Impact of Magnetic Resonance Imaging in the Diagnosis of Pituitary Adenoma

Pituitary adenoma is the third most common primary intracranial neoplasm involving the adult population with clinical features due to excess or deficient hormone secretion or due to its mass effect. Debate about the diagnostic accuracy, sensitivity and specificity of MRI imaging in detecting pituitary adenoma has been continuing. The study was aimed to evaluate the accuracy, sensitivity and specificity of MR imaging in detecting pituitary adenoma. This cross sectional study was conducted in the Department of Radiology and imaging, Bangabandhu Sheikh Mujib medical University (BSMMU) from July 2013 to August 2015. It was carried out in 50 pituitary adenoma cases of which, 28 male and 22 female to see the impact of MRI in the diagnosis of pituitary of adenoma. Out of 50 cases 43 cases were diagnosed by MRI, 3 were normal and 2 were pituitary apoplexy, one was immature teratoma as confirmed through histopathology. So, MRI has got major impact in the diagnosis of pituitary adenoma.

Non-linear optical microscopy as a novel quantitative and label-free imaging modality to improve the assessment of tissue-engineered cartilage

OBJECTIVE

Current systems to evaluate outcomes from tissue-engineered cartilage (TEC) are sub-optimal. The main purpose of our study was to demonstrate the use of second harmonic generation (SHG) microscopy as a novel quantitative approach to assess collagen deposition in laboratory made cartilage constructs.

METHODS

Scaffold-free cartilage constructs were obtained by condensation of in vitro expanded Hoffa's fat pad derived stromal cells (HFPSCs), incubated in the presence or absence of chondrogenic growth factors (GF) during a period of 21 d. Cartilage-like features in constructs were assessed by Alcian blue staining, transmission electron microscopy (TEM), SHG and two-photon excited fluorescence microscopy. A new scoring system, using second harmonic generation microscopy (SHGM) index for collagen density and distribution, was adapted to the existing "Bern score" in order to evaluate in vitro TEC.

RESULTS

Spheroids with GF gave a relative high Bern score value due to appropriate cell morphology, cell density, tissue-like features and proteoglycan content, whereas spheroids without GF did not. However, both TEM and SHGM revealed striking differences between the collagen framework in the spheroids and native cartilage. Spheroids required a four-fold increase in laser power to visualize the collagen matrix by SHGM compared to native cartilage. Additionally, collagen distribution, determined as the area of tissue generating SHG signal, was higher in spheroids with GF than without GF, but lower than in native cartilage.

CONCLUSION

SHG represents a reliable quantitative approach to assess collagen deposition in laboratory engineered cartilage, and may be applied to improve currently established scoring systems.

Multimodality Treatment Outcome of Hepatoblastoma in a Resource Limited Country

Our objective is to review the records of management of hepatoblastoma (HB) at the Paediatric Haematology and Oncology (PHO) department in the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2004 to December 2012. This is a retrospective study of clinical, radiological and pathological data of hepatoblastoma patients treated at our institution. Thirteen patients were treated for HB between 2004 and 2012. The records of clinical presentations, chemotherapy tolerance and response, surgical procedure undertaken, and complications were analyzed. Median age of the study population was 12 months (3-60 months) and male: female was 3.3:1. Nine patients were treated with neoadjuvant chemotherapy consists of cisplatin and adriamycin. Primary surgery was done in four patients. Extent of hepatic resection in the operated patients varied. Mixed type was the predominant histopathological diagnosis. Adjuvant chemotherapy was well tolerated with no morbidity or mortality. Five-year event-free survival (EFS) and overall survival (OS) of all the 13 patients is 76.9%. All the nine patients who could complete multimodality treatment are alive with no evidence of disease or complications with median follow-up of 63 months (46-122 months). Treatment of HB with multidisciplinary approach was well tolerated. OS and EFS of patients were comparable with published studies.

Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition

Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.

Overweight and obesity among children and adolescents in Bangladesh: a systematic review and meta-analysis

OBJECTIVES

The increasing prevalence of overweight and obesity among children (0-12 years) and adolescents (13-19 years) has emerged as a major public health threat in Bangladesh. Unfortunately, there is a serious paucity of credible data on these issues that can be used for policy and programmatic development. This article presents a systematic review of studies on overweight and obesity to present a more accurate estimate by pooling results.

STUDY DESIGN

Systematic review.

METHODS

The study systematically reviewed relevant literature published between 1998 and 2015 using predefined inclusion/exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to identify relevant studies. Measures of heterogeneity and variability were calculated, and a random effect model was used to report pooled prevalence rates of overweight and obesity.

RESULTS

The findings show that prevalence rates of overweight and obesity among children and adolescents varied widely from 1.0% to 20.6% and 0.3% to 25.6%, respectively. The pooled prevalence rates of overweight and obesity were 7.0% (95% confidence interval [CI] 5.0-10.0) and 6.0% (95% CI 4.0-8.0), respectively. The pooled prevalence rate of overweight increased substantially over the years, from 3.6% during 1998-2003 (95% CI 0.3-29.2) to 5.7% during 2004-2009 (95% CI 0.8-30.2) and 7.9% by 2010-2015 (95% CI 5.1-12.1). However, the pooled prevalence rate of obesity registered a sharp decline between 1998-2003 and 2004-2009 - from 9.7% (95% CI 5.7-16.2) to 2.0% (95% CI 0.3-11.1) - and subsequently increased significantly to 9.0% by 2010-2015 (95% CI 5.3-14.6).

CONCLUSIONS

This review identified increasing trends in the prevalence of overweight and obesity among children and adolescents in Bangladesh. This study underscores the urgent need to promote healthy lifestyles among children and adolescents with a view to effectively address the increasing problem of overweight and obesity. This would also help to prevent the development of chronic non-communicable diseases in adulthood.

Incidence of Hyperglycemia during Induction of Remission Phase of Pediatric Acute Lymphoblastic Leukemia

Hyperglycemia is frequently associated with acute lymphoblastic leukemia (ALL) therapy. It has long been recognized as a consequence of corticosteroids and asparaginase. These medications are usually administrated concurrently in high doses during the initial induction phase of chemotherapy. As a result, hyperglycemia frequently develops during this phase, with resolution after the steroids and asparaginase have been discontinued or reduced in dose. Various recent studies have evaluated the incidence of hyperglycemia in this particular group of patients and its relationship with chemotherapy. However the incidence of hyperglycemia during induction of remission therapy in children with ALL is not known, and is the subject of this study. To determine the incidence as well as identification of day of onset and duration of hyperglycemia and other complications during induction of remission therapy. This prospective cross-sectional study included 50 newly diagnosed patients aged 1-15 years and was done from December 2010 to May 2011 in the department of Pediatric Haemato Oncology, Bangabandhu Sheikh Mujib Medical University, Bangladesh. Hyperglycemia was defined as ≥2 random glucose determinations of ≥200mg/dl during the first 28 days of induction chemotherapy. Out of 50 patients, 4(8%) patients developed hyperglycemia during remission induction therapy. No significant difference was found between two groups regarding age distribution (p>0.05) and body weight (p>0.05). Among patients who developed hyperglycemia 3 patients (75%) and 1 patient (25%) experienced hyperglycemia during second week and third week of induction therapy respectively. Hyperglycemia persists <7 days in case of 3(75%) patients and >7 days in case of 1(25%) patients. The incidence of chemotherapy induced hyperglycemia in this present study is 8%. Most patients who develop therapy induced hyperglycemia recover when L-asparaginase and corticosteroids are discontinued and they suffer no long term adverse effects.

Rice Vision for Bangladesh: 2050 and Beyond

CORRECTION: Due to a number of formatting and layout issues, the PDF of this paper was replaced on 10th October 2016.Combined efforts of farmers, rice scientists, extension personnel and Government of Bangladesh have yielded clean rice growth rate of 0.34 million ton (MT) year-1 during 2009-10 to 2013-14 in the country. In 2014-15, the country acquired a rice surplus of about 2 MT. However, maintaining the current surplus of rice in the coming decades is a great challenge. Authentic estimation of future rice requirement and future resource availability would guide to way forward. This paper presents rice vision for Bangladesh leading to 2050 and beyond. In this study, secondary data from different government-owned statistics and research institutes were collected, analyzed and synthesized to develop models and/or model parameters to generate outputs such as future population, rice production and rice requirement. Population of Bangladesh will reach 215.4 million in 2050, when 44.6 MT of clean rice will be required. With the pace of rice-production-increase in the last five years, production can reach 47.2 MT, having a surplus of 2.6 MT in 2050. The study sets 2.6 MT as the target for clean rice surplus every year leading to 2050 and beyond. Several hurdles, such as increasing population, decreasing resources and increasing climate vulnerability, can hinder achieving the target. Three major interventions?accelerating genetic gain, minimizing yield gap and curtailing adoption lag?are proposed to break the barriers to achieve the target. Major challenges to implement the interventions include shrinking net cropped area, decreasing availability of irrigation water and increasing pressure on soil fertility. Smart technology such as, location specific variety, profitable cropping sequences, innovative cultural management, and mechanization coupled with smart dissemination using multiple means would ease production barriers. We recommend a number of measures, such as, guaranteeing a minimum cropped area, accelerating the rate of genetic gain in varietal development and intensifying collaboration among the stakeholders to reduce adoption lag of newly released promising rice varieties, to achieve the rice vision of Bangladesh leading to 2050 and beyond.Bangladesh Rice j. 2015, 19(2): 1-18

Mesenchymal stromal cells from human umbilical cords display poor chondrogenic potential in scaffold-free three dimensional cultures

Many researchers world over are currently investigating the suitability of stromal cells harvested from foetal tissues for allogeneic cell transplantation therapies or for tissue engineering purposes. In this study, we have investigated the chondrogenic potential of mesenchymal stromal cells (MSCs) isolated from whole sections of human umbilical cord or mixed cord (UCSCs-MC), and compared them with cells isolated from synovial membrane (SMSCs), Hoffa's fat pad (HFPSCs) and cartilage. All MSCs were positive for surface markers including CD73, CD90, CD105, CD44, CD146 and CD166, but negative for CD11b, CD19, CD34, CD45 and HLA-DR in addition to CD106 and CD271. Chondrogenic potential of all cell sources was studied using 3D pellet cultures incubated in the presence of different combinations of anabolic substances such as dexamethasone, IGF-1, TGF-β1, TGF-β3, BMP-2 and BMP-7. BMP-2 and dexamethasone in combination with TGF-β1 or TGF-β3 excelled at inducing chondrogenesis on SMSCs, HFPSCs and chondrocytes, as measured by glycosaminoglycans and collagen type II staining of pellets, quantitative glycosaminoglycan expression, quantitative PCR of cartilage signature genes and electron microscopy. In contrast, none of the tested growth factor combinations was sufficient to induce chondrogenesis on UCSCs-MC. Moreover, incubation of UCSCs-MC spheroids in the presence of cartilage pieces or synovial cells in co-cultures did not aid chondrogenic induction. In summary, we show that in comparison with MSCs harvested from adult joint tissues, UCSCs-MC display poor chondrogenic abilities. This observation should alert researchers at the time of considering UCSCs-MC as cartilage forming cells in tissue engineering or repair strategies.

Increasing prevalence of diabetes in Bangladesh: a scoping review

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly in Bangladesh. However, studies documenting the increasing trend of diabetes prevalence are scarce. The aim of this study was to conduct a scoping review of published literature to ascertain the changing patterns of diabetes prevalence in Bangladesh.

METHODOLOGY

We conducted a scoping review based on York scoping reviews framework and performed a comprehensive search of published literature through Medline, BanglaJOL, and Google Scholar published between 1994 and 2013. We summarised and calculated the time trends and pooled prevalence for type 2 diabetes among adults (≥18 years) in both urban and rural areas in Bangladesh.

RESULTS

Of 152 studies identified, we included 22 studies for the scoping review which met the inclusion criteria. Overall, 11 studies (50%) were conducted in rural areas, eight in urban (36%) and three (14%) in semi-urban, semi-rural and tribal areas. The overall prevalence of type 2 diabetes ranged between 4.5% and 35.0%. The final estimate of diabetes prevalence obtained after pooling of data from individual studies among 51,252 participants was 7.4% (95% CI 7.2-7.7%). The prevalence of diabetes was higher in males compared to females in urban areas and vice-versa in rural areas. Analyses of exponential trend revealed an increasing trend of diabetes prevalence among urban and rural population at a rate of 0.05% (R = 0.18) and 0.06% (R = 0.35) per year, respectively.

CONCLUSION

The prevalence of type 2 diabetes showed an increasing trend in both urban and rural population in Bangladesh. Our findings suggest the need for an all-out effort by the government and stakeholders to implement preventive strategies for diabetes in Bangladesh.

Efficiency of the Clinical Veterinary Diagnostic Practices and Drug Choices for Infectious Diseases in Livestock in Bangladesh

As in most low-income countries, adequate laboratory facilities are not available in Bangladesh to assist veterinarians in diagnosing animal diseases. We aimed to determine the efficiency of veterinary diagnoses for two common ruminant diseases in Bangladesh: Peste des petits ruminants (PPR) and foot-and-mouth disease (FMD). We conducted the study from May 2009 to August 2010 in three government veterinary hospitals where veterinarians collected samples from sick livestock and recorded the presumptive diagnosis on the basis of clinical presentations. Samples were tested for PPR and FMD using real-time RT-PCR. We estimated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the presumptive diagnoses when compared to laboratory tests. We tested 539 goats for PPR and 340 cattle and goats for FMD. Our results indicate that the veterinarians' presumptive diagnoses were different from laboratory findings for both PPR (P < 0.05) and FMD (P < 0.05). The overall sensitivity of the presumptive clinical diagnoses was 54% (95% CI: 47-61%) while specificity was 81% (95% CI: 78-84%) compared to real-time RT-PCR tests. The kappa value obtained in our validation process for PPR (kappa: 0.25) and FMD (kappa 0.36) indicated a poor performance of the presumptive diagnoses. Most of the animals (93%) were treated with antibiotics. Our findings indicate that veterinarians can detect animals not infected with FMD or PPR but miss the true cases. The clinical competency of these veterinarians needs to be improved and access to laboratory diagnostic facilities could help veterinarians to improve the diagnostics and outcomes. The rational use of antibiotics by veterinarians in animals must be ensured.

Facilitating Frailty Identification: Comparison of Two Methods among Community-Dwelling Order Adults

BACKGROUND

Frailty is characterized by increased vulnerability for adverse events such as falls, fractures, placement, and death. Several frailty models have been developed, including the widely accepted Frailty Phenotype. However, the Frailty Phenotype can be difficult to apply in clinical practice. Alternatively, the Clinical Frailty Scale has been proposed based on its simplicity. To date, the Clinical Frailty Scale has not been validated against the Frailty Phenotype.

OBJECTIVE

We aimed to test the inter-rater reliability of the Clinical Frailty Scale and its agreement with the Frailty Phenotype in frailty identification.

DESIGN

Cross-sectional study.

SETTING

Retirement community in London, Ontario, Canada.

PARTICIPANTS

One hundred and four community-dwelling older adults (age ≥75 years).

MEASUREMENTS

Participants were first classified using the Frailty Phenotype criteria as not frail, pre-frail or frail. Subsequently, two clinicians blinded to the first assessment, determined frailty status using the Clinical Frailty Scale. Differences between assessments were resolved by consensus. Inter-rater reliability was assessed using kappa statistics. Spearman Rho correlation coefficients evaluated the concurrent validity of the Clinical Frailty Scale against Frailty Phenotype components.

RESULTS

Analysis with kappa statistic showed substantial agreement between raters in applying the Clinical Frailty Scale to the sample (κw= 0.76, 95% CI 0.68, 0.84). The Clinical Frailty Scale scores also positively correlated with an increasing number of Frailty Phenotype components (ρ=0.69, p<0.01).

CONCLUSION

The Clinical Frailty Scale is reliable and comparable to the Frailty Phenotype in identifying frailty in community-dwelling older adults with the advantage of being easy to administer in clinical settings. Reliable tools to identify frailty in community-dwelling older adults may help provide timely interventions to ameliorate risk of adverse events.

Oral epithelial cells and their interactions with HIV-1

As the AIDS pandemic has continued, our understanding of the events that occur during the entry and infection of conventional, susceptible cells has increased dramatically, leading to the development of control therapies for HIV-infected individuals. However, an ongoing hole in our understanding is how HIV crosses the mucosal barriers to gain access to permissive cells, despite how important this information would be in developing successful vaccines and other preventative measures such as topical anti-HIV microbicides. In particular, our knowledge of the role that epithelial cells of the mucosal surfaces play in infection - both during early phases and throughout the life of an infected individual, is currently hazy at best. However, several studies in recent years suggest that HIV can bind to and traverse these mucosal epithelial cells, providing a reservoir of infection that can subsequently infect underlying permissive cells. Despite this interaction with epithelial cells, evidence suggests HIV-1 does not productively infect these cells, although they are capable of transferring surface-bound and transcytosed virus to other, permissive cells. Further, there appear to be key differences between adult and infant epithelial cells in the degree to which HIV can transcytose and infect the epithelium. Thus, it is clear that, whilst not primary targets for infection and virus replication, epithelial cells play an important role in the infection cycle and improving our understanding of their interactions with HIV could potentially provide key insights necessary to develop effective preventative therapies.

Treatment referral system for tuberculosis patients in Dhaka, Bangladesh

OBJECTIVE

To evaluate the referral system in an urban DOTS-based programme in Dhaka, Bangladesh, including the peri-urban area, and to identify opportunities to strengthen the system.

DESIGN

This was a retrospective cohort study in which diagnosed tuberculosis (TB) patients and health providers from DOTS centres were interviewed. Research tools included pre-tested structured questionnaires and the TB patients' referral records.

RESULTS

Of 4974 TB patients who were referred to the different treatment centres, only 1756 (35%) of the counterfoils of the referral slips were returned. Of 250 patients randomly selected for interview, 165 reported to a DOTS centre, 69 did not and 16 could not be traced. Variations in educational qualification, residence and the identification of DOTS centres after counselling were statistically significant (P < 0.05). Lower monthly income (RR = 7.84, RR = 5.03), distance from the centre (RR = 36.21) and those receiving treatment from pharmacies (RR = 3) or non-governmental organisations (RR = 28.48) have more risk of irregular treatment.

CONCLUSION

A high proportion of referred patients were registered and initiated treatment, but many did not report to the referral treatment centre. Proper counselling and taking into account the patients' preferences during referral are essential to address access barriers to treatment adherence and improved treatment outcome.

Anti-tuberculosis drug resistance in Bangladesh: reflections from the first nationwide survey

OBJECTIVE

To determine the prevalence of tuberculosis (TB) drug resistance in Bangladesh.

DESIGN

Weighted cluster sampling among smear-positive cases, and standard culture and drug susceptibility testing on solid medium were used.

RESULTS

Of 1480 patients enrolled during 2011, 12 falsified multidrug-resistant TB (MDR-TB) patients were excluded. Analysis included 1340 cases (90.5% of those enrolled) with valid results and known treatment antecedents. Of 1049 new cases, 12.3% (95%CI 9.3-16.1) had strains resistant to any of the first-line drugs tested, and 1.4% (95%CI 0.7-2.5) were MDR-TB. Among the 291 previously treated cases, this was respectively 43.2% (95%CI 37.1-49.5) and 28.5% (95%CI 23.5-34.1). History of previous anti-tuberculosis treatment was the only predictive factor for first-line drug resistance (OR 34.9). Among the MDR-TB patients, 19.2% (95%CI 11.3-30.5; exclusively previously treated) also showed resistance to ofloxacin. Resistance to kanamycin was not detected.

CONCLUSION

Although MDR-TB prevalence was relatively low, transmission of MDR-TB may be increasing in Bangladesh. MDR-TB with fluoroquinolone resistance is rapidly rising. Integrating the private sector should be made high priority given the excessive proportion of MDR-TB retreatment cases in large cities. TB control programmes and donors should avoid applying undue pressure towards meeting global targets, which can lead to corruption of data even in national surveys.

A Comparative Study between FNAC and Histopathology in Diagnosis of Breast Lump

Worldwide a large number of patients have been suffering from breast lump and this trend is gradually increasing. It is difficult to determine whether a lump is benign or malignant from clinical assessment. Thus the need for microscopic tissue analysis arises. This study was designed to determine the value of fine needle aspiration cytology in the diagnosis of breast lumps and to compare the result of FNAC with histopathological diagnosis to assess its accuracy. A prospective study in the period of January 2009 to December 2010 was done. One hundred and ten (110) patients who came to the Department of Surgery in Mymensingh Medical College Hospital, Bangladesh in two years for their palpable breast masses were chosen for the study. There were 70(63.63%) benign, 33(30.00%) malignant and 07(6.36%) suspicious smears in FNAC. Inadequate samples were repeated. The number of repeats increased the diagnostic accuracy of aspirates which is statistically significant when compared with histopathology. In histopathology Invasive ductal carcinoma was the most commonly reported lesion with maximum incidence in the 4th, 5th, and 6th decades followed by invasive lobular carcinoma and other malignant lesions. FNAC serves as a rapid, economical and reliable tool for the diagnosis of palpable breast lesions and its reliability is influenced by the skillness of the aspirator. So physician should use this tool with clinical experience.