Breaking barriers in cancer treatment: nanobiohybrids empowered by modified bacteria and vesicles

Cancer, the leading global cause of mortality, poses a formidable challenge for treatment. The effectiveness of cancer therapies, ranging from chemotherapy to immunotherapy, relies on the precise delivery of therapeutic agents to tumor tissues. Nanobiohybrids, resulting from the fusion of bacteria with nanomaterials, constitute a promising delivery system. Nanobiohybrids offer several advantages, including the ability to target tumors, genetic engineering capabilities, programmed product creation, and the potential for multimodal treatment. Recent advances in targeted tumor treatments have leveraged bacteria-based nanobiohybrids. Here, we outline the progress in cancer treatment using nanobiohybrids. Our focus is particularly on various therapeutic approaches within the context of nanobiohybrid systems, where bacteria are integrated with nanomaterials to combat cancer. It has been demonstrated that bacteria-based nanobiohybrids present a robust and effective method for tumor theranostics.

New record of Philometra species from the marine edible fish Terapon jarbua collected from the Sindh, Arabian Sea, Pakistan

Diseases in fish due to helminth parasites, especially Philometra species, are the primary worry in aquaculture. Philometra are responsible for health problem in fishes they directly affect fish growth and population parameters. A comprehensive survey was conducted involving the examination of the marine fish species Terapon jarbua, gathered from the coastal waters of Sindh, Pakistan In this research different Philometra species from marine fish Terapon jarbua during 2021 and 2022. Philometra nematodes, belonging to the family Philometridae, are common parasitic organisms inhabiting both marine and freshwater environments. Their prevalence, particularly when existing in high numbers within host organisms, can lead to severe and potentially lethal consequences. Employing light microscopy techniques, diverse species of Philometra were identified, including Philometra teraponi, P. jarbuai, P. arabiai, P. karachii, and P. awarii, localized primarily within the ovaries of the host fish. A total of 140 fish samples were examined and 76 were infected. The intensity of infected fish was 54.28%. The identification process encompassed meticulous analysis of crucial parameters, such as body size, esophagus length, positioning of the nerve ring, dimensions of the ventriculus, and ligament size. Intriguingly, the parasites were found in varying contexts; while some were free within the ovaries, others were embedded within tissues, inducing severe muscular dystrophy. This research presents novel findings of Philometra nematodes in the marine waters of Pakistan, extending their host and geographical distribution records. Future studies are needed to better evaluate and describe the dynamics and the epidemiology of Philometra infection in wild and cultured fish species.

COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2)

BACKGROUND

Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19.

OBJECTIVE

To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients.

METHODS

In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed.

RESULTS

CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality.

CONCLUSION

Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.

Cell membrane-coated biomimetic nanomedicines: productive cancer theranostic tools

As the second-leading cause of human death, cancer has drawn attention in the area of biomedical research and therapy from all around the world. Certainly, the development of nanotechnology has made it possible for nanoparticles (NPs) to be used as a carrier for delivery systems in the treatment of tumors. This is a biomimetic approach established to craft remedial strategies comprising NPs cloaked with membrane obtained from various natural cells like blood cells, bacterial cells, cancer cells, etc. Here we conduct an in-depth exploration of cell membrane-coated NPs (CMNPs) and their extensive array of applications including drug delivery, vaccination, phototherapy, immunotherapy, MRI imaging, PET imaging, multimodal imaging, gene therapy and a combination of photothermal and chemotherapy. This review article provides a thorough summary of the most recent developments in the use of CMNPs for the diagnosis and treatment of cancer. It critically assesses the state of research while recognizing significant accomplishments and innovations. Additionally, it indicates ongoing problems in clinical translation and associated queries that warrant deeper research. By doing so, this study encourages creative thinking for future projects in the field of tumor therapy using CMNPs while also educating academics on the present status of CMNP research.

Salsalate: a pleotropic anti-inflammatory drug in the treatment of diabetes, obesity, and metabolic diseases

Type two Diabetes Mellitus (T2DM) is a rising epidemic. Available therapeutic strategies have provided glycaemic control via HbA1c reduction but fail to provide clinically meaningful reduction in microvascular and macrovascular (cardiac, renal, ophthalmological, and neurological) complications. Inflammation is strongly linked to the pathogenesis of T2DM. Underlying inflammatory mechanisms include oxidative stress, endoplasmic reticulum stress amyloid deposition in the pancreas, lipotoxicity, and glucotoxicity. Molecular signalling mechanisms in chronic inflammation linked to obesity and diabetes include JANK, NF-kB, and AMPK pathways. These activated pathways lead to a production of various inflammatory cytokines, such as Interleukin (IL-6), tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP), which create a chronic low-grade inflammation and ultimately dysregulation of glucose homeostasis in the liver, skeletal muscle, and smooth muscle. Anti-inflammatory agents are being tested as anti-diabetic agents such as the IL-1b antagonist, Anakinra, the IL-1b inhibitor, Canakinuma, the IL-6 antagonists such as Tocilizumab, Rapamycin (Everolimus), and the IKK-beta kinase inhibitor, Salsalate. Salsalate is a century old safe anti-inflammatory drug used in the treatment of arthritis. Long-term safety and efficacy of Salsalate in the treatment of T2DM have been evaluated, which showed improved fasting plasma glucose and reduced HbA1C levels as well as reduced pro-inflammatory markers in T2DM patients. Current publication summarizes the literature review of pathophysiology of role of inflammation in T2DM and clinical efficacy and safety of Salsalate in the treatment of T2DM.

A state-of-the-art liposome technology for glioblastoma treatment

Glioblastoma (GBM) is a challenging problem due to the poor BBB permeability of cancer drugs, its recurrence after the treatment, and high malignancy and is difficult to treat with the currently available therapeutic strategies. Furthermore, the prognosis and survival rate of GBM are still poor after surgical removal via conventional combination therapy. Owing to the existence of the formidable blood-brain barrier (BBB) and the aggressive, infiltrating nature of GBM growth, the diagnosis and treatment of GBM are quite challenging. Recently, liposomes and their derivatives have emerged as super cargos for the delivery of both hydrophobic and hydrophilic drugs for the treatment of glioblastoma because of their advantages, such as biocompatibility, long circulation, and ease of physical and chemical modification, which facilitate the capability of targeting specific sites, circumvention of BBB transport restrictions, and amplification of the therapeutic efficacy. Herein, we provide a timely update on the burgeoning liposome-based drug delivery systems and potential challenges in these fields for the diagnosis and treatment of brain tumors. Furthermore, we focus on the most recent liposome-based drug delivery cargos, including pH-sensitive, temperature-sensitive, and biomimetic liposomes, to enhance the multimodality in imaging and therapeutics of glioblastoma. Furthermore, we highlight the future difficulties and directions for the research and clinical translation of liposome-based drug delivery. Hopefully, this review will trigger the interest of researchers to expedite the development of liposome cargos and even their clinical translation for improving the prognosis of glioblastoma.

Emerging extracellular vesicle-based carriers for glioblastoma diagnosis and therapy

Glioblastoma (GBM) treatment is still a big clinical challenge because of its highly malignant, invasive, and lethal characteristics. After treatment with the conventional therapeutic paradigm of surgery combined with radio- and chemotherapy, patients bearing GBMs generally exhibit a poor prognosis, with high mortality and a high disability rate. The main reason is the existence of the formidable blood-brain barrier (BBB), aggressive growth, and the infiltration nature of GBMs. Especially, the BBB suppresses the delivery of imaging and therapeutic agents to lesion sites, and thus this leads to difficulties in achieving a timely diagnosis and treatment. Recent studies have demonstrated that extracellular vesicles (EVs) exhibit favorable merits including good biocompatibility, a strong drug loading capacity, long circulation time, good BBB crossing efficiency, specific targeting to lesion sites, and high efficiency in the delivery of a variety of cargos for GBM therapy. Importantly, EVs inherit physiological and pathological molecules from the source cells, which are ideal biomarkers for molecularly tracking the malignant progression of GBMs. Herein, we start by introducing the pathophysiology and physiology of GBMs, followed by presenting the biological functions of EVs in GBMs with a special focus on their role as biomarkers for GBM diagnosis and as messengers in the modulation of the GBM microenvironment. Furthermore, we provide an update on the recent progress of using EVs in biology, functionality, and isolation applications. More importantly, we systematically summarize the most recent advances of EV-based carriers for GBM therapy by delivering different drugs including gene/RNA-based drugs, chemotherapy drugs, imaging agents, and combinatory drugs. Lastly, we point out the challenges and prospects of future research on EVs for diagnosing and treating GBMs. We hope this review will stimulate interest from researchers with different backgrounds and expedite the progress of GBM treatment paradigms.

Recent Progress in NIR-II Fluorescence Imaging-guided Drug Delivery for Cancer Theranostics

Fluorescence imaging in the second near-infrared window (NIR-II) has become a prevalent choice owing to its appealing advantages like deep penetration depth, low autofluorescence, decent spatiotemporal resolution, and a high signal-to-background ratio. This would expedite the innovation of NIR-II imaging-guided drug delivery (IGDD) paradigms for the improvement of the prognosis of patients with tumors. This work systematically reviews the recent progress of such NIR-II IGDD-mediated cancer therapeutics and collectively brings its essence to the readers. Special care has been taken to assess their performances based on their design approach, such as enhancing their drug loading and triggering release, designing intrinsic and extrinsic fluorophores, and/ or overcoming biological barriers. Besides, the state-of-the-art NIR-II IGDD platforms for different therapies like chemo-, photodynamic, photothermal, chemodynamic, immuno-, ion channel, gas-therapies, and multiple functions such as stimulus-responsive imaging and therapy, and monitoring of drug release and therapeutic response, have been updated. In addition, for boosting theranostic outcomes and clinical translation, the innovation directions of NIR-II IGDD platforms are summarized, including renal-clearable, biodegradable, sub-cellular targeting, and/or afterglow, chemiluminescence, X-ray excitable NIR-IGDD, and even cell therapy. This review will propel new directions for safe and efficient NIR-II fluorescence-mediated anticancer drug delivery.

Advances in Antioxidant Nanomedicines for Imaging and Therapy of Alzheimer's Disease

Significance: Reactive oxygen species (ROS) are crucial signaling molecules in the regulation of numerous physiological activities including the formation and function of the central nervous system (CNS). So far, many functional antioxidant nanomedicines with ROS scavenging capability to reduce oxidative stress in Alzheimer's disease (AD) have been developed for both imaging and therapy of AD. Recent Advances: This review focuses on the most recent advances in antioxidant nanomedicines such as ROS-scavenging nanoparticles (NPs), NPs with intrinsic antioxidant activity, and drug-loaded antioxidant NPs for AD theranostics. In addition to antioxidant nanomedicines, the emerging phototherapy treatment paradigms and the promising preclinic drug carriers, such as exosomes and liposomes, are also introduced. Critical Issues: In general, excessive generation of ROS can cause lipid peroxidation, oxidative DNA, as well as protein damage, aggravating pathogenic alterations, accumulation of amyloid-beta plaques and neurofibrillary tangles in the brain. These negative factors further cause cell death, which is the beginning of AD. Future Directions: We anticipate that this review will help researchers in the area of preclinical research and clinical translation of antioxidant nanomedicines for AD imaging and therapy.

Recent progress in nanomedicines for imaging and therapy of brain tumors

Nowadays, a malignant brain tumor is one of the most life-threatening diseases with poor prognosis, high risk of recurrence, and low survival rate for patients because of the existence of the blood-brain barrier (BBB) and the lack of efficient diagnostic and therapeutic paradigms. So far, many researchers have devoted their efforts to innovating advanced drugs to efficiently cross the BBB and selectively target brain tumors for optimal imaging and therapy outcomes. Herein, we update the most recent developments in nanomedicines for the diagnosis and treatment of brain tumors in preclinical mouse models. The special focus is on burgeoning drug delivery carriers to improve the specificity of visualization and to enhance the efficacy of brain tumor treatment. Also, we highlight the challenges and perspectives for the future development of brain tumor theranostics. This review is expected to receive wide attention from researchers, professors, and students in various fields to participate in future advancements in preclinical research and clinical translation of brain tumor nanomedicines.

First Cardiac Magnetic Resonance Experience in Bangladesh: A Case of Arrhythmogenic Right Ventricular Dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive degeneration and replacement of the right ventricular (RV) myocardial tissue by fat and fibrosis and produce clinical condition. Desmosome gene mutations are only the causative state for ARVD hereditary disorder. The arrhythmogenic right ventricular cardiomyopathy incidence is about 1/1000-5000. Mostly young people and athletes are bearing the clinical presentations include presyncope, syncope, ventricular tachycardias or ventricular fibrillation leading to cardiac arrest. We report about the first case of Cardiac magnetic resonance (CMR) imaging to diagnose a case Arrhythmogenic right ventricular dysplasia (ARVD) of a 34-year-old male from Savar, Dhaka, Bangladesh who was referred to cardiac emergency for the evaluation recurrent dizzy spells.

Shoe soles as a potential vector for pathogen transmission: a systematic review

Shoe soles are possible vectors for infectious diseases. Although studies have been performed to assess the prevalence of infectious pathogens on shoe soles and decontamination techniques, no systematic review has ever occurred. The aim of this study was to perform a systematic review of the literature to determine the prevalence of infectious agents on shoe bottoms and possible decontamination strategies. Three electronic bibliographic databases were searched using a predefined search strategy evaluating prevalence of infectious pathogens on shoe bottoms and decontamination strategies. Quality assessment was performed independently by two reviews with disagreements resolved by consensus. Thirteen studies were identified that supported the hypothesis that shoe soles are a vector for infectious pathogens. Methicillin-resistant Staphylococcus aureus, Clostridium difficile and multidrug-resistant Gram-negative species among other pathogens were documented on shoe bottoms in the health care setting, in the community and among food workers. Fifteen studies were identified that investigated decontamination strategies for shoe soles. A number of decontamination strategies have been studied of which none have been shown to be consistently successful at disinfecting shoe soles. In conclusion, a high prevalence of microbiological pathogens was identified from shoe soles studied in the health care, community and animal worker setting. An effective decontamination strategy for shoe soles was not identified. Studies are needed to assess the potential for contaminated shoes to contribute to the transmission of infectious pathogens.

The present and future disease burden of hepatitis C virus infections with today's treatment paradigm - volume 3

The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved.

Strategies to manage hepatitis C virus infection disease burden - volume 3

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: increased treatment efficacy while holding the annual number of treated patients constant and increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995).

Historical epidemiology of hepatitis C virus (HCV) in select countries - volume 3

Detailed, country-specific epidemiological data are needed to characterize the burden of chronic hepatitis C virus (HCV) infection around the world. With new treatment options available, policy makers and public health officials must reconsider national strategies for infection control. In this study of 15 countries, published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates were gathered from the literature and validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Iran and Lebanon to 4.2% in Pakistan. The largest viraemic populations were in Pakistan (7 001 000 cases) and Indonesia (3 187 000 cases). Injection drug use (IDU) and a historically unsafe blood supply were major risk factors in most countries. Diagnosis, treatment and liver transplant rates varied widely between countries. However, comparison across countries was difficult as the number of cases changes over time. Access to reliable data on measures such as these is critical for the development of future strategies to manage the disease burden.

In vivo measurements and numerical analysis of the biomechanical characteristics of the human periodontal ligament

The periodontal ligament is a complex tissue with respect to its biomechanical behaviour. It is important to understand the mechanical behaviour of the periodontal ligament during physiological loading in healthy patients as well as during the movement of the tooth in orthodontic treatment or in patients with periodontal disease, as these might affect the mechanical properties of the periodontal ligament (PDL). Up to now, only a limited amount of in vivo data is available concerning this issue. The aim of this study has been to determine the time dependent material properties of the PDL in an experimental in vivo study, using a novel device that is able to measure tooth displacement intraorally. Using the intraoral loading device, tooth deflections at various velocities were realised in vivo on human teeth. The in vivo investigations were performed on the upper left central incisors of five volunteers aged 21-33 years with healthy periodontal tissue. A deflection, applied at the centre of the crown, was linearly increased from 0 to 0.15mm in a loading period of between 0.1 and 5.0s. Individual numerical models were developed based on the experimental results to simulate the relationship between the applied force and tooth displacement. The numerical force/displacement curves were fitted to the experimental ones to obtain the material properties of the human PDL. For the shortest loading time of 0.1s, the experimentally determined forces were between 7.0 and 16.2N. The numerically calculated Young's modulus varied between 0.9MPa (5.0s) and 1.2MPa (0.1s). By considering the experimentally and numerically obtained force curves, forces decreased with increasing loading time. The experimental data gained in this study can be used for the further development and verification of a multiphasic constitutive law of the PDL.

The effect of implant splinting on the load distribution in bone bed around implant-supported fixed prosthesis with different framework materials: A finite element study

Analysing the influence of implant splinting and its relation to different framework materials is a complex issue. The stiffness of framework materials and the overload of the implant system directly affect the final transferred load of the bone around implants. A finite element model of a long-span cementable implant-supported fixed prosthesis was created. Three materials were analysed for the framework: Titanium, gold alloy, and zirconia. The connection screws were first preloaded with 200 N. Two loading conditions were studied: The implant at the molar region was first loaded without splinting to the framework, and in the second condition, the implant was splinted to the framework. A total force of 500 N and 1000 N in 30° from the long axis of the framework were applied in buccal or distal direction on the implant system. The stresses and strains within the framework materials, implant system, and bone bed around the supporting implants were analysed. Loading the implant distally was associated with high stresses within the implant system in comparison to buccal loading. By splinting the implant, the stress in the implant system was reduced from 5393 MPa to 2942 MPa. Buccal loading of the implant was more critical than the distal loading. In the splinted condition of the implant, the stresses in the cortical bone were reduced from 570 MPa to 275 MPa.

Risk factors of non-alcoholic fatty liver disease

This case control study was carried out in Mymensingh Medical College Hospital, Mymensingh, Bangladesh and Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2010 to October 2011 to find out the risk factors of non-alcoholic fatty liver disease. A total of 90 participants (45 cases and 45 controls) were included. A higher proportion of patients with age >45 years were found in case group compared to control (51.1% vs. 15.6%). The mean age was significantly higher in case group 49.8±12.6 years. Males demonstrated their predominance in both case (62.2%) and control (68.9%) groups, although the two groups did not differ in terms of sex distribution. Body mass index demonstrates that 26.7% of patients in case group were of normal weight, 46.7% overweight and 26.7% obese. In the control group, two-thirds (68.9%) of the patients were of normal weight and 24.4% overweight and 7.8% obese. Diabetes and hypertension were significantly present in the case group than those in control counterparts 75.6% vs. 15.6% and 86.7% vs. 15.6 % respectively. The mean fasting blood glucose, ALT, total cholesterol and triglycerides were significantly higher in case group compared to control group 7.8±1.3 vs. 5.4±2.5mmol/L (p<0.001); 39.1±12.4 vs. 30.3±14.1IU/L, (p=0.002); 239.9±14.3 vs. 183.3±11.4mg/dl, (p<0.001) and 183.6±12.5 vs. 133.5±16.0mg/dl, (p<0.001) respectively. However, no significant difference was observed between the case and the control groups in terms of HDL cholesterol (35.9±1.2 vs. 38.0±1.1mg/dl, p=0.203). Majority of the patients in case group (88.9%) exhibited increased echogenicity of liver on ultrasonogram as opposed to 15.6% in the control group.

Fecal indicators and bacterial pathogens in bottled water from Dhaka, Bangladesh

Forty-six bottled water samples representing 16 brands from Dhaka, Bangladesh were tested for the numbers of total coliforms, fecal indicator bacteria (i.e., thermotolerant Escherichia coli and Enterococcus spp.) and potential bacterial pathogens (i.e., Aeromonas hydrophila, Pseudomonas aeruginosa, Salmonella spp., and Shigella spp.). Among the 16 brands tested, 14 (86%), ten (63%) and seven (44%) were positive for total coliforms, E. coil and Enterococcus spp., respectively. Additionally, a further nine (56%), eight (50%), six (37%), and four (25%) brands were PCR positive for A. hydrophila lip, P. aeruginosa ETA, Salmonella spp. invA, and Shigella spp. ipaH genes, respectively. The numbers of bacterial pathogens in bottled water samples ranged from 28 ± 12 to 600 ± 45 (A. hydrophila lip gene), 180 ± 40 to 900 ± 200 (Salmonella spp. invA gene), 180 ± 40 to 1,300 ± 400 (P. aeruginosa ETA gene) genomic units per L of water. Shigella spp. ipaH gene was not quantifiable. Discrepancies were observed in terms of the occurrence of fecal indicators and bacterial pathogens. No correlations were observed between fecal indicators numbers and presence/absence of A. hydrophila lip (p = 0.245), Salmonella spp. invA (p = 0.433), Shigella spp. ipaH gene (p = 0.078), and P. aeruginosa ETA (p = 0.059) genes. Our results suggest that microbiological quality of bottled waters sold in Dhaka, Bangladesh is highly variable. To protect public health, stringent quality control is recommended for the bottled water industry in Bangladesh.

Pattern of poisoning in a tertiary level hospital

This cross sectional observational study was carried out in the Department of Medicine, Mymensingh Medical College Hospital over a period of 4 months from January 2012 to April 2012 to assess the clinico-epidemiological condition of different types of poisoning and to evaluate immediate hospital outcome. Suspected case of poisoning aged 12 years or above of either sex was included. Patients of paediatric age group, having other co-morbid condition and died before clinical evaluation were excluded. This study revealed that rural people (76.9%), aging 20-30 years (46.3%) were mostly affected in poisoning. Patients belong to low socioeconomic group (65.3%), illiterate (26.5%) and educated up to primary level (29.9%) were mostly identified. Regarding the occupation this study showed student (30.6%) and farmer (25.2%) were predominantly involved. In this series organophosphorus compound (63.9%) poisoning was in the top of the list followed by benzodiazepine (6.8%). Suicidal attempt (81.6%) was found as a motive of poisoning in maximum cases. Among the precipitating factors quarrel with spouse, girl or boy friend (46.9%) were significant in number. In this study outcome was measured as complete recovery (92.5%) and death (3.4%).

Diagnostic evaluation of supraclavicular lymphadenopathy

Patients presented with the supraclavicular lymphadenopathy in the medicine department have a strong suspicion of serious illness like tuberculosis, sarcoidosis, toxoplasmosis and malignancy of lymphnode, blood, lung, upper GIT, breast, ovary, testes, and other sites of body. This prospective type of observational study carried out in the indoor and out patient department of medicine of Mymensingh Medical College Hospital over a period of 6 month from April 2011 to September 2011 to diagnose the causes of supraclavicular lymphadenopathy. Patient of either sex, 18 years or above presented with supraclavicular lymphadenopathy were included. Biopsy or FNAC were done. The study showed that mean age of the patient of supraclavicular lymphadenopathy that finally diagnosed as malignant was 49.7 years and that of non malignant was 33.7 years. Male patient have suffered more (60%) from malignant disease than that of female patient (40%). Discrete, hard, non tender either fixed or non fixed supraclavicular lymphadenopathy was found malignant (18 of 18 cases, 100%) and discrete, firm, tender lymphnode were found non malignant (5 of 5 cases, 100%). Increased frequency (11 of 28, 39.3%) of granulomatous inflammation from the tuberculoid lymphadenitis were found among the patient undergone supraclavicular lymphnode biopsy. FNAC result was also of simillar type and finally it was found that frequency of tuberculosis (20 of 53, 37.7%) was highest and bronchial carcima was the second most frequent diagnosis (14 of 53, 26.4%). This study showed that supraclavicular lymphadenopathy is associated mostly with serious disease like tuberculosis and malignancy.

Demographics and cell types of bronchial carcinoma of a tertiary care hospital in Bangladesh

Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style such as smoking have been noted to influence the occurrence of bronchial carcinoma. We conducted this study to document the frequency of various histological types of bronchial carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out among admitted patient with the suspicion of Bronchial carcinoma from January 2010 to January 2011 in medicine units of Mymensingh Medical College Hospital, Mymensingh. Among those only 30 consecutive histopathologically &/or cytological confirmed cases of Bronchial carcinoma were included in the study. No age, gender, environmental or occupational limits were applied for the selection of patients. Patients already diagnosed by some other hospital presenting to our unit with complications were not included in the study. Age rang were 26-70 years. Majority of patients i.e. 63.33% (n=19) were found to be in their fourth and sixth decade of life. Males were 86.66% (n=26) as compared to females 13.44% (n=4) and male to female ratio were 6.5:1. The majority of the patients were belonged to urban areas 63.34% (n=19), while 36.66% (n=11) came from the Rural population. In this study smokers were 86.66% (n=26) and nonsmokers were 13.33% (n=4). In Occupational distribution farmers were 33.33% (n=10), service holders were 20% (n=6), businessman were 16.66% (n=5), all the female were house wife 13.33% (n=4). Specimens for histopathological study were collected by trans-thoracic needle aspiration under CT or ultrasono-guided. The results of cell types in histopathologically proven 30 Bronchial carcinoma patients were; 10(33.36%) adenocarcinoma, 7(23.33%) squamous cell carcinoma, 6(20%) small cell carcinoma, 4(13.33%) large cell carcinoma and 3(10%) non-small cell carcinoma.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

Numerical investigations of the loading behaviour of a prefabricated non-rigid bar system

The aim of this study has been to systematically evaluate the loading behaviour of a novel pre-fabricated chair-side SFI-Bar(®) bar system supported by two implants using finite element (FE) analysis. Two series of FE models were created of the bar placed on two idealised implants and embedded in idealised bone segments using CAD data. In the first series, the inter-implant distance varied from 10 to 26mm; the second series consisted of a bar with a fixed implant distance of 26mm and varying horizontal fitting inaccuracy from 0.0 to 0.3mm. The bar was loaded vertically at 500 N. In all simulations, the regions with the greatest amount of stress were concentrated on the connecting elements of the bar and the bar itself. A slight increase in stress was observed with decreasing inter-implant distance. With a non-zero fitting inaccuracy, no clear correlation was observed between the amount of play and the stress distribution in the system. For a perfect fit, an obvious increase in stress was found in the implant and strain in the implant bed. With respect to the excessive static loading performed in our simulations and the resulting loading behaviour, we conclude that the SFI-Bar is a system suitable for clinical application.

Influence of the implant cervical topography on the crestal bone resorption and immediate implant survival

The aim of the study was the investigation of the survival rate of immediate implants in addition to the evaluation of the level of the alveolar bone around the neck region of immediately placed implants of different macrodesigns. To address the question whether the "biological", highly polished area of the implant neck is more associated with crestal resorpiton than the rough neck region, the influence of the surface characters of the implant cervical region was studied. The survival rate of 129 implants from 52 patients was evaluated on different time points after immediate implantation. The level of peri-implant bone contacts to the implant border from 24 implants, which included implants types Tiolox, NobelReplace Tapered and PrimaConnex Tapered, was measured radiographically in seven patients who received immediate implants followed by a healing period of 3-6 months. Various periods from the time of insertion were considered for the measurement depending on the clinically available data. No differences in the status of the alveolar crest around highly polished and roughened cervical-implant regions were observed in the seven patients. The most noticeable resorption was detected in the distal margin of the alveolar crest. The present study shows that highly polished- or roughened neck implants are inserted into a fresh extraction socket do not differ significantly in the clinical and radiographical outcomes after various post-operative periods.

Long-term management of bilateral metastases of renal cell carcinoma to the choroid plexus

BACKGROUND

Metastatic tumors to the brain presenting exclusively in the choroid plexus are exceedingly rare. These events are frequently associated with renal cell carcinoma (RCC), of which all reported cases have been solitary lesions.

METHODS

The authors present the unusual case of a patient with metastatic RCC who developed bilateral tumors of the choroid plexus. These tumors, one of which was confirmed to be metastatic RCC by histologic analysis, were treated over a 5-year period with a combination of interventions, including surgical resection, stereotactic radiosurgery, and chemotherapy, in conjunction with continual radiological monitoring.

FINDINGS

Follow-up over a 5-year period demonstrated good control of the patient's intracranial disease and very little neurologic sequelae.

INTERPRETATION

This strategy was successful in keeping the patient in good health with minimal neurological symptoms, despite the bilateral nature of the disease and its generally poor prognosis.

Vertebral arterial dissection associated with Klippel-Feil syndrome in a child

BACKGROUND

Vertebral artery dissection resulting in stroke is rare in children. We report here on a 7-year-old boy with Klippel-Feil abnormality, who presented with a pontine infarction after a supervised swimming session.

METHODS

Evaluation after a second acute neurological event included a formal cerebral angiogram, which revealed a complete upper basilar artery occlusion and right vertebral arterial dissection. Cervical spine radiographs demonstrated an associated fusion of the C2 and C3 vertebrae. Anticoagulation therapy was initiated, and the neurological deficits associated with the pontine infarction resolved. Anticoagulation was discontinued after 6 months of therapy, with no recurrence of symptoms.

CONCLUSION

Vertebral artery dissection may rarely be associated with Klippel-Feil abnormality in children.

Effect on treatment outcome of coinfection with SEN viruses in patients with hepatitis C

The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-transfusion hepatitis. We assessed whether coinfection of patients with chronic hepatitis C and SEN D or SEN H correlates with the outcome of treatment with interferon and ribavirin. Of 31 patients with hepatitis C studied, six were positive for SEN D and seven for SEN H (one was positive for both). All of those positive for SEN D and five of those positive for SEN H failed to respond to therapy. Overall response (RNA titre and alanine aminotransferase concentration after treatment) was lower in SEN-infected patients than uninfected patients (p=0.025). We conclude that coinfection with SEN viruses is frequent in chronic hepatitis C patients and might adversely affect the outcome of treatment with interferon and ribavirin.

Nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NSAIDs) alter the kinetics of human colon cancer cell lines more effectively than traditional NSAIDs: implications for colon cancer chemoprevention

Nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs), consisting of a known nonsteroidal anti-inflammatory drug (NSAID) and a nitric oxide (NO)-releasing group, are reported safer than NSAIDS: To assess their potential in colon cancer chemoprevention, we studied in vitro the effect of NO-aspirin, NO-sulindac, and NO-ibuprofen on colonocyte kinetics. These three NO-NSAIDs reduced the growth of cultured HT-29 colon adenocarcinoma cells much more effectively than the corresponding NSAIDs; e.g., at 24 h, their IC(50) values were as follows: (a) aspirin, >5000 microM; (b) NO-aspirin, 1 microM; (c) sulindac, 750 microM; (d) NO-sulindac, 150 microM; (e) ibuprofen, >1000 microM; and (f) NO-ibuprofen, 42 microM. This effect was due to inhibition of proliferation and induction of apoptosis and perhaps to the induction of novel cell changes, characterized by extensive DNA degradation. NO-NSAIDs also blocked the G(0)-G(1) to S cell cycle transition. Their superior effectiveness compared with traditional NSAIDs, combined with their reported safety, makes them promising candidates for chemopreventive agents against colon cancer.

Antifungal susceptibility testing of dermatophytes: establishing a medium for inducing conidial growth and evaluation of susceptibility of clinical isolates

A standardized reference method for dermatophyte in vitro susceptibility testing is lacking. In a previous study, Norris et al. (H. A. Norris, B. E. Elewski, and M. A. Ghannoum, J. Am. Acad. Dermatol. 40(6, part 2):S9-S13) established the optimal medium and other growth variables. However, the earlier study did not address two issues: (i) selection of an optimal medium for conidial formation by dermatophytes and (ii) validation of the method with a large number of dermatophytes. The present study addresses these two points. To select which agar medium best supported conidial growth, representative isolates of dermatophytes were grown on different agars. Preliminary experiments showed that only oatmeal cereal agar supported the production of conidia by Trichophyton rubrum. We tested the abilities of 251 T. rubrum isolates to form conidia using three different cereal agars and potato dextrose agar. Overall, oatmeal cereal and rice agar media were comparable in their abilities to support T. rubrum conidial growth. Next, we used the oatmeal cereal agar for conidial formation along with the optimal conditions for dermatophyte susceptibility testing proposed by Norris et al. and determined the antifungal susceptibilities of 217 dermatophytes to fluconazole, griseofulvin, itraconazole, and terbinafine. Relative to the other agents tested, terbinafine possessed the highest antifungal activity against all of the dermatophytes. The mean +/- standard error of the mean MICs of fluconazole, itraconazole, terbinafine, and griseofulvin were 2.07 +/- 0.29, 0.13 +/- 0.01, 0.002 +/- 0.0003, and 0.71 +/- 0.05 microgram/ml, respectively. This study is the first step in the identification of optimal conditions that could be used for the standardization of the antifungal susceptibility testing method for dermatophytes. Inter- and intralaboratory agreement as well as clinical correlations need to be established.

[Superselective intra-arterial chemotherapy in therapy-refractory lymph node recurrences of breast carcinoma]

PURPOSE

To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer.

METHODS

14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms.

RESULTS

In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects.

CONCLUSION

Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used.

Determination of 1H relaxation times of water in human bone marrow by fat-suppressed turbo spin echo in comparison to MR spectroscopic methods

Relaxation times of water were measured in human vertebral bodies by a fat-suppressed dual-echo turbo spin echo/turbo inversion recovery MRI sequence. Comparison was made with T1 and T2 values obtained by localized 1H-MR spectroscopy. The accuracy of the results and the diagnostic potential of the fast quantitative MRI technique were evaluated in 20 volunteers, 11 patients with osteoporosis, 6 patients with lymphoma, and 6 patients with bone marrow metastasis. No significant alterations of T1 and T2 relaxation times of water and fat were found in osteoporosis. With both methods, an increase in the T1 values of the water resonance by 16% was observed in lymphomas, which was highly significant (P < .001) in the MRS measurements, and an elevation by the same amount was obtained by the MRI sequence for the metastases (P = .040). A strong reduction of fat fraction was quantified by MRS in the tumorous cases. T2 of the water resonance increased by more than 30% (P < .003) in metastases. Water T2 values obtained by the MRI sequence showed systematic deviations from the MRS results, especially at short echo spacings.

[Intra-arterial treatment of therapy-resistant residual tumors of the pelvis]

PURPOSE

Evaluation of intraarterial cancer treatment in recurrent pelvic tumors, which were resistent to other treatment modalities.

PATIENTS AND METHODS

Ninety-seven patients suffering from pelvic recurrences originating from bladder (n = 40), rectum (n = 19), cervix (n = 21) oder other organs (n = 17) were treated by intraarterial chemotherapy (111 times) or transcatheter embolisation (52 times).

RESULTS

Less than 20% of our patients had remission of the tumor burden but tumor symptoms (especially pain and bleeding) could be controlled in 35 to 87% of the patients. The main complication was a muscle necrosis after intraarterial chemotherapy because of recurrent bladder cancer.

CONCLUSION

Intraarterial cancertherapy is a useful procedure for symptomatic treatment of tumor symptoms especially in case of bleeding. Local tumor control can only be achived in a minority of the patients.

Previously treated, locally recurrent breast cancer: treatment with superselective intraarterial chemotherapy

PURPOSE

To evaluate the effectiveness of intraarterial infusion chemotherapy (IAC) with mitoxantrone hydrochloride in patients with previously treated, locally recurrent breast cancer.

MATERIALS AND METHODS

Thirty-nine women (aged 31-82 years) with recurrent breast cancer underwent superselective IAC (25 mg/m2 mitoxantrone hydrochloride every 24 hours) through the subclavian artery branches after heparin administration. The extent of tumor perfusion was monitored with computed tomography during the intraarterial administration of contrast medium. IAC was repeated one to nine times. Patients had previously undergone radiation therapy (n = 39), surgery (n = 20), or systemic chemotherapy (n = 23).

RESULTS

The overall response rate was 77% (n = 30). Eight patients had complete remission. Progression occurred in three patients. Remission was observed in cases of lymph node involvement (n = 9). Seven patients are still undergoing treatment. Side effects were usually moderate. Nine patients died of systemic tumor spread. In 14 patients, distant metastases developed during the first 18 months of treatment.

CONCLUSION

IAC is an effective, well-tolerated therapy in patients with locally recurrent breast cancer.

[Embolization of bone metastases]

Eighteen patients (11 renal tumours, 3 bronchogenic carcinomas, 4 others) with 24 different bone metastases were embolized for preoperative devascularization (11 x) or for intractable pain (7 x). Metastases were localized in the spine (17 x), pelvis (5 x), and shoulder girdle (2 x). All metastases were hypervascularized. Post-embolization showed no complications. Intraoperative blood loss was minimized to 2100 ml (600 ml-4200 ml). Pain relief was achieved in 6 out of 7 patients. Eight of 18 patients died as a result of underlying diseases (follow-up 7 months).

[Superselective intra-arterial chemotherapy in breast cancer]

Forty-two patients with locally advanced breast cancer (n = 8) or recurrent breast cancer (n = 34) received regional chemotherapy (mitoxantrone 25 mg/m2 per 24 h) via the internal mammary artery or other vessels of the subclavian artery. To prevent artery thrombosis 500-1000 U heparin per hour were administered i.v. Tumour perfusion was monitored by intra-arterial angio-CT. Remission rates (CR + PR) were 100% (primary breast cancer) and 89% (recurrent tumours), respectively. Intra-arterial chemotherapy was well tolerated. No complications were noted.