Indications for and outcome of primary repair compared with faecal diversion in the management of traumatic colon injury.

AIM: Injuries of the colon are a serious sequel of abdominal trauma owing to the associated morbidity and mortality. This study aims to assess postoperative outcome and complications of faecal diversion and primary repair of colon injuries when applied according to established guidelines for the management of colon injuries. METHOD: This retrospective study was conducted on 110 patients with colon injuries. Guided by estimation of risk factors, patients were managed either by primary repair alone, repair with proximal diversion or diversion alone. RESULTS: There were 102 (92.7%) male patients and 8 (7.3%) female patients of median age 38 years. Thirty-seven were managed by primary repair and 73 by faecal diversion. Colon injuries were caused by penetrating abdominal trauma in 65 and blunt trauma in 45 patients. Forty-three patients were in shock on admission, and were all managed by faecal diversion. Forty patients developed 84 complications after surgery. Primary repair had a significantly lower complication rate than faecal diversion (P = 0.037). Wound infection was the commonest complication. The overall mortality rate was 3.6%. CONCLUSION: Primary repair, when employed properly, resulted in a significantly lower complication rate than faecal diversion. Significant predictive factors associated with a higher complication rate were faecal diversion, severe faecal contamination, multiple colon injuries, an interval of more than 12 h after colon injury and shock.

Epitope-based peptide vaccine design and target site depiction against Ebola viruses: an immunoinformatics study.

Ebola viruses (EBOVs) have been identified as an emerging threat in recent year as it causes severe haemorrhagic fever in human. Epitope-based vaccine design for EBOVs remains a top priority because a mere progress has been made in this regard. Another reason is the lack of antiviral drug and licensed vaccine although there is a severe outbreak in Central Africa. In this study, we aimed to design an epitope-based vaccine that can trigger a significant immune response as well as to prognosticate inhibitor that can bind with potential drug target sites using various immunoinformatics and docking simulation tools. The capacity to induce both humoral and cell-mediated immunity by T cell and B cell was checked for the selected protein. The peptide region spanning 9 amino acids from 42 to 50 and the sequence TLASIGTAF were found as the most potential B and T cell epitopes, respectively. This peptide could interact with 12 HLAs and showed high population coverage up to 80.99%. Using molecular docking, the epitope was further appraised for binding against HLA molecules to verify the binding cleft interaction. In addition with this, the allergenicity of the epitopes was also evaluated. In the post-therapeutic strategy, docking study of predicted 3D structure identified suitable therapeutic inhibitor against targeted protein. However, this computational epitope-based peptide vaccine designing and target site prediction against EBOVs open up a new horizon which may be the prospective way in Ebola viruses research; the results require validation by in vitro and in vivo experiments.

Basophils exhibit antibacterial activity through extracellular trap formation.

Basophils are primarily associated with immunomodulatory functions in allergic diseases and parasitic infections. Recently, it has been demonstrated that both activated human and mouse basophils can form extracellular DNA traps (BETs) containing mitochondrial DNA and granule proteins. In this report, we provide evidence that, in spite of an apparent lack of phagocytic activity, basophils can kill bacteria through BET formation.

Thrombotic Thrombocytopenic Purpura: Issues in Diagnosis and Treatment.

Thrombotic thrombocytopenic purpura (TTP) is a hematologic emergency fatal without prompt treatment. Plasma exchange (PEX), the treatment of choice for TTP, is not readily available and has major complications. We report seven cases of TTP, both acquired immune and secondary. Two patients had TTP secondary to malignancy and one secondary to SLE. Male to female ratio was 1:3 and median age at presentation 38 years. Six patients had moderate to very high level of LDH while one primary TTP had only mild elevation. Median haemoglobin and platelet at presentation were 6.3 gm/dL and 38 k/UL respectively. Median LDH value was 4595 u/L. All patients were treated with plasma exchange (PEX) except the two cases secondary to malignancy. One patient died of cardiac arrest during plasma exchange. None of the patients treated with PEX had relapsed over a median follow up of 18 months.

Parathyroid Carcinoma in a 10 Years Old Female Child.

Parathyroid carcinoma (PC) is a rare cause of hypercalcaemia in children. Only 7 cases of PC have been reported so far in the world journal. The authors report the 8th case of parathyroid carcinoma in children less than 16 years of age. A 10 year old girl presented with difficulty in walking, dorsiflexion and ulnar deviation of both wrist joints and occasional pain in the central abdomen of about two years duration. Biochemical investigations revealed serum calcium 12.2 mg/dL (normal 9-11 mg/dL), serum alkaline phosphate 4992 U/L (normal 50-136 U/L), PTH (parathyroid hormone) 2217 pg/ml (normal 9-80 pg/ml). Parathyroid scintigraphy localized the lesion in the left parathyroid gland. X-ray showed bilateral coxa vera, genu valgus deformity and multiple stress fractures in both wrist joints. Histopathology confirmed PC with capsular and vascular invasion.

Maternal-infant transfer of SARS-CoV-2 antibodies following vaccination in pregnancy: A prospective cohort study.

OBJECTIVES: To measure and evaluate the impact of receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in pregnancy on immunoglobulin G (IgG) and immunoglobulin A (IgA) titres in maternal and infant samples. DESIGN: Prospective cohort study. SETTING: Tertiary obstetric centre. POPULATION OR SAMPLE: 52 pregnant women who received one or more SARS-CoV-2 vaccine doses during pregnancy and their neonates. METHODS: IgG and IgA concentrations against SARS-CoV-2 antigens were measured from samples collected at delivery and 4-6 weeks postpartum and compared using Spearman correlations. MAIN OUTCOME MEASURES: Maternal and infant IgG and IgA titres in response to vaccination and infection in pregnancy. RESULTS: In maternal serum collected at delivery, participants without evidence of prior infection who received 3 + doses of a SARS-CoV-2 vaccine had higher Anti-Spike (S) IgG geometric mean concentrations (log10 AU/mL)(GMC) than those who received 2 doses (3 + Doses = 5.00, 2 Doses = 4.60, p = 0.08). The differences in IgG Anti-S GMC were statistically significant in cord serum, and in postpartum samples of maternal serum, infant serum and breast milk (Cord GMCs: 3 + Doses = 5.32, 2 Doses = 4.98, p < 0.05; Postpartum maternal serum GMCs: 3 + Doses = 5.25, 2 Doses = 4.57, p < 0.001; Postpartum infant serum GMCs: 3 + Doses = 5.10, 2 Doses = 4.72, p = 0.03; Postpartum breast milk GMCs: 3 + Doses = 2.61, 2 Doses = 1.94, p < 0.0001). Among participants with 3 + Doses, those with evidence of SARS-CoV-2 infection had statistically significant higher anti-S IgG GMCs than those without prior infection (Maternal serum at delivery: SARS-CoV-2+=5.65, SARS-CoV-2-=5.00, p = 0.004; Cord: SARS-CoV-2+=5.68, SARS-CoV-2-=5.32, p = 0.02; Postpartum maternal serum: SARS-CoV-2+=5.66, SARS-CoV-2-=5.25, p < 0.001; postpartum infant serum: SARS-CoV-2+=5.50, SARS-CoV-2-=5.10, p = 0.003; Postpartum breast milk: SARS-COV-2+=3.25, SARS-COV-2-=2.61, p = 0.009). Significant positive correlations were found for anti-S IgG titres between paired maternal and infant samples at delivery and postpartum (Delivery: R = 0.91, p < 0.001; postpartum: R = 0.86, p < 0.001). CONCLUSIONS: Receipt of a SARS-CoV-2 vaccine and SARS-CoV-2 infection elicit strong IgG and IgA antibody responses in pregnant women with evidence of transplacental transfer to the fetus.

Rearrangement of 4-amino-3-halo-pyridines by nucleophilic aromatic substitution.

The reaction of 3-halo-4-aminopyridines with acyl chlorides and triethylamine is described. The pyridin-4-yl α-substituted acetamide products were obtained in moderate to high yields. The presented rearrangement reaction, in which the presumed N-acylated intermediate reacts intramolecularly via nucleophilic aromatic substitution, results in a formal two-carbon insertion.

Otitis interna induced by Cryptococcus neoformans var. grubii in a cat.

Cryptococcus neoformans var. grubii was identified at necropsy in a case of bilateral otitis interna in a 7-year-old, female, domestic shorthair cat with a 9-day history of acute onset of vestibular disease. Gross examination, including that of the middle and inner ears, was unremarkable. Histologically, the auricular vestibuli, cochleae, and semicircular canals were bilaterally affected by granulomatous inflammation with extracellular and intrahistiocytic yeasts. The yeasts and associated inflammation obstructed and disrupted perilymphatic and endolymphatic spaces of the inner ears. Disruption of the saccular and utricular maculae, cristae ampularis, and organ of Corti, as well as changes in the endolymphatic and perilymphatic fluids, probably impaired the vestibular and auditory functions of this cat. The route of infection was most likely hematogenous.

A case of Conn's syndrome presenting with painfull muscular weakness.

We present a case of 30-year-old lady presenting with gradual difficulty in standing up from sitting position for 6 months, pain in arms and thighs, tingling sensation and numbness in palms and soles, increased fluid intake and increased frequency of micturition for the same duration. She was hypertensive for 12 years. On general examination patient seemed depressed and on nervous system examination her power of muscles in both upper and lower limb of both side was 3/5. Plasma sodium at the upper normal range 144mmol/l (normal range 135-146), lower level of serum potassium 1.7mmol/L (normal range 3.5-5.0), high urinary potassium 26.7mmol/l (normal range 1-10), very high serum CPK 4269U/L (for female normal range 10-79), low normal plasma rennin 1.58mg/ml/hr (normal range standing 0.40-8.80, supine 0.30-3.0), high serum aldosterone 1326.39pg/ml (normal range 25-315), high pH 7.45 (normal range 7.36-7.44) and on imaging evidence of an adrenal adenoma on left side was found and the patient was diagnosed as a case of Conn's syndrome.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery.

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section.

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Thymic stromal lymphopoietin stimulates the formation of eosinophil extracellular traps.

BACKGROUND: Thymic stromal lymphopoietin (TSLP) that is released by epithelial cells upon certain environmental triggers activates cells of the innate and adaptive immune system resulting in a preferential T helper 2 immune response. By releasing eosinophil extracellular traps (EETs), eosinophils achieve an efficient extracellular bacterial killing. Eosinophil extracellular traps release, however, has been observed in both infectious and noninfectious eosinophilic diseases. Here, we aim to investigate whether eosinophils generate functional EETs as a direct response to TSLP, and further to study the extra- and intracellular mechanisms involved in this process as well as TSLP receptor (TSLPR) expression by eosinophils in vitro and in vivo. METHODS: Thymic stromal lymphopoietin receptor expression on blood and tissue eosinophils was assessed by immunoblotting, flow cytometry, and immunofluorescence staining. Purified eosinophils were stimulated with recombinant human TSLP. The release of extracellular DNA in association with eosinophilic cationic protein (ECP) was detected by fluorescence staining techniques and confocal microscopy. In addition, cell survival, cell adhesion, production of reactive oxygen species (ROS), and the inhibition of bacterial growth by TSLP-stimulated eosinophils were measured. RESULTS: Thymic stromal lymphopoietin receptor was observed on peripheral blood eosinophils as well as on tissue infiltrating eosinophils in skin diseases. TSLP did not affect eosinophil survival, but induced the formation of EETs consisting of mitochondrial DNA in association with ECP in a concentration- and time-dependent manner. Eosinophil extracellular trap release could be inhibited by blocking either cell adhesion or ROS production. While eosinophils prevented the growth of both Staphylococcus aureus and Staphylococcus epidermidis, the latter were unable to elicit EET formation and eosinophils required additional TSLP stimulation to achieve this antibacterial activity. CONCLUSIONS: thymic stromal lymphopoietin directly stimulates eosinophils to produce EETs. Our observations link epithelial TSLP expression triggered by environmental factors with pathogen defense mechanisms involving eosinophils.

Design and synthesis of novel bone-targeting dual-action pro-drugs for the treatment and reversal of osteoporosis.

There is an important medical need for effective therapies to redress the general bone loss associated with advanced osteoporosis. Prostaglandin E(2) and related EP4 receptor agonists have been shown to stimulate bone regrowth but their use has been limited by systemic side effects. Herein is described the design and synthesis of novel dual-action bone-targeting conjugate pro-drugs where two classes of active agents, a bone growth stimulating prostaglandin E(2) EP4 receptor subtype agonist (5 or 6) and a bone resorption inhibitor bisphosphonate, alendronic acid (1), are coupled using metabolically labile carbamate or 4-hydroxyphenylacetic acid based linkers. Radiolabelled conjugates 9, 11a/b and 25 were synthesized and evaluated in vivo in rats for uptake of the conjugate into bone and subsequent release of the EP4 agonists over time. While conjugate 11a/b was taken up (9.0% of initial dose) but not released over two weeks, conjugates 9 and 25 were absorbed at 9.4% and 5.9% uptake of the initial dose and slowly released with half-lives of approximately 2 weeks and 5 days respectively. These conjugates were well tolerated and offer potential for sustained release and dual synergistic activity through their selective bone targeting and local release of the complimentary active components.

Beneficial Effect of Low Dose Aspirin in Adult Patients with COVID-19: A Retrospective Observational Study in Bangladesh.

Presently Coronavirus disease 2019 is a huge human misery that is almost unstoppable with little remedy on board. The disease is predominantly associated with inflammation and thrombosis. Although aspirin exhibits excellent anti-thrombotic and anti-inflammatory properties, it is yet to be explored in treating Covid-19 patients. In this article we want to bring forth its beneficial effect in Covid-19 case management. It is a retrospective observational study. Adult Covid-19 patients either diagnosed with RT-PCR (reverse transcriptase polymerized chain reaction), or categorized as probable cases (as per World Health Organization case definition protocol) by medical doctors were enrolled as participants. Data were collected from doctors' office records for the period ranging from May 2020 to September 2020 in six districts of Bangladesh. Out of 44 participants 42 were eligible (2 children excluded) for the study. Among them 11 participants took low dose aspirin (75mg daily) during the disease process. All participants in aspirin group became cured without complication or death (RR 2.2, 95% CI 1.5-3.2, p<0.001). On the other hand, no aspirin group suffered complications and deaths. The study findings revealed that complications were significantly low among aspirin users. It documented that low dose aspirin is beneficial for Covid-19 patients. Further study is warranted with larger sample size.

Serum Leptin Correlates with Obesity But Does Not Differ Between Gestational Diabetes and Normal Glucose Tolerance during 24-28 Weeks of Gestation.

Leptin is an adipocytokine secreted by adipocytes which positively correlates with obesity. It is considered as a potential mediator for precipitating Gestational diabetes mellitus (GDM) which is more evident during 24-28 weeks of gestation. This study was conducted to see serum leptin level during 24-28 weeks of gestation in GDM at the Department of Endocrinology, BSMMU, Bangladesh from March 2019 to August 2020. Pregnant women (N=108) were challenged with 75gm oral glucose (OGTT) at 24-28 weeks of gestation and divided into GDM [n=45, age: 27.80±3.98 years, mean±SD; BMI: 27.88 (24.46-30.43) kg/m², median Interquartile range (IQR)] and normal glucose tolerance [NGT; n=62, age: 26.19±5.30 years, mean±SD; BMI: 25.80 (23.65-28.42) kg/m², median (IQR)] on basis of WHO-2013 diagnostic criteria. Fasting serum leptin and glucose were measured by ELISA and glucose oxidase method respectively. No statistically significant difference was found between GDM and NGT for leptin [26.05(16.92-50.55) vs. 23.50(14.95-38.30) median (IQR), p=0.360]. It was also not different statistically between GDM and NGT either for age groups (p=NS for all) or for Asian categories of BMI subgroups (p=NS for all). However, it was higher in subjects with BMI ≥23kg/m² than that with BMI ≤23kg/m² for both GDM [16.65 (6.39, 35.75) vs. 28.35 (19.60, 51.10) median (IQR), p=0.114] and NGT [14.65(9.19, 19.60) vs. 26.00 (17.30, 43.40) median (IQR), p=0.002]. It was also statistically similar in the GDM subgroups divided by Asian BMI cut-off (p=NS). BMI correlated with leptin in NGT (r=0.495, p<0.001) but not in GDM (r=0.177, p=0.251) and regression analysis revealed BMI (kg/m²) as predictor for high leptin (p=0.008). ROC curve analysis for leptin showed AUC for GDM was 0.553 (p=0.360) suggesting it as a poor predictor. It is concluded that fasting leptin in 24-28 weeks of gestation better relates with BMI but does not differ between GDM and NGT anddoes not seem to be a good predictor for GDM. Further study is required to make a comment on its prediction over GDM.

Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers.

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODµg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) µg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Maxillary sinusitis and fungal infection.

This cross sectional study was done to identify the fungal etiology of maxillary sinusitis. This study was done in the department of Otolaryngology & Head-Neck Surgery, Shahid Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The study period was 5 years (January 2003 to December 2007). Total 63 patients who were diagnosed clinically and radiologically as a maxillary sinusitis were enrolled in this study. All the patients were included randomly. Among 63 patients 8(12.69%) patients had laboratory proved fungal maxillary sinusitis. Collection of the laboratory specimen was done from antral wash out and biopsy for histopathology was taken by endoscopic surgery. By histopathological and fungal stain revealed noninvasive type of fungal infection in all cases. Post nasal drip (100%), Headache (100%), Nasal obstruction (65% cases) were the main presenting symptoms in case of fungal maxillary sinusitis. Anti fungal treatment along with systemic antibiotic was given in case of proven maxillary sinusitis and 100% cure rate was observed after treatment.

Lack of acetylcholine nicotine alpha 7 receptor suppresses development of collagen-induced arthritis and adaptive immunity.

Activation of the alpha7 receptor (α7nAChR) has been shown to be important in inflammation and immune regulation, and is also essential in the neural cholinergic anti-inflammatory pathway. The aim of this study was to investigate the role of α7nAChR in the development of experimental arthritis and immune activation. Mice lacking the α7nAChR were immunized with collagen II and the development of arthritis was assessed. Another group of α7nAChR-deficient mice was immunized with ovalbumin, spleen and lymph node cells were isolated and the proliferative responses to restimulation with ovalbumin or concanavalin A were investigated. We could demonstrate significantly milder arthritis and less cartilage destruction, together with a decrease of T cell content in lymph nodes in mice lacking the α7nAChR compared to wild-type controls. In addition, mice lacking the α7nAChR had a deficient proliferative response to concanavalin A, whereas antigen presentation-dependent proliferation was not affected. These results indicate important roles for α7nAChR in arthritis development as well as in regulation of T cell-dependent immunological mechanisms. In addition, the data implicate α7nAChR as a therapeutic target for modulation of adaptive immune responses.

Congenital sideroblastic anemia treated as thalassemia major.

Sideroblastic anemia is a rare cause of microcytic hypochromic anemia. In Bangladesh, most common causes of microcytic anemia are iron deficiency anemia, anemia of chronic diseases and thalassemia. Serum ferritin is usually done to differentiate them. If serum ferritin is low, the diagnosis of iron deficiency is entertained. When serum ferritin is raised but erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are normal - anemia of chronic disease is excluded. The next investigation is Hb-electrophoresis. Normal Hb-electroporesis excludes thalassemia. Then bone marrow examination with iron stain is done for the diagnosis of sideroblastic anemia. Here we report a case of a 14 year old girl presenting with intermittent leg pain and anemia. Her blood flim showed microcytic hypochromic anemia with raised serum ferritin and normal Hb-electroporesis. Initially she was labeled as a case of unusual type of thalassemia and treated with blood transfusion. Finally bone marrow examination with iron stain was done and she was diagnosed as a case of congenital sideroblastic anemia. We reviewed the literature and discussed the management as well.

Utility of serum preoperative carcinoemberyonic antigen in colorectal cancer patients.

BACKGROUND/AIMS: The usefulness of preoperative CEA in CRC remains controversial as regards its biological function, and its use in the diagnosis, prognosis, and management and follow up of CRC patients. the aim of this study was to provide a critical and updated study for the value of CEA in CRC. METHODOLOGY: From January 2000 to June 2005, a prospective randomized study involving 200 CRC patients for whom curative resection was performed, another 100 healthy persons as a control group was included. Basal CEA using chemilumescence technique and routine follow up were done. RESULTS: (1) The mean basal CEA in CRC patients (17.3 ng% +/- 1.67) was significantly higher than control (3.41 ng% +/- 1.1). (2) A significant linear association between basal CEA and Dukes' classes was evident with the mean basal CEA for Dukes' A, B, C were 7.8, 12.7, 25.8 respectively (expressed as ng%). (3) The validity of basal CEA in primary CRC diagnosis was highly positive (sensitivity 80%--PPV 86.95%--accuracy 73.66%), with hig her efficacy in advanced disease detection (sensitivity 93%--NPV 7%--accuracy 84.5%--odds ratio 30.3) and negative exclusion power for DFS prediction (specificity 13.84%). (4) The basal CEA was a discriminate factor in colorectal prognosis - B value (3.74). (5) Patients with CEA < or =5 ng% had better DFS (15%) and DFT (23.6 months) than those with CEA > 5 ng% as they had DFS (33.75%) and DFT (18.48 months). (6) Basal CEA above 15 ng% had a significant shift in the cumulative hazard of recurrence. CONCLUSION: The CEA is a metastasis potentiator. The high serum CEA in CRC screening programs should be considered a marker of malignancy especially in patients with appropriate symptoms. The preop CEA in CRC patients identifies subsets with favorable, indolent and uneven biological behavior (< or =5 ng%, < or =15 ng%, > 15 ng% respectively). Moreover, the addition of preop CEA level to conventional staging forms a strong prognostic tool and supplies adopted practice guideline initiative for follow up and therapy in CRC.