Outcome of Induction of Labour in Prolonged Pregnancy

This was a hospital based prospective clinical study conducted among women having prolonged pregnancy to assess the outcome of induction of labour in prolonged pregnancy cases. One hundred and thirty nine women having uncomplicated prolonged pregnancy were studied. The study was carried out in Sir Salimullah Medical College & Mitford Hospital, Dhaka from 01 July 2010 to 30 March 2011. In this study 66% of the respondents had vaginal delivery on routine induction of labour and in 34% cases induction failed. Ninety three percent (93%) of the multigravida had vaginal delivery and in primigravida their vaginal delivery rate was 47.5%. Regarding cervical condition for delivery, 75% of the respondents having favourable cervix had vaginal delivery and in case of unfavourable cervix respondents, they had 55% cases of vaginal delivery. About the foetal outcome it was evidenced from this study that the perinatal adverse outcome increases with the increasing age of gestation beyond 40 completed weeks of gestation. This study showed that the use of prostaglandins for cervical ripening and by confirming the diagnosis of prolonged pregnancy, the delivery outcome in prolonged pregnancy can be improved. The study also showed that induction of labour is not associated with any major complications and the routine induction of labour in prolonged pregnancy is beneficial for both mother and the baby.

Diversity of Eimeria spp. in dairy cattle of Guwahati, Assam, India

Aim:

To determine the prevalence and diversity of Eimeria spp. in dairy cattle present in and around Guwahati, Kamrup district, Assam, India.

Materials and Methods:

A total of 2339 fecal samples of calves (535), heifer (641) and adult (1163) cattle were screened for 1 year present in and around Guwahati, Assam for detection of Eimeria oocysts by flotation techniques. Sporulation of the oocyst was done in 2.5% potassium dichromate solution for identification of the Eimeria species.

Results:

Examination of fecal samples revealed an overall prevalence of 11.97% Eimeria infection in dairy cattle of Guwahati, Assam. Age-wise, 33.2%, 45.4%, and 21.4% infections were recorded in calves (<1 year), heifer (1-3 years) and adult (>3 years) cattle, respectively. Season-wise, infection was recorded highest during post-monsoon (16.29%), followed by monsoon (15%), winter (9.44%), and pre-monsoon (7.49%) season. Seven species of Eimeria were recorded viz. Eimeria bovis, Eimeria zuernii, Eimeria subspherica, Eimeria bukidnonensis, Eimeria auburnensis, Eimeria ellipsoidalis and Eimeria alabamensis. The oocyst count per gram of feces ranged from 50 to 1500 in infected cattle.

Conclusion:

This study indicates that there is the prevalence of seven species of Eimeria in dairy cattle of Guwahati, Assam and mostly prevalent during the post-monsoon season.

A male person of 55 years with hypothyroidism, ascites and heart failure

Primary hypothyroidism is a common clinical condition but ascites caused by hypothyroidism is rare. Concurrent exudative ascites with heart failure even rarer. So its diagnosis is often delayed and patients frequently receive unnecessary procedures such as liver biopsies and exploratory laparotomies. We report a male person of 55 years with hypothyroidism with ascites and heart failure who responded well with thyroid hormone replacement therapy with complete resolution of ascites. Analyses of ascites from patients in this condition usually shows exudative ascites with high protein (>2.5gm/dl) and SAAG <1.1gm/dl. High index of suspicion is required to reach at such diagnosis. Though it is a rare but prognosis is excellent with replacement therapy.

Epidemiological Aspect and common Bacterial and Fungal isolates from Suppurative Corneal Ulcer in Mymensingh Region

This prospective study was done to find out the epidemiological factors of suppurative corneal ulcer and the common causative bacterial and fungal isolates from the, patients with suppurative corneal ulcer in secondary and tertiary level hospital at Mymensingh region. A total 100 samples of corneal scrapings were collected purposively from clinically diagnosed suppurative corneal ulcer patients from March 18, 2012 to March 17, 2013. Out of the total 100 samples, bacterial species were 29(29%) cases and the fungal spacies were 71(71%) identified by the culture in blood agar, chocolate agar and sabouraud's agar media and also by microscopic examination. The bacterial species were streptococcus pneumonae 12 cases (12%), Staphylococcus aureus 9 cases (9%), pseudomonas in 6 cases (6%), and Streptococcus pyoganes 2 cases (2%). Fungal species were aspergillus fumigatus 61 cases (61%), aspergillus niger 10 cases (10%). Out of the study populations, most of the populations were from the age group of 41 to 60 years (39 %), followed 21 to 40 years (34%) age group. Considering the sex, male were 67%, female were 33%. The majority of patients came from the rural area of Mymensingh region; occupationally they were farmers (44%). Ocular trauma due to agricultural materials was the most common associated factor (71%). The etiological and epidemiological pattern of suppurative corneal ulcer varies significantly with geographical region, patient population and health of the cornea. The present study was carried out to explore the epidemiological pattern, causative bacterial and fungal specie by laboratory procedure from corneal scraping and to invent a prospective guide line for the management of corneal ulcer in the community.

Clinical and Biochemical Characteristics of Polycystic Ovarian Syndrome among Women in Bangladesh

Clinical and Biochemical characteristics age, central obesity, Glucose intolerance, lipid abnormality, thyroid function, prolactin level, clinical signs & symptoms and ultrasonographic ovarian feature of 70 women were studied and prevalence of hyper-prolactinemia, hypothyroidism and Metabolic syndrome were calculated in the Endocrine OPD of BIRDEM during November 2010 to May 2011.Age of the PCOS population was 23.02±7.04 year, central obesity in 81.4%, abnormal glucose tolerance in 47.1%, dyslipidemia in 45.7%, hypertension in 24.3%, hirsutism in 88.6%, acanthosis nigricans in 50%, polycystic ovaries by ultrasound (87%) cases. One third of the PCOS cases i.e.; 33% were without hyperprolactinemia or hypothyroidism or Metabolic Syndrome. And the rest 47 cases had one, two or all the 3 with them. The distribution was PCOS with hyperprolactinemia 18.6%, PCOS with hypothyroidism 11.4%, PCOS with Metabolic Syndrome 15.3%, PCOS with hyperprolactinemia with MS 8.6%, PCOS with hypothyrodism with MS 5.6%, PCOS with hypothyrodism with hyperprolactinemia 4.3% and rest 4.3% had all the 4 in combination. Blood glucose levels during OGTT and TSH levels of the group without Hypothyrid, hyperprolactinoma or Metabolic Syndrome were significantly lower (p≤0.008). Significant proportion of Bangladeshi women with PCOS has hypothyroidsm with or without high prolactin and also have higher incidence of metabolic syndrome. So, all PCOS patients should also be screened for hypothyroidsm and hyperprolactinemia.

Patient costs during tuberculosis treatment in Bangladesh and Tanzania: the potential of shorter regimens

OBJECTIVE

To estimate the costs incurred by patients during the intensive and continuation phases of the current 6-month tuberculosis (TB) regimen in Bangladesh and Tanzania, and thus identify potential benefits to patients of a shorter, 4-month treatment regimen.

DESIGN

The validated Stop TB patient cost questionnaire was adapted and used in interviews with 190 patients in the continuation phase of treatment with current regimens.

RESULTS

In both countries, overall patient costs were lower during 2 months of the continuation phase (US$74 in Tanzania and US$56 in Bangladesh) than during the 2 months of the intensive phase of treatment (US$150 and US$111, respectively). However, continuation phase patient costs still represented 89% and 77% of the 2-month average national income in the respective countries. Direct travel costs in some settings were kept low by local delivery system features such as community treatment observation. Lost productivity and costs for supplementary foods remained significant.

CONCLUSIONS

Although it is not a straightforward exercise to determine the exact magnitude of likely savings, a shorter regimen would reduce out-of-pocket expenses incurred by patients in the most recent 2 months of the continuation phase and allow an earlier return to productive activities.

Trabecular bone score (TBS) in postmenopausal African American women

Trabecular bone score (TBS) is a newly developed parameter that can be derived from DXA scans of the spine and may reflect bone quality. This study provides TBS values in healthy postmenopausal women of African descent.

INTRODUCTION

African American women have a lower risk for osteoporotic fractures as a result of higher bone density and better bone quality. We examined TBS in postmenopausal African American women since there are no previous reports in this population.

METHODS

This was a study of healthy African American volunteers using baseline values prior to their participation in two vitamin D intervention studies conducted at an ambulatory research center of an academic health center.

RESULTS

The study population consisted of 518 healthy postmenopausal African American women with a mean age of 66 years and a BMI of 30.1. Mean TBS (L1 to L4) was 1.300(.100 SD). Significant negative correlations were found between TBS and age and BMI. None of the biochemical variables were significantly correlated with TBS whereas the various bone density sites were correlated with TBS.

CONCLUSION

TBS values for African American women are higher than those reported in the literature for white women and are inversely related to age and BMI.

Toxic epidermal necrolysis in a neonate receiving fluconazole

Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous condition, which may occur as an adverse reaction to a number of medications. The anitifungal agent, fluconazole, has been associated with TEN in limited reports, mainly in adults with HIV infection. We describe the case of a neonate with liver disease who developed TEN, presumably induced by fluconazole.

Attitude and practice of cervical cancer screening among the women of Bangladesh

Cervical cancer is the second most common cancer in women worldwide, but 80% of cancer occurs in developing countries. Bangladesh, like other developing countries faces a burden of diseases, in spite of having established screening program. This cross-sectional study was done to determine the knowledge, attitude and practice of cervical cancer screening among the women attending outpatient department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Two hundred women were enrolled in this study by purposive sampling. All the information was collected in a pre-designed structured questionnaire by an interviewer. Data were analyzed using statistical program SPSS version 17.0. About 12% of women had good knowledge regarding cervical cancer screening. Seventy eight percent of women did not ever have a screening test and 78.5% of women had no access to the facility of having a screening test. Seventy five percent of women had never been suggested by a doctor to have a screening test. The more the participants' age, low level of education and poor knowledge, the less the practice of cervical cancer screening (p<0.05). The most common reason cited for not having screening test was the lack of information. The women studied here demonstrated a very low coverage of the screening test and a poor knowledge regarding its utility. Improving the awareness is imperative for better implementation of cervical cancer screening program in Bangladesh.

Characterization of Biological Activities ofBrucella melitensisLipopolysaccharide

Biological activities of lipopolysaccharide (LPS) from Brucella melitensis 16M were characterized in comparison with LPS from Escherichia coli O55. LPS extracted from B. melitensis was smooth type by electrophoretic analysis with silver staining. The endotoxin-specific Limulus activity of B. melitensis LPS was lower than that of E. coli LPS. There was no significant production of tumor necrosis factor-alpha and nitric oxide in RAW 264.7 macrophage cells stimulated with B. melitensis LPS, although E. coli LPS definitely induced their production. On the other hand, B. melitensis LPS exhibited a higher anti-complement activity than E. coli LPS. B. melitensis LPS as well as E. coli LPS exhibited a strong adjuvant action on antibody response to bovine serum. The characteristic biological activities of B. melitensis are discussed.

Role of p38 Mitogen-Activated Protein Kinase (MAPK) for Vacuole Formation in Lipopolysaccharide (LPS)-Stimulated Macrophages

The role of p38 mitogen-activated protein kinase (MAPK) on vacuole formation in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells was examined. LPS definitely induced the formation of vacuoles in RAW 264.7 cells and SB202190 as a p38 specific inhibitor also induced slight vacuole formation. The simultaneous treatment with LPS and SB202190 induced many more vacuoles in RAW 264.7 cells than the treatment with LPS or SB202190 alone, and the vacuoles were extraordinarily large in size. On the other hand, an inactive inhibitor of p38 MAPK did not augment LPS-induced vacuole formation. Further, the inhibitors of other MAPKs and nuclear factor (NF)-kappaB pathways did not affect it. The extraordinarily large vacuoles in RAW 264.7 cells treated with LPS and SB202190 were possibly formed via fusion of small vacuoles. However, SB202190 did not augment vacuole formation in CpG DNA or interferon (IFN)-gamma-stimulated RAW 264.7 cells. The role of p38 MAPK in the vacuole formation in LPS-stimulated macrophages is discussed.

Piceatannol Prevents Lipopolysaccharide (LPS)-Induced Nitric Oxide (NO) Production and Nuclear Factor (NF)-κB Activation by Inhibiting IκB Kinase (IKK)

The effect of piceatannol on lipopolysaccharide (LPS)-induced nitric oxide (NO) production was examined. Piceatannol significantly inhibited NO production in LPS-stimulated RAW 264.7 cells. The inhibition was due to the reduced expression of an inducible isoform of NO synthase (iNOS). The inhibitory effect of piceatannol was mediated by down-regulation of LPS-induced nuclear factor (NF)-kappaB activation, but not by its cytotoxic action. Piceatannol inhibited IkappaB kinase (IKK)-alpha and beta phosphorylation, and subsequently IkappaB-alpha phosphorylation in LPS-stimulated RAW 264.7 cells. On the other hand, piceatannol did not affect activation of mitogen-activated protein (MAP) kinases including extracellular signal regulated kinase 1/2 (Erk1/2), p38 and stress-activated protein kinase/c-Jun NH2-terminal kinase (SAPK/JNK). Piceatannol inhibited the phosphorylation of Akt and Raf-1 molecules, which regulated the activation of IKK-alpha and beta phosphorylation. The detailed mechanism of the inhibition of LPS-induced NO production by piceatannol is discussed.

Abstract C40: Histone demethylase Jmjd1a: A novel preventive target in pancreatic cancer

Purpose: Pancreatic cancer is the fourth leading cause of mortality in the United States with no significant treatment currently available. Therapeutic options for patients with advanced disease are time limited and non-curative. A growing body of evidence suggests that cancer stem cells/tumor initiating cells (CSC/TIC) within a solid tumor including in pancreatic cancer initiate and sustain tumor growth. Our preliminary data implicates Jumanji demethylases1a (Jmjd1a) as a prime regulator of stem cell renewability for cancer progression. Hypoxia most prominently controls malignant properties of cancer cells by stimulating hypoxia inducible factor 1 (HIF1). The fact that HIF1 binds to its responsible elements (HREs) in the Jmjd1 promoters and subsequently up-regulates Jmjd1 could explain why hypoxia exacerbates malignancy. In this context, the availability of small molecules will allow us to determine mechanistic aspects of the interconnection among hypoxia, Jmjd1a and CSC/TIC self-renewal. Indeed, the inhibition of the members of the Jmjd family, 2-oxoglutarate (2OG)-dependent histone lysine demethylases (KDMs), suppresses tumor growth in many types of cancer. Therefore, we hypothesize that hypoxia induces Jmjd1a that regulate self-renewability of CSC/TIC, thereby promoting tumor initiation. Recently, two small molecules analogues of crocetinic acid, a carotenoid molecule isolated from saffron, have revealed to have potent antimitotic effects in pancreatic cancer models.

Experimental Procedure: In this study, we have developed pancreatic CSC/TIC during hypoxic and normoxic conditions using ultra-low binding tissue culture dishes to form multicellular spheroids called pancospheres and monitored expression of Jmjda1a using western blots and immunohistochemistry on those CSC/TIC. We also used RNA technology to silenced Jmjd1a using lenntiviral vectors different pancreatic cancer cell lines. We have also determined Jmjd1a expression in pancreatic cancer patients' samples.

Results: Jmjd1a is highly expressed in pancreatic cancer cells and it is significatly reduced when it is knocked down through shRNA in those cell lines. The proliferation of those knockdown cell lines was significantly reduced using colony formation and wound healing assays. Hypoxia stimulated pancospheres formation associated with concomitant overexpression of Jmjd1a. Knockdown of Jmjd1a using shRNA demonstrated significant reduction of pancreatic pancospheres formation ability in both normoxic and hypoxic conditions. The demethylation of specific substrate of Jmjd1a, H3-K9me2, was significantly affected by knockdown of Jmjd1a in pancreatic cancer cells. Treatment with gemcitabine, drug of choice for pancreatic cancer, did not affect in Jmjd1a expression in those cell lines particularly during hypoxic conditions. Crocetinic acid and its analogues inhibited Jmjd1a expression in both in vivo and in vitro pancreatic cancer models. We also observed that Jmjd1a was significantly overexpressed in human pancreatic cancer patient samples than the adjacent normal tissues.

Conclusions: Jmjd1a is overexpressed in pancreatic cancer and stimulates the self-renewability of pancospheres. Taken together, Jmjd1a is one of important factors for pancreatic cancer progression and could be a novel preventive target for pancreatic cancer.

Citation Format: Kanagaraj Palaniyandi, Shamima Islam, Parthasarathy Rangarajan, Deep Kwatra, Satish Ramalingam, Dharmalingam Subramaniam, Subhash Padhye, Shrikant Anant, Animesh Dhar. Histone demethylase Jmjd1a: A novel preventive target in pancreatic cancer. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C40.

Pattern of hypothyroid cases in Bangladeshi People: A pilot study

Aims: The present study was undertaken to explore the pathological basis of hypothyroidism and it relationship to clino-biochemical features of Bangladeshi patients. Material and Methods: A total number of 47 hypothyroid patients with duration less than two years and had no other comorbid disease were consecutively recruited from BIRDEM Out-patient department. Patients having serum FT4 level <9.14 pmol/L and serum TSH >5.01 IU/ml were identified as hypothyroidism. Presence of either anti TG antibody >40 IU/ml or anti TPO antibody > 35 IU/ml or both were defined as autoimmune hypothyroidism. Thyroid gland was examined and classified according to joint criteria of WHO, UNICEF and ICCIDD criteria. Results: Female preponderance was observed in this series though small total number of samples. Familial hypothyroidism was reported in 19% of cases and 8% of patients came from iodine deficient area. Out of 47 cases autoimmune markers were done in 40 and of them 32 (68%) were positive for autoantibodies. Of the positive case 22% were positive for anti TPO antibody and 6% for anti TG antibody; 72% cases both. Drug and radiation were excluded as the cause of hypothyroidism in this series. Family history of hypothyroidism was positive in 22% and 25% autoimmune and non-autoimmune study cases. Of the autoimmune case 44% had age between 30-44 years and among non-autoimmune case 37% were 15-30 years. Eleven of 32 (34%) autoimmune hypothyroid cases presented with irregular menstrual cycle. Out of 47 hypothyroid patients in this study, 36 (77%) had palpable or enlarged thyroid gland. Of the 40 cases autoimmune status evaluated palpable among 25 (78%) autoimmune and 6 (75%) non-autoimmune hypothyroid patients. Conclusions: It is concluded that higher proportion of hypothyroid cases are of antoantibody positive. These subjects have heterogeneous phenotypic presentation. This necessitates that all newly detected hypothyroidism should be screened for autoimmune status with the same importance as given for thyroid hormone level and managed accordingly. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16660 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 405-412