Ondansetron versus granisetron in the prevention of chemotherapy induced nausea and vomiting in children with acute lymphoblastic leukemia

Effect of ondansetron and granisetron were evaluated in sixty (60) children (age 4-11 years) irrespective of sex, diagnosed case of acute lymphoblastic leukemia (ALL) who received high dose methotrexate and did not receive any antiemetic 24 hours prior to HDMTX. This was a prospective, randomized, double-blind, single center study. Of 60 children, 30 received oral ondansetron (4mg) and rest 30 granisetron (1mg) half an hour before therapy. Drugs were randomly allocated with appropriate code. The patients were followed up from day 1 to day 5 of therapy. Episodes of nausea and vomiting were recorded and scorings was done every 24 hours following chemotherapy. No significant difference was found between two groups according to acute emesis (Day-1) (p=0.053). In day two and day three it was significant (p<0.05). In day four it was significant (p=0.002). Early chemotherapy induced nausea and vomiting (CINV) were controlled 90% in children who received granisetron and 70% in children who received ondansetron. Delayed (Day 2-4) CINV were controlled in 80% of children who received granisetron and 43.4% who received ondansetron (p<0.05). Granisetron group required additional doses only 3.3% cases and ondanseton group 30% cases on the second day (p<0.05). Result was significant between two groups. About 36.7% patients had episodes of nausea on day four of chemotherapy in ondansetron group and it was only 3.3% in granisetron group due to adverse effects of antiemetic drug itself (p=0.001). Maximum episodes of vomiting were found on the second day in ondansetron group 33.3% and in granisetron group 3.3% (p=0.003). Though adverse effects like headache, constipation, abdominal pain and loose motion were common in both group of children but their number was much less in children who received granisetron. On second day of therapy score of nausea and vomiting was maximum in ondansetron and minimum in granisetron treated on day 4 and the result was significant. So, to prevent acute and delayed CINV in children with ALL, oral graniseteron can be considered as more effective and well tolerated with minimum adverse effects compared with ondansetrons.

Correlation between clinical presentation, peroperative finding and histopathological report in acute appendicitis

Acute appendicitis is usually encountered clinically as acute abdomen. Typical cases are easy to diagnose, but sometimes it is very difficult to make a diagnosis in atypical cases. The objective of the study was to determine the diagnostic accuracy in patient of clinically diagnosed acute appendicitis. This prospective study conducted in Mymensingh medical college hospital on 1136 patients presented with acute abdomen and clinically diagnosed as acute appendicitis from July 2004 to June 2010. Emergency appendicectomy was done in all consecutive patients after relevant investigation. Intraoperative findings along with histopathological reports were compared with clinical diagnosis. On the basis of histopathological report, 85.65% were found to have acute appendicitis with misdiagnosis in rest of the subjects requiring unnecessary explorations. Negative exploration was more in emergency than office hour. This may be due to diagnostic inaccuracy and decision-making in the management of the acute appendicitis. Management errors can be significantly reduced by accurate preoperative diagnosis of acute appendicitis by improving clinical skill and appropriate investigations.

An overview of Brucellosis

Brucellosis is the most important zoonotic disease caused by Brucella species comprising Gram negative, facultative, intracellular pathogens. The true incidence of human brucellosis is unknown for most countries of the world including Bangladesh. But brucellosis is not uncommon in our country. Due to its increasing incidence in many countries of the world it is an important issue now days. Domestic animals such as cattle, goats, sheep, pigs, camel, buffalo and dogs serve as a reservoir hosts. Transmission of brucellosis to humans occurs through the consumption of infected, unpasteurized animal milk and milk products, through direct contact with infected animal parts, through ruptures of skin and mucous membranes and through the inhalation of infected aerosolized particles. Due to variability of clinical features and limited availability of laboratory facilities, the disease remains largely under-reported. Early and specific diagnosis is important to ensure a favourable outcome regarding this zoonotic disease.

Effects of transportation on expression of Hsp90, Hsp70, Hsp27 and αB-crystallin in the pig stomach

Twenty pigs were randomly divided into four groups based on the amount of time spent in transport (zero, one, two or four hours). Pathological examination of all transported pigs showed that exfoliation of chief cells from the gastric surface occurred in pigs during transportation. These results imply that integrity of the gastric mucosa was compromised by damage occurring during the four-hour transportation, despite the fact that gastric ulcers were not present. Levels of Hsp90 expression in stomach tissues were significantly decreased (P<0.01) after two-hour transportation, but Hsp70 levels increased significantly (P<0.05) after one, two and four hours of transportation. Hsp27 levels remained relatively stable independent of the length of transport. Levels of αB-crystallin expression in the stomach were significantly increased (P<0.05) after four hours of transportation. Variations in Hsp90, Hsp70, Hsp27 and αB-crystallin levels suggest that distinct protective functions are modulated by different Hsps in stomach tissues during transportation. Alterations in Hsp70 and αB-crystallin expression appear to be associated with protective functions, as no apparent gastric ulcers were present in pigs that underwent four hours of transportation. Levels of heat shock transcription factor-1, which regulate the expression of Hsps, remained relatively stable independent of the transportation period.

Novel TMPRSS3 variants in Pakistani families with autosomal recessive non-syndromic hearing impairment

Mutations in the TMPRSS3 gene are known to cause autosomal recessive non-syndromic hearing impairment (ARNSHI). After undergoing a genome scan, 10 consanguineous Pakistani families with ARNSHI were found to have significant or suggestive evidence of linkage to the TMPRSS3 region. In order to elucidate if the TMPRSS3 gene is responsible for ARNSHI in these families, the gene was sequenced using DNA samples from these families. Six TMPRSS3 variants were found to cosegregate in 10 families. None of these variants were detected in 500 control chromosomes. Four novel variants, three of which are missense [c.310G>A (p.Glu104Lys), c.767C>T (p.Ala256Val) and c.1273T>C (p.Cys425Arg)] and one nonsense [c.310G>T (p.Glu104Stop)], were identified. The pathogenicity of novel missense variants was investigated through bioinformatics analyses. Additionally, the previously reported deletion c.208delC (p.His70ThrfsX19) was identified in one family and the known mutation c.1219T>C (p.Cys407Arg) was found in five families, which makes c.1219T>C (p.Cys407Arg) as the most common TMPRSS3 mutation within the Pakistani population. Identification of these novel variants lends support to the importance of elements within the low-density lipoprotein receptor A (LDLRA) and serine protease domains in structural stability, ligand binding and proteolytic activity for proper TMPRSS3 function within the inner ear.

Studies on the antidiarrhoeal, antimicrobial and cytotoxic activities of ethanol-extracted leaves of yellow oleander (Thevetia peruviana)

This study screened the antidiarrhoeal, antimicrobial and cytotoxic effects of ethanol-extracted leaves of yellow oleander (Thevetia peruviana). The extract was tested against castor oil-induced diarrhoea in a model of albino rats and showed significant antidiarrhoeal activity (P<0.01). Disc diffusion technique was used to test the in vitro antibacterial activities of the extract and exhibited poor antibacterial activities against both Gram positive and Gram negative bacteria (mainly Bacillus sp). Ethanol-extracted leaves of yellow oleander showed narrow zone of inhibition in the bacterial lawns of Shigella flexineri, Salmonella typhi, Klebsiella sp, Staphylococcus aureus and Shigella sonnei. Cytotoxicty was determined against brine shrimp nauplii and LC50 of the plant extract was determined as 627.21�g/ml. The wide range of LC50 value denotes the safety effect of the extract.

Human thelaziasis in Bangladesh

Very few cases of Human Thelaziasis are reported worldwide. This is the first case of its kind from Bangladesh. A 58 years old man was admitted to Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, with itching, redness, foreign body sensation, lacrimation & filamentary discharge from right eye (R/E). He had visual acuity <6/60, conjunctival congestion & advanced bi-headed pterygium of R/E. After exposure of R/E ball with universal eye's speculum, a thin white nematode was found into the right lower conjunctival fornix. It was taken out by a plain forceps, placed into a bottle containing Hartman's solution & immediately sent to Microbiology department of Mymensingh Medical College for proper identification. Subsequently with the joint collaboration & detailed examination by the Parasitology department of Bangladesh Agricultural University (BAU), Mymensingh, the nematode was identified as an adult Thelazia callipaeda worm.

Studies on the antidiarrhoeal, antimicrobial and cytotoxic activities of ethanol-extracted leaves of yellow oleander (Thevetia peruviana)

This study screened the antidiarrhoeal, antimicrobial and cytotoxic effects of ethanol-extracted leaves of yellow oleander (Thevetia peruviana). The extract was tested against castor oil-induced diarrhoea in a model of albino rats and showed significant antidiarrhoeal activity (P<0.01). Disc diffusion technique was used to test the in vitro antibacterial activities of the extract and exhibited poor antibacterial activities against both Gram positive and Gram negative bacteria (mainly Bacillus sp). Ethanol-extracted leaves of yellow oleander showed narrow zone of inhibition in the bacterial lawns of Shigella flexineri, Salmonella typhi, Klebsiella sp, Staphylococcus aureus and Shigella sonnei. Cytotoxicty was determined against brine shrimp nauplii and LC50 of the plant extract was determined as 627.21μg/ml. The wide range of LC50 value denotes the safety effect of the extract.

A young lady with secondary tuberculosis of breast

Tuberculosis of breast is an extremly rare form of extrapulmonary tuberculosis even in endemic area like Bangladesh and the incidence is 0.25-4.5% of all breast lesions. The diagnosis is difficult because of nonspecific clinical, radiological and histopathological findings. Very often biopsy specimens are inadequate and microscopy or culture is negative. It is usually suspected in a multiparous woman who may be immunocompromised. We report a case of breast tuberculosis in a 26 years old multiparous lady who previously present with two times attack of right sided breast lump and then diagnosed as a case of breast abscess and treated by incision and drainage with antibiotics in a nearby local hospital. During her third time attack she admitted into Mymensingh Medical College Hospital with right sided breast lump with multiple discharging sinuses for one month. Biopsy was taken from the lump and sinus tract and histopathological report confirmed the diagnosis as a case of tuberculosis of breast. Her X-ray chest showed tubercular lesion in lungs. So this is a case of secondary breast tuberculosis. This case highlights how difficult is the diagnosis of a case of breast tuberculosis for which the patient may require even mastectomy at very late case. So this case is reported.

A new generation of X ray irradiators for insect sterilization

Recent fears of terrorism have provoked an increase in delays and denials of transboundary shipments of radioisotopes. This represents a serious constraint to sterile insect technique (SIT) programs around the world as they rely on the use of ionizing radiation from radioisotopes for insect sterilization. To validate a novel X ray irradiator, a series of studies on Ceratitis capitata (Wiedemann) and Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae) were carried out, comparing the relative biological effectiveness (RBE) between X rays and traditional gamma radiation from 60Co. Male C. capitata pupae and pupae of both sexes of A. fraterculus, both 24-48 h before adult emergence, were irradiated with doses ranging from 15 to 120 Gy and 10-70 Gy, respectively. Estimated mean doses of 91.2 Gy of X and 124.9 Gy of gamma radiation induced 99% sterility in C. capitata males. Irradiated A. fraterculus were 99% sterile at approximately 40-60 Gy for both radiation treatments. Standard quality control parameters and mating indices were not significantly affected by the two types of radiation. The RBE did not differ significantly between the tested X and gamma radiation, and X rays are as biologically effective for SIT purposes as gamma rays are. This work confirms the suitability of this new generation of X ray irradiators for pest control programs that integrate the SIT.

Back pain and vertebral compression: an unusual presentation of childhood acute lymphoblastic leukemia

Junayet, a nine years and six months old boy was admitted to the hospital because of back pain and vertebral compression fractures. The boy had been well until two months earlier, when he began to have back pain after falling on his back along with occasional fever. The pain was intermittent initially but gradually it became constant. One month before admission, he fell again and the back pain became deteriorated. He was mildly pale, liver was palpable, skin survey revealed normal, BCG scar mark was present. He had bone pain, cervical lymphadenopathy and a tender swelling on the lumbusacral region. Two weeks before admission, the hematological findings were suggestive of leukemia of lymphoblastic type. Biochemical values were normal except high level of serum lactate dehydrogenase (LDH). Cerebrospinal fluid (CSF) examination was free of malignant cell. Skeletal survey showed diffuse osteopenia of the thoracic and lumber spine with multiple compression fracture of the vertebral bodies of D7, D8, D12 and L1, L3 and L5 with increased disc space. Radiograph of the chest also showed diffuse osteopenia of ribs. Magnetic resonance (MRI) showed uniform signal intensity in the marrow throughout the spine with compressed fracture of the same vertebrae. Bone marrow morphology study and the cytochemistry of the aspirated marrow were consistent with acute lymphoblastic leukemia (ALL-L2). Then, he was started protocol based chemotherapy for induction of remission, consolidation, high dose methotrexate and maintenance therapy. Now, he is on regular follow up with repeated hematological and radiological examinations. Following six month of chemotherapy the boy was found with significant improvement of his physical, hematological and radiological abnormalities.

Extensive skeletal lesions in childhood acute lymphoblastic leukemia

A 2 years old male child was admitted in Dhaka Shishu Hospital with one month history of fever, swelling and pain in joints of right leg. Hematological and microbiological investigation revealed normal except radiological findings when there were destructive lesions of affected bones and thought to be Langerhan's cell histiocytosis but did not respond to treatment. Subsequently, he was transfer to Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) for proper management. On examination, the boy was mildly pale, severe bone pain, no organomegaly but few occipital group of lymphnode were palpable. He had extensive red tender swelling over the hands and legs. Hematological values showed high WBC, low platelet count and lymphoblasts. Biochemical values were high serum LDH and serum uric acid. Skeletal survey showed diffuse osteolytic lesion and osteoporosis with evidence of transverse metaphyseal radiolucent bands (leukemic line), lamellar periosteal reactions and cortical erosions widespread throughout the skeleton with subperiosteal new bone formation. Radioisotop of skeleton showed increase uptake at the site of lesions. Bone marrow aspiration findings were suggestive of ALL-L1 and cytochemistry of aspirate showed PAS positive and Sudan black negative. Immunophenotype confirmed as pre-B ALL, Then, protocol based induction had given for 4 weeks. Thereafter, a short course of intensification followed by maintenance therapy had started with significant improvement of physical, hematological and radiological findings. So, an awareness of varied clinical and radiological manifestations of childhood ALL in bone marrow and skeletal system are needed in order to establish a correct diagnosis when the presenting signs and symptoms are enigmatic. It is also important to keep in mind the possibility of extensive skeletal involvement in ALL, especially when a child present with pain, swelling of limb with walking difficulties. The curability of ALL in contrast to metastatic malignancies makes accurate diagnosis of paramount importance.

Effect of Chronic Renal Failure with and without Secondary Hyperparathyroidism on the Activities of Synaptosomal Tyrosine Hydroxylase and Monoamine Oxidase

Norepinephrine (NE) content, release and uptake by brain synaptosomes are reduced in chronic renal failure (CRF), and this has been attributed to the state of secondary hyperparathyroidism. The decrease in NE content in CRF could not be explained by changes in NE uptake or release since in normal circumstances, NE content usually remains unchanged despite fluctuation in NE uptake and release. Since NE content is determined by its production and degradation, we examined the effect of CRF with and without excess parathyroid hormone (PTH) on the Michaelis-Menton constant (Km) and Vmax of tyrosine hydroxylase (TH), the rate-limiting enzyme for NE production, and monoamine oxidase (MAO), an enzyme involved in NE degradation of brain synaptosomes. Brain synaptosomes from rats with a 21-day CRF have a significantly (p less than 0.01) lower Vmax of TH (39.5 +/- 5.3 pmol tritiated H2O/mg protein/min) than that of normal rats (61. +/- 7.5 pmol tritiated H2O/mg protein/min) and a higher Km of MAO (59 +/- 2.9 nM tyramine) than normal animals (46 +/- 1.7 nM tyramine). Parathyroidectomy (PTX) in CRF rats normalized Vmax of TH (54 +/- 4.5 pmol tritiated H2O/mg protein) and Km of MAO (48.4 +/- 2.3 nM tyramine). Cytosolic calcium, [Ca2+]i, in brain synaptosomes is significantly (p less than 0.01) higher in rats with CRF (488 +/- 8.5 nM) than in normal (355 +/- 6.0 nM) or PTX-CRF (360 +/- 8.1 nM) rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database

OBJECTIVE

To determine the extent to which antibiotics reduce the risk of serious complications after common respiratory tract infections.

DESIGN

Retrospective cohort study.

SETTING

UK primary care practices contributing to the general practice research database.

DATA SOURCE

3.36 million episodes of respiratory tract infection.

MAIN OUTCOME MEASURES

Risk of serious complications in treated and untreated patients in the month after diagnosis: mastoiditis after otitis media, quinsy after sore throat, and pneumonia after upper respiratory tract infection and chest infection. Number of patients needed to treat to prevent one complication.

RESULTS

Serious complications were rare after upper respiratory tract infections, sore throat, and otitis media, and the number needed to treat was over 4000. The risk of pneumonia after chest infection was high, particularly in elderly people, and was substantially reduced by antibiotic use, with a number needed to treat of 39 for those aged > or =65 and 96-119 in younger age groups.

CONCLUSION

Antibiotics are not justified to reduce the risk of serious complications for upper respiratory tract infection, sore throat, or otitis media. Antibiotics substantially reduce the risk of pneumonia after chest infection, particularly in elderly people in whom the risk is highest.

Synthesis and characterization of 2,13- and 3,13-octadecadienals for the identification of the sex pheromone secreted by a clearwing moth

In addition to 2,13- and 3,13-octadecadien-1-ols and their acetates, aldehyde analogs have been identified from lepidopteran species in the family Sesiidae. To establish a reliable analytical method for determining the positions and configurations of the two double bonds in natural pheromone components, all geometric isomers of the 2,13- and 3,13-octadecadienals were synthesized by Dess-Martin oxidation of the corresponding alcohols with limited isomerization of the double bond at the 2- or 3-position. GC-MS analysis of these aldehydes showed isomerization of (Z)-2-, (Z)-3-, and (E)-3-double bonds to an (E)-2-double bond, even with a cool on-column injection. In contrast, HPLC analysis with an ODS column was accomplished without isomerization. The geometric isomers of each dienal eluted in the order ZZ --> EZ --> ZE --> EE. The conjugated 2,13-dienals were detectable in nanogram amounts with a UV detector at 235 nm. Whereas the detection of 3,13-dienals was difficult because of the lack of a chromophore, a highly sensitive analysis was achieved after derivatization with 2,4-dinitrophenylhydrazine. LC-MS with atmospheric pressure chemical ionization showed a strong [M-1](-) at m/z 443 for the derivatives. Based on these analytical data, a pheromone extract of a sesiid moth, Macroscelesia japona, was examined by HPLC and LC-MS, and it was confirmed that the octadecadienal tentatively identified by a previous GC-MS analysis did indeed have the 2E,13Z configuration. Furthermore, field evaluation of four synthetic geometric isomers of the 2,13-dienal revealed specific attraction to a lure with the (2E,13Z)-isomer as a main component.