Clinical Profile and Outcome of Intracranial Meningioma in Apollo Hospitals Dhaka

Background: A meningioma is a tumor that arises from the meninges- the membranes that surround the brain and spinal cord.Objective: This is a retrospective analysis of the recorded data of patients managed for intracranial meningiomas between January 2007 and June 2015 at Apollo Hospital, Dhaka.Methodology: Demographic data was analyzed for all but only patients who had surgery and histological diagnosis were analyzed for outcome.Results: This study shows that meningiomas had female preponderance. Majority cases were above 50 years of age. Convexity is the most common anatomical location of meningioma. Most common symptoms were headache (70%) followed by seizure in 34.3% of patients. 90% of the cases were benign. Malignant meningioma was 1.4% and recurrence was found in 1.4% of cases. Six patients with histological grades I, II and III meningi- omas were sent for stereotactic radiotherapy after incomplete tumor resection or for residual tumour. Total removal was done in 80% cases and the mortality was 1.4%, in patient who had poor GCS score on admission.Pulse Vol.9 January-December 2016 p.22-26

Evaluation of iris functional capillary density in experimental local and systemic inflammation

The ocular microcirculation represents an important target to treat inflammatory diseases of eye, where impairment of microvascular blood flow plays key role as, for example, in anterior uveitis. To evaluate novel interventions targeting the microcirculation, appropriate and reliable tools to study this particular microvascular bed are needed. Intravital microscopy (IVM) belongs to several methods allowing evaluation of microcirculation experimentally, even in small animals. The aim of our study was to examine the iridial microcirculation (IMIC) in uveitis induced by local or systemic endotoxin administration in rats and mice by IVM and to propose new parameters to quantify the changes within the IMIC. Systemic inflammation was induced in rats by intravenous endotoxin administration, control group received normal saline intravenously. Local inflammation was induced in mice by intravitreal endotoxin administration, the control group received normal saline intravitreally. IVM of IMIC was performed in animals receiving systemic endotoxin prior injection and 1 and 2 h afterwards, respectively, in animals receiving intravitreal endotoxin/saline prior local injection and 5 h afterwards. Obtained video recordings were analyzed off-line. Functional capillary density (FCD) and dysfunctional capillary density (DCD) were evaluated for description of IMIC, and calculation of FCD/DCD ratio was performed. In systemic inflammation, FCD was significantly decreased compared to control animals. In local inflammation, the number of functional capillaries in the IMIC was significantly reduced following the endotoxin challenge. Analysis of the DCD revealed a significant increase in capillaries with reduced perfusion after intravitreal endotoxin administration and right shift of the FCD/DCD ratio was observed after endotoxin local injection. Detecting and quantifying changes in IMIC during systemic or local inflammation in experimental animals by IVM was feasible. Therefore, IVM of the IMIC represents a valuable tool to evaluate and quantify inflammatory changes in experimental eye disease.

Gastrointestinal nematode larvae in the grazing land of cattle in Guwahati, Assam

Aim:

To know the prevalence of gastrointestinal nematode larvae (L₃) in the grazing land of cattle in Guwahati, Kamrup district, Assam.

Materials and Methods:

Pastures were collected and examined for the presence of nematode larvae (L₃) from six localities of Guwahati at monthly interval from August 2012 to July 2013. The counted larvae were then expressed as per kg dry matter of herbage (L₃/kg DM).

Results:

Examination of pastures revealed presence of nematode larvae (L₃) in pastures throughout the year which varied from 4.5 L₃/kg DM in January to a maximum of 106.33 L₃/kg DM in August. The L₃ of Haemonchus contortus, Trichostrongylus spp., Oesophagostomum spp., Cooperia spp., and Mecistocirrus spp. were recovered from pastures. The average pasture larval burden (PLB) was 34.75±3.48 L₃/kg DM. Season-wise PLB revealed the presence of 23.89±3.01, 67.54±5.41, 26.67±1.92, and 7.28±0.89 L₃/kg DM during pre-monsoon, monsoon, post-monsoon, and winter seasons, respectively. Monsoon season has significant (p<0.05) effect on PLB. However, analysis of variance of different locations with respect to season revealed that there was no significant difference but season-wise it was highly significant (p<0.01). Pearson correlation of environmental variables (temperature, relative humidity, and rainfall) with PLB revealed correlation was statistically significant with rainfall (p<0.05).

Conclusion:

This study reveals the presence of five nematode larvae (L₃) in the pastures of Guwahati, Assam throughout the year, statistically significant during monsoon season.

The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm

Objectives

Conservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality.

Study design

A prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone.

Methods

Patients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention.

Results

Sixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality.

Conclusion

Conservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality.

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The retropharyngeal abscess is a deep neck space infection commonly seen in the pediatric population.

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Drainage of these abscesses is associated with multiple complications.

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Patient presenting with hoarseness requires surgical intervention.

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Conservative management can be successfully performed in patients who have abscesses that are greater than 2 cm.

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Patients treated with antibiotic alone need to be closely followed up for lack of improvement or deterioration.

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.

Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Background

Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs.

The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.

Methods/design

This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.

Discussion

A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.

Trial registration

Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.

Genetic characterization of cysteine-rich type-b avenin-like protein coding genes in common wheat

The wheat avenin-like proteins (ALP) are considered atypical gluten constituents and have shown positive effects on dough properties revealed using a transgenic approach. However, to date the genetic architecture of ALP genes is unclear, making it impossible to be utilized in wheat breeding. In the current study, three genes of type-b ALPs were identified and mapped to chromosomes 7AS, 4AL and 7DS. The coding gene sequence of both TaALP-7A and TaALP-7D was 855 bp long, encoding two identical homologous 284 amino acid long proteins. TaALP-4A was 858 bp long, encoding a 285 amino acid protein variant. Three alleles were identified for TaALP-7A and four for TaALP-4A. TaALP-7A alleles were of two types: type-1, which includes TaALP-7A1 andTaALP-7A2, encodes mature proteins, while type-2, represented byTaALP-7A3, contains a stop codon in the coding region and thus does not encode a mature protein. Dough quality testing of 102 wheat cultivars established a highly significant association of the type-1 TaALP-7A allele with better wheat processing quality. This allelic effects were confirmed among a range of commercial wheat cultivars. Our research makes the ALP be the first of such genetic variation source that can be readily utilized in wheat breeding.

Phenotypic Characteristics of Commercial Layer Strains, ISA Brown and Hisex Brown

The study was conducted to observe and compare the phenotypic characteristics of ISA brown and Hisex brown commercial layer strains. A total of 200 birds were examined out of 36000 in a commercial layer farms at Chandonysh upazila (sub-district) of Chittagong district, Bangladesh during the period of July to December, 2013. Observable difference was found in several phenotypic characteristics like plumage, beak, shank, egg, comb color and comb type between ISA brown and Hisex brown. In ISA brown shank length (cm), egg weight (gm) and body weight (gm) was 3.32±0.01, 59.44±0.47 and 1846.60±11.18 respectively where in case of Hisex brown it was 3.11±0.00, 55.82±0.45 and 1769.10±33.90. Significant (P<0.05) difference was found in shank length (cm), egg weight (gm) and body weight (gm). In ISA brown beak length and age at first lay was 2.02±0.01 and 141±0.51 respectively, On the other hand for Hisex brown, it was 2.02 ± 0.01 and 141 ± 0.58. There was no Significant (P>0.05) difference between the strains in respect of shank length, egg weight and body weight. Some innate characteristics of studied strains differentiate them and any improvement program of commercial layer strains should be incorporate production objectives and trait performance of the society.International Journal of Natural Sciences (2015), 5(2) 41-45

The largest and neglected giant phyllodes tumor of the breast-A case report and literature review

INTRODUCTION

Phyllodes tumours are rare fibro-epithelial lesions. The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. Wide local excision or mastectomy with adequate margin remains the treatment of choice. Local recurrence occurs in approximately 10- 16.1% of patients (Wei et al., 2014) [1] and distant metastases occurs in 6.3-31% of patients with malignant phyllodes tumours (Wei et al. (2014), Chaney et al., 1998) [1,2] but only in 4% of all phyllodes tumours (Salvador et al., 1989) [3]. Emphasis should be given in early diagnosis and intervention to decrease morbidity and mortality.

Relationships between misreported energy intake and pregnancy in the pregnancy, infection and nutrition study: new insights from a dynamic energy balance model

OBJECTIVE

Providing effective dietary counselling so that pregnancy weight gain remains within the 2009 Institute of Medicine (IOM) guidelines requires accurate maternal energy intake measures. Current practice is based on self-reported intake that has been demonstrated unreliable. This study applies an objective calculation of energy intake from a validated mathematical model to identify characteristics of individuals more likely to misreport during pregnancy.

METHODS

A validated maternal energy balance equation was used to calculate energy intake from gestational weight gain in 1,368 subjects. The difference between self-reported and model-predicted energy intake was tested for demographics, economic status, education level and maternal health status.

RESULTS

A weight gain of 15.2 kg resulted in model-predicted intake during pregnancy of 2,882.97 ±  135.71 kcal day-1, which differed from self-reported intake of 2,180.5 ± 856.0 kcal day-1. The achieved weight gain exceeded the IOM guidelines; however, the model predicted weight gain from self-reported energy intake was below IOM guidelines. Higher income (p = 0.004), education (p = 0.003), birth weight (p = 0.017), gestational diabetes (p = 0.008) and pre-existing diabetes (p < 0.001) were associated with under-reported energy intake. More children living at home (p = 0.001) were associated with more accurate self-reported intake.

CONCLUSIONS

When assessing self-reported energy intake in pregnancy studies, birth weight, gestational diabetes status, pre-existing diabetes, higher income and education predict higher under-reporting. Clinicians providing dietary treatment recommendations during pregnancy should be aware that individuals with pre-existing diabetes and gestational diabetes mellitus are more likely to misreport their intake. Additionally, the systems model approach can be applied early in intervention to objectively monitor dietary compliance to treatment recommendations.

Nicotinamide Phosphoribosyltransferase Attenuates Methotrexate Response in Juvenile Idiopathic Arthritis and In Vitro

Variability in response to methotrexate (MTX) in the treatment of juvenile idiopathic arthritis (JIA) remains unpredictable and poorly understood. Based on previous studies implicating an interaction between nicotinamide phosphoribosyltransferase (NAMPT) expression and MTX therapy in inflammatory arthritis, we hypothesized that increased NAMPT expression would be associated with reduced therapeutic response to MTX in patients with JIA. A significant association was found between increased plasma concentrations of NAMPT and reduced therapeutic response in patients with JIA treated with MTX. Inhibition of NAMPT in cell culture by either siRNA‐based gene silencing or pharmacological inhibition with FK‐866 was found to result in a fourfold increase in the pharmacological activity of MTX. Collectively, these findings provide evidence that NAMPT inhibits the pharmacological activity of MTX and may represent a predictive biomarker of response, as well as a therapeutic target, in the treatment of JIA with MTX.

Requirements for the formal representation of pathophysiology mechanisms by clinicians

Knowledge of multiscale mechanisms in pathophysiology is the bedrock of clinical practice. If quantitative methods, predicting patient-specific behaviour of these pathophysiology mechanisms, are to be brought to bear on clinical decision-making, the Human Physiome community and Clinical community must share a common computational blueprint for pathophysiology mechanisms. A number of obstacles stand in the way of this sharing-not least the technical and operational challenges that must be overcome to ensure that (i) the explicit biological meanings of the Physiome's quantitative methods to represent mechanisms are open to articulation, verification and study by clinicians, and that (ii) clinicians are given the tools and training to explicitly express disease manifestations in direct contribution to modelling. To this end, the Physiome and Clinical communities must co-develop a common computational toolkit, based on this blueprint, to bridge the representation of knowledge of pathophysiology mechanisms (a) that is implicitly depicted in electronic health records and the literature, with (b) that found in mathematical models explicitly describing mechanisms. In particular, this paper makes use of a step-wise description of a specific disease mechanism as a means to elicit the requirements of representing pathophysiological meaning explicitly. The computational blueprint developed from these requirements addresses the Clinical community goals to (i) organize and manage healthcare resources in terms of relevant disease-related knowledge of mechanisms and (ii) train the next generation of physicians in the application of quantitative methods relevant to their research and practice.

Abstract P1-01-11: Nuclear immunohistochemical IKK-ϵexpression in flat epithelial atypia (FEA) of the breast: A predictor of ipsilateral ADH, in-situ or invasive malignancy?

Background:Flat Epithelial Atypia of the breast (FEA) is associated with in situ and invasive low grade neoplasia. However, the role of excision after FEA on biopsy is controversial as rates of upgrading to atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) or invasive carcinoma in subsequent excision are relatively low. Problems include difficulties in inter-observer reproducibility and lack of morphologic or immunohistochemistry (IHC) tools that better identify cases at risk for concurrent ADH/Carcinoma. Nuclear image analysis may be useful, but is not widely available. IKK-ϵ, part of the NF-kB activating pathway, is absent in normal breast epithelium and non atypical (usual) ductal hyperplasia, but is over-expressed in &gt;30% of breast cancers. In addition, in our experience ADH/DCIS shows IKK-ϵ staining, mostly cytoplasmic. Of note, in prostate cancer, nuclear accumulation of IKK-ϵ has been described in hormone sensitive prostate disease while cytoplasmic accumulation is associated with metastatic progression. No previous studies of IKK-ϵ levels in FEA are reported. Here we report IKK-ϵ status in FEA and correlation with ipsilateral, synchronous ADH, DCIS or invasive carcinoma.

Method: Resection specimens from 61 patients with diagnosis of FEA were retrieved. Presence of ADH/carcinoma and laterality (ipsi or contralateral) was recorded. Synchronous neoplasia was defined as ADH, DCIS or invasive carcinoma diagnosed within 6 months of the diagnosis of FEA. Presence of FEA was confirmed by three observers using strict morphologic criteria. IHC for IKK-ϵ was performed using ABCAM, rabbit anti-IKK-ϵ (ab7891) and pH 6 citrate buffer heat-induced epitope retrieval for 20 minutes. IHC slides were scanned and FEA regions captured for blind scoring of nuclear and cytoplasmic staining. Cut off for positive nuclear staining was 10% and cytoplasmic staining was graded as negative, weak, moderate or strong positive.

Results:40 patients had ipsilateral synchronous ADH/carcinoma, and 21 did not. Within these groups, 6 patients had contralateral ADH/carcinoma (2 with and 4 without ipsilateral neoplasia). While cytoplasmic staining showed no difference between the groups, nuclear positivity was more frequent in cases with ipsilateral synchronous ADH/carcinoma, χ2(1, N = 61) = 5.1, p = .025 (Table 1). In contrast, there was no correlation between IKK-ϵ staining and ADH/carcinoma in the opposite breast (p=.25).

Table 1Nuclear IKK-eSynchronous Ipsilateral ADH/DCIS/Carcinoma Negative (%)Positive (%)TotalNegative10 (48)11 (52)21Positive10 (25)30 (75)40

Conclusion:Nuclear IKK-ϵ staining may prove useful in predicting synchronous ipsilateral ADH or malignancy in cases of FEA in biopsy material. Given its more frequent association with ipsilateral synchronous ADH/carcinoma, IKK-ϵ nuclear expression in FEA may represent a step in continuous local oncogenesis rather than a general marker of risk. Given the pleiotropic role of IKK-ϵ in growth and survival, the significance of the shift from nuclear staining in FEA to cytoplasmic staining in ADH/DCIS may reflect different signaling pathways and requires further investigation. Further validation of our findings in larger cohorts is necessary.

Citation Format: Williams PA, Parra-Herran CE, Ayroud Y, Islam S, Gravel DH, Robertson SJ, Pratt C. Nuclear immunohistochemical IKK-ϵexpression in flat epithelial atypia (FEA) of the breast: A predictor of ipsilateral ADH, in-situ or invasive malignancy?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-11.

Treatment referral system for tuberculosis patients in Dhaka, Bangladesh

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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