Evaluation of serum carbohydrate antigen 19-9 as a diagnostic marker for pancreatic malignancy

Background: Carbohydrate antigen (CA) 19-9 is considered as a tumor marker in biliary-pancreatic malignancy. Though a high level may indicate the presence of a malignant disorder, it may rise even in benign condition. Similarly, the value may be normal even in malignant condition.Methods: An observational comparative study was conducted in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 01 June 2016 to 31 May 2017 to find out the sensitivity and specificity of CA 19-9 as a tumor marker in pancreatic malignancy in our perspective and to find out a cut-off value of CA 19-9 which might prove as a definitive indication of pancreatic malignancy.Results: The study shows when the cut off value of CA 19-9 is 37 U/ml. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were 77.8%, for all four characteristics respectively. But if the serum CA 19-9 threshold used to diagnose pancreatic cancer was raised to 100 and 120, sensitivity decreased to 72.2% and 66.7% and NPV decreased to 76.2% and 73.9% respectively. However, specificity increased to 88.9% and 94.4% and PPV increased to 86.7% and 92.3% respectively.Conclusions: Serum CA 19-9 level may be considered as an important determinant in the diagnosis of malignant pancreatic diseases and to assess the resectability of the lesions preoperatively, but other adjuncts are necessary in the overall management of pancreatic diseases.

Attributes of Childhood Cancer among the Patients Attending Specialized Hospitals in Bangladesh.

Background: Childhood cancer is an emerging health problem worldwide. It is the second common cause of child death. Epidemiological and clinical attributes of childhood cancer are not properly documented in Bangladesh. This study was designed to reveal the attributes of childhood cancer among the patients attended specialized hospitals in Dhaka city. Objective: To determine the epidemiological and clinical attributes of childhood cancer. Materials and Methods: The cross-sectional study was conducted among 99 under 18 years old children suffering from cancer, who were included considering specific selection criteria. Data were collected by face to face interview using a semi-structured questionnaire with the help of a semi-structured questionnaire and checklist. Data were analyzed by using SPSS software. Results: Of all the children, majority (40.4%) was in age group of 6-10 years and their mean (±SD) age was 7.48 (±3.70) years. Male to female ratio was 1.9:1.6 and majority (48.5%) was in middle income group. Major part (42.4%) of the children was from sub-urban followed by 30.3% rural and 27.2% from urban communities. Major types of childhood cancer comprised acute lymphoblastic leukaemia (37.4%), retinoblastoma (14.1%), neuroblastoma (10.1%), and Wilm’stumour (10.1%). Less common cancers included non-Hodgekin’s lymphoma (7.1%), Hodgekin’s lymphoma (5.1%), osteosercoma (5.1%), nasopharyngeal carcinoma (4.0%), germ cell tumour (3.0%), acute myeloid leukaemia (3.0%) and Ewing’s tumour (1.0%). Majority (35.1%) of acute lymphoblastic leukaemia patients were from urban while most (85.7%) of retinoblastoma patients from sub-urban, 50.0% of neuroblastoma cases from rural, and 40.0% of Wilm’s tumour from sub-urban communities, this geographical variation of childhood cancer was statistically significant [χ2(33)=56.46, p=0.01]. In poor and middle income group, most of the children (91.8%) were detected in stage II while among the higher income group, most (88.9%) of the cancer were detected in stage-I and this variation was statistically significant [χ2(9)=16.77, p=0.05]. Family history was strongly related with childhood cancer [χ2(20)=32.81, p=0.04]. Conclusion: Cancer was more prevalent among male children with poor socio-economic condition residing in sub-urban communities. The study recommends specific measures to detect childhood cancer and related risk factors at early stage to prevention and control.

Bone marrow changes in elderly.

Aim: To study the bone marrow changes in elderly patients (above 60 years of age). Material and methods: Bone marrow records from the pathology laboratory in the Department of Pathology, Bangalore Medical College, Bangalore, from March 2012 to june 2013, were searched, and cases from all patients at least 60 years old at the time of bone marrow study were retrospectively reviewed. Results: During the 16 months period, 164 bone marrow examinations were performed, andout of these, 50 patients were at least 60 years old. The age range of the patients was 60 to 82 years , 27 were males and 23 were females. 47 cases (94%) yielded specific diagnosis. 27 cases (54%) had nutritional anemia, 6 cases (12%) were diagnosed as myeloma, 3 cases (6%) had aplastic anemia, 3 cases (6%) had chronic lymphocytic leukemia/ small lymphocytic leukemia infiltrating the bone marrow; 2 cases (4%) had acute myeloid leukemia, 2 myelofibrosis - grade 3, 2 cases were diagnosed to have monoclonal gammopathy of undetermined significance (4%), 1 case (2%) had metastatic deposits from prostatic carcinoma and 1 case (2%) of mylodysplastic syndrome - refractory cytopenia with multi lineage dysplasia and ringed sideroblasts was diagnosed. Conclusions: In this study we found that after nutritional anemia, plasma cell dyscrasias were the most common findings in bone marrow studies in elderly patients. Diagnosis of plasma cell dyscrasias prompt for early institution of treatment resulting in reduced morbidity and mortality in such patients.

Morphological Study of Length, Breadth and Thickness of the Ovary at Different Age Group in Bangladeshi People.

The morphological study was done to see length, breadth and thickness of the ovary in different age group of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty two postmortem tissue block containing ovary and fallopian tube along with surrounding structures were collected from 62 female cadavers of different age groups and fixed in 10% formol saline solution. Gross & fine dissections were carried out to study these morphological parameters of ovary in different age group. In the present study, findings were compared with the finding of other researchers. In this study the mean length of ovary was maximum in found in group C (46-80 years) 4.32cm and minimum was found in group A (2-13 years) 2.81cm of both side. The mean breadth of ovary was maximum in group C 2.01cm and minimum was in group A 1.38cm. The mean thickness of ovary maximum was in group C 0.971cm and minimum was in group A 0.682cm of both sides. In statistical analyses significant difference between two groups was calculated by using students “t” test. A difference between two groups was considered to be significant when p<0.05. In the present study it is observed that the size of the ovary is not equal on both side of same individual.

Effect of aerobic exercise on patients with primary fibromyalgia syndrome.

Sixty eight adult patients of fibromyalgia were included in this prospective study from the Outpatient Department of Physical Medicine and Rehabilitation of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of January 2003 to June 2003. Study samples were assigned into two treatment groups: Group A (n = 38) with exercise by static bicycle and aerobic walking in addition to tricyclic antidepressant and analgesic and Group B (n = 30) was non exercise group, treated with tricyclic antidepressant and analgesic only. The total duration of treatment was 16 weeks. Pre-treatment (week 0) and post treatment (week 16) evaluation was performed in both groups. Evaluation parameters included pain grade, number of trigger points, occurrence of arousal at night, frequency of micturition and global evaluation by the physician. After 16 weeks, mean improvement of exercise group and non exercise group was 48% and 39% respectively but this difference was not statistically significant. Therefore, from this study it was observed that aerobic exercise showed no significant benefit to fibromyalgia patients.

Role of modified rapid AFB method in histopathological sections of Hansen's disease.

Leprosy is a chronic debilitating disease. A reliable diagnosis hinges around a good histopathological diagnosis and demonstration of the bacilli in the histopathological section. The usual method performed Modified Fite Faraco Method is time consuming, laborious and less sensitive. It has been our endeavor to devise a more rapid and sensitive method for the diagnosis and bacillary load detection in histopathological sections. The Modified Rapid AFB devised by us is sensitive and time saving which is essential for the pathologist and for the treatment by the Dermatologist. We have studied about 53 cases of different types of Hansen's disease and compared with both Modified Fite Faraco method and Modified Rapid AFB method. The results were found to be very encouraging with the Modified Rapid AFB method.

Post circumcision clitoridal cyst; the unique sexual phenomenon before and after surgery

In this work, 57 cases of clitoridal cysts were studied for their relation to circumcision and their sexuality. Different pathogenetic factors were identified. Sexuality was assessed by sexual questionnaire sheet. The development of clitoridal cyst was associated with a compensatory increase in all sex scores, so as to reach nearly the total sexuality gain recorded for the uncircumcised controls. The development of clitorolabial orientation after its previous loss by circumcision explains the occurrence of this unique phenomenon of stimulated sex following the formation of such cysts

Psoriasis and hepatitis C virus

Hepatitis C virus antibody [HCV-Ab] was assessed in 30 patients with psoriasis using enzyme-linked immunosorbent assay [ELISA]. Also, liver function tests were done for patients [30 patients] and normal controls [60 persons]. Liver enzymes [ALT, AST and ALP] were significantly increased in psoriatic patients when compared with controls. Hepatitis C virus antibody was positive in 11 psoriatic patients and only nine persons of normal controls. It was concluded that HCV may have a role in the pathogenesis in a subgroup of psoriatic patients

Is spinal anaesthesia safe in pre-eclamptic toxaemia patients?

Thirty-three patients of pre-eclamptic toxaemia underwent caesarean section (CS) under general anaesthesia (n = 16) and spinal anaesthesia (n = 17). The Apgar score at 1, 5 and 10 minutes of the babies following spinal anaesthesia (SA) were only marginally better than that of general anaesthesia (GA; P > 0.05). The incidence of complication following GA (68.8%) were significantly (P < 0.05) more than that of SA (47.1%). Commonest complications following GA were intra-operative hypertension (68.8%) followed by difficult intubation (25%), pulmonary oedema (12.8%), delayed recovery (12.8%) and mortality (4.3%). While following SA complications were intra-operative hypotension (47.1%), difficult SA (29.4%) and intra-operative vomiting (5.9%). The nature of complications following GA were more serious which may even lead to mortality (4.3%), whereas following SA it was less serious and easily manageable. Hence SA is not as unsafe as it is thought.

Lansoprazole potentiates vecuronium paralysis.

The effect of lansoprazole, a newer second generation proton pump inhibitor, on vecuronium induced muscle paralysis was evaluated. Fifty adult patients comprising grade I (normal healthy patient) and grade II (patient with a mild systemic disease) as classified by the American Society of Anesthesiologists were randomly allocated into two different groups each consisting of 25 patients. Group I (control) did not receive lansoprazole and group II (study) received 30 mg lansoprazole in the night before operation. There was no statistically significant difference (p > 0.05) in the time required for complete paralysis between group I (215.7 +/- 15.19 seconds) and group II (197.5 +/- 14.13 seconds). However, the duration of paralysis was significantly different (p < 0.05) between group I (32.7 +/- 8.7 minutes) and group II (43.9 +/- 9.3 minutes). It was concluded that there is a potential for interactions and one should carefully and closely monitor the patients to prevent prolonged paralysis in patients receiving lansoprazole, as a pre-anaesthetic medication.

Serum proteins in chronic lymphocytic leukemia

Total serum protein, serum albumin and serum globulin levels were measured to 71 Iraqi Cll patients at presentation. It was found that hypoproteinemia was present in 77.5%, hypoalbuminemia 18.3% and hypoglobulinemia in 73.2% of the cases. The frequency of patients having low serum proteins values were found to be significantly increasing as the stages of the disease advances

Carboxyhemoglobin levels in primary and secondary traditional Iraqi 'nargila' smokers

In a group of eigth men who smoked the traditional Iraqi "Nargila" but who had not previously smoked cigarattes venous blood carboxyhemoglobin levels were higher [mean 3.7+0.5%] to those found in non-smokers. However, six men who switched from cigarettes to "Nargila" had carboxyhemoglobin levels [mean 7.1+0.9%] still higher than those of cigarette smokers. It is suggested that "Nargila" smokers who learned the habit of inhalation run a greater risk to their health than those continue to smoke cigarettes

Serum immunoglobulin in chronic lymphocytic leukemia

Serum Immunoglobulin levels of IgA, IgM and IgG were measured in 40 cases of chronic lymphocytic leukemia at presentation and prior to the initiation of treatment. All patients were staged according to the Binet clinical staging system. The number of patients showing abnormally low serum immunoglobulin values was found to be significantly increasing as the stage of the disease advances. At least the level of one serum immunoglobulin was reduced in 90% of the cases. IgA deficiency was found to be more frequent than IgG deficiency - The reduction of only one immunoglobulin was found to be more frequent than the reduction of two immunoglobulins in all cases in this study