Prevalence of cervical intraepithelial neoplasia and cervical carcinoma in a tertiary care hospital at Rajshahi

Background: Cervical intraepithelial neoplasia (CIN) is a precancerous cervical condition with the potential to develop into cervical carcinoma if untreated. While research on CIN and cervical carcinoma exists in various regions, the Rajshahi area lacks such investigations. Examining the prevalence of CIN and cervical carcinoma in this region is essential. This study aimed to assess the prevalence of CIN and cervical carcinoma in a tertiary care hospital at Rajshahi in Bangladesh. Methods: This cross-sectional descriptive study was conducted at the department of pathology, Rajshahi medical college, and the department of gynaecology and obstetrics, Rajshahi medical college hospital, Rajshahi, Bangladesh from July 2019 to June 2022. A total of 1000 VIA test-positive cases of cervical lesions were enrolled as study subjects purposively. Data were processed and analyzed by the MS office tools. Results: Cervical carcinoma was identified through cytological analysis in 4.6% of cases, with 7.6% exhibiting high-grade squamous intraepithelial lesions (HSIL) and 13.1% showing low-grade squamous intraepithelial lesions (LSIL). Through histopathological analysis, cervical carcinoma found in 5.3% of cases, CIN-grade III (CIN-III) in 7.1%, and CIN-II and CIN-I in 2.2%, 16.4% of cases, respectively. Human papillomavirus (HPV) vaccination rate was 0.70%. Conclusions: The prevalence of CIN and cervical carcinoma in the Rajshahi region of Bangladesh is alarmingly high. These findings underscore the pressing need for the immediate implementation of a comprehensive vaccination and awareness development program for cervical carcinoma.

Diagnostic Accuracy of Imprint Cytology and Frozen Section for CNS Tumor.

The present study was a cross-sectional type of descriptive one carried out with the objective of determining the diagnostic accuracy of imprint cytology and frozen section of central nervous system tumors. A purposively selected sample of 33 clinically diagnosed patients with CNS tumors has been included for the study. The relevant data on CNS tumors were collected by using imprint cytology, frozen section and paraffin section. The sensitivity of imprint cytology was 75.0% and specificity was 55.17% respectively. On the other hand positive predictive value of imprint cytology was 18.75% and negative predictive value was 94.11%. The sensitivity of frozen section was 100% and specificity was 86.21% respectively. Comparing the findings of the frozen section to histopathology, the positive predictive value was 50.0% and negative predictive value was 100%. The sensitivity and specificity of imprint cytology was lower in comparison to frozen section and paraffin section. Still then imprint cytology is preferred, because it can be carried out rapidly and easily. It will also be a very helpful aid especially when facilities for frozen section are limited but neurosurgical-procedure is available. A well designed research with adequate sample size should be carried out to get better diagnostic accuracy of imprint cytology in central nervous system tumors.

Basic ideas on medical ethics.

Abstract: Introduction: Medical ethics means the moral principles, which should guide the members of the medical profession in the course of their practice of medicine and in relationship with their patients and other members of the profession. Objective: To recapitulate the matter to the medical practitioners so that they can apply them in course of their practice. Methodology: A search focused on the basic terminologies on medical ethics was made in Medline, PubMed and Cochrane database. The search captured citation on history of medical ethics. Both advances in medical ethics and advances in medicine and science with ethical ramifications were included. The topics span clinical medicine (end of life care and medical error), healthcare management (priority setting), science (biotechnology), and education (of medical ethics). Discussion & Conclusion: Core issues in in medical ethics: Autonomy, beneficence, non-malfeasance, justice – dignity, truthfulness and honesty. Different terms in the Field of Medical Ethics: Medical Etiquette, Professional infamous conduct, Professional death sentence, Professional secrecy, A physician should not commit any negligence or mal-practice. Islamic Medical Ethics: A Muslim physician derives his /her conclusion from rules of Islamic laws (Shariah). The goal of medical ethics is to improve the quality of patient care by identifying, analyzing, and attempting to resolve the ethical problems that arise in the practice of clinical medicine. Medical ethics is an important part of the undergraduate medical curriculum. It should not be left to a 'laissez-faire' process of osmosis from teachers to students.

Quality Assurance Scheme (QAS) in Medical & Dental Colleges in Bangladesh -Teacher's Knowledge.

This cross-sectional study was conducted with the objective to assess the teacher's knowledge about ongoing quality assurance scheme (QAS) at different government and nongovernment medical & dental colleges in Bangladesh. Teachers of different categories were the respondents of this study. Self administered structured questionnaire was used to collect data adopting simple random sampling. The study was conducted in 2008 & 2009. The study revealed that both government and nongovernment medical colleges are conducting the QAS in their respective institutions. The academic coordinator play a vital role to run the QAS and for phase coordination. Students also participate as the representative member of the committee. Existing infrastructure of QAS is performing at its best effort but needs further development for upgradation of the services with an aim to improve the performance of the institutes. Principles of QAS are accountability, selfevaluation and external peer review. Major areas of QAS are organizational & operational frameworks. Organizational framework consists of both academic council and course committee. External examiners are appointed by university. External assessors are appointed by academic council but needs faculty approval. Operational framework consists of course appraisal, faculty development, review scheme, & external review. The study recommends that quality assurance scheme (QAS) should be thoroughly implemented and evaluated by the national quality assurance body. Both the organizational and operational frameworks should run along with faculty development and review scheme. Teachers should be more oriented to update their knowledge for better practices of QAS.

Persistence of low serum iron and high total iron binding capacity in pregnant women.

A cross sectional descriptive type of study was done in 98 women of reproductive age. Among them 25 were in control group of non pregnant women and 73 were pregnant women of 1st, 2nd and 3rd trimester of pregnancy with and without iron supplementation. The period of study was July 2004 to June 2005. The main objective of our study was to compare serum iron and total iron binding capacity in pregnant and non pregnant women. In present study serum iron was significantly increased in 2nd and 3rd trimester of pregnancy that was supplemented with iron when compared with the same category of women who were not supplemented with iron. On the other hand serum total iron binding capacity (TIBC) was significantly increased in 3rd trimester of pregnancy that was not supplemented with iron when compared with the same category of women who were supplemented with iron. It is evident that the significantly low serum iron and high TIBC in pregnant women is due in part to dietary iron deficiency. Therefore, iron therapy in pregnancy is helpful to maintain the serum iron and TIBC nearer to that of non pregnant normal women.

Effects of stresses on serum cortisol level in Bangladeshi people.

The present study was undertaken to estimate serum cortisol level in control experimental groups in Bangladeshi people. For this purpose a total number of 55 subjects of age range (18-55) years were selected from Mymensingh Medical College Hospital during July 2003 to June 2004. Subjects included in this study were divided in to two main groups: control (n=13) and experimental (n=42). According to different types of stress the experimental group was further divided in to four subgroups: infection, psychiatric, pre and post surgery. Blood samples were collected from all subjects with aseptic precautions at 8 AM and serum cortisol concentration was measured by Radioimmunoassay method. Statistical analyses were done by using Student's 't' test. A distinct and statistically significant increased serum cortisol level was observed in infection, psychiatric disorders and post surgical group in comparison to control group (P< 0.001). While no significant difference was observed in pre surgery when compared to that of control group.

Alteration of serum glucose level in infection and surgical stress.

The present study was conducted to see the alteration of serum glucose level in infection and surgical stress. For this purpose a total number of 37 subjects in the age range (18 - 55) years were selected from Mymensingh Medical College Hospital from July 2003 to June 2004. Subjects were grouped as follows: control (n=13), infection (n=14) and surgery (n=10). Fasting serum glucose levels were estimated from all subjects by enzymatic calorimetric (GOD-PAP) method. A distinct and statistically significant increase in serum glucose level was observed in infection and surgery group in comparison to control group (p< 0.001).

Morphometric study of atrioventricular orifices of postmortem hearts of adult Bangladeshi people.

To study the circumference of atrioventricular orifices of the Bangladeshi adult people, fifty postmortem hearts were collected, fixed in 10% formol saline and examined. In the present paper, the findings were compared between male and female values and also with the findings of Western and Bangladeshi researchers. Among fifty hearts, thirty-six hearts were collected from male and fourteen hearts were collected from female cadavers. The findings suggest that the atrioventricular orifices of the hearts examined were lower in circumferences as compared to those described in the available texts. The female values were slightly lower than the male values but on statistical analyses, they showed no significant difference (P > 0.05).

Serum zinc status of rural women taking combined OC.

This prospective case-control study was undertaken on 78 women between 15 to 45 years of age from rural area to see alteration of serum zinc due to oral contraceptive (OC) use. Of the subjects, 34 women was taken as controls having no history of taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. All of the women in the control group were advised to start consuming oral pill (Sukhi) for 3 consecutive cycles and at the 3(rd) month, 25 women were taken as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for 4 months onwards. Subjects were classified as follows on the basis of duration of oral contraceptive use: Group I (n=34) -- controls, Group II (n=25) -- 3 months, Group III (n=17) -- 4 months -- 2 years and Group IV (n=27) -- >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Zinc (microg/dl) by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer. MeanSD of Serum Zinc significantly reduced in all 3 contraceptive groups in comparison to controls (p<0.001). It was recommended to carry out further study including larger population from rural area to elucidate alteration in serum zinc and other trace elements to correlate with side effects caused by hormonal contraceptive so that attempt could be made to mitigate those.

Holmium YAG laser treatment of superficial bladder carcinoma.

Holmium YAG laser is one of the new modalities of treatment of urinary bladder tumor. Thirty patients of superficial bladder carcinoma were selected from the Urology out patient department of Dhaka Medical College Hospital from January 2004 to July 2004. Among thirty cases, 18 were recurrent and 12 were primary superficial bladder carcinoma. Out of thirty patients, 24 were male and six were female. Patients were treated with Holmium YAG laser under spinal anesthesia. Before resection, cold cup biopsy were taken from the apex and after resection of the tumor, another cold cup biopsy were taken from the base of the tumor. Holmium YAG laser therapy was given with a 550 micron end firing quartz laser fiber through the working element of resectoscope. Small tumors (< 1 cm) were ablated and large tumors (1-4 cm) were resected. The initial laser setting was 0.5 to 0.8 J and 10 Hz. For resection of the tumor, a slightly higher energy of 1 to 1.2 J was used at 10 to 12 Hz. After resection, bleeding vessels were coagulated. The resected tumor was evacuated by Elik's evacuator. All cases were followed for 6 to 12 months by history, physical examination, urine analysis, sonogram and cystoscopy three monthly. Bleeding was minimum during the procedure and no transfusion was required. Complications like obturator jerk, clot retention or perforation were not developed. No recurrence was found during the 6 to 12 months follow up period. The procedure was found safe, effective, and acceptable. The study was conducted to evaluate the initial result of Holmium YAG laser for the treatment of superficial bladder carcinoma. We warrants further studies in this regard.

Is serum C-reactive protein really a sensitive stress marker in Bangladeshi people.

The present study was done to determine the serum C-reactive protein (CRP) concentration in normal subjects and patients suffering from infection, psychiatric disorders and of surgery. A total number of 55 subjects within 18-55 years age were selected from Mymensingh Medical College Hospital during the period from July 2003 to June 2004. Normal subjects as control were 13 and 42 comprised the group experimental. According to different types of stress the experimental group was further divided in to four subgroups: infection, psychiatric, pre and post surgery. Serum CRP concentration was measured by Immunoturbidimetric method from each subject. Statistical analyses were done by using Student's ' t' test. Statistically significant rise of serum CRP was observed in infection, psychiatric disorders and post surgery group in comparison to control group (P< 0.001). The study indicated that subjects with infection, psychiatric disorder and post surgery stage were in stressful conditions that resulted increased synthesis of CRP by liver cells due to Hypothalamopituitaryadrenal (HPA) axis hyperactivity and immune mediated inflammation.

Hypoglycemic effects of Coccinia indica: inhibition of key gluconeogenic enzyme, glucose-6-phosphatase.

Coccinia indica (Family: Cucurbitaceae, locally known as telakucha) leaves were extracted with 95% ethanol. Following evaporation of the solvents, the residue was suspended in distilled water. When this suspension was fed orally to male normal-fed and 48-hr starved rats, the blood glucose was lowered 21% (P less than 0.01) in normal-fed and 24% (P less than 0.001) in 48-hr starved animals respectively. Starvation had induced a 3-fold increase in the activity of glucose-6-phosphatase and this activity was depressed 19% (P less than 0.05) by extract feeding while basal activity of the enzyme in normal-fed rats remained unaffected. Consistent with the depression of glucose-6-phosphatase, urea cycle enzyme arginase was also depressed 21% (P less than 0.001) and 12% (P less than 0.01) in the liver of 48 hr-starved and normal-fed animals respectively. Unlike glucose-6-phosphatase, starvation induced levels of gluconeogenic enzymes alanine aminotransferase and aspartate aminotransferase were not affected by Coccinia extract. These results suggest that the hypoglycemic effect of C. indica is partly due to the repression of the key gluconeogenic enzyme glucose-6-phosphatase.