Clinicopathological profile of patients with abdominal tuberculosis

BACKGROUND

Tuberculosis (TB) is not a uncommon problem throughout the world particularly in the developing countries like Nepal, India and Bangladesh. Abdominal Tuberculosis accounts for nearly 2% of tuberculosis worldwide. The aim of this study was to evaluate the clinicopathological profile with the help of other investigations in the diagnosis of patients with abdominal TB and their response to anti-tubercular therapy. This was a prospective cross-sectional study conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of October 2002 to June 2009.

METHODS

Total 53 patients with abdominal TB diagnosed on the basis of clinical profile and supported investigation data like gross morphological findings at endoscopy, colonoscopy, diagnostic laparoscopy , laparotomy or histologically proven caseating granulomas were selected for this study. Detailed demographic, clinical profile, investigations and treatment response were recorded properly in a predesigned data collection sheet which were analyzed and compared with other studies.

RESULTS

Out of the 53 patients, 33 were males and 20 females with age ranging 16-70 (Mean 30.01±11.7) years. Abdominal pain was the most common presenting symptom in 47 (88.68%), fever in 45 (84.9%) and weight loss in 37 (69.81%) cases. Anemia was found in 41 (77.36%), cachexia 40 (75.47%), ascites 20 (37.74%), palpable abdominal mass in 14 (26.42%) and features of intestinal obstruction in 5 (9.43%) cases. Five patients had positive family history of TB and five had past history of pulmonary TB. The diagnosis of abdominal TB was confirmed microscopically in 5 (9.43%), histopathologically in 31 (58.49%) and the remaining 17 (32.07%) cases were diagnosed by a positive response to anti-TB therapy. According to site of involvement, 31 (58.51%), patients had intestinal TB, 9 (16.98%) had peritoneal TB and disseminated TB in 20 (37.74%) of the case. Twenty seven patients were given 3 drugs regimen for 12 months and 26 patients received 4 drugs regimen for 9 months under close supervision. By 9 months of therapy 51 patients become symptom free and no pathological findings were observed thereafter at follow up visits after 6 months. Response was not satisfactory in two patients and subsequent follow up investigation revealed to have crohn's disease rather than TB and none of them died.

CONCLUSIONS

Abdominal TB is an important clinical entity having varied mode of clinical presentation. So the diagnosis of abdominal TB is difficult and careful approach to the patients and supportive investigation data are necessary to make the final diagnosis. Neither clinical features, laboratory, radiological and Endoscopic methods nor bacteriological and histopathological findings by themselves provide a gold standard in the diagnosis of abdominal TB. In this series of abdominal TB, intestinal TB was the most frequent clinical type and the common presenting symptoms were abdominal pain, fever and weight loss. If diagnosed early, it can be treated successfully with anti-TB drugs.

Role of Saccharomyces boulardii in diarrhea predominant irritable bowel syndrome

Several studies with probiotics have shown promising results in the treatment of IBS. One of the probiotics used was saccharomyces boulardii. This is a randomized double blind placebo controlled clinical trial of S. boulardii in diarrhoea predominant IBS and was carried out in the hospital of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2004 to July 2005. Thirty five (35) patients were included in each of the control and study groups. The study group was treated with S. boulardii 250 mg twice daily orally for one month. Patients were evaluated before therapy, at the end of therapy and 30 days after end of therapy by a scoring system which included symptoms as well as personal and professional life. No significant difference between the two groups was found in any of the parameters evaluated on any of the observation days. S. boulardii treatment for 30 days in diarrhoea predominant IBS patients did not result in any improvement in this study.

Free Health Camps at 476 Upazillas in Bangladesh

DOI:  http://dx.doi.org/10.3329/bmrcb.v37i1.7798 Bangladesh Med Res Counc Bull 2011; 37: 39

Protective potential of Bacopa monniera (Brahmi) extract on aluminum induced cerebellar toxicity and associated neuromuscular status in aged rats

The present study attempts to assess the comparative effects of Bacopa monniera, (40 mg/kg body weight) and donepezil (2.5 mg/kg b. wt) on aluminum (100 mg / kg b. wt. of AlCl3) mediated oxidative damage in the cerebellum of aged rats (24 months) along with the associated dysfunctioning of neuromuscular coordination and motor activity. A significant decrease in the activities of antioxidant enzymes and increased total reacting oxygen species, lipid and protein peroxidation products observed in aluminum exposed rats. We observed that treatment with B. monniera extract restored the altered antioxidant enzyme activities more, when compared with donepezil. However, acetylcholinesterase showed similar effect both in donepezil and B. monniera treated groups. The content of aluminum was increased in all experimental groups, however, iron content was found increased in all groups except the B. monniera treated groups. Moreover, aluminum treated groups of rats exhibited significant changes in behavioral profiles but these changes were in both B. monniera and donepezil treated groups. The light microscopic and ultrastructural studies revealed damaged Purkinje's neurons and altered granular cell layer along with the increased accumulation of lipofuscin granules in aluminum treated animals. These changes were quite less pronounced in B. monniera group than that of donepezil and this may be due to the reduction of excess iron content by B. monniera. On the basis of our results it may be concluded that Al may be linked with cerebellar degeneration and neuromuscular disorders while Bacopa monniera extract helps in reversing these changes.

Regional association analysis delineates a sequenced chromosome region influencing antinutritive seed meal compounds in oilseed rapeThis article is one of a selection of papers from the conference “Exploiting Genome-wide Association in Oilseed Brassicas: a model for genetic improvement of major OECD crops for sustainable farming”

This study describes the use of regional association analyses to delineate a sequenced region of a Brassica napus chromosome with a significant effect on antinutritive seed meal compounds in oilseed rape. A major quantitative trait locus (QTL) influencing seed colour, fibre content, and phenolic compounds was mapped to the same position on B. napus chromosome A9 in biparental mapping populations from two different yellow-seeded × black-seeded B. napus crosses. Sequences of markers spanning the QTL region identified synteny to a sequence contig from the corresponding chromosome A9 in Brassica rapa . Remapping of sequence-derived markers originating from the B. rapa sequence contig confirmed their position within the QTL. One of these markers also mapped to a seed colour and fibre QTL on the same chromosome in a black-seeded × black-seeded B. napus cross. Consequently, regional association analysis was performed in a genetically diverse panel of dark-seeded, winter-type oilseed rape accessions. For this we used closely spaced simple sequence repeat (SSR) markers spanning the sequence contig covering the QTL region. Correction for population structure was performed using a set of genome-wide SSR markers. The identification of QTL-derived markers with significant associations to seed colour, fibre content, and phenolic compounds in the association panel enabled the identification of positional and functional candidate genes for B. napus seed meal quality within a small segment of the B. rapa genome sequence.

Maintenance of glycaemic control with the evening administration of a long acting sulphonylurea in male type 2 diabetic patients undertaking the Ramadan fast

BACKGROUND

In Ramadan, misuse of hypoglycaemic agents, alterations in diet and hypoglycaemia are frequent. This study assessed whether switching to an evening administration of a long acting sulphonylurea during the 29-day, dawn to dusk fast, can maintain glycaemic control in patients with type 2 diabetes.

PATIENTS AND METHODS

Male type 2 diabetic patients from Bangladesh, Pakistan and India, under glycaemic control with gliclazide modified release (MR) 60 mg monotherapy, switched to evening administration of the same dose during Ramadan, and reverted to the morning schedule thereafter. The primary outcome was the difference in fasting plasma glucose (FPG) before and after Ramadan.

RESULTS

In 136 patients, mean (95% CI) FPG decreased by 0.01 mmol/l (0-0.2, p = 0.3) with evening medication by the end of the fast, and increased by 0.2 mmol/l (0.1-0.3, p = 0.01) after reverting to morning medication 20 days later. There were 5 (3.7%) hypoglycaemic episodes before, 3 (2.2%) during and 2 (1.5%) after Ramadan.

CONCLUSION

Male type 2 diabetic patients undertaking the Ramadan fast can safely maintain glycaemic control with evening administration of gliclazide MR 60 mg during the fast, and reverting to a morning schedule thereafter.

The incidence of complications of central venous catheters at an intensive care unit

Central venous catheter (CVC) placement in the intensive care unit (ICU) is a common practice and is being increasingly used also in general wards. Its use is associated with both mechanical and infectious complications.

Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study

BACKGROUND AND STUDY AIMS

Cystic pancreatic lesions (CPLs) are increasingly detected by various imaging studies. Mucinous CPLs carry a risk of malignant transformation but this is often difficult to diagnose preoperatively. In a previous report of 10 suspected mucinous CPLs, the cellular yield of endoscopic ultrasonography (EUS)-guided cytology brushings was found to be superior to the yield from standard fine-needle aspiration (FNA). The aim of this prospective and blinded study was to compare the cytology yield of mucinous epithelium from brushing with FNA in suspected mucinous CPLs.

PATIENTS AND METHODS

In total, 37 patients with 39 CPLs measuring at least 20 mm were enrolled between June 2006 and July 2008 for EUS-cytobrushing and EUS-FNA of CPLs. Demographic, clinical, EUS, cytopathologic, and surgical data were recorded whenever available. Yield of cytology brushings was compared with that of FNA. Procedure morbidity was evaluated after 30 days. The main outcome assessed was yield of intracellular mucin (ICM) on cytobrushing specimens compared with EUS-FNA for the diagnosis of suspected mucinous CPL.

RESULTS

Cytobrushings were more likely to detect ICM than the EUS-FNA method ( P = 0.001). In three patients with hypocellular FNA, dysplasia was found on cytology brushing and later confirmed by surgical pathology. Significant complications occurred in three patients (8 %): one postbrushing bleeding and two acute pancreatitis.

CONCLUSIONS

Cytology brushings are more likely to provide an adequate mucinous epithelium specimen than standard FNA and could aid the diagnosis of CPLs in a selective group of patients.

Sero-epidemiology of sporadic acute hepatitis in Bangladesh: high prevalences of infection with type-B, type-E and multiple types of hepatitis virus

In a recent investigation of hepatitis in Bangladesh, the sera from 74 adult patients (aged 15-67 years) who had been clinically diagnosed as cases of sporadic acute hepatitis were collected at various hospitals in and around Dhaka. Five cases were positive for IgM antibody against the hepatitis A virus and 30 were positive both for the surface antigen of the hepatitis B virus (HBV) and for IgM antibody against the HBV core (HBc). The six cases found positive for antibodies against the hepatitis D virus were all also positive for the HBV surface antigen but negative for anti-HBc IgM. Thirteen patients harboured hepatitis C virus RNA and 29 were positive for IgM antibody against the hepatitis E virus (HEV). There were 14 non-A-to-E subjects, whose illness was of unknown aetiology. Of the 83 infections with hepatitis viruses detected in the other 60 patients, 6%, 36%, 16%, 7% and 35% were of types A, B, C, D and E, respectively. Each of 28 of the patients (47% of those confirmed to have viral hepatitis) had concomitant infection with more than one type of hepatitis virus. The predominance of HBV and HEV infections and the high prevalence of multiple infection seen among these Bangladeshi cases have not been observed among hepatitis cases in developed countries.

Prevalence and health-care seeking pattern of patients with functional diarrhoea in an urban community of Bangladesh

Continuous or recurrent passage of loose (mushy) or watery stools without pain constitutes functional diarrhea (FD). This study aimed to find out the prevalence of functional diarrhea and health care seeking pattern in an urban community of Bangladesh. In this population-based cross-sectional survey 1503 (>/=15 years) subjects from an urban community were personally interviewed in a home setting using a valid questionnaire based on internationally accepted Rome II criteria. For this study, FD was defined as passage of loose or mushy or watery stools more than a quarter (25%) of time without abdominal pain in the last one-year. Significance value was assessed using Chi-squared test and the level of significance was denoted as P value of 0.05 or less. A response rate of 97.2% yielded 1503 questionnaires for analysis. Forty-four subjects were excluded from the study for various illness and denial to participate in the study. A lower prevalence of FD (3.7%) was found in our study population in comparison to irritable bowel syndrome (7.7%) by Rome II definition. Prevalence was found more in males than females (4.4% vs.3.3%) and in the 45-54 years' group. Approximately 26(47.3%) FD subjects consulted a physician in the past one-year with a slightly higher rate of women consulters (57.7%) (P=0.181). The main predictor for health care seeking was presence of multiple symptoms. The prevalence of FD is low in our community in comparison to irritable bowel syndrome. A good number of FD patients do not seek medical care for their illness.

The Effect of Disease Progression on Patient Reported Outcomes in HER-2 Negative Metastatic Breast Cancer Patients

Background: Patients with HER-2 neg metastatic breast cancer (MBC) often experience a wide range of cancer related symptoms, which may impact their quality of life (QoL). We conducted a retrospective analysis to characterize the differences between patient-reported outcomes (PROs) of MBC patients prior to progression of disease (PD) and following PD, and examined the effect of metastases in bone, lung, liver, peritoneum and central nervous system (CNS) on PROs.Methods: 102 HER-2 neg MBC patients were enrolled from 7 community oncology practices within the U.S. The source data comprised data abstracted from medical records and PROs from the 38-item Patient Care Monitor (PCM). The PCM consists of 6 indices including impaired ambulation, impaired performance, general physical symptoms, treatment-related side effects, despair and depression, and acute distress. Linear mixed-effect models were used to analyze change in PCM index scores over time, controlling for individual, disease, and treatment characteristics. Minimum important difference for PCM index scores was estimated to be 1.5 to 3 points (Ringash 2000).Results: The sample (n=102) consists of 72% Caucasian, 25% African American, 3% other race patients, with mean age of 57 years. The ECOG performance status (PS) was unknown in 58% of the cases. Among those with known PS, 79% had a status of 0 or 1. Most patients (87%) had previous surgery, and 62% had received adjuvant chemotherapy. The mean time from metastatic diagnosis to first PD was 14 months. The predominant sites of metastasis were bone (66%), lung (35%), and liver (33%). First line treatment was hormone therapy only for 29%, no treatment recorded for 4%, taxane based for 42%, and non-taxane based for 25%. Linear mixed-effect model results showed modest but statistically significant (p<0.005) worsening for General Physical Symptoms (2.4 points), Acute Distress (2.3 points), and Impaired Performance (1.7 points) scores following PD. The effect of PD was non significant for other index scores. Changes in symptoms severity following PD varied depending on metastasis location, being on chemotherapy, and ECOG status at baseline. There were marked detrimental effects of liver metastasis on Treatment related Side Effects, and of brain metastasis on Acute Distress. The most consistent effect on PROs was associated with PS. Patients with PS of 2 – 4 had worse scores in all areas except Acute Distress and Treatment Side effects.Conclusions: PD was associated with modest but significant worsening of general physical symptoms, acute distress, and impaired performance scores. Patients with poor ECOG PS at baseline were most affected. These findings suggest that delaying disease progression may have a positive impact on patients' QoL.Reference: Ringash J et al. Minimal important difference for quality of life measures is about five to ten percent of the instrument range. Presented at Proc Am Soc Clin Oncol. May 20-23, 2000. New Orleans, LA.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5050.