System Identification of mGluR-Dependent Long-Term Depression

Recent advances have started to uncover the underlying mechanisms of metabotropic glutamate receptor (mGluR)–dependent long-term depression (LTD). However, it is not completely clear how these mechanisms are linked, and it is believed that several crucial mechanisms remain to be revealed. In this study, we investigated whether system identification (SI) methods can be used to gain insight into the mechanisms of synaptic plasticity. SI methods have been shown to be an objective and powerful approach for describing how sensory neurons encode information about stimuli. However, to our knowledge, it is the first time that SI methods have been applied to electrophysiological brain slice recordings of synaptic plasticity responses. The results indicate that the SI approach is a valuable tool for reverse-engineering of mGluR-LTD responses. We suggest that such SI methods can aid in unraveling the complexities of synaptic function.

Low hippocampal PI(4,5)P₂ contributes to reduced cognition in old mice as a result of loss of MARCKS

Cognitive and motor performances decline during aging. Although it is clear that such signs reflect synaptic compromise, the underlying mechanisms have not been defined. We found that the levels and activity of the synaptic plasticity modulators phosphatidylinositol-(4,5)-bisphosphate (PI(4,5)P₂) and phospholipase Cγ (PLCγ) were substantially reduced in hippocampal synaptic membranes from old mice. In addition, these membranes contained reduced levels of the PI(4,5)P₂-clustering molecule myristoylated alanine-rich C kinase substrate (MARCKS). Consistent with a cause-effect relationship, raising MARCKS levels in the brain of old mice led to increased synaptic membrane clustering of PI(4,5)P₂ and to PLCγ activation. MARCKS overexpression in the hippocampus of old mice or intraventricular perfusion of MARCKS peptide resulted in enhanced long-term potentiation and improved memory. These results reveal one of the mechanisms involved in brain dysfunction during aging.

Loss of survivin in neural precursor cells results in impaired long-term potentiation in the dentate gyrus and CA1-region

In adult mammals, newborn neural precursor cells (NPCs) derived from either the subventricular zone (SVZ) or the subgranular zone (SGZ) migrate into the olfactory bulb and the dentate gyrus (DG), respectively, where some of them mature into excitatory and inhibitory neurons. There is increasing evidence that this neurogenesis process is important for some types of learning and synaptic plasticity and vice versa. Survivin, a member of the inhibitor-of-apoptosis protein (IAP) family, has been suggested to have a central role in the regulation of neurogenesis. The protein is abundantly expressed in nervous tissue during embryonic development while being restricted postnatally to proliferating and migrating NPCs in SVZ and SGZ. Here we examined adult Survivin(Camcre) mice with a conditional deletion of the survivin gene in embryonic neurogenic regions. Although the deletion of survivin had no effect on basic excitability in DG and CA1-region, there was a marked impairment of long-term potentiation (LTP) in these areas. Our data support a function of survivin in hippocampal synaptic plasticity and learning and underline the importance of adult brain neurogenesis for proper operation of the hippocampal tri-synaptic circuit and the physiological functions that depend on it.

Association of positive thyroid auto antibodies with thyroid carcinoma

The association between thyroid autoimmunity and thyroid cancer was carried out in a series of solitary thyroid nodules submitted to fine-needle aspiration cytology and subsequent histopathology. US guided FNACs were obtained from 295 unselected consecutive patients with single thyroid nodules and positive (98) or negative (197) serum anti-thyroid antibody. Cytological results were classified in three classes of increased risk of malignancy: low risk (class II); indeterminate risk (class III); and suspect or malignant (class IV). A higher prevalence of class III (29.6%, p<0.05) and class IV (17.34%, p<0.05) and lower prevalence of class II (52.06%, p<0.01) were found in ATA+ nodules respectively. By multivariate logistic regression analysis ATA+ conferred a significant risk (odds ratio: 1.97 & 95% confidence interval: 0.97-3.97) for class IV cytology independently for age and sex. In 53 patients where thyroidectomy was carried out, thyroid cancer was found in (86.66%) patients with class IV nodules, in (19.4%) of class III nodules (all ATA-) and in none of 7 class II nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (13.2%) of ATA+, when compared with ATA- nodules (8.1%, p>0.01), but the significance of this finding is limited by the low number of class II nodules operated on. The presence of ATA+ confers an increased risk of suspicious or malignant cytology in solitary thyroid nodules.

Molecular epidemiology of tuberculosis in rural Matlab, Bangladesh

OBJECTIVE

To characterise and classify clinical isolates collected from tuberculosis (TB) patients in rural Bangladesh and to investigate the mode of transmission.

DESIGN

An epidemiological study using a combination of conventional and molecular methods was performed in a rural population of Bangladesh. A total of 168 clinical isolates were collected from TB patients. Deletion analysis, used for rapid differentiation of members of the Mycobacterium tuberculosis complex, spoligotyping and variable number tandem repeats of mycobacterial interspersed repetitive units (VNTR-MIRU) typing were used.

RESULTS

Deletion analysis identified all isolates as M. tuberculosis and further divided them into 109 strains (65%) carrying the M. tuberculosis deletion region 1 (TbD1-intact or 'ancestral' strains) and 59 strains (35%) lacking this region (TbD1 or 'modern' strains). MIRU analyses showed that 149 strains (89%) had unique patterns, whereas 19 strains (11%) clustered into eight groups. The largest cluster comprised five TbD1 strains of the Beijing type. The rate of recent transmission was estimated to be 6.5%.

CONCLUSIONS

Our results suggest that TB in rural Bangladesh is caused primarily by reactivation of latent infections involving TbD1 intact strains, overlaid with the recent emergence of Beijing strain clusters that include multidrug-resistant isolates.

Role of intraoperative flexible Choledochoscopy in calculous biliary tract disease

Ninety six percent of patients with overlooked bile duct stones required surgery within 5 years of cholecystectomy, every effort should be made to keep the incidence of retained stones minimum. The facilities of pre-operative ERCP are not always available. Examination of the bile ducts under direct vision with a choledochoscope seems a certain method of ensuring that there are no residual stone. A total of 26 patients were evaluated between the periods of 2004 to 2005. Age of the patients ranged from 20 to 70 years. The mean age is about 45.88 years approximately. Six (23.07%) cases had previous history of cholecystectomy. Peroperatively 14(53.84%) cases had only choledocholithiasis, 6(23.07%) cases had cholelithiasis with choledocholithiasis, 4(15.38%) cases had choledocholithiasis with hepatolithiasis and 2(7.69%) cases had Mirrizi's type II with choledocholithiasis. After Choledochoscopy, 22(84.61%) cases had complete blind clearance, 4(15.38%) cases had incomplete blind clearance. Twenty two (84.61%) cases did not require any Choledochoscopy guided stone extraction. Four (15.38%) cases required Choledochoscopy guided Dormia basket extraction. Twenty two (84.61%) cases have undergone T tube drainage, 4(15.38%) cases undergone Roux-en-Y hepaticojejunostomy who had associated hepatolithiasis. In this series percentage of stone overlooked by instrumental exploration was 15.38 & percentage of residual stone in this study was 0%.

Cognitive defects are reversible in inducible mice expressing pro-aggregant full-length human Tau

Neurofibrillary lesions of abnormal Tau are hallmarks of Alzheimer disease and frontotemporal dementias. Our regulatable (Tet-OFF) mouse models of tauopathy express variants of human full-length Tau in the forebrain (CaMKIIα promoter) either with mutation ΔK280 (pro-aggregant) or ΔK280/I277P/I308P (anti-aggregant). Co-expression of luciferase enables in vivo quantification of gene expression by bioluminescence imaging. Pro-aggregant mice develop synapse loss and Tau-pathology including missorting, phosphorylation and early pretangle formation, whereas anti-aggregant mice do not. We correlated hippocampal Tau pathology with learning/memory performance and synaptic plasticity. Pro-aggregant mice at 16 months of gene expression exhibited severe cognitive deficits in Morris water maze and in passive-avoidance paradigms, whereas anti-aggregant mice were comparable to controls. Cognitive impairment of pro-aggregant mice was accompanied by loss of hippocampal LTP in CA1 and CA3 areas and by a reduction of synaptic proteins and dendritic spines, although no neuronal loss was observed. Remarkably, memory and LTP recovered when pro-aggregant Tau was switched-OFF for ~4 months, Tau phosphorylation and missorting were reversed, and synapses recovered. Moreover, soluble and insoluble pro-aggregant hTau40 disappeared, while insoluble mouse Tau was still present. This study links early Tau pathology without neurofibrillary tangles and neuronal death to cognitive decline and synaptic dysfunction. It demonstrates that Tau-induced impairments are reversible after switching-OFF pro-aggregant Tau. Therefore, our mouse model may mimic an early phase of AD when the hippocampus does not yet suffer from irreversible cell death but cognitive deficits are already striking. It offers potential to evaluate drugs with regard to learning and memory performance.

Acute abdomen 10 years after surgery for duodenal ulcer disease

A 55 years old male was admitted in the surgical unit of Dhaka Medical College & Hospital with the complaints of pain and discomfort in the upper abdomen for 1 day and hiccough and vomiting for several episodes for same duration. He had history of abdominal operation 10 years back for his peptic ulcer disease probably due to pyloric stenosis. On examination a linear scar mark was present along the upper midline region & visible peristalsis was seen on the left hypochondriac region. A palpable diffuse lump was present in the left hypochondriac region which was intraperitoneal seemed to be distended gut and the peristaltic wave moved from left to right. Endoscopy of upper GIT Showed loops of small intestine (evidenced by valvulae conneventes) protruded through a stoma suggestive of jejunogastric intussusception. Laparotomy revealed a portion of adherent small gut already become gangrenous so the whole portion of the intussuscepted gut was resected. After that revision and take-down of the anastomosis was done with vicryl stitches. The post operative period was uneventful. The patient underwent regular follow up.

Co-morbidity: exploring the clinical overlap between pneumonia and diarrhoea in a hospital in Dhaka, Bangladesh

BACKGROUND

There is limited information on risk factors for pneumonia and pneumonia-related deaths in children who also have diarrhoea.

AIM

To identify risk factors for the above in order to improve strategies for case management and to develop appropriate public health messages.

METHODS

All children under 5 years of age admitted to the Special Care Ward, Dhaka Hospital of the International Centre for Diarrhoeal Disease Research (ICDDR,B) from 1 September to 31 December 2007 were considered for enrollment if they also had diarrhoea. Of the 258 children with diarrhoea enrolled, those with (n=198) or without (n=60) WHO-defined pneumonia constituted the pneumonia and comparison groups, respectively. Among the 198 children with pneumonia, children who survived (n=174) were compared with those who died in hospital (n=24).

RESULTS

After adjusting for socio-demographic factors, including low levels of literacy of either parent, low household income, not having a window or exhaust fan in the kitchen, household smoking and over-crowding, children with pneumonia were more likely to sleep on a bare wooden-slatted or bamboo bed (OR 2·7, 95% CI 1·40-5·21, p = 0·003) than on other bedding, and were also more likely to have a parent/care-giver with poor knowledge of pneumonia (OR 1·94, 95% CI 1·02-3·70, p=0·043). Independent risk factors for death include severe underweight (OR 5·2, 95% CI 1·2-22·0, p=0·03), hypoxaemia (OR 17·5, 95% CI I 1·9-160·0, p=0·01), severe sepsis (OR 8·7, 95% CI I 1·8-41·5, p=0·007) and lobar consolidation (OR 11·9, 95% CI 2·3-61·6, p=0·003).

CONCLUSIONS

Increased public awareness of signs of pneumonia and severe sepsis in children under 5 is important to mitigate the risks of pneumonia and pneumonia-related deaths, and the importance of appropriate bedding for young children in reducing the risk of pneumonia needs to be addressed.

Proper synaptic vesicle formation and neuronal network activity critically rely on syndapin I

Synaptic transmission relies on effective and accurate compensatory endocytosis. F-BAR proteins may serve as membrane curvature sensors and/or inducers and thereby support membrane remodelling processes; yet, their in vivo functions urgently await disclosure. We demonstrate that the F-BAR protein syndapin I is crucial for proper brain function. Syndapin I knockout (KO) mice suffer from seizures, a phenotype consistent with excessive hippocampal network activity. Loss of syndapin I causes defects in presynaptic membrane trafficking processes, which are especially evident under high-capacity retrieval conditions, accumulation of endocytic intermediates, loss of synaptic vesicle (SV) size control, impaired activity-dependent SV retrieval and defective synaptic activity. Detailed molecular analyses demonstrate that syndapin I plays an important role in the recruitment of all dynamin isoforms, central players in vesicle fission reactions, to the membrane. Consistently, syndapin I KO mice share phenotypes with dynamin I KO mice, whereas their seizure phenotype is very reminiscent of fitful mice expressing a mutant dynamin. Thus, syndapin I acts as pivotal membrane anchoring factor for dynamins during regeneration of SVs.

Clinical Profile and Outcome of Patients with Dengue Syndrome in Hospital Care

Dengue is a viral febrile illness, which has become a major international public health concern including Bangladesh, spectrum of illness ranging from dengue fever (DF) to life threatening dengue haemorrhagic fever (DHF), dengue shock syndrome (DSS) and ultimately death. The clinical profiling and outcome during epidemic dengue outbreak was observed in Dhaka Medical College Hospital in 2000 to 2001. One hundred and fifty patients were systematically observed. Male female ratio was 5:1 with severity of illness in younger patients. Hundred percent patients had fever with 83% having generalized weakness. The severe cases(DHF) were having sudden sustained temperature of 103 degree farenheight. Majority have abdominal symptoms(>80%) while 10% had respiratory only. Sixty percent have hepatomegaly while 40 % spleenomealy while 80% of DHF had ascites. Above 75% cases of Dengue haemorhagic fever had positive tourniquet test while melaena was the commonest mucosal bleeds. No fatality was observed in this study although variability of discharge was seen in different groups. Keyword: Clinical, Profile, Outcome, Dengue, Hospital DOI: http://dx.doi.org/10.3329/jom.v12i2.6733 JOM 2011; 12(2): 131-138

Regression of plaque burden after primary percutaneous coronary intervention (PCI) in a patient with TVD: 4 years follow-up

Coronary Artery disease (CAD) is an important cause of mortality and morbidity in the developed world as well as in Bangladesh. Treatment of Acute Myocardial Infarction (AMI) patient either by Streptokinase (STK) or Primary Percutaneous Coronary Intervention (pPCI) has increased the survival outcome and reduced the mortality. Several studies have documented the significant beneficial role pPCI in terms of in-hospital survival outcome over thrombolysis.  Our patient, who had Anterior MI in 2004 and his CAG revealed TVD.  pPCI of the culprit mid LAD lesion with Bare Metal Stent (BMS) was done immediately after hospitalization. He was later referred for CABG, but decision postponed because of asymptomatic status. His re-look CAG on 20-02-2008 (i.e., 4 yrs after the original procedure), revealed patent LAD stent with the regression of atherosclerotic plaque in Ostio-Proximal LAD and proximal LCX. Our findings indicated that pPCI with rigid control of CAD risk factors and modification of lifestyle plays a key role in the regression of atherosclerotic plaque and maintenance of stent patency.DOI: http://dx.doi.org/10.3329/pulse.v4i1.6959Pulse Vol.4 January 2010 p.22-25

Evaluation of a probiotics, Bifidobacterium breve BBG-01, for enhancement of immunogenicity of an oral inactivated cholera vaccine and safety: a randomized, double-blind, placebo-controlled trial in Bangladeshi children under 5 years of age

To evaluate the probiotic, Bifidobacterium breve strain Yakult (BBG-01), for safety and enhancement of immunogenicity in an oral inactivated cholera vaccine, a randomized double-blind placebo-controlled study was performed. Bangladeshi children under 5-year-old received BBG-01 or placebo for 4 weeks with two doses of oral cholera vaccine. Serum/fecal antibodies and fecal bacterial flora in the study participants were monitored. All adverse events were mild and transient and had no significant difference between the two groups. Immunological responses were similar comparing the two groups. A negative correlation between Bifidobacterium and Enterobacteriaceae in the probiotic group suggests a possible involvement of BBG-01 in alteration of the enteric bacterial flora. In conclusion, BBG-01 is well tolerated by Bangladeshi children although the post vaccinal immunostimulatory effect of BBG-01 was not evident.

A 30 year old female with lower abdominal lump

A female of 30 years of age, hailing from Narayangonj, Dhaka got admitted herself into Dhaka medical College & Hospital on 25.10.08 with the complaints of a lump in the lower abdomen for 1 year and pain in the lower abdomen for the same duration. Local examination reveals a lump in the lower abdomen which is intra abdominal, 10cm × 12cm in size. CT scan of Abdomen reveals a solid mass measuring (12 × 9 × 8.5) cm is seen in left side of abdominal cavity extending up to pelvic cavity. FNAC of abdominal lump shows sheets of mesothelial cells and few small clusters of regular epithelial like cells. Laparotomy was done on 27.11.08 under G/A & reveals a solid mass measuring about 10 × 8cm size & was well encapsulated, adherent with omentum found in the lower abdomen. Few mesenteric lymph nodes were enlarged. The mass was gently separated from the omentum ensuring adequate haemostasis. Post-operative period was uneventful. Histopathology report shows neoplasm composed of plump of fibroblasts arranged in broad sweeping fascicles and infiltrate into adjacent tissue consistent with fibromatosis. The patient was discharged with advice on 10th post operative day.

Hippocampal tauopathy in tau transgenic mice coincides with impaired hippocampus-dependent learning and memory, and attenuated late-phase long-term depression of synaptic transmission

We evaluated various forms of hippocampus-dependent learning and memory, and hippocampal synaptic plasticity in THY-Tau22 transgenic mice, a murine tauopathy model that expresses double-mutated 4-repeat human tau, and shows neuropathological tau hyperphosphorylation and aggregation throughout the brain. Focussing on hippocampus, immunohistochemical studies in aged THY-Tau22 mice revealed prominent hyper- and abnormal phosphorylation of tau in CA1 region, and an increase in glial fibrillary acidic protein (GFAP) in hippocampus, but without signs of neuronal loss. These mice displayed spatial, social, and contextual learning and memory defects that could not be reduced to subtle neuromotor disability. The behavioral defects coincided with changes in hippocampal synaptic functioning and plasticity as measured in paired-pulse and novel long-term depression protocols. These results indicate that hippocampal tauopathy without neuronal cell loss can impair neural and behavioral plasticity, and further show that transgenic mice, such as the THY-Tau22 strain, might be useful for preclinical research on tauopathy pathogenesis and possible treatment.

The synergy of permeable pavements and geothermal heat pumps for stormwater treatment and reuse

The use of permeable pavement systems with integrated geothermal heat pumps for the treatment and recycling of urban runoff is novel and timely. This study assesses the efficiency of the combined technology for controlled indoor and uncontrolled outdoor experimental rigs. Water quality parameters such as biochemical oxygen demand, nutrients, total viable heterotrophic bacteria and total coliforms were tested before and after treatment in both rigs. The water borne bacterial community genomic deoxyribonucleic acid (DNA) was analyzed by polymerase chain reaction (PCR) amplification followed by denaturing gradient gel electrophoresis (DGGE) and was further confirmed by DNA sequencing techniques. Despite the relatively high temperatures in the indirectly heated sub-base of the pavement, potentially pathogenic organisms such as Salmonella spp., Escherichia coli, faecal Streptococci and Legionella were not detected. Moreover, mean removal rates of 99% for biochemical oxygen demand, 97% for ammonia-nitrogen and 95% for orthophosphate-phosphates were recorded. This research also supports decision-makers in assessing public health risks based on qualitative molecular microbiological data associated with the recycling of treated urban runoff.

Evaluating and regulating lead in synthetic turf

BACKGROUND

In 2007, a synthetic turf recreational field in Newark, New Jersey, was closed because lead was found in synthetic turf fibers and in surface dust at concentrations exceeding hazard criteria. Consequently, public health professionals across the country began testing synthetic turf to determine whether it represented a lead hazard. Currently, no standardized methods exist to test for lead in synthetic turf or to assess lead hazards.

OBJECTIVES

Our objectives were to increase awareness of potential lead exposure from synthetic turf by presenting data showing elevated lead in fibers and turf-derived dust; identify risk assessment uncertainties; recommend that federal and/or state agencies determine appropriate methodologies for assessing lead in synthetic turf; and recommend an interim standardized approach for sampling, interpreting results, and taking health-protective actions.

DISCUSSION

Data collected from recreational fields and child care centers indicate lead in synthetic turf fibers and dust at concentrations exceeding the Consumer Product Safety Improvement Act of 2008 statutory lead limit of 300 mg/kg for consumer products intended for use by children, and the U.S. Environmental Protection Agency's lead-dust hazard standard of 40 µg/ft² for floors.

CONCLUSIONS

Synthetic turf can deteriorate to form dust containing lead at levels that may pose a risk to children. Given elevated lead levels in turf and dust on recreational fields and in child care settings, it is imperative that a consistent, nationwide approach for sampling, assessment, and action be developed. In the absence of a standardized approach, we offer an interim approach to assess potential lead hazards when evaluating synthetic turf.

A 40 year old man with acute abdomen

A 40 years old man with the complaints of abdominal pain and per rectal bleeding for 2 days and abdominal distension for 1 day. There was an ill defined, tender intra abdominal solid mass at the left side of the lower abdomen measuring about 3 x 3cm2 on deep palpation. Direct rectal examination could not be done due to excessive pain at the anal region and non co operation of the patient. Plain X-ray of the abdomen A/P view in erect posture including both domes of the diaphragm shows distended large intestinal gas shadow & bottle like radiopaque shadow at the lower mid abdomen. Ultrasonogram (USG) of the abdomen could not be done due to the restlessness of the patient. With all available aseptic precaution the abdomen was opened by a lower midline incision. After exploration of the sigmoid colon two glass bottles (One measuring 10cm x 5 cm, the other 12cm x 7cm) were removed and the colon was closed primarily. There was also a small piece of stone found in the peritoneal cavity measuring 2 cm in diameter which was sent for histopathology. Post operative period was uneventful. The patient was discharged with advice on the 8th POD.

Bordetella holmesii: a rare cause of bacterial endocarditis in a post-splenectomy patient

We present a rare case of endocarditis in a 33-year-old woman with a splenectomy. The patient presented with meningeal symptoms and was diagnosed with endocarditis on the medical admissions unit using a portable echocardiography machine. Bordetella holmesii was cultured from the blood on admission and the patient underwent subsequent aortic valve replacement. We discuss the importance of echo skills within the specialty of acute medicine and the benefits of swift senior review at the front door. We emphasise the guidelines on antibiotic prophylaxis for the post-splenectomy patient as well as discuss the pathogen B holmesii and its growing association of septicaemia in asplenic individuals.

Impaired neurogenesis, learning and memory and low seizure threshold associated with loss of neural precursor cell survivin

BACKGROUND

Survivin is a unique member of the inhibitor of apoptosis protein (IAP) family in that it exhibits antiapoptotic properties and also promotes the cell cycle and mediates mitosis as a chromosome passenger protein. Survivin is highly expressed in neural precursor cells in the brain, yet its function there has not been elucidated.

RESULTS

To examine the role of neural precursor cell survivin, we first showed that survivin is normally expressed in periventricular neurogenic regions in the embryo, becoming restricted postnatally to proliferating and migrating NPCs in the key neurogenic sites, the subventricular zone (SVZ) and the subgranular zone (SGZ). We then used a conditional gene inactivation strategy to delete the survivin gene prenatally in those neurogenic regions. Lack of embryonic NPC survivin results in viable, fertile mice (SurvivinCamcre) with reduced numbers of SVZ NPCs, absent rostral migratory stream, and olfactory bulb hypoplasia. The phenotype can be partially rescued, as intracerebroventricular gene delivery of survivin during embryonic development increases olfactory bulb neurogenesis, detected postnatally. SurvivinCamcre brains have fewer cortical inhibitory interneurons, contributing to enhanced sensitivity to seizures, and profound deficits in memory and learning.

CONCLUSIONS

The findings highlight the critical role that survivin plays during neural development, deficiencies of which dramatically impact on postnatal neural function.

High Dose Chemotherapy with Thiotepa, Mitoxantrone and Carboplatin (TMJ) Followed by Autologous Stem Cell Support in 100 Consecutive Lymphoma Patients in a Single Centre: Analysis of Efficacy, Toxicity and Prognostic Factors

High dose chemotherapy with autologous stem cell transplant is often used in patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) who either do not respond to, or relapse after conventional chemotherapy. There is no consensus on the "ideal" pretransplant conditioning regimen. In this study, we analyzed the results of 100 consecutive patients with HD and NHL who met our eligibility criteria and underwent autologous stem cell transplant at New York Medical College and Zalmen A. Arlin Cancer Institute. All patients received high dose chemotherapy with thiotepa, mitoxantrone and carboplatin (TMJ). One hundred patients, 37 with HD and 63 with NHL underwent autologous stem cell transplant using TMJ as a conditioning regimen. All patients with HD had chemo-sensitive relapse while 50 patients with NHL had chemo-sensitive relapse and 13 patients had first complete remission. The source of stem cells was bone marrow (18 patients), peripheral blood (50 patients) and both bone marrow and peripheral blood (32 patients). With a median follow up of 91 months (range 23-147 months), the median survival of patients with HD and NHL who underwent autologous stem cell transplant is 107 months and the 5 years disease free survival is 43%. Median survival of patients with HD and NHL is 87 and 107 months respectively. There were 4 transplant related deaths. Median survival of patients who had sensitive relapse at the time of transplant is 87 months while median survival has not been reached for patients who had first complete remission at the time of transplant. Multivariate analysis identified age>35 years (P=0.02) as a predictor for poor survival for the whole group as well as for patients with NHL (P=0.04). TMJ is a safe and effective regimen when used as a part of autologous stem cell transplant for patients with HD and NHL.

Upper abdominal mass with diagnostic dilemma

A 32 years old gentleman presented with a lump occupying the epigastric, left hypochondriac and umbilical region for the last 3 months which gradually increased in size & dull aching pain. He also complained of low grade fever and early satiety. On examination, he had a lump on upper abdomen which was irregular, firm, mildly tender, lobulated surface, restricted mobility, dull on percussion. USG examination of HBS revealed hepatomegaly and SOL in liver. CT abdomen revealed soft tissue mass in left upper abdomen. FNA revealed cells of mesenchymal origin. Per operatively a large lobulated, myxomatous highly vascular mass arising from the fundal part of the stomach was found and removed. Histopathology report comments about two differential diagnosis-leiomyosarcoma and gastrointestinal stromal tumour. CD117 immunostaining confirmed it was gastrointestinal stromal tumor (GIST). Post operatively patient was treated by Imatinib and is now under regular follow up.

Patient with bilateral breast enlargement and hypospadias

A 20 year old man was admitted in the surgical unit of Dhaka Medical College Hospital on August 2007 presented with Hypospadias & underdeveloped penis from childhood, gradual enlargement of both breasts for the last 10 years, absence of axillary and pubic hair from puberty & painful swelling of both testes for the last 3 years. The patient was regarded as a female upto the age of 10 years. He has got no voice change since puberty. On examination he had average body built, there was bilateral gynaecomastia, hypospadias, rudimentary penis & absence of pubic and axillary hair. His testosterone level, serum prolactin level, serum progesterone level, serum estradiol level was done. Cytology on buccal smear done and ultrasonography revealed no ovary and uterus. Ultimately patient was diagnosed as a case of androgen insensitivity syndrome (AIS). The case is reported for clinical awareness & to share our experience.

The effect of IVX-0142, a heparin-derived hypersulfated disaccharide, on the allergic airway responses in asthma

BACKGROUND

IVX-0142 is a heparin-derived hypersulfated disaccharide devoid of anticoagulant activity while possessing anti-allergic and anti-inflammatory activity in preclinical studies. In a proof-of-concept study, the allergen inhalation challenge model was used to investigate the effect of IVX-0142 in mild atopic asthma.

METHODS

Nineteen subjects, not on controller medications, were randomized to an evaluator-blind, placebo-controlled, cross-over study. The effect of a single nebulized dose of IVX-0142 (80 mg) or placebo administered 30 min prior to allergen inhalation was evaluated on the allergic airway responses, airway responsiveness, and airway inflammation.

RESULTS

When compared with placebo, 14 and 13 subjects experienced a relatively smaller maximum fall in forced expiratory volume in 1 s (maxFEV(1)%) for the early airway response (EAR) and late airway response (LAR) with IVX-0142, respectively (P < 0.01). The degree of attenuation in the EAR [maxFEV(1)% (mean +/- SE) 26.5 +/- 2.8%vs placebo 31.0 +/- 2.8%, P = 0.059] and LAR (15.6 +/- 2.9%vs placebo 19.0 +/- 2.9%, P = 0.24) with IVX-0142, however, was small and did not reach statistical significance compared with placebo. Similarly, a trend in the attenuation of allergen-induced increase in the absolute sputum cell counts was also observed. No difference in the allergen-induced increase in airway hyper-responsiveness and exhaled nitric oxide was noticed.

CONCLUSIONS

The majority of mild atopic asthmatics demonstrated a reduction in the EAR and LAR to IVX-0142. However, the treatment effect observed with a single prechallenge dose of IVX-0142 was small and heterogeneous. The potential anti-allergic and anti-inflammatory effects using multiple higher doses need to be evaluated.

Cytomegalovirus induced hepatitis in an immunocompetent host

Cytomegalovirus (CMV) infection is most commonly sub clinical. In the immunocompromised host, primary CMV infection, reactivation and re-infection are all associated with significant morbidity and mortality. The clinical presentation of CMV infection in immunocompromised host varies according to the degree of immunocompromisation and to host factors. Populations at greatest risk of CMV infection and disease include individuals with HIV infection, transplant recipients, cancer patients receiving chemotherapy and burn patients. In the immunocompetent adult, primary CMV infection is usually asymptomatic but can result in a mononucleosis syndrome. The clinical course of the infection is usually mild, although a small percentage of patients suffer from protracted and severe fever. CMV infection in immunocompetent hosts may rarely be able to lead to severe organ specific complications. Most cases of CMV induced hepatitis occur in adults with severe immune deficiency. Only a few cases involving immunocompetent patients have been reported. But majority of the cases are anicteric or mildly icteric. Severe hepatitis is an uncommon presentation. We describe the first case reported in Bangladesh, of Cytomegalovirus induced severe hepatitis in an immunocompetent patient. The case was improved without the use of antiviral therapy.

Cyclic esotropia

Cyclic esotropia is a rare condition in which esotropia alternates with binocular single vision (BSV). A five years old female child presented with the complain of acute onset infrequent squinting of left eye (L/E) for 3 years. Squinting of L/E starts in morning and persists throughout the day. The child becomes completely normal on the following morning without any residual effect. Initially there was 24 hours squinting followed by several months of non-squinting. Gradually interval is lessening. For the last 6 months, she was esotropic for 24 hours and non-esotropic for another 24 hours. She complains of no diplopia during the attack. On examination she is otherwise healthy and hypermetropic by +0.50Dsph on cycloplegic refraction with normal visual acuity (6/6, N5). She was 50 prism diopter esotropic in her left eye on esotropic day both for distant and near fixation and had alternate suppression. Ocular motility is full. Anterior and posterior segment reveals no abnormality. There is BSV with positive stereoscopic vision on Titmus test (40 sec of Arc) on non-esotropic day. This case can be treated surgically either by bilateral medial rectus recession or by recession of medial rectus and resection of lateral rectus of the eye according to the amount of esotropia on the esotropic day.