Histological and Cytological Correlation of Cervical Cancer and Precancerous Lesions in a Tertiary Hospital in Bangladesh

Over 500,000 new cases of cervical cancer are diagnosed each year in the world, resulting in 250000 deaths. Prevalence of HPV-related cervical carcinoma in Bangladesh is highest among SAARC countries. In Bangladesh very few studies have been published on establishing the correlation between histological and cytological findings on cervical cancer and precancerous lesions. This descriptive cross-sectional study was performed to find out the correlation between histological & cytological findings of cervical cancer and precancerous lesions. In the present study, cervical smears were collected from the selected patients attending the colposcopy clinic of BSMMU from July 2011 to April 2013. Biopsy was done on colposcopically positive cases and histopathological reports were obtained. Thus 99 histologically proven cases of cervical cancer and precancerous lesion were selected. Pap smear was carried out on these 99 samples after histopathological examination. Among the 60 CIN-1 cases in histology, 18(30%) cases were diagnosed positive by Pap smear; out of 20 histologically diagnosed cases of CIN-II, only 12(60%) cases were correctly diagnosed by cytology. But in case of invasive squamous cell carcinoma 18 out of 19 were correctly diagnosed by Pap smear reaching a concordance rate of 94.74%. Overall the relation reached statistical significance (p<0.05). Larger community based studies are required in this respect to find a consistent correlation between hr-HPV load and cervical cancer and precancerous lesions.

Spin echo transverse relaxation and atrophy in multiple sclerosis deep gray matter: A two-year longitudinal study

Background:

Deep gray matter (DGM) is affected in relapsing–remitting multiple sclerosis (RRMS) and may be studied using short-term longitudinal MRI.

Objective:

To investigate two-year changes in spin-echo transverse relaxation rate (R2) and atrophy in DGM, and its relationship with disease severity in RRMS patients.

Methods:

Twenty six RRMS patients and 26 matched controls were imaged at 4.7 T. Multiecho spin-echo R2 maps and atrophy measurements were obtained in DGM at baseline and two-year follow-up. Differences between MRI measures and correlations to disease severity were examined.

Results:

After two years, mean R2 values in the globus pallidus and pulvinar increased by ~4% ( p<0.001) in patients and <1.7% in controls. Two-year changes in R2 showed significant correlation to disease severity in the globus pallidus, pulvinar, substantia nigra, and thalamus. Multiple regression of the two-year R2 difference using these four DGM structures as variables, yielded high correlation with disease severity ( r=0.83, p<0.001). Two-year changes in volume and R2 showed significant correlation only for the globus pallidus in multiple sclerosis (MS) ( p<0.05).

Conclusions:

Two-year difference R2 measurements in DGM correlate to disease severity in MS. R2 mapping and atrophy measurements over two years can be used to identify changes in DGM in MS.

ID: 96: CINOBUFOTALIN AS A NOVEL AGENT TO INHIBIT IN-VITRO EPITHELIAL OVARIAN CANCER CELL PROLIFERATION, MIGRATION AND INVASION

Objective

Cinobufotalin (CINO), a cardiotonic steroid (CTS) or bufadienolide, is extracted from the skin secretions of giant toads and is utilized in traditional Chinese medicine (Chan Su). CINO has been used as a cardiotonic, diuretic and a hemostatic agent. Our lab is familiar with CINO and has shown it to inhibit cytotrophoblast cells function. Recently, it has been shown that CINO also inhibits the lung cancer cell function, and has been further implicated in other disease processes. In the present study, we propose to pursue this potential application of CINO using ovarian tumor cell line SK-OV-3.

Study Design

We evaluated the in-vitro effect of CINO on ovarian cancer cell line SK-OV-3. Cells were treated with 0.1, 1, 5, and 10 µM CINO. Cell proliferation was measured using a CellTiter Assay (Promega), which is a colorimetric method for determining the number of viable cells. Cell migration was measured using a CytoSelect Assay (Cell Biolabs). Cell invasion was measured using a FluoroBlok Assay (BD). Cell viability was measure using a CellTiter Assay (Promega). Cell cycle progression was evaluated by a Cell Cycle Phase Determination Kit (Cayman Chemical) and apoptosis was evaluated by an Apoptotic Blebs Assay Kit (Cayman Chemical). Cell cycle arrest and apoptotic signaling was determined by fluorescence-activated cell sorting (FACS) analysis.

Results

CINO at ≥0.5 µM inhibited SKOV-3 cell proliferation, migration, and invasion (p<0.05). There was a higher (p<0.05) percentage of S phase cells in groups treated with CINO at 0.5 µM. CINO at ≥0.5 µM down regulated expression of PCNA and caused cell death.

Conclusion

This data demonstrates that CINO impairs SK-OV-3 cell function via cell cycle arrest and apoptotic signaling. These findings demonstrate the complex nature of this compound. Not only is CINO directly modulating the actions of the Na/K ATPase through classic mechanism of cardiotonic steroids, but is also directly influencing the nuclear expression of proteins involved in cell cycle progression and DNA repair. Additional investigational studies looking into the molecular pathways involved in altering cell cycle and entry into apoptosis are warranted.

In conclusion, we have shown CINO to impair SK-OV3 cell function via cell cycle arrest and apoptotic signaling and suggest that CINO might be further investigated as a novel anti-ovarian cancer agent.

ID: 71: PRAVASTATIN PROTECTS A SW-71 CYTOTROPHOBLAST CELL LINE FROM A HYPERGLYCEMIA-INDUCED PREECLAMPSIA PHENOTYPE

Objective

An increasing level of evidence supports the utility of pravastatin as prevention against preeclampsia (preE). We previously demonstrated a hyperglycemia induced cytotrophoblast (CTBs) dysfunction characteristic of a preE-like phenotype and sought to demonstrate the utility of pravastatin in rescuing CTBs from this hyperglycemia induced dysfunction.

Methods

Human CTBs were treated with 100, 150, 200, 300, or 400 mg/dL glucose for 48 hrs. Cells were treated with pravastatin (1 ug/mL) either alongside or 2 hrs prior to glucose exposure. Some cells were treated with D-Mannitol as a negative control for glucose exposure. Cell migration was performed by Matrigel migration assay kit according to manufacturer protocol. Cell lysates were utilized to evaluate the mRNA expression of urokinase plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1), while also assessing proliferating cell nuclear antigen (PCNA) and p38 MAPK phosphorylation by western blot. Levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), soluble endoglin (sEng) and interleukin 6 (IL-6) were measured in culture media using ELISA kits. Statistical comparisons were performed using analysis of variance with Duncan's post hoc test.

Results

Hyperglycemia inhibited CTBs migration by down-regulating uPA, PAI-1, PCNA and up-regulating p38 phosphorylation in cells treated with >150 mg/dL glucose compared to basal (100 mg/dL) (*p<0.05 for each). Secretion of sFlt-1, sEng and IL-6 were increased while VEGF and PIGF were decreased in CTBs treated ≥150 mg/dl of glucose (*p<0.05 for each). Both pravastatin pretreatment and co-treatment significantly rescued CTBs migration, up-regulating uPA, PAI-1, PCNA, down-regulating p38 phosphorylation, and correcting the angiogenic profile of CTBs (p<0.05 for each). D-Mannitol showed no osmotic effect on CTBs.

Conclusions

Pravastatin mitigates the hyperglycemia-induced dysfunction of CTBs by attenuating the glucose-induced anti-proliferative, anti-migratory, anti-invasive and anti-angiogenic phenotype similar to that seen in Preeclampsia. This study supports the potential for pravastatin use on CTBs development early in pregnancy and the importance of continuing research of pravastatin in preE prevention.

ID: 69: MARINOBUFAGENIN-INDUCED ANTI-ANGIOGENIC MILIEU IN CYTOTROPHOBLASTS IS ATTENUATED BY NOVEL ANTI-MBG ANTIBODIES

Preeclampsia (PreE) is a hypertensive pregnancy disorder, which occurs in approximately 10% of all gestations. Recently, a digitalis-like factor, marinobufagenin (MBG) has been implicated as a causative factor in preE. We demonstrated that MBG inhibits the proliferation, migration, and invasion of cytotrophoblast (CTB) cells. We have identified a novel human monoclonal antibody with higher specificity than Digibind for MBG. We assessed the attenuation of MBG-induced CTBs dysfunction by three anti-MBG antibodies: 206–208, H1L2, and 3e9.

Methods

A panel of anti-MBG antibodies with potential as human therapeutic agents was developed by Panorama Research, Inc.; Sunnyvale, CA (206–208, H1L2). H1L2 was a humanized version of previously described anti-MBG murine antibody 3e9. 206–208 was identified in a human phage antibody library. Human CTBs were treated with DMSO (vehicle) or 0.1, 1, 10 or 100 nM of MBG for 48 h. Some cells were pretreated with 206–208, H1L2, or 3e9 for 2h, while others were co-treated with these antibodies prior to MBG treatment. Culture media were collected for analysis of pro-angiogenic and anti-angiogenic factors. Cell viability was measured using a CellTiter Assay kit. Cell lysates were utilized to evaluate the expression of proliferating cell nuclear antigen (PCNA) and p38 MAPK phosphorylation by western blot. Levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and soluble endoglin (sEng) were measured in culture media using ELISA kits. Statistical comparisons were performed using analysis of variance with Duncan's post hoc test.

Results

MBG down-regulated PCNA and up-regulated p38 phosphorylation in CTBs treated with ≥1 nM MBG compared to basal (DMSO treatment) (*p<0.05 for each). Secretion of sFlt-1 and sEng were increased, while VEGF and PIGF were decreased in CTBs treated with ≥1.0 nM MBG (*p<0.05 for each). Both anti-MBG antibodies pretreatment and co-treatment significantly up-regulated PCNA and down-regulated p38 phosphorylation, and corrected the angiogenic profile of CTBs (p<0.05 for each). The anti-proliferative and anti-angiogenic effects of MBG were not due to a cytotoxic effect, as evaluated by a cell viability assay. MBG at 0.1 nM had no effect.

Conclusions

We found that all 3 anti-MBG antibodies attenuate MBG-induced anti-proliferative and anti-angiogenic milieu in cultured CTBs. Here we describe for the first time two fully human anti-MBG antibodies, which can be targeted as therapeutic agents for the development of innovative treatment strategies for preE and potentially other disorders involving aberrant MBG signaling.

ID: 105: COMPARISON OF PLACENTAL AND PLASMA SOLUBLE (PRO)RENIN RECEPTOR IN NORMAL AND PREECLAMPTIC PREGNANCY

Objective

Preeclampsia (preE), a syndrome of hypertension and proteinuria. Most recently it was demonstrated that high circulating levels of soluble (pro) renin receptor s(P)RR at delivery were associated with preE. In this study the placental expression of (P)RR were evaluated in preE patients and in a rat model of preE as well as in nonhuman primates. We also evaluated the circulatory levels of s(P)RR.

Study Design

(1) Placental samples were collected from 20 NP and 20 preE consenting patients in an IRB approved prospective study. (2) An established rat model of preE and NP rats (n=10 each) were used. (3) The placental samples from squirrel monkey (NP; n=10) and owl monkey (both early and term, NP, n=1) were collected. The (P)RR expression were measured both by western blotting (WB) and Immunohistochemistry (IHC) using anti-ATP6IP2. The levels of serum s(P)RR were measured by ELISA.

Results

The placental expression of (P)RR were higher (p<0.05) in preE compared to NP both in patients and rat model. The s(P)RR levels were higher in preE (preE patients: 29.2±4.5; PDS rats: 16.9±1.9 ng/mL) compared to NP (NP human: 19.3±4.2; NP rats: 10.4±3.7 ng/mL). The early placenta of owl monkey expressed higher (P)RR compared to term and were expressed in squirrel monkey placentas.

Conclusions

These data suggest that increased expression of (P)RR in the placenta are related to the occurrence of preE in both patients and rat models. These data also reconfirmed that the high level of circulatory s(P)RR is associated with preE. The higher expression of (P)RR in early owl monkey in compare to term placenta suggests that the (P)RR is important for normal placental development. The expression of (P)RR in nonhuman primates reveals the approach of future studies on owl monkey and squirrel monkey preE models.

ID: 45: EVALUATION OF CELLULAR MECHANISMS BY WHICH CINOBUFOTALIN INHIBITS OVARIAN CANCER CELL LINES FUNCTION

Objective

Cinobufotalin (CINO), a cardiotonic steroid (CTS) or bufadienolide, is extracted from the skin secretions of the traditional Chinese medicine giant toads (Chan su). CINO has been used as a cardiotonic, diuretic and a hemostatic agent. Previously we have shown that CINO inhibits the cytotrophoblast cell function. Recently other study has shown that CINO inhibits A549, a lung cancer cell function. In this study, we assessed the effect of CINO on three different ovarian cancer cell lines; SK-OV-3, CRL-1978 and CRL-11731 to confirm whether the effect of CINO is cell specific.

Study Design

We evaluated the effect of CINO on three ovarian cancer cells SK-OV-3, CRL-1978, and CRL-11731 function in vitro. Each Cell lines were treated with different concentrations of CINO (0.1, 1, 5 and 10 µM). For each cell line cell proliferation, migration and invasion were measured by using a CellTiter Assay (Promega), Cytoselect Assay (Cell Biolabs) and by using a FluoroBlock Assay (BD) respectively. Proliferating Cell Nuclear Antigen (PCNA) was also evaluated in cell lysates of CINO treated these 3 ovarian cancer cells by western blot analysis. Cell Cycle arrest and Cell viability were determined by fluorescence-activated cell sorting (FACS) analysis. We also performed Annexin V staining on CINO treated these 3 ovarian cancer cell lines by immunofluorescence to evaluate the pro-apoptotic protein expression. In addition mitochondrial membrane potential has also been measured for all these 3 ovarian cell lines after CINO treatment using MMP kit, by FACS analysis.

Results

Concentration of CINO at 0.5 µM inhibit SK-OV-3, CRL-1978, and CRL-11731 ovarian cancer cells proliferation, migration and invasion without cell death and loss of cell viability but cell viability differs for each cell line. Each cell lines differ in response to CINO doses for PCNA expression as well as Annexin V pro-apoptotic protein expression. CINO decreases mitochondrial membrane potential for SK-OV-3 but for CRL-1978 and CRL-11731 increases in response to CINO treatment.

Conclusion

CINO is cell specific, as each cancer cell line responds differently. These data demonstrate that the mode of action of CINO is different on these 3 types of ovarian cancer cells.

ID: 104: CINOBUFOTALIN HINDERS CYTOTROPHOBLASTS FUNCTION VIA CELL CYCLE ARREST

Objective

Preeclampsia (preE) is a hypertensive disorder of pregnancy. Cardiotonic steroids (CTS) are endogenous inhibitors of Na+/K+ ATPase and at least one CTS, marinobufagenin (MBG), is elevated in preE prior to the development of the syndrome in rats with preE. MBG and ouabain impair cytotrophoblast (CTB) function, which is critical for placental development.

Study Design

We evaluated the effect of a CTS, cinobufotalin (CINO), on CTB cell function in vitro.

Results

CINO at ≥1 nM inhibited CTB cell proliferation, migration, and invasion (p<0.05) but had no effect on cell viability. There was a higher (p<0.05) percentage of G0/G1 phase cells in groups treated with CINO at ≥1 nM. CINO caused an increase in stress signaling p38 MAPK and a positive annexin-V staining in CTB cells, indicating the activation of apoptotic signaling. However, the CINO induced apoptotic signaling was prevented by p38 inhibition.

Conclusion

This data demonstrates that CINO impairs CTB cell function via cell cycle arrest and apoptotic signaling.

ID: 56: COMPARISON OF OUTCOMES BETWEEN NORMAL AND PREECLAMPTIC PREGNANCIES: A PROSPECTIVE STUDY

Objective

Preeclampsia (preE) is a multifaceted complication found uniquely in the pregnant patient and one that has puzzled scientist for years. It has been demonstrated that preE is not a single disorder, but a complex syndrome that is produced by various pathophysiologic triggers and mechanisms affecting 3–8% of obstetrical patients worldwide. PreE, is a major cause of premature delivery and maternal and fetal death. It is characterized by de novo development of hypertension and proteinuria after 20 weeks gestation. preE has a significant link to alterations of placental function leading to stress and apoptotic signaling, which pass the placental barrier and leave persistent defect in the circulation of the offspring. We assessed the comparison of pregnancy outcome between patients with and without preE.

Methods

We recruited 20 normal pregnant (NP) and 20 preE consenting patients after deliveries in an IRB approved prospective study from Scott & White Healthcare. We evaluated the following parameters for mothers BP, Proteinuria, BMI, Gestational age, Age, Placental factors: circumference, placental signaling proteins. The placental stress signaling proteins (p38 MAPK, COX-2 and Bax/Bcl-2) were measured. We also evaluated babies for IUGR and anthropometric measurements. Comparisons were performed using Student's t test.

Results

Mothers in the PE group had significantly higher blood pressures (SBP p=0.0000001 and DBP p=0.001) and also higher urinary protein excretion (p=0.002). Average hospital stay for PreE babies were longer than NP babies (p=0.001879). No complications were reported for NP babies; however, preE babies had multiple complications like hypoglycemia, RDS etc though they were born at preterm. Many of the PreE babies were born premature (p=0.017). The birth weights of the PE babies were much lower than the NP babies with a p value of 0.027 and also the PE babies were significantly SGA when compare to the NP babies with significant difference in their Ponderal Index (PI) (p=0.0004). The placental stress signaling proteins p38 MAPK, COX-2 and Bax/Bcl-2 were up-regulated in preE compared to normal pregnancy (p<0.05, in each case).

Conclusions

PreE alters the intrauterine environment and activates the detrimental signaling that is transported to fetus resulting in premature deliveries, IUGR babies and their related complications like extended hospitalization.

ID: 18: DIABETES AND PRE-ECLAMPSIA: A RETROSPECTIVE CROSS-SECTIONAL STUDY OF PREGNANCY OUTCOMES

Objective

Despite growing knowledge of the pathophysiology leading to the development of preeclampsia (PreE) and diabetes mellitus (DM), the interaction between the two disease processes needs to be further examined. This study compared normal pregnancies to those complicated with preE, gestational diabetes mellitus (GDM), and/or pre-existing diabetes in order to assess the effects of elevated glucose on placental development and its potential role in the pathogenesis of preE.

Methods

The chart review was performed in an IRB approved retrospective cross-sectional study of live born singleton deliveries. A total 621 subjects were randomly selected from deliveries occurring between 2008 to 2011 at Baylor Scott & White Memorial hospital. Statistical analysis was performed using Duncan's post-hoc test and ANOVA.

Results

Patients who developed preE had higher systolic and diastolic blood pressures than those who did not develop preE (p<0.05). Patients with either pre-existing diabetes or GDM were older. There was no difference among groups for gravidity (p=0.21) with an average gravidity of 2.7 (1.8SD) for 621 subjects and a range of 1 to 14 pregnancies. Patients with preE delivered earlier in pregnancy than those without preE regardless of diabetes status. However, those with preE and pre-existing diabetes delivered significantly earlier at 35.0+/−0.4 than the other two preE groups (*p<0.05 for each), suggesting more severe condition. Additionally, patients with pre-existing diabetes who developed preE delivered smaller babies than those with pre-existing diabetes without preE (1.00±0.03, p<0.05 for each). However, the development of GDM did not result in smaller babies for those pregnancies with preE.

Conclusions

The development of preE in those with pre-existing diabetes led to growth restriction and more severe disease as evidenced by lower birth weights and earlier gestational ages at delivery. These differences were not seen in GDM pregnancies. This supports the concept that elevated glucose levels during placental development in the first trimester may alter the placenta and lead to restriction later in pregnancy when a second stimulus triggers preE.

ID: 57: PRE-GESTATIONAL DIABETES AND PREECLAMPSIA IN BANGLADESHI PATIENTS: A RETROSPECTIVE STUDY

Objective

Preeclampsia (PreE) is one of considerable public health threat particularly in developing countries globally affecting approximately 8% of all pregnancies. PreE is a pregnancy-specific condition that increases maternal and infant mortality and morbidity, but the etiology remains unknown. Despite numerous basic, clinical, and epidemiologic studies that have been conducted over the past half century, knowledge of the etiology and pathogenesis of preeclampsia remains elusive. It is diagnosed by new onset increased blood pressure and proteinuria during second or third trimester of gestation; key features of the preeclampsia category include a cut-off blood pressure of 140/90 mm Hg or higher and absolute requirement of proteinuria. Approximately 20% of the diabetic pregnant women develop preE. The mechanisms contributing to this effect is not well characterized. In a recent study, we have shown that hyperglycemia impairs cytotrophoblast (CTB) function via stress signaling. Several researchers demonstrate a direct link between preE and diabetes. The objective of the study was to evaluate potential linkage between the risk of developing preE and the presence of diabetes in pregnant patients in Bangladesh.

Methods

This is a cross-sectional study of 351 pregnant women performed to evaluate the prevalence of PreE with respect to different risk factors such as previous pregnancy, presence of Antiphospholipid antibodies, pre-existing diabetes (before this pregnancy), multiple gestation / singleton, family history of preE in first degree relative (mother, sister and daughters; most commonly mother), maternal age of 40 or greater. The study was conducted in selected hospitals of Dhaka city, Bangladesh during December 2013 to December 2015.

Results

The key study findings revealed that the overall rate of development of PreE in Bangladeshi pre-gestational diabetic patients is 22.6 percent. We gave special emphasis on the occurrence of PreE in pre-gestational diabetic patients. Among 351 respondents, 145 Patients (25.5%) with either DM prior to pregnancy or developing gestational diabetes or without diabetes were older (age >35 years) pregnant women (13.1%). Prevalence of PreE is 25.5 (n=145) and 19.6 (n=199) percent among those who developed pre-gestational diabetes and without diabetes prior to pregnancy. Of the respondents 17.2 percent have both systolic and diastolic hypertension those who developed DM prior to this pregnancy and 13 percent among those who does not developed DM prior to this pregnancy. Occurrence of abortion was up to 3 percentage before this pregnancy 45 percentage who developed DM prior to this pregnancy and 35 percent who does not have diabetes among the respondents.

Conclusions

There is an association has been found between the risk of developing preE and the presence of diabetes in pregnant patients in Bangladesh.

Status of Serum Zinc in Multidrug Resistant Tuberculosis

Zinc plays a vital role in the immune status. Its deficiency affects host defense by reducing the number of circulating T cells and phagocytosis activity of other cells which ultimately impair cell mediated immunity. The cell-mediated immunity plays a major role in the causation of pulmonary tuberculosis. The present study was carried out to estimate serum zinc level in newly detected multidrug resistant tuberculosis (MDR-TB) in adult population. In this study total fifty (50) MDR-TB patients were enrolled conveniently from the in-patients departments of National Institute of Diseases of the Chest Hospital (NIDCH), Bangladesh. Serum zinc was estimated by atomic absorption spectrophotometry method from early morning fasting blood sample. Serum zinc level was assessed according to normal cut-off value 70-120 μgm/dl and 76% studied population were found lower than this value. The mean±SD serum zinc level was observed 60.40±8.91 μgm/dl. No associations were found between serum zinc level with age (p=0.11) and with sex (p=0.085) of the study population respectively. The low level of serum zinc in MDR-TB patients suggested impaired immune status of our study population.

Antidiabetic and Antioxidant Activities of Decoctions of Coccinia grandis Linn. and Centella asiatica (L.) on Alloxan-induced Diabetic rats

The decoctions of Coccinea grandis (L.) and Centella asiatica (L.) leaves were evaluated for their antidiabetic and antioxidant potentials in alloxan-induced rat model and by DPPH free radical scavenging assay, respectively. Graded doses of the decoctions administered to normal and experimental diabetic rats for two weeks showed significant reduction in fasting blood glucose levels in the normal as well as in treated diabetic animals. The experiment showed 188.42 ± 1.2 mg/dl glucose and 117.78 ± 11.2 mg/dl cholesterol levels for C. grandis, while 187.23 ± 0.8 mg/dl glucose and 116.14 ± 1.5 mg/dl cholesterol for C. asiatica. Although, the decoctions produced significant effect on serum urea level, the total protein and liver enzymes (SGOT and SGPT) were found to be normal. Acute toxicity studies showed that both the decoctions were safe at 2-fold high dose when compared with the commonly used antidiabetic dose. Total phenolic contents in decoctions were found to be 12.45±0.52 and 8.32 ± 0.31 for C. grandis and C. asiatica, respectively while DPPH free radical scavenging assay showed the IC50 values of 0.14 ± 0.001 for C. grandis and 0.17± 0.001 for C. asiatica. Our current studies for the first time, justified the use of decoctions of the leaves of C. grandis and C. asiatica for treating diabeties, hyperlipaedemia and atherogenic lesion in the indigenous system of medicine. DOI: http://dx.doi.org/10.3329/bpj.v17i1.22322 Bangladesh Pharmaceutical Journal 17(1): 86-91, 2014

Clinico-pathological profile of dengue syndrome: an experience in a tertiary care hospital, Dhaka, Bangladesh

Dengue is the fastest emerging arboviral infection and became a major public health concern in tropical and subtropical countries. Dengue infections can result in a wide spectrum of disease severities ranging between dengue fever (DF) to the life-threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). This study was performed to find out the varied presentations and laboratory findings to put forward an overview about dengue syndrome in Bangladesh, in order to create better awareness and diagnostic skills among the health care providers. This hospital based observational study was conducted in the department of Medicine, Square Hospitals Ltd. during January, 2008 to December, 2010. A total of 262 adult subjects of both sexes having dengue syndrome were included in this study. Dengue syndrome was common in younger age group and the majority (72%) was below 45 years of age. All the patients had fever and the majority had malaise (96%), severe headache (72%) and musculoskeletal pain (65%). Skin rash (47%) was the commonest hemorrhagic manifestation while tourniquet test (49%) and low pulse pressure (37%) were the commonest clinical signs. All had thrombocytopenia (100%) and the majority had leukopenia (84%) and elevated liver transaminase (ALT-74%, AST-88%). Most of the subjects developed anti dengue antibody (IgM-92%, IgG -72%). All subjects survived.

Efficacy of Low Dose Low Molecular Weight Heparin in the Treatment of Cutaneous Lichen Planus

Introduction: Lichen planus is a common pruritic, inflammatory disease of the skin, mucous membranes, nail and hair follicles. Low dose low molecular weight heparin is administered in the treatment of cutaneous lichen planus. Objective: The objective is to evaluate the efficacy of low dose low molecular weight heparin in the treatment of cutaneous lichen planus. Materials and Methods: An interventional study was carried out in the department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka. Total thirty seven patients of cutaneous lichen planus were selected by purposive type non-probability sampling technique. Data were collected by face to face interview and clinical examination. Results: It was observed that before treatment, the score of cutaneous lichen planus lesion was 6.83 ± 1.30 and after treatment was 3.83 ± 1.18 and ‘t’ test was found statistically significant (P<0.05). Improvement was shown in 26 (70.27%) cases. Out of these, response was good in 23 (88.46%), fair in 2 (7.69%) and poor in 1 (3.85%) cases. Conclusion: The study revealed that low dose low molecular weight heparin has remarkable efficacy profile as treatment option for cutaneous lichen planus. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18717 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 2-7

Percutaneous nephrolithotomy--a versatile technique for both simple and complex renal stone

Percutaneous Nephrolithotomy is currently the preferred first line treatment for simple & complex renal calculi. The technique also being used increasingly for smaller stones that have failed ESWL. Aim of the study is to share our experience in PCNL in course of time. This study was conducted from January 2009 to December 2012, 131 patient's with 142 renal units of 5-75 yrs of age, PCNL were performed in NIKDU, BSMMU & JBFH. Stone were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvic stone with accompanying calyceal stones). The stone size was 1.5-5cm approximately. We asses our initial puncture technique, need for multi-tract, supra 12th rib access, stone free rate, operative duration, postoperative complication, number of transfusion and hospital stay. Operative durations were 60 min -180 minutes. Puncture technique improved in course of time. 14 patients need multi-puncture and tract, all are supra 12th access. Out of 142 renal units 120 (83%) were stone free after first procedure, another 22 need and auxiliary procedure, (5 2nd look PCNL, 6 URS, 11 ESWL) to become stone free result in a 95% stone free rate. Complications occurred in 17 procedures which dealt accordingly. This study revealed PCNL is an effective, versatile safe and cosmetically acceptable procedure for all age groups in simple and complex renal stone.

Evaluation of serum lipid profile in patients with hypertension living in a coastal region of Bangladesh

Serum lipid levels are greatly controlled by genetic and environmental factors. When investigating the relationship between lipid disturbances and hypertension it is necessary to use local data on blood lipid profile in each region. Unfortunately, there is no literature reporting the lipid profile in hypertensive patients in coastal region of Bangladesh. The present study was conducted as a case-control study with 100 hypertensive patients as cases and equal number of normotensive individuals as controls. Socio-demographic, anthropometric and clinical data of both patients and controls were collected. Serum lipid parameters were analyzed biochemically. Independent sample t-test, Chi-Square test and Pearson's correlation test were done for the statistical analysis using the statistical software package SPSS. Our study found that serum total cholesterol (TC), triglyceride (TG), LDL, VLDL, TC/HDL, LDL/HDL were significantly higher (p<0.05) whereas the level of HDL cholesterol was significantly lower in hypertensive patients as compared to control subjects (p<0.05). Pearson's correlation analysis reveals that HDL cholesterol was inversely correlated with systolic and diastolic blood pressure in both patient and control groups. But serum TC, TG, LDL and HDL cholesterol were directly correlated with systolic and diastolic blood pressure in both groups. This study explored that hypertensive patients have higher level of TC, TG, LDL and VLDL cholesterol but lower level of HDL cholesterol than the normotensive subjects. Routine investigation of lipid profile in hypertensive patients may help to prevent further aggravation and risks of coronary artery diseases.

Renal function impairment in Hypothyroidism

Background: Hypothyroidism is an important public health problem in Bangladesh. It is associated with increased risk for atherosclerosis and other complications. The frank development of hypothyroidism is associated with metabolic derangements including dyslipidemia- which is an etiopathologic factor for development of renal impairment. This study was to evaluate whether hypothyroidism is associated with impaired renal function. Methods: Using a cross sectional analytical study design, a total of 111 subjects attending Out Patient Department, Center for Nuclear Medicine and Ultrasound, Bogra Medical College during January 2007 to December 2007 were included purposively. Eighty newly diagnosed hypothyroid patients (Group I) and 31 healthy adults (Group II) were enrolled in this study. Serum thyroid stimulating hormone and serum free thyroxine were assayed by radioimmunoassay. Serum fasting lipid profile, serum creatinine and serum uric acid were estimated by enzymatic colorimetric method. Estimated GFR was calculated using MDRD equation. Results: The mean (±SD) age of in Group I and Group II were 35.59 (±6.91) and 37.35 (±2.78) years and were comparable. In Group I, there were 66 females and 14 males. In Group II, there were 16 females and 15 males. The mean BMI was 25.49 ±2.17 kg/m2 in Group I and 24.24 ±1.99 kg/m2 in Group II. The mean (±SD) Serum total-cholesterol, LDL- cholesterol and tryacylglycerol in Group I were significantly higher than that in Group II. Serum HDL cholesterol in Group I was significantly lower than that in Group II (p<0.001). The mean (±SD) serum creatinine was significantly higher in Group I than Group II (P<0.001). The estimated glomerular filtration rate (eGFR) was lower in Group I compared to Group II (p=0.011). In Group I (Hypothyroid), there were significant correlations of BMI, S Total-Cholesterol, S HDLCholesterol, S LDL-Cholesterol, S triglycerides and S creatinine with serum TSH level. In Group I (Hypothyroid), there were significant positive correlations of BMI and TSH with serum creatinine. Conclusions: Hypothyroidism is associated with dyslipidemia, hyperuricemia and impaired renal function. Therefore, patients presenting with these biochemical abnormalities are recommended to be investigated for hypothyroidism and vice versa. DOI: http://dx.doi.org/10.3329/bjmb.v6i1.13283 Bangladesh J Med Biochem 2013; 6(1): 19-25

Effectiveness of levofloxacin in enteric fever

This intervention study was conducted to determine the efficacy of Levofloxacin in the treatment of uncomplicated enteric fever. Among 100 patients, who were purposively selected for the study had presented sign and symptoms of enteric fever with blood culture positive salmonella in laboratory findings during the admission in the department of Medicine, Uttara Adhunik Medical College & Hospital, Dhaka. Patients who fulfilled the diagnostic criteria were enrolled in the study and divided into two groups. One group was treated with oral levofloxacin 750mg once daily (OD) and another was injected with Levofloxacin 500mg once daily for 7 days. All the patients were examined twice daily to observe the clinical cure or failure of levofloxacin. Study was conducted from January 2008 to December 2008. Statistical analysis was performed by using statistical software SPSS version 12. Among the 100 patients in the study, majority of them 46(92%) were aged between 15 to 25 years, the next group was between 25 to 35 years 26(52%) and only three patients were aged above 65 years. Significant number of the patients were male (67), and the rest of them were female. The patients were clinically examined specially for anaemia, jaundice, caecal gurgling, hepatosplenomegaly in both the groups and the relevant investigations were performed. It was found that 46 patients in group A, who took oral levofloxacin, were cured after seven days, whereas 48 patients in group B were fully cured by taking injectable levofloxacin by seven days. In this study, levofloxacin was found to be the most effective drug in both oral and injectable form in one-week treatment of uncomplicated typhoid.

Contribution of angiogenic factors in a rat model of pre-eclampsia

BACKGROUND/AIMS

Pre-eclampsia is a disorder that results in significant feto-maternal complications with yet no definitive pharmacologic intervention. One postulated etiologic mechanism is an imbalance between circulating pro-angiogenic and anti-angiogenic factors. We investigated these factors sequentially throughout pregnancy (19-21 days) in our rat model of pre-eclampsia, which involves the imposition of excessive volume expansion.

METHODS

We evaluated the status of the pro-angiogenic and anti-angiogenic factors at the following time points: 3-5, 7-10 and 17-20 days of gestation.

RESULTS

We have previously determined that the urinary excretion of the circulating bufodienolide, marinobufagenin, is elevated at the 3- to 5-day time period, prior to the advent of hypertension and proteinuria. At 3-5 days of pregnancy, there was no evidence of angiogenic imbalance in the normal pregnant (NP) and 'pre-eclamptic' (PDS) rats. At the 7- to 10-day time point, plasma PlGF was greater in the NP rats than in the PDS group (p < 0.05). The plasma sFlt-1/PlGF ratio in the PDS animals was greater than that in the NP rats (p < 0.05). The placental sFlt-1 and sFlt-1/PlGF ratio were greater in the PDS rats than in NP rats (p < 0.05). These changes were also present at the 17- to 20-day time point in both plasma and placenta. The administration of resibufogenin, an antagonist of marinobufagenin, early in pregnancy, prevented angiogenic imbalance.

CONCLUSION

We conclude that angiogenic imbalance plays a role in the pathogenesis of pre-eclampsia in this rat model. Furthermore, the earliest event in the pathogenetic sequence appears to be the secretion and elaboration of marinobufagenin.

Bicellar mixture phase behavior examined by variable-pressure deuterium NMR and ambient pressure DSC

Variable-pressure deuterium nuclear magnetic resonance ((2)H NMR) has been used to study the pressure-temperature phase diagram of bicellar mixtures containing 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and 1,2-dihexanoyl-sn-glycero-3-phosphocholine (DHPC). Spectra were obtained for DMPC-d(54)/DHPC (3:1), DMPC-d(54)/DHPC (4.4:1), DMPC/DHPC-d(22) (3:1), and DMPC/DHPC-d(22) (4.4:1) in the range 10-68 degrees C at ambient pressure, 66 MPa, 102 MPa, and 135 MPa. Isotropic-to-nematic and nematic-to-lamellar transition temperatures were found to rise with pressure at approximately 0.15 and approximately 0.14 degrees C/MPa, respectively, for DMPC-d(54)/DHPC (3:1) and at at approximately 0.19 and approximately 0.18 degrees C/MPa, respectively, for DMPC-d(54)/DHPC (4.4:1). Pressure had little effect on the range of DMPC-d(54) chain orientational order through the nematic phase temperature range, but the behavior of chain orientational order at the nematic-to-lamellar transition was found to vary slightly with pressure. Comparison of differential scanning calorimetry (DSC) observations with ambient-pressure (2)H NMR observations of DMPC-d(54) in the bicellar mixtures suggests that absorption of heat persists for a few degrees above the onset of axially symmetric DMPC-d(54) reorientation.

Marinobufagenin, resibufogenin and preeclampsia

The bufodienolides are cardiac glycosides which have the ability to inhibit the enzyme, Na(+)/K(+) ATPase (sodium potassium adenosine triphosphatase). They are cardiac inotropes, cause vasoconstriction (and, potentially, hypertension) and are natriuretic. Evidence has accrued over time which supports the view that they are mechanistically involved in volume expansion-mediated hypertension. In this communication, the authors summarize data which support the view that the bufodienolides and, in particular, marinobufagenin (MBG) are involved in the pathogenesis of preeclampsia. In a rat model of the syndrome, MBG causes hypertension, proteinuria, intrauterine growth restriction and increased weight gain. All of these phenotypic characteristics are prevented by an antagonist to MBG, resibufogenin (RBG). The "preeclamptic" animals also develop a vascular leak syndrome, resulting in hemoconcentration. Abnormalities in the MAPK (mitogen-activated protein kinase) system play a role in the mechanism by which MBG produces the abnormalities in the pregnant rat. Studies to discover the relevance of these findings to human preeclampsia are currently underway in several laboratories and clinics.

Effects of resibufogenin in experimental hypertension

BACKGROUND/AIMS

There are two major pathophysiologic processes involved in the development of hypertension: (1) expanded extracellular fluid volume and (2) vasoconstriction. We have developed a model of preeclampsia in the rat, in which excessive volume expansion (VE) plays a role. These animals excrete increased amounts of the bufodienolide, marinobufagenin (MBG), even before their hypertension and proteinuria become established. Furthermore, their hypertension is corrected by administration of resibufogenin (RBG), a compound structurally similar to MBG.

METHOD

We studied two models of experimental hypertension in the nonpregnant animal, produced either by deoxycorticosterone acetate (DOCA)-salt administration or by angiotensin infusion.

RESULTS

RBG administered to the DOCA-salt rats lowered blood pressure and reduced proteinuria in the VE animals, but had no affect on the rats infused with angiotensin. Furthermore, although the production of superoxide anion in the aortas of both groups of hypertensive rats was increased over control, RBG reduced these levels to normal in the VE (DOCA-salt) animals only. RBG had no effect in the angiotensin-infused rats. The urinary excretion of angiotensinogen did not rise in VE-mediated hypertension, but did increase in the angiotensin-infused rats.

CONCLUSIONS

MBG plays an important role in the causation of hypertension in the VE rats, but not in the vasoconstrictive model. RBG is effective only in VE-mediated hypertension.