Performance evaluation of nanofluid-based photovoltaic thermal (PVT) system with regression analysis

The recent global energy crisis has shocked Bangladesh's power sectors, and experts recommend using alternative energy sources to conserve natural gas, fossil fuels, and electricity. Numerous investigations on the photovoltaic thermal (PVT) system have been carried out to get the source efficiently. As a result, a parametric evaluation of the PVT system's efficiency in Dhaka, Bangladesh, is investigated numerically using CNT nanofluid as a coolant. The numerical simulation is performed using the Galerkin weighted residual based finite element method. For accurate computations, the meteorological data for Dhaka, Bangladesh, is taken from open sources of Renewables.ninja. The effect of regulating parameters Reynolds number (200 ≤ Re ≤ 1000), solar irradiation (200 W/m2 ≤ G ≤ 1000 W/m2), and the monthly influence on performance such as cell temperature, fluid domain exit temperature, efficiencies, and energy are discussed. In addition, regression analyses of electrical efficiency and thermal efficiency are discussed for the input variables Reynolds number and solar irradiation. After postprocessing, empirical results are compiled and presented as 3D surface graphs, tables, and line diagrams. As the Reynolds number increased, the cell temperature and discharge temperature decreased, resulting in increased efficiency. However, the opposite situation is found for solar irradiation. Month-to-month variation also has a considerable impact on photovoltaic thermal performance. This research will help to improve the efficacy of PVTs in Dhaka, Bangladesh, by identifying useful alternative renewable energy sources.

Population-based survey of the prevalence and types of glaucoma in Bangladesh

BACKGROUND

To delineate the epidemiological landscape of glaucoma using a population-based sample representative of Bangladesh.

METHODS

Using multistage stratified cluster random sampling, households were selected to identify individuals ≥35 years across all 8 divisions of Bangladesh. Sampling frames were derived from the 2011 national census. Fifty-eight study examination sites were set up for comprehensive eye evaluations, including intraocular pressure, gonioscopy and visual field testing when indicated. International Society for Geographic and Epidemiological Ophthalmology definitions were used to define glaucoma and glaucoma suspect cases.

RESULTS

One hundred forty clusters (89 rural and 51 urban) were randomly selected, and 13 791 residential households were visited. We invited 17 002 individuals ≥35 years for on-site examination, of which 12 000 (71%) complied, with a male-to-female ratio of 1:1. The prevalence of glaucoma was 3.2% (95% CI 2.79% to 3.64%), and glaucoma suspect was 10.1% (95% CI 9.05% to 11.12%). The majority (78%) had primary open-angle glaucoma (POAG), while angle closure was seen in 16%. Of the POAG, 83% (n=251) were normal-tension glaucoma. Multivariable logistic regression showed increasing age (OR=1.01 for every 5-year increment, 95% CI 1 to 1.01) and male gender (OR=1.43, 95% CI 1.15 to 1.77) to be associated with an increased risk of glaucoma.

CONCLUSIONS

The prevalence of glaucoma in Bangladesh is 3.2% in ≥35-year-old individuals with older men most at risk. Extrapolating the results, we estimate about 2 million patients with glaucoma. Though normal-tension variety was the most common type, caution should be exercised in generalising these results to other populations.

Steroid-free combination of 5-azacytidine and venetoclax for the treatment of multiple myeloma

Multiple Myeloma (MM) is an incurable plasma cell malignancy, that despite an unprecedented increase in overall survival, lacks truly risk-adapted or targeted treatments. A proportion of patients with MM depend on BCL-2 for survival and recently the BCL-2 antagonist venetoclax has shown clinical efficacy and safety in t(11;14) and BCL-2 overexpressing MM. However, only a small proportion of MM patients rely on BCL-2 (~20%), there is a need to broaden the patient population outside of t(11;14) that can be treated with venetoclax. Therefore, we took an unbiased screening approach and screened epigenetic modifiers to enhance venetoclax sensitivity in two non-BCL-2 dependent MM cell lines. The demethylase inhibitor 5-azacytidine was one of the lead hits from the screen, and the enhanced cell killing of the combination was confirmed in additional MM cell lines. Using dynamic BH3 profiling and immunoprecipitations we identified the potential mechanism of synergy is due to increased NOXA expression, through the integrated stress response. Knockdown of PMAIP1 or PKR partially rescues cell death of the venetoclax and 5-azacytidine combination treatment. The addition of a steroid to the combination treatment did not enhance the cell death and interestingly we found enhanced death of the immune cells with steroid addition, suggesting that a steroid-sparing regimen may be more beneficial in MM. Lastly, we show for the first time in primary MM patient samples, that 5-azacytidine enhances the response to venetoclax ex-vivo, across diverse anti-apoptotic dependencies (BCL-2 or MCL-1) and diverse cytogenetic backgrounds. Overall, our data identifies 5-azacytidine and venetoclax as an effective treatment combination and this could be a tolerable steroid-sparing regimen, particularly for elderly MM patients.

Targeting conditioned media dependencies and FLT-3 in chronic lymphocytic leukemia

The importance of the stromal microenvironment in chronic lymphocytic leukemia (CLL) pathogenesis and drug resistance is well established. Despite recent advances in CLL therapy, identifying novel ways to disrupt interactions between CLL and its microenvironment may identify new combination partners for the drugs currently in use. To understand the role of microenvironmental factors on primary CLL cells, we took advantage of an observation that conditioned media (CM) collected from stroma was protective of CLL cells from spontaneous cell death ex vivo. The cytokine in the CM-dependent cells that most supports CLL survival in short-term ex vivo culture was CCL2. Pretreatment of CLL cells with anti-CCL2 antibody enhanced venetoclax-mediated killing. Surprisingly, we found a group of CLL samples (9/23 cases) that are less likely to undergo cell death in the absence of CM support. Functional studies revealed that CM-independent (CMI) CLL cells are less sensitive to apoptosis than conventional stroma-dependent CLL. In addition, a majority of the CMI CLL samples (80%) harbored unmutated immunoglobulin heavy-chain variable (IGHV) region. Bulk-RNA sequence analysis revealed upregulation of the focal adhesion and RAS signaling pathways in this group, along with expression of fms-like tyrosine kinase 3 (FLT3) and CD135. Treatment with FLT3 inhibitors caused a significant reduction in cell viability among CMI samples. In summary, we were able to discriminate and target 2 biologically distinct subgroups of CLL based on CM dependence with distinct microenvironmental vulnerabilities.

Abstract A39: Targeting tumor-microenvironmental dependencies as a therapeutic approach in Chronic Lymphocytic Leukemia (CLL)

Interaction between CLL and its microenvironment is a major factor in drug resistance. Bone marrow derived stroma cells provide a protective and supportive niche to allow CLL cells to survive drug-induced apoptosis. Therefore, a current challenge is to develop new strategies to target the microenvironment. To understand the role of tumor microenvironment in CLL survival, we studied conditioned media (CM) derived from NKTert cells. Human NKTert stroma cells provide a survival advantage to primary CLL cells by protecting them from spontaneous apoptosis in ex-vivo culture. We identified three cytokines (IL6, IL8 and CCL2) from CM as candidates for mediating survival. We exposed CLL cells to neutralizing antibodies against each cytokine and found significant decrease in CLL viability in presence of anti-CCL2 suggesting its role in CLL survival. BH3 profiling revealed an increase in apoptotic priming with anti-CCL2 treatment as well. Using dynamic BH3 profiling (DBP), we found that anti-CCL2 increased dependence on BCL-2 as well as BCL-xL in primary CLL cells suggesting a potential role of CCL2 on CLL survival. To our surprise, we also identified a CLL group (CM independent, CMI) that were resilient to cell death in the absence of stroma support in ex-vivo culture. In addition to this, anti-CCL2 antibody showed no effect on their survival. Next, we exposed CMI CLL cells to venetoclax and found that these CLL cells were less sensitive to apoptosis compared to the CLL samples that are stroma dependent (CM dependent, CMD). BH3 profiling showed that CMI CLL cells are less primed for apoptosis. Consistent with our findings, DBP with anti-CCL2, venetoclax or the combination didn’t increase any drug induced apoptotic priming in CMI CLL samples. In our study, 80% of CMI harbor unmutated IgHV. To provide additional insight to the molecular mechanism, we performed western blot analyses for BCL-2 family proteins and found decreased BAX ad BCL-2 expression in CMI samples. This result suggests altered BCL-2 family proteins expression might be a mechanism for differential priming. Bulk RNA seq analysis revealed upregulation of focal adhesion genes and Ras signaling pathway in CMI samples. In summary, our study suggest that in the CMD subset of CLL, anti-CCL2 therapy enhances apoptotic priming and venetoclax efficacy. Furthermore, we have also functionally defined two biologically distinct CLL subgroups based on stroma dependence.

Citation Format: Salma Parvin, Aditi Aryal, Shanye Yin, Matthew S. Davids, Geoffrey G. Fell, Catherine J. Wu, Anthony Letai. Targeting tumor-microenvironmental dependencies as a therapeutic approach in Chronic Lymphocytic Leukemia (CLL) [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A39.

Numerical Simulation for Nanofluid Flow in a Wall Driven Cavity with Solid Hindrance: Impact of Thermal Conductivity Ratio and Heat Generation

The current work performs the heatline revelation for combined convection of nanofluid within an enclosure with two moving walls at several thermal conductivity ratios plus heat generation parameter. A solid obstacle that produces uniform heat q per unit area is positioned at the middle of the domain. Sliding lids are assigned to the opposite side walls. Two cases: (I) vertical lids are moving in the same directions and (II) horizontal lids are moving in the opposite directions are analyzed. The computational fluid throughout the enclosed space is water-alumina nanofluid. The Finite Element Method of Galerkin’s weighted residual technique is used to solve the governing nonlinear partial differential equations. Numerical estimations are conducted for a wide range of solid fluid thermal conductivity ratio (0.2 ≤ K ≤ 50) and heat generation parameter (1 ≤ Q ≤ 4) for both cases. Outcomes are obtained as streamlines, isothermal lines, heatlines, heat transfer rate and average heat flow. The results show that the heat flux magnitude is higher for case II than case I but the rate of heat transfer stays nearly same for both cases which increase for the increment of Q and decrement of K. Finally, correlations have been established between the heatfunction with parameters K and Q. There exist strong correlations between the variables which measured from the R-squared values.

Change of Hemoglobin Level among Exclusively Breastfed Term and Preterm Babies up to Six Months of Age

There is progressive increase of Hb levels is observed during course of intrauterine development of fetus but high concentrations found at birth. In preterm neonate normal Hb is characteristically deviated from term neonate. Breast milk is the only natural ideal food for both term and preterm babies from birth up to 6 months. Preterm milk was found to contain significantly higher concentrations nutrients particularly iron than term milk. Preterm human milk is more suitable for the premature infant than term human milk. As Hb concentration varies in term and preterm babies in different counties in different feeding practices. The purpose of this longitudinal descriptive study is to find out the pattern of changes in the Hb level among exclusively breastfed preterm and term infants during the first six months of life. This study was carried in the Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital (MMCH), Mymensingh from September 2016 to February 2018. One hundred fifty (150) neonates both term and preterm were included in this study and followed up to 6 months of age. After admission informed written consent was taken from parents, thorough history taking and clinical examination were done. Data were collected in a pre-designed case record form. All the babies of Group A provided 2mg/kg iron supplementation from 6 weeks for 2 months for universal recommendation. Hb level was measured of all exclusively breast feed babies at admission after birth then next follow-up at 6 weeks, 3 months and 6 months. All information regarding history, anthropometrics measurement, Hb level was recorded in structural questionnaire. Data analysis was done by SPSS version 20.0. Male were predominant in both groups. Most of the preterm (72.0%) and term babies (65.3%) were delivered by vaginal route. Mean Hb level was found significantly higher among preterm babies than term babies after birth were 16.55g/dl and 15.98g/dl respectively. Sharp fall of Hb concentration was observed after birth up to 6 weeks in both preterm and term babies but Hb level was found significantly lower in preterm in comparison to term babies (9.27gm/dl vs. 9.58gm/dl). In term babies, even after 6 weeks fall of Hb level continued to 3 months of age followed by gradual increase up to 6 months without iron supplementation. Hb level of in preterm babies gradually increased from 6 weeks up to 6 months with universal iron supplementation. Hb level fall sharply up to 6 weeks in both exclusively breastfed term and preterm babies but even after 6 weeks term babies experienced gradual fall of Hb levels up to 3 months. Hb level increases in exclusively breast-fed term babies without iron supplementation from 3 months of age. Hb level in exclusively breastfed preterm babies increase from 6 weeks onward might be effect of universal iron supplementation.

Activation of Notch and Myc Signaling via B-cell-Restricted Depletion of Dnmt3a Generates a Consistent Murine Model of Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is characterized by disordered DNA methylation, suggesting these epigenetic changes might play a critical role in disease onset and progression. The methyltransferase DNMT3A is a key regulator of DNA methylation. Although DNMT3A somatic mutations in CLL are rare, we found that low DNMT3A expression is associated with more aggressive disease. A conditional knockout mouse model showed that homozygous depletion of Dnmt3a from B cells results in the development of CLL with 100% penetrance at a median age of onset of 5.3 months, and heterozygous Dnmt3a depletion yields a disease penetrance of 89% with a median onset at 18.5 months, confirming its role as a haploinsufficient tumor suppressor. B1a cells were confirmed as the cell of origin of disease in this model, and Dnmt3a depletion resulted in focal hypomethylation and activation of Notch and Myc signaling. Amplification of chromosome 15 containing the Myc gene was detected in all CLL mice tested, and infiltration of high-Myc-expressing CLL cells in the spleen was observed. Notably, hyperactivation of Notch and Myc signaling was exclusively observed in the Dnmt3a CLL mice, but not in three other CLL mouse models tested (Sf3b1-Atm, Ikzf3, and MDR), and Dnmt3a-depleted CLL were sensitive to pharmacologic inhibition of Notch signaling in vitro and in vivo. Consistent with these findings, human CLL samples with lower DNMT3A expression were more sensitive to Notch inhibition than those with higher DNMT3A expression. Altogether, these results suggest that Dnmt3a depletion induces CLL that is highly dependent on activation of Notch and Myc signaling. SIGNIFICANCE: Loss of DNMT3A expression is a driving event in CLL and is associated with aggressive disease, activation of Notch and Myc signaling, and enhanced sensitivity to Notch inhibition.

Vaccination against COVID-19 in Bangladesh: Perception and Attitude of Healthcare Workers in COVID-dedicated Hospitals

Healthcare professionals are the crucial and influencing source of information for vaccines and their communication among patients and communities that can accelerate successful vaccination in a country. This cross-sectional study was one of the first and foremost ones in Bangladesh to observe the basic perception and attitudes towards vaccination against COVID-19 among the healthcare workers (HCWs) - doctors, interns, nurses, ward boys, cleaners, and medical technologists of major COVID-dedicated hospitals. The cross-sectional questionnaire-based study was conducted in February 2021 among 550 HCWs to assess the perception and attitude towards vaccination against COVID-19. The study participants were targeted as the priority group for COVID-19 vaccination, working in two major COVID-dedicated hospitals, Holy Family Red Crescent Medical College Hospital (HF-center), and Sheikh Russel National Gastro-liver Institute and Hospital (SR-center) in Dhaka, Bangladesh during the pandemic. The questionnaire was structured with a three-point scale of responses from 'true', 'false', and 'do not know'. The responses were calculated on point-score as +1 for the correct response, -1 for the wrong response, and 0 for 'do not know' with an overall highest and the lowest possible score of +5 to -5. Absolute (n) and relative frequencies (%) were presented for qualitative variables, while quantitative variables were presented as mean (± standard deviation). Chi-square test was done for univariate analysis of qualitative variables and Student's t-test for quantitative variables. With the 95.27% response rate, including 204 males and 320 were female and the male: female ratio was 1: 1.56. The majority of the participants were doctors (45.8%) followed by nurses (27.9%), and MLSS (26.3%) respectively. The respondents were between 18 to 64 years of age with a mean of 36.17±10.94 years. Most of the respondents (95.99%) responded correctly about the cost-free availability of a vaccine against COVID-19 in the country, 87.40% preferred vaccination as safe and effective. Again 29.77% HCWs think the vaccine might not be safe or effective due to emergency authorization. Only 38.93% of respondents could respond correctly about the necessity of vaccines for children, 31.10% think the vaccination was not required instead of natural immunity. The positive perception and attitude of the frontline HCWs in COVID-dedicated hospitals in Bangladesh are crucial which will positively influence motivation and wide acceptance among the general population for the attainment of the nationwide vaccination program, and adopt effective strategic modification to minimize the gaps for a low-middle income country like Bangladesh with its resource constrain.

Overweight and Obesity among Children of Primary Schools of Mymensingh Municipal Area

Obesity is now recognized as a major cause of morbidity and mortality throughout the world. The relative percentage of change is higher in developing countries. Childhood obesity has become a serious public health emerging problem because of its strong association with adulthood obesity and related adverse health consequences. The main objective of the study was to find out the status of overweight and obesity among primary school children of Mymensingh municipal area. This cross sectional descriptive study was carried out among primary school children of Mymensingh municipal area from September 2016 to February 2018. Total 1450 students were enrolled from 6 schools. Schools were selected by random lottery method. Data was collected in predesigned case record forms by investigator with the help of students, teachers and parents. Anthropometry was measured by principal investigator. Body mass index (BMI) was calculated and plotted by using Center for disease control (CDC) BMI growth charts for age and sex. Children were categorized as obese, overweight, normal and underweight. Data analysis was done by computer software SPSS version 20.0. Mean age of children was 9.0±1.124 years. There was 47.4% male and 52.6% female. Among the 1450 children 18.6% obese, 17.5% overweight, 53.5% normal and 10.4% underweight. So, total 36.1% children had BMI above normal limit. Obesity was found more common among male children (p<0.001). Obesity and overweight was significantly associated with fast food consumption (p<0.001), playing computer and mobile games (p<0.001), watching TV (p<0.001), higher parent's education (p<0.001), higher parent's income (p<0.001), service holder father (p<0.001), family history of overweight or obesity (p<0.001), single child in family (p<0.001) and increased birth weight (p<0.001). A large number of primary school children in Mymensingh municipal area were overweight and obese. Childhood obesity and overweight varies from school to school. Childhood obesity and overweight is an emerging and growing health issue in municipal area.

Metabolic perturbations sensitize triple-negative breast cancers to apoptosis induced by BH3 mimetics

Cancer cells have differential metabolic dependencies compared to their nonmalignant counterparts. However, few metabolism-targeting compounds have been successful in clinical trials. Here, we investigated the metabolic vulnerabilities of triple-negative breast cancer (TNBC), particularly those metabolic perturbations that increased mitochondrial apoptotic priming and sensitivity to BH3 mimetics (drugs that antagonize antiapoptotic proteins). We used high-throughput dynamic BH3 profiling (HT-DBP) to screen a library of metabolism-perturbing small molecules, which revealed inhibitors of the enzyme nicotinamide phosphoribosyltransferase (NAMPT) as top candidates. In some TNBC cells but not in nonmalignant cells, NAMPT inhibitors increased overall apoptotic priming and induced dependencies on specific antiapoptotic BCL-2 family members. Treatment of TNBC cells with NAMPT inhibitors sensitized them to subsequent treatment with BH3 mimetics. The combination of a NAMPT inhibitor (FK866) and an MCL-1 antagonist (S63845) reduced tumor growth in a TNBC patient-derived xenograft model in vivo. We found that NAMPT inhibition reduced NAD⁺ concentrations below a critical threshold that resulted in depletion of adenine, which was the metabolic trigger that primed TNBC cells for apoptosis. These findings demonstrate a close interaction between metabolic and mitochondrial apoptotic signaling pathways and reveal that exploitation of a tumor-specific metabolic vulnerability can sensitize some TNBC to BH3 mimetics.

Serum Iron Profile and Red Cell Indices in Children with Severe Acute Malnutrition in A Tertiary Level Hospital

This cross-sectional analytical study was conducted in the department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from March 2017 to August 2018 to assess the pattern of serum iron profile and red cell indices in children with severe acute malnutrition. Seventy children having severe acute malnutrition were compared with 70 age matched children those had normal growth. Age range of the studied children was 6 months to 59 completed months. Male was found predominant (54.3%) in both study group and comparison group. Mean serum iron, serum ferritin, serum total iron binding capacity and transferrin saturation in severely malnourished children were 45.3±19.3μg/dl, 26.5±20.0ng/ml, 246.3±47.5μg/dl and 16.4±2.0% respectively which were significantly lower than that of healthy children (p<0.05). Mean Hb level in children with severe acute malnutrition was found 8.3±1.6gm/dl which was also found significantly lower than that of normal children (p<0.05). Anaemia was found in all (100%) severely malnourished children compared to 25.7% of children in comparison group. Mean MCV, MCH and MCHC in children with severe acute malnutrition was found 71.7±13.5fl, 24.0±5.8pg and 31.4±4.0gm/dl respectively which were significantly lower than that of comparison group (p<0.05). Serum iron profile and red cell indices should be routinely done in severely malnourished children for early intervention and management of iron deficiency anaemia.

Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.

Abstract PO-53: Combined EZH2 and BCL2 inhibitors as precision therapy for genetically defined DLBCL subtypes

Molecular alterations in the histone methyltransferase EZH2 and the antiapoptotic protein BCL2 frequently co-occur in diffuse large B-cell lymphoma (DLBCL). We hypothesized that EZH2 inhibition and BCL2 inhibition would be synergistic in DLBCL. To test this, we evaluated the EZH2 inhibitor tazemetostat and the BCL2 inhibitor venetoclax in DLBCL cells, 3D lymphoma organoids, and patient-derived xenografts (PDXs). We found that tazemetostat and venetoclax are synergistic in DLBCL cells that harbor both an EZH2 mutation and a BCL2/IGH translocation, as demonstrated by CI values &lt;1 (CI: 0.034, 0.259 and 0.074 in SUDHL-6, WSU-DLCL2, and OCI-Ly1 respectively), but not in wild-type cells. Since cell lines in suspension do not reflect lymph node architecture, we developed a 3D lymphoma organoid culture system that consists of extracellular matrix, lymphoma cells, and stromal cells (Tian et al., Biomaterials 2015). We observed synergy between the two agents in two organoid model systems: 1) OCI-LY1; 2) PDX derived from a DLBCL with BCL2/IGH translocation and EZH2 mutation. To investigate mechanisms of synergy, we evaluated previously published RNA-seq profiles of DLBCL cell lines (n=26) treated with vehicle or tazemetostat to investigate changes in BCL2 family members (Brach et al., Mol Can Ther 2017). Tazemetostat-treated cells showed enhanced expression of proapoptotic BCL2 family members including BCL2L11 (p=0.012), BMF (p&lt;0.001), and BCL2L14 (p=0.002), suggesting that these may be direct or indirect EZH2 target genes that are de-repressed upon EZH2 inhibition. To assess mitochondrial priming to apoptosis as a result of EZH2 inhibition, we performed BH3 profiling of DLBCL PDX organoids treated with vehicle vs. tazemetostat. Tazemetostat-treated cells had increased priming as evidenced by cytochrome c release in response to general apoptotic signaling peptides BIM and PUMA (p&lt;0.0001) and to the BCL2 specific peptide BAD (p&lt;0.0001), suggesting that pretreatment with tazemetostat increases mitochondrial sensitivity to BCL2 inhibition. We next evaluated combination therapy in vivo. In SUDHL-6 xenografts, the combination resulted in attenuation of tumor growth compared to either drug alone (combination vs. venetoclax p&lt;0.0001, combination vs. tazemetostat p=0.0004) and improved overall survival. In DLBCL PDXs, combination therapy resulted in complete resolutions of tumors, which were durable over time and associated with improved overall survival. Strikingly, after 197 days of follow-up there was no detectable disease in any combination-treated animal. In summary, we demonstrate that combined BCL2 and EZH2 inhibition results in synergistic anti-lymphoma effects. We expect this combination to be especially effective as precision therapy for the newly identified cluster 3/EZB DLBCL subtype, which frequently harbors both EZH2 and BCL2 alterations. A clinical trial of this combination is currently in development.

Citation Format: Hanna Scholze, Regan E. Stephenson, Raymond Reynolds, Shivem Shah, Rishi Puri, Matthew R. Teater, Herman van Besien, Destini Gibbs-Curtis, Hideki Ueno, Salma Parvin, Anthony G. Letai, Susan Mathew, Ankur Singh, Ethel Cesarman, Ari Melnick, Lisa Giulino-Roth. Combined EZH2 and BCL2 inhibitors as precision therapy for genetically defined DLBCL subtypes [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-53.

Leukemia Cell of Origin Influences Apoptotic Priming and Sensitivity to LSD1 Inhibition

The cell of origin of oncogenic transformation is a determinant of therapeutic sensitivity, but the mechanisms governing cell-of-origin-driven differences in therapeutic response have not been delineated. Leukemias initiating in hematopoietic stem cells (HSC) are less sensitive to chemotherapy and highly express the transcription factor MECOM (EVI1) compared with leukemias derived from myeloid progenitors. Here, we compared leukemias initiated in either HSCs or myeloid progenitors to reveal a novel function for EVI1 in modulating p53 protein abundance and activity. HSC-derived leukemias exhibit decreased apoptotic priming, attenuated p53 transcriptional output, and resistance to lysine-specific demethylase 1 (LSD1) inhibitors in addition to classical genotoxic stresses. p53 loss of function in Evi1 ^lo progenitor-derived leukemias induces resistance to LSD1 inhibition, and EVI1^hi leukemias are sensitized to LSD1 inhibition by venetoclax. Our findings demonstrate a role for EVI1 in p53 wild-type cancers in reducing p53 function and provide a strategy to circumvent drug resistance in chemoresistant EVI1 ^hi acute myeloid leukemia. SIGNIFICANCE: We demonstrate that the cell of origin of leukemia initiation influences p53 activity and dictates therapeutic sensitivity to pharmacologic LSD1 inhibitors via the transcription factor EVI1. We show that drug resistance could be overcome in HSC-derived leukemias by combining LSD1 inhibition with venetoclax.See related commentary by Gu et al., p. 1445.This article is highlighted in the In This Issue feature, p. 1426.

Effect of heat wave on N2 fixation and N remobilisation of lentil (Lens culinaris MEDIK) grown under free air CO2 enrichment in a mediterranean-type environment

The stimulatory effect of elevated [CO₂ ] (e[CO₂ ]) on crop production in future climates is likely to be cancelled out by predicted increases in average temperatures. This effect may become stronger through more frequent and severe heat waves, which are predicted to increase in most climate change scenarios. Whilst the growth and yield response of some legumes grown under the interactive effect of e[CO₂ ] and heat waves has been studied, little is known about how N₂ fixation and overall N metabolism is affected by this combination. To address these knowledge gaps, two lentil genotypes were grown under ambient [CO₂ ] (a[CO₂ ], ~400 µmol·mol^-1 ) and e[CO₂ ] (~550 µmol·mol^-1 ) in the Australian Grains Free Air CO₂ Enrichment facility and exposed to a simulated heat wave (3-day periods of high temperatures ~40 °C) at flat pod stage. Nodulation and concentrations of water-soluble carbohydrates (WSC), total free amino acids, N and N₂ fixation were assessed following the imposition of the heat wave until crop maturity. Elevated [CO₂ ] stimulated N₂ fixation so that total N₂ fixation in e[CO₂ ]-grown plants was always higher than in a[CO₂ ], non-stressed control plants. Heat wave triggered a significant decrease in active nodules and WSC concentrations, but e[CO₂ ] had the opposite effect. Leaf N remobilization and grain N improved under interaction of e[CO₂ ] and heat wave. These results suggested that larger WSC pools and nodulation under e[CO₂ ] can support post-heat wave recovery of N₂ fixation. Elevated [CO₂ ]-induced accelerated leaf N remobilisation might contribute to restore grain N concentration following a heat wave.

LMO2 Confers Synthetic Lethality to PARP Inhibition in DLBCL

Deficiency in DNA double-strand break (DSB) repair mechanisms has been widely exploited for the treatment of different malignances, including homologous recombination (HR)-deficient breast and ovarian cancers. Here we demonstrate that diffuse large B cell lymphomas (DLBCLs) expressing LMO2 protein are functionally deficient in HR-mediated DSB repair. Mechanistically, LMO2 inhibits BRCA1 recruitment to DSBs by interacting with 53BP1 during repair. Similar to BRCA1-deficient cells, LMO2-positive DLBCLs and T cell acute lymphoblastic leukemia (T-ALL) cells exhibit a high sensitivity to poly(ADP-ribose) polymerase (PARP) inhibitors. Furthermore, chemotherapy and PARP inhibitors synergize to inhibit the growth of LMO2-positive tumors. Together, our results reveal that LMO2 expression predicts HR deficiency and the potential therapeutic use of PARP inhibitors in DLBCL and T-ALL.

Relationship between HbA1c and Lipid Profile Seen in Bangladeshi Type 2 Diabetes Mellitus Patients Attending BIRDEM Hospital: A Cross-Sectional Study

Diabetes mellitus is one of the leading non-communicable diseases all over the world including Bangladesh. Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. Glycated hemoglobin (HbA1c) level of ≥6.5% has been included as a criterion for diagnosis of diabetes. Impaired lipid profile is commonly present in type 2 diabetes. Aim of the study was to investigate the association between serum lipid profile and blood glucose. And hypothesizing that early detection of lipid abnormalities and treatment can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular calamity in patients with type 2 diabetes mellitus (T2DM). This observational cross sectional study was carried out in the department of Biochemistry, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, Dhaka, Bangladesh from January 2016 to June 2016. A total 105 patients with T2DM of age within the range of 30-45 years were selected for the purpose. Fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and glycated haemoglobin (HbA1c) levels were evaluated. Test of significance was calculated by unpaired Student's 't' test. Correlation studies (Pearson's correlation) were performed between glycated haemoglobin (HbA1c) and serum lipid profile. Significance was set at p<0.05. Significantly higher mean serum levels of TC, TG and LDL-C and significantly lower mean serum levels of HDL-C were noted in patients with diabetes. Significant correlations were observed between HbA1c value and serum levels of TC, TG and HDL-C (p<0.05) but no significant correlation of HbA1c value with LDL-C in-diabetes patient. The study concluded that HbA1c value correlate well with lipid profile in-diabetes patients. So, HbA1c can be used as a predictor of dyslipidemia in type 2 diabetes.

Lmo2 expression defines tumor cell identity during T-cell leukemogenesis

The impact of LMO2 expression on cell lineage decisions during T‐cell leukemogenesis remains largely elusive. Using genetic lineage tracing, we have explored the potential of LMO2 in dictating a T‐cell malignant phenotype. We first initiated LMO2 expression in hematopoietic stem/progenitor cells and maintained its expression in all hematopoietic cells. These mice develop exclusively aggressive human‐like T‐ALL. In order to uncover a potential exclusive reprogramming effect of LMO2 in murine hematopoietic stem/progenitor cells, we next showed that transient LMO2 expression is sufficient for oncogenic function and induction of T‐ALL. The resulting T‐ALLs lacked LMO2 and its target‐gene expression, and histologically, transcriptionally, and genetically similar to human LMO2‐driven T‐ALL. We next found that during T‐ALL development, secondary genomic alterations take place within the thymus. However, the permissiveness for development of T‐ALL seems to be associated with wider windows of differentiation than previously appreciated. Restricted Cre‐mediated activation of Lmo2 at different stages of B‐cell development induces systematically and unexpectedly T‐ALL that closely resembled those of their natural counterparts. Together, these results provide a novel paradigm for the generation of tumor T cells through reprogramming in vivo and could be relevant to improve the response of T‐ALL to current therapies.

Nocturnal serum melatonin levels in sulfur mustard exposed patients with sleep disorders

BACKGROUND

Sulfur mustard (SM) exposure causes respiratory disorders, progressive deterioration in lung function and mortality in injured victims and poor sleep quality is one of the most common problems among SM-exposed patients. Since melatonin has a critical role in regulation of sleep and awareness, this study aimed to evaluate the serum melatonin levels in SM-injured subjects.

METHODS

A total of 30 SM-exposed male patients and 10 controls was evaluated. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was measured by the Epworth Sleepiness Scale (ESS), and the risk of obstructive sleep apnoea was determined by the STOP-Bang questionnaire. Polysomnography (PSG) and pulmonary function tests (PFTs) were also available. Nocturnal serum melatonin levels were measured using an ELISA kit.

RESULTS

The mean of PSQI, ESS and STOP-Bang scores in patients (11.76±3.56, 12.6±3.03 and 5.03±1.09, respectively) were significantly (p<0.01) higher than those in the controls (2.78±0.83, 4.69±1.15 and 1.18±0.82, respectively). PFTs also showed declined respiratory quality in SM-patients. There was a significant difference regarding the PSG results between patients and controls (p<0.01). The mean of nocturnal serum melatonin levels in patients (29.78±19.31 pg/mL) was significantly (p=0.005) lower than that in the controls (78.53±34.41 pg/mL).

CONCLUSIONS

Reduced nocturnal serum melatonin and respiratory disorders can be the reasons for poor sleep quality among these patients.

TRIAL REGISTRATION NUMBER

IRCT2015092924267N1, Pre-results.

Finite element analysis of double-diffusive natural convection in a porous triangular enclosure filled with Al2O3 -water nanofluid in presence of heat generation

The problem of double-diffusive natural convection of Al₂O₃-water nanofluid in a porous triangular enclosure in presence of heat generation has been studied numerically in this paper. The bottom wall of the cavity is heated isothermally, the left inclined wall is non-isothermal and the right inclined wall is considered to be cold. The concentration is higher at bottom wall, lower at right inclined wall and non-isoconcentration at left inclined wall of the cavity. The governing equations are transformed to the dimensionless form and solved numerically using Galerkin weighted residual technique of finite element method. The results are obtained in terms of streamlines, isotherms, isoconcentrations, average Nueeslt number (Nu) and average Sherwood number (Sh) for the parameters thermal Rayleigh number (Ra_T), dimensionless heat generation parameter (λ), solid volume fraction (ϕ) and Lewis number (Le) while Prandtl number (Pr), Buoyancy ratio (N) and Darcy number (Da) are considered to be fixed. It is observed that flow pattern, temperature fields and concentration fields are affected by the variation of above considered parameters.

Antidiabetic and Antioxidant Activities of Decoctions of Coccinia grandis Linn. and Centella asiatica (L.) on Alloxan-induced Diabetic rats

The decoctions of Coccinea grandis (L.) and Centella asiatica (L.) leaves were evaluated for their antidiabetic and antioxidant potentials in alloxan-induced rat model and by DPPH free radical scavenging assay, respectively. Graded doses of the decoctions administered to normal and experimental diabetic rats for two weeks showed significant reduction in fasting blood glucose levels in the normal as well as in treated diabetic animals. The experiment showed 188.42 ± 1.2 mg/dl glucose and 117.78 ± 11.2 mg/dl cholesterol levels for C. grandis, while 187.23 ± 0.8 mg/dl glucose and 116.14 ± 1.5 mg/dl cholesterol for C. asiatica. Although, the decoctions produced significant effect on serum urea level, the total protein and liver enzymes (SGOT and SGPT) were found to be normal. Acute toxicity studies showed that both the decoctions were safe at 2-fold high dose when compared with the commonly used antidiabetic dose. Total phenolic contents in decoctions were found to be 12.45±0.52 and 8.32 ± 0.31 for C. grandis and C. asiatica, respectively while DPPH free radical scavenging assay showed the IC50 values of 0.14 ± 0.001 for C. grandis and 0.17± 0.001 for C. asiatica. Our current studies for the first time, justified the use of decoctions of the leaves of C. grandis and C. asiatica for treating diabeties, hyperlipaedemia and atherogenic lesion in the indigenous system of medicine. DOI: http://dx.doi.org/10.3329/bpj.v17i1.22322 Bangladesh Pharmaceutical Journal 17(1): 86-91, 2014

Radiologic evaluation of hyperacute brain infarction: a review

Imaging cerebral infarction in first few hours after the onset of clinical symptoms is a challenge. The role of stroke imaging underwent a paradigm shift from confirmation of infarction from and exclusion of hemorrhage to the detection of the tissue at risk that may be rescued with restoration of circulation. Computed tomography (CT) is generally performed before starting the therapy in order to exclude the presence of bleeding and tumors. Although CT may show findings of infarction as early as 3-6 hours after ictus 30% of CT scans are normal in the first few hours after ischemic insult. Conventional spin-echo MR imaging is more sensitive and specific than CT in the detection of cerebral ischemia during the 1st few hours symptom onset. Lesion conspicuity can be further optimized by using an FLAIR sequence. Diffusion-weighted MR imaging is a technique that is more sensitive than conventional MR imaging for detection of hyperacute cerebral ischemia, within minutes after the onset of ischemia, a profound restriction in water diffusion occurs in affected brain tissue and DWI is sensitive to diffusion restriction. But DWI only shows areas that are already irreversibly damaged. Around this core, there is believed to be a region of ischemic penumbra where reversible cell death occurred. An imaging technique that accurately identifies this tissue at risk could have a tremendous impact on patient management by thrombolysis. Perfusion imaging allows depiction of both areas of irreversible ischemia and areas of reversible ischemia. Both MR and CT Perfusion imaging help define the tissue at risk. The introduction of intravenous thrombolysis with tPA has radically changed the role of neuroimaging for stroke evaluation. The ECASS trial prescribed for treatment with intravenous tPA with stroke symptoms of less than 6 hours in duration and who did not have identifiable infarction of greater than one- third of the middle cerebral artery (MCA) territory on CT images. The NINDS trial established that intravenous tPA treatment is efficacious if administered less than 3 hours after symptom onset. The experience of interventional cardiologists in treating acute myocardial infarction may predict the future of intervention neuro in treating ischemic stroke.

Neuropathic changes in young type 2 diabetes mellitus related to high serum t-PA

Background and Aims: A substantial number of diabetic patients, diagnosed at relatively younger age, who don’t fit to typical type 2 and type 1 class of diabetes. These patients usually present with very high level of glycemia. The uniqueness of this group of patient provide the opportunity to explore the pathophysiology of nerve functional status at an early stage of diabetes. The present study was aimed to determine markers of endothelial dysfunction and evaluate nerve functional status of a group of newly diagnosed clinically uncomplicated young diabetic patients. Material and Methods: A total number of 32 (male-13 and female-19) newly diagnosed young (diabetes diagnosed under 30 yrs) were consecutively recruited from BIRDEM Out-patient department and 30 age-, BMI-matched healthy subjects with no family history of diabetes up to second generation served as controls. Serum fructosamine was measured by reduction test with NBT method. Serum C-peptide, endothelin-1 and tissue plasminogen activator (t-PA) by ELISA and von Willebrand factor (vWF) by Radial Immunodiffusion (RID) methods. Urinary albumin measured by immunoturbidimetry method. Nerve functional status was evaluated by nerve conduction velocities (NCV), distal latencies (DL), compound muscle action potential (CAMP), F wave latencies (FWL), nerve action potential (SNAP) for motor and sensory nerve as appropriate following the standard protocol. Results: Severe hyperglycemia in the diabetic group was reflected in their mean (SD) fasting C-peptide and fructosamine level. Altered endothelial dysfunction, as evidenced by significantly high tissue plasminogen activator (t-PA) (p<0.001) in the diabetic group. Albumin creatinine ratio (ACR) was almost similar in the two groups. Ulnar distal latency was similar in both the groups. But its CAMP and NCV were significantly lower in the diabetic group (p<0.02-0.001). Ulnar F wave latency were significantly higher (p=0.016) in the diabetic group. Ulnar sensory conduction parameters did not show any difference between two groups. Peroneal motor and sural sensory functional status of the diabetic subjects showed similar trend like that of ulnar motor and sensory status. Peroneal nerve motor NCV was significantly negatively correlated with fasting glucose [r=- 0.456, p=0.001]. Peroneal motor distal latency was significantly correlated with fasting fructosamine [r=0.439, p=0.012]. Fasting fructosamine showed significant negative correlation with motor peroneal NCV [r=-0.572, p=0.001], motor ulnar NCV [r=-0.468, p=0.007], both ulnar and sural sensory NAP (p=0.02 for both]. On the basis of F wave latency 53% of diabetic subjects had diabetic neuropathy and markedly higher t-PA compared to nonneuropathy groups (p=0.001). Conclusions: The data suggest that (i) Young type 2 diabetic subjects had endothelial dysfunction at the time of diagnosis even in the presence of normoalbuminuria state; (ii) Motor nerve conduction parameters are affected more than the sensory component; (iii) F wave latencies are more frequently and early to be involved in these subjects and linked to high serum t-PA. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18302 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.190-197

EFFECTS OF CHRONIC ARSENIC TOXICITY ON THE HAEMATOLOGY AND HISTOARCHITECTURE OF FEMALE REPRODUCTIVE SYSTEM OF BLACK BENGAL GOAT

This study was aimed to observe the effects of chronic arsenic toxicity on the haematology and histoarchitecture of female reproductive system of black Bengal goat. Adult She goats (N=4) were orally administered with sodium arsenite (4 mg/kg body weight) for first seven weeks followed by 5 mg/kg body weight for next eight weeks. Blood was collected from the treated goat at day0, 20, 40, 60, 80 and 100. There was significant difference of TEC, Hb concentration and TLC in goats which are chronically exposed with arsenic. Lymphocyte was decreased with the treatment of sodium arsenite but neutrophil, eosinophil and monocyte were increased. At the end of study the goats were euthanasized. The ovary, uterine tube, uterus, cervix and vagina were collected for gross and histopathological examinations. In histopathological examination the ovarian follicles appeared degenerated and there was much stromal thickening around the follicle. Thickened myometrial layer and shortened mucosal folds in the uterine tube were observed. There was reduction in the number and size of endometrial glands. The mucosal cell lines appeared degenerated. Thin vaginal mucosa and proliferation of connective tissue; shortened cervical crypts and thickened glandular epithelium of cervix were also observed. It may be concluded that chronic arsenic exposure might have adverse effects on the female reproductive system.DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11214 Bangl. J. Vet. Med. (2011). 9(1): 59-66 

Report: analgesic activities of ethanol extract of leaf, stem and their different fractions of Swertia chirata

The purpose of the present study was to investigate the analgesic activity of ethanol extract of leaf, stem, and their different fractions i.e. pet-ether, dichloromethane, and methanol fraction of Swertia chirata (Family-Gentianaceae) on Swiss albino mice. Acetic acid induced writhing in mice was used as the process to evaluate the analgesic activity. The ethanol extract of leaf and stem of Swertia chirata showed moderate inhibition (p<0.001) of writhing. Among different fractions pet-ether fraction showed significant inhibition (p<0.0001) of writhing where as methanol fraction showed moderate inhibition (p<0.003) of writhing as well. The inhibition of writhing was calculated in respective to control (vehicle). The test samples were administered at a dose of 200 mg/kg body weight of experimental animals where diclofenac sodium at a dose of 25 mg/kg body weight was used as standard drug in this study.

In vitro antimicrobial activities of different fractions of Swertia chirata ethanolic extract

The aim of the present study was to evaluate the in vitro antimicrobial activity of pet-ether, dichloromethane and methanol fractions of Swertia chirata (Family: Gentianaceae) ethanolic extract. Disc diffusion technique and food poison method were used for antibacterial and antifungal activity, respectively. Dichloromethane fraction from both leaf and stem showed significant antimicrobial activities against some Gram-positive and Gram-negative bacteria and mild to moderate activity against some fungi. A large zone of inhibition was observed (19 mm) against Staphylococcus aureus. Test materials at a concentration of 400 microg disc(-1) were used to evaluate the antimicrobial activity while Kanamycin at a concentration of 30 microg disc(-1) was used as positive control in this study. Among different fractions, dichloromethane fraction showed significant antimicrobial activity against Gram-positive, Gram-negative and fungi. The most significant antimicrobial activity was seen against Staphylococcus aureus which reflects it potentiality to be used in skin infections.

Arsenic contamination in food-chain: transfer of arsenic into food materials through groundwater irrigation

Arsenic contamination in groundwater in Bangladesh has become an additional concern vis-à-vis its use for irrigation purposes. Even if arsenic-safe drinking-water is assured, the question of irrigating soils with arsenic-laden groundwater will continue for years to come. Immediate attention should be given to assess the possibility of accumulating arsenic in soils through irrigation-water and its subsequent entry into the food-chain through various food crops and fodders. With this possibility in mind, arsenic content of 2,500 water, soil and vegetable samples from arsenic-affected and arsenic-unaffected areas were analyzed during 1999-2004. Other sources of foods and fodders were also analyzed. Irrigating a rice field with groundwater containing 0.55 mg/L of arsenic with a water requirement of 1,000 mm results in an estimated addition of 5.5 kg of arsenic per ha per annum. Concentration of arsenic as high as 80 mg per kg of soil was found in an area receiving arsenic-contaminated irrigation. A comparison of results from affected and unaffected areas revealed that some commonly-grown vegetables, which would usually be suitable as good sources of nourishment, accumulate substantially-elevated amounts of arsenic. For example, more than 150 mg/kg of arsenic has been found to be accumulated in arum (kochu) vegetable. Implications of arsenic ingested in vegetables and other food materials are discussed in the paper.

Diabetes mellitus in Tropical Chronic Pancreatitis Is Not Just a Secondary Type of Diabetes

AIMS

In chronic calcific pancreatitis of the tropics, etiology and relationship to developing diabetes mellitus are unknown. Some consider these cases a straightforward secondary type of diabetes, while others suggest selective beta-cell impairment. Testing pancreatic function, we investigated whether selective beta-cell impairment triggers diabetes associated with tropical pancreatitis.

METHODS

At a Bangladeshi research institute, 8 chronic tropical pancreatitis and no diabetes mellitus subjects, 14 fibrocalculous pancreatic diabetics and 27 matched healthy controls underwent arginine (endocrine pancreatic function) and secretin (exocrine pancreatic function assessment) stimulation tests.

RESULTS

All patients with clinically-diagnosed, chronic pancreatitis demonstrated pronounced exocrine pancreatic dysfunction with beta-cell functioning differing significantly between the two groups. Compared to controls, patients having tropical pancreatitis and no diabetes showed normal plasma C-peptide values at baseline and after arginine stimulation, while fibrocalculous pancreatic diabetics demonstrated a typical diabetic pattern for plasma C-peptide levels. In contrast, pancreatic alpha-cell functioning (glucagon response to arginine) was preserved in both pancreatitis groups.

CONCLUSION

A preserved pancreatic alpha-cell function in diabetics with advanced chronic pancreatitis of the tropics supports the concept of two different pathogenic mechanisms, one eliciting chronic pancreatitis and the other selective pancreatic beta-cell impairment and subsequent diabetes mellitus.

A study of 415 cases of esophageal carcinoma in northwest of Iran

BACKGROUND AND OBJECTIVE

Considering the serious and fatal nature of esophageal carcinoma and as prevalence in the population on the banks of Caspian sea and northern region (Azerbaijan, Khorassan, Gilan, Mazandaran, Golestan and Kurdistan) along with the importance of its early diagnosis in the initial stage in order to increase the survival period of the patient, we aimed to proceed in regard to these factual observations so that this study should be an incentive and beginning of our future perfect study.

MATERIALS AND METHODS

In a prospective study over a period of five years (from year 1994 to 1999), a total of 415 pathologically documented esophageal carcinoma out of those 33000 referred cases those with clinical signs and symptoms of esophageal cancer were enrolled in this study. Main complain of patients included (Dysphagia, odynophagia retrosternal pain with unknown origin, anorexia, weight loosE, and anemia with undetermined etiology) in one of the treatment center Age of these patients ranged from 20 to 80 years old, with mean age of 60 years and stable variables were selected from the chart of the patients. The study was accomplished with serial radiography and Endoscopy. Biopsy specimens collected during Endoscopy were sent for histological examination and staging of the disease. Finally, with the confirmation of pathological report, patients were referred for the therapeutical management.

RESULTS

Out of 415 patients with distinct confirmative pathological findings, 349 (88.3%) cases had squamous cell carcinoma while, 46 (11.7%) of them were having adenocarcinoma. Among these patients, 214 were males and 201 females. The male to female ratio was almost equal.

CONCLUSION

This study highlights the type of esophageal cancer along with the sex distribution and its diagnostic approaches. Squamous cell carcinoma was mainly observed among the patients studied and there was not significant difference between its involvement among males and females. After the diagnosis, 5 years survival rate will depend upon its early diagnosis, accurate staging of the disease and management of the patient with appropriate therapy.

SPINK1/PSTI mutations are associated with tropical pancreatitis in Bangladesh. A preliminary report

BACKGROUND/AIMS

Tropical pancreatitis (TP) refers to a severe type of idiopathic chronic pancreatitis that develops in children in tropical regions of Africa and southern Asia. Phenotypically TP is subdivided into fibrocalculous pancreatic diabetes (FCPD) and tropical calcific pancreatitis without diabetes mellitus (TCP). Recently an association was identified between idiopathic pancreatitis in the USA and Europe and mutations in the serine protease inhibitor, Kazal type 1 (SPINK1) gene (previously termed pancreatic secretory trypsin inhibitor, PSTI). Our aim was to determine if either form of TP has a genetic basis.

METHODS

We studied 8 well-characterized patients from Bangladesh with FCPD, 4 with TCP and 4 controls without pancreatic disease. The entire SPINK1 gene was sequenced in these patients.

RESULTS

We detected two disease-associated SPINK1 mutations (N34S/IVS1 - 37T > C and IVS3 + 2T > C) in 6 of 8 patients from Bangladesh with FCPD but not in 4 patients with TCP (p < 0.03) or 4 controls (p < 0.03).

CONCLUSIONS

We conclude that SPINK1 mutations are associated with FCPD in Bangladesh. Since SPINK1 mutations in Europeans and North Americans are associated with idiopathic chronic pancreatitis that is phenotypically different from FCPD, we further conclude that mutated SPINK1 markedly increases the risk of developing a variety of pancreatic diseases possibly through a chronic elevation of active trypsin within the pancreas.

Endovascular stent repair for a dissecting thoracoabdominal aneurysm is feasible in the setting of a district general hospital: a multidisciplinary approach

A patient presented to a district general hospital with a type B dissection of the aorta. He was deemed too unwell for surgical intervention. An endovascular stent repair was successfully carried out. The case shows that such a procedure can be safely performed by a multidisciplinary team within a district general hospital.

Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults

BACKGROUND & AIMS

In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence.

METHODS

One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains.

RESULTS

Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) within the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori-negative patients.

CONCLUSIONS

In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.

Lack of R117H mutation in the cationic trypsinogen gene in patients with tropical pancreatitis from Bangladesh

The etiology of nonalcoholic chronic pancreatitis, occurring in tropical regions, is unknown. Although environmental factors may play a role in its pathogenesis, a specific genetic predisposition may be necessary. The genetic mutation responsible for hereditary pancreatitis was described recently. Unlike in patients with hereditary pancreatitis, we found a lack of the R117H mutation in the cationic trypsinogen gene in all patients with tropical pancreatitis from Bangladesh.

Peritoneal lavage in children with blunt abdominal trauma

Quantitative peritoneal lavage was performed in 52 children with blunt abdominal trauma to determine the presence of intraabdominal injuries. A strongly positive lavage was 100% accurate in diagnosing an intraabdominal injury requiring operation. A negative lavage demonstrated absence of a significant intraperitoneal injury with 100% accuracy. A weakly positive lavage was not diagnostic and required additional evaluation including intravenous pyelography echography, and arteriography. Diagnosis and treatment was prompt, and in 20 of 21 cases, operation was performed within 4 hr. Peritoneal lavage was found to be safe and much more accurate than physical examination in diagnosing significant intraabdominal injury.

Echographic evaluation of splenic injury after blunt trauma

In a significant number of patients with blunt abdominal trauma, the diagnosis of ruptured spleen is not readily apparent. Is is in these cases that echographic evaluation appears to aid significantly in diagnosis. Seventy patients with blunt abdominal trauma were studied by echography. Results indicated 61 true negative cases, 1 false negative, 4 true positives, and 4 false positives. Criteria for splenic rutures are set forth. Ultrasound is considered to be an excellent screening procedure for suspected splenic rupture.

Effectiveness of peritoneal lavage in blunt abdominal trauma

To analyze the effectiveness of peritoneal lavage and to define its limitations in the evaluation of patients who have sustained blunt abdominal trauma, a prospective study of 500 such patients was undertaken by the Trauma Service at the Naval Hospital, San Diego. Utilizing a qualitative colorometric method to evaluate the degree of hemoperitoneum, patients could rapidly be divided into three clinical groups: strongly positive, weakly positive, and negative. Using this method, patients with a strongly positive peritoneal lavage had a 94% incidence of significant intra-abdominal injuries. In 333 patients with a negative lavage, there was no documented incidence of significant intra-abdominal injuries. Visceral angiography and abdominal echography were utilized in this group of patients to identify those with significant intra-abdominal injuries. By utilizing this approach, there were only eight unnecessary celiotomies in the total group of 500 patients. It is concluded, therefore, that peritoneal lavage is a safe, rapid, and effective means of evaluating patients who have sustained blunt abdominal trauma.

Study of serum non-HDL cholesterol in cerebrovascular disease

Background: Non-HDL cholesterol is a potential newer risk factor for cerebrovascular diseases (CVD). Objective: To explore the association of non-HDL cholesterol with cerebrovascular disease. Methods: This case control study was carried out in the Department of Biochemistry, BSMMU, Dhaka during the period of January to December 2007 to evaluate the association of non-HDL cholesterol with CVD in Bangladeshi population. A total number of 135 subjects of both sexes were grouped as Group-I (CVD cases) and Group-II (Healthy controls). Group-I include 85 cases of which 59 were ischaemic cerebrovascular diseases (ICVD) and 26 were haemorrhagic cerebrovascular diseases (HCVD). By taking the history and doing clinical examination and laboratory investigations, diabetes mellitus, malignant disease, renal disease, liver disease and diuretic medication were excluded from study subjects. Serum non-HDL cholesterol was measured in all study subjects. Statistical analysis was performed by using SPSS for windows version 12.0. Mean values of the findings were compared between groups. One way ANOVA test and multiple comparison (Bonferroni‘t’) test were used to see the level of significance. Results: Serum non-HDL cholesterol found significantly increased in CVD, ICVD and HCVD cases in comparison to control subjects. But ICVD and HCVD cases did not differ with respect to serum non-HDLcholesterol. Conclusion: The result shows that elevated non-HDL cholesterol is associated with CVD. Prospective study with large sample size is required to evaluate the elevated Non-HDL cholesterol as a risk factor of CVD. Key words: Non-HDL cholesterol; Cerebrovascular disease; Ischaemic cerebrovascular disease; Haemorrhagic cerebrovascular disease. DOI: 10.3329/bjms.v9i3.6469Bangladesh Journal of Medical Science Vol.09 No.3 July 2010, pp.143-149

Microvascular Free Tissue Transfer at Chittagong Medical College Hospital - A Milestone

Introduction: A defect in any part of the body involving extensive soft tissue loss adversely affects the functional ability. With the advent of microvascular free tissue transfer in the reconstruction of large defects, the problem is going to be solved. However, studies are still going on about the different aspects of its success and failure. The present study is one such step to share our early experience.Methods: The study was carried out in the Department of Plastic Surgery, Chittagong Medical College Hospital from August 2009 to April 2010. We reviewed the operative experiences of free tissue transfer on 5 cases. Standard microvascular anastomotic techniques as well as peroperative & postoperative heparinization were maintained in all the cases. Follow up results were evaluated at varying periods following standard protocol.Results: Of the 5 cases reconstructed, 4(80%) had lesions in the maxillofacial region and 1(20%) in the ankle region. In terms of diseases they suffered, 3(60%) had squamous cell carcinoma and 2(40%) sustained mechanical injury. The outcome of treatment demonstrates that 3(60%) cases recovered uneventfully, one developed slight loss of sensation on the left thumb (20%) and another one failed to recover (20%).Conclusion: In this study successful microvascular free tissue transfer was possible in 80% cases. With the increase in experience we can expect increased success rate as well.DOI: http://dx.doi.org/10.3329/bdjps.v1i1.6485Bangladesh Journal of Plastic Surgery (2010) Vol. 1 (1) pp.3-8