Bangladesh Medical Research Council Bulletin (Vol. 50, No. 02, 2024)

Abstract

Background: Colorectal cancer (CRC) is the third commonest diagnosed cancer and the second leading cause of cancer-related mortality. Though anterior resection with total mesorectal excision (TME) is the gold standard for the treatment of non-disseminated rectal or distal sigmoid cancer, but almost all patients have experienced some degree of bowel dysfunctions.

Objective: To evaluate short-term bowel dysfunction after anterior resection by LARS score.

Methods: This prospective observational study was carried out in the Department of Surgical Oncology, National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka. The study was undertaken with the patients who already underwent AR for carcinoma rectum. Data collection was started from January 2020 to March 2021 and the 35 case was collected from OPD and indoor of NICRH maintaining inclusion and exclusion criteria at 3rd month and 6th month. Statistical analysis was done according to the objective of the study by using Statistical Package for Social Science software version 27.0 for windows.

Results: Out of 35 eligible patients, the majority of 21 (60.0%) patients were male. The mean age was found 45.83±11.92 years. Regarding tumor distance from the anal verge, 8(22.86%) patients’ tumors were found at the high rectum, 22(62.86%) at mid rectum (8-11 cm) and 5(14.29%) at low rectum. Bowel dysfunction was observed in 94% of cases; out of them, 37% had major dysfunction in 6th month. The mean LARS score was found 28.6±7.2 in 3rd month and 25.7±6.8 in 6th month. The difference was statistically significant (p ≤ 0.05) between the two groups. Bowel dysfunction, i.e., Incontinence, clustering, urgency and frequency were documented at 6th month 74.29%, 77.14%, 71.43% and 82.86% respectively and were not statistically significant (p >0.05) between at 3rd and 6th months. At 6th month, bowel dysfunctions were higher in ultra-low anterior resection than high anterior resection

Conclusion: The high prevalence of ARS emphasizes the importance of evaluating bowel dysfunction for rectal cancer treatment in future research and counseling the patient in hospital and daily clinical practice.

Keywords: Carcinoma Rectum, Bowel Dysfunction, Anterior Resection, Anterior Resection Syndrome

Abstract

Background: Malignant connective tissue tumors, or sarcomas, are derived from the connective tissue of the body. They fall into two categories: hard tissue sarcomas, such as osteosarcoma, Ewing’s sarcoma, and chondrosarcoma, and soft tissue sarcomas, such as leiomyosarcoma and rhabdomyosarcoma. Clinicopathological research can shed light on the biological activity of oral sarcomas.

Objectives: The study intends to explore clinical, pathological, and radiological aspects of sarcoma affecting the oral and maxillofacial regions in a tertiary health care center in Dhaka, Bangladesh.

Methods: It was a descriptive cross sectional study carried out in the Department of Oral and Maxillofacial Surgery, Dhaka Dental College and Hospital, during the period from January 2017 to December 2018. Regardless of age or gender, 20 individuals with maxillofacial sarcoma who met the inclusion and exclusion criteria and had a histological diagnosis were enrolled.

Results: A total of 215 maxillofacial malignancies were found, of which 20 (9.3%) were sarcomas. Numerous histopathological varieties were identified, with fibrosarcoma making up the majority of cases (30%), followed by rhabdomyosarcoma (25%), osteosarcoma (15%), and Ewing’s sarcoma (10%). The proportion of men to women was 1:1. Patients with sarcomas ranged in age from one year to sixty years (mean age, 22.75 ± 13.79 years). The area primarily impacted was the anterior maxilla (25%), followed by the left body of the mandible (15%), the right maxilla (10%), and the right body of the mandible (10%). The clinical manifestations of sarcoma included swelling in all patients, pain (85%), toothaches (85%), loose teeth (70%), ulcers (50%), paresthesia (50%), and restriction of mouth opening (40%). The radiological findings revealed that 30% of patients exhibited a widening of the periodontal ligament space, and 65% of patients had tooth resorption and displacement.

Conclusion: Out of 215 maxillofacial malignancies 9.3% were sarcomas, with fribrosarcoma being the most common kind. In addition to radiologically showing tooth resorption, displacement, and widening of the periodontal ligament, the majority of patients also reported pain and swelling.

Keywords: Clinicopathological, maxillofacial region, sarcoma.

Abstract

Background: Acute pancreatitis is the most common and dangerous medical emergency in the practice of gastroenterology. Severity of presentation and uncertain prognosis make it as a threatening disease. There is limited information on how well physicians comply with standard guidelines, but compliance is suboptimal in developing countries, according to several studies

Methods: This study was intended to determine the clinico-pathological profile, severity assessment, etiology and challenges of management of acute pancreatitis in tertiary care hospital of Bangladesh.

Results: In this study our main concern was to identify the challenges of management in acute pancreatitis. The most common challenges we faced was delayed admission (59.11%)). Others were delayed hospital diagnosis by physicians (42.97%) non-adherence of patient party regarding (29.95%), lack of investigations facility at hospital (53.13%) and only 8.07% faced no challenges during management. Only 13% patients got current guideline-based treatment of acute pancreatitis.

Conclusion: In our study, we have explored some unknown and new challenges regarding management of acute pancreatitis. Addressing these challenges, we should be careful while managing patients of acute pancreatitis to reduce morbidity and mortality.

Keywords:Acute pancreatitis, Challenges of management, Guideline-based treatment.

Abstract

Background: Human papillomavirus (HPV) is the most frequent cause of high-grade lesions and carcinogenesis such as cervical intraepithelial neoplasia (CIN) and cervical cancer (CC). However, the prevalence and genotype distribution of HPV infection varies greatly with respect to geographical regions. Determining the prevalence and distribution of HPV in a particular area is, therefore, of immense significance.

Objectives: This study was undertaken to evaluate the distribution of high-risk HPV genotypes in cervical precancerous lesions.

Methods: This descriptive cross-sectional study was conducted at the Colposcopy Clinic in the Department of Gynecologic Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka over a period of 6 months from November 2022 to April 2023. A total of 151 women aged between 30-70 years with Colposcopically abnormal and histopathologically proven precancerous lesions of the cervix were purposively included in the study. HPV- DNA test was done by US FDA-approved Digene’s Hybrid Capture II (HCII) technology. However, the high-risk (HR) HPV DNA was assessed by PCR testing.

Results: In the present study majority (81.5%) of patients had low-grade CINs (CIN1), and the rest (18.5%) had high-grade lesions (CIN2 & CIN3). Over half of the patients tested positive for HPV DNA. The predominant genotype harbored by the patients was HPV16 (63.2%). The genotype HPV18 alone was negligible (3.3%6). The HPV16 and HPV18 together comprised 6.6%. While HPV 16 in association with other genotypes comprised 6%, HPV18 associated with other genotypes was the least (0.7%). About two-fifths (39%) of the low-grade CINs (CIN1) and all of the high-grade CINs (CIN2 & CIN3) were tested positive for HPV (p < 0.001). No significant association was found between HPV-DNA genotypes and CIN grade.

Conclusion: The majority of women with CIN had low-grade lesions. Over half of the CIN patients have positive HPV-DNA test results. While HPV16 is the most prevalent genotype among the patients, the HPV18 genotype is uncommon. The prevalence of other genotypes are rare. All of the high-grade CINs and two-fifths of the low- grade CINs are found HPV-positive. Nevertheless, there is no significant association between CIN grade and HPV-DNA genotypes.

Keywords: High risk Human papilloma virus genotype, precancerous lesion of cervix, high grade lesion, low grade lesion.

Abstract

Background: Heart failure is a global health emergency affecting millions of people worldwide and is increasing in prevalence. NT-proBNP is a hormone that is a marker of severity and prognosis of heart failure. Thyroid hormone has an important regulatory impact on the heart. Altered thyroid function specially triiodothyronine and increase NT-proBNP are highly prevalent in heart failure patients without apparent thyroid diseases.

Objectives: To evaluate the association of serum FT3 with heart failure severity and its correlation with NT-proBNP as a potential marker.

Methods: A cross-sectional analytical study was conducted at the Department of Biochemistry, Sir Salimullah Medical College (SSMC), over a 12-month period following ethical approval. A total of 110 clinically diagnosed heart failure subjects were enrolled based on inclusion and exclusion criteria. Written informed consent was obtained from patients and detailed histories, clinical examinations and Serum FT3, serum TSH and serum NT-proBNP were performed. Data was collected using a semi-structured questionnaire and Statistical analysis was done by using SPSS version 22.0.

Results: Serum FT3 level was significantly lower among heart failure patients with high NT-proBNP but the mean value of serum TSH was normal. Low FT3 level is associated with more severe heart failure patients having high NT-proBNP levels.

Conclusion: Serum FT3 has an inverse relation with NT-proBNP in patients with heart failure. As low FT3 associated with severe heart failure patients with high NT-proBNP, low FT3 could be a potential marker for heart failure severity.

Keywords: Heart failure patients, serum FT3, serum TSH, serum NT-proBNP

Abstract

Background: Paget’s disease of bone (PDB) is a localized disorder of bone remodeling resulting in abnormal bone architecture. It is a chronic and slowly progressive disorder. The disease was first described in England, in 1877, by Sir James Paget who defined it with the name of “osteitis deformans”.

Objectives: This patient underwent craniotomy for excision of the swelling. The bony destruction was reconstructed using titanium mesh.

Methods: A forty seven years old lady suffering from Paget’s disease, presented to us with a progressive firm swelling in the front of the left frontal bone including the orbit. She was operated upon and her swelling was diagnosed as Giant cell tumour.

Results: After surgery she became well and orbital swelling had subsided and she had a good cosmetic appearance.

Conclusion: surgery is the main options for GCT. Patients with Paget’s disease have a tendency to have GCT, and this should be kept in the mind during diagnosis.

Keywords: Giant cell tumour, Paget’s disease, Titanium mesh, Alkaline phosphatase, Bangladesh.