Author Correction: Chemotherapy with radiotherapy influences time-to-development of radiation-induced sarcomas: a multicenter study.

Since the publication of this paper, the authors noticed an error in Fig. 1. The X-axis on all the figure panels should read 'Time (years)', not 'Time (months)'. The corrected Fig. 1 is shown below.

A new look at the supposed risks of early institutional rearing.

The main focus is on the assessment of the effects of early institutional care and compares three longitudinal studies from Romania, Greece and Hong Kong/China. The findings have been strikingly contrasting. The review asks if the risks are dependent on whether or not the institutional rearing is accompanied by gross pervasive deprivation (as it was in Romania) and investigates the methodological issues to explore the causal influence of the outcomes. Evidence is considered on changing institutional practices and the benefits of doing so. Comparison is made between institutions with major deprivation and those without global deprivation. A small number of studies are discussed that look at direct comparisons between institutional and community care. The empirical and conceptual implications of the findings are discussed.

Chemotherapy with radiotherapy influences time-to-development of radiation-induced sarcomas: a multicenter study.

BACKGROUND: An increasing number and proportion of cancer patients with apparently localised disease are treated with chemotherapy and radiation therapy in contemporary oncology practice. In a pilot study of radiation-induced sarcoma (RIS) patients, we demonstrated that chemotherapy was associated with a reduced time to development of RIS. We now present a multi-centre collaborative study to validate this association. METHODS: This was a retrospective cohort study of RIS cases across five large international sarcoma centres between 1 January 2000 to 31 December 2014. The primary endpoint was time to development of RIS. RESULTS: We identified 419 patients with RIS. Chemotherapy for the first malignancy was associated with a shorter time to RIS development (HR 1.37; 95% CI: 1.08-1.72; P=0.009). In the multi-variable model, older age (HR 2.11; 95% CI 1.83-2.43; P<0.001) and chemotherapy for the first malignancy (HR 1.61; 95% CI 1.26-2.05; P<0·001) were independently associated with a shorter time to RIS. Anthracyclines and alkylating agents significantly contribute to the effect. CONCLUSIONS: This study confirms an association between chemotherapy given for the first malignancy and a shorter time to development of RIS.

Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

A phase II trial of induction chemotherapy and chemo-IMRT for head and neck squamous cell cancers at risk of bilateral nodal spread: the application of a bilateral superficial lobe parotid-sparing IMRT technique and treatment outcomes.

PURPOSE: To determine the feasibility of induction chemotherapy and chemo-IMRT in head and neck squamous cell cancers at risk of bilateral nodal spread (midline tumours) and to evaluate whether bilateral superficial lobe parotid-sparing IMRT can reduce the incidence of ⩾G2 subjective xerostomia. METHODS: Patients with midline tumours were enrolled to a phase II trial to receive induction platinum/5-fluorouracil and concomitant platinum with combined superficial lobe parotid-sparing IMRT. The primary site and involved nodal levels received 65 Gy in 30 fractions (f) and at risk nodal levels, 54 Gy/30f. Incidence of ⩾G2 subjective xerostomia was defined as the primary endpoint. Secondary endpoints included incidences of acute and late toxicities and survival outcomes dependent on human papilloma virus (HPV) status. RESULTS: One hundred and twenty patients with midline cancers completed treatment between December 2005 and May 2010 with median follow-up of 50 months. Incidences of ⩾G2 acute toxicities were: dysphagia 75%; xerostomia 65%; mucositis 86%; pain 83%; and fatigue 64%. At 12 months, ⩾G2 subjective xerostomia was observed in 21% (17% in HPV +ve). Two-year loco-regional progression-free survival (PFS) was 90.7% (95% CI: 85.2-96.2). According to HPV status, there was a significant difference for 2-year loco-regional PFS, 76.8% (HPV-negative) vs 98.6% (HPV-positive), P=0.001. 2-year overall survival was 93% for HPV-positive compared with 52% for HPV-negative cases, P<0.001. CONCLUSIONS: Sequential chemotherapy/chemo-IMRT for midline tumours is feasible, with excellent survival outcomes. At 1 year, 21% experience ⩾G2 subjective xerostomia. Two-year survival outcomes differ significantly between HPV-positive and HPV-negative disease, suggesting development of different treatment schedules for the different disease entities.

Desmoid-type fibromatosis.

Desmoid-type fibromatosis is a rare, locally infiltrative, mesenchymal neoplasm that is associated with high rates of local recurrence but lacks the potential to metastasise. The disease affects younger individuals, with a peak age of 30 years, and is the most common cause of an anterior abdominal wall mass in young women of childbearing age. It may, however, involve nearly every body part, including the extremities, head and neck, trunk, and abdominal cavity; as such, desmoid-type fibromatosis may present to a range of general and subspecialty radiologists. These rare tumours have a widely variable clinical presentation and unpredictable natural history, hence input from a soft-tissue tumour centre is recommended, although much of the imaging may be performed at the patient's local hospital. The consensus for treatment has changed over the past decade, with most centres moving away from primary radical surgery towards a front-line 'watch-and-wait' policy. Therefore, imaging has an increasingly important role to play in both the diagnosis and follow-up of these patients. This review will discuss the typical imaging characteristics of these lesions and suggest diagnostic and follow-up magnetic resonance imaging protocols, with details of suitable sequences and scanning intervals.

Primary hyperparathyroidism: a case report.

Primary hyperparathyroidism results from the excessive secretion of PTH and typically produces frank hypercalcaemia. With the advent of multiphasic screening of serum chemistries, it has been recognized that primary hyperparathyroidism is not an uncommon disorder. Here, a 32 years old lady with burning to colicky recurrent upper abdominal pain, polyuria, polydipsia associated with anorexia, dyspepsia, generalized body ache, joint pain, constipation and weight loss has been described. An initial abdominal ultrasound was performed at hospital and revealed features of cholelithiasis and bilateral nephrocalcinosis. Serum biochemistries revealed that her serum calcium was 12.60mg/dl, serum PTH was 222.80ng/dl, serum creatinine was 0.90mg/dl, 99 Tc-sestamibi scanning for parathyroid evaluation revealed features suggestive of parathyroid adenoma adjoining the lower pole of right lobe of thyroid gland. Bone densitometry of femur and spine by DEXA showed osteoporosis with T score value <-3.5 SD. Right hemithyroidectomy with parathyroid adenoma excision was performed. Patient was closely monitored. Serum calcium and parathyroid hormone levels were markedly reduced near to the normal range within two weeks of surgery. Following five months after surgery, serum PTH was 29.59ng/dl, six months after surgery serum calcium was 9.2mg/dl. Patient is now in good physical condition and under regular follow up.

Efficacy of adefovir dipivoxil therapy in patients with chronic hepatitis B viral infection.

Hepatitis B virus (HBV) infection is a major public health problem in the world. About 30% of world population has serological evidence of HBV infection. The prevalence of chronic hepatitis B in Bangladesh is reported to be 7.8%. Several potentially effective agents with different mechanisms of action have entered clinical practice and adefovir dipivoxil is one of them. Studies on the efficacy of adefovir dipivoxil in Bangladeshi patients are lacking. This was a prospective study to find out the effect of one year adefovir therapy in patients with chronic hepatitis B virus infection who were HBeAg positive. Total number of patients included in this study was 68. Among them 53(77.94%) patients continued the therapy and completed follow up. At the end of one year of therapy, intention to treat analysis showed that the rate of response (HBeAg seroconversion and HBV DNA negative) was 37.73% which was comparable to the results obtained in other studies. There was major difference in the pre treatment serum ALT level between the responders and non-responders. Comparison of reduction of serum ALT level before treatment and after treatment showed that ALT level to be lower in both responder group and non responder group. Adefovir was effective in replicative HBV infection in Bangladeshi population. So we suggest that treatment can be started and subsequent follow up can be done in chronic HBV patients who are HBeAg positive without liver biopsy.

Disease extent and local complication of ulcerative colitis in Bangladeshi population.

Ulcerative colitis may involve anywhere from the rectum alone to the entire colon. Local complications like perforation, life threatening haemorrhage, toxic megacolon, pseudo polyps, stricture, and carcinoma of colon are seen. Patients who were diagnosed as Ulcerative Colitis in Departmental Ulcerative Colitis record book from January 1990 to June 2010 was considered as study population. Information regarding the extent of the disease and local complications were taken from earliest documented Lower GIT Endoscopy. Out of 164 patients disease extent were seen in 126(76.83%) patients and among them proctitis/proctosigmoiditis were seen in 57(45.24%) patients, left sided colitis were seen in 11(8.73%) patients, extensive/pan colitis were seen in 58(46.03%) patients. Complication were seen in 164 patients and 1(0.60%) patient had life threatening haemorrhage, 25(15.24%) patients developed pseudo polyps. There was no report of perforation, toxic megacolon, stricture or carcinoma of colon. The differences found between our study and studies from other Western and Asian countries in terms of complication rate and disease extent for were probably due to low index of suspicion, incomplete workup, or incomplete records, and influence of various environmental factors. So, further large scale prospective evaluation is suggested.

Unraveling the Myth of Radiation Resistance in Soft Tissue Sarcomas.

There is a misconception that sarcomas are resistant to radiotherapy. This manuscript summarizes available (pre-) clinical data on the radiosensitivity of soft tissue sarcomas. Currently, clinical practice guidelines suggest irradiating sarcomas in 1.8-2 Gy once daily fractions. Careful observation of myxoid liposarcomas patients during preoperative radiotherapy led to the discovery of this subtype's remarkable radiosensitivity. It resulted subsequently in an international prospective clinical trial demonstrating the safety of a reduced total dose, yet still delivered with conventional 1.8-2 Gy fractions. In several areas of oncology, especially for tumors of epithelial origin where radiotherapy plays a curative role, the concurrent application of systemic compounds aiming for radiosensitization has been incorporated into routine clinical practice. This approach has also been investigated in sarcomas and is summarized in this manuscript. Observing relatively low α/ß ratios after preclinical cellular investigations, investigators have explored hypofractionation with daily doses ranging from 2.85-8.0 Gy per day in prospective clinical studies, and the data are presented. Finally, we summarize work with mouse models and genomic investigations to predict observed responses to radiotherapy in sarcoma patients. Taken together, these data indicate that sarcomas are not resistant to radiation therapy.

Comparison of salbutamol with normal saline and salbutamol with magnesium sulphate in the treatment of severe acute asthma.

This study compared the efficacy and safety of nebulized magnesium sulphate with salbutamol to normal saline with salbutamol as the initial treatment of severe acute asthma patients. The present study was designed as a randomized open controlled clinical trial. The study was conducted Mymensingh Medical College Hospital over a period of 11 months from December 2009 to October 2010. Patients admitted with severe acute asthma having inclusion criteria were the study population. Among 120 study population 60 were in salbutamol with magnesium sulphate group and 60 were in salbutamol with normal saline group. The study finding showed that peak flow at baseline was similar in two groups. At 10 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in magnesium sulphate group (20±4%) than in the normal saline salbutamol group (13±3%). At 20 minutes the percentage increase in peak flow was greater in magnesium sulphate group (35±7%) than in the normal saline salbutamol group (24±6%) p value <0.001. Magnesium sulphate plus salbutamol group reached PEF near to 60% which is not in saline salbutamol group. There was no significant changed in respiratory rate, pulse rate, systolic, diastolic blood pressure and clinical evidence of unwanted adverse effect.

Efficacy of Peppermint oil in diarrhea predominant IBS - a double blind randomized placebo - controlled study.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder which is associated with considerable sufferings of patient and Peppermint oil is volatile oil, its active principle is menthol-contain a cyclic monoterpine which has anti-spasmotic properties due to its ability to block calcium channel of intestinal smooth muscles. This study observed the efficacy of peppermint oil for relieving the symptoms and changes of quality of life (QOL) in diarrhea predominant IBS. This was a prospective double blind randomized placebo-controlled study conducted in the Bangabandhu Sheikh Mujib Medical University during July 2008 to September 2009. Patients who fulfilled ROME II were initially selected but those had red flag signs or any organic disease was excluded from the study. Seventy four patients were enrolled in the study and randomly allocated to receive either peppermint oil or placebo three times daily for six weeks. Changes of symptoms were assessed three week interval during treatment and two weeks after the end of treatment. Data were analyzed by paired and unpaired 't' test. Finally sixty five patients completed the trial. It was observed that, at six weeks of therapy abdominal pain is markedly improved (mean±SD) 4.94±1.30 in peppermint oil group compared with 6.15±1.24 in placebo group and the difference was statistically highly significant (p>0.001). But two weeks after end of trials pain score again increased (6.09±1.93). Other symptoms and quality of life did not improve significantly. So the study result concludes that peppermint oil is effective in reliving only abdominal pain in diarrhea predominant IBS transiently.

Assessment of anaemia in patients with rheumatoid arthritis.

The present cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh from December 2009 to November 2010 to find out the association of iron deficiency, in anaemia with rheumatoid arthritis and to find a sensitive and less invasive marker to differentiate iron deficiency anaemia from the anaemia of chronic disease. A total of 45 patients of rheumatoid arthritis were provisionally included in the study. Of them, 12 patients were excluded as they did not allow for aspirating the bone marrow, leaving 33 patients to complete the study. The mean age of the patients was 42.6 years (22-66 years) with female to male ratio being roughly 3:1. Majority (97%) of the patients presented weakness followed by 78.8% dizziness, 54.5% palpitation, 24.2% pallor, 12.1% breathlessness, another 12.1% smooth tongue and 6.1% nail change. About 79% of the patients were positive for RA test and nearly 70% of patient had moderate anaemia. The mean serum ferritin was significantly reduced in patients with hypochromic with or without microcytic anaemia than that with normocytic normochromic anaemia (p<0.001). While total iron binding capacity was found to be significantly increased in patients with iron deficiency anaemia than that in patients with anaemia of chronic disease (p<0.021). The serum iron level was considerably reduced in the former group than that in the later group (p<0.066). Bone marrow iron grading revealed 48.5% of the patients with iron depleted and 51.5% with iron repleted. Serum ferritin level of patients with iron depleted bone marrow was significantly decreased than that in patients with iron repleted bone marrow (p<0.001). Serum iron level of the former group was also reduced than that of the later group (p<0.133). Total iron binding capacity was significantly raised in patients with iron depleted group than that in patients with iron repleted group (p<0.001). The study finds that anaemia of chronic disease and iron deficiency anaemia frequently coexist in patients with rheumatoid arthritis and serum ferritin and total iron binding capacity are considered good indicator for differentiating iron deficiency anaemia from the anaemia of chronic disease. Serum iron levels will not help for differentiating.

Efficacy of amitriptyline, pizotifen and propranolol in the prevention of migraine.

This intervention study conducted in the Neurology outpatient Department of Mymensingh Medical College Hospital (MMCH) from January 2006 to December 2007 to compare efficacy of amitriptyline, pizotifen and propranolol in the prophylaxis of migraine. Ninety cases were selected following certain inclusion and exclusion criteria. Result showed that the differences in duration, frequency and severity of attack were reduced in all groups but the differences among the groups were not significant (p>0.05). However, compared with amitriptyline and pizotifen, the propranolol group needed tablet paracetamol as abortive therapy less frequently which was statistically significant (p<0.05). All the drugs were well tolerated with minimum adverse effects.

Diagnostic evaluation of supraclavicular lymphadenopathy.

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

Pattern of poisoning in a tertiary level hospital.

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

Assessment of Serum Homocysteine Level to Predict Early Prognosis of Ischaemic Stroke.

Cerebrovascular disease is the third most familiar cause of mortality worldwide and in Bangladesh. The reported prevalence of stroke in Bangladesh is 0.3%. Age, high serum glucose, elevated admission blood pressure, fever, large infarction size, and hyperhomocysteinemia has been reported to be risk factor for early post-stroke neurological deterioration. Early serum homocysteine level estimation can predict the early prognosis of ischemic stroke. In a developing country like Bangladesh, an earlier stroke outcome prediction for guiding therapeutic approach is essential. This study aimed to specify the role of estimating serum homocysteine during the early phase of acute ischemic stroke to assume an early prognosis that would guide- a management plan, the need to stay in the hospital and the need for intervention. This cross-sectional descriptive study was performed at the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from October 2021 to April 2022. Radiologically confirmed all ischemic stroke patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, during the study period fulfilling the inclusion and exclusion criteria were included in this study. Non-probability purposive sampling technique was used. Data was collected using a pre-designed case record form. Quantitative data were represented as mean and standard deviation and qualitative data as frequency and percentage. The comparison was made by Chi-square test and independent samples t-test using SPSS (version 26.0). During the study period, among 716 stroke patients, 59 ischemic stroke patients were included in this study. The mean age of the patients was 64.0±11.72 years. After 72 hours of supportive treatment, early neurological outcomes were observed using NIHSS scoring. Out of 59 patients, the condition of 45(76.0%) patients improved or remained stable (END-) and the state of 14(24.0%) patients worsened (END+). Elderly age-raised temperature and elevated blood glucose level are known to increase infarction size, but only elevated temperature (p value 0.009) has statistical significance in this study. The mean homocysteine level ±SD was 20.22±6.95µmol/L, which is above the normal (<15µmol/L). The level was above average for both outcome groups. Serum homocysteine level was significantly higher in END(+) group (31.59±2.98µmol/L) than END(-) group (16.69±2.66µmol/L) and p value was <0.001.

Development of a polymerase chain reaction (PCR) test for the detection of virulent forms of Vibrio parahaemolyticus.

Vibrio parahaemolyticus is a marine bacterium and some strains cause gastroenteritis in humans. Clinical isolates are thought to possess virulence factors that are absent from the majority of environmental isolates. Use of randomly amplified polymorphic DNA (RAPD)-PCR produced a unique 600 bp amplicon (band Y) in the majority of clinical isolates and rarely in environmental isolates tested. The DNA from band Y was cloned and sequenced and found to code for an outer membrane protein (OMP). Two polymerase chain reaction (PCR) primers were designed to specifically amplify a 200 bp unique sequence from presumptive virulent strains (PCR-OMP). The virulence of 23 clinical and 32 environmental isolates was assessed in cytotoxicity tests by treatment of Caco-2 cells with extracellular products (ECPs). All but two of the clinical isolates (91%) were positive for the 200 bp PCR-OMP and their ECPs produced a significantly higher (p < 0.05) lactate dehydrogenase (LDH) release (mean 72.88%) than the ECPs of environmental isolates (mean 15.3%) with the exception of one environmental isolate that produced the 200 bp amplicon. A positive 200 bp PCR-OMP is strongly correlated with virulence, as determined by the cytotoxicity assay, and identified virulent forms better than current PCR tests for tdh, trh or T3SS2.