Assessment of the feasibility of a community-based mental health training programme for persons with disabilities by non-specialists from different stakeholders' perspectives in Bangladesh

INTRODUCTION

Bangladesh is a developing country where 11% of the population has at least one disability, but no community-level mental health service is available. There is limited evidence of the burden of mental health issues and health-seeking behaviour among this population. This study assessed the feasibility of a training intervention for persons with disabilities, where peer support providers provided community-based disability-inclusive mental health services.

METHODS

Four stakeholder groups participated in this qualitative study: peer responders (trained persons with disabilities), trainers, representatives of organisations of persons with disabilities and disability-specific organisations, and officials of international and national non-governmental organisations. Two types of qualitative interviews were used to collect data, and thematic analysis techniques were utilised.

RESULT

Stakeholders perceived the peer responder training programme as acceptable for persons with disabilities to develop themselves as peer support providers, with potential benefits including increased mental health literacy, ensuring accessible mental health services, and improving the well-being of persons with disabilities. Potential challenges included receiving training and delivering services. Increased training duration, more fieldwork, supervision opportunities, and refresher training were recommended to mitigate training challenges. Financial support and formal community recognition were deemed necessary for training delivery.

CONCLUSION

The peer responder training programme was feasible to ensure accessible mental health services for persons with disabilities, build a workforce to screen for mental health conditions, and provide appropriate referrals. A multi-sectoral collaboration of government and non-governmental institutions is recommended to policy advocates to expand the peer responder training programme in the mainstream mental healthcare system.

Translational Biochemistry of the Skin

Understanding translational biochemistry of the skin is an essential component in mastering non-invasive aesthetic treatments. Collagen is the most abundant protein in the animal kingdom and plays a significant role in maintaining structural function in biologically healthy human skin. Collagen degradation and synthesis occurs throughout human life. Upregulation of collagen synthesis remains the mainstay of non-invasive aesthetic skin treatments. Elastin is a smaller yet significant component in the skin's ability to maintain biologically healthy stretch and recoil. Multi-Omics represents a relatively nascent field in the optimization and development of therapies aimed at the aesthetic improvement of the skin.

Outcomes of Patients with Oral Cavity Squamous Cell Carcinomas Treated with Adjuvant IMRT with Perineural Invasion

PURPOSE/OBJECTIVE(S)

Patients with advanced oral cavity squamous cell carcinoma (OCSCC) have high rates of recurrence and dismal outcomes. Treatment consists of definitive surgery followed by risk-adapted adjuvant radiation therapy based on pathologic review. Perineural invasion (PNI) is thought to be an intermediate risk factor, leading to clinical uncertainty as to adjuvant therapy in the setting of PNI. We performed a single institution retrospective review of patients with OCSCC treated with adjuvant radiation with or without PNI and examined relapse-free survival (RFS) and overall survival (OS).

MATERIALS/METHODS

We performed a single-institutional retrospective review of patients with OCSCC treated with adjuvant IMRT +/- chemotherapy after surgical resection from July 2002- August 2021 using our institution's Head and Neck SPORE database. Time to recurrence or death was calculated from end of RT. OCSCC within 5 years of RT was considered a recurrence, beyond this timeframe any OCSCC was considered a new primary. Univariate analysis of predictors for RFS and OS were performed using the Kaplan-Meier method with log-rank test. Factors significant on univariable analysis were entered into parsimonious cox multivariable analysis using forward selection methodology. A p-value <0.05 was considered significant in both analyses.

RESULTS

In total, 494 patients with OCSCC were identified that received surgery and adjuvant IMRT. In this cohort, 48.8% of patients had pT4 tumors, 62.2% of patients had nodal involvement, and 40.3% of patients had extranodal extension. PNI was present in 63.6% of patients (n = 314). With regards to tumor subsite, 40.9% originated from the oral tongue, 21.5% originated from the gums, 18% originated from the floor of mouth, and 19.6% from the other sites. Median age was 59 years, and median adjuvant RT dose was 63 Gy (Interquartile range [IQR]) 60-66 Gy). The majority of patient received platinum-based chemotherapy (51.8%), and 44.1% of patients did not receive adjuvant chemotherapy. The 3-year RFS and OS with a median follow-up of 32 months (IQR 12-69 months) is presented in Table 1. On univariable analysis for OS, T stage (p = 0.003), N stage (p<0.001), PNI (p = 0.005), extranodal extension (ENE) (p<0.001), margin status (p = 0.038), and chemotherapy (p<0.001) were significant. On multivariable analysis, T stage (p<0.001), N stage (p = 0.010), PNI (p = 0.017), and ENE (p = 0.007) remained significant. Similar results were seen in the RFS analysis.

CONCLUSION

In this large single institution study, PNI was a significant and independent negative predictive factor for RFS and OS in patients with OCSCC that had received definitive surgery followed by adjuvant IMRT. To our knowledge this is the largest study of its kind, and these findings can help guide clinical decision making for these patients.

Biliary Embryonal Rhabdomyosarcoma: A Case Report

A 10 years old boy who was initially diagnosed as choledochal cyst underwent laparotomy. There was presence of necrotic and soft tissue growth within common bile duct (CBD). After extensive toileting of bile duct, a T-tube was placed. His histopathology followed by immunohistochemistry revealed Embryonal Rhabdomyosarcoma. Later the patient received VAC regime chemotherapy. On follow-up imaging, there was no tumour mass in CBD. So, T-tube removed and now the patient is doing well.

β^{+} Gamow-Teller Strengths from Unstable ^{14}O via the (d,^{2}He) Reaction in Inverse Kinematics

For the first time, the (d,^{2}He) reaction was successfully used in inverse kinematics to extract the Gamow-Teller transition strength in the β^{+} direction from an unstable nucleus. The new technique was made possible by the use of an active-target time-projection chamber and a magnetic spectrometer, and opens a path to addressing a range of scientific challenges, including in astrophysics and neutrino physics. In this Letter, the nucleus studied was ^{14}O, and the Gamow-Teller transition strength to ^{14}N was extracted up to an excitation energy of 22 MeV. The data were compared to shell-model and state-of-the-art coupled-cluster calculations. Shell-model calculations reproduce the measured Gamow-Teller strength distribution up to about 15 MeV reasonably well, after the application of a phenomenological quenching factor. In a significant step forward to better understand this quenching, the coupled-cluster calculation reproduces the full strength distribution well without such quenching, owing to the large model space, the inclusion of strong correlations, and the coupling of the weak interaction to two nucleons through two-body currents.

1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations

BACKGROUND

The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength.

OBJECTIVE

To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system.

MATERIALS AND METHODS

Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system.

RESULTS

For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled.

CONCLUSION

The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.

Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations

BACKGROUND

Fractional laser treatment was introduced in 2004 as a non-invasive technique to treat sun-damaged and aging skin. Since then, numerous ablative and non-ablative photothermolysis technologies and devices have been introduced, increasing the options for clinicians and patients but also increasing the complexity regarding which system to use and the techniques to optimize outcomes. No two devices are the same and the user-manuals preset dosimetry does not address many clinical situations, which can create confusion for new and inexperienced users.

METHODS

An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device. The survey included 39 questions, addressing experience, best practices and recommendations for use.

RESULTS

The survey data suggests that the device can be used to treat patients of all ages and skin types for indications including photoaging and photodamage, periorbital wrinkles, freckles, (ephelides), solar lentigines, poikiloderma, scarring due to acne or surgery. It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks. Unexpected and adverse effects were rarely reported and those that did were mild and transient.

CONCLUSIONS

This position paper provides practical real-world guidelines resulting from a small survey of experienced users, for new and early uses of the novel 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser. J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/JDD.6181.

Detection of Aflatoxins in Peanut Oils Marketed in Peshawar, Pakistan Using Thin Layer Chromatography

Background: Aflatoxins (AFs) are natural toxins produced by fungus belonging to genus Aspergillus. These toxins are the secondary metabolites, which may cause teratogenic, mutagenic, and carcinogenic effects due to contamination of food. Peanut is an economi- cally important crop, grown in many parts of the world. The main aim of this survey was to detect AFs in peanut oils marketed in Peshawar, Pakistan. Methods: During September 2020 to February 2021, a total of 60 peanut oil samples were obtained from retail stores and markets; 20-each from three different areas of Pesh- awar (University, City, and Cantt), Pakistan. AFB1, AFB2, AFG1, and AFG2 were deter- mined using Thin Layer Chromatography. Data analysis was done using SPSS 21.0. Results: Prevalence rates of AFB1, AFB2, AFG1, and AFG2 in peanut oils were 70, 51.7, 3.3, and 0%, respectively. The mean of total AFs was 8.59 μg/kg ranged from 0.12 to 55 μg/kg. Totally, 5% (3 out of 60) of the samples were found contaminated with AFB1 above the permissible limits (20 μg/kg) according to national regulation. There was significant difference (p<0.05) between AF levels in the samples from different three areas of Peshawar. Conclusion: Although, the majority of samples of peanut oils in Peshawar (Pakistan) were safe for consumption, monitoring of AFs must be carried out on a regular basis in the case of peanut oil consumed in this region. This study suggested that farmers, food processors, and local processors should be aware of acceptable hygiene practices for the cultivation, protection, transportation, processing, and handling of peanut oil.

The Diagnostic Efficacy of Swede Score for Prediction of Pre-invasive Cervical Lesions: A Prospective Hospital-Based Study

Context

The accuracy of colposcopy has recently been called into question particularly with regard to determining the site requiring biopsy. The technique of colposcopy is largely operator dependent, and the agreement between colposcopists is less reliable than once presumed. In an attempt to standardize colposcopy a new scoring system, the Swede score has been devised, which includes lesion size as a variable to be scored in addition to the 4 variables found in the modified Reids Colposcopic Index (RCI).

Aim

To assess the diagnostic accuracy of Swede score for pre-invasive cervical lesion.

Setting and Design

A cross-sectional study in a tertiary care centre.

Method

Swede score was calculated for assessment of pre-invasive cervical lesions on patients undergoing colposcopy who were suspected with pre-invasive cervical lesion. Cervical biopsy was taken if modified RCI ≥ 3 or Swede score ≥ 5. Histopathology report of the cervical biopsy was taken as gold standard.

Results

Swede scores of 5 or more had sensitivity, specificity, positive and negative predictive values of 94.9%, 88.4%, 75.5% and 92.9% respectively.

Conclusion

The Swede score by just incorporating one additional variable that is size of the lesion, showed better correlation with histopathology.

Factors affecting quality of life of cervical cancer patients: A multivariate analysis

Objective

The aim of good management for cancer survivors should not be limited to only clinical care, but rather it should also include best quality of life (QOL). The objective of this study was to find out various factors affecting QOL in cervical cancer patients so that by modifying these factors, the best QOL can be provided to them.

Materials and Methods

This was a prospective cohort study conducted in the Department of Obstetrics and Gynaecology and Department of Radiotherapy, King George's Medical University (KGMU), Lucknow, from May 2015 to July 2016. The cases were selected from patients visiting the outpatient department or who were admitted to the Department of Obstetrics and Gynaecology and Department of Radiotherapy, KGMU. The data information was collected in the form of face-to-face interview using European Organization for Research and Treatment of Cancer general cancer QOL Score 30 (EORTC QLQ C-30) and EORTC QOL questionnaire cervical cancer module (QLQ CX-24) questionnaire.

Results

QOL was assessed in 85 patients. Health-related QOL was separately studied in terms of overall general QOL and cancer cervix-specific QOL, and various factors affecting QOL were studied by multivariate analysis.

Conclusion

Education, tobacco use, degree of differentiation of tumor, and size of tumor were the independent factors found to have statistically significant effect on QOL of cervical cancer survivors.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Ethanol-induced gastric ulcer in rats and intervention of tert-butylhydroquinone: Involvement of Nrf2/HO-1 signalling pathway

Gastric ulcer (GU) is the most common health concern that occurs due to alcohol consumption, smoking and physiological stress. Ethanol-induced GU in animal model resembles the pathophysiology of human ulcer. The present study was designed to investigate the cytoprotective and anti-inflammatory properties of tert-butylhydroquinone (tBHQ), a nuclear factor erythroid 2-related factor 2 (Nrf2) activator, against gastric mucosal damage induced by acute exposure of ethanol (5 ml/kg). The intervention of tBHQ (25 and 50 mg/kg, per os (po)) and omeprazole (20 mg/kg, po) was done for 10 consecutive days. Omeprazole was chosen as a standard drug because it is prescribed for the treatment of GU. Pretreatment of tBHQ decreased gastric mucosal lesion, ulcer index, apoptotic cells and lipid peroxidation level induced by ethanol. Furthermore, the intervention of tBHQ increased gastric mucosa integrity, pH, reduced glutathione, collagen and mucus-producing goblet cells. Intervention of tBHQ increased the expression of antioxidant markers such as Nrf2, haeme oxygenase-1 and catalase and decreased the expressions of inflammatory markers such as nuclear factor kappa-light-chain-enhancer of activated B cells and cyclooxygenase-2. The cytoprotective potential of tBHQ against gastric mucosal damage might be due to its ability to enhance cellular antioxidants and anti-inflammatory responses.

Abstract P6-14-04: Not presented

This abstract was not presented at the conference.

Citation Format: Mohd Taib NA, Islam T, Su TT, Musthaffa S, Abdullah Din N, Rahman Z, Mohamed KNB, Kaur S, Filza J, Shaheera F, Ellsworth Beaumont C. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-14-04.

Outcomes of tumour related epilepsy in a specialised epilepsy surgery unit

INTRODUCTION

Seizures are an important cause of morbidity in patients with low grade gliomas with approximately 40% of cases drug resistant. The pathogenesis is quite complex and poorly understood. The treatment aims vary between almost purely epilepsy considerations and those that are primarily oncologic.

AIM

To determine whether patients who present with seizures and are found to have a low grade glioma have better outcomes when managed through a specialized epilepsy unit compared to the general neurosurgical service.

METHODS

A review of the prospectively collected database was performed over a 10 year period to identify 48 adult patients who present with a seizure and were subsequently found to have a low grade glioma. These patients were analysed with respect to management through the specialized epilepsy service or the general neurosurgical service. The primary outcome was Engel classification between the two groups. Secondary outcomes included recurrence, postoperative deficits, delay to surgery, histology, grade and extent of resection.

OUTCOMES

The patients managed through the epilepsy service had significantly higher rate of favourable Engel outcomes (I and II) compared to the general neurosurgery service (OR: 13.2, 95% CI: 1.239-140.679; P = 0.033). The epilepsy surgery group patients had a significantly higher delay to surgery (P < 0.001). The patients in the epilepsy service had a significantly higher resection ratio compared to the general neurosurgery service (73% vs 127%, P = 0.014). Rates of recurrence were not different between the two groups.

CONCLUSION

Patients with tumour related epilepsy who undergo an intensive presurgical evaluation may obtain better seizure related outcomes.

Improving Breast Health Literacy Through an Innovative Breast Cancer Awareness Campaign Using the Know Your Lemons (KYL) Materials in Malaysia

Background: Breast cancer (BC) is the most common cancer in Malaysia but has the worst survival in the Asia Pacific region. Main drivers identified in previous research include late-stage disease at presentation, poor adherence to treatment and sociocultural barriers. Factors affecting late presentations include lack of awareness on basic symptoms of BC and poor access to early detection. Although BC awareness campaigns have been done, Hadi et al., showed low BC awareness among university students in Malaysia. This is an evaluation of the “Show You Care, Be Aware” campaign that was done in University of Malaya, Kuala Lumpur in October 2017. The campaign was carried out using KYL materials through use of posters, awareness booths and public forums. The materials contain information on the normal breast, 12 symptoms of BC, information on breast self examination (BSE), screening and diagnostic (detection) pathways in Malay and English language. Aim: To evaluate the campaign effect on breast health literacy. Methods: A quasi-experimental research was conducted. The KYL materials were forward and backward translated by 2 native bilingual individuals. The context and content of the translation was ensured to be accurate and fitted into the KYL design. A total of 679 participants participated in the study. A self-designed questionnaire was used to assess effectiveness of the materials. Educational intervention sessions were provided in the form of KYL materials (leaflets, posters and banners) displayed in awareness booths in the campus. Discussion on leaflets and questions and answers, and practical demonstrations of BSE dummy were done. The questionnaire was administered through face to face interview. The data were analyzed via SPSS 20; descriptive and Wilcoxon matched paired signed rank test was performed. Results: 72% (n=492) of our participants were Malay, 19% (n=119) Chinese and 10% (n=68) Indians and others. Majority of our participants were female (94.2%), age 30 or below (61%), single (62.9%), had college or university education (85.7%). Most of our participants, 96.2% stated that the language used in the KYL materials were clear and understandable; 95.3% thought materials were attractive and 89.2% found them acceptable in Malaysian culture. 52.7% preferred Malay materials, 40.4% English and 6.5% in both Malay and English. The materials improved perceived knowledge on the process of detecting BC (96.5%). 92.8% agreed or strongly agreed that they felt more confident in recognizing the symptoms of BC themselves. There was an increase in self reported knowledge of BC; mean scores before and after exposure to KYL materials were 2.83 versus 4.30 respectively ( P < 0.001). Conclusion: Health education using KYL materials promoted breast cancer awareness, confidence in detecting symptoms and knowing processes of diagnosis among urban and educated Malaysians. Future research in lower educated and rural communities in Malaysia is warranted.

Effectiveness of Breast Care Nurse Led Video Orientation Programme on Information and Navigation for Newly Diagnosed Breast Cancer Patients at University Malaya Medical Center, Malaysia

Background: Advancement in medical treatment with wider treatment options have made breast cancer (BC) care more complex. Short consultation time with physicians, treatment complexities, patients' fears and poor coping skills at the time of diagnosis may affect patient´s decision that cause treatment delays and nonadherence. Main reasons for advance BC presentation in Malaysia are delay in taking treatment decision and poor breast health literacy on disease and treatment outcomes may contribute to nonadherence to treatments. To address this knowledge gap, a breast care nurse (BCN) led orientation video for new patients to navigate them through complex multimodal treatment processes. This audio-visual educational tool address multimodal treatments and its side effects and in addition navigating admission, discharge and follow-up, advice on diet and exercise to maintain a healthy life style during survivorship period was developed in layperson language in Malay, Mandarin and English. Aim: To assess the effectiveness of BCN led video orientation on the improvement of patient knowledge and satisfaction. Methods: A pilot study was carried out in 50 patients to assess the effectiveness of the video, and found that patients needed a face to face interaction to watch the video. Hence, a BCN led orientation was developed to use the video. A self-administered pre- and postsurvey on 246 newly diagnosed breast cancer patients in University Malaya Medical Center (UMMC) was performed to evaluate expectations, satisfactions and knowledge (a Likert scale response using items 4 number scale was used, 0 means “no knowledge” and 4 means “a great degree of knowledge”). The scoring was done before and after the video orientation was done. A Wilcoxon matched-paired signed-rank test was perform to analyze the changes in the scoring. Results: Among 247 patients, who received the BCN led video orientation program, 79.3% (n= 197) found that the video met or exceeded their expectations. 23.9% (n=59) and 56.3% (139) consecutively found the video very effective and effective in broadening their perspective on BC treatments. And 171 (69.2%) of them overall rated the video highly met their expectations. There were significant improvement in knowledge for treatment options for BC, mean scores (M=0.93 versus M=2.97) before and after watching the video ( P < 0.001). Similar findings were found in different types of operation for BC; procedure for admission in UMMC, information on chemotherapy; radiotherapy; hormone therapy and alternative medicine for BC. It also showed improved knowledge scores for healthy diet; physical activity after treatments and care of the arm after operation ( P < 0.001). Conclusion: Video-based information on treatments and navigating care through a BCN led service had effectively improved patients' knowledge and satisfaction. This approach can be used to educate cancer patients in a middle resource setting.

A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment

Background: Chemoexfoliation, also known as chemical peeling, is a method of targeted cutaneous ablation using specific caustic agents that allow for rapid, predictable, and uniform thickness of chemoablation to a desired cutaneous depth, ultimately resulting in an improved appearance of skin. Objective: In this review, we provide an up-to-date analysis of all currently available chemical peels for dermatologic use, as well as a step-by-step instructional protocol for an algorithmic approach to treatment. Methods: A comprehensive search of the Cochrane Library, MEDLINE, and PUBMED databases was performed to identify relevant literature investigating chemical peeling agents. In addition, a search of all commercially available, prescription-based peeling agents was performed to identify all products currently available in the United States market. Results and Conclusion: Chemical peels are the third most commonly performed noninvasive cosmetic procedure in the United States, with over 1,300,000 procedures performed in 2016 alone. There has been a paradigm shift in recent years, with lasers largely supplanting deep peels. Despite this shift, superficial peels have proliferated in both popularity and product diversity. When used for the appropriate indication and with proper technique, nearly all peeling agents have demonstrated excellent clinical efficacy and remain an indispensable cost-effective tool in the dermatologist's aesthetic toolbox.

Salvage from cervical dystocia in third degree uterovaginal prolapse: Duhrssen's incision

We present a case of a 28-year-old woman second gravida with a full-term pregnancy who presented to us in active phase of labour with third degree uterovaginal prolapse complicated by entrapment of fetal head by dystocia of cervix and fetal distress. Patient was immediately shifted to the operation theatre and prompt delivery was conducted by giving Duhrssen's incision on the highly vascular, oedematous prolapsed cervix. The outcome was an alive and healthy male baby. Duhrssen's incision was stitched with minimal blood loss. Postnatal management included antibiotics and daily intravaginal packing. Patient was discharged along with the baby in satisfactory condition.

Mitigation of epidermal growth factor receptor inhibitor-induced side effects utilizing melanin and vascular-specific lasers: A case report series

The advent of targeted chemotherapy has led to the emergence of new dermatologic toxicities. We sought to use lasers and light devices to treat recalcitrant cutaneous adverse effects related to cancer treatment. Three stage III or IV cancer patients with cutaneous complications due to epidermal growth factor receptor (EGFR) inhibitors were treated with melanin and vascular-specific laser and light technologies. Two patients reported reduction in papulopustular eruption following pulse dye laser (PDL) treatment. Two patients noted reduction in hair growth following intense pulsed light (IPL) and/or Alexandrite laser treatments. One patient was treated with both the PDL and IPL and reported improvement of both EGFR-induced hypertrichosis and papulopustular eruption. Laser and light devices targeting melanin and hemoglobin can be utilized to mitigate the cutaneous adverse effects associated with EGFR inhibitors in patients who have failed traditional therapies. This represents a new option for the cancer patient who is suffering from chemotherapy-induced side effects.

Assessment of Quality of Life in Treated Patients of Cancer Cervix

Aim:

The aim of the study was to assess the quality of life (QoL) in women suffering from cancer cervix before and after the treatment, to study various factors affecting the QoL in these women, and to evaluate the impact of treatment modalities on the QoL.

Materials and Methods:

Women with cervical cancer attending Department of Obstetrics and Gynecology and Department of Radiotherapy who met the eligibility criteria were interviewed with a structured questionnaire of QoL, the European Organization for Research and Treatment of Cancer QLQ30, and its Cervical Cancer Module (Cx24). The baseline observations were recorded when the patient first reported, second evaluation was done at 3 months posttreatment, and the third evaluation at 6 months posttreatment. QoL domains along with sociodemographic and clinicopathological variables were analyzed.

Results:

A total of ninety patients were included for analysis, of which 5 were lost to follow up. A statistically significant improvement was found in physical, emotional function, pain, fatigue, and vaginal symptoms of the participants; however, there was no significant improvement in social, cognitive, or role functioning, body image, sexual activity, or sexual enjoyment. Vaginal and sexual function worsened significantly. Multivariate analysis showed that young women and those with a higher level of education had better QoL. Stage and type of cancer had little impact on the general QoL, but participants with earlier stage and well-differentiated cancer had better cancer cervix-specific QoL.

Conclusion:

The QoL of the participants in terms of physical (P = 0.04) and emotional functioning (P = 0.001) improved with treatment. Women with a higher level of education and early stage of disease had better QoL.

Pregnant Women Diet Quality and Its Sociodemographic Determinants in Southwestern Bangladesh

Background:

Diet diversity of pregnant women is associated with nutrition sufficiency, micronutrient adequacy, and pregnancy outcomes. However, the sociodemographic determinants of diet diversity among pregnant women in low-income countries are not well studied.

Objective:

The analysis was undertaken to study the determinants of high dietary diversity and consumption of micronutrient-rich foods by pregnant women from rural Bangladesh.

Methods:

Pregnant women (508) were randomly selected from southwestern Bangladesh and interviewed to collect data about diet and sociodemographic characteristics. A 24-hour recall was used to collect information about diet. Diet diversity score was calculated for 9 major food groups. All analyses were conducted using STATA SE 12.

Result:

The overall mean diet diversity score was low at 4.28 and was significantly high among pregnant women who have higher educational achievement, whose husbands’ occupation was business, who live in households of 4 or more family members, and who were dwelling in a house with more than 1 room. Highest gap on knowledge and consumption was reported for 3 food groups including dairy foods, eggs, and dark green leafy vegetables. Consumption of dairy and eggs was lower among women from low socioeconomic status, but no significant association was found between sociodemographic characteristics and consumption of leafy vegetables.

Conclusion:

Our analysis has shown that diet quality of pregnant women was poor and intake of micronutrient-rich foods was low despite having knowledge about the importance of these foods, underscoring the need for promoting the diet quality in developing countries through behavior change communication programs.

P14: DOXYCYCLINE: A RARE CAUSE OF DRUG INDUCED PANCREATITIS

Purpose of Study

Drug-induced pancreatitis (DIP) is a rare clinicopathologic entity. We report a 58-year-old female who developed DIP secondary to administration of doxycycline.

Methods Used

A 48 year old female with a history of hypertension presented to the hospital with complains of nausea/vomiting, right upper-quadrant gnawing abdominal pain, 8/10 in intensity with radiation to the back. She denied exacerbating factors, use of alcohol, tobacco and drug. Patient also denied diarrhea, constipation and changes in skin or stool color. On examination patient was hypertensive (155/95) with a heart rate of 102. She had epigastric/right upper quadrant tenderness on superficial palpation, hypoactive bowel sounds without any palpable organs, rebound tenderness or rigidity. Serum lipase was elevated at 2508 IU/L, negative pregnancy and insignificant urinalysis findings. Liver function tests, lipid panel, chemistry panel and hematologic panel were within normal limits. Radiologic investigations with abdominal ultrasound depicted mild proximal dilatation of the common bile duct with smooth tapering of the duct distally indicating status post-cholecystectomy. Contrast enhanced computed tomography scan revealed mild enlargement of the body of the pancreas with adjacent peripancreatic fatty infiltration consistent with acute pancreatitis. Upon further questioning patient explains recent diagnosis (7 days) of tibial orthopedic hardware infection as she was prescribed doxycycline 200 mg twice a day in anticipation of irrigation of infected site. After confirmation, and discontinuation of doxycycline, our patient recovered and has been disease-free for over a month.

Summary of Results

Drug-induced pancreatitis is uncommon etiology of acute pancreatitis, which is responsible for 0.1%–2% of all the acute pancreatitis cases. Among adverse drug reactions, pancreatitis is often-ignored because of the difficulty in implicating a drug as its cause.

Conclusions

In our vastly evolving pharmacotherapy world, DIP should be included in the differential of idiopathic pancreatitis, especially after other common causes have been ruled out.

Role of mass media in increasing knowledge and practices of mothers on IYCF: findings from a community trial in rural Bangladesh

Poor IYCF (Infant and Young Children Feeding) practices are factors of poor nutrition among infants and young children in developing countries including Bangladesh. To address this problem, a national mass media campaign was launched using television channels along with home counseling. The study was designed to explore the effect of IYCF intervention on changing knowledge and practices of mothers in rural Bangladesh. The study used a cluster randomized trial design where six unions were randomized to allocate them to 'only mass media intervention (intervention-I)' or 'mass media + direct counseling (Intervention-II)'. Three unions were subjected to 'intervention-I' and the other three were subjected to 'intervention-II'. In intervention-I areas, the knowledge of initiation of breast feeding was improved by 8.5% and practice was improved by 23.7%. It was 17.9% and 16.6% respectively in intervention-II areas. In intervention-I areas knowledge about initiation of complementary feeding improved by 2.7% and in practice it was 19.3%. In intervention-II areas it was 8.6% and 21.3% respectively. Regarding giving the right quantity of complementary food, in intervention-I areas the improvement rate was 6.2% for children between 7-8 months old and 34% for children between 9-12 months old. In intervention-II areas it was 13.7% for children between 7-8 months old and 56.8% for children between 9-12 months old. Significant improvements were found in both the intervention areas, but changes were almost similar in both groups. Coverage of interpersonal communication was found to be very low. Improvement of IYCF knowledge and practice might be the contribution of mass media.South East Asia Journal of Public Health Vol.5(1) 2015: 18-24

Epilepsy in patients with primary brain tumors: The impact on mood, cognition, and HRQOL

BACKGROUND

A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impact on health-related quality of life (HRQOL). Presence of epilepsy and adverse reactions from tumor and epilepsy treatments may cause additional decline in HRQOL.

OBJECTIVES

We aimed to study the impact of epileptic seizures on cognition, mood, and HRQOL in patients with brain tumor-related epilepsy.

MATERIALS AND METHOD

Patients were grouped on an ordinal scale according to epilepsy burden from none to severe based on the presence of epileptic seizures and seizure frequency: L1, no epilepsy; L2, with epilepsy, seizure-free in the last 6 months with antiepileptic drugs; and L3, with epilepsy, at least one seizure in the last 6 months with AEDs. Health-related quality of life was measured by Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Quality of Life in Epilepsy-31 (QOLIE-31) tools, cognition by the Montreal Cognitive Assessment (MoCA) tool and Frontal Assessment Battery (FAB), mood by the Hospital Anxiety and Depression Scale (HADS), activities of daily living (ADLs) by the Barthel Index (BI), and performance status by the Karnofsky Performance Status (KPS) scale in patients with primary brain tumors at least one month following neurosurgery with or without radiotherapy and chemotherapy.

RESULTS

Eighty-one patients with a diagnosis of primary brain tumors were recruited. Sixty-eight percent of patients were diagnosed with primary brain tumor-related epilepsy, 50.61% patients had cognitive impairment, 33% had abnormal scores in the anxiety scale, and 34% had abnormal scores in the depression scale. There were no statistically significant differences in these scores among L1, L2, and L3 groups. There were statistically significant differences in duration of disease and KPS and BI scores between L1 and L3 groups. The L3 group has significantly longer duration of disease and scored low in both the BI and KPS scale when compared to the L1 group. All patients with primary brain tumors scored significantly low in FACT-Br 'physical well-being' (PWB) and 'emotional well-being' (EWB) and high in 'social well-being' (SWB) when compared to healthy controls. When scores of each group were individually compared to healthy controls, the L3 group showed the lowest scores in PWB, EWB, and 'functional well-being'. In SWB, L1 and L2 groups showed statistically significantly high scores when compared to normative data. The QOLIE-31 applied to groups with epilepsy showed statistically significantly lower scores in the L3 group when compared to the L2 group in 'cognitive' and 'social functioning' domains. On multivariate analysis, both poor performance status and frequency of seizures were found to be independent risk factors for poor HRQOL when FACT-Br mean scores were compared. Level of seizures was found to be an independent risk factor for poor HRQOL when QOLIE-31 scores were compared between L2 and L3 groups.

DISCUSSION

Presence of brain tumors could be attributed to cognitive impairment irrespective of the presence of epilepsy in our cohort. High seizure burden is an independent risk factor for poor HRQOL in patients with primary brain tumors. The QOLIE-31 is a more sensitive tool than the FACT-Br because of the presence of a seizure-related questionnaire.

Effect of incorporation of fermented bamboo shoot on physicochemical and microbial quality of pork pickle

Replacement of commercial chemical preservative (Vinegar) by incorporating fermented bamboo shoot (FBS) products partially or completely and their effect on physicochemical, microbial and shelf life qualities on pork pickle products was studied. Different FBS products such as FBS extract, paste and powder were incorporated in the pork pickle products at the level of 50 to 100 % with or without vinegar and stored at room temperature for 90 days. Highest pH values and lowest titrable acidity was recorded in products with 50 and 100 % FBS powder. No significant differences were observed with respect to proximate composition i.e. percent moisture, protein, fat and ash contents among the products except the product with 100 % FBS powder which had significantly (p < 0.01) lower moisture content. Microbial load (Log total plate counts) and thiobarbituric acid (TBA) values were found to be increasing as the storage periods were advancing. Except the product with 100 % FBS powder which could be stored for 30 days only, other products could be stored upto 90 days without any physicochemical and microbial problems. It can be concluded from this study that natural and organic FBS extract and paste can be used successfully replacing the conventional chemical preservative (Vinegar) for preparation of pork pickle products and preserved more than 90 days at room temperature. However, FBS powder can be used for preservation of the pickle products for a short period (30 days).

Role of USG-guided fine needle aspiration cytology in the diagnosis of abdominal mass

The present study was carried out with the aims to diagnose abdominal masses by FNAC with the help of ultrasonography guidance and to determine the diagnostic accuracy of FNAC. One hundred consecutive patients were studied during the period from January 2005 to December 2005. Histopathological examination was done to correlate with the cytologic diagnosis. The results of comparative study of USG-guided FNAC and histopathology were significant (P value was <0.001). In USG-guided FNAC, it was found that 64 were malignant tumors, 5 were benign tumors, 28 were inflammatory and 3 were inadequate material. Histopathology of 3 inadequate materials showed 1 was adenoma and 2 were leiomyoma. As a whole test results of USG-guided FNAC were sensitivity 95.52%, specificity 100%, positive predictive value 100%, negative predictive value 91.67% and accuracy 97%. USG-guided FNAC has been proved to be a rapid, reliable and cost-effective diagnostic method.

Response and remission rates with adjunctive aripiprazole in patients with major depressive disorder who exhibit minimal or no improvement on antidepressant monotherapy

BACKGROUND

The efficacy of adjunctive aripiprazole in patients with major depressive disorder (MDD) with no improvement after 8 weeks of prior antidepressant monotherapy has not been evaluated.

METHODS

A post hoc analysis of three similarly designed, randomised, double-blind, placebo-controlled, phase III studies was conducted investigating the efficacy and safety of aripiprazole adjunctive to standard antidepressant treatment (ADT) in MDD patients with a prior inadequate response to one to three ADTs. Minimal improvement to antidepressant monotherapy was defined as a Clinical Global Impressions - Improvement (CGI-I) score of 3 and non-improvement as a CGI-I of 4 at weeks 6 and 8 of antidepressant monotherapy.

RESULTS

The end-point response rate for ADT minimal improvers receiving adjunctive aripiprazole was 38.8% vs. 26.6% for adjunctive placebo (p < 0.05; number needed to treat [NNT] = 9 [95% confidence interval: 4.8-27.7]), and for ADT non-improvers receiving adjunctive aripiprazole was 24.0% vs. 10.3% for adjunctive placebo (p < 0.05; NNT = 8 [95% confidence interval: 4.4-21.5]). ADT minimal improvers and non-improvers demonstrated significant improvements in response vs. ADT alone as early as after 1 and 2 weeks of adjunctive treatment, respectively. The end-point remission rate for ADT minimal improvers receiving adjunctive aripiprazole was 34.2% vs. 21.0% for adjunctive placebo (p < 0.05; NNT = 8), and for ADT non-improvers receiving adjunctive aripiprazole was 16.0% vs. 5.9% for adjunctive placebo (p < 0.05; NNT = 10). The most common adverse events for ADT minimal improvers and non-improvers receiving adjunctive aripiprazole were akathisia, restlessness and insomnia.

CONCLUSION

Patients with minimal or no improvement after 8 weeks of antidepressant monotherapy significantly benefited from adjunctive aripiprazole treatment, supporting the efficacy of this treatment for MDD patients with all levels of response to ADT.

Effect of pre-bypass methylprednisolone on post-operative renal function following correction of atrial septal defect under cardiopulmonary bypass

Conventional open heart surgery with cardiopulmonary bypass (CPB) are associated with transient post-operative renal dysfunction which is caused by systemic inflammatory response induced by CPB. Corticosteroids are administered to attenuate the systemic inflammatory response. The purpose of this study was to compare the effects of pre-bypass and post-bypass methylprednisolone on postoperative renal function after correction of ASD under CPB. Forty (40) patients were selected in the University cardiac centre of BSMMU undergoing ASD correction under CPB. Patients were randomized into two group to receive pre-bypass (Group A) or post-bypass (Group B) methylprednisolone 30mg/kg. Markers of glomerular function (BUN, serum creatinine, creatinine clearance) and damage (micro-albuminuria) and tubular function (glucosuria) were evaluated 24 hours after operation. Transient impairment of glomerular and tubular function of kidney was observed in patients those received post-bypass metylprednisolone (Group B) while Group A patients shown no significant difference between baseline and post-operative renal function. Use of pre-bypass methylprednisolone has a protective effect on post-operative renal function after correction of ASD under CPB.

Ad-hoc percutaneous coronary intervention and staged percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is a catheter based procedure where a catheter system is introduced through a systemic artery under local anesthesia in a stenotic coronary artery by controlled inflation of a distensible balloon. At early period, PCI was done in a separate session following coronary angiogram (Staged PCI) and it was more costly and hospital stay was long. As the expertization and laboratory facilities improved, the health care providers think about cost, hospital stay and patient convenience. So, to reduce the cost and patient preferred more PCI being done immediately following diagnostic catheterization (Ad-hoc PCI). Subsequently this Ad-hoc procedure becomes popular and now most of the PCI are Ad-hoc PCI worldwide. Rate of combined procedure (Ad-hoc) progressively increased from 54% in 1990 to 88% in 2000 with a significant decrease in rate of complications. In the initial study of Ad-hoc PCI suggested that Ad-hoc PCI should be done in selected group of patients as there was some potential risk factors (e.g. Multivessel diseases, unstable angina, aortic valve disease, and recent infarction or thrombolytic therapy) for Ad-hoc procedure and some (e.g. Older age, multivessel PTCA and complex lesion PTCA) for staged procedure. But recent studies showed that no significant difference in respect of safety and efficacy between Ad-hoc and staged PCI. Previous studies, in the era of balloon angioplasty from 1985 to 1995, Haraphonges et al. (1988), Rozenman et al. (1995) and Kimmel et al. (1997) suggested that an ad hoc approach is safe, with potentially more complications in patients with unstable angina pectoris or other high-risk factors. However, these reports have been limited to observational studies representing single institution experiences with small samples and inclusion of patients who underwent emergency PCI procedures. In Bangladesh a prospective observational study was done among 120 patients to compare the outcome of Ad-hoc and staged PCI and high angiographic, procedural and clinical success rate with minimum complications were observed in Ad-hoc PCI in comparison to Staged PCI.

Blood conservation strategies for reducing peri-operative blood loss in open heart surgery

Defects in hemostasis are frequently seen in open heart surgery. Strategies should be reviewed about the peri-operative blood loss and conservation of blood here. In this study, comparison among three agents (Aprotinin, Tranaexaemic Acid & Epsilon Amino Caproic Acid) is done to reduce the peri-operative blood loss in open-heart surgery. Ninety male and female patients within 20-60 years of age were selected who underwent conventional cardiac surgery and anesthesia with Cardio-pulmonary-bypass for common open heart surgeries (ASD, VSD, AVR, etc) and randomly divided into three groups 30 patients in each. Group A, B, C was administered Inj. Aprotinin, Tranaexaemic acid & EACA respectively. Perioperative hemodynamic parameters and blood loss in suction bottle & drainage tube were noted until the 3rd POD. Requirement of blood transfusion, heparin, protamine and blood derived products were also noted. Activated clotting time was documented in the perioperative period. Clinically relevant outcome like re-exploration, mechanical ventilation, morbidities, mortality etc were also verified. Data were analyzed and results were calculated with student's T test & ANOVA. The groups were matched regarding recorded peri-operative variables. Peri-operative blood loss is significantly reduced (p<0.05) both in the Aprotinin and Tranexamic acid groups. Renal dysfunction was reported in 20% of aprotinin patients, 14.29% of tranexaemic acid patients and 18.51% of EACA patients. A conclusion was drawn from the study that Tranexamic acid can significantly reduce the peri-operative blood loss in open heart surgery cases and that it can be preferred as an agent of choice in blood conservation strategy in these cases.

Caesarean of Lion (Panthera leo) at Dulahajra Safari Park, Bangladesh

A six years eight months pregnant lioness at the Dulahajara Safari Park, Chakoria, Cox�s Bazar, Bangladesh, was presented with dystocia. This paper described the pre-, intra- and postoperative procedures including anesthetic protocol carried out and performing a caesarean section to remove dead fetuses and the successful recovery of the lioness without complications.

Correlation of platelet count and acute ST-elevation in myocardial infarction

The role of platelets in the pathogenesis of ST-elevation myocardial infarction (STEMI) has been substantiated by studies that demonstrated significant clinical benefits associated with antiplatelet therapy. Initial platelet counts in Acute Myocardial Infarction (AMI) may be a useful adjunct for identifying those patients who may or may not respond to fibrinolytic agents. Patient with acute STEMI has variable level of platelet count and with higher platelet count have poor in hospital outcome. There are many predictors of poor outcome in Acute Myocardial Infarction (AMI) like cardiac biomarkers (Troponin I, Troponin T and CK-MB), C-Reactive Protien (CRP) and WBC (White Blood Cell) counts. Platelet count on presentation of STEMI is one of them. Higher platelet count is associated with higher rate of adverse clinical outcome in ST-Elevation Myocardial Infarction (STEMI), like heart failure, arrhythmia, re-infarction & death. So, categorization of patient with STEMI on the basis of platelet counts may be helpful for risk stratification and management of these patients.

In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence

In vivo wound healing response post nonablative fractional laser treatment is evaluated. Seven healthy subjects receive treatments with a Fraxel re:store laser system on the forearm with pulse energies ranging from 10 to 70 mJ. The treatment sites are imaged at 1-h increments up to 40 h using confocal microscope z-stacks using 10-mum-depth spacing. At least five individual microscopic treatment zones are imaged per subject, time point, and treatment energy. Images are analyzed for tissue structure and morphology to classify each lesion as healed or not healed, depending on epidermal re-epithelialization at each time point and treatment energy. Probit analysis is used to statistically determine the ED(50) and ED(84) probabilities for a positive dose response (healed lesion) as a function of treatment energy. Confocal observations reveal epidermal keratinocyte migration patterns confirmed with histological analysis using hematoxylin and eosin (HE) and lactate dehydrogenase (LDH) staining at 10 mJ at 0, 7, 16, and 24-h post-treatment. Results indicate that more time is required to conclude re-epithelialization with larger lesion sizes (all less than 500 mum) corresponding to higher treatment energies. For the entire pulse energy range tested, epidermal re-epithelialization concludes between 10 to 22-h post-treatment for ED(50) and 13 to 28 h for ED(84).

ATF-2 controls transcription of Maspin and GADD45α genes independently from p53 to suppress mammary tumors

The activating transcription factor, ATF-2, is a target of p38 and JNK that are involved in stress-induced apoptosis. Heterozygous Atf-2 mutant (Atf-2+/-) mice are highly prone to mammary tumors. The apoptosis-regulated gene GADD45alpha and the breast cancer suppressor gene Maspin, both of which are known to be p53 target genes, are downregulated in the mammary tumors arisen in Atf-2+/- mice. Here, we have analysed how ATF-2 controls the transcription of GADD45alpha and Maspin. ATF-2 and p53 independently activate the GADD45alpha transcription. ATF-2 does not directly bind to the GADD45alpha promoter; instead, it is recruited via Oct-1 and NF-I. ATF-2 simultaneously binds to Oct-1, NF-I and breast cancer suppressor BRCA1 to activate transcription. With regard to Maspin, ATF-2 and p53 directly bind to different sites in the Maspin promoter to independently activate its transcription. Consistent with the observation that ATF-2 and p53 independently activate the transcription of Maspin and GADD45alpha is that the loss of one copy of p53 shortened the period required for mammary tumor development in Atf-2+/- mice. These studies suggest the functional link between the ATF-2 and the two tumor suppressors BRCA1 and p53.