Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14331 Bangladesh Med Res Counc Bull 2012; 38(3): 84-89 (December)

Management of bilateral congenital choanal atresia

This study was conducted to adopt better management technique for better outcome of bilateral congenital choanal atresia. Six consecutive neonates with bilateral congenital choanal atresia were included in this study. Emergency and elective management was done in various ways. Postoperative outcome was assessed clinically and endoscopically. Surgical management was done in two approaches. Three done in endoscopic transnasal approach and another 3 in transpalatine approach. Patient with endoscopic approach recovered earlier with minimum morbidity. Application of mitomycin-c minimizes granulation tissue and adhesions. Management of bilateral congenital choanal atresia is better by endoscopic transnasal approach with application of mitomycin-c.

Role of red cell distribution width (RDW) in the detection of iron deficiency anaemia in pregnancy within the first 20 weeks of gestation

Iron deficiency anemia is common problem during pregnancy. Red cell size variation (anisocytosis) is the earliest morphologic changes in iron deficiency anemia. Red cell distribution width is a quantitative measure of red cell size variation and it can give the idea of early iron deficiency before other test to become positive. 190 pregnant women were included in this study. Red cell distribution width was compared between iron deficient & non-iron deficient pregnant women. Red cell distribution width also compared with Hb level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and peripheral blood film in prelatent iron deficiency, latent iron deficiency, mild and moderate iron deficiency anemia. Red cell distribution width had sensitivity 82.3% and specificity 97.4%. Whereas Hb level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and peripheral blood film all had 56.6%, 29.2%, 68.1%, 15% and 38.9% sensitivity but specificity was 90.9%, 98.7%, 83.1%, 96.1% and 98.7% in the detection of iron deficiency. Red cell distribution width appears to be a reliable and useful parameter for detection of iron deficiency during pregnancy.

Early diagnosis of neonatal septicemia by hematologic scoring system, C-reactive protein and serum haptoglobin

Neonatal septicemia is one of the major health problems throughout the world. Infections are frequent and important cause of morbidity and mortality in neonatal period. The objective of the present study was to find out the role of hematologic scoring system (HSS), C-reactive protein (CRP) and haptoglobin in the early diagnosis of neonatal septicemia. This is a descriptive consisted of 100 neonates admitted at neonatal ICU, BSMMU, who were clinically suspected sepsis. The hematological parameter, C-reactive protein and haptoglobin were measured in all cases. Blood culture was done as the gold standard for diagnosis of neonatal septicemia. There were 12 out of 100 neonates (12%) who had culture proven sepsis and they were predominantly preterm and very low birth weight. On evaluation of various hematological parameters total leukocyte count, total neutrophil count, immature to total neutrophil ratio (>0.2), immature to mature neutrophil ratio (>0.3), total immature count, platelet count were found to have optimal sensitivities and negative predictive values. Using these values hematologic scoring system (HSS) was formulated according to Rodwell et al. Score ≥4 was found sensitivity of 100%, specificity of 60%. C-reactive protein (CRP) had sensitivity of 75%, specificity of 74%. Haptoglobin was not found significant (p<0.05) with sepsis and sensitivity was very low. But Combination of score ≥4 and CRP showed sensitivity of 75%, specificity 85%, positive predictive value (PPV) 41% and negative positive value (NPV) 96%. HSS and CRP are useful test to differentiate the septicemic from non septicemic neonates and also provide a effective guideline to make decisions regarding judicious use of antibiotic therapy. But haptoglobin level was not found useful for screening of sepsis.

Immature reticulocyte fraction as a predictor of bone marrow recovery in children with acute lymphoblastic leukaemia on remission induction phase

Immature reticulocyte fraction a new routine parameter in the hematology analyzer can give the idea of the earliest morphologic change of bone marrow recovery before other test become positive after chemotherapy. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University during a period of one year starting from October 2009 to September 2010 to evaluate the bone marrow recovery in children with acute lymphoblastic leukaemia by automated reticulocyte analysis. Total fifty patients were enrolled in this study on remission induction phase. All patients were between 8 months to 15 years age range with a mean age of 5.5 +/- 3.2. At the end of the study out of 50 cases, 52% patients showed early immature reticulocyte fraction recovery and concluded that the immature reticulocyte fraction parameter showed earlier haematopoietic recovery than the current practice of absolute neutrophil count recovery.

Value of dysmorphic red cells and G1 cells by phase contrast microscopy in the diagnosis of glomerular diseases

The morphology of red cells by phase-contrast microscopy (PCM) is a useful diagnostic marker for glomerular haematuria. This study evaluated the value of urinary dysmorphic red cells and G1 cells (special type of dysmorphic red cell) count by PCM providing a simple, cost effective and low risk technique in the diagnosis of glomerular diseases. Urine samples of 120 patients with haematuria and proteinuria were examined and the percentage of dysmorphic red cells and G1 cells were calculated. Cases were divided into two groups; group I (>20% dysmorphic red cells- glomerular group) and group II (≤20% dysmorphic red cells as non glomerular group). Renal histopathology was used as the gold standard method for the diagnosis of glomerulonephritis. Results from PCM showed a sensitivity of 92.7%, specificity 100% by the detection of dysmorphic red cell while by the detection of G1 cells, a sensitivity of 97.6% and specificity 100% were observed. The percentage of G1 cells is superior to counting dysmorphic red cells. The high sensitivity of phase contrast microscopy confirms its usefulness for the detection of dysmorphic red cells and G1 cells that can guide clinicians in the identification of the site of haematuria using non invasive tests.

Role of discrimination indices in differentiation of beta thalassaemia trait and iron deficiency anaemia

Iron deficiency anaemia (IDA) and beta thalassaemia trait (BTT) are the most common causes of microcytic hypochromic anaemias. Several discrimination indices have been introduced to discriminate quickly these similar entities via parameters obtained from automated cell counter. The purpose of the study was to evaluate the value of five discrimination indices in differentiation of BTT and IDA. This study consists of 57 cases of BTT and 72 cases of IDA. Five discrimination indices evaluated in this study for differentiation of BTT and IDA were red blood cell (RBC) count, red blood cell distribution width index (RDWI), Green & King Index (G & K), Mentzer index (MI) and England & Fraser (E & F) index. Sensitivity, specificity, positive and negative predictive values and Youden's index (YI) had been calculated. RBC count and RDWI appears to be reliable and useful index for the differentiation of BTT and IDA, as both of the indices had more than 80% sensitivity, specificity in differentiation of IDA and BTT. Patients with microcytic hypochromic anaemia could be easily screened out for BTT and IDA through these discrimination indices in the absence of other complicated diseases.

Radiative Heat Transfer Flow of Micropolar Fluid with Variable Heat Flux in a Porous Medium

A two-dimensional steady convective flow of a micropolar fluid past a vertical porous flat plate in the presence of radiation with variable heat flux has been analyzed numerically. Using Darcy-Forchheimer model the corresponding momentum, microrotation and energy equations have been solved numerically. The local similarity solutions for the flow, microrotation and heat transfer characteristics are illustrated graphically for various material parameters. The effects of the pertinent parameters on the local skin friction coefficient, plate couple stress and the heat transfer are also calculated. It was shown that large Darcy parameter leads to decrease the velocity while it increases the angular velocity as well as temperature of the micropolar fluids. The rate of heat transfer in weakly concentrated micropolar fluids is higher than strongly concentrated micropolar fluids.

Medical causes and histological pattern of glomerulonephritis

Glomerulonephritis (GN) is one of the commonest causes of chronic renal failure (CRF) and end stage renal failure (ESRF). The outcome largely depends on the underlying medical cause, clinical findings and histological appearance. 1188 patients were taken in this study. Of these, 980 had primary and 208 secondary GN. Commonest histological types of primary GN were mesangial proliferative glomerulonephritis (31%) and membranous nephropathy (21%). Among patients with secondary GN, predominant cause was lupus nephritis (76%) followed by poststreptococcal GN (18%). Clinically, nephrotic syndrome was present in 54%, hypertension in 39% and renal failure in 28%. But clinical pictures were variable among different histological types of GN.

Cytological grading of duct cell carcinoma, NOS of breast and its correlation with histological grading

Fine needle aspiration cytology is a widely practiced technique in the diagnosis of breast carcinoma and it is the only, diagnostic procedure performed before definitive treatment, at most institutions. While the histological grading of Duct Cell Carcinoma (DCC), NOS is done routinely in many centers worldwide the cytopathological grading of DCC, NOS is not commonly done. Grading of breast carcinoma, while the tumour is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of appropriate therapy for the patient. This study was undertaken with the aim to determine the grade of DCC, NOS by simple cytological scoring system as a method of predicting histological grade. We selected 80 cases of DCC, NOS which were initially diagnosed by Fine Needle Aspiration Cytology (FNAC) with subsequent histological confirmation. For cytological grading Papanicolou's stained smears and for histological grading Haematoxylin and Eosin stained sections were examined under light microscope. For histological grading Scraff Bloom Richardson's grading and for cytological grading Robinson's grading were followed. In both system grading were grade I, grade II and grade III of DCC, NOS. On cytological grading 39 (48.8%) cases were grade-I, 38 (47.5%) cases were grade-II and 3 (3.8%) cases were grade-III. On histological grading 33 (41.3%) cases were grade-I, 39 (48.8%) cases were grade-II and 8 (10%) cases were grade-III. In this study cytological grade correlated with histological grade in 69 (86.3%) cases. For grade-I tumour, sensitivity was 96.96%, efficiency was 94%. For grade-II tumour the sensitivity was 87.18% and efficiency was 77%. For grade-III tumour the sensitivity was 37.50% and efficiency was 23%. The overall accuracy was 96.3%. Significant association between histological and cytological grading of breast carcinoma, NOS was noted. Our observations in this study revealed that grading of duct cell carcinoma, NOS on FNAC material can be a useful in preoperative assessment of DCC, NOS prognosis and can be useful as an alternative to histological grading when neoadjuvant therapy is planned.

A comparison between glass/polyimide and titanium/polyimide microjoint performances in cerebrospinal fluid

Assessment of neural biocompatibility requires that materials be tested with exposure in neural fluids. Laser bonded microjoint samples made from Ti coated glass substrate and polyimide film (GPI) and titanium foil and polyimide film (TIPI) were evaluated for mechanical performance before and after exposure in artificial cerebrospinal fluid (CSF) for two, four, and 12 weeks at 37 degrees C. These samples represent a critical feature, i.e., the microjoint-a major weakness in the bioencapsulation system. Both material systems showed initial degradation up to 4 weeks which then stabilized afterwards and retained similar strength until 12 weeks. The TIPI system appears to exhibit better overall performance with less degradation compared to its as-received strength. The CSF exposed TIPI samples predominantly failed at the interface, while GPI samples had mixed glass and polyimide substrate and interface failure. The amount of glass failure decreases and interface failure increases with increase in CSF exposure time. The failure mechanism of the as-received (not exposed to CSF) GPI samples under tension was predominantly flexure type failure of the glass substrate.

Molecular identity, expression and functional analysis of interleukin-1alpha and its isoforms in rat testis

Interleukin-1alpha (IL-1alpha) is a proinflammatory cytokine that has also been found to act as a paracrine mediator involved in the regulation of testicular functions. The present review provides an overview of the role of IL-1alpha in testicular physiology. Bioactive IL-1alpha isolated from adult rat testis was found to consist of three distinct immunoreactive protein species with apparent sizes of 45, 24 and 19 kDa. These isoforms showed bioactivity in a thymocyte proliferation and steroidogenesis assays with different biopotencies. The background of the molecular heterogeneity and processing, secretion and regulation of the isoforms of testicular IL-1alpha are discussed. All three isoforms have been found to be secreted into the testis tubular lumen and interstitial space. We have provided evidence that IL-1alpha is a paracrine factor that may be of importance in, e.g., the regulation of Leydig cell steroidogenesis. Pathophysiologically, testicular IL-1alpha may contribute to testicular relapse of acute lymphocytic leukemia in boys.

The Paracrine Role Played by Interleukin-1α in the Testis

Interleukin-1alpha (IL-1alpha) plays an important role(s) in the regulation of immune and inflammatory responses. The testis is an immunologically privileged organ and the variety of effects exerted by IL-1alpha on this organ have yet to be explored in detail. The aim of the present review is to describe our current view of the paracrine role played by IL-1alpha in testicular physiology. Testicular IL-1alpha is expressed during development, primarily in Sertoli cells, appearing in rats for the first time 20 days after birth. This cytokine is microheterogeneous, consisting of three molecular species with molecular weights of 45, 24 and 17 KDa. The 17 KDa form represents mature IL-1alpha, while the 24-KDa IL-1alpha has been shown by our research group to be an alternately spliced form of the 45-KDa pro-IL-1alpha. IL-1alpha was observed to stimulate the proliferation of immature Sertoli cells with higher efficacy than FSH. IL-1alpha was also found to exert mitogenic effects both on isolated peritubular cells and germ cells. Furthermore, isoforms of IL-1alpha were seen to stimulate basal testosterone production in immature Leydig cells, but not in the corresponding adult cells. This effect involved induction of the steroidogenic acute regulatory (StAR) protein and positively regulation by p38 MAPK. Recently, we have observed positive interactions between IL-1alpha and hormones of the GH/IGF-I system that lead to enhanced androgen production by the Leydig cell. In conclusion, our findings suggest that isoforms of IL-1alpha may serve as paracrine mediators, alone or in concert with other factors, that support proper testicular cell functioning and, thereby, reproduction and fertility.

Determination of alpha-1 antitrypsin genetic deficiency in duodenal ulcer by polymerase chain reaction

OBJECTIVE

To confirm alpha-1-AT deficiency status in duodenal ulcer using a combination of PCR and restricted enzyme digestion.

METHODS

Fifty patients with endoscopically proven duodenal ulcer and hundred controls with no signs of the disease were included. Alpha-1-AT phenotypes were confirmed by polymerase chain reaction followed by restriction enzyme digestion.

RESULTS

Alpha-1-AT concentration in duodenal ulcer patients showed a mean value of 2.12 +/- 0.11 g/l (range: 0.52-3.95 g/l, p < 0.05). In controls this was 2.47 +/- 0.08 g/l (range: 0.52-5.0 g/l). Among the controls 70% had the MM phenotype, 28% M1 M2 and 2% FM. In duodenal ulcer, MM predominates (70%), followed by M1 M2 (18%), SS (4%), SZ (4%), ZZ (2%) and MZ (2%).

CONCLUSION

Alpha-1 AT deficiency was found in 10% of duodenal ulcer patients. DNA analysis more accurately resolved the phenotypes as S and Z mutations.

Age-dependent stimulation of Leydig cell steroidogenesis by interleukin-1 isoforms

Different isoforms of testicular interleukin-1 (IL-1) were analysed to determine whether there were differences in the ability to modulate rat Leydig cell steroidogenesis in vitro. Rat 17K IL-1alpha and IL-1beta, 32K IL-1alpha precursor (32proIL-1alpha) and a 24K splice variant (24proIL-1alpha) stimulated testosterone production by Leydig cells from 40- but not 80-day-old rats. The potency of the isoforms was IL-1alpha>IL-1beta>32proIL-1alpha>24proIL-1alpha, IL-1alpha being 50-fold more potent than IL-1beta. IL-1 receptor antagonist reversed the effects and IL-1 receptor type I mRNA was expressed by the responding Leydig cells, indicating a receptor mediated action. Inhibition of PKA and Ca(2+) channels abolished IL-1-induced steroidogenesis, while inhibition of PKC had no significant effect. Except for 24proIL-1alpha which was stimulatory, all IL-1 isoforms suppressed hCG-driven testosterone production. This inhibitory effect was abolished by androstendione, suggesting that P450c17 was suppressed by IL-1. Our results indicate that IL-1 plays a paracrine role in the regulation of Leydig cell steroidogenesis.

Constitutive production of interleukin-1alpha mRNA and protein in the developing rat testis

Interleukin-1 (IL-1), a multifunctional cytokine produced mainly by activated macrophages, is also produced in the intact testis. Rat testicular IL-1 was found to be identical to IL-1alpha, judged by immunoneutralization of the bioactive protein and sequence comparison of cloned rat testicular and macrophage pro-IL-1alpha cDNA. Testicular IL-1alpha mRNA was first demonstrated on postnatal day 15, and the corresponding bioactive protein from day 20. IL-1alpha mRNA was still low on day 20, but then increased rapidly in parallel with the bioactive protein to establish a plateau level from day 25. In adult testes, IL-1alpha mRNA and immunoreactive protein were low in stage VII of the seminiferous epithelial cycle, whereas other stages showed a clearly detectable expression. In the adult testis, the concentration of IL-1alpha was 75 pg/mg testicular protein (approximately 200 pM). In conclusion, production of testicular IL-1alpha is developmentally and stage-dependently regulated, probably at the transcriptional level, emphasizing an important paracrine role in testicular function.

Molecular cloning and expression of a functionally different alternative splice variant of prointerleukin-1alpha from the rat testis

We report here the characterization of an alternative splice variant of prointerleukin-1alpha (proIL-1alpha), constitutively expressed by the normal adult rat testis. In addition to the classical 32K proIL-1alpha (32proIL-1alpha) messenger RNA, the testis produced a shorter variant encoding a putative protein of 24K (24proIL-1alpha). In situ hybridization demonstrated constitutive expression of the splice transcript in the seminiferous tubules. This alternative complementary DNA lacked the fifth exon, harboring the calpain cleavage site essential for generation of mature 17K IL-1alpha. This was verified by calpain treatment, producing the expected cleavage products of recombinant 32proIL-1alpha, but not of 24proIL-1alpha. Similarly, expression in COS-7 cells demonstrated processing of 32proIL-1alpha to the mature 17K form and secretion, whereas 24proIL-1alpha remained unprocessed. Both 32proIL-1alpha and 24proIL-1alpha showed a dose-dependent stimulatory effect in a thymocyte proliferation assay, although at lower potency than mature 17K IL-1alpha. In contrast, when tested on hCG-stimulated Leydig cells in vitro, a dose-dependent inhibition of testosterone production was obtained with mature 17K IL-1alpha and at a lower potency with 32proIL-1alpha, whereas 24proIL-1alpha was inactive. In conclusion, the three IL-1 bioactive proteins described here contribute to IL-1 protein heterogeneity and may serve as constitutive paracrine mediators in the testis.

The interleukin-1 system in the testis

The interleukin-1 (IL-1) family consists of two agonist proteins, IL-1 alpha and IL-1 beta, and one antagonist, IL-1 receptor antagonist (IL-1ra), which blocks the action of the agonists by binding and competing at the IL-1 receptor level. IL-1 beta and to a lesser extent IL-1 alpha were originally described as rapidly inducible proinflammatory cytokines released by activated macrophages. However, IL-1 alpha has been found to be constitutively produced by certain tissues, and noninflammatory functions have been proposed for this protein, although they have not yet been well elucidated. Consistent with this suggestion, we previously showed that the intact rat testis constitutively produces large amounts of IL-1 alpha at both the mRNA and protein levels. The expression of IL-1 alpha was found to be confined to Sertoli cells, with evidence of a developmental as well as a stage-dependent production pattern. In more recent studies, we have found indications that the testis can also initiate production of IL-1 beta upon stimulation with inflammatory inducers such as endotoxin. Further, we have detected constitutive testicular expression of IL-1ra, opening up the possibility that IL-1 action in the testis may be specifically regulated by paracrine mechanisms. Recent data have demonstrated that the testis can produce more than one isoform of IL-1 alpha with indications of both post-transcriptional and post-translational modifications, resulting in at least three distinct bio- and immunoreactive IL-1 alpha proteins. We conclude that all three classical IL-1 ligands and novel IL-1 alpha isoforms are present in the testis and may serve as paracrine mediators under physiological or pathophysiological conditions. The function of this testicular IL-1 agonist-antagonist network is a current focus of investigation.

Proteins in renal stones and urine of stone formers

Knowledge of the essential characteristics of macromolecules constituting the organic matrix of the nidus of urinary stones is required to understand the mechanism of urolithogenesis. The aim of this study was to isolate and characterise those stone nidus proteins. Using an extraction buffer containing SDS and beta-mercaptoethanol, we were able to overcome known problems of protein isolation from urinary stone matrix. These proteins were characterised by a strong tendency to aggregate under reducing and denaturing conditions. On SDS-PAGE, their molecular weights range from < or = 12 to 66 kDa. Antisera raised against stone matrix proteins showed a cross-reactivity between proteins isolated from different stones irrespective of their origin or mineral composition. Moreover, urinary proteins from stone formers also cross-reacted with these whereas there was no reaction with urinary proteins of non-stone formers. Western blotting confirmed these findings. Given the above summarised properties, it can be safely concluded that these proteins are prevalent in urines of stone formers, that they are selectively incorporated into renal stones of all aetiologies, and that they most likely have a role in nidus and, therefore, early stone formation.