Study of Commonest Variety of Sinonasal Malignancy and Its Sex Wise Distribution

This study was done to find the commonest variety of sinonasal malignancy and its association with sex.This cross-sectional study was conducted in the Department of Otolaryngology - Head & Neck Surgery Department, Dhaka Medical College & Hospital and in the Department of Otolaryngology - Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University between January 2009 and December 2009. A total of 146 cases of sinonasal malignancy were consecutively included in the study. The diagnosis was confirmed by histopathology. The mean age was 47.8 years (range: 22-75 years). Over three-quarters (77%) of the patients were male with male to female ratio being 3:1. Nearly one-third (30.8%) of the patients was farmer and over one-third (36.3%) was illiterate. The right sinonasal region was involved in 48.6% cases, left sinonasal region in 39% and both sinonasal region in 12.4% cases. Histopathological diagnosis of sinonasal malignancy revealed that squamous cell carcinoma accounted for 82.9% of sinonasal malignancies, 9.6% adenocarcinoma and the rest were olfactory neuroblastoma, adenoid cystic carcinoma and mucoepidermoid carcinoma. About 96.6% of the tumours involved nasal cavity, 97.9% maxillary sinuses, 17.8% frontal sinuses, 48.6% ethmoidal sinuses and 13% sphenoid sinuses. Over 80% of patients were smoker. Exposure to wood dust was found in 26% of cases. Lather tanning in 4.8% of cases and welding in 4.1% of cases. T staging shows that nearly half (48.6%) of the patients lesion was T2, 29.5% T3, 19.9% T4 and 2.1% T1. None of the patients exhibited lymph node involvement or distant metastasis. Males tend to develop squamous cell carcinoma significantly more than the females with risk of acquiring squamous cell carcinoma being nearly 3(1.1-7.1) times higher in male than that in female (p=0.022). The study concludes that the most common histopathological variety of sinonasal malignancy is squamous cell carcinoma and males are prone to develop this malignancy more frequently than the females.

Etiology of Laryngeal Squamous Cell Carcinoma: Study of 50 Cases in Mymensingh Medical College Hospital

This cross sectional observational study was done in the Department of ENT & Head-Neck Surgery, Mymensingh Medical College, Bangladesh from January 2013 to July 2014. Fifty (50) cases of carcinoma larynx were purposively selected. Clinically diagnosed cases of carcinoma larynx and histologically proven squamous cell carcinoma were included. Among 50 cases age ranged from 35-75 years with an average age of 58.1 years. Maximum patients were in 5th and 6th decades with male-female ratio 16:1. Most of the patient (78%) came from rural areas and came from low socio-economic condition (58%); maximum patients were cultivator (42%) & illiterate (50%). Smoking was the commonest (64%) personal habit. The other common personal habits were chewing of Betel nut & leaf (44%) and chewing of Tobacco (36%). Most of them have more than one habit.

Recurrent Laryngeal Nerve Injury in Thyroid Surgery: One Year Prospective Study in a Tertiary Care Hospital

This prospective, cross sectional study was carried out in the Department of Otolaryngology & Head-Neck Surgery, Mymensingh Medical College Hospital, Bangladesh from August 2010 to July 2011. One hundred & twenty eight (128) patients with thyroid swelling who underwent surgery were purposely included. The study was designed to determine the incidence of recurrent laryngeal nerve injury during thyroid surgery. Among the 128 patients, female were predominant 78.90%, majority of the patient were in third decade, 96.87% patients were biochemically euthyroid. Total 5.46% patient had recurrent laryngeal nerve injury. Among them 14.28% had transient and 85.72% had permanent injury. Injury was more in total thyroidectomy done for extensive malignancy.

Left Ventricular Diastolic Dysfunction is More Common in Patients of Uncontrolled Diabetes Mellitus

There is a relationship between the left ventricular diastolic dysfunction with uncontrolled diabetes mellitus. A cross sectional study was designed to see the association of uncontrolled diabetes mellitus with diastolic dysfunction of the heart. The study was conducted from April 2012 to March 2013 in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh. Sixty cases were selected as study population; twenty one patients were in Group I with good glycaemic controlled of HbA1C <7% and 39 patients were in Group II with poorly controlled diabetes mellitus having HbA1C ≥ 7%. In the study population male were 43(71.70%) and female were 17(28.30%). Mean age in the two groups were 49.05 ± 6.34 years vs. 53.64 ± 5.38 years, which was not significant difference. Duration of diabetes was <10 years and ≥ 10 years in two groups. Glycaemic status (percentage of HbA1C) was 6.55 ± 0.29% vs. 8.72 ± 1.01% in controlled and uncontrolled diabetic patient groups respectively which was significant difference. Diastolic dysfunction was found more in uncontrolled diabetic patient (patients having HbA1C% ≥ 7%) than controlled diabetic patients (HbA1C <7%). Grade I diastolic dysfunction was in uncontrolled and controlled glycaemic status were 33(84.60%) and 04(19.00%). The difference was statistically significant. Diastolic dysfunction in type 2 diabetic subjects was significantly higher as compared to the well control group (p<0.001). And this study concluded as - Diastolic dysfunction is more common in patient with poorly controlled diabetes mellitus.

Bone turnover biomarkers in obese postmenopausal Saudi women with type-II diabetes mellitus

BACKGROUND

There is a high prevalence of diabetes mellitus type-2 (T2DM) and osteoporosis are problems worldwide. In this study, we evaluated the correlation between T2DM and bone turnover in diabetic obese postmenopausal Saudi women.

SUBJECTS AND METHODS

The present study included total of 65 T2-DM obese postmenopausal Saudi women, (36 uncontrolled, 29 controlled). The following serum biochemical parameters were evaluated [fasting blood glucose (FBG), total calcium (Ca), phosphorus (Pi), parathyroid hormone (PTH), 1,25-(OH)2 Vitamin D3, osteocalcin (OC), procollagen (PICP) and cathepsin k (Cath K)].

RESULTS

Serum OC levels were significantly decreased in diabetic obese postmenopausal group compared to their respective healthy group (P < 0.004). PICP and Cath K were significantly elevated in diabetic postmenopausal group compared to the healthy group (P < 0.024 & 0.001). A significant elevation in 1,25(OH)2 Vitamin D3, Ca and Pi levels in diabetic obese postmenopausal patients group compared to the healthy group. However, a non-significant changes was observed in serum PTH level between different groups.

CONCLUSION

In this study, the changes in the biochemical parameters and bone turnover markers in obese women are strong risk factors for diabetes development that may contribute to osteopenia and osteoporosis. The study showed the strong effect of T2DM on biochemical markers of bone turnover in obese postmenopausal Saudi women.

The role of children with congenital anomalies in generating parental depressive symptoms

BACKGROUND

Many expectant parents wish to have a normal child. Unfortunately this does not always happen and some of them may have a child with birth defects leading to detrimental psychological effects on the parents. One of the common presentations generally observed is depression. The presence of depressive symptoms amongst such parents needs to be recorded to find out its prevalence. The results of such finding can help shape future programs for the prevention and treatment in this population group. This study will therefore explore the extent of depressive symptoms amongst parents of children with congenital anomalies.

METHODS

A case control study design was chosen. Ethical Review Board gave approval for the study on December 31, 2010, and the collection of data was started on January 5, 2011. Two randomly chosen samples of 132 parents each were collected from National Institute of Child Health (NICH), Ida Rieu, and Civil Hospital Karachi (CHK) over 8 months. First group consisted of parents of children with congenital anomalies and the second group was chosen as the control group from general population. Zung scale was used to record the presence of depressive symptoms in these two populations. Mann-Whitney test was performed to compare the depression scores.

RESULTS

The scale was completed by 132 parents in both sets. The parents of children with congenital anomalies showed greater (p < 0.0001) depressive symptoms. Mothers displayed greater (p = 0.029) depressive symptoms than fathers.

CONCLUSION

The parents of children with anomalies (60.6%) had more depressive symptoms than parents of normal children (27.3%).

Effect of supervised exercise on physical function and balance in patients with intermittent claudication

Background

The aim of the study was to identify whether a standard supervised exercise programme (SEP) for patients with intermittent claudication improved specific measures of functional performance including balance.

Methods

A prospective observational study was performed at a single tertiary vascular centre. Patients with symptomatic intermittent claudication (Rutherford grades 1–3) were recruited to the study. Participants were assessed at baseline (before SEP) and 3, 6 and 12 months afterwards for markers of lower-limb ischaemia (treadmill walking distance and ankle : brachial pressure index), physical function (6-min walk, Timed Up and Go test, and Short Physical Performance Battery (SPPB) score), balance impairment using computerized dynamic posturography with the Sensory Organization Test (SOT), and quality of life (VascuQoL and Short Form 36).

Results

Fifty-one participants underwent SEP, which significantly improved initial treadmill walking distance (P = 0·001). Enrolment in a SEP also resulted in improvements in physical function as determined by 6-min maximum walking distance (P = 0·006), SPPB score (P &lt; 0·001), and some domains of both generic (bodily pain, P = 0·025) and disease-specific (social domain, P = 0·039) quality of life. Significant improvements were also noted in balance, as determined by the SOT (P &lt; 0·001).

Conclusion

Supervised exercise improves both physical function and balance impairment.

Economic analysis of a randomized trial of percutaneous angioplasty, supervised exercise or combined treatment for intermittent claudication due to femoropopliteal arterial disease

Background

The aim was to compare costs and utilities of percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA + SEP) in patients with intermittent claudication (IC) to establish the most cost-effective treatment.

Methods

Patients with IC due to femoropopliteal disease were randomized to receive PTA, SEP or PTA + SEP. Assessments were performed before, and at 1, 3, 6 and 12 months postintervention. Clinical and quality-of-life indicators were recorded. The SF-6D Health Utilities index was calculated from the Short Form 36, plotted, and quality-adjusted life-years (QALYs) were generated by calculating the area under the curve. Costs were calculated using National Health Service 2009–2010 payment-by-results tariffs and the National Institute for Health Research Clinical Research Network Investigation pricing index, and adjusted for reinterventions. Cost per QALY and incremental costs were calculated, and sensitivity analyses performed.

Results

A total of 178 patients (PTA, 60; SEP, 60; PTA + SEP, 58) were randomized. All treatments resulted in significant improvement in the SF-6D index (P &lt; 0·001). There was no significant difference between treatments in mean QALYs gained (PTA: 0·620, 95 per cent confidence interval 0·588 to 0·652; SEP: 0·629, 0·597 to 0·660; PTA + SEP: 0·649, 0·622 to 0·675). The adjusted mean cost per procedure was significantly higher for PTA (€7301·74) compared with SEP (€3866·49) and PTA + SEP (€6911·68) (P &lt; 0·001). The cost per QALY was significantly higher for PTA (€11 777·00) compared with SEP (€6147·04) and PTA + SEP (€10 649·74). QALYs were lost when PTA alone was used as first-line treatment in comparison with SEP or PTA + SEP. These results were robust and valid in sensitivity analyses.

Conclusion

Supervised exercise is the most cost-effective first-line treatment for IC, and when combined with PTA is more cost-effective than PTA alone.

Phylogenetic relationships between Mediterranean and middle-Asian wild species of the genus Hordeum L. as revealed by biochemical and molecular markers

The phylogenetic relationships of 60 accessions of the genus Hordeum (29 Mediterranean and 20 middle-Asian wild accessions, together with nine American accessions and two of unknown origin), representing together nine species, were investigated by AFLP markers. Three hundred sixty six AFLP fragments were used for studying the molecular genetic diversity among the studied species, 339 out of them were polymorphic. Forty seven protein bands were obtained from the water soluble and the water insoluble seed storage protein by SDS-PAGE electrophoresis of 18 accessions representing nine species (two accessions/species). One band was common to all species and the other 46 bands were polymorphic. The phylogenetic tree deduced from AFLP analysis is concordant to a large extent with that deduced from seed storage protein. Highly significant cophenetic correlation coefficient was obtained between both AFLP (0.96) and seed storage protein (0.89) indicating the reliability of the results. The studied taxa were clustered according to their genome type. All Mediterranean and middle-Asian wild accessions could be integrated into the existing phylogenetic scheme.

An analysis of the performance of UK medical graduates in the MRCOG Part 1 and Part 2 written examinations

BACKGROUND

There is a lack of evidence on whether graduates from different medical schools perform differently in postgraduate examinations.

OBJECTIVE

To evaluate the variations in performance of UK medical graduates in Member of the Royal College of Obstetricians and Gynaecologists (MRCOG) examination.

METHODS

A retrospective analysis of performance of 1335 doctors graduating in UK medical schools who entered the Part 1 MRCOG and 822 doctors taking the Part 2 MRCOG written examination for the first time between 1998 and 2008. The main outcome measures were to evaluate medical school effects, gender effects and academic performance effect.

RESULTS

Graduates of UK medical schools performed differently in the Part 1 and Part 2 written MRCOG examination. The graduates of Oxford (pass rate 82.6%), Cambridge (75%), Bristol (59.3%) and Edinburgh (57.5%) performed significantly better and the graduates of Liverpool (26.8%), Southampton (21.8%) and Wales (18.2%) performed significantly worse than the remaining cohort in the Part 1 examination. The candidates of Newcastle (88.9%), Oxford (82.4%), Cambridge (81%) and Edinburgh (78.2%) performed significantly better and the graduates of Glasgow (49.2%) and Leicester (36.2%) have significantly underperformed compared with the remaining cohort in Part 2 written examination. There was no difference in the success rates of male (47.5%) and female (42.0%) candidates in the Part 1; however, female candidates had a significantly better success rate in the Part 2 written examination than male candidates (65.6% vs 52.9%).

CONCLUSION

These results show that there is variation in performance among the graduates from different medical schools in the Part 1 and Part 2 MRCOG written examination.

Difficulty in diagnosis of nasopharyngeal carcinoma

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.

Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease

Background

The aim was to compare percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA plus SEP) for intermittent claudication due to femoropopliteal arterial disease.

Methods

Consenting patients with femoropopliteal arterial lesions were randomized to one of three treatment arms: PTA, SEP, or PTA plus SEP. All patients received optimal medical treatment. Patients were assessed at baseline and 1, 3, 6 and 12 months after intervention. Clinical (ankle pressures, walking distances, symptoms) and quality-of-life (QoL) outcomes (Short Form 36, VascuQol) were analysed.

Results

A total of 178 patients (108 men, median age 70 years) were included. All three treatment groups demonstrated significant clinical and QoL improvements. One year after PTA (60 patients, 8 withdrew), 37 patients (71 per cent) had improved (16 mild, 16 moderate, 5 marked), nine (17 per cent) showed no improvement and six (12 per cent) had deteriorated. After SEP (60 patients, 14 withdrew), 32 patients (70 per cent) had improved (19 mild, 10 moderate, 3 marked), six (13 per cent) showed no improvement and eight (17 per cent) had deteriorated. After PTA plus SEP (58 patients, 11 withdrew), 40 patients (85 per cent) had improved (18 mild, 20 moderate, 2 marked), seven (15 per cent) showed no improvement and none had deteriorated. On intergroup analysis, PTA and SEP alone were equally effective in improving clinical outcomes, although the effect was short-lived. PTA plus SEP produced a more sustained clinical improvement, but there was no significant QoL advantage.

Conclusion

For patients with intermittent claudication due to femoropopliteal disease, PTA, SEP, and PTA plus SEP were all equally effective in improving walking distance and QoL after 12 months. Registration number: NCT00798850 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Constrictive pericarditis presenting as chylothorax

Chylothorax is a rare clinical condition that can be attributed to a damaged thoracic duct. The condition is suggested by aspiration of milky white fluid from the pleural cavity and is commonly associated with either malignant diseases or trauma (e.g. cardiothoracic surgery). We present the case of a 15-year-old boy with chylothorax, whose effusion was due to constrictive pericarditis. The definitive treatment of chylothorax involves identification and management of the underlying pathology. We suggest that when dealing with cases of chylothorax, constrictive pericarditis should be considered among the causes.

Mediastinal mass diagnosed as a benign schwannoma

Neurogenic tumours of the mediastinum are most commonly present in the posterior mediastinal compartment. Schwannomas, being the most frequently encountered type, can be either benign or malignant, although the former is more common. They typically appear as an asymptomatic mass on radiographic imaging. These tumours with spindle-shaped cells are often asymptomatic, and are routinely detected on standard pulmonary radiography. However, computed tomography and magnetic resonance imaging, especially for posterior mediastinal tumours, provide additional information and help to determine its possible extension to adjacent structures. Therefore, radiographic and histopathological examinations are vital diagnostic tools in the detection of these silent tumours. Complete surgical resection using video-assisted thoracic surgical technique is the mainstay of treatment, and offers an excellent prognosis.

Study of betasatellite molecule from leaf curl disease of sunn hemp (Crotalaria juncea) in India

Leaves of sunn hemp (Crotalaria juncea) showing geminiviral symptoms were collected from Lucknow, India during rainy season in 2008. DNA template isolated from the symptomatic leaf tissues were subjected to polymerase chain reaction (PCR) using specific primers to amplify coat protein (CP) gene of DNA-A as well as betasatellite DNA associated with the leaf curl disease. CP gene showed 97% sequence identity with that of Cotton leaf curl Burewala virus (CLCuBwV). Further, the betasatellite DNA molecule revealed sequence similarity with previously characterized betasatellite DNA of begomoviruses affecting malvaceous crops from different regions of India and Pakistan. Maximum similarity (>90%) of betasatellite DNA under study was observed with Cotton leaf curl Multan betasatellite (CLCuMB-[Pak: Mul17:08) and other betasatellite DNA from Pakistan thus confirming possible infection of C. juncea with begomovirus. A complementary sense open reading frame (ORF) βC1 is present at nucleotide position 194-550. Sequence comparison of this ORF with other members of begomoviruses further confirmed association of a begomovirus with C. juncea. The betasatellite DNA when expressed under the control of CaMV35S promoter Nicotiana tabacum, showed leaf deformities. Our results demonstrated that a malvaceous betasatellite is adapted by a nonmalvaceous host and causes similar disease symptoms.

Metastasis in differentiated thyroid carcinoma

Seventy patients of differentiated thyroid carcinoma (DTC) irrespective of age and sex were selected in ENT Department of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Rangpur Medical College Hospital who were admitted from March 2003 to March 2005. Female were more commonly affected (2.6:1) Papillary carcinoma was more common in 31-50 years of age and follicular carcinoma (ca) common in 41-50 years of age. Among the differentiated thyroid carcinoma papillary carcinoma found 77.15% and follicular ca. found 22.85%. Lymph node metastasis was more common in papillary (35%) than follicular carcinoma (12.5%). But distant metastasis was more common in follicular (12.5%) than papillary carcinoma (3.70). Maximum lymph node metastasis was found in level 3(55%), level 2(45%).

Identification and molecular characterization of begomovirus and associated satellite DNA molecules infecting Cyamopsis tetragonoloba

Monopartite begomoviruses comprise DNA-A as the main genome and associated satellite DNAs. Viral DNA extracted from guar (Cyamopsis tetragonoloba) showing leaf curl symptoms exhibited positive amplification of coat protein (CP) gene of DNA-A component, suggesting the presence of begomovirus. Full length DNA-A was amplified by primer pair re-designed from CP gene nucleotide sequence. The associated alphasatellite and betasatellite DNA molecules were amplified and sequenced, confirming the presence of monopartite begomovirus. Sequence comparisons showed 89% identity with other begomoviruses. The Neighbor-Joining tree based on full length DNA-A nucleotide sequence showed that the guar infecting begomovirus clustered separately from other known begomoviruses. The betasatellite shared a high (96%) nucleotide identity to Cotton leaf curl Multan betasatellites. The alphasatellite showed 91% nucleotide identity to alphasatellite associated with begomovirus infecting Okra. Recombination analyses showed three recombinant fragments in DNA-A, two in betasatellite, and four in alphasatellite. The results suggest that the begomovirus identified in this study was a new recombinant virus. Its name was proposed as Cyamopsis tetragonoloba leaf curl virus (CyTLCuV).

Identification and molecular characterization of begomovirus and associated satellite DNA molecules infecting Cyamopsis tetragonoloba

Monopartite begomoviruses comprise DNA-A as the main genome and associated satellite DNAs. Viral DNA extracted from guar (Cyamopsis tetragonoloba) showing leaf curl symptoms exhibited positive amplification of coat protein (CP) gene of DNA-A component, suggesting the presence of begomovirus. Full length DNA-A was amplified by primer pair re-designed from CP gene nucleotide sequence. The associated alphasatellite and betasatellite DNA molecules were amplified and sequenced, confirming the presence of monopartite begomovirus. Sequence comparisons showed 89% identity with other begomoviruses. The Neighbor-Joining tree based on full length DNA-A nucleotide sequence showed that the guar infecting begomovirus clustered separately from other known begomoviruses. The betasatellite shared a high (96%) nucleotide identity to Cotton leaf curl Multan betasatellites. The alphasatellite showed 91% nucleotide identity to alphasatellite associated with begomovirus infecting Okra. Recombination analyses showed three recombinant fragments in DNA-A, two in betasatellite, and four in alphasatellite. The results suggest that the begomovirus identified in this study was a new recombinant virus. Its name was proposed as Cyamopsis tetragonoloba leaf curl virus (CyTLCuV).

Graphic tobacco health warnings: which genre to choose?

BACKGROUND

Tobacco prevention studies show that graphic health warnings are more effective than text warnings, but there are no data on the effectiveness of different types of graphic health warnings in a Pakistani population. Even marginal differences in the effectiveness of genres can be of potential significance for public health.

OBJECTIVE

To study the effectiveness of different types of graphic tobacco warnings in a Pakistani population.

STUDY DESIGN

We presented ten anti-smoking warnings to randomly selected volunteers (n = 170) and recorded their opinion on the effectiveness of each warning. The warnings were based on a range of images aimed at the diverse population interviewed. A grading scale based on appeal, application, educational potential and motivation towards cessation was used to produce a composite grade of perceived effectiveness of the warning.

RESULTS

Our results indicate that graphic warnings reach a greater proportion of the population than text warnings. Those appealing to logic, and those inculcating a sense of fear by showing a deleterious outcome of smoking, were judged likely to be most effective in motivating smokers to quit and preventing experimental smokers from forming a habit.