Clinical and Liver Enzymes among the Patients with Metabolic Syndrome with or without Non Alcoholic Fatty Liver Disease attending a Tertiary Care Hospital.

Metabolic syndrome is characterized by central obesity, dyslipidemia, raised blood pressure and impaired blood sugar levels. Patients with metabolic syndrome are at increased risk of type 2 diabetes and atherosclerotic cardiovascular disease. This cross-sectional observational study was carried out from January 2019 to December 2019 at the inpatient and outpatient department of BIRDEM General Hospital, Dhaka, Bangladesh. Adult subjects aged ≥18 years with metabolic syndrome (IDF criteria, 2006) were included and purposive sampling was done. A total of 242 participants were included and the mean age was 40.2±14.1 years ranging from 18-70 years. Among them, 140(57.85%) were female and 102(42.15%) were male. Out of 242 participants, 170(70.25%) subjects had Metabolic Syndrome (MetS) with Non-Alcoholic Fatty Liver (NAFLD) and 72(29.75%) subjects had metabolic syndrome without NAFLD. In the male participants, the mean waist-hip ratio (WHR) of MetS with NAFLD and MetS without NAFLD was 1.01±0.07 vs. 0.96±0.08 respectively (p-value 0.003). In female subjects, the mean waist-hip ratio (WHR) of MetS with NAFLD and MetS without NAFLD group was 0.90±0.10 vs. 0.86±0.08 respectively (p-value 0.026). MetS with NAFLD subjects were more hypertensive than MetS without NAFLD subjects (61.2% vs. 42.7%). In the MetS with NAFLD group (n=170), 11.8% was normoglycemic, 43.5% was prediabetic and 44.7% was diabetic. In the MetS without NAFLD group (n=72), 19.5% was normoglycemic, 50% was prediabetic and 30.5% was diabetic. SGPT value was significantly raised in MetS with NAFLD subjects (56.4%) than MetS without NAFLD (38.9%) subjects (p-value 0.038). SGOT value was significantly raised in MetS with NAFLD subjects (58.8%) than MetS without NAFLD subjects (41.7%); (p-value 0.005). Mean Total Cholesterol and Triglyceride were significantly raised in MetS with NAFLD subjects than MetS without NAFLD subjects (p-value 0.01). In Subjects with grade I fatty liver, mean SGPT and SGOT were 42.27±22.31 vs. 39.59±16.93 respectively. In Subjects with grade II fatty liver, mean SGPT and SGOT were 62.13±32.42 vs. 52.45±28.56 respectively. In grade III fatty liver, mean SGPT and SGOT were 51.50±32.19 vs. 41.00±17.52 respectively (p value <0.001). More than two-third of participants with metabolic syndrome had non-alcoholic fatty liver disease (NAFLD) and a significant elevation of liver enzymes than metabolic syndrome without NAFLD participants. About 85.0% of metabolic syndrome participants had glucose intolerance in the form of prediabetes and diabetes.

Hadron production models' prediction for pT distribution of charged hadrons in pp interactions at 7 TeV.

The yield of transverse momentum (pT) spectra of integrated hadrons and their ratios produced in pp collisions at 7 TeV are reported using DPMJET-III, EPOS1.99, EPOS-LHC, HIJING1.383, QGSJETII-04, and Sibyll2.3c models. The models' predictions are compared with the ALICE measurements obtained at mid rapidity and in the pT range from 0.3-6 GeV/c, 0.2-6 GeV/c, and 0.1-3 GeV/c for protons, kaons and pions respectively. Compared to the experimental data, the EPOS1.99 and EPOS-LHC models predict the yield of pion very well while reproducing yields of kaon and proton at low pT only. The DPMJET-III model predicts the yield of pions, kaons and protons only at intermediate value of pT. The HIJING and Sibyll models describe the integrated yield of pion well at high pT only. The QGSJETII model predicts the yield of kaon for almost the whole pT range. EPOS1.99 and Sibyll models reproduce excellent prediction of the K/π ratio over the entire range of pT whereas the EPOS-LHC, HIJING and DPMJET models underpredict with increasing order of discrepancy respectively. The EPOS1.99, EPOS-LHC, and Sibyll models predict the p/π ratio for low values of pT, but overpredict at high values, while the DPMJET-III and HIJING models underpredict over the entire range of pT. Although the models' predictions are mostly consistent with the ALICE measurements but none of the models completely describe the entire distribution for the integrated yield of hadron and their ratios.

Phase I trial outcomes in older patients with advanced solid tumours.

BACKGROUND: This study had two aims: (a) to test the hypothesis that advanced age is associated with lower levels of tolerability and clinical benefit to experimental Phase I trial agents; (b) to assess the validity of the Royal Marsden Hospital (RMH) prognostic score as a patient selection tool in older patients. METHODS: Clinico-pathological characteristics and treatment outcomes of all patients treated consecutively from 2005 to 2009 in phase I trials at the RMH were recorded. All toxicity and clinical outcome data were compared between patients aged below and above 65 years of age. RESULTS: One thousand and four patients were treated in 30 Phase I trials, with 315 (31%) patients aged 65 years and older. Grade 3-5 toxicities (22.8% vs 24.8% (P=0.52)), trial discontinuation (6% vs 4%; P=0.33), and dose interruptions (8.0% vs 8.0% (P=0.96)) were observed at similar rates in patients below and above 65 years of age, respectively. The overall response rate 5.2% vs 4.1%, progression-free survival (PFS) 1.9 vs 3.5 months and clinical benefit rate (CBR) at 6 months 15.2% vs 14.3% were comparable in both groups. To avoid bias due to the potential therapeutic benefit of abiraterone, comparisons were repeated excluding prostate cancer patients with similar results (ORR 4.6% vs 4%, PFS 1.8 vs 3.0 months, CBR at 6 months 13.5% vs 9.5%). Multivariate analysis indicated that the previously identified RMH score (including albumin and lactate dehydrogenase levels) was an accurate predictor of outcome. CONCLUSIONS: Phase I clinical trials should be considered in patients with advanced cancers regardless of age, as older patients who enter these have similar safety and efficacy outcomes as their younger counterparts. The RMH prognostic score can assist in the selection of suitable older patients.

Wedge Versus Core Biopsy at Time Zero: Which Provides Better Predictive Value for Delayed Graft Function With the Remuzzi Histological Scoring System?

BACKGROUND: Histopathological features on time-zero renal biopsies correlate with graft outcome after renal transplantation. With increasing numbers of marginal donors, assessment of pre-implantation graft quality is essential. The clinician's choice of wedge or core biopsy is performed without evidence of efficacy or safety. This study aims to compare the information derived from wedge biopsy versus core biopsy. METHODS: Prospective evaluation of 37 wedge biopsies and 30 core biopsies was performed. Histopathological data were collected on number of glomeruli and arterioles observed, and Remuzzi scoring for glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriolar narrowing was performed. Clinical data on delayed graft function (DGF) were also collated. Sensitivity, specificity, and positive and negative predictive values for DGF were compared. RESULTS: Patient demographics between the two cohorts were comparable. No complications of biopsies occurred; 81% of wedge biopsies versus 50% of core biopsies had >10 glomeruli (P = .01), whereas 32% of wedge biopsies and 57% of core biopsies had >2 arterioles (P = .02). Wedge biopsies were more likely to identify pathology with more glomerulosclerosis, tubular atrophy (P < .01), and interstitial fibrosis (P < .01). There was a non-significant trend toward high Remuzzi scores in wedge biopsy (22% versus 7% with Remuzzi ≥ 4; P = .12). The sensitivity and positive predictive value of Remuzzi ≥ 4 for predicting DGF was better on wedge biopsy (45.5% versus 0%; P < .01 and 62.5% versus 0%; P < .01, respectively). CONCLUSIONS: Wedge biopsies were safe and superior to core biopsies for identifying clinically significant histopathological findings on pre-implantation renal biopsy. We believe that the wedge biopsy is the method of choice for time-zero biopsies.

Melphalan plus prednisolone in the treatment of multiple myeloma.

Various chemotherapies are used for better remission of symptoms of multiple myeloma as it is not a curable disease. This study was carried out to evaluate the response of melphalan plus prednisolone therapy for the treatment of Multiple myeloma. The study was conducted in the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January to December 2009. A total of 21 patients were included in this study. Combinations of melphalan plus prednisolone were given. Data were analyzed by paired 't' test to evaluate the response after treatment. Most of the patients were within 40-60 years with a male predominance. Haemoglobin level significantly raised after therapy (p<0.001) and ESR was found significantly reduced of these patients after treatment (p<0.001). On the other hand no significant change seen in calcium level before & after therapy (p=0.713). Significantly raised albumin and B2 microglubulin level were also found after treatment (p<0.001). After therapy with malphalan plus prednisolone, 11(52.38%) patient's M Protein reduction was >75%, 7(33.33%) patients M Protein reduction was 50-75%, 1(9.5%) patient's M Protein reduction was >25-50% and 1(12.50%) patient's M Protein reduction was <25%. Mean±SD M protein values before & after therapy were 50.23±19.49 gm/l and 21.01±16.11 gm/1 respectively. M protein level significantly reduced after treatment (p<0.001).

Isolated appendicular tuberculosis (TB) presented as peritonitis.

Tuberculosis is very common entity in both developing and under developed countries. Each year 3 million people worldwide died of the disease. Among extra pulmonary TB, alimentary system accounts for about 3.0% cases. The Commonest presentation of alimentary tuberculosis is Ileo-caecal disease, but isolated appendicular involvement is very rarely seen. Although some cases have been reported from our neighboring countries, there is still no such report from Bangladesh. We are here for the first time reporting a case of isolated appendicular tuberculosis which presented to us with peritonitis.

Acute hypervitaminosis A in a young lady.

Acute vitamin A toxicity from a large dose has been reported to cause pseudotumour cerebri. Usually it is common in children. Herein we present the case of a young lady of 18 years old with the complaints of headache, vomiting, back pain and diplopia after ingestion of high dose (about 10 million international units) vitamin A capsule intentionally at a time due to some family problems. She gave no history of fever, convulsion, unconsciousness, pain in eyes, difficulties in walking and jaundice or any urinary problem during this illness. On query she gave no history of taking any other drugs including oral contraceptive and tetracycline & steroids. She also gave no history of sleep disorder. There was bilateral papilloedema, pupils were a bit dilated symmetrically but reacting to light, visual acuity 6/60 on left eye and 6/18 on right eye and bilateral 6th cranial nerve palsy more marked on left side. MRI of brain and orbits showed normal study. Patient improved after giving acetazolamide.

Inflammation and glandular proliferation in hyperplastic prostates: association with prostate specific antigen value.

A series of 73 cases of surgically resected prostatic tissue were histologically diagnosed as nodular hyperplasia, of which 10 (13.69%) cases had chronic prostatitis. The mean value of prostate specific antigen in prostatic hyperplasia without chronic prostatitis and prostatic hyperplasia with chronic prostatitis were 6.09 ng/ml and 13.61 ng/ml respectively. A statistically significant difference of prostate specific antigen level between these two groups were noted (P<.05). The degree of glandular proliferation in nodular hyperplasia was subjectively assessed and was recorded as mild, moderate or severe degree of proliferation. The mean value of prostate specific antigen were 3.28 ng/ml in patients with mild proliferation, 7.21 ng/ml in those with moderate proliferation and 14.78 ng/ml in those with severe proliferation. A significant association between prostate specific antigen level and degree of glandular proliferation was found (P<.05). Chronic prostatitis and glandular proliferation are the two important factors contributing to serum prostate specific antigen elevation in hyperplastic prostates.

Citric acid production with mixed strains of Aspergillus niger in submerged culture.

Citric acid yield of 8 different strains of Aspergillus niger in pure and mixed cultures was investigated. The yield varied remarkably with the strain and combination of strains. Generally, the yield of citric acid for a given strain was higher in pure than in mixed culture. However, low yielding strains in combination often augmented the yield under mixed culture. The possibility of an additive genic effect is discussed.