mymensingh, bangladesh 3. dr sultana ferdousi, assistant professor of physiology, bsmmu, shahbag, dhaka, bangladesh 4. dr m anowar hussain, consultant entd, kishoregonj adhunik sadar hospital, kishoregonj, bangladesh * for correspondence references 1. kopin la, pearson ta. dyslipidemia. ann intern med. 2007;147(5):itc9-2-itc9-16. 2. bloomfield p, brodbury, grubbnr, newby de. cardiovascular disease. in: boon na, colledge nr, walker br, hunter ja, editors. davidson’s principles & practice of medicine. churchill livingstone: elsevier limited; 2006. p.519-646. 3. executive summary of the third report of the national cholesterol education program(ncep)expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(adult treatment panel iii).jama. may 16 2001;285(19)2486-2497. 4. screening for lipid disorders in adult u.s. preventive services task force. rockville md; 2001.accessed at www.ahrq.gov/clinic/uspstf/uspscholhtm on11 july 2007. 5. mayne pd. clinical chemistry in diagnosis and treatment. 6th ed. india: b.i publication pvt ltd;1994 6. ganong wf. review of medical physiology. 22nd ed. singapore : mcgraw hill; 2005. 7. kreisberg ra, oberman a. medical management of hyperlipedemia/ dyslipidemia. j clin endocrinol metab. june 2003; 88(6): 2445-2461. 8. lichenstein ah, appel lj, brands m et al. diet & lifestyle recommendations revision 2006. a scientific statement from the american heart association nutrition committee.circulation.2006;114:82-96 9. garber am, browner ws. guidelines for using serum cholesterol, high-density lipoprotein cholesterol, and triglyceride levels as screening tests for preventing coronary heart disease in adults. ann intern med.1996 march 1; 124(5):516-17. 10. van dam rm, rimma eb, willett wc, stampfer mj, hu fb. dietary patterns and risk type 2 diabetes mellitus in u.s men. ann internmed.2002; 136:201-209 j bangladesh soc physiol. 2006 dec;(1):40-41 41 letter phys. journal no. 3, december 2008.pmd introduction serum immunoglobulin-g level in children with respiratory tract infection ahkter s1 begum n2 introductionacute respiratory tract infection is one of the important cause of death in children under 5 years of age in developing countries. perhaps they have a reduced immunologic capacity. objectivesto observe the serum igg level in the children suffering from respiratory tract infection in order to evaluate the immunity status in this group of population. study designthis cross-sectional study was conducted in the department of physiology, bangabandhu sheikh mujib medical university (bsmmu), shahbagh, dhaka from january to december 2001.total 60 children age ranged from 35 years of both sexes were included in this study. of them 30 apparently healthy children were considered as control and 30 children suffering from respiratory tract infection were considered as study group and further subdivided into 2 subgroups on the basis of presence of type of rti. group b1 consisted of 15 children with acute attack and b2 with recurrent attack. method: serum imunoglobulin g level of all the children were measured by radial immuno diffusion method. datawere analyzed by unpaired t test. resultthe mean (±se) of serum igg levels were 10.17±0.37, 10.05± 0.40 and 10.01± 0.52 g/l in control group and two study subgroups respectively. the data were almost similar in all the groups and no statistically significant(p>0.05) differences were observed. conclusion this study reveals that there was no involvement of the igg status with acute and recurrent respiratory tract infections in the children. keywords children, respiratory tract infection, immunoglobulin g. j bangladesh soc physiol.2008 dec;(3):55-57. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp cute respiratory tract infection is one of the important cause of death in children under 5 years of age in that lower level of serum igg in children suffering from recurrent respiratory tract infection 10. again it was also found that there was no significant change in serum igg level in children suffering from similar type of respiratory tract infection 11. acute respiratory tract infection is one of the important cause of morbidity and mortality in children under 5 years of age in developing countries like bangladesh. only a few data are available on immunity status in children with respiratory tract infection in our country 9, 12. but serum igg level is one of the common marker to observe the immunity status of any a developing countries1 . a high proportion of this death is due to acute lower respiratory tract infections especially pneumonia 2-3. malnourished children appear to have a higher incidence of acute lower respiratory tract infection4-5. perhaps they have a reduced immunologic capacity. it is reported that attack of respiratory tract infection was more in immunodefient children than that of immunocompetent children 6-9. it was observed article j bangladesh soc physiol. 2008 dec;(3):55-57 55 individual. therefore the present study has been designed to observe the serum igg level in the children suffering from respiratory tract infection in order to evaluate the immunity status in this group of population. methods this cross sectional study was carried out in the department of physiology, bangabandhu sheikh mujib medical university (bsmmu), shahbagh, dhaka from january to december 2001. for this purpose, a total number of 60 children of both sexes with age ranged from 3 to 5 years were taken from the relatives and the out patient department (opd) of dhaka shishu hospital. among them, 30 apparently healthy children were taken as control (group a) and 30 children suffering from respiratory tract infections (rti) were selected as study group (group b). the study group was further subdivided into 2 subgroups (each consisted of 15 children) on the basis of presence of type of rti (with acute attack b1 and with recurrent attack b2). in the present study, patients of pneumonia (lower chest indrawing / increased respiratory rate more than age specific value) was considered as acute respiratory infection (rti) and included and patients with bacterial infections other than rti, diarrhoea, kidney diseases, malnutrition, any serious or prolonged illness and vaccinated in any time within 6 months were excluded from the study by taking history and clinical examinations. estimation of igg was done by radial immuno diffusion (rid) method13 and data were compared among different groups of children. statistical analysis of the data were done by using unpaired students ‘t’ test. results results are shown in table i. the values of mean serum igg levels among groups and subgroups were almost similar and their differences were not statistically significant. table-i serum igg levels in different study groups (n = 60) group/ n serum igg level (g/l) subgroup range mean(±se) a 30 6..90 -14.50 1 0 . 1 7 ± 0 . 3 7 b1 15 7.60-14.50 1 0 . 0 5 ± 0 . 4 0 b2 15 6.50-12.70 10.01± 0.52 statistical analysis df t value p a vs b1 43 0.112 >0.05ns a vs b2 43 0.262 >0.05ns b1 vs b2 28 0.111 >0.05ns a= healthy children (control) b1= children with acute respiratory tract infection (experimental) b2= children with recurrent respiratory tract infection (experimental) n= number of subjects. df = degree of freedom ns = not significant discussion in the present study, the serum igg level (non specific) was measured to evaluate the status of immune response of the children suffering from acute and recurrent respiratory tract infection and these level were within normal range. these results are in agreement with those reported by other workers of different countries11. it has been suggested that decreased serum igg level in children suffering from recurrent respiratory tract infection may be due to malnutritional changes in the immune system10. the findings of the present study showed that serum igg level was not affected in children with acute and recurrent respiratory tract infection. measurement of specific serum ig g after specific vaccination in children may be a more conclusive one. article igg in respiratory tract iinfection 56 j bangladesh soc physiol. 2008 dec;(3):55-57 authors and affiliations *1. salma akhter, assistant professor. department of physiolgogy, shahabuddin medical college, dhaka. tele: +88-02-8053404,+88-01720426526 2. noorzahan begum ,chairman, department of physiology, bangabandhu sheikh mujib medical university, (bsmmu) dhaka. * for correspondence references 1. bull a, hitze kl. acute respiratory infections; a review. who bull. 1978; 1978 56(3):481-98,. 2. pio a, leowski j, ten dam hg. the magnitude of the problem of acute respiratory infection. in: dogulas rm, kerby-eaton e (eds.). ari in childhood proceedings of an international workshop. ad laide, australia university of adelaide.,sydney, 1984; pp3-16. 3. devy fw, loda fa. acute respiratory infections are the leading cause of death in children in developing country. am j trop med hgg 1986; 35:1-2. 4. tapasi te, mangubal nv, sunico me, megdangal dm, navarro ee, leonor za et al. malnutrition and acute respiratory tract infections in filipino children. rev infect dis 1990; 12(suppl): 1047-54. 5. james jw. tongitudinal study of the morbidity of diarrheal and respiratory infections in malnourished children. am j clin. nutr 1972;25:690-4. 6. black ee, lanata cf, lazo f. delayed cutaneous hypersensitivity; epiemiologic factors affecting and usefulness in predicting diarrheal incidence in young peruvian children. pediatr infect dis 1989;8:210-5. 7. baqui ah, black re, sack rb, chowdhury hr, yunus m, siddique ak. malnutrition cell mediated immune deficiency and diarrhoea: a community-based longitutinal study in rural bangladeshi children. am j epidemiol 1993;137:355-65. 8. snell-duncan b. determinants of infant and childhood morbidity among nomadic tarkana postoralists of north-west kenya [doctoral dissertation], pennsylvania state university, usa, pp84-112, 1994. 9. zaman k, bagui ah, yunus m, sack rb, baleman om, chowdhury hr et al. association between nutritional status, cell mediated immune status and acute lower respiratory infections in bangladeshi children. eur j clin nutr 1996; 50: 309-14. 10. gross s, blaiss ms, herrod hg. role of immunoglobulin subclasses and specific antibody determinations in the evaluation of recurrent infection in children. j pediatr 1992; 121(4): 516-22. 11. berman s, lee b, nurs r, roark r, giclus pl. immunoglobulin g, total and subclass in children with or without recurrent otitis media. j pediatr 1992; 121(2): 249-51. 12. shakur s, malek ma, torafder sa. zinc status of bangladeshi children suffering from and respiratory infection. orion 2000; 5: -7. 13. fahey jl, mckelvey em. quantative determination of serum immunoglobulins in antibody agar plates. j immunol 1965; 94: 84-90. articleigg in respiratory tract iinfection article j bangladesh soc physiol. 2008 dec;(3):55-57 57 phys. journal no. 3, december 2008.pmd introduction: article summative assessment (written) in undergraduate physiology curriculum in bangladesh: reflection of educational objective ali t1, begum n2, begum aa3, shamim km4, ferdousi s5, bennoor ks6 background: a new curriculum for undergraduate medical education has been introduced for all universities in bangladesh since 2002. it is expected that this new curriculum will improve the qualitative level of medical education. according to this curriculum the assessment system for the students has also been modified. this new scheme gives more emphasis on certain evaluation procedures in written examination to be customized. for example, short essay questions (seq) are preferred to long descriptive and short answer questions (saq). questions should be specific answer oriented and targeted towards assessing the level of cognitive domain of the examinees. objective: the present retrospective analysis was done to observe the qualitative status in the written assessment procedure in undergraduate physiology after the implementation of the new curriculum by comparing the setting of the different question types under new curriculum with that of the old curriculum. this study was done also to identify the areas that warrant modification.methods: this study analyzed all new and old curriculum based written questions of the assessment examinations (except mcq) for undergraduate physiology course from 2001 to 2006, under 4 different universities in bangladesh. in total 63 question papers on physiology were included for evaluation. data were statistically analyzed by proportion test using spss software.results: the analysis indicates that there are significant improvement in type of questions (seq, saq and combined) and language (specific vs. non specific) field. however improvement in all the fields of medical education was statistically insignificant.conclusion: therefore, it may be concluded that the question setting procedure of the written examination according to the modern assessment technique has partially fulfilled j bangladesh soc physiol.2008 dec;(3):61-65. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp great alteration has been occurred in the attitude and style in the medical education worldwide to make it more to meet the global need of these objectives changes in medical course curriculum and assessment technique became essential in bangladesh. in this country a set up for undergraduate medical education was continued from the preliberation period up to 1988. then a great change was brought in curriculum in 1988 by making it more community oriented3. although, it was a combined product of reorientation of medical education (rome) and community oriented medical education (come) a motivated and time oriented.1 in 1988, world conference on medical education in edinbergh2 gave emphasis on a national health priority based curriculum, community oriented educational settings, self directed student centered active learning and use of assessment technique ensuring achievement of professional competence and social values. j bangladesh soc physiol. 2008 dec;(3):61-65 61 62 j bangladesh soc physiol. 2008 dec;(3):61-65 but a thoroughly revised new curriculum for undergraduate course in medicine was implemented in 2002 in bangladesh aiming at qualitative improvement in medical education4 . this new problem oriented curriculum for undergraduate medical education was introduced following the recommendations of medical educationist and it was approved by bangladesh medical and dental council4 . assessment is a very important component of medical course curriculum. medicine itself is a profession in which accurate and responsible assessment is of cardinal requirement. the assessment procedures have a powerful influence over learning process5. scientific studies confirmed that it is the evaluation system rather than the educational objectives or curriculum or instructional techniques that have the most profound impact on what the students ultimately learn6. as study of the whole curriculum is laborious and time consuming, rotem in 1982 showed an easy approach to review curriculum that was based on analysis of examination system7. modern assessment technique prescribed in the new curriculum in bangladesh includes short answer question (saq and multiple choice question (mcq) for written aptitude4. in the past, long essay questions were commonly used in written section of examination to assess the cognitive ability of students. but these traditional essay questions could not yield the expected answers and wide variation in student’s interpretation was noted. therefore, it showed limited validity, poor reliability and less objectivity8. on the other hand, wording in seq limits the scope of the content and directs the student towards a precise and specific response that makes it more reliable and valid8. in addition saq carries greater objectivity and reliability and their range of subject areas testes is extended9. very few study focusing assessment technique in undergraduate physiology in bangladesh has been carried out. one comparative study on soe1 and another on ospe10 are available. but no published data on written assessment technique in undergraduate physiology has been reported in bangladesh. therefore, the present retrospective analysis was done to observe the qualitative status in the written assessment procedure in undergraduate physiology after the implementation of the new curriculum by comparing the setting of the different question types under new curriculum with that of the old curriculum. this study was done also to identify the areas that warrant modification. methods: total eighty five question papers for written examination in physiology in first professional examinations held under dhaka, chittagong, rajshahi, shahjalal university from january 2001 to july 2008 were collected. under old curriculum 57 question papers and under new curriculum 28 question papers were studied. they were grouped as gr i (new curriculum) and gr ii (old curriculum). both the groups were again sub grouped as a (dhaka university), b (chittagong university), c (rajshahi university), d (shahjalal university). all the questions were categorized into recall, understanding, problem based, combined and uncategorized according to their assessing power. again, the questions were marked as saq, seq, combined according to answer length and specific, nonspecific, combined according to forms of their language. all these different types of questions were expressed in percentage out of the total questions in new and old curriculum under individual university. data were analyzed statistically by proportion z test. result: in the question papers under new curriculum of all universities, percentage of saq was higher and percentage of seq was lower compared to old curriculum. but this difference were not statistically significant (figure 1). article summative assessment in physiology j bangladesh soc physiol. 2008 dec;(3):61-65 63 in all universities the recall type of questions were decreased in new curriculum question papers in comparison to those of old except in shahjalal. but this difference was not statistically significant (figure 2). in the question papers under new curriculum of all universities percentage of saq was higher compared to old curriculum. but this differences were not statistically significant (figure 1). figure: 1 proportions of saq of both the curriculums of different universities figure: 2 proportions of recall type of questions of both the curriculums of different universities inclusion of problem based questions in dhaka and chittagong universities was a notable finding in the new curriculum question papers (figure 3). again percentage of specific type question was increased whereas non specific type was decreased in the question papers under new curriculum in all the universities when compared to old curriculum. but these changes were also not statistically significant (figure 4). figure: 3 proportions of problem based questions of both the curriculums of different universities figure: 4 proportions of specific type of questions of both the curriculums of different universities table – i proportions of different types of questions of both the curriculums of all universities (n=) variables new old p curriculum curriculum value saq 0.66 0.54 1.33 ns seq 0.37 0.46 1 ns combined 0 0 0 ns recall 0.87 0.88 0.17 ns understanding 0.13 0.09 0.68 ns problem based 0.01 0 1 ns combined 0 0 0 ns specific 0.66 0.64 0.22 ns non specific 0.39 0.45 0.62 ns combined 0 0 0 ns summative assessment in physiology article 64 j bangladesh soc physiol. 2008 dec;(3):61-65 discussion the present study was done to observe the status of the qualitative pattern of the written question paper setting of the new undergraduate medical curriculum and to compare it with that of the traditional one. while analyzing the written question papers of undergraduate physiology course of the present curriculum in bangladesh, the basic problem faced was lacking of the objective of this course in the terms of amount of different types of questions, or how much component of the questions should be of different levels of cognitive domain, or different types of languages4. there should be fixed criteria as written document for setting questions for the written examinations that fulfill the objectives of the course. the finding of this study reveals that, there is an increase in understanding and specific type of questions in the new curriculum question papers. along with this a decline in the amount of recall and non-specific type of questions are also observed, though the change was nonsignificant. again, increase in the amount of short answered questions (saq), decrease in short essay questions (seq) and absence of long essay questions in the ongoing curriculum in comparison to the older one. this observation has accomplished the task, though partially, to achieve the target of modern assessment technique in written question paper setting. unfortunately no data was available to compare these findings. however, when the question papers under new curriculum were compared among the four different universities, there was an increase in the frequency of understanding type of questions in three universities than those of shahjalal and the difference was significant (p<0.001). again, the addition of problem based questions in the physiology written question papers of dhaka and chittagong universities in comparison to rajshahi and shahjalal, indicates wide variation in question paper setting among different universities. it is important to note that the different variables of written assessment used in the question papers under the present study is similar to the methods adopted by the few investigators of our country 12,13 but the scoring system is different. therefore, it may be concluded that the question setting procedure of the written examination according to the modern assessment technique has partially fulfilled. so, it may be recommended that, proper orientation and implementation of the evaluators and educators are imperative to get the desired benefit from the present undergraduate physiology written assessment system. author affiliations 1. *taskina ali, assistant professor of physiology, bsmmu, shahbag, dhaka, bangladesh. 2. noorzahan begum, chairman & professor of physiology, bsmmu, shahbag, dhaka, bangladesh. 3. anjuman ara begum, assistant professor of anatomy, rangpur medical college, rangpur, bangladesh. 4. khandaker manzare shamim, chairman & professor of anatomy, bsmmu, shahbag, dhaka, bangladesh. 5. sultana ferdousi, assistant professor of physiology, bsmmu, shahbag, dhaka, bangladesh. 6. kazi saifuddin bennoor, assistant professor of respiratory department, national institute of diseases of chest & hospital (nidch), mohakhali, dhaka, bangladesh. * for correspondence references 1. ferdousi s, latif sa, ahmed mm, nessa a . summative assessment in undergraduate medical student’s performance in physiology by structured oral examination. mymensingh med j, 2007, jan; 16(1): 64-69. 2. gracia barbero m. medical education in the light of the world health organisation. health for all strategy and european union. medical education, 1995, jan, 29(1): 3-12. 3. karim a, haque m. assessment system in pharmacology-does it reflect educational objectives and community health needs? bangladesh j physiol pharmacol, 1996, july, 12(2): 65-67. article summative assessment in physiology 4. curriculum for under-graduate medical education in bangladesh 2002. approved by bangladesh medical & dental council. 5. miller g e. assessments in medical school. med educ 1976; 10: 79-80 6. miller g e. educational strategies for the health professions. in: developments of educational programmes for the health professionals who public health papers no. 52, 1973. 7. rotem a, barrand j, azman a. analysis of examination in curriculum review. medical education, 1982, 16: 3-6. 8. paul vk. essay questions. in: sood r, paul vk, sahni p, mittal s, kharbandra op, adkoli bv. editors. assessments in medical education, trend and tools. new delhi: k. l. wig centre for medical education and technology, 1995, p 17-25. 9. sabherwal u. short answered questions. in: sood r, paul vk, sahni p, mittal s, kharbandra op, adkoli bv. editors. assessments in medical education, trend and tools. new delhi: k. l. wig centre for medical education and technology, 1995, p 27-31. 10. rahman n, ferdousi s, hoq n, amin r, kabir j. evaluation of objective structured practical examination and traditional practical examination. mymensingh med j, 2007, jan; 16(1): 7-11. 11. karim a, haque m. assessment system in pharmacology-does it reflect educational objectives and community health needs? bangladesh j physiol pharmacol, 1996, july, 12(2): 65-67. 12. begum aa. a study of the assessment system of the mphil (medical science) anatomy course in bangladesh [thesis]. department of anatomy: bangabandhu sheikh mujib medical university, dhaka, bangladesh; 2001. 13. guilbert jj. educational hand book for health personnel (revised edition), who offset publications no. 35. geneva: who; 1981. j bangladesh soc physiol. 2008 dec;(3):61-65 65 summative assessment in physiology article volume 1 december 2006.pmd j bangladesh soc physiol. 2006 dec;(1):14-18 14 article introduction evaluation of serum triglyceride and total cholesterol status in adolescent smokers afrin l1, sultana r2, ferdousi s3, ahmed a4, amin mr 5 objectives: a cross sectional comparative study was performed to evaluate the changes of the serum lipid profile in apparently healthy adolescent male non smokers and smokers’ subjects. method: this study was carried out in the department of physiology of dhaka medical college from january to december 2005. for this purpose, total 80 subjects with age range 12-19 years were selected, of whom 20 were non smokers (control) and 60 were smokers (experimental) who smoked for at least one year. again smokers were grouped according to the number of cigarettes smoked per week,( mild < 19, moderate 20-59, heavy >60). fasting serum triglyceride and total cholesterol levels of all subjects were measured. data were compared between smokers and non smokers and between non smoker and mild moderate and heavy smokers and analyzed statistically by unpaired t test. result: mean ±sd triglyceride levels were136.80mg/dl ± 42.18 vs. 153.12mg/dl ± 26.66 and mean ±sd total cholesterol levels were 165.20mg/dl ± 15.13 vs165.36mg/dl ± 10.12 in non smokers and smokers respectively. there were no significant changes in the mean serum total cholesterol levels in adolescent smokers but the mean serum triglyceride level in smokers were significantly higher (p<0.01 )than that of non smokers. hyper triglyceridemia (tg level> 150mg/dl) were observed in 56% of smoker subjects whereas 36% in non smokers. the dose response effect of smoking was observed in serum triglyceride levels of smoker subgroups. mean ±sd tg levels in mild, moderate, heavy groups were148.15mg/dl±21.32,152.8mg/dl± 29.49,154.12mg/dl± 23.75 respectively. conclusion: from the result of the present study it may be concluded that, cigarette smoking during adolescent period induces alteration in serum lipid levels in the direction of increased risk for coronary artery disease. j bangladesh soc physiol. 2006 dec;(1):14-18. for author affiliations, see end of text. c is one of the largest single preventable causes of ill health in the world1. smoking is considered as an important factor in the stimulation of the development of atherosclerosis and cardiovascular diseases and associated with an average 70 % increase in the risk of death from coronary artery disease2. further more it is one of the main avoidable causes of death in the world3. smoking is most likely to begin during adolescence and there is a common reported that children smoke their first cigarette while they were attending primary school 4. it has been observed that, the start of even modest cigarette smoking during adolescence and early adulthood adversely alters the serum lipid and lipoprotein levels. 5-7 smokers had higher risk for coronary artery disease compared to non smokers, partly attributed to some altered physiological factors including altered coagulation state damaged vascular wall and alteration in lipid and lipoprotein content2. a slow progression of atherosclerosis that begins in childhood and culminates in a variety of igarette smoking is now acknowledged to be one of the leading causes of preventable morbidity and mortality and j bangladesh soc physiol. 2006 dec;(1):14-18 15 article clinical diseases such as myocardial infarction, cerebrovascular accident and peripheral vascular disease in middle age or later6,8 . there is evidence from experimental study that cigarette smoking is related to production of oxidized ldl which contributes to foam cell formation and subsequent development of atherosclerosis in smokers. analysis of published data from investigations carried out to study the effect of smoking on lipid levels in adults showed significantly higher serum total cholesterol and triglyceride levels in smokers. again the same analysis revealed serum total cholesterol significantly decreased in younger smoker but increased in adult7. dyslipidemia has been recognized as a major coronary risk factor which was defined as the presence of high serum total cholesterol level (tc>200mg/dl) and serum triglyceride level (tg>150mg/dl) according to the usaatp-11guidelines9-10. statistical analysis of published data also showed that smoking was associated with significantly higher triglyceride and cholesterol 2. on further analysis several studies also have demonstrated dose response relationship between number of cigarettes smoked and change in serum lipid and lipoprotein level 6-7,18 several investigators 6-7,18 found normal serum cholesterol in adolescent cigarette smokers. in contrast lower level of serum total cholesterol in adolescent smokers was also reported 3,7,19. again some study 6-7,18 reported higher level of triglyceride whereas others 19 found no difference in triglyceride in adolescent smokers compared to non smokers. despite the differences in view about the direction of changes in lipid levels in adolescent smoker, it is clear that smoking have an appreciable impact on lipid and lipoprotein levels in adolescent smokers if it continues to adult life can culminate in atherosclerotic cardiovascular disorder. cigarette smoking is a common problem in bangladesh and also a major public health problem associated with cardiovascular and respiratory morbidity and mortality. the prevalence of cigarette smoking has reached its peak among high school students. although many studies have been carried out examining lipid and lipoprotein profile in adult smokers but no such works have yet been carried out for studying adolescent male smokers in our country. so, the present study has been undertaken to investigate the effect of cigarette smoking on serum lipid and lipoprotein levels particularly serum total cholesterol (tc), serum triglyceride (tg), level in adolescent male smokers with a view to take rational approach for taking preventive measures. methods this prospective observational study was carried out in the department of physiology of dhaka medical college from january to december 2005. total 80 apparently healthy male adolescents age ranged from 12-19 years were selected, of whom 20 were non smokers taken as control (group a) and 60 were smokers selected as experimental (group b). again experimental subjects were subdivided in to group b1b2, b2. each group consisting 20 smokers according to number of cigarettes smoked per week. those who smoked 1-19 cigarettes were included in b1, 20-59 in b2 and more than 60 in b3. all the control subjects had never smoked while the experimental subjects were considered as one who had smoked at least one or more cigarettes weekly for one year or more. the subjects were excluded for any endocrine, hepatic disease, diabetes mellitus, renal disease, cardiopulmonary diseases, history of drugs intake such as β-blocker, lipid lowering drugs, steroid therapy, obesity & alcohol intake. before inclusion in to the study all ethical considerations for the subjects were taken into account. the aim and benefit of the study were explained to each subject and they were encouraged for voluntary participation. a written informed consent was obtained from each subject. a through clinical examination was done and detail medical, family, personal socioeconomic drug and alcohol intake and dietary history and detail information about physical activity were recorded in prepared questionnaire. the subjects were advised for 12 16 j bangladesh soc physiol. 2006 dec;(1):14-18 article hours overnight fasting. in the morning 5ml venous blood was drawn under proper aseptic precaution and serum was prepared by centrifugation and sent to the laboratory. serum triglyceride and serum total cholesterol levels were determined in an auto analyzer hitachi 902 in the laboratory of the clinical pathology of bangladesh medical college and hospital. data were expressed as mean and standard deviation. statistical analysis were done by unpaired “t” test to compare the groups and computerized in excel program. results all subjects were male adolescents and students of secondary school and preliminary section of college. all of them belonged to middle socioeconomic class and reported similar type physical activity. the anthropometric parameters of all study subjects are presented in table-i. mean ± sd age , height and body mass index of two groups were 16.35years ± 1.98 vs. 16.81 years ± 1.75 , 1.6m ± 0.06 vs1.57 m± 0.07, 19.52kg/sqm ± 1.62 vs. 19.92 kg/sqm± 2.58 respectively. no statistically significant differences were observed between the groups in relation to age, height, bmi of the subjects. therefore the biological and social factors were adjusted. table i : mean± sd age , height and bmi of both groups (n=80) variable group a group b p (n= 20) (n = 60) value age 16.35 ± 16.81± (years) 1.98 1.75 0.177ns height 1.6 ± 1.57 ± (m) 0.06 0.07 0.09ns bmi 19.52 ± 19.92± (kg/m2) 1.62 2.58 0.217ns group a = non smoker apparently healthy adolescent, group b = smoker apparently healthy adolescent fasting serum triglyceride and total cholesterol levels were examined and compared between smoker and non smoker groups. mean ± sd triglyceride and total cholesterol levels of both groups were 136.80 mg/dl ± 42.18 vs. 153.12mg/ dl± 26.66, 165.20 mg/dl ± 15.13 vs165.36 mg/ dl ± 10.12 respectively. mean serum triglyceride level was significantly higher (p<0.01) in smoker group than that of non smokers. but the men total cholesterol levels were almost similar and no significant difference was observed between them (table-ii). table ii: shows tg and total cholesterol levels variable group a group b p (n= 20) (n = 60) value serum total 165.20 165.36 ± >0.5 cholesterol ± 15.13 10.12ns (mg/dl) mean ±sd serum tg 136.80 153.12± <0.01 (mg/dl) ± 42.18 26.66** mean ±sd hypertriglyceridemia was identified in 34 (52%) among the 60 smoker adolescents, and in 7 (34%) among 20 non smoker subjects as the cut off value 150mg/dl for tg was used. the difference was statistically significant. on the other hand only 1(1.66%) of smoker group had hypercholesterolemia on cut point for hypercholesterolemia was fixed at 200mg/dl. no one of the non smoker group had haypercholesterolemia (figure 1). figure 1. hypertriglyceridemia in % subjects in smoker and non smoker group (n=80) dose response effect of mild, moderate , heavy smoking on lipid status in smokers was also analyzed and the results are presented in figure 2. j bangladesh soc physiol. 2006 dec;(1):14-18 17 article * = p<0.05 ** = p<0.01 ***= p<0.001, group a = non smoker, group b1= smoker (<19cigerette/week), group b2= smoker (20-59 cigarettes/week), group b3= smoker>60 cigarettes/week) statistically no significant differences in relation to cholesterol were observed among b1, b2 , b3 . but progressively increased mean triglyceride levels(148.15mg/dl± 21.32 ,152.8mg/dl± 29.49,154.12mg/dl± 23.75) among the b1, b2 , b3 were observed and the differences when compared with non smokers were statistically significant.(p<0.01, p<0.01, p<0.05) . discussion the present study was undertaken to evaluate the changes in the serum lipid profile in apparently healthy adolescent non smoker and smoker subjects to identify the possible high risk factor for developing atherosclerotic changes in early ages. association of higher cholesterol and triglyceride levels with smoking has been investigated in a series of studies on both adolescents and adults. 5-7,13,15,18 in this study, the mean serum total cholesterol and triglyceride levels in non smokers subjects were almost similar to those reported by other workers in different countries.20 results of this study shows no significant changes in the mean serum total cholesterol levels in adolescent smokers probably because of its opposing effects on different lipoprotein fractions as reported by different studies 6,18,21 that smoking was not related to total cholesterol. but the mean serum triglyceride level was significantly higher in adolescent smokers compared to those of non smokers. these findings are also similar to those reported by other workers in different countries.6,7,18 the probable explanation for this change might be related to the effect of nicotine causing alteration in lipids in smokers. nicotine stimulates sympathetic nerve activity leading to enhanced release of catecholamine from adrenal medulla which in turn causes increased rate of lipolysis. this effect results in raised plasma concentration of free fatty acid, triglyceride and increased hepatic production of endogenous vldl.2,6,13,16 in addition, muscut et al. proposed the physiological change in appetite in smokers resulting in difference in dietary intake between smokers and non smokers is also responsible.13 literature documents dose response relationship between degree of alteration in lipid profile and number of cigarettes smoked per day. in the present study a dose response effect in triglyceride level were observed among the smokers categorized according to the number of cigarettes smoked per week.. though some study 8 differ but others 13,15-16 reported similar findings. the effect of smoking on alteration of lipid status and its association with formation of atheromatous plaque is related to the frequency of cigarettes smoked per day.12,22 is well recognized. as suggested by other workers, the present observation also suggests that, the changes in serum lipid levels among smokers are proportional to the number of cigarette consumption per week. again increased frequency of hypertriglyceridemia noted in the smoker adolescents in the present study indicating dyslipidemia similar to others 8 also draws special attention at their increased risk to develop cardiovascular disorder. it is evident from the findings of this study that, adolescent smoking may induce changes in the serum lipid levels towards an atherogenic figure 2. mean serum triglyceride levels in non smoker and 3 subgroups of smokers (n =80) 18 j bangladesh soc physiol. 2006 dec;(1):14-18 article direction. the out come of this study therefore have emphasized the importance of controlling smoking behavior in adolescents to prevent the long term development of adult atherosclerotic cardiovascular diseases. author affiliations 1. * dr lazina afrin, assistant professor of physiology, zh sikder medical college, dhaka, bangladesh 2. dr rezina sultana, lecturer, department of physiology, khaleda zia medical college, dhaka, bangladesh 3. dr sultana ferdousi, assistant professor of physiology, bsmmu, dhaka, bangladesh 4. professor abida ahmed, professor and head of physiology, comilla medical college, comilla, bangladesh 5. professor md ruhul amin, professor and head of physiology, dhaka medical college, dhaka bangladesh * for correspondence references 1. who. chronicle. 1983:37(3):86-90. 2. craig wy, palomaki ge, haddow je. cigarette smoking and serum lipid and lipoprotein concentration: an analysis of published data. bmj 1989;298:784 3. ghannem h., harrabi i., ben abdelaziz a., gaha r., trabelsi l. smoking habits and cardiovascular risk factors among adolescents in sousse, tunisia. arch public health 2003; 61: 151-160. 4. azevedo a, machado ap, baros h. tobacco smoking among portuguese high school students. bulletin, who 1999; 77:6. 5. glueck cj, heiss g, morrison ja, khoury p, moore m. alcohol intake, cigarette smoking and plasma lipids and lipoproteins in 12-19 year children. circulation 1981;64:48-56. 6. freedman ds, srinivasan sr, shear cl, hunter sm, croft jb, webber ls, berenson gs. cigarette smoking initiation and longitudinal changes in serum lipids and lipoproteins in early adulthood: the bogalusa heart study. am j epidemiol 1986;124(2):207-219. 7. craig wy, palomaki ge, jojnson am, haddow je. cigarette smoking-associated changes in blood lipid and lipoprotein levels in the 8 to 19 year old age group: a meta analysis. american academy of pediatrics 1990;85(2):155-158. 8. coelho vg; caetano lf; junior rdrl; corderio ja; souza drs. lipid profile and risk factors for cardiovascular diseases in medicine students. arq. bras. cardiol 2005; 85: 1-13. 9. rahm an ma, ali ma, majumdar aas, haque kmhss , banoo h, zaman ma dyslipidemia and coronary artery disease. bangladesh heart j 2001;16:(1):30-35. 10. gupta r, gupta vp, sarma m, bhatnagar s, thanvi j, sharma v, singh ak, gupta jb, kaul v. prevalence of coronary heart disease and risk factors in an urban indian population.: jaipur heart watch-2. indian heart j 2002;54:59-66. 11. halfon st., green ms, heiss g. smoking status and lipid levels in adults of different ethnic origin: the jerujalem lipid research clinic program. int j epidemiol 1984;13(2):177-183 12. castelli wp. cholesterol and lipids in the risk of coronary artery disease. the framingham heart study. can j cardiol 1988; 4a-5a 13. muscat je, harris re, haley nj, wynder el, columbus. cigarette smoking and plasma cholesterol. am heart j 1991;121:141-147. 14. fachini fs, hollenbeck cb,jeppesen j, chen ydi, reaven gdm. insulin resistance and cigerette smoking. the lancet.1992;339:128-130. 15. sirisali k, poungvarin n, kanluan t, prabhant c. serum lipid, lipoprotein-cholesterol and apolipoproteins a-i and b of smoking and nonsmoking males. j med. assoc thai 1992;75:709-713. 16. lee ks, park cy, meng kh, bush a, lee sh, lee wc, koo lw, chung ck. the association of cigarette smoking and alcohol consumption with other cardiovascular risk factors in men from seoul, korea. ann epidemiol 1998;8:31-38. 17. neki ns. lipid profile in chronic smokers.-a clinical study. jiacm2002;3(1):51-4 18. morrison ja, kelly k, mellies m, groot id, khoury p, gartside ps, glueck cj. cigarette smoking, alcohol intake and oral contraceptives: relationships to lipids and lipoproteins in adolescent school children. metabolism 1979;28(11):1166-1170. 19. orchard tj, rodgers m, hedley aj, mitchell jra. changes in blood lipid and blood pressure during adolescence, brit med j 1980;1563-1567 20. bahar a, sevgican u, karademir f, gocman i. serum cholesterol, triglycride, vldl-c, ldl-c and hdlc levels in healthy children. tohoku j. exp. med. 2003; 201:75 21. higginsmw, kjelberg m. characteristics of smokers and non smokers in tecumseh, michigan. am j epidemiol 1967;86:60-77. 22. oren a, vos le, uiterwaal cspm. cardiovascular risk factors and increased carotid intima-media thickness in healthy young adults. arch intr med 2003;163:178792. phys. journal no. 3, december 2008.pmd introduction article evaluation of parasympathetic nerve function status in healthy elderly subjects islam t1, begum n2, begum s3, ferdousi s4, ali t5 background: autonomic control on cardiovascular activity is modified with age. impaired autonomic nerve functions are common features of patients suffering from cardiovascular diseases particularly in old age. objective: to observe the influence of aging process on parasympathetic nerve function. study design: this observational study was conducted in the department of physiology, bsmmu, dhaka during the period of july 2005 to june 2006. for this purpose, 60 apparently healthy elderly subjects of both sexes were selected as study group and divided into two groups-one group consisted of 30 elderly subjects with age ranged from 51-60 years and another group consisted of 30 elderly subjects with age ranged from 61-70 years. thirty sex and bmi matched healthy adults with age ranged from 21-30 years were studied as control. methods: parasympathetic nerve function status of all the subjects were assessed by three simple non-invasive cardiovascular reflex tests. these were heart rate response to valsalva maneuver, heart rate response to deep breathing and heart rate response to standing (30th:15th ). for statistical analysis one way anova (post hoc test) and the pearson’s correlation co-efficient tests were done. results: mean (± sd) of valsalva ratio were 1.50±0.23, 1.32±0.14 and 1.28±0.15; hr response to deep breathing test were 25.36±3.90, 18.82±3.35 and 15.96±3.54 beats/min; 30th:15th ratio in standing test were 1.100.06, 1.05±0.03 and 1.04±0.02 in 2130, 51-60 and 61-70 years age groups respectively. all the 3 parameters were significantly lower in both elderly groups compared to that of control adults (p<0.001) again, hr response to deep breathing was significantly lower in 61-70 years age group compared to that of 51-60 years age group. valsalva ratio and 30th:15th ratio were also lower in 61-70 years age group than that of 51-60 years group but the differences were not statistically significant. all the 3 parameters were negatively correlated with age which were statistically significant. conclusion: from this study it may concluded that aging process substantially impaired cardiovascular parasympathetic nerve functions. key wards: cardiovascular reflex test, elderly person. j bangladesh soc physiol.2008 dec;(3):23-28. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp innervations may also be affected with increasing age3-6. thus aging may affect cardiac autonomic nerve functions, mostly heart rate (hr) and blood pressure (bp) regulations which ultimately may lead to the development of many cardiovascular diseases6. aging is a physiological process 1. with the advancement of age, there is a progressive declination of almost all body functions, including autonomic nerve function2. autonomic nervous system is vital for homeostasis and its potency is gradually reduced with aging. therefore, the cardiac autonomic j bangladesh soc physiol. 2008 dec;(3):23-28 23 autonomic nervous activity helps in regulation of blood pressure (bp), heart rate (hr), fluid and electrolyte balance7. in old age though both sympathetic and parasympathetic systems are affected but parasympathetic involvement appears to be more frequent than sympathetic8. as age advances, the parasympathetic tone and baroreflex sensitivity are gradually reduced9. cardiac parasympathetic nerve function can be assessed by heart rate response to valsalva maneuver (valsalva ratio) 10. in valsalva maneuver, the subject performs sustained forced expiratory effort against an obstructed airway. it has been observed that throughout the straining, release and recovery segment of the maneuver, the h.r exhibits well-defined changes in normal healthy subjects10 . but in patients with parasympathetic nerve dysfunction, this hr response to valsalva maneuver is reduced11-13. aging process may also reduce this respnse12. normally, lower limit of valsalva ratio is 1.2112 which may start to fall after the age of 53 years14. again some investigators reported that valsalva ratio was declined by 0.009 per years of age15. hr response to deep breathing has been proved to be more sensitive diagnostic index for autonomic nerve dysfunction16. normally, during deep breathing hr is increased by equal or more than 15 beats per minute17. an increase in resting heart rate and loss of hr variation to deep breathing are the primary indicators of parasympathetic nerve dysfunction14. hr variation to deep breathing is decreased progressively with the increasing age18. again hr response to standing up is also a simple test for assessment of parasympathetic autonomic nerve function. changing from lying to standing produces an integrated reflex response of the cardiovascular system, which includes alteration in hr17. normally, hr response to standing represented by 30th:15th ratio is equal or more than 1.0419. but this ratio is relatively lower in healthy elderly person20-21. about 15 percent of the current world population exceeds 60 years9. majority of them may have parasympathetic nerve impairment which may be the underlying cause of many diseases especially cardiovascular diseases. unfortunately most of them remained unnoticed and usually treated without knowing the underlying etiology. with the above background, study of the effect of age on cardiovascular parasympathetic function is important. though a number of investigations have been undertaken in different countries, no such data is published in our country. therefore the present study was conducted to observe the parasympathetic nerve function status in healthy elderly person in our population, in order to evaluate the presence of any impairment of the parasympathetic activity in this age. methods this study was conducted on healthy elderly person to observe the influence of age on cardiovascular parasympathetic nerve activity. it was done in the department of physiology, bangabandhu sheikh mujib medical university, dhaka, from july 2005 to june 2006. for this, total 90 apparently healthy subjects of both sexes were selected from a slum area of malibag wireless gate and bsmmu staff quarter, paribag, dhaka and all of them belonged to lower socioeconomic status. thirty apparently healthy adults with age ranged from 21-30 years were taken as control (group-a and 60 elderly healthy subjects were selected as study group. they were again subdivided into group b which consisted of 30 elderly subjects with age ranged from 5160 years and group c which consisted of 30 subjects with age ranged from 61-70 years. the subjects having the history of chronic renal failure, diabetes mellitus, hypertension, heart diseases, cardiac failure and neurological disorder were excluded. before inclusion into the study all ethical considerations for the subjects were taken in account. an informed written consent was obtained from each subject. a detail article parasympathetic nerve function in elderly 24 j bangladesh soc physiol. 2008 dec;(3):23-28 medical, family, personal and socio-economic history was recorded in a prefixed questionnaire. a thorough clinical examination was done. height and weight of the subjects were recorded and bmi was calculated. the random blood sugar and serum creatinine levels were estimated for exclusion. subjects were asked to attend the laboratory of department of physiology as per schedule and their cardiovascular parasympathetic nerve functions were assessed by heart rate response to valsalva maneuver, heart rate response to deep breathing and heart rate response to standing (30th:15th ratio)10. data were expressed as mean ± sd (standard deviation). for statistical analysis one way anova (post hoc test) and pearson’s co-relation co-efficient test were used as applicable. analysis was done by spss program verson-12. results the mean (±sd) of age, height, weight and bmi of the different groups are shown in table i. except age all the groups were matched for height, weight and bmi. results of parasympathetic nerve function parameters of all groups are shown in table-ii. the values of valsalva ratio, hr response to deep breathing and 30th:15th ratio were significantly lower in both elderly groups compared to those of control. again the differences in all the parameters between 51-60 years and 61-70 years age groups were not statistically significant except heart rate response to deep breathing. result of relationships of parasympathetic nerve function parameters with age are shown in figure1,2,3. valsalva ratio, hr response to deep breathing and 30th:15th ratio were negatively correlated with age. these relationships of age were statistically significant for valsalva ratio (r= 0.494, p<0.001), hr response to deep breathing (r= 0.745, p<0.001) 30th : 15th (r= 0.568, p<0.001). table-i mean ±sd of age, height, weight and bmi in different groups (n=90) groups n age(years) height(cm) weight(kg) bmi(kg/m2) a 30 26 ± 2.67 161 ± 7.93 52 ± 5.28 20.22 ± 1.83 (21-30) (150-172) (44-64) (17.36 –23.61) b 30 56 ± 2.68 159 ± 7.33 52 ± 5.31 20.77 ± 2.12 (51-60) (148-171) (40-60) (16.49-24.78) c 30 66 ± 2.97 158 ± 7.11 52 ± 5.82 20.81 ± 1.96 (61-70) (148-170) (40-64) (16.53-24.89) statistical analysis groups p values a vs b 0.000*** 0.310ns 0.944ns 0.278ns a vs c 0.000*** 0.090ns 0.672ns 0.258ns b vs c 0.000*** 0.491ns 0.622ns 0.948ns group a: 21-30 years of adults (control) group b: 51-60 years of elderly subjects group c: 61-70 years of elderly subjects figures in parentheses indicate ranges *** = significant at p< 0.001 ns = not significant n = number of subjects parasympathetic nerve function in elderly article j bangladesh soc physiol. 2008 dec;(3):23-28 25 table-ii mean±sd parasympathetic nerve function parameters in different groups (n=90) heart rate response groups n to valsalva to deep to standing maneuver breathing (30th:15th) (valsalva ratio) (rate/min) a 30 1.50 ± 0.23 25.36 ± 3.90 1.10± 0.06 (1.21-1.93) (20.00-32.03) (1.04-1.28) b 30 1.32 ± 0.14 18.82 ± 3.35 1.05± 0.03 (1.17-1.61) (11.67-30.06) (1.00-1.10) c 30 1.28 ± 0.15 15.96 ± 3.54 1.04± 0.02 (1.04-1.65) (9.21-21.28) (1.00-1.08) statistical analysis groups p values a vs b 0.000*** 0.000*** 0.000*** a vs c 0.000*** 0.000*** 0.000*** b vs c 0.349ns 0.003** 0.300ns group a: 21-30 years of adults (control) group b: 51-60 years of elderly subjects (study) group c: 61-70 years of elderly subjects (study) figures in parentheses indicate ranges *** = significant at p< 0.001 ** = significant at p< 0.01 ns = not significant n = number of subjects figure-1 : relationship between age and heart rate response to valsalva maneuver (n=90) pearson correlation-coefficient (r) test was performed as the test of significance. *** significant at p<0.001 figure -2: relationship between age and heart rate response to deep breathing pearson correlation-coefficient (r) test was performed as the test of significance. *** significant at p<0.001 article parasympathetic nerve function in elderly 26 j bangladesh soc physiol. 2008 dec;(3):23-28 discussion: in the present study the mean value of valsalva ratio was significantly lower in both elderly groups compared to that of adults. this finding is in agreement with other workers9, 12, 14-15, 22. again, this ratio was lower in 61-70 years age group than that of 51-60 years but it was not statistically significant. no data is available to compare this finding. again, hr response to deep breathing was significantly lower in 51-60 years and 61-70 years than that of 21-30 years. similar observation was made by other workers 7,15-16,2324. again, significantly lower values of this h.r responses were also observed in 61-70 years compare to 51-60 years of elderly subjects. but no data is available to compare the finding. mean 30th:15th ratio was significantly lower in both 51-60 years and 61-70 years age groups than that of 21-30 years. other workers also observed similar results 7, 9-10, 14,25. the mean measured value of this h.r response was also lower in 5160 years than that of 61-70 years age group but it was not statistically significant. no data is available to compare the finding. in this study, correlation of different parasympathetic nerve function parameters with age was analyzed. here valsalva ratio, h.r response to deep breathing and 30th:15th ratio were negatively correlated with age and all these relationships were statistically highly significant. these findings are also similar with other workers 9, 14. the results of present study showed that impairment of parasympathetic nerve functions occured in apparently healthy elderly subjects. different investigators suggested that vagal tone is reduced or loss of vagal tone occurs gradually as age advances13,27. again, vagal damage causes reduction of heart rate to various stimuli5,9. as a consequence, baroreflex activity may be decreased in old age. in addition, impaired transmission of impulse through both afferent and efferent pathway as well as reduced central integration of afferent inputs may be the contributory factors for this lower baroreflex activity in elderly subjects 6,18. all these explanations may be the cause of reduced parasympathetic nerve activity of elderly subjects in the present series, though the exact mechanism can not be elucidated from this study. conclusion therefore, considering the above features it may be concluded that aging process substantially impaired parasympathetic nerve functions. author affiliations *1. assistant professor, medical college for women & hospital, sector-1, plot-4, road-8/9, uttara model town, dhaka-1230. 2. professor & chairman, department of physiology, bsmmu, shahbagh, dhaka. 3. professor, department of physiology, bsmmu, dhaka. 4. assistant professor, department of physiology, bsmmu, dhaka. 5. assistant professor, department of physiology, bsmmu, dhaka. *for correspondence figure -3: relationship between age and heart response to standing from lying. pearson correlation-coefficient (r) test was performed as the test of significance. *** significant at p<0.001 parasympathetic nerve function in elderly article j bangladesh soc physiol. 2008 dec;(3):23-28 27 references 1. latif sa, hossain m, hossain ms. beginning to understand the human aging. mymensingh med j. 1999; 8(1): 64-69. 2. esler md, tunner ag, kaye dm. aging effect on human sympathetic neuronal function. am j physiol. 1995; 264:278-85. 3. francine gs, cohn jn. cardiac failure and the autonomic nervous system. in: bannister sr, mathias cj editors. autonomic failure, a textbook of clinical disorders of the autonomic nervous system. 3rd edition. new york: oxford university press; 1992, 822-38 p. 4. maser re, lenhard mj, pecherney gs. cardiovascular autonomic neuropathy and the clinical significance of its determination. j endol. 2000; 10:27-33. 5. grubb bp. syncope in the older patient. hellenic j cardiol. 2003; 44: 235-42. 6. jones pp, christou dd, jordan j, seals dr. baroreflex buffering is reduced with age in healthy men. circulation. 2003; 107:1770-74. 7. lipsitz la. syncope in the elderly. ann intern med. 1983; 99:92-105. 8. ingal tj, mcleod jg, 0’brien pc. the effect of aging on autonomic nervous system function. aust nz j med. 1990; 20 (4): 570-77. 9. 0’brien iad, 0’hare p, carrall kim. heart rate variability in healthy subjects: effect of age and derivation of normal ranges for test of autonomic function. br heart j. 1985; 55: 348-54. 10. ewing dj. cardiovascular reflexes and autonomic neuropathy. clin sci mol med. 1978; 55: 312-27. 11. shimada k, kitazumi t, hisakazu 0, sadakane n. effect of age and blood pressure on the cardiovascular responses to the valsalva maneuver. j am geriatr soc. 1986; 34:431-34. 12. gautschy b, weidmann p, gnadinger mp. autonomic function tests as related to age and gender in normal man. j klin wocherschr. 1986; 64(11): 499-505. 13. wieline w, vanbrederode jem, derijk lg, borst c, dunning aj. reflex control of hr in normal subjects in relation to age, a data base for cardiac vagal neuropathy. diabetologia. 1982; 22: 163-66. 14. chu ts, tasi tj, lai js, chen wy. evaluation of cardiovascular autonomic function tests in normal subjects. j formosan med assoc. 1989; 88:40406. 15. smith se, smith sa. heart rate variability in healthy subjects with a bedside computer based technique. clin sci. 1981; 61: 373-83. 16. hellman jb, stacy rw. variation of respiratory sinus arrhythmia with age. j appl physiol. 1976 ; 41(5): 73438. 17. ewing dj, clarke bf. diagnosis and management of diabetic autonomic neuropathy. br med j. 1982; 285:916-18. 18. johnson rh. aging and autonomic nervous system. in: bannister sr, mathias cj. editors. autonomic failure, a textbook of clinical disorders of the autonomic nervous system. 3rd ed. new york: oxford university press; 1992, 882-903 p. 19. mathias cj, bannister r. investigation of autonomic disorders. in: bannister sr, mathias cj, editors. autonomic failure, a text book of clinical disorders the autonomic nervous system. 3rd ed. new york: oxford university press; 1993, 255-90 p. 20. cybulski g. influence of age on the immediate cardiovascular response to orthostatic maneuver. euro j appl physiol. 1996 ; 73 (6):563-72. 21. rajerdra au, kannathal n, sing ow, plng ly, chua t. heart rate analysis in normal subjects of various age groups. j biomed engin. 2004 ; 3 (24): 1-8. 22. levin ab. a simple tests of cardiac changes induced by the valsalva maneuver. am j cardiol. 1966; 18: 9099. 23. smith sa. reduced sinus arrhythmia in diabetic autonomic neuropathy: diagnostic value of an age related normal range. br med j. 1982 ; 285:1599-1601. 24. maddens m, lipstiz la, wei jy, pluchino fc, mark p. impaired heart rate response to cough. and deep breathing in elderly patients with unexplained syncope. am j cardiol. 1987 ; 60:1368-72. 25. dambrink jha. orthostatic regulation of blood pressure. a comparative study in young and old subjects. clin sci. 1991 ; 81:51-58. 26. mancia g, ferrari a, gregorini l, parati g, pomidossi g, bertinieri g, grassi g. blood pressure and hr variability in normotensive and hypertensive human beings. circ res. 1983; 53: 96-104. 27. shi x, gallagher km, 0’connor w, foreman bh. arterial and cardiopulmonary baroreflex in 60 to 69 vs 18 to 36 years old humans. j appl physiol. 1996; 80: 1903-10. article parasympathetic nerve function in elderly 28 j bangladesh soc physiol. 2008 dec;(3):23-28 volume 1 december 2006.pmd j bangladesh soc physiol. 2006 dec;(1):35-39 35 review a days in different ways. 1st kidney transplant occurred in 1950 in usa. heart transplant first done by christian barnard of south africa in 1967. then other organs were transplanted in different periods. every day, people die because there are insufficient tissues available for transplantation 1. ethical issues in health care have increased during the past two decades, primarily in response to rapidly evolving advanced technologies 2. shortage of cadaver organs has prompted transplant centers to seek new sources of grafts. while living donor left lobe transplantation (segment ii and iii) is an established procedure for children, living donor right liver transplantation (segments v, vi, vii, viii) which can provide adequate liver mass for an average sized adult patient 3. an urgent and steadily increasing need exists world wide for a greater supply of donor thoracic organs. xenotransplantation offers the possibility of an unlimited supply of hearts and lungs that could be available electively when required 4. ethical issues successful transplantation of bone marrow obtained from unrelated donors with their consent. we believe that the ethical issues are overcome by requesting the donation before identification of any patient 5. bone marrow transplantation is one of numerous new medical technologies that have raised review on organ transplantation and ethical issues rahman mm j bangladesh soc physiol. 2006 dec;(1):35-39. for author affiliations, see end of text. complex legal and ethical issues 6, 7. law has been passed in response to the need to resolve conflicts in judicial opinions 7. this article discusses some of the medical, legal and ethical issues in using organs from primates, and anencephalics to transplant to infants who will otherwise die. the use of primates is discouraging on ethical grounds due to scarcity of chimpanzees, the preferred species and to the poor chance of survival. anencephalic fetuses and newborns are promising sources of organs for pediatric transplants, if ethical and legal considerations are met. an argument is made, based on current practice in management of dying donors that complies with the legal requirement to delay organ removal until after whole brain death.8 as the number of children in need of organ transplants increases because of medical advances, so does the demand for organs that can be used in transplantation. in the face of compelling medical need, prospective donors as well as prospective recipients are subject to strong pressures. social workers can play a large role in protecting the rights and interests of both groups of youthful clients 9. there are grounds for believing therefore that the pressure to subvert good ethical standards in acquiring these organs (that pressure imposed by long waiting lists and a high death rate on those waiting lists) should be avoidable10. is fetal tissue transplantation necessary and beneficial? are fetal rights violated by the use of fetal tissue in research? is there a moral danger that the potential of fetal tissue donation will encourage elective abortions? should pregnant women be introduction rgan transplantation is by far the best form of treatment for organ failure, different organs are transplanted nowo 36 j bangladesh soc physiol. 2006 dec;(1):35-39 review allowed to designate specific fetal transplant recipient. what criteria should be used to select fetal tissue transplant? whose consent should be required for the use of fetal tissue for transplantation? 11 during liver transplantation, like for any organ transplantation, the ethical and economical issues must be constantly kept in mind.12, 13, 14, 15. a 50 year old man who has a daughter with end stage renal disease has suffered a severe cerebral vascular accident but is neither brain dead nor a candidate for ‘’non-heart beating” donation. given his poor prognosis, should the father be able to donate his kidney to the daughter in his compromised condition?16 xenotransplantation or the use of animal cells tissues and organs for humans, has been promoted as an important solution to the worldwide shortage of organs. while scientific studies continue to be done to address problems of rejection and the possibility of animal to human virus transfer, socio-ethical and legal questions have also been raised around, informed consents, life long monitoring, animal welfare and animal rights and appropriate regulatory practices.4, 17 an analysis of the unos database suggests a practice pattern that uses live minor kidney donors in clinical circumstances not endorsed by the recommendations of a recent consensus conference on live organ donation. live organ donation from a minor should only be considered when there is no other living donor available and all other opportunities for transplantation have been exhausted.18,19, 20 basic neuro transplantation research evoked clinical trials of restorative brain surgery. neural grafting in cns is irreversible and is therefore not suitable for experimental approaches originally designed for and best suited to drug studies21. neural fetal tissue transplantation offers promise as a treatment for devastating neurologic conditions such as parkinson’s disease. two types of issues arise from this procedure: those associated with the use of fetuses and those associated with the use of neural tissue.22 transplantation and banking of stem cells from cord blood raise different legal and ethical questions. who owns the cord blood? does transplantation infringe the physical integrity of the neonate? in addition, if so, who has to give her or his consent? in any case, legal representation by the neonate’s guardians has to be guided by the “welfare of the child’’. banking stem cells from cord blood may be private or public. private banking causes difficulties concerning the right to health care and the issues of justice and equity. public banking too raises complex legal issues e.g. protection of potential recipients from life threaten illness at the one hand and the right of the donor to autonomy in disclosing information at the other.23 the ethics of embryo stem cell use are complex and deeply personal.24 the conclusion is that only patients at risk of dying and with no alternative treatment available should be recruited to xenotransplantation trails in the early phase.25 in addition to defensible donor education about risk and benefit, three fundamental obligations of the centre are identified: (i) to recognize that it is after ethical to participate in acts of individual risk and sacrifice that are performed to benefit others: (ii) do not deny transplantation without good reason to donors and recipients who apply to the centre; and (iii) to neutralize, but not overreact to centre self-interest, which stems from the professional benefits of transplantation and the center ’s desire to help potential transplant recipients. the basic medical facts surrounding donation must be understood by all parties as part of ethical decision-making. donor risk can be presented quantitatively using us renal data system data as a baseline. confirmation of accurate donor understanding of risks, benefits and alternatives is always a fundamental center obligation. donors should not be rejected j bangladesh soc physiol. 2006 dec;(1):35-39 37 review except for the general reasons. we identify and when these reasons do not seem to apply the decision to deny transplantation should be reconsidered.26 physicians must include both donors and recipients regarding risk, benefits, and allow freely giving consent.27 development of cloning and embryonic stem cell line technologies offers real hope for developing better sources of tissues for transplantation. research into therapeutic cloning and the development of embryonic stem cell lines is illegal in several states in australia. there is controversy regarding ethical issues. it is time to review that legislation in order to allow destructive embryo research.1, 28, 29, 30, 31, 32 questions are posed as to the justification for certain procedures and those pertaining to the goals of medicine, informed consent and patient quality of life. other issues include benefits versus risks, patient autonomy and medical paternalism or non-maleficence.3 though xenotransplantation is, important in fulfilling demand of need yet a clinical trial of xenotransplantation should not be undertaking until experts in microbiology and the relevant regulatory authorities consider this risk to be minimal.4 ethical principle of utility is enhanced by living donor liver transplantation. most serious ethical concerns in living donor liver transplantation focus on the risks to the donor and relate to the principle of nonmaleficence “do no harm”, although exact risk remains uncertain, there is potential for significant donor morbidity and even mortality. careful consideration must be given to the informed consent, specific criteria for transplant centre and national registry for donors and recipients.33, 34 careful and critical evaluation of donor and recipient is required for optional outcome.35 ethical and psychological aspects related to transplantation from a living donor are complex and need to be carefully evaluated when this treatment is offered to the patients.36 article summarizes the procedure for cloning human cells to obtain tissues for transplants and comments on the therapeutic possibilities. it discusses the ethical objections raised against the creation of embryos for this purpose.37 in uterus stem cell, transplantation represents a new and still experimental therapeutic strategy for diseases related to the hemopoietic system. ethical considerations based on the use of fetal cells are pointed out and prospective view concerning.38 living relative liver transplantation is a valid alternative to cadaver transplantation especially at a time when the availability of organs cannot meet the requests of long waiting lists. however, the ethical aspect has been widely debated and in order to be acceptable procedure must be comply with three critical points: the need for innovation, an acceptable risk benefit ratio and adequate informed consent.39 article addresses the ethics of selling transplantable organs, i examine and refute the claim that catholic teaching would permit and even encourage on organ market. the acceptance of organ transplantation by church and even it praise of organ donors should not distract us from the quite explicit church teaching that condemn an organ market.40 insofar as organ transplantation itself is concerned one must bear in mind that both the quran and sunnah neither sanction it nor condemn it.41 one muslim scholar was given opinion against organ transplantation.42 on the other hand, muslim scholars from various parts of the world gave arguments in favor of organ transplantation and that should be recognized as a form of altruistic service to fellow muslims.43 it is true that islam forbids any act of aggression against human life as well as the body after death. thus if one were to take an organ out of the dead mans body so as to transplant into another person, it could justifiably be argued to be tantamount to mutilation of the body and violation of the 38 j bangladesh soc physiol. 2006 dec;(1):35-39 review sanctity of the corpse. however, it is to be noted here that the islamic legal system takes the interests of man into consideration.44, 45 muslim scholars concern that such sale would be deemed batil.46 it is permissible within the shariah to take a part of the human body and transplant it into the same body like removing skin or bone in order to graft it to some other part of the same body.47 it is permissible within the shariah to remove the organ from one person and transplantation in into another person’s body in order to save the life of that person or to assist in stabilizing the normal functioning of the basic organs of that person.47 it is also permissible for a healthy person in the light of the opinion of medical expert of donate on of his/her kidneys to an ailing relative.48 ii is permissible within shariah to transplantation the organ of an animal, which has been slaughtered according to islamic rites and/or that of other animals out of necessity.49 permissible in shariah to remove an organ from a dead person and transplantation in into a living recipient on the condition that donor was sane and had wished it so.49 surgeon must obtain consent of the next kin before removing organs from cadaver so long as a person is alive his organs should not be removed without his consent.50 conclusion organ transplantation is one of the modern treatments for saving life. though there is controversy in different religious person yet majority were accepted. it is essential to continue this process but ethical issues must be kept in mind so that harm should be minimum to both donors and recipients. acknowledgement the author thanks to bangladesh medical research council, mohakhali, dhaka – 1212, for financial support. author affiliations * dr md mohidur rahman, associate professor of physiology, faridpur medical college, faridpur, bangladesh * for correspondence references 1. savulescu j. the ethics of cloning and creating embryonic stem cells as a source of tissue for transplantation : time to change the law in australia. aust n z j med. aug 2000; 30(4): 492-498. 2. guido g. w. heart transplantation from an ethical perspective. crit care nurs clin north am. mar, 2000; 12(1): 111-119. 3. mentha g, morel p, majno p, giostra e, rubbia l, bednarkiewicz m, van-gessel e, klopfens tein c e, romand j and hadengue a. start of an adult living donor liver transplantation program in switzerland. schweiz med wochenschr. aug 26, 2000; 130(34): 1199-1205. 4. cooper dk, keogh am, brink j, corris pa, klepetko w, pierson rn, schmoeckel m, shirakura r, and warner-stevenson l. report of the xenotrans plantation advisory committee of the international society for heart and lung. transplantation: the present status of xenotransplantation and its potential role in the treatment of end-stage cardiac and pulmonary diseases. j heart lung transplant. dec, 2000; 19(12): 1125-1165. 5. rock g, decary f, mccombie n, smiley r k, aye m t and huebsch l. registry of unrelated bone marrow donors. cmaj. 15 aug, 1987;137(4): 294-296. 6. durbin m. bone marrow transplantation economic, ethical and social issues. pediatrics. nov. 1988; 82(5):774 -783. 7. williams te. legal issues and ethical dilemmas surrounding bone marrow transplantation in children. am. j. pediatr hematol oncol. 1984 spring: 6(1): 83-88. 8. fletcher, cg, robertson ga and hanison mr. primates and anencephalics as sources for pediatric organ transplants. medical, legal and ethical issues. fetal ther.1986; 1(2-3): 150-164. 9. bell cj. children as organ donors: legal rights and ethical issues. health soc work: 1986 fall; 11(4): 291-300. 10. sells ra. ethical issues in transplantation. baillieres clin gastroenterol. sept, 1994; 8(3): 465-479. 11. sanders lm, giudice l and raffin ta. ethics of fetal tissue transplantation. west j med. sept, 1993; 159(3): 400-407. 12. evans r w, manninen d l, garrison l p jr. and maier a m. donor availability as the primary determinant of the future of heart transplantation. jama. 11 april, 1986; 255 (14): 1892 -1898. 13. halkic n, bally f and gillet m. organ transplantation in hiv infected patients. n engl j med, nov 28, 2002; 347 (22): 1801 -1803. 14. parks w e, barber r and painvin g.a ethical issues in transplantation. surg clin north am. jun, 1986; 66(3): 633-639. j bangladesh soc physiol. 2006 dec;(1):35-39 39 review 15. pichlmayr r. transplantation hepatiques. l experience dehanovre. chirurgie. 1991; 117(3) : 225-229. 16. schlessinger s, crook ed. black r and barber h. ethical issues in transplantation: living related donation in the setting of severe neurological damage without brain death. am j med sci. oct, 2002; 324 (4): 232-236. 17. einsiedel e f and ross h. animal spare parts. a canadian public consultation on xenotrans plantation. sci eng ethics. oct, 2002; 8(4): 579-591. 18. delmonico f l and harmon we. the use of a minor as a live kidney donor. am j transplant. apr, 2002; 2(4): 333-336. 19. hou s. expanding the kidney donor pool; ethical and medical considerations. kidney int. oct, 2000; 58(4): 1820: 1836. 20. kher v. end stage renal disease in developing countries. kidney int. jul, 2002; 62(1): 350-362. 21. boer g j and widner h. clinical neurotransplantation: core assessment protocol rather than sham surgery as control. brain res bull. 30th sept, 2002; 58(6): 547-553. 22. nora l m and mohowald m b. neural fetal tissue transplants: old and new issues. zygon. dec, 1996; 31(4): 615-633. 23. seelmann k. stammzellen aus nabelschnurblut rechtliche und rechtsethische fragen von transplantation und banking. ther umsch. nov, 2002, 59(11): 583-587. 24. juengst e and fossel m. the ethics of embryonic stem cells-now and forever, cells without end. jama, dec 27, 2000; 284(24): 3180-3184. 25. welin s. starting clinical trials of xenotransplantationreflections on the ethics of the early phase. j med ethics. aug 2000; 26(4): 231236. 26. steiner rw and gert b. ethical selection of living kidney donors. am j kidney dis. oct. 2000; 36(4): 677-686. 27. anonymous. american college of physician’s ethics manual. part ll: research, other ethics issues. recommended reading. ad hoc committee on medical ethics, american college of physicians. ann intern med. aug, 1984; 101(2): 263 -274. 28. anonymous. human somatic cell nuclear transfer (cloning). the ethics committee of the american society for reproductive medicine. fertil-steril. nov, 2000; 74(5): 873-876. 29. krishman a, molina a and forman s j. organ transplantation in hiv infected patients. n engl j med. nov 28, 2002; 347(22)1801-1803. 30. lanza r p, caplan a l, silver l m, cibelli j b, west m d and green r m. the ethical validity of using nuclear transfer in human transplantation. jama. dec 27, 2000; 284 (24): 3175-3179. 31. marshall e. medical ethics. moratorium urged on germ line gene therapy. science. sept 22, 2000; 289 (5487): 2023. 32. mckay r stem cells-hype and hope. nature. jul 27, 2000; 406 (6794): 361-364. 33. akabayashi a, nishimori m, fujita m, and slingsby bt. living related liver transplantation: a japanese experience and development of a checklist for donors’ informed consent. gut. jan. 2003; 52 (1) : 152. 34. shapiro rs and adams m. ethical issues surrounding adult-to-adult living donor liver transplantation liver transpl. nov, 2000; 6 (6 suppl 2): 77-80 35. marcos a. right lobe living donor liver transplantation. liver transplantation. nov. 2000; 6(6 suppl 2): 59-63. 36. kamper a l, lokkegaard h and rasmussen f, nyretrans plantation med levende donor. ugeskr laeger. nov 27, 2000; 162 (48): 6527-6532. 37. soutullo d. clonacion humana no reproductive: utilizacion de embriones para la obtencion de tejidos para transplantes. law hum genome rev. jan-jun 2000; (12) 213-223. 38. pschera h. stem cell therapy in utero. j perinat med. 2000; 28(5): 346-354. 39. emond j and de luca t. trapiam to di fegato da familiare vivente: selezione dei riceventie donatori. minerva chir. nov, 2000; 55(11): 759-769. 40. stempsoy we. organ markets and human dignity: on selling your body and soul. christ bioeth. aug, 2000; 6(2): 195-204. 41. ebrahim m f a. organ transplantation: an islamic ethico-legal perspective. fima. 2002. 2nd edition. 69-85. 42. mufti muhammad shafi, insani a za’i ki paivandkari -shari’at islamiyyah ki roshni main. karachi: dar alisha at, 1967, pp. 29-38. 43. for example see the arguments put forward in favor of organ transplantation by shaykh abd al-rahman albassam and shaykh pp. muhammad rashid rida qabbani, zira at al-a da al insaniyyah fi jism al-insan in majallat al majma al-fiqhi (1408 ah/1987), pp 1322 and 27-33. 44. resolutions and recommendations of the fourth session of the council of the islamic fiqh academy (1408ah/1988), p. 52. 45. resolutions and recommendations of the fourth session of the council of the islamic fiqh academy (1408 ah/1988), pp.52-53. 46. fatwa issued to islamic medical association of south africa by dar al-ifta, riyadh, saudi arabia, p. 14. 47. qarar al-majma al-fiqhi in majallat al-majma al-fiqhi (1408-ah/1987),p. 40. 48. islamic fiqh academy of indiadeveloping a religious law in modern times, p. 178. 49. see qarar al-majma al fiqhi in majallat al majma al fiqhi (1408 ah/1987), p. 40. 50. jesse d jr. and david s. organ transplantation : a proposal for routine salvaging of cadaver organs. new egnl. j med. aug 22,1968;279(8)413-419. phys. journal no. 3, december 2008.pmd introduction splenic mass and its relation to age sex and height of the individual in bangladeshi peoples khalil m 1, chowdhury mai 2, rahman h 3, mannan s 4, sultana sz 5, rahman mm 6, ahamed ms 7, sultana zr 8 the aim of this study was to establish the standard weight of the normal spleen in bangladeshi people. one hundred and twenty human cadavers of which eighty seven male and thirty three female were dissected to remove spleen with associated structures. collected specimens were tagged with specific identification number, and divided into five groups according to age, sex and height of the individual. gross and fine dissections were carried out after fixing the specimen in 10% formal saline solution. weight of the spleen was measured by analytical balance and expressed in gram and findings of the study were compared with the findings of national and global studies. this cross sectional descriptive study was carried out in the department of anatomy of mymensingh medical college, mymensingh. in this study maximum mean weight of spleen was 86.35 gram in male and 85.33 gram in female in 31 – 45 years age group. minimum mean weight of spleen was 47.37 gram in male and 38.83 gram in female up to 15 years age group. the weight of spleen increases with age of the individual. mean weight of spleen in male was 73.43 gram, which was higher than the mean weight of female spleen (59.17 gram). according to height of individual the mean weight of spleen was maximum 84.32 gram in 165.01 to 180 cm height group and minimum in 54.87 gram in up to 120 cm height group which indicate that weight of the spleen increases with height of the individual. in conclusion, the weight of the spleen depends on the age, sex and body height of the individual. key words: spleen, weight, age, height j bangladesh soc physiol.2008 dec;(3):71-78. for author affiliations, see end of text. http://www.banglajol.info/index.php/jbsp he spleen is an organ that is involved in the regulation of circulating blood volume, haematopoiesis and immunity the more recent observation of how often an enlarged spleen was associated with various blood diseases confirmed the relationship between the spleen and the haemopoietic system. in some of this disease the effect of splenectomy made this relationship even more apparent 3. splenic enlargement may be an important diagnostic clue to the existence of an underlying disorder 2. a normal spleen weight 150 gm and spleen weight from 400 – 500gm indicate splenomegally 4. rollo and deland derived a formula for the in vivo estimation of liver and and in the protection of the body from infections and malignancies; recently the role of the spleen in the prevention of metastasis of malignant tumour has also been emphasized 1,2 . enlargement of the spleen has been of concerned to physicians as far back as ancient greece, when it was almost certainly associated with endemic malaria. t j bangladesh soc physiol. 2008 dec;(3):71-78 71 article spleen masses from radionuclide images. in order to evaluate the clinical significance of splenic size, it is important to know the normal range of organ size relative to a specific parameter, e.g. body weight, height, surface area, or age 5. from several studies on spleen described that, weight of the spleen decreased with ages in both sex and the spleen of female was slightly smaller 6. in order to establish the normal standard of spleen weight in bangladeshi people, 120 spleens from 200 autopsies were selected from the morgue of the department of forensic medicine of mymensingh medical college, mymensingh. from this study relationship of spleen size to age, sex and body height of the individual was observed. methods the present study was carried out on 120 postmortem human spleens collected from bangladeshi cadavers of both sexes (male and female) age ranging from birth to 80 years in the department of anatomy of mymensingh medical college, mymensingh from july 2007 to june 2008. the specimens for the study were selected from dead bodies that were under postmortem examination in the morgue of the department of forensic medicine of mymensingh medical college, mymensingh on different dates from october 2007 to april 2008. the spleens were chosen from individuals who died within 12 24 hours and discarded those were apparently ill or debilitated and the samples which were found with considerable sign of decomposition. injured spleens, spleens of poisoning cases, known cases of diseases affecting spleen were also excluded from the present study. since no autopsy is done for routine hospital death or other deaths from natural cause in our country, most of the spleens were collected from bodies where cause of death was medico legal i.e. road accident, suicidal, homicidal. sufficient care was taken during removal of spleen from the cadaver to prevent undesired cutting of the tissue. the dead bodies were kept on the table in supine position and allotted an identification number. the particulars of the body (age, sex, cause of death) were recorded in a record book against respective specimen number. height of the cadaver was measured and recorded. after removal from the bodies the spleen were cleaned gently with running tap water. blood and blood clots were removed as far as possible. the spleens were brought to the department of anatomy, mymensingh medical college. all fat and other unwanted associated tissue were removed from the spleen. the collected specimens were tagged by a piece of waxed cloth which bore an identifying number along with the age of victim. the collected specimen were divided into five groupsa (upto 15 years), b (16 – 30 years), c (3145 years), d (46 – 60 years) & e (above 60 years) according to age and a (0120cm), b (120.01 – 135cm), c (135.01 – 150 cm), d (150.01 – 165cm) and e (165.01 – 180cm) group according to height for convenience of description of their various changes in relation to age, sex and height. the whole dissected specimen was placed in the fixatives (10% formal saline solution). the specimen was allowed to get fixed for 48-72 hours. ignoring a little hardness and shrinkage, further study was carried out with these preserved specimens. weight of spleen was measured by means of a scientific balance. before weighting, fat and unwanted tissues were removed carefully and spleen was dried with tissue paper. weight of the spleen was expressed in gm. collected data was noted in a tabulated form. data were expressed as mean and ± se, analysed statistically by anova using computerized spss version-12 and findings of the present study were compared with national and international studies. results weight of 120 human spleens (male 87 and female 33) was studied in relation to age and height of the individual. it was evident from the 72 j bangladesh soc physiol. 2008 dec;(3):71-78 article splenic mass in bangladesh table i that the maximum weight of spleen in male was 132, 166, 171, 195, 79 gm and in female was 76, 128, 107, 70, 61gm in group a, b, c, d and e respectively. the minimum weight of spleen in male was 35, 47, 70, 61 and 61.50gm and in female were 20, 50, 73, 68 and 41 gm in group a, b, c, d and e respectively. it was evident that weight of spleen was very variable with considerable overlapping between different age group. from the figure 1 it was evident that the weight of spleen shows regular increase up to 60 years of age then weight began to decrease. the mean(± se) weight of male spleen was 47.37± 14.38, 86.28 ± 6.18, 88.00 ± 4.15, 86.35 ± 10.12, 49.35 ± 5.02 gm and in female was 38.83±11.01, 73.83± 8.91, 85.33 ± 10.86, 69.00 ± 1.00, 49.37 ± 1.95 gm in group a, b, c, d and e respectively. difference of splenic weight between group a and b, a and c, a and d, b and e, c and e, d table – i: weight of spleen in different age and sex group age group number of specimen weight in gm (mean ± se) (range) male female male female a 8 8 47.37 ± 14.38 38.83 ± 11.01 (up to 15 years) (35.00 – 132.00) (20.00 – 76.00) b 26 12 86.28 ± 6.18 78.08 ± 8.91 (16-30 years) (47.00 – 1 66.00) (50.00 128.00) c 29 3 88.00 ± 4.15 85.33 ± 10.86 (31-45 years) (70.00 – 171.00) (73.00 – 107.00 ) d 13 2 86.35 ± 10.12 69.00 ± 1.00 (46-60 years) (61.00 – 195.00) (68.00 – 70.00) e 11 8 49.35 ± 5.02 49.37 ± 1.95 (above 60 years) (40.50 – 79.00) (41.00 – 61.00) total 87 40 73.43 ± 3.90 59.17 ± 5.29 35.00 – 195.00 20.00 – 128.00 significant test byone way anova comparison between p value comparison between p value different age groups different age groups a b 0.000 hs c e 0.000 hs a c 0.000 hs d e 0.000 hs a d 0.000 hs comparison between mean weight of male and female sex of the number of mean volume (±) se t value p value person the specimen in ml male 87 73.43 3.90 2.16 0.10 ns female 33 59.17 5.29 j bangladesh soc physiol. 2008 dec;(3):71-78 73 splenic mass in bangladesh article table – ii: weight of spleen in different height group height group number of specimen weight in gram (mean ± se) range a(0-120 cm) 12 54.87 ± 6.23 20.00 – 100.00 b(120.01-135cm) 11 58.95 ± 6.15 39.00 – 107.00 c(135.01-150cm) 23 79.36 ± 7 .50 32.00 – 171.00 d(150.01-165cm) 49 68.26 ± 4.31 30.00 – 166.00 e(165.01-180cm) 25 84.32 ± 6.90 41.10 – 195.01 total 120 71.54 ± 2.91 20.00 – 195.01 significant test byone way anova comparison between p value comparison between p value different height groups different height groups a c 0.017 s b e 0.031 s a e 0.004 ms d e 0.027 s hs highly significant (p<0.001) ms moderately significant (p<0.01) s significant (p<0.05) ns non significant (p>0.05) and e were statistically significant. the difference was not significant between group a and e, b and c, b and d, c and d. the weight of male spleen was greater than the weight of female spleen but the difference was not significant. from table ii it was evident that mean ( ± se) weight of the spleen in a (0 120cm) height group was 54.87 ± 6.23gm and the range was from 20 -100gm, in height group b (120.01-135cm) was 58.95 ± 6.15gm and range was from 39 -107gm, in c (135.01150cm) group mean (± se) weight was 79.36 ± 7.50gm and range from 32 -171gm, in group d ( 150.01 165cm) mean (± se) weight was 68.26 ± 4.31gm, range from 30 -166gm, in group e ( 165.01 180cm) 84.32 ± 6.90gm and range from 41.10 195gm. it was also evident that weight of spleen was very variable with considerable overlapping between different height groups. difference of splenic weight between group a and c, a and e, b and e, d and e was significant. from the figure 2 it was evident that the weight of the spleen increases with height of the individual. there was a slight decrease in height group d due to presence of extreme age people in this height group which indicate that the weight of the spleen depends on the variation of age of people. 74 j bangladesh soc physiol. 2008 dec;(3):71-78 article splenic mass in bangladesh discussion to establish a standard weight for normal spleen in bangladeshi people, the present study was carried out on 120 spleens of bangladeshi cadaver and found that, mean (±se) weight of figure 3: spleens of different size and weight figure 4: spleens of different size and weight figure 1: bar diagram representing mean weight of spleen in different age and sex group. figure 2: line diagram representing mean weight of spleen in different height group spleen was maximum in 3146 years age group and minimum upto 15 years age group in both male and female. the mean (± se) weight of 87 male was 73.43 ± 5.20gm, range from 35-195gm and of 33 female was 59.17± 5.29gm, range from j bangladesh soc physiol. 2008 dec;(3):71-78 75 splenic mass in bangladesh article 120128gm. mean weight of male spleen was higher then female spleen but the deference was not significant. it was observed in present study that, weight of spleen increases progressively with the age of the individual upto 60 years and weight of spleen was maximum in the middle age groups (b, c and d). after 60 years, weight of spleen starts to decrease. it may be due to degeneration of tissue. according to height of individual the mean weight was maximum 84.32gm in group e and minimum 54.87 gm in group a, range from 20195gm, which shows that the weight of spleen proportionately increases with the height of the individual. in 2007 a study was done in sir salimullah medical college under dhaka university on spleen of 60 bangladeshi cadaver in different age groups and described the mean (± se) weight of the spleen was maximum in 40-49 years age group as 83.00 ± 16.53gm and minimum 45.00 ± 17.73gm in 60 years and above age group, range from 30 -120gm 7. in present study the maximum mean (± se) weight of spleen was found in 31 45 years age group in both male and female which were close to the above mention findings. the minimum mean (± se) weight of spleen observed in upto 15 years age group in both male and female because most of the cases were close to lower limit of this age group which was not similar. range of present study was higher than the range described by the author 7. in 2006 rayhan studied in dhaka medical college under dhaka university on 70 spleens of bangladeshi cadavers of different age groups found that maximum mean weight of spleen was 104.64gm in 40 49 years age group and minimum mean weight of spleen as 61 gm in 0 21years of age group 8, which was higher than maximum and minimum mean weight of spleen of the present study in group a and c in both male and female, but the range was 30-170gm which was within the range of the present study. the mean weight of present study differs from the above mention studies 7, 8 because they follow deland for age grouping who start his grouping from 20 years and the space between the groups was 10 years 6. the present study was designed to observe the changes of spleen in different age group from birth 15 years, 16-30 years, and 3145 years, 46 -60 years and above 60 years age group. in present study weight was measured in relatively fresh spleen fixed after washing in running tap water to remove the remaining blood from the spleen as much as possible and clearing the related structures before measurement and most of the values in present study was close to the lower limit of their age group. the mean weight of spleen in male and female in different age group of present study was lower than the study carried out in 1970 on 440 autopsies from 20 years to 70 years of age in johns hopkins hospital and described the mean weight of male and female spleen in different age groups. at 20 – 34 years age group the mean weight of spleen was 172gm and 152gm, in 35 – 59 years age group 169gm and 157gm, in above 60 years age group 167gm and 156gm in male and female respectively 6. the present study shows that the weight of spleen increases progressively with age from birth to 30 years, followed by a relative constant weight upto 60 years of age, then start to decrease above the age of 60 years which was not supported by deland who describe that, weight of the spleen decreases between 20 – 29 years age, followed by relative constant weight from 30 – 59 years of age and start to decrease again above the age of 60 years 6. in 1933 normal variation in the weight of the spleen based upon an autopsy material was examined of which 1266 males with weight 61 – 364gm and 316 females with weight 63 – 310gm, in 1974 study on 366 spleens was done and found that weight of spleen for male was 70 – 280 gm and female was 55 – 195gm 13, but the authors did not mention any age group of their population. the range of splenic weight of both 76 j bangladesh soc physiol. 2008 dec;(3):71-78 article splenic mass in bangladesh male and female in group c of present study was within this range. the mean weight of spleen of group b, c and d in both male and female of present study was lower than the findings studied in 1993 on 1598 medicolegal autopsies and describe the mean weight of adult (>16 years) spleen as 167 gm for male and 117 gm for female 13. in 1982 studied on south african people in university of captown, south africa, in 2005 studied on american people in yale university school of medicine, florida. the authors mentioned the mean weight of normal spleen as 150 gm, range from 80 – 300 gm, which was also described by standard text books 4,9,10,11. the authors did not mention about the age and sex of the population. if their measurement took as the normal adult value, the range of splenic weight in group d of both male and female of present study was within the range, but the mean weight of their study was higher than the present study. in the present study mean weight of spleen in male was higher than the female which was supported by various studies 6, 12. in 1965 studied carried out on 400 caucasian and 708 negro autopsy cases in university of tennessee and observed that above the age of sixty years the weight of spleen starts to decrease 12, which was also observed in the present study. the mean weight of spleens of the caucasians differe significantly from the mean weight of the spleens of negroes which indicate that weight of the spleen also influenced by races 12. in 1996 an extensive study was done on 539 autopsies of which 203 female and 336 male in the department of forensic medicine in odense university, denmark and found that the spleen weight is positively correlated to height, body weight and degree of acute congestion but not to sex or age. they studied the weight of spleen in relation to height of the individual in different groups and observed that the weight of spleen increase with height of the individual 13, which confirm the findings of present study. in present study it was observed that the weight of the spleen was lower than the weight of europeans standard because splenic weight varies in normal people with sex, age and is in proportion to body weight, height, and body surface area 3, 12, 13 which is much higher in european people than the bangladeshi people as, organ weight was found positively correlated to body height and body mass 6. the difference may be due to racial variation, which was observed in 1965 during studying on 400 caucasian and 708 negro autopsy cases in university of tennessee 12. different authors have different inclusion criteria and the results are stated in different ways, e.g. different age grouping, mean weight or ranges, making it difficult to comparison with each other. in this study it was observed that weight of the spleen depends on the age, sex and height of the individual which was supported by various studies. to establish a standard data on spleen in bangladeshi people, further studies adopting better techniques on larger sample from different part of bangladesh should be done. factor that influence the weight of the spleen should be fixed and keep in mind. author affiliations 1. * professor dr mohsin khalil, mbbs, m phil, professor and head of anatomy, mmc, mymensingh, bangladesh (guide of this manuscript) 2. professor and head of the department of anatomy, mmc, mymensingh, bangladesh 3. dr md ashraful islam chowdhury, m phil, department of anatomy, mmc, mymensingh, bangladesh 4. dr habibur rahman, assistant professor, department of anatomy, mmc, mymensingh, bangladesh 5. dr sabina mannan, assistant professor, department of anatomy, mmc, mymensingh, bangladesh 6. dr seheli zannat sultana, assistant professor, department of anatomy, mmc, mymensingh, bangladesh 7. dr md mahbubur rahman, curator, department of anatomy, mmc, mymensingh, bangladesh 8. dr m shibbir ahamed, lecturer, department of anatomy, mmc, mymensingh, bangladesh 9. dr zinat rezina sultana, department of anatomy, mmc, mymensingh, bangladesh * for correspondence j bangladesh soc physiol. 2008 dec;(3):71-78 77 splenic mass in bangladesh article references 1. liu dl, xia s, xu w, ye q, gao y & qian j. anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy . surgery 1996 jan; 119: p. 27 – 33. 2. cortan rs, kumar v & robbins sl eds. robbins pathologic basis of disease. 6th ed. new delhi: w.b. saunders; 2003. p. 686-90. 3. lampert ia. ‘the spleen’, in mcgee j. isaacson pg, wright na, editors. oxford text book of pathology. england: oxford university press; 1992. p. 17941807. 4. kaplan lj. splenomegaly. emedicine: 2004 octa 5;1-4. 5. rao uvg & wagner hn 1972, ‘normal weight of human organs’, radiology vol. 102, no. 337 – 9. 6. deland fk 1970, ‘normal spleen size’, radiology, vol. 97, no. 2, p. 589 92. 7. 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