Reno-protective effect of nicorandil and pentoxifylline against potassium dichromate-induced acute renal injury via modulation p38MAPK/Nrf2/HO-1 and Notch1/TLR4/NF-κB signaling pathways.

BACKGROUND: Occupational and environmental exposure to chromium compounds such as potassium dichromate (PDC) (K2Cr2O7) has emerged as a potential aetiologic cause for renal disease through apoptotic, and inflammatory reactions. The known potent antioxidants such as nicorandil (NIC) and/or pentoxifylline (PTX) were studied for their possible nephroprotective effect in PDC-treated rats. METHODS: Forty male Wistar rats were divided into five groups; control, PDC group, NIC+PDC, PTX+PDC group, and combination+PDC group. Nephrotoxicity was evaluated histopathologically and biochemically. Invasive blood pressure, renal function parameters urea, creatinine, uric acid and albumin, glomerular filtration rate markers Cys-C, Kim-1 and NGAL, inflammatory markers IL-1ß, IL-6, TNF-α, TGF-ß, COX-II, p38MAPK, NF-κB and TLR4, oxidative stress SOD, GSH, MDA, MPO, HO-1 and Nrf2 and apoptotic mediators Notch1 and PCNA were evaluated. Besides, renal cortical histopathology was assayed as well. RESULTS: PDC led to a considerable increase in indicators for kidney injury, renal function parameters, invasive blood pressure, oxidative stress, and inflammatory markers. They were markedly reduced by coadministration of PDC with either/or NIC and PTX. The NIC and PTX combination regimen showed a more significant improvement than either medication used alone. Our results demonstrated the nephroprotective effect of NIC, PTX, and their combined regimen on PDC-induced kidney injury through suppression of oxidative stress, apoptosis, and inflammatory response. CONCLUSION: Renal recovery from PDC injury was achieved through enhanced MAPK/Nrf2/HO-1 and suppressed Notch1/TLR4/NF-κB signaling pathways. This study highlights the role of NIC and PTX as effective interventions to ameliorate nephrotoxicity in patients undergoing PDC toxicity.

Novel drug therapy of acute hepatic failure induced in rats by a combination of tadalafil and Lepidium sativum.

BACKGROUND: Hepatocyte death and a systemic inflammatory response are the outcome of a complex chain of events mediated by numerous inflammatory cells and chemical mediators. The point of this study was to find out if tadalafil and/or Lepidium sativum (L. sativum) could help people who have been exposed to carbon tetrachloride (CCL4) and are experiencing acute moderate liver failure. This was especially true when the two were used together. METHOD AND MATERIALS: To cause mild liver failure 24 h before sacrifice, a single oral dosage of CCL4 (2.5 mL/kg b.w.) (50% in olive oil) was utilized. Furthermore, immunohistochemical expression of nuclear factor kappa B (NF-κB) as well as histological abnormalities were performed on liver tissue. RESULTS: The results showed that tadalafil and/or L. sativum, especially in combination, performed well to cure acute mild liver failure caused by CCL4. This was demonstrated by a decrease in NF-κB expression in the liver tissue and an improvement in organ damage markers observed in the blood and liver tissues. Furthermore, such therapy reduced interleukin1 beta (IL-1ß) and tumor necrosis factor-alpha (TNF-α) levels in the liver tissue. It's worth noting that the tested combination resulted in greater liver improvement. CONCLUSIONS: According to the findings, tadalafil and L. sativum, particularly in combination, have the ability to protect the liver from the negative effects of CCL4 exposure. Because of its capacity to improve liver function, restore redox equilibrium, and decrease inflammatory mediators, it is a prospective option for mitigating the negative effects of common environmental pollutants such as CCL4.

Role of Red Cell Distribution Width to Platelet Ratio in Predicting Hepatic Fibrosis in Chronic Hepatitis B.

Hepatitis B virus (HBV) infection is a serious global health problem. Globally more than 2 (Two) billion people are infected with Hepatitis B virus and about 400 million people are chronic carriers who are at risk of death from liver cirrhosis and liver cancer that kill more than one million people globally each year. Prevalence of HBV infection in Bangladesh is 2.3 to 9.7% and approximately 10 million people are harboring the virus as carrier. HBV infection is increasing at an alarming rate in Bangladesh due to lack of health education, poverty, illiteracy and lack of hepatitis B vaccination. This cross sectional study was carried out in the Department of Clinical Pathology, in collaboration with Department of Hepatology and Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2013 to August 2014 to assess the role of Red cell distribution width to platelet ratio (RPR) as a non invasive marker in predicting hepatic fibrosis in chronic hepatitis B patients. Total 40 patients with chronic hepatitis B virus infection who fulfilled the criteria of chronic hepatitis B were included in this study. In this study, majority of the patients belonged to 20-29 years, most of the patients were male and HBeAg negative .Histopathology was gold standard to identify the stages of hepatic fibrosis. We also measured RDW and Platelet count by automated haematology analyzer when platelet count was rechecked manually; RDW to platelet ratio was calculated to see the correlation between RPR with different stages of hepatic fibrosis. In chronic hepatitis B patients a positive and significant correlation was found between RPR and stages of hepatic fibrosis and Spearman's correlation coefficient for RPR was 0.749 which was positive and highly significant (p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RDW to Platelet ratio (RPR) was 62.86%, 80%, 95.65%, 23.53% and 65% respectively. To assess the diagnostic performance of RPR we also used receiver-operating curve (ROC). The area under ROC was 0.889 for identification of hepatic fibrosis. This data revealed that RPR is strongly associated with stages of hepatic fibrosis in chronic hepatitis B patients. As such RPR may be a useful diagnostic tool for assessing the hepatic fibrosis in chronic hepatitis B patients.

Alanine Aminotransferase and Total Bilirubin Concentration in Preeclampsia and Eclampsia.

Eclampsia is an important cause of maternal mortality in developing countries. This cross-sectional comparative study was conducted in the Departments of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Obstetrics and Gynecology, BSMMU, and Dhaka Medical College Hospital, Dhaka, Bangladesh, from March 2012 to February 2013 and was designed to evaluate liver markers to predict preeclampsia. One hundred fifty (150) women with pregnancy of ≥28 weeks, 50 for each normal, preeclampsia and eclampsia group, were enrolled purposively. The protocol was approved by IRB of BSMMU. Consent was taken from each patient. Serum total Bilirubin and ALT were assessed. Data was collected in a questionnaire and analyzed by SPSS-16. Quantitative data were compared by ANOVA or 't' test and qualitative data by chi-square test. P value <0.05 was considered significant. The patients of all groups were similar in age and gravida. The mean±SD serum total bilirubin and ALT were significantly higher in preeclampsia and eclampsia groups than normal pregnancy. However they were similar in preeclampsia and eclampsia group.

Evaluation of Serum Ferritin Concentration in Mild and Severe Pre-Eclamptic Women.

Pre-eclampsia is one of the most important complications of pregnancy. About 16% of maternal death is associated with pre-eclampsia in Bangladesh. It is necessary to diagnose or to predict pre-eclampsia for minimizing maternal morbidity and mortality. This case control study was carried out in the department of Clinical Pathology, in collaboration with department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2011 to February 2012 which included 20 mild pre-eclamptic and 20 severe pre-eclamptic patients and 30 gestation matched normotensive pregnant women within 28-40 weeks of gestation. Serum iron profile was measured and PBF was done to observe the association of higher concentration of serum ferritin, serum iron, percent saturation of total iron binding capacity, hemoglobin and lower level of total iron binding capacity, increased neutrophil count and decreased platelet count with pre-eclampsia. The mean serum ferritin concentration of mild pre-eclamptic group 99.91±7.84 ng/ml was 5 times and severe pre-eclamptic group 149.59±13.75 ng/ml was 8 times higher than that of control group 18.47±2.03 ng/ml. The mean serum iron level of mild pre-eclamptic group was (114.45±8.72 µg/dl) and in severe pre-eclamptic group was (174.35±13.59 µg/dl) and control group was (72.64±4.72 µg/dl) (p<0.05). The mean TIBC was higher and percent saturation was lower in control group than mild and severe pre-eclamptic group. The mean differences of iron parameters were statistically significant (p<0.05) among the three groups in ANOVA test. Both hemoglobin (gm/dl), total count of WBC and percentage of neutrophil were significantly higher (p<0.05) but platelet count was significantly lower in mild and severe pre-eclamptic group than normal control group. So higher concentration of serum ferritin, serum iron, percent saturation of total iron binding capacity and hemoglobin level increased and total iron binding capacity decreased in mild and severe pre-eclampsia than those of uncomplicated normal pregnancy. Pre-eclampsia is one of the most important complications of pregnancy. About 16% of maternal death is associated with pre-eclampsia in Bangladesh. It is necessary to diagnose or to predict pre-eclampsia for minimizing maternal morbidity and mortality. This case control study was carried out in the department of Clinical Pathology, in collaboration with department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2011 to February 2012 which included 20 mild pre-eclamptic and 20 severe pre-eclamptic patients and 30 gestation matched normotensive pregnant women within 28-40 weeks of gestation. Serum iron profile was measured and PBF was done to observe the association of higher concentration of serum ferritin, serum iron, percent saturation of total iron binding capacity, hemoglobin and lower level of total iron binding capacity, increased neutrophil count and decreased platelet count with pre-eclampsia. The mean serum ferritin concentration of mild pre-eclamptic group 99.91±7.84 ng/ml was 5 times and severe pre-eclamptic group 149.59±13.75 ng/ml was 8 times higher than that of control group 18.47±2.03 ng/ml. The mean serum iron level of mild pre-eclamptic group was (114.45±8.72 µg/dl) and in severe pre-eclamptic group was (174.35±13.59 µg/dl) and control group was (72.64±4.72 µg/dl) (p<0.05). The mean TIBC was higher and percent saturation was lower in control group than mild and severe pre-eclamptic group. The mean differences of iron parameters were statistically significant (p<0.05) among the three groups in ANOVA test. Both hemoglobin (gm/dl), total count of WBC and percentage of neutrophil were significantly higher (p<0.05) but platelet count was significantly lower in mild and severe pre-eclamptic group than normal control group. So higher concentration of serum ferritin, serum iron, percent saturation of total iron binding capacity and hemoglobin level increased and total iron binding capacity decreased in mild and severe pre-eclampsia than those of uncomplicated normal pregnancy.

Comparative Study of Adenosine Deaminase and Other Conventional Diagnostic Parameters in Diagnosis of Tuberculous Pleural Effusion.

Though pulmonary tuberculosis is the common presentation of Mycobacterium tuberculosis infection, extra-pulmonary tuberculosis is also a growing problem worldwide. Tuberculous pleural effusion is the second frequent form of extra-pulmonary presentation after tuberculous lymphadenitis and if untreated up to 65% of patients with tubercular pleural effusions will eventually develop active TB. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. So,the aim of this study was to evaluate the diagnostic value of ADA level in plural fluid and other conventional methods for diagnosis of tubercular plural effusion. This was a cross sectional study. This study was carried out in 64 Patients suffering from plural effusion and were consecutively selected and divided into two groups: tuberculous (n=40) and non tuberculous (n=24), depending upon etiology. Details clinical history, physical examination, routine and other relevant investigations including ADA estimation was measured. The mean value of ADA in the tuberculous group was 64.11 ± 19.50 U/L which was significantly higher (p<0.05). Cut off value of ADA was ≥ 40 U/L with 97% sensitivity and 93%specificity. In this study, sensitivity, specificity, PPV and NPV of ADA level in pleural effusion were more significant than other conventional parameters.

Comparison of Serum CA72-4 and CEA Levels in Patient with Endoscopically Suspected Gastric Carcinoma.

Several serum tumour markers have been described for gastric cancer. Preoperative level of tumor marker helps to predict the diagnosis of gastric carcinoma. CA72-4 as a serum tumour marker for gastric cancer is evaluated, and compared its utility in this regard with that of carcinoembryonic antigen (CEA). Analysis of gastric carcinoma by serum levels of CEA and CA72-4 and their correlation with histopathology help the clinician to develop his management strategies for gastric carcinoma. A prospective observational study was carried out in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with Department of Surgery BSMMU, DMCH, Delta Hospital Limited, Dhaka, during the period of October 2010 to September 2011. Serum CA72-4 and CEA were analyzed in 71 endoscopically suspected patients for gastric carcinoma. Among them 58 cases were diagnosed as malignant gastric disease and 13 cases were nonmalignant gastric disease. Sensitivity of CA 72-4 and CEA were 48.3% and 31% respectively and specificity were 92.3% and 76.9% respectively. In poorly differentiated carcinoma, positivity for CA72-4 and CEA were 55.6% and 36.1% respectively. Because of the high positivity of CA72-4 in poorly differentiated carcinoma, CA72-4 is reliable tumour marker in advanced cases. As the sensitivity of CA72-4 was more than that of CEA in diagnosis of gastric cancer, CA72-4 can be used in conjunction with other diagnostic tests like endoscopy that would be more helpful for the patients.

Correlation of Connective Tissue Growth Factor (CTGF/CCN2) with Hepatic Fibrosis in Chronic Hepatitis B.

CTGF/CCN2 plays an important role in the formation and development of hepatic fibrosis. This study determined the correlation between serum CTGF/CCN2 and stages of hepatic fibrosis and explored the clinical value of serum CTGF/CCN2 in the assessment of hepatic fibrosis in chronic hepatitis B. This cross sectional study was done in department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2012 to February 2013. Serum CTGF was measured by using of a sandwich immunoassay technique. Forty (40) chronic hepatitis B patients were included in this study. The sensitivity of CTGF/CCN2 was 71.6%, specificity 67.5%. Spearman's rank correlation coefficient was 0.652 between serum CTGF/CCN2 and stages of hepatic fibrosis (p<0.001). The area under receiver-operating curve (ROC) was 0.750 for identification of hepatic fibrosis. This present data revealed that serum CTGF/CCN2 in chronic hepatitis B were strongly associated with stages of hepatic fibrosis. CTGF/CCN2 may useful diagnostic tool for assessing the hepatic fibrosis in chronic hepatitis B.

National characteristics and variation in Arabic handwriting.

From each of four Arabic countries; Morocco, Tunisia, Jordan and Oman, 150 participants produced handwriting samples which were examined to assess whether national characteristics were discernible. Ten characters, which have different configurations depending upon their position in the word, along with one short word, were classified into distinguishable forms, and these forms recorded for each handwriting sample. Tests of independence showed that character forms used were not independent of country (p<0.001) for all but one character-position (this was dropped from subsequent analyses). A correspondence analysis ordination plot and analysis of similarity (R=0.326, p=0.0002) showed that whole samples were discernibly grouped by country, and a tree analysis produced a classification which was 71% accurate for the original data and 83% accurate for 80 new handwriting samples that underwent 'blind' classification. When the countries were combined into two regions, North Africa and Middle East, the grouping was more marked. Thus, there appears to be some scope for narrowing down the nationality, and particularly the wider geographical region of an author based upon the character forms they use in Arabic handwriting.

Value of red cell distribution width (RDW) and RBC indices in the detection of iron deficiency anemia.

Iron deficiency anemia is the common problem during pregnancy. Detection of iron deficiency early during pregnancy can reduce maternal and child mortality and morbidity. Red cell distribution width is a new routine parameter in fully automated hematology analyzer that can give the idea of early iron deficiency before other test. It gives the idea of red cell size variation which is the earliest morphologic changes in iron deficiency anemia. In prelatent and latent stage of iron deficiency MCV are normal. Whereas in latent stage Red Cell Distribution Width (RDW) would be expected to increase because of a microcytic population of cells appears in the blood. This study evaluates the role of red cell distribution width and RBC indices in determining iron deficiency early and provide reliable and useful technique. In this study 190 pregnant women were included. RDW, MCV, MCH, MCHC and iron profile were done. RDW compared with MCV, MCH and MCHC in various stages of iron deficiency. In latent stage of iron deficiency higher RDW was found significant than MCV, MCH, MCHC (p<0.05). In this study RDW had sensitivity 82.3% and specificity 97.4%. Whereas MCV, MCH and MCHC had 29.2%, 68.1% and 15% sensitivity but specificity was 98.7%, 83.1% and 96.1% in the detection of iron deficiency. Iron deficiency anaemia without other complicating disease could be screened out early by increased RDW when RBC indices were normal.

Highly fluorescent reticulocyte count is the early predictor of haematopoietic recovery on remission induction phase.

Highly fluorescent reticulocyte count a new routine parameter in the hematology analyzer can give the idea of the earliest morphologic change of bone marrow recovery before other test become positive after chemotherapy. A prospective study was carried out in the Department of Clinical Pathology in collaboration with Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during a period of one year starting from October 2009 to September 2010 to evaluate the bone marrow recovery in children with acute lymphoblastic leukemia (ALL) by automated reticulocyte analysis. Total fifty patients were enrolled in this study on remission induction phase. All patients were between 8 months to 15 years age range with a mean age of 5.5±3.2. At the end of the study highly fluroscent reticulocyte count recovery occurred earlier than the current practice of absolute neutrophil count (ANC) recovery.

A comparative study of chemical and immunological method of fecal occult blood test in the diagnosis of occult lower gastrointestinal bleeding.

Fecal occult blood test is the most widely used screening test for diagnosis of gastrointestinal bleeding disorders specially colorectal carcinoma. Among the various methods of fecal occult blood tests, chemical method is being used commonly, but the method has some drawbacks like low participation rate, high false positive rate, low sensitivity etc. To overcome these short comings, newer immunological method was introduced. This study evaluated the role of immunological method of fecal blood test in the diagnosis of occult lower GIT bleeding. Stool samples from two hundred patients were examined by both chemical and immunological method. The patients who were positive by any or both methods of occult blood test, were advised for colonoscopy. During colonoscopy tissues were taken for histopathology which was the gold standard of this study. Among 110 OBT positive patients pathological lesions were detected in 65 patients by colonoscopy and histopathology. The diseases detected by colonoscopy and histopathology 18 colorectal polyp, 8 colorectal cancer, 24 ulcerative lesions and 5 inflammatory bowel disease etc. Regarding comparative analysis of chemical and immunological method, the higher sensitivity (95.4% vs. 49.2%), specificity (44.4% vs. 37.8%), accuracy (74.5% vs. 44.5%), PPV (71.3% vs. 53.3%) and NPV (87% vs. 34%) of immunological method than chemical method was observed. Thus immunological method of fecal occult blood test was appeared to be a better alternative to conventional chemical method of fecal occult blood test in the diagnosis of occult lower GIT bleeding.

Early diagnosis of neonatal septicemia by hematologic scoring system, C-reactive protein and serum haptoglobin.

Neonatal septicemia is one of the major health problems throughout the world. Infections are frequent and important cause of morbidity and mortality in neonatal period. The objective of the present study was to find out the role of hematologic scoring system (HSS), C-reactive protein (CRP) and haptoglobin in the early diagnosis of neonatal septicemia. This is a descriptive consisted of 100 neonates admitted at neonatal ICU, BSMMU, who were clinically suspected sepsis. The hematological parameter, C-reactive protein and haptoglobin were measured in all cases. Blood culture was done as the gold standard for diagnosis of neonatal septicemia. There were 12 out of 100 neonates (12%) who had culture proven sepsis and they were predominantly preterm and very low birth weight. On evaluation of various hematological parameters total leukocyte count, total neutrophil count, immature to total neutrophil ratio (>0.2), immature to mature neutrophil ratio (>0.3), total immature count, platelet count were found to have optimal sensitivities and negative predictive values. Using these values hematologic scoring system (HSS) was formulated according to Rodwell et al. Score ≥4 was found sensitivity of 100%, specificity of 60%. C-reactive protein (CRP) had sensitivity of 75%, specificity of 74%. Haptoglobin was not found significant (p<0.05) with sepsis and sensitivity was very low. But Combination of score ≥4 and CRP showed sensitivity of 75%, specificity 85%, positive predictive value (PPV) 41% and negative positive value (NPV) 96%. HSS and CRP are useful test to differentiate the septicemic from non septicemic neonates and also provide a effective guideline to make decisions regarding judicious use of antibiotic therapy. But haptoglobin level was not found useful for screening of sepsis.

Comparative study of total prostate specific antigen and free to total prostate specific antigen ratio in the diagnosis of prostate cancer.

This descriptive study was done to compare total Prostate Specific Antigen (tPSA) and the Free to Total Prostate Specific Antigen [(F/T) PSA] ratio measurements for prostate cancer detection. This study included a total of 43 patients with suspected prostate cancer observed over a period of 12 months. Out of 43 consecutive male patients (mean age 69±9.39 years, range 48-100 years), 32 had benign disease (74%) and 11 had prostate carcinoma patients (26%), who had histologically proven prostate cancer. The mean total PSA was 67.9 ng/ml and 12.4 ng/ml in patients with carcinoma prostate and nodular hyperplasia of prostate (NHP) respectively (p<0.05). The mean free PSA in carcinoma patients was 7.4±9.8 ng/ml and in NHP patients it was 2.3±4.1 ng/ml. The difference in mean free PSA concentration was significant (p<0.05). The free to total PSA ratio in two groups was significantly different (p<0.01) from each other. In carcinoma patients, mean F/T PSA ratio was 0.144±0.152 as compared 0.328±0.076 in patients with benign disease. The sensitivity and specificity of the test was calculated at different F/T PSA ratio cutoff. At 0.1 cut off value, sensitivity of the test was 64% and specificity was 84%. The positive predictive value (PPV) was 58% and negative predictive value (NPV) was 87%. From cutoff value of 0.12 to 0.16, sensitivity was increased from 64% to 91% but specificity was reduced from 84% to 59%. The PPV did not show much change and NPV was increased from 89% to 95%. Increasing the cut off value thereafter showed no change in sensitivity but specificity was further reduced to 41%. Therefore in this patient, F/T PSA ratio cut off of 0.15 was found to be the appropriate cutoff value. In 43 men who were biopsied, 11(26%) prostatic carcinoma were identified. Only one patient (9.1%) had F/T PSA ratio above 0.15 and diagnosed by biopsied. Out of 32 patients who were negative for malignancy, 13 patients had F/T PSA ratio more than 0.15 and 19 patients had F/T PSA ratio less than 0.15. The validity of tPSA and F/T PSA ratio in the diagnosis of prostate cancer was identified by calculating their sensitivity, specificity, PPV and NPV. In case of F/T PSA ratio the sensitivity was 91% and in conventional tPSA the sensitivity was 82%. Specificity was low in both the cases. But in tPSA the specificity was only 13% compare to 59% in F/T PSA. Positive predictive value (PPV) for tPSA was 25% and in F/T PSA it was 44%. Negative predictive value (NPV) for t PSA was 67% and for F/T PSA was 95% which was very high. The effectiveness of F/T PSA ratio at 0.15 cut off value with corresponding tPSA>10ng/ml shows sensitivity 83% in prostate cancer and 50% in NHP patient.

Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients.

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy.

Immature reticulocyte fraction as a predictor of bone marrow recovery in children with acute lymphoblastic leukaemia on remission induction phase.

Immature reticulocyte fraction a new routine parameter in the hematology analyzer can give the idea of the earliest morphologic change of bone marrow recovery before other test become positive after chemotherapy. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University during a period of one year starting from October 2009 to September 2010 to evaluate the bone marrow recovery in children with acute lymphoblastic leukaemia by automated reticulocyte analysis. Total fifty patients were enrolled in this study on remission induction phase. All patients were between 8 months to 15 years age range with a mean age of 5.5 +/- 3.2. At the end of the study out of 50 cases, 52% patients showed early immature reticulocyte fraction recovery and concluded that the immature reticulocyte fraction parameter showed earlier haematopoietic recovery than the current practice of absolute neutrophil count recovery.

Usefulness of light emitting diode (LED) fluorescent microscopy as a tool for rapid and effective method for the diagnosis of pulmonary tuberculosis.

BACKGROUND: Tuberculosis remains world's leading cause of death from a single infectious agent. Fluorescence microscopy offers well-described benefits, comparing with brightfield microscopy, for the evaluation sputum smear samples for tuberculosis. We evaluated the diagnostic performance of fluorescence microscopy, using novel Light Emitting Diode (LED) technology as an alternative to the conventional fluorescence microscopy by Auramine stain as well as brightfield microscopy by Ziehl-Neelsen (ZN) stain. OBJECTIVES: The objective of the study was to see the usefulness of LED fluorescent microscopy in the diagnosis of pulmonary tuberculosis. METHODS: This is a prospective study consisted of 150 sputum samples from the patients of NIDCH, Mohakhali. All samples were stained by auramine and ZN stain at BSMMU and culture was done in Lowenstein-Jensen (L-J) media as gold standard at NTRL, Mohakhali. RESULTS: In this study total 66 (44%) out of 150 sputum specimens were positive for Mycobacterium Tuberculosis by culture. Sensitivity and specificity documented for the different modalities were 95.38% and 94.11%, respectively, for the LED assessment; 68.18% and 90.47%, respectively, for the CFM assessment; and 56.06% and 97.61%, respectively, for brightfield microscopy by ZN stain. The difference in their case detection rate was statistically significant (chi2=119.38, p<0.001). CONCLUSION: Fluorescence Microscopy (FM) is more sensitive than ZN for diagnosis of pulmonary tuberculosis. However, since FM is more sensitive and rapid, using this method (LED) in clinical laboratories with large specimen numbers is recommended.

Value of dysmorphic red cells and G1 cells by phase contrast microscopy in the diagnosis of glomerular diseases.

The morphology of red cells by phase-contrast microscopy (PCM) is a useful diagnostic marker for glomerular haematuria. This study evaluated the value of urinary dysmorphic red cells and G1 cells (special type of dysmorphic red cell) count by PCM providing a simple, cost effective and low risk technique in the diagnosis of glomerular diseases. Urine samples of 120 patients with haematuria and proteinuria were examined and the percentage of dysmorphic red cells and G1 cells were calculated. Cases were divided into two groups; group I (>20% dysmorphic red cells- glomerular group) and group II (≤20% dysmorphic red cells as non glomerular group). Renal histopathology was used as the gold standard method for the diagnosis of glomerulonephritis. Results from PCM showed a sensitivity of 92.7%, specificity 100% by the detection of dysmorphic red cell while by the detection of G1 cells, a sensitivity of 97.6% and specificity 100% were observed. The percentage of G1 cells is superior to counting dysmorphic red cells. The high sensitivity of phase contrast microscopy confirms its usefulness for the detection of dysmorphic red cells and G1 cells that can guide clinicians in the identification of the site of haematuria using non invasive tests.

Role of discrimination indices in differentiation of beta thalassaemia trait and iron deficiency anaemia.

Iron deficiency anaemia (IDA) and beta thalassaemia trait (BTT) are the most common causes of microcytic hypochromic anaemias. Several discrimination indices have been introduced to discriminate quickly these similar entities via parameters obtained from automated cell counter. The purpose of the study was to evaluate the value of five discrimination indices in differentiation of BTT and IDA. This study consists of 57 cases of BTT and 72 cases of IDA. Five discrimination indices evaluated in this study for differentiation of BTT and IDA were red blood cell (RBC) count, red blood cell distribution width index (RDWI), Green & King Index (G & K), Mentzer index (MI) and England & Fraser (E & F) index. Sensitivity, specificity, positive and negative predictive values and Youden's index (YI) had been calculated. RBC count and RDWI appears to be reliable and useful index for the differentiation of BTT and IDA, as both of the indices had more than 80% sensitivity, specificity in differentiation of IDA and BTT. Patients with microcytic hypochromic anaemia could be easily screened out for BTT and IDA through these discrimination indices in the absence of other complicated diseases.

Role of red cell distribution width (RDW) in the detection of iron deficiency anaemia in pregnancy within the first 20 weeks of gestation.

Iron deficiency anemia is common problem during pregnancy. Red cell size variation (anisocytosis) is the earliest morphologic changes in iron deficiency anemia. Red cell distribution width is a quantitative measure of red cell size variation and it can give the idea of early iron deficiency before other test to become positive. 190 pregnant women were included in this study. Red cell distribution width was compared between iron deficient & non-iron deficient pregnant women. Red cell distribution width also compared with Hb level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and peripheral blood film in prelatent iron deficiency, latent iron deficiency, mild and moderate iron deficiency anemia. Red cell distribution width had sensitivity 82.3% and specificity 97.4%. Whereas Hb level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and peripheral blood film all had 56.6%, 29.2%, 68.1%, 15% and 38.9% sensitivity but specificity was 90.9%, 98.7%, 83.1%, 96.1% and 98.7% in the detection of iron deficiency. Red cell distribution width appears to be a reliable and useful parameter for detection of iron deficiency during pregnancy.