Treatment with the PI3K inhibitor buparlisib (NVP-BKM120) suppresses the growth of established patient-derived GBM xenografts and prolongs survival in nude rats

Glioblastomas (GBMs) are aggressive brain tumours with a dismal prognosis, despite combined surgery, radio- and chemotherapy. Close to 90 % of all GBMs harbour a deregulated PI3K pathway, which is essential in regulating central cellular functions such as proliferation, cell growth, motility and survival. Thus, PI3K represents a potential target for molecular therapy in GBM. We investigated the anti-tumour efficacy of the PI3K inhibitor buparlisib (NVP-BKM120) in GBM cell lines in vitro and in vivo, when treatment was initiated after MRI-confirmed tumour engraftment. We found that buparlisib inhibited glioma cell proliferation in a dose dependent manner, demonstrated by MTS assay, manual cell count and BrdU incorporation. A dose dependent increase in apoptosis was observed through flow cytometric analysis. Furthermore, by immunocytochemistry and western blot, we found a dose dependent inhibition of Akt phosphorylation. Moreover, buparlisib prolonged survival of nude rats harboring human GBM xenografts in three independent studies and reduced the tumours’ volumetric increase, as determined by MRI. In addition, histological analyses of xenograft rat brains showed necrotic areas and change in tumour cell nuclei in buparlisib-treated animals. The rats receiving buparlisib maintained their weight, activity level and food- and water intake. In conclusion, buparlisib effectively inhibits glioma cell proliferation in vitro and growth of human GBM xenografts in nude rats. Moreover, the compound is well tolerated when administered at doses providing anti-tumour efficacy. Thus, buparlisib may have a future role in glioma therapy, and further studies are warranted to validate this compound for human use.

Communication: Electron ionization of DNA bases

No reliable experimental data exist for the partial and total electron ionization cross sections for DNA bases, which are very crucial for modeling radiation damage in genetic material of living cell. We have measured a complete set of absolute partial electron ionization cross sections up to 500 eV for DNA bases for the first time by using the relative flow technique. These partial cross sections are summed to obtain total ion cross sections for all the four bases and are compared with the existing theoretical calculations and the only set of measured absolute cross sections. Our measurements clearly resolve the existing discrepancy between the theoretical and experimental results, thereby providing for the first time reliable numbers for partial and total ion cross sections for these molecules. The results on fragmentation analysis of adenine supports the theory of its formation in space.

Cutaneous Tuberculosis: An Update

Among extra pulmonary tuberculosis cutaneous tuberculosis occurs rarely, despite a high and increasing prevalence of tuberculosis worldwide particularly in developing countries. Cutaneous tuberculosis can be acquired exogenously or endogenously and present as a diverse of differing clinical morphologies. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. Moreover, microbiological confirmation is poor, despite scientific advances, such as the more frequent use of polymerase chain reaction. Furthermore, treatment of cutaneous tuberculosis is also challenging in many cases.

Comparison between Decompressive Craniectomy with Durotomy and Conservative Treatment in Spontaneous Supratentorial Intracerebral Hemorrhage

Large Intracerebral hematoma (ICH), compounded by perihematomal edema can produce severe elevations of intracranial pressure (ICP). Decompressive craniectomy (DC) beneficially addresses mass effect. Therefore this study is aimed to prove that decompressive craniectomy with durotomy has better outcome in patients with spontaneous supratentorial ICH than conservatively treated patients. This Quasi-Experimental study was carried out in the Department of Neurosurgery, Dhaka Medical College & Hospital (DMCH), Dhaka, Bangladesh from July 2012 to December 2013 using purposive sampling procedure. A total of 80 admitted adult hypertensive patients with spontaneous supratentorial ICH were enrolled in the study population fulfilling all selection criteria. Of them 40 patients underwent decompressive craniectomy with durotomy was considered as surgical group and 40 patients were treated conservatively was considered as conservative group. All the cases were continuously followed up and GCS score at 7(th) day of treatment (D7) and at discharge was recorded. Mean±SD hematoma volume was 56.91±13.72ml in surgical patients and in conservative group 51.80±13.58ml. Outcome measured by modified Rankin Scale at 3 months. Sixty percent (60%) patients had good outcome (mRS 0-4) and 40% patients had poor outcome (mRS 5-6) in surgical group. On the other hand, 52.5% patients had good (mRS 0-4) and 47.5% had poor (mRS 5-6) outcome in conservative group. In logistic regression analysis, conservative group was 3.643 times more prone to develop poor outcome than surgical group which was statistically significant (95% CI, 1.040-13.047; p value <0.05) and volume of hematoma [OR (95% CI), 1.131(1.059-1.207); p value <0.001)] was the most important predictor of outcome. This study indicates that decompressive craniectomy with preservation of brain integrity in patients with spontaneous supratentorial ICH is feasible and safe. It can be a useful alternative surgical procedure in the treatment of spontaneous supratentorial ICH.

Total Serum IgE Level Estimation in Asthma Patient and Healthy Volunteers in a Tertiary Care Hospital, Bangladesh

A strong association between total serum Immunoglobulin E (IgE) levels, skin test reactivity to aeroallergens, and asthma phenotype was found in previous studies. The current study has been undertaken to observe the total serum IgE level in asthmatic patients compared with normal healthy volunteers (control) of Bangladeshi subjects and to see its prospect in diagnostic aid. This case-control study was carried out in the department of Respiratory Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka during the period from July 2008 to June 2009. Four hundred & eight (408) cases (asthmatics matching age, sex and geographic location) and 478 controls (non-asthmatics matching age, sex and geographic location) were studied. The level of serum IgE was found more in asthma patients than control group which were 345.88 and 224.64 respectively (p<0.001). In both group, serum IgE level was more in male than female. There was wide variation in serum IgE level in both the asthma and control group (4.2 to 3471.0 iu/ml in asthma group and 1.2 to 1045.7 iu/ml in control). Considerable overlap has been observed between the IgE values of control and asthma group. Due to this overlap its diagnostic significance in allergic condition in Bangladeshi population seems to be limited.

Surgical Closure of Atrial Septal Defect with High Pulmonary Vascular Resistance--A Case Report

We have reported a case of successful pericardial patch closure of atrial septal defect with high pulmonary vascular resistance in a 32 years aged male. Diagnosis was confirmed by Doppler Echocardiography, Cardiac catheterization and lung biopsy. Before starting (orally) bosentan pulmonary arterial pressure was 105 mm Hg and pulmonary vascular resistance was 8 wood's unit. Bosentan was started at a dosage of 125 mg per day (62.5 mg twice a day) for 4 months before operation in this case. Just day before operation pulmonary arterial pressure was 87 mm Hg. Bosentan lowered pulmonary arterial pressure and reversed remodeling of pulmonary arteries and allowed surgical correction. During the post operative course, partial pressure of oxygen was significantly decreased and bilateral radiolucent opacity was present in lower zone of both lungs. All these were managed successfully in postoperative period. This case report has demonstrated that surgical correction of an atrial septal defect is feasible but requires long time pre and post operative treatment with pulmonary vasodilators.

Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

Patterns of Coronary Artery Anomalous Origin Reviewed by Coronary Angiogram in a Cardiac Center of Bangladesh

Coronary Angiogarm (CAG) has been used to detect coronary artery anomalies. This cross sectional observational study aimed to assess the prevalence of anomalous origin of the coronary artery in the Bangladeshi patients. The researchers summarized responses of the target patients who underwent coronary angiography (CAG) from August 2010 to March 2011 in United Hospital Ltd., Gulshan, Dhaka, Bangladesh and data of anomalous origin of the coronary artery in Bangladeshi patients were recorded. Eighteen hundred (1800) patients underwent CAG during that period; 66 patients with an anomalous origin of the coronary artery were detected, giving a prevalence of 3.6%. The prevalence of anomalous origin of the coronary artery in Bangladeshi people in this study is 3.6%. CAG can visualize the anomalous origin of the coronary artery and is a useful screening modality.

Sociocultural and host factors related to extra-pulmonary tuberculosis in rural Bangladesh: A case control study

Bangladesh ranks sixth among higher TB burden countries. Extra-pulmonary TB contributes 12% of all tuberculosis cases in 2008. Risk factors for EPTB in Bangladesh are hypothesized to be different from pulmonary tuberculosis as seen in other high-burden countries. A case control study was conducted to compare the sociodemographic, household condition and lifestyle characteristics between extra pulmonary and pulmonary tuberculosis. This case control study was conducted in thirteen sub districts of Pabna, Shirajgonj and Cox's Bazar districts from January to June 2013. The samples were classified as either extra pulmonary tuberculosis EPTB (cases) or pulmonary tuberculosis PTB (controls). A total of 490 participants including 245 extra pulmonary tuberculosis (cases) and 245 pulmonary tuberculosis (controls), who were being enrolled in DOTS treatment for last six months, were interviewed for epidemiological and clinical information using a standardized questionnaire. Children, adolescent and younger adults had four-time higher risk of being manifested with extra pulmonary tuberculosis [Adjusted odds ratio (AOR) 3.97; 95% Confidence Interval (CI) 1.10 to 14.35] and (AOR 4.50; 95% CI 1.48 to 13.72). Respondents, who lived in their own houses showed three times more chance of getting extra pulmonary disease (AOR 3.11; 95% CI 1.15 to 8.39). Extra pulmonary tuberculosis was seven to eight times more likely to occur among those whose resided in bedrooms ventilated with one (p= .001) or more windows (p =.004) and having window shutter made of glasses or wood slit raised the probability of getting extra pulmonary involvement by twenty times. Households using grain husk and leaves as cooking fuel revealed seven times higher chance of being manifested as extra pulmonary tuberculosis (P <.001). Extra pulmonary cases were three times more common among respondents, who had no history of exposure with known tuberculosis cases than those who had frequent exposure history (AOR 3.01; 95% CI 1.24 to 7.34). Extra pulmonary tuberculosis was found 1.5 times more common among BCG vaccinated respondents than pulmonary tuberculosis (AOR 1.66; 95% CI 1.06 to 2.58). Younger age, house ownership, bedroom ventilation, fuel material used for cooking, contact history and BCG vaccination status might be the important risk factors for the extra pulmonary manifestation of tuberculosis relative to pulmonary tuberculosis.

Two-year survival following discharge from hospital after spinal cord injury in Bangladesh

STUDY DESIGN

Mixed retrospective-prospective cohort study.

OBJECTIVES

To determine 2-year survival following discharge from hospital after spinal cord injury in Bangladesh.

SETTING

Bangladesh.

METHODS

Medical records were used to identify all patients admitted in 2011 with a recent spinal cord injury to the Centre for Rehabilitation of the Paralysed, a large Bangladeshi hospital that specialises in care of people with spinal cord injury. Patients or their families were subsequently visited or contacted by telephone in 2014. Vital status and, where relevant, date and cause of death were determined by verbal autopsy.

RESULTS

350 of 371 people admitted with a recent spinal cord injury in 2011 were discharged alive from hospital. All but eleven were accounted for two years after discharge (97% follow-up). Two-year survival was 87% (95% CI 83% to 90%). Two-year survival of those who were wheelchair-dependent was 81% (95% CI 76% to 86%). The most common cause of death was sepsis due to pressure ulcers.

CONCLUSION

In Bangladesh, approximately one in five people with spinal cord injury who are wheelchair-dependent die within two years of discharge from hospital. Most deaths are due to sepsis from potentially preventable pressure ulcers.

Comparative study of early and conventional catheter removal following buccal mucosal graft urethroplasty

The duration of catheterization period following urethroplasty is a great controversy. For buccal mucosal graft urethroplasty recommended catheterization period ranges from 2-4 weeks. In recent years, early catheter removal has been advocated for several reasons. Early catheter removal improves both patient comfort, mobility and reduces catheter related complications and shortens post operative hospital stay. This prospective observational study was done from January 2007 and December 2008, 50 patients underwent dorsal onlay buccal mucosal graft urethroplasty for stricture urethra. Among them 25 cases were selected for early catheter removal on 7th postoperative day and 25 cases for conventional catheter removal at 3 weeks. Three patients (12%) of early catheter removal group and 2 patients (8%) of conventional catheter removal group exhibited periurethral leakage. One patient (4%) and three patients (12%) developed wound infection in early and conventional catheter removal group respectively. No significant difference was observed in urinary flow (p=0.089). In these two groups the mean postoperative hospital stay was significant (p<0.001). Early catheter removal on 7th postoperative day is safe and has better impact on patient comfort with minimum catheter related complications and shortens hospital stay.

Simple top-down preparation of magnetic Bi₀.₉Gd₀.₁Fe₁-xTixO₃ nanoparticles by ultrasonication of multiferroic bulk material

We present a simple technique to synthesize ultrafine nanoparticles directly from bulk multiferroic perovskite powder. The starting materials, which were ceramic pellets of the nominal compositions Bi₀.₉Gd₀.₁Fe₁-xTixO₃ (x = 0.00-0.20), were prepared initially by a solid state reaction technique, then ground into micrometer-sized powders and mixed with isopropanol or water in an ultrasonic bath. The particle size was studied as a function of sonication time with transmission electron microscopic imaging and electron diffraction that confirmed the formation of a large fraction of single-crystalline nanoparticles with a mean size of 11-13 nm. A significant improvement in the magnetic behavior of Bi₀.₉Gd₀.₁Fe₁-xTixO₃ nanoparticles compared to their bulk counterparts was observed at room temperature. This sonication technique may be considered as a simple and promising route to prepare ultrafine nanoparticles for functional applications.

A comparative study of chemical and immunological method of fecal occult blood test in the diagnosis of occult lower gastrointestinal bleeding

Fecal occult blood test is the most widely used screening test for diagnosis of gastrointestinal bleeding disorders specially colorectal carcinoma. Among the various methods of fecal occult blood tests, chemical method is being used commonly, but the method has some drawbacks like low participation rate, high false positive rate, low sensitivity etc. To overcome these short comings, newer immunological method was introduced. This study evaluated the role of immunological method of fecal blood test in the diagnosis of occult lower GIT bleeding. Stool samples from two hundred patients were examined by both chemical and immunological method. The patients who were positive by any or both methods of occult blood test, were advised for colonoscopy. During colonoscopy tissues were taken for histopathology which was the gold standard of this study. Among 110 OBT positive patients pathological lesions were detected in 65 patients by colonoscopy and histopathology. The diseases detected by colonoscopy and histopathology 18 colorectal polyp, 8 colorectal cancer, 24 ulcerative lesions and 5 inflammatory bowel disease etc. Regarding comparative analysis of chemical and immunological method, the higher sensitivity (95.4% vs. 49.2%), specificity (44.4% vs. 37.8%), accuracy (74.5% vs. 44.5%), PPV (71.3% vs. 53.3%) and NPV (87% vs. 34%) of immunological method than chemical method was observed. Thus immunological method of fecal occult blood test was appeared to be a better alternative to conventional chemical method of fecal occult blood test in the diagnosis of occult lower GIT bleeding. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19641 Bangladesh Med Res Counc Bull 2013; 39: 52-56

Association between elevated B-type Natriuretic Peptide levels with extent of coronary artery disease in patients with unstable angina and NSTEMI

The study was undertaken to find out the correlation of elevated B-type Natriuretic Peptide (BNP) levels with the severity of coronary artery disease in patients with unstable angina and NSTEMI. This cross sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka during a period of August 2011 to June 2012. A total of 100 consecutive patients with unstable angina and NSTEMI undergoing coronary angiography were included in the study. BNP assay was done by Architect system, a chemo luminescent microparticle immunoassay (CMIA). CAG was done by conventional method within 14 days of index hospital admission. Study patients were divided into two groups on the basis of BNP levels. In Group I, BNP Levels were ≤80pg/ml and in Group II, BNP levels were elevated >80pg/ml. with 50 patients in each group. Angiographic severity of CAD was assessed by vessel score and Friesinger score. Vessel score showed single vessel was involved in 21(47.7%) patients while multi vessel in 23(52.3%) patients was found in Group I. On the contrary 11(22.4%) single vessel patients and 38(77.6%) multivessel patients were found in Group II. There was significant association between vessel involvement (p=0.01). Friesinger score revealed that less severe CAD was found in 22(44%) patients and significant severe CAD in 28(56.0%) patients in Group I. On the contrary 7(14.0%) less severe CAD patients and 43(86.0%) severe CAD patients were found in Group II. There was significant difference between severity of CAD among the study groups (p=0.01). There was linear correlation between BNP pg/ml and coronary artery disease severity in terms of Vessel score (r=0.38, p=0.01) and Friesinger score (r=0.51, p=0.01). The present study concluded that increased BNP level >80pg/ml was significantly associated with the presence and severity of CAD in patient with UA and NSTEMI.

Goldenhar syndrome - a case report

Goldenhar syndrome is a developmental abnormality of 1st & 2nd branchial arch involving the craniofacial microsomia with ocular & vertebral abnormality. Though most of the cases are sporadic, some familial association is also found in autosomal dominant or recessive manner. Teratogenic effect of some toxic substances may lead to the condition. Ocular abnormalities are epibulbar dermoid, lipodermoid & coloboma. Otic defects are preauricular tags, microtia, anotia & conductive hearing loss. Cardio-pulmonary & genitourinary abnormalities are common associations. Here we have described the case of a 10 years old girl had ocular, auricular & vertebral changes consistent with Goldenhar syndrome, she was managed with multidisciplinary approach and she was symptomatically improved but corrective surgery was planned as schedule of respective department.

Rapid detection of microbial contamination in Ghanaian herbal medicines by PCR analysis

BACKGROUND

There is widespread use of herbal medicines across the world and the need for regulatory measures to ensure their safety, efficacy and quality is therefore imperative. Conventional microbiological methods are used in carrying out quality control analysis of herbal medicines but these are often slow, may be less sensitive or specific and labour-intensive. In this study we investigated the ability to use Polymerase Chain Reaction (PCR) as a fast, accurate and inexpensive novel method to detect the presence of common pathogens in herbal medicines from Ghana.

METHODS

We employed different DNA extraction techniques including TE buffer, boiling method for DNA extraction as well as commercially available DNA extraction kits from Qiagen, UK: Gentra Pure-gene Yeast/Bact. Kit and DNeasy™ Tissue Kit which is column based to identify Escherichia coli, Staphylococcus aureus and Salmonella sp. in herbal products from Ghana in local African shops on the UK market.

RESULTS

The TE buffer and boiling methods did not yield any bacterial DNA, however both commercial kits yielded significant amounts of DNA. PCR was able to detect pathogens present in the samples directly. Escherichia coli could be detected at 10 cfu/ml whilst Staphylococcus aureus was detectable at a threshold of up to 10(3) cfu/ml when samples were enriched overnight. Salmonella sp. could not be detected in DNA samples extracted from herbal medicines.

CONCLUSION

We conclude that PCR and similar new molecular techniques such as Real Time PCR have the potential as rapid microbiological analytical techniques especially in busy clinical settings and for quality control of herbal medicines.

Diameter of the lymphoid follicles in the vermiform appendix of Bangladeshi cadaver

Appendicitis is the most common clinical condition of the appendix. Many cases of acute appendicitis result from obstruction of the lumen of the appendix by lymphoid hyperplasia. The vermiform appendix is a worm-like, closed-ended, narrow, small tubular structure, projecting from posteromedial wall of cecum. It is an integral part of the Gut Associated Lymphoid Tissue (GALT) system. The lymphoid follicles of the vermiform appendix vary in respect to their number, diameter and location in different ages. This study was done to measure and establish the normal diameter with age related variation of the lymphoid follicles of vermiform appendix in Bangladeshi population. This descriptive cross sectional study was carried out in the Department of Anatomy, Sir Salimullah Medical College, Dhaka, from January 2008 to June 2009. Sixty (60) postmortem vermiform appendices of different age groups of Bangladeshi cadavers. For studying the diameter of lymphoid follicles in the vermiform appendix in relation to age, the collected samples were divided into five groups namely Group-A between age ranges 0-20 years, Group-B between age ranges 21-30 years, Group-C between age ranges 31-40 years, Group-D 41-50 years and Group-E age above 50 years. From each age group, six (6) fresh samples were selected for histological study. From each vermiform appendix three slides were prepared each from its base, middle part and near the tip and were stained with routine H & E stain. The normal diameter of the follicles of the vermiform appendix ranged from 0.40 mm to 0.66 mm. The highest average group diameter was 0.62±1.10mm in Group-A and the lowest value was 0.45±2.73mm in Group-E. It was obvious that the diameter decreased gradually with advancing age. The average normal diameter of the lymphoid follicles per histological section of vermiform appendix reduced with advancing age and showed a significant negative correlation with age (p<0.001). In the present study, the normal diameter of the lymphoid follicles of the vermiform appendix reduced significantly with advancing age.

Primary adrenal leiomyosarcoma in an adult female

Primary leiomyosarcoma of the adrenal gland is a rare tumour and we describe such a case in a 35 year old female who had dull pain in the left flank for 6 months. There was no weight loss or fever only mild tenderness was in the left subcostal region. She was normotensive and there was no evidence of virilization. CT scan revealed left adrenal mass, after adrenalectomy it was 8.5×7.5×6.2cm³ in size. There was no evidence of local extension or metastasis. Histopathology confirmed adrenal leiomyosarcome.

Peginterferon α-2a and rivabirin in the treatment of chronic hepatitis C

Peginterferon α-2a with ribavirin produces significantly higher sustained virological response (SVR) in comparison to conventional interferon monotherapy in patients with chronic hepatitis C virus (HCV) infection. We evaluated the efficacy and safety of peginterferon α-2a plus ribavirin combination in the treatment of chronic hepatitis C among Bangladeshi patients. A total of 64 patients were randomly selected in this study and were assigned for treatment with peginterferon α-2a 180μg once weekly plus ribavirin daily for 24 weeks in case of genotypes 2 and 3 infections and 48 weeks in case of genotypes 1 and 4 infections. Ribavirin was given 800mg in divided doses in case of genotypes 2 and 3 infections and 1000mg-1200 mg in case of genotypes 1 and 4 infections according to body weight daily(1000 mg in divided doses if body weight <75kg and 1200mg in divided doses if body weight >75kg). Efficacy was assessed by measurements of serum HCV-RNA and serum ALT. A higher proportion of patients (71.87%) who received peginterferon α-2a plus ribavirin had a sustained virological response. It is observed that genotype 3 (a and b) patients showed poor response (SVR-47.05%), where as genotypes 1(a,b), 3 and 4 mixed, 2b and 4 infections showed response rate of 100%. So it can be concluded that once weekly peginterferon α-2a plus daily ribavirin is effective in chronic HCV infection in Bangladesh and overall response rate is similar to that reported in other studies.

Does the HPV vaccination programme have implications for cervical screening programmes in the UK?

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Women who did not take up the HPV vaccination were less likely to attend for cervical screening.

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HPV vaccinated women who attended cervical screening had the lowest proportion of cytological abnormalities detected.

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Social deprivation was the main factor-affecting uptake of both HPV vaccination and cervical screening.

In the UK, a national HPV immunisation programme was implemented in 2008 for girls aged 12–13 years. In addition a catch-up programme was implemented for older girls up to 18 years of age from 2009 to 2011, with an uptake rate of 49.4%. Information about future uptake of cervical screening according to vaccination statistics is important in order to understand the impact of the vaccination programme and implications for a national cervical screening programme. We analysed data on a cohort of women who had been offered the HPV vaccine in the catch-up programme and were invited for cervical screening between 2010 and 2012 in Wales (n = 30,882), in a record-linked database study, to describe the cervical screening uptake and clinical outcome according to HPV vaccination status.

In our cohort, 48.5% (n = 14,966) women had had HPV vaccination and 45.9% (n = 14,164) women attended for cervical screening. Women who were unvaccinated were less likely to attend cervical screening (adjusted OR 0.58; 95% CI (0.55, 0.61)). Of those who attended for screening, 13.9% of vaccinated women had abnormal cytology reported compared to 16.7% of women who were unvaccinated. Women who lived in areas with high levels of social deprivation were less likely to be vaccinated (Quintile 5 OR 0.48 95% CI (0.45, 0.52)) or attend cervical screening (Quintile 5 OR 0.70; 95% CI (0.65, 0.75)) compared to those who lived in the least deprived areas.

These data highlight the need for new strategies to address inequalities in cervical screening uptake and can inform further mathematical modelling work to clarify the impact of the HPV vaccination programme on future cervical cancer incidence.

Surgical management of rectourethral fistula in different situations

This study was done to see the outcome of repair of rectourethral fistula (RUF) in different situations between 2002 and 2009 in Chittagong and Dhaka Medical College Hospitals. We prospectively reviewed the records of all the patients who developed rectourethral fistula. Total 18 patients were included and in all cases faecal and urinary diversion was done preoperatively. In 4 patients fistulas size was <1cm where spontaneous closure of RUF occured after 6 months of diversion. In 8 patients repair of fistula was done through the perineal approach where excision of fistulas tract with anastomotic urethroplasty and repair of rectal wound was done. Out of these 8 patients tunica vaginalis flap was applied in 3 and dartos pedicle flap in 5 cases, in the remaining 6 patients transrectal York-Mason repair was done. Out of 6 patients of York-Mason repair, one developed recurrent fistula - which underwent repair with a graft through the perineal approach later on with good result. No patient developed urinary or faecal incontinence. In 2 patients leakage of urine was noted in post operative days in the perineal wound and catheter was kept for 3 weeks more. No one had erectile dysfunction. Both faecal & urinary diversion adds benefit to the outcome of the rectourethral fistula. Transrectal York-Mason repair is easier to do with less morbidity and complication while perineal approach with graft interposition may be done in cases where anastomotic urethroplasty is needed along with fistula repair.

Clinical, biochemical, virological and sonographic profile of incidentally detected asymptomatic HBsAg positive subjects, in Bangladesh

Chronic hepatitis B virus (HBV) is known to be the significant cause of Liver related morbidity and mortality, affecting 400 million people worldwide and a major public health problem in Bangladesh where carrier rates of HBV infection varies from 7.5 to 10%. In Bangladesh prevalence of asymptomatic HBV infection and incidentally detected HBsAg positive subjects were not well studied. The aim of this study is to evaluate the disease activity, replicative status of the virus and to find out the stages of chronic liver disease among incidentally detected asymptomatic HBsAg positive Bangladeshi subjects. Two hundred (200) incidentally detected healthy HBsAg positive subject were evaluated clinically, biochemically, serologically and ultrasonographically from January 2004 to June 2008. HBeAg was found positive in 17(8.5%), anti-HBe was positive in 174(87%), raised serum ALT (>45iu/L) in 45(22.5%), prothrombine time (PT) >3 sec of control in 33(16.5%). Ultrasonography showed coarse hepatic echotexture in 13(6.5%). Evidence of active viral replication and signs of chronic liver disease were observed among incidentally detected healthy HBsAg positive subjects. Such individuals should be followed up at regular interval to evaluate the replicative status of the virus and disease activity so that appropriate measures could be initiated in time.

Comparative efficacy and safety of trimebutine versus mebeverine in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional disorder characterized by chronic or recurrent abdominal pain or discomfort with bowel disturbances. This prospective, randomized clinical trial has been conducted on IBS patients, using trimebutine and Mebeverine in separate group in parallel design to compare the efficacy and safety of Trimebutine 100mg twice daily with mebeverine 135mg twice daily. Patients of 15 to 60 years old and both sexes were included from the out patient department (OPD) of gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from June 2010 to December 2011. A validated IBS-QOL instrument consisted of 34 questions used to assess improvement of quality of life before and after treatment. A total of 140 patients were enrolled in this study. Eighteen patients dropped out. One hundred twenty two patients completed the trial. In this study at the end of 6 weeks therapy, improvement of symptoms was statistically significant. However, differences of improvement between the two groups in relieving various symptoms were not statistically significant. Mean QOL score before treatment was 103 in Trimebutine group and 106 in Mebeverine group. After 6 weeks of treatment mean QOL score was 82 in Trimebutine group and 95 in Mebeverine group indicating improvement in both groups was statistically significant. The difference between the two groups was also significant. No worsening of symptoms and no side effects of the therapeutic agents was observed in any patient during the trial.