Spectrum of skin lesions of post-kala-azar dermal leishmaniasis in kala-azar endemic areas of Bangladesh

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) and serves as a potential reservoir for Leishmania parasite. The study was aimed to evaluate the spectrum of skin lesions of PKDL in kala-azar endemic areas in Bangladesh. This cross sectional study was carried out to observe the characteristics of skin lesions among 250 PKDL cases. The suspected PKDL patients in highly endemic villages of Fulbaria Upazilla of Mymensingh district.were subjected to a dipstick test (rK39) for kala azar. The median time interval between diagnosing kala-azar and PKDL was 23 month (m-21, r- 0-60 months). The most common skin lesions were multiple symmetrical hypopigmented macules with irregular margins in 179(71.6%) cases followed by erythematous facial induration in 74(29.6%), papular in 33(13.2%), nodular in 28(11.2%) cases, combination of macules, papules, nodules and plaques in 88(35.2%) cases, annular in 7(2.8%) cases and Papillomatous mucosal growth in 2(0.8%) cases. Sites of involvement were mostly in face (92.4%), Trunk (84.8%), extremities (33.2%), oral mucosa and tongue (0.8%) and Genitalia (1.2%). Suspicion of PKDL on the basis of skin lesions will lead to early diagnosis and prompt treatment will impart an important role in prevention and eradication of Leishmaniasis in Bangladesh.

Cell block cytology in pleural effusion

Cell blocks prepared from residual tissue fluid can be used as adjuncts to smear for establishing a more definitive cytopathological diagnosis. It can be useful for categorisation also. Improved ethanol formalin fixative is used which offers excellent cytomorphologic features corresponding closely to cell in Papanicolaou stained smears. The technique is simple, safe, cost effective and reproducible even in resource limited rural areas. In this study among a total of 60 cases of suspected malignant pleural effusion, 56 were confirmed to be of malignant aetiology by all modalities. Only cell block preparation diagnosed 46 cases. Other modalities of diagnosis like bronchoscopy, broncho-alveolar lavage fluid study, fine needle aspiration cytology also have a great role in diagnosis. Twenty-two cases were diagnosed by Papanicolaou stain smear. So cell block preparation have more effective role in definitive diagnosis. It can be useful for better diagnosis in cases of poorly differentiated malignant neoplasms by immunocytochemistry.

Large calcified subdural empyema

Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.

Demographic and clinical profile of myelopathy patients

This descriptive type of cross sectional study was aimed to identify the demographic profile, clinical presentations of myelopathy and to find out the etiological factors associated with myelopathy. Total 65 patients having clinical features of myelopathy, admitted in Neurology and Medicine ward of Mymensingh Medical College Hospital from February 2009 to December 2010 were purposively studied. Patients underwent a detailed clinical evaluation followed by laboratory investigations and neuro-imaging studies. Out of 65 cases, 80.0% were male and 20.0% were female with mean age 39.15 ± 16.8 years. Highest number of cases (41.6%) was farmers. Most of the cases (72.3%) hailed from rural area. Mean duration of illness was 7.74 ± 15.8 months. 41.54% patients presented with paraplegia/paraparesis and 58.46% with quadriparesis/quadriplegia. 63.1% patients had sensory disturbance. It is observed that 58.5% had urinary sphincter disturbance and 21.5% had bowel sphincter disturbance. Among the causes of myelopathy found in this study, 29.23% patients had spondylotic myelopathy and 24.62% had transverse myelitis (ATM). In 12.31% patients the cause of myelopathy could not be identified. Myelopathy is more common in males and most of the patients are farmers. Spondylotic and Transverse myelopathy is the main etiology of compressive and non-compressive myelopathy respectively.

Sex differentiation and risk factor evaluation in stroke patients

This study was conducted to find out the possible influencing factors on stroke in two sexes. It was a descriptive type of cross sectional study, conducted on 177 stroke patients admitted in Mymensingh medical college hospital from February 2009 to March 2010. Patients were selected according to WHO stroke definition and confirmed by CT or MRI. The results of the study showed that Stroke was more common (58.19%) in male than female (41.8%), mean age of male stroke patients was 60.58±12.36 years and that of female was 63.58±13.62 years with no significant statistical sex difference. But after 70 years, females are more sufferer than male. Hypertension, Diabetes mellitus, ischemic heart disease, atrial fibrillation and dyslipidemia in male and female were equally present without significant difference, although male had a higher rate of smoking and previous stroke (p<0.05). Motor weakness was more in male than female and unconsciousness was more in female (p<0.05). Type and sub types of stroke showed no significant difference. Females had more severe stroke in terms of severity score (Scandinavian Stroke Scale) on admission. Duration of hospital stay were similar among male and female but on discharge functional scale (Modified Rankin Scale) score was higher in male (p<0.05) and in hospital mortality was higher in female (p<0.05) which was statistically significant.

A rare case of lung cancer with invasion in the heart giving rise to electrocardiographic features simulating myocardial infarction

Bronchogenic carcinoma commonly metastasises to liver, bone, brain and adrenals. Involvement of mediastinal structures like superior vena cava, recurrent laryngeal nerve, phrenic nerve, pericardium, etc, is also common. But invasion of myocardium is very rare in bronchogenic carcinoma. A rare case of lung cancer with invasion to left atrium and ST segment elevation on electrocardiogram (ECG) mimicking myocardial infarction is presented here.

Autophagy regulates embryonic survival during delayed implantation

Delayed implantation, considered a state of suspended animation, is widespread in mammals. Blastocysts under this condition remain dormant for an extended period but resume implantation competence upon favorable conditions. The underlying mechanism by which extended longevity of dormant blastocysts is maintained is not clearly understood. Using autophagy markers and the well-defined delayed implantation model in mice, we show that autophagy is important for the extended longevity of dormant blastocysts in utero during delayed implantation. However, prolonged dormancy leads to reduced developmental competency of blastocysts and cellular damage with compromised pregnancy outcome. Estrogen supplementation, which activates implantation of dormant blastocysts, induces the formation of multivesicular bodies in the trophectoderm in vivo. Collectively, our results suggest that autophagy is a critical cellular mechanism that is utilized for the prolonged survival of dormant blastocysts.

Diagnosis of three cases of endobronchial tuberculosis presenting as unresolved pneumonia, following fiberoptic bronchoscopic biopsy

Nowadays, endobronchial tuberculosis is of rare occurrence. This article presents three such cases. All of them presented as unresolved pneumonia with collapse-consolidation in chest X-ray. All the three patients were sputum smear negative for acid fast bacilli. Diagnosis was possible only with fiberoptic bronchoscopy and bronchial biopsy.

Genetic Testing for Huntington's Disease in Parkinsonism

The study was conducted to find out Huntington's disease (HD) by genetic analysis from those presenting with parkinsonism in the Neurology department of Mymensingh Medical College & Hospital. A sample of about 5ml blood was collected by veni puncture in EDTA tube with informed consent from 9 patients & 7 healthy individuals after approval of the institutional ethics committee for genetic study. The neurological disorder along with a complete history and physical findings were recorded in a prescribed questionnaire by the neurologists of Mymensingh Medical College & Hospital. Extraction of genomic DNA from the venous blood using FlexiGene DNA kit (Qiagen, Japan) was performed in Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh. The extracted DNA was stored and accumulated and then these DNA were sent to Division of Clinical Genetics, Department of Medical Genetics, Osaka University Medical School, Suita, Osaka 565 0871, Japan for PCR and further analysis. PCR amplification of the CAG repeat in the 1T15 gene was performed with primers HD1 and HD3. HD PCR products revealed the DNA product of about 110bp (no. of CAG repeats=21) to 150bp (no. of CAG repeats=34) in both healthy individual and suspected PD patient DNA.

A primary intracranial ependymal cyst

A case of a giant ependymal cyst in the fronto-parieto-temporal region in a 9 months old male baby, who presented with recent onset epilepsy, drowsiness and loss of vision. Neurosurgical intervention of this cystic lesion was curative. Interesting clinical and neuroimaging features are presented. This ependymal and primary intracranial cystic lesion which is rare. These are congenital, benign ependyma lined, commonly intraparenchymal and uncommonly extraparenchymal cysts in leptomeningeal location of variable size. Surgical intervention is warranted in cysts, which produce a mass effect and raised intracranial pressure.

Mediastinal teratoma mimicking massive pleural effusion

Immature mediastinal teratoma is very rare, found in only 1% of all mediastinal teratomas. Raised serum alpha feto-protein acts as important surrogate marker for both diagnosis and follow up in such cases. Surgery and adjuvant chemotherapy are keys in the management, especially in patients older than 15 years of age. We present a 14-year-boy presenting clinico-radiologically as left sided massive pleural effusion. Raised serum marker as well as excision biopsy of the mediastinal mass following thoracotomy were indicative of a diagnosis of immature teratoma.

Induction and Catabolite Repression of beta-Glucosidase Synthesis in Myceliophthora thermophila D-14 (= ATCC 48104)

beta-Glucosidase activity in Myceliophthora thermophila D-14 (= ATCC 48104) was inducible and was produced in culture filtrate during growth with various inducers, of which PNPG (p-nitrophenyl-beta-d-glucoside) was the most efficient. Induction of beta-glucosidase also occurred when the organism was grown in medium supplemented with different carbon sources. Carboxymethyl cellulose, cellobiose, and Solka-Floc were found effective for induction of enzyme biosynthesis. The addition of glucose to the culture medium severely repressed beta-glucosidase synthesis, which could not be reversed by exogenous cyclic AMP or dibutyryl cyclic AMP.

Lipid profile among ischemic and haemorrhagic stroke patients

This study is a prospective cross- sectional study conducted in the Neurology and Medicine department of Mymensingh Medical college Hospital (MMCH) to see the association of different components of serum lipids among ischemic and hemorrhagic stroke patients. Cases were selected following certain inclusion and exclusion criteria. Result showed that both types of stroke were more common after the age of 50 years. Male suffered more than female. M:F in ischemic stroke group was 1.73:1, and in hemorrhagic group was 1.42:1. Both types of stroke belong to middle class people. Smoking, hypertension and diabetes mellitus were equally common in both types of stroke. Low density lipoprotein (LDL) level were more than desired level in both types of stroke and there was no significant difference between two groups (p>0.05). Other components of lipid profile (total cholesterol, HDL, Triglyceride) were within normal range and there was no significant difference between two groups (p>0.05).

Role of reduced glutathione in the amelioration of nicotine-induced oxidative stress

Nicotine, a major toxic component of cigarette smoke has been identified as a major risk factor for different diseases. This study investigates the role of reduce glutathione (GSH) against nicotine treated liver and kidney toxicity. Results showed that the application of 80 mg GSH per kg body weight per day exert protective effect against nicotine-induced liver and kidney toxicity by modulating the biochemical marker enzyme LDH, lipid peroxidation and augmenting antioxidant defense system. To our knowledge, this is the first finding of this sort.

Current knowledge of the aetiology of human tubal ectopic pregnancy

BACKGROUND An ectopic pregnancy is a pregnancy which occurs outside of the uterine cavity, and over 98% implant in the Fallopian tube. Tubal ectopic pregnancy remains the most common cause of maternal mortality in the first trimester of pregnancy. The epidemiological risk factors for tubal ectopic pregnancy are well established and include: tubal damage as a result of surgery or infection (particularly Chlamydia trachomatis), smoking and in vitro fertilization. This review appraises the data to date researching the aetiology of tubal ectopic pregnancy. METHODS Scientific literature was searched for studies investigating the underlying aetiology of tubal ectopic pregnancy. RESULTS Existing data addressing the underlying cause of tubal ectopic pregnancy are mostly descriptive. There are currently few good animal models of tubal ectopic pregnancy. There are limited data explaining the link between risk factors and tubal implantation. CONCLUSIONS Current evidence supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the Fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur. Future studies are needed that address the functional consequences of infection and smoking on Fallopian tube physiology. A greater understanding of the aetiology of tubal ectopic pregnancy is critical for the development of improved preventative measures, the advancement of diagnostic screening methods and the development of novel treatments.

Development and physical characterization of chloramphenicol loaded biodegradable nanoparticles for prolonged release

The objectives of our study were to prepare a biodegradable nanoparticulate system of chloramphenicol (CHL) and to evaluate its ability to prolong in vitro release of CHL compared to free drug suspension (FDS). CHL-loaded polylactide-co-glycolide nanoparticles (CHL-PLGA-NPs) were prepared by an emulsion/solvent evaporation method using ethyl acetate and polyvinyl alcohol. CHL-PLGA-NPs were characterized by particle size, zeta potential, infrared spectra, drug entrapment efficiency and in vitro release kinetics measurement. Sonication was done with an ultrasound pulse sonicator at 70 W, 30 kHz for 60 s to produce stable NPs of mean size range from 277 nm to 433 nm. Drug to polymer ratio (D:P) was selected as formulation variable and significantly influenced entrapment efficiency (approximately 30% to 66%) and release (p < 0.05). Entrapment of CHL in biodegradable NPs significantly prolonged drug release compared to FDS and thus implies potential antibiotic delivery system for ocular application.

HB-EGF: a unique mediator of embryo-uterine interactions during implantation

An implantation-competent blastocyst, several hours prior to its attachment on the uterine wall, transmits signals to surrounding uterine cells and vice-versa to initiate a two-way interaction. The language of this precocious dialogue is versatile, taking advantage of secreted molecules for long-range interactions and membrane-bound molecules for more immediate interactions. Heparin-binding epidermal growth factor-like growth factor (HB-EGF) was identified as an early messenger of implantation which uses both modes of communication. In this review, we discuss the footprint of HB-EGF as to how it was initially identified as a mediator of implantation and how it initiates embryo-uterine interactions during this process.

Imaging mass spectrometry reveals unique protein profiles during embryo implantation

A reciprocal interaction between the implantation-competent blastocyst and receptive uterus is an absolute requirement for implantation, a process crucial for pregnancy success. A comprehensive understanding of this interaction has yet to be realized. One major difficulty in clearly defining this discourse is the complexity of the implantation process involving heterogeneous cell types of both the uterus and blastocyst, each endowed with unique molecular signatures that show dynamic changes during the course of pregnancy. Whereas gene expression studies by in situ hybridization or immunohistochemistry have shown differential expression patterns of specific genes during implantation, there is no report how numerous signaling proteins are spatially displayed at specific times and stages of implantation in the context of blastocyst-uterine juxtaposition. Using in situ imaging (matrix assisted laser desorption/ionization) mass spectrometry directly on uterine sections, here we provide molecular composition, relative abundance, and spatial distribution of a large number of proteins during the periimplantation period. This approach has allowed us for the first time to generate in situ proteome profiles of implantation and interimplantation sites in mice in a region- and stage-specific manner with the progression of implantation. This application is reliable because patterns of expression of several proteins displayed by in situ imaging mass spectrometry correlate well with in situ hybridization results. More interestingly, the use of this approach has provided new insights regarding uterine biology of cytosolic phospholipase A(2alpha) null females that show implantation defects.

Response to high LET radiation 12C (LET, 295 keV/microm) in M5 cells, a radio resistant cell strain derived from Chinese hamster V79 cells

PURPOSE

To study the effects of 12C-beam of 295 keV/microm (57.24 MeV) on M5 and Chinese hamster V79 cells by using cytogenetic assays like micronuclei (MN) induction, chromosomal aberrations (CA) and apoptosis. Additionally, the relative survival of these two cell lines was tested by the colony forming ability of the cells, with a view to understanding the mechanism of cellular damages that lead to difference in cell survival.

MATERIALS AND METHODS

Confluent cells were irradiated with 12C-beam at various doses using 15UD Pelletron accelerator. Cell survival was studied by the colony forming ability of cells. MN assay was done by fluorescent staining. Different types of chromosomal aberrations in metaphase cells were scored at 12 h after irradiation. Apoptosis was measured at different post irradiation times as detected by nuclear fragmentation and DNA ladder was prepared after 48 h of incubation.

RESULTS

Dose-dependent decrease in surviving fractions was found in both the cell lines. However, the surviving fractions were higher in M5 cells in comparison to V79 cells when exposed to the same radiation doses. On the other hand, induced MN frequencies, CA frequencies and apoptosis percentages were less in M5 cells than V79 cells. Very good correlations between surviving fractions and induced MN frequencies or induced total CA or induced apoptosis percentages were obtained in this study.

CONCLUSIONS

The cell strain M5 showed relatively more radio-resistance to 12C-beam compared to Chinese hamster V79 cells in this study. As the MN formation, CA and apoptosis induction were less in M5 cells as compared to parental V79 cells, the higher cell survival in the former could possibly be attributed to their better repairing ability leading to higher cell survival.

Combined occurrence of hyperthyroid Graves' and Hashimoto's thyroiditis

A 40 years old, married Govt. servant from Sadar upazila, Mymensingh was admitted in Mymensingh Medical College Hospital on 9(th) February, 2005 with the complaints of excessive sweating for 1 year, gradual loss of weight for 6 months, swelling in front of the neck for 1(1/2) months, and hoarseness of voice for 1 month. He was nervous, irritable, emotionally labile. Thyroid gland was symmetrically enlarged, firm in consistency with scalloped surface. Palms were warm and sweaty with fine tremor in outstretched hands. Lid lag, lid retraction and proptosis were the occular manifestations. All the reflexes were exaggerated. Radioactive iodine uptake showed enlarged gland with homogenously increased radiotracer concentration, ultrasonogram findings were enlarged gland with hypoechoic parenchyma with fibrous septa, T(3), T(4), TSH values were 6.56 nmol/L, 241.09 nmol/L and 0.14 mIU/L respectively. Thyroid microsomal antibody level was 32.87%. Thyroid FNAC findings were sheets of regular follicular cells, some large cells with granular basophilic cytoplasm, macrophages, a few inflammatory cells and giant cells. All the above findings were in favour of a diagnosis of hyperthyroid Graves' with Hashimoto's thyroiditis.

Molecular cues to implantation

Successful implantation is the result of reciprocal interactions between the implantation-competent blastocyst and receptive uterus. Although various cellular aspects and molecular pathways of this dialogue have been identified, a comprehensive understanding of the implantation process is still missing. The receptive state of the uterus, which lasts for a limited period, is defined as the time when the uterine environment is conducive to blastocyst acceptance and implantation. A better understanding of the molecular signals that regulate uterine receptivity and implantation competency of the blastocyst is of clinical relevance because unraveling the nature of these signals may lead to strategies to correct implantation failure and improve pregnancy rates. Gene expression studies and genetically engineered mouse models have provided valuable clues to the implantation process with respect to specific growth factors, cytokines, lipid mediators, adhesion molecules, and transcription factors. However, a staggering amount of information from microarray experiments is also being generated at a rapid pace. If properly annotated and explored, this information will expand our knowledge regarding yet-to-be-identified unique, complementary, and/or redundant molecular pathways in implantation. It is hoped that the forthcoming information will generate new ideas and concepts for a process that is essential for maintaining procreation and solving major reproductive health issues in women.

Differential Expression of Ezrin/Radixin/Moesin (ERM) and ERM-Associated Adhesion Molecules in the Blastocyst and Uterus Suggests Their Functions During Implantation1

Development of the blastocyst to implantation competency, differentiation of the uterus to the receptive state, and a cross talk between the implantation-competent blastocyst and the uterine luminal epithelium are all essential to the process of implantation. In the present investigation, we examined the possibility for a potential cross talk between the blastocyst and uterus involving the ezrin/radixin/moesin (ERM) proteins and ERM-associated cytoskeletal cross-linker proteins CD43, CD44, ICAM-1, and ICAM-2. In normal Day 4 blastocysts and after rendering dormant blastocysts to implantation-competent by estrogen in vivo (activated), the outer surface of mural trophectoderm cells showed much higher levels of radixin as compared to those in the polar trophectoderm cells, inner cell mass (ICM), and primitive endoderm. In contrast, ezrin was present on both the mural and the polar trophectoderm cell surfaces of normal Day 4 and activated blastocysts at higher intensity than dormant blastocysts. A distinct localization was noted in the primitive endoderm of dormant blastocysts that was not apparent in activated or normal Day 4 blastocysts. The expression of moesin was modestly higher at the mural trophectoderm of implantation-competent blastocysts, while the localization appeared to be present primarily on the polar trophectoderm cell surface of Day 4 blastocysts. The localization of ERM-associated adhesion molecules CD43, CD44, and ICAM-2 was more intense in the implantation-competent blastocysts compared with the dormant blastocysts. However, while CD44 was present both in the trophectoderm and in ICM, CD43 and ICAM-2 were localized primarily to the trophectoderm. The signal for ICAM-1 was very intense in the ICM but was modest in the trophectoderm. No significant changes in fluorescence intensity were noted between activated and dormant blastocysts. In the receptive uterus on Day 4 of pregnancy, ERM proteins were localized to the uterine epithelium, while on Day 5 the localization, especially of radixin and moesin, extended to the stroma surrounding the implantation chamber. With respect to ERM-associated adhesion molecules, while CD44 and ICAM-1 were exclusively localized in the stroma on Day 4, CD43 and ICAM-2 were localized to the epithelium. On Day 5, the localization of CD44 and ICAM-1 became highly concentrated in the antimesometrial stroma of the implantation chamber. The localization of CD43 and ICAM-2 remained mostly epithelial, although some stromal localization of CD43 was noted on Day 5. These results suggest that differential expression and distribution of ERM proteins and ERM-associated adhesion molecules are involved in the construction of the cellular architecture necessary for blastocyst activation and uterine receptivity leading to successful implantation.