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Expression of CD56 and HBME-1 in surgically excised thyroid nodules
Full text linkIntroduction: Thyroid nodules represent a wide spectrum of neoplasms with different biological behaviors Majority of thyroid nodules are benign, but malignancy is found in approximately 5–15% of cases. Accurate diagnosis of these thyroid nodules is difficult, because of subtle and subjective histomorphological criteria. Immunohistochemistry method may play a complementary role to clarify diagnostic dilemma. CD56 is a neural cell adhesion molecule expressed on thyroid follicular cells. Down regulation of CD56 can shows correlation with tumour progression. Hector Battifora mesothelial epitope (HBME-1) is a membranous antigen located on follicular thyroid tumour cells and normal thyroid tissue is negative for HBME-1. Objective: To observe the expression of CD56 and HBME-1 in the diagnosis of surgically excised thyroid nodules. Methods: This cross sectional study was conducted in the Department of Pathology, Chittagong Medical College, Chattogram from March 2019 to February 2021. Immunohistochemistry was done at Armed Forces Institute of Pathology, Dhaka Cantonment. Sixty-three surgically resected thyroid nodules were evaluated to find out their histopathological type. Immunostaining was done by using primary antibody against CD56 (FLEX Monoclonal Mouse Anti-Human CD56 Clone 123C3 Ready to use (LINK). Denmark) and HBME-1 (Anti–Mesothelioma mouse monoclonal antibody HBME-1ab2383. Abcam, UK). Patient’s demographic data were collected and recorded in a predesigned data sheet. Statistical analysis was carried out as required. Ethical practice was ensured in every step of the study. Results: Among the 63 cases, mean age (±SD) of the patients was 39.47 ± 13.67 years and male to female ratio of 1:6.9. Thirty-four patients (76.3%) had multiple nodules. Among the 63 patients, 68.3% (43 cases) were histologically diagnosed as benign and 31 .7% (20 cases) as malignant thyroid nodules according 2017 WHO classification of thyroid tumours. Immunohistochemistry was performed using the markers CD56 and HBME-1 for all the 63cases.In present study weak to strong positive expression of CD56 was observed in 33(76.7%) cases out of 43 benign nodules whereas negative CD56 expression was observed in 20(100%) malignant cases. CD56 expression between benign and malignant lesion was statistically significant (p value, 0.002). HBME-1 was showed positive expression for 17(85%) out of 20 cases of malignant nodules and negative expression was observed in benign nodules. No statistically significant (p>0.250) difference was found between HBME-1 expression and histopathological diagnosis. So this study has improved the better understanding of thyroid nodules by expression of these immunomarkers (CD56 and HBME1) and thus may help the patients for selecting appropriate management protocol. Conclusion: In this study, Positive HBME-1 staining is a strong indicator of malignancy, although negative staining does not rule it out. IHC with CD56 and HBME-1 is considered to be important ancillary test in the diagnosis of thyroid neoplasms, but it does not replace the conventional histopathological examination
The Efficacy of Serum Procalcitonin as A Reliable Marker for Diagnosis of Neonatal Sepsis
Full text linkBackground: Newborn sepsis (NS) is a major cause of neonatal morbidity and mortality, and it has become a serious global public health issue. Because the clinical appearance of NS can be confounded with non-infectious conditions, the onset of sepsis might be fast, and the clinical process can swiftly subside. Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and non-specific clinical presentation of this condition. Objective: To evaluate the efficacy of serum procalcitonin as a reliable marker in diagnosis of neonatal sepsis. Methods: This cross sectional analytical study was carried out in the Department of Pediatric, Mugda Medical College Hospital, Dhaka, Bangladesh from March to May 2020. Total 55 new-borns with suspected sepsis were included in the study. Specimens of blood were obtained from each neonate prior to commencement of antibiotic for sepsis work up. Serum CRP and procalcitonin levels were measured. Data analysis was performed by using SPSS for windows version 21. Chi-square test, Mann- Whitney U test and Validity test was done to measure the level of significance. Area under the ROC (Receiver operating characteristics) was evaluated. A p value ≤0.05 was considered level of significance. Results: Among total 55 new-borns included in this study, 27(49.09%) new-born were diagnosed as proven sepsis and 28(50.9%) new-born as clinical sepsis. A statistical significant difference was observed between the mean of birth weight in septic and suspected groups. The mean of gestational age (GA) in proved sepsis infants was 31.9 weeks that was lower than two other groups (P< 0.05). The procalcitonin (PCT) was high in 58.2% (500-<2000 pg/ml) new-born and remarkably high (2000-<10000) in 36.4% new-born with sepsis. At a cut-off value > 500pg/ml, the sensitivity of PCT in detecting sepsis was 46.4% its specificity 75%, positive predictive value was 67.9%, and negative predictive value was 60.7% whereas the sensitivity of CRP for predicting sepsis was 33.3%, specificity 77.8%, positive predictive value 62.9% and negative predictive value was 55.6%. The area under the ROC curve for procalcitonin (0.653) was significantly higher than CRP (0.571). Conclusion: In conclusion, the serum levels of PCT is a more reliable marker than the serum levels of CRP or the WBC counts in the early diagnosis of neonatal sepsis and in the evaluation of the response of the disease to the antibiotic therapy. The benefit of measuring serum PCT routinely in the diagnosis and follow-up of neonatal sepsis, is that it reduces the hospital costs.
 
Assessment of Graft Patency Between Pedicled Saphenous Vein and Conventional Saphenous Vein Conduits for Coronary Artery Bypass Surgery
Full text linkIntroduction: The long-term successes of coronary artery bypass graft surgery depends on continued patency of the bypass conduits. After coronary artery bypass graft, however, the saphenous vein grafts show a high incidence of accelerated atherosclerosis. A major contributing factor to the early atherosclerotic process is damage to the vessel wall, especially endothelial injury that occurs during the conventional harvesting of the vein, using high- pressure distension. A new pedicled saphenous vein technique, the saphenous vein is harvested with its pedicled of surrounding tissue, preserves the entire vein wall including the vasa vasorum.
Objective: To determine the patency rate in between pedicled saphenous vein and Conventional saphenous vein by coronary computed tomography angiogram.
Methods: This comparative cross-sectional study was carried out at the department of cardiac surgery in National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. The period of study was from January, 2019 to September, 2020 and purposive sampling method was applied for this study. The study population was 80, with two groups having 40 patients each. Grouping of patients were done by purposive sampling method and all patients underwent elective coronary artery bypass graft in 2015. These group of patients again investigated through coronary computed tomography angiogram in 2020 for evaluation of saphenous vein patency and occlusion rate. Data was collected by using a standardized semi- structured questionnaire, face to face interview and hospital records.
Results: After five years postoperative follow up through the coronary computed tomography angiographic assessment showed 91.92% patency rate of pedicled saphenous vein grafts compared to 85.56% patency rate of conventional saphenous vein grafts. Similarly, the proportion of study saphenous vein grafts with total occlusion were higher in conventional saphenous vein grafts than pedicled saphenous vein grafts, but that was not statistically significant [Group A: 08 venous grafts occluded out of 99 venous grafts (8.08%); Group B: 13 venous grafts occluded out of 90 venous grafts (14.44%), p= 0.209].
Conclusion: This study was concluded that, pedicled saphenous vein has higher patency rate than conventional vein. It has also significantly slower progression of occlusion in pedicled vein grafts.
 
Classifications and Theories of Orbital Fractures: A Review of Literature
Full text linkOrbital fractures occur in isolation or may even be associated with other maxillofacial injuries. The classifications of these fractures are dispersed in literature and an encompassing review of classifications is unavailable. The authors thus attempt to comprehensively review the classifications of orbital fractures while also reviewing the historical background and etiologic theories of the same
Spectrum of neurological disorders in children with neonatal hypoglycemia of western rural Maharashtra.
Full text linkBackground: Glucose is an essential metabolic fuel for the brain, and in the newborn the proportionately large brain accounts for almost all of total tissue glucose requirements. Neonatal hypoglycemia is not timely and properly treated, the infants may develop permanent brain injury. Persistent or recurrent hypoglycemia may lead to long-term visual disturbance, hearing impairment, cognitive abnormalities, secondary epilepsy, and other disorders in the central nervous system. Aims and objectives: To study the clinical profile of hypoglycemia in high-risk newborns, as well as neurological squeal. Methods: This is a descriptive cross sectional study was conducted at the department of pediatrics, Dr. Vitthalrao Vikhe Patil Pravara Rural hospital Loni, Maharastra, India, performed on children aged 3 months to 12 years coming to Paediatrics neurology OPD from Feb 2022 to Dec 2023. Results: Out of 60 patients 31(51.6%) presented with seizures. Global developmental delay is found in children, out of which - gross motor delay in 28 (46.67%), fine motor delay in 29(48.33%), social milestone delay in 18(30%) and language mile stone delay in 18(30%) children. 6 (10%)children had autism spectrum disorders. Vision impairment is seen in 36(60%) cases which have significant p value of 0.042. Out of 60 children, 26(43.33%) undergone MRI brain of which in 23(88.46%) of the cases MRI brain was abnormal. Conclusion: Neonatal hypoglycemia is the most common condition in neonatal critical care units, with a significant morbidity rate during infancy and childhood in the form of developmental delay, epilepsy, vision abnormalities, hearing abnormalities and autism etc. It is important to regularly follow these babies for neurodevelopmental assessment to detect and monitor sequalae like developmental delay, epilepsy, visual impairment etc. so as to start early intervention therapy for better neurodevelopmental outcome
Pattern of presentation in clinically diagnosed epileptic patients
Full text linkBackground: Diagnosis of epilepsy is based mainly on clinical history and examination. EEG constitutes the single most valuable laboratory test in the evaluation of patients with epilepsy. It is a safe, non-invasive procedure for evaluation of electrophysiological state of patients with epilepsy. Objective: To find out the Pattern of presentation in clinically diagnosed epileptic patients. Methods: This cross-sectional study carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 152 epileptic patients attended in the Epilepsy Clinic of the Department of Neurology were enrolled for this study. Information on socio-demographic and seizure characteristics was obtained. The recordings from patients were obtained using the standard. Results: A total of 152 patients were recruited. Maximum patients (43.4%) were in age group 11-20 followed by 37 (24.3%), 27 (17.8%), 13 (8.6%) and 9 (5.9%) were in age groups 21-30 years, 1-10 years, 31-40 years and >40 years respectively. Male (62.5%) were predominant than female (37.5%). Male female ratio was 1.67:1. Distribution of patients according to common presenting features. Out of 95 patients most common clinical features were generalized convulsion 63.2%, frothy mouth 61.8%, loss of consciousness 59.9% and tongue bite 57.2% in case of generalized seizure and in focal seizure most common was abnormal movement (20.4%). Most of the patients (50.7%) had GTCS followed by 19 (12.5%), 18 (11.8%), 13 (8.6%), 13 (8.6%) and 12 (7.9%) patients had focal seizure without impairment of consciousness, focal seizure with secondary generalization, absence seizure, focal seizure with impairment of consciousness and myoclonic seizure respectively. Among distribution of abnormal EEG findings in patients with generalized seizure. Of them 56 (87.5%) patients had generalized epileptic discharge and 8(12.5%) patients had typical absence seizure. Conclusion: Based on the above study it can be concluded that diagnosis of epilepsy is based on clinical history and examination. The most common clinical presentation of epileptic patients is generalized seizure, generalized convulsion and frothy mouth help to clinical diagnosis of epilepsy, assist in planning drug management and determining prognosis.
 
Incidence of Anastomotic Bleeding, Anastomotic Leakage, SSI and Operative Time Following Linear Cutting Stapling Device Gastro-Jejunostomy
Full text linkBackground: The condition known as gastric cancer (GC) is complex and complicated. In both rich and developing nations, it poses a threat to people\u27s physical and psychological well-being and places a heavy financial and health cost on society.
Objective: The aim of the study was to evaluate the Incidence and risk factors of anastomotic bleeding, anastomotic leakage, SSI and operative time following linear cutting stapling device gastro-jejunostomy.
Methodology: The study was a Prospective observational study which was conducted in Department of Surgery, Dhaka Medical college & Hospital, over Six months’ period after approval of protocol using a semi-structured questionnaire through face to face interview. Data were analyzed using a computer programme SPSS 23.0 version.
Results: Total 40 patients were enrolled in this study with the mean age of 57.45±7.04 years and 65% were male. The overall mean BMI of the patients was 21.94±1.61 kg/m2. Among all the respondents 25% had comorbidity. among all the study participants 85% Tumor location was in middle and 47.5% had T1a stage followed by T1b (40%), T2 (7.5%) and T3 (5%) further 90% had N0 stage followed by N2 (5%) and N3 (5%). The mean operation time was 24.6±2.9 minutes with the incidence of anastomotic hemorrhage was 5%, Anastomotic leak 5% and fortunately no SSI had occurred.
Conclusion: This study concluded that the ease and speed with which surgical staplers may be used make them the favored choice
Socio-Demographic and Occupational Factors in Benign Mucosal Vocal Fold Lesion
Full text linkBackground: Benign mucosal vocal fold lesions are common disorders in our Otolaryngology department. Most of the patient presents with changes of voice quality ranging from voice hoarseness to voice weakness. Fibre optic laryngoscopic diagnosis of benign mucosal vocal fold lesion was taken from a sample population in this study. Vocal fold nodules were the commonest benign mucosal vocal fold lesion (46%); followed by vocal fold polyp (32%), thickened vocal fold (9%), keratosis (4%), multiple papilloma (3%), vocal fold cyst (3%), Reinke’s edema (2%), contact ulcer (1%). Materials and Methods: This cross sectional study was carried out at the Otolaryngology department of the Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka for a period of six (06) months from 222nd June, 2014 to 211st December, 2014 on patients who had undergone fibre optic laryngoscopy (FOL) examination inpatient and outpatient department. Patient who was diagnosed with benign mucosal vocal fold lesions by FOL and gave informed written consent was included in this study. Results: The total number of first hundred cases has been taken in this study. The study population was comprised of (65%) male and (35%) female. A male preponderance with a male to female ratio of 1.8:1 was observed. Majority of the patients were in the age group of 21-30 years. The youngest patient was 12 years and the oldest was 72 years of age. The average age of male subjects (37.34 years) was significantly higher compared to that of females (33.76 years). Majority of the vocal fold pathology were vocal fold nodules (46%), followed by vocal fold polyp (32%), thickened vocal fold (9%), keratosis (4%), multiple papilloma (3%), vocal fold cyst (3%), Reinke’s edema (2%), contact ulcer (1%). Among the study subject’s majority were housewife (19%), followed by service holder (18%), Garments worker (7%), student (9%), agriculture workers (8%), teacher (7%), hawker (5%), Imam (4%), business man (5%), salesman (3%), lawyer (2%), birth attendant (2%), unemployed (2%), singer (1%), engineer (1%), beggar (1%) and nurse (1%). Conclusion: It was found that people of different occupations, ages and both sexes, were suffering from benign mucosal vocal fold lesions. Early diagnosis of the lesions can lead to effective management and good recovery. As such, the standard treatment of choice in benign vocal fold lesion consist of triad of approach that includes microlaryngeal surgery, voice rest and vocal rehabilitation
Allelic frequency and genotype distribution of ABO and Rh blood group among students in the major tribal communities at Gambella Teachers Education and Health Science College, Gambella Regional State, Ethiopia. 2021
Full text linkThe distribution of blood groups was different from place to place and may not be found similar even among same ethnic groups. Frequency distribution of blood groups is important for modern medicine, genetic research, anthropology, ancestral relations of humans and forensic science. Aim of this study was to determine the allelic, genotypic, and phenotypic frequency distribution of ABO and Rh blood groups among students in Gambella region of Ethiopia. For1000 Blood samples from five major tribal communities, blood groups were determined by agglutination method using commercially available anti-sera A, B, and Rh (D). Hardy-Weinberg equation was used to calculate percentage of the observed and expected allelic genotypic frequency. In the ABO system, majority was type O (48%) followed by A (25%), B (21%) and AB the least frequency (6%). In Rh system, majority were Rh+ (95.3%) and the rest were Rh-(4.7 %). The allelic frequencies of O (IO), B (IB) and A (IA) were 0.691, 0.171 and 0.144, respectively. While allelic frequencies of the Rh blood group of D and d were 0.783 and 0.217, respectively. Genotypic frequencies of OO, AA, AO, BB, BO, and AB were 0.477481, 0.029241, 0.236322, 0.020736, 0.199008 and 0.049248 respectively. While the genotypic frequency of DD, Dd and dd were 0.613089, 0.339822, and 0.047089 respectively. This study gives baseline information regarding the management of blood bank and transfusion services in the community. Large sample size with different areas is recommended to make strong generalizations
Maternal and Perinatal Outcome of Liver Function in Severe Pre Eclampsia and Eclampsia Patients
Full text linkBackground: Preeclampsia and eclampsia are common pregnancy specific multi system disorder in Bangladesh and are major causes of maternal, foetal and neonatal mortality and morbidity. Objective: To determine the extent of hepatic involvement in severe preeclampsia & eclampsia and its relation to fetomaternal outcome. Methods: It was a hospital based prospective study. This randomized clinical trial was conducted to evaluate liver function in severe preeclampsia and eclampsia on 100 patients with severe preeclampsia and eclampsia selected randomly who were admitted in department of obstetrics and gynaecology unit of Rangpur medical college and hospital through outpatient department and emergency during a time period of June 2015 to November 2015. Data was collected in preformed questionnaires after taking written informed consent from the patient or legal guardian after proper counseling.Then date was presented in graph and tabulated form and finally analyzed by SPSS version–16. Results: 100 patients were taken in this study–62 as eclampsia and 38 as severe preeclampsia. 0ut of 100 patients maximum (60%) were between 20-35 years of age, 62% patients were primigravida, 46% were more than 36 weeks of gestation, 53% patients were belonged to low socioeconomic status, 59% patients were primarily educated, 25% patients had no antenatal checkup and 42% were on irregular antenatal checkup. Most of the severe preeclamptic patients presented on admission with headache (65.78%) and epigastric pain (13.15%) and most of the eclamptic patient (51.61%) were conscious and 29.03% were unconscious. Maximum patients (56%) were delivered by LSCS. In severe preeclampsia group blood urea were raised in 73.68%, S. Creatinine were raised in 71.05% and S.Uric acid were raised in 65.78%. Liver function was abnormal in 21.05% patients among them S.bilirubin was raised in 15.7%, SGPT was raised in 21.05% patients SGOT was raised in 18.42% patients. LDH was raised in 13.15% patients. In eclamptic patients’ blood urea was raised in 72.58% patients, S. creatinine was raised in 66.12% patients; S. uric acid was raised in 61.29% patients. Liver function was abnormal in 22.58% patients, among them, S. bilirubin was raised in 29.03%, SGPT in 48.38%, SGOT was raised in 30.64% and LDH was raised in 45.16% patients. Maternal morbidity and mortality was more in patients with abnormal liver function. It maternal mortality was 12.5% in severe preeclamptic patients and 14.28% in eclamptic patients with abnormal liver function. Perinatal morbidity and mortality was also higher in patients with abnormal liver function. Perinatal mortality was 62.5% in severe preeclamptic patients and 42.85% in eclamptic patients with abnormal liver function. Conclusion: From this study it was found that abnormal liver function in patients with severe preeclampsia and eclampsia, affect both maternal and fetal outcome negatively. Therefore, prior information of liver function in such patients may help to reduce maternal and perinatal mortality and morbidities.