Efficacy and Safety of Repeated Use of Ulipristal Acetate in Uterine Fibroids.

Uterine fibroids are benign tumor of the uterus that often appear during child bearing ages. Medical treatments are considered the first-line treatment to preserve fertility, avoid or delaying surgery. This randomized control study was carried out in OPD of Obstetrics and Gynecology Department of BSMMU, Dhaka, Bangladesh from May 2018 to March 2019 to evaluate the efficacy and safety of ulipristal acetate (5mg) once daily in reproductive women with three months treatment courses. Total 52 samples with symptomatic uterine fibroids for treatment course-1, among them 36 were needed for treatment course-2 which was slow or non-responding in treatment course-1. Main outcome measures were amenorrhea, controlled bleeding, fibroid volume, anaemia, quality of life. Sixty one percent (61.0%) of patients were achieved amenorrheic during both treatment courses. Ninety percent (90.0%) patients were control of bleeding during both treatment courses. In treatment course-1, reductions from baseline in fibroid volume were 62.70%, whereas in course-2, reductions in fibroid volume were 75.33%. Five percent (5.0%) of patients were discontinuing Ulipristal acetate due to adverse effects. Renal and liver function tests were performed before and after each course of treatment. The level of creatinine, SGPT in the blood for both treatment courses had no statistically significant effects. Ulipristal acetate may be an alternative to surgical treatment, the safety profiles and prolong effects with improvement of symptoms, quality of life after cessation of drugs. Repeated use of drugs reduces the size and also improves the patient's condition.

Prevalence of subclinical cardiac abnormalities in patients with metal-on-metal hip replacements.

BACKGROUND: Metal-on-metal (MOM) hip prostheses have a higher failure rate than conventional prostheses and leaching of cobalt and chromium has been linked to cardiomyopathy. We screened MOM subjects to evaluate if cobalt and chromium are related to subclinical cardiac dysfunction. METHODS: A single centre, non-randomised, observational study using echocardiography in 95 patients who had undergone MOM hip prostheses, and 15 age matched controls with non-MOM hip replacement. Serial plasma cobalt and chromium levels were recorded, and data compared by tertiles of cobalt exposure. RESULTS: Indexed left ventricular (LV) end-diastolic and end-systolic volumes (EDVi and ESVi) increased with tertile of cobalt (omnibus p = 0.003 for EDVi and ESVi), as did indexed left atrial (LA) volumes (p = 0.003). MOM subjects had 25% larger EDVi than controls, 32% larger ESVi (40 ml vs. 32 ml, and 15 ml vs. 11 ml, p = 0.003 for both) and 28% larger indexed LA (23 ml vs. 18 ml, p = 0.002). There were no differences in LV systolic or diastolic function, including ejection fraction, tissue velocity and mitral E/e'. Estimated glomerular filtration rate was 18% lower in the highest tertile compared with the lowest (p = 0.01) and correlated inversely with LA volume (r = -0.36, p < 0.001) and LV EDV (r = -0.24, p = 0.02). CONCLUSIONS: No correlations between sensitive measures of systolic or diastolic cardiac function or serum cobalt/chromium levels were observed in this study. However, there was a relationship between increasing left ventricular and left atrial volumes and declining renal function with high cobalt levels which requires further evaluation in MOM patients.

Multidrug-resistant tuberculosis in Bangladesh: results from a sentinel surveillance system.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh. METHODS: Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Löwenstein-Jensen medium. RESULTS: Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged 65 years. CONCLUSIONS: The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.

Molecular epidemiology of tuberculosis in rural Matlab, Bangladesh.

OBJECTIVE: To characterise and classify clinical isolates collected from tuberculosis (TB) patients in rural Bangladesh and to investigate the mode of transmission. DESIGN: An epidemiological study using a combination of conventional and molecular methods was performed in a rural population of Bangladesh. A total of 168 clinical isolates were collected from TB patients. Deletion analysis, used for rapid differentiation of members of the Mycobacterium tuberculosis complex, spoligotyping and variable number tandem repeats of mycobacterial interspersed repetitive units (VNTR-MIRU) typing were used. RESULTS: Deletion analysis identified all isolates as M. tuberculosis and further divided them into 109 strains (65%) carrying the M. tuberculosis deletion region 1 (TbD1-intact or 'ancestral' strains) and 59 strains (35%) lacking this region (TbD1 or 'modern' strains). MIRU analyses showed that 149 strains (89%) had unique patterns, whereas 19 strains (11%) clustered into eight groups. The largest cluster comprised five TbD1 strains of the Beijing type. The rate of recent transmission was estimated to be 6.5%. CONCLUSIONS: Our results suggest that TB in rural Bangladesh is caused primarily by reactivation of latent infections involving TbD1 intact strains, overlaid with the recent emergence of Beijing strain clusters that include multidrug-resistant isolates.

Identifying women with severe angiographic coronary disease.

OBJECTIVES: To determine sex/gender differences in the distribution of risk factors according to age and identify factors associated with the presence of severe coronary artery disease (CAD). DESIGN: We analysed 23,771 consecutive patients referred for coronary angiography from 2000 to 2006. SUBJECTS: Patients did not have previously diagnosed CAD and were referred for first diagnostic angiography. OUTCOME MEASURES: Patients were classified according to angiographic disease severity. Severe CAD was defined as left main stenosis > or = 50%, three-vessel disease with > or = 70% stenosis or two-vessel disease including proximal left anterior descending stenosis of > or = 70%. Univariate and multivariate logistic regression was used to assess the association between risk factors and angina symptoms with severe CAD. RESULTS: Women were less likely to have severe CAD (22.3% vs. 36.5%) compared with men. Women were also significantly older (69.8 +/- 10.6 vs. 66.3 +/- 10.7 years), had higher rates of diabetes (35.0% vs. 26.6%), hypertension (74.8% vs. 63.3%) and Canadian Cardiovascular Society (CCS) class IV angina symptoms (56.7% vs. 47.8%). Men were more likely to be smokers (56.9% vs. 37.9%). Factors independently associated with severe CAD included age (OR = 1.05; 95% CI 1.05-1.05, P < 0.01), male sex (OR = 2.43; CI 2.26-2.62, P < 0.01), diabetes (OR = 2.00; CI 1.86-2.18, P < 0.01), hyperlipidaemia (OR = 1.50; CI 1.39-1.61, P < 0.01), smoking (OR = 1.10; CI 1.03-1.18, P = 0.06) and CCS class IV symptoms (OR = 1.43; CI 1.34-1.53, P < 0.01). CCS Class IV angina was a stronger predictor of severe CAD amongst women compared with men (women OR = 1.82; CI 1.61-2.04 vs. men OR = 1.28; CI 1.18-1.39, P < 0.01). CONCLUSIONS: Women referred for first diagnostic angiography have lower rates of severe CAD compared with men across all ages. Whilst conventional risk factors, age, sex, diabetes, smoking and hyperlipidaemia are primary determinants of CAD amongst women and men, CCS Class IV angina is more likely to be associated with severe CAD in women than men.

Effect of hexane extract of spirulina in the removal of arsenic from isolated liver tissues of rat.

The present study was conducted to investigate whether the active compound(s) of spirulina is present in its -- alcohol extract, hexane extract, DCM extract or in their residues. In phase I the accumulation of arsenic in isolated liver tissues of rat at different incubation period (15, 30, 45 minutes) was seen. In phase II arsenic-loaded liver tissues were incubated in presence and absence of alcohol extract, alcohol extraction residues, hexane extract, hexane extraction residues, DCM extract and DCM extraction residues of spirulina respectively. The percentage removal of arsenic from liver tissues by different extracts and residues of spirulina was estimated by Atomic Absorption Spectrophotometer. In phase III arsenic-loaded liver tissues were incubated in presence and absence of different concentration of hexane extract of spirulina and the percentage removal of arsenic from liver tissues was estimated. This study showed that the accumulation of arsenic in isolated liver tissue was time dependent and highest accumulation found was 0.69 microg/g tissues after 45 minutes incubation, which was highly significant. The percentage removal of arsenic from arsenic loaded liver tissues by alcohol extract, alcohol extraction residues, hexane extract, hexane extraction residues, DCM extract, DCM extraction residues were 33.8%,4.4%,83.0%,10.2%,7.3% and 2.9%, respectively. The percentage removal of arsenic by hexane extract at the concentration of 1, 10, 100 microg were 13.2%, 29.4% and 89.7%, respectively. Among the different extracts and residues of spirulina the hexane extract causes highly significant (p<0.001) removal. In conclusion the present study suggests that the active compound(s) of spirulina is present mostly in its hexane extract.

Immunohistochemical study of transferrin receptor expression in the placenta of pre-eclamptic pregnancy.

Transport of iron from the mother to the fetus is essential for the normal development of the fetus and abnormalities in the transferrin receptor (TFR) on the placental trophoblasts might have some crucial effects on the fetal iron metabolism. The present study was undertaken to determine whether there are any changes in the expression of the transferrin receptor in the placenta from pre-eclamptic mothers. An immunohistochemical study using antibodies specific for C-terminus and N-terminus regions of the TFR revealed that TFR expression by syncytiotrophoblasts around chorionic villi is markedly reduced in placentae from pre-eclamptic pregnancies compared to those from normal pregnancies and pregnancies at early gestational age that terminated by abortion. The same result, although to a lesser extent, was obtained even in trophoblasts which were located around atrophic villi with fibrotic changes in the interstitium, or which invaded into the deciduas. The expression of human chorionic gonadotropin (HCG) on those cells was observed to the same extent in the normal and pre-eclamptic pregnancy groups. The concentration of TFR in the peripheral blood also decreased in pre-eclampsia. These results suggest that TFR synthesis in the pre-eclampsia, especially in the placental trophoblasts, is decreased.

Dendritic cell-like immunoreactivity in the glomerulus of the olfactory bulb and olfactory nerves of mice.

Dendritic cell-like immunoreactivity was examined in the mouse brain. The glomerulus of the olfactory bulb and the olfactory nerves were stained by antibodies against the dendritic cells, NLDC-145 and MIDC-8, while these structures were not stained by antibodies against microglia or macrophages, F4/80, Mac1 or CD45. Immunoelectron microscopy showed that the immunoreaction for NLDC-145 was localized to the sheath and presynaptic terminals of the olfactory nerves. These findings suggest that the sheath and presynaptic terminals of the primary olfactory nerves have some degree of the antigenicity in common with dendritic cells.

Production of macromolecular activators of phagocytosis by lysed platelets.

Macromolecular activators of phagocytosis from platelets (MAPP: 1-MAPP and s-MAPP) are released from activated fresh platelets and enhance leukocyte phagocytosis via the Fcgamma receptors. In this study, production of MAPP was investigated in lysate of freeze-thawed stored platelets (PL). Incubation of PL and thrombin with precursors of MAPP (pre-MAPP: pre-1-MAPP and pre-s-MAPP) produced 1-MAPP and s-MAPP, whereas products released from stored platelets by stimulation with thrombin or collagen did not produce MAPP after incubation with pre-MAPP. The action of thrombin in MAPP formation with PL and pre-MAPP was inhibited by antithrombin III and heparin, and sequential incubation studies indicated that the key site of action of thrombin was on a component of PL. Other serine proteases such as trypsin could be substituted for thrombin in this reaction, whereas the action of thrombin was specific when whole platelets were used instead of PL. Gel filtration of PL before and after treatment with thrombin suggested that a macromolecule in PL (PMA-I) is digested by thrombin and liberates a 700 to 800 Da substance (PMA-II) which converts pre-MAPP to MAPP.

Serological response to immunization with tetanus toxoid.

A total of two hundred women were immunized with tetanus toxoid vaccine. Two batches of toxoid prepared at the Institute of Public Health (IPH), Dhaka and one batch of imported vaccines, were being used by the EPI in Bangladesh for immunization. Each hundred women were immunized by IPH and imported vaccine. Two human doses were given in one month interval. Blood samples from all the study subjects were collected on the day of 1st dose and one month after second dose. Both the preimmunized sera and the sera after vaccination were tested to determine the antibody titre against tetanus toxoid by the haemagglutination method. The preimmunized sera showed the presence of protective antibody in 50(25%) subjects who had the history of previous immunization. Including these initial antitoxin positive cases the seroconversions found among 95% and 96% of the study population respectively after immunization with IPH and imported toxoids, which were 93.05% and 94.87% when these 50 subjects were excluded. No significant difference (p = 1.0) was observed between the immunity of the subjects after receiving IPH and imported vaccine. Antibody titre of initial tetanus-antitoxin positive cases raised eight folds after getting more doses. The result gave fair indication of the antigenicity of all the toxoids used in the study.

Glycoprotein Ibalpha-bound thrombin functions as a serine protease to produce macromolecular activators of phagocytosis from platelets.

Production of macromolecular activators of phagocytosis from platelets (MAPPs) was observed when the lysate of fresh platelets was incubated with MAPP precursors and thrombin. An 800-Da MAPP activator (PMA-II) was obtained by Superdex peptide gel filtration of the lysate after thrombin treatment. The necessity of thrombin in MAPP production in fresh platelets was confirmed by the action of anti-thrombin monoclonal antibody or anti-thrombin III and heparin. To specify the thrombin receptor on which the thrombin forming PMA-II binds, the effects of thrombin-receptor-derived peptides and anti-thrombin receptor antibodies on MAPP production by stored platelets which have lost their thrombin content were investigated. DYYPEEDTEGD involved in glycoprotein Ibalpha and anti-glycoprotein Ibalpha antibody prevented stored platelets from producing MAPP. These observations suggest that thrombin bound to glycoprotein Ibalpha functions as a serine protease in MAPP formation.