Search

Background: Till today, there has been some hesitation to accept the role of fine needle aspiration cytology (FNAC) in pelvic mass. We have tried to study the role of ultrasonography (USG) and computed tomography (CT) guided FNAC as diagnostic and supportive investigation for ovarian tumors. Aim: To evaluate the current status of image-directed percutaneous aspiration of ovarian neoplasm for the purpose of early detection of malignancy. Materials and Methods: Seventy-four fine needle aspirations of ovarian neoplasms were performed between January 2007 and December 2008 by transabdominal approach under USG and CT guidance and correlated with histopathological findings and tumor markers. Results: A total of 47 (63.5%) cases were assessed as malignant and 21 (28.3%) as benign and 6 (8.1%) as inconclusive. The neoplastic lesions were categorized as per World Health Organization (WHO) classification. Conclusion: With the availability of modern techniques, USG and CT guided FNAC can be an optimum modality for the diagnosis of primary and metastatic ovarian neoplasms and evaluation of recurrent malignant tumors, which has great impact on patient management consequently. [ABSTRACT FROM AUTHOR]

The perception of social support among patients with advanced diseases is influenced by various factors. The socio-cultural context of Bangladesh significantly shapes the experience of patients with advanced cancer and their perception of social support. This study's aim was to assess the perceived social support by these patients and investigate the factors that shape their perception. This cross-sectional study was conducted among 115 advanced cancer patients admitted to the palliative medicine department of a tertiary care hospital in Bangladesh. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). Perceived social support was moderate to high for most (74.7%) of the participants. The majority (97.4%) perceived moderate to high level of support from their families. The lowest level of support was perceived from friends (53%). Factors such as economic status, family size, companionship of children, and emotional support from spouses influenced the level of perceived social support. Social support is one of the important aspects of palliative care. Identifying the factors influencing the perception of social support among cancer patients is essential for palliative care professionals to effectively address their care needs.

Background: Cancer patients experience significant changes in their social roles along with various physical and psychological challenges. Despite the growing recognition of the importance of palliative care in Bangladesh, there is a notable gap in research focusing on the psychosocial issues faced by patients with advanced cancer., Aim: This study aims to explore the level of social support perceived by Bangladeshi cancer patients and determine how this support relates to their mental health status., Methods: This cross-sectional study was conducted among 115 advanced cancer (stages III and IV) patients admitted to the palliative medicine department of a tertiary care hospital in Bangladesh. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support, and the mental health status of the patients was assessed by Depression, Anxiety, and Stress Scale-21. Data collection was done from June to November 2023. Relationships between perceived social support, depression, anxiety, and stress were assessed by the Spearman correlation test. The moderating effect of perceived social support on patients' mental health variables was determined by multiple linear regression and simple slope analysis. p Value <0.05 was considered to be statistically significant., Result: The study included an almost equal number of male (49.6%) and female (50.4%) patients, with a mean age of 50.7 ± 14.4 years. Overall, perceived social support was moderate to high for most (74.7%) of the participants. Among the participants, 78.3% experienced anxiety, 77.4% suffered from depression, and 70.5% experienced stress. Depression, anxiety, and stress were all negatively and significantly ( p  < 0.05) correlated with perceived social support. Younger patients reported higher levels of anxiety, stress, and depression. Perceived social support had a significant buffering effect on depression and anxiety among the younger patients., Conclusion: Perceived social support has a profound and significant effect on the mental health of advanced cancer patients. Integrating psychosocial support early in palliative care can be highly beneficial to the mental health of these patients., (© The Author(s), 2024.)

The experiment was conducted at the research field, Department of Agronomy, Hajee Mohammad Danesh Science and Technology University, Dinajpur from December 2017 to May 2018 to find out the best treatment of foliar application of urea on the growth and yield of boro rice cv. BRRI dhan28. The experiment consisted of 10 treatments, laid out in a randomized complete block design in triplicate. The recommended doses (RD) of urea, TSP, MOP, gypsum, ZnSO 4 , and borax were applied during land preparation except for urea at 250, 75, 100, 75, 7, and 5 kg ha -1 , respectively, where urea was applied as per treatment specification. The results revealed that the application of N fertilizer as foliage along with soil significantly influenced the growth, plant characteristics, and yield of BRRI dhan28. There was no significant difference between T 8 (70% in soil and 10% as foliage) and T 9 (100% in soil) treatment regarding the maximum panicle length (21.43 and 20.71 cm), fertile grains (117.40 and 113.30), total grains (134.40 and 130.97), 1000-grain weight (24.56 and 23.56 g), grain yield (5.91 and 5.74 t ha -1 ), straw yield (7.83 and 7.92 t ha -1 ), biological yield (13.74 and 13.66 t ha -1 ), and harvest index (43.01 and 42.02%), respectively, in this study. These results indicated that N fertilization as direct soil application (70%) and as foliage application (10%), i.e., 80% N fertilization, produced the highest grain yield and major yield traits which we received by 100% N fertilization as soil that was practiced traditionally by the farmers. The effect of overfertilization (T 10 ) was not positive, producing the highest number of noneffective tillers and sterile grains (nonfilled grains). Therefore, it is possible to achieve an equivalent or more yield by saving 20% urea by the combination of soil (70%) and foliage (10%) application as compared to the traditional method of fertilizer application (100% in soil)., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Objective: Routine symptom assessment represents the cornerstone of symptom management of patients with advanced incurable diseases in palliative care. At present, there is no validated tool to assess symptoms among the Bengali-speaking population with incurable diseases. The aim of the study is to translate, culturally adapt, and validate the Edmonton Symptom Assessment Scale (Revised) into Bengali language., Methods: The study was conducted in two phases. Forward and backward translations of the English version of the Edmonton Symptom Assessment Scale (Revised) into Bengali were conducted by four independent translators. After obtaining reviews from an expert committee, pre-testing and cognitive debriefing the Bengali version of the tool was finalized. The final validation was conducted among 110 patients admitted to the Palliative Medicine Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Validity (content, face, and construct validity) and reliability (internal consistency) were assessed in the final validation phase., Result: All participants responded to all items. Seventy percent of the participants completely understood all questions but 30% had difficulty with three questions. The expert committee expressed their satisfaction regarding the face and content validity of the questionnaire. The Bengali version also had high reliability (α = 0.862). Principal component analysis with the distribution of varimax rotation of Edmonton Symptom Assessment Scale (Revised) Bengali ranged from 0.41 to 0.83., Conclusion: After the translation and cross-cultural adaptation, the Bengali version of the Edmonton Symptom Assessment Scale (Revised) achieved good levels of validity and reliability. It can be used as a symptom assessment tool for Bengali speaking population receiving palliative care., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Cancer, a leading cause of mortality worldwide, is often diagnosed at late stages in low- and middle-income countries, resulting in preventable suffering. When added to standard oncological care, palliative care may improve the quality of life (QOL) of these patients. A longitudinal observational study was conducted from January 2020 to December 2021. Thirty-nine cancer patients were enrolled in the Compassionate Narayanganj community palliative care group (NPC), where they received comprehensive palliative care in addition to oncological care. Thirty-one patients from the Dept. of Oncology (DO) at BSMMU received standard oncological care. In contrast to the DO group, the NPC group had a higher percentage of female patients, was older, and had slightly higher levels of education. At 10 to 14 weeks follow-up, a significant improvement in overall QOL was observed in the NPC group ( p = 0.007), as well as in the psychological ( p = 0.003), social ( p = 0.002), and environmental domains ( p = 0.15). Among the secondary outcomes, the palliative care group had reduced disability and neuropathic pain scores. Additionally, there were statistically significant reductions in pain, drowsiness, and shortness of breath, as well as an improvement in general wellbeing, based on the results of the Edmonton Symptom Assessment Scale-Revised. At the community level in Bangladesh, increased access to palliative care may improve cancer patient outcomes such as QOL and symptom burden.

Background: In 2020, the International Association for Hospice and Palliative Care redefined palliative care to incorporate the concept of serious health-related suffering. An estimated 21 million children globally live with conditions which would benefit from a palliative approach to relieve suffering. Bangladesh is a lower-middle income country with isolated provision of palliative care., Aim: To synthesise existing evidence describing serious health-related suffering of children with disability and their families living in Bangladesh and the intersection between this suffering, palliative care and rehabilitation., Design: Scoping review methodology., Data Sources: A search strategy related to serious health-related suffering and childhood disability was applied to online databases and grey literature. English language studies (1990-2021) were included. Papers pertaining to serious health-related suffering of typically developing children and those over eighteen years were excluded. Data which addressed the three domains of serious health-related suffering (physical, social and emotional/spiritual) were extracted. Palliative care interventions were assessed with a pre-existing checklist., Results: Forty-six studies were included, representing ten different methodologies. Sample sizes ranged from 11 to 2582 participants, with 87% of studies including children with cerebral palsy. Serious health-related suffering was described in 100% of the studies, only 14 of the studies described specific interventions to mitigate suffering. Convergence between palliative care and rehabilitation approaches was evident., Conclusion: Findings document the extensive nature and burden of serious childhood health-related suffering that may be remediated by a palliative approach. They highlight the urgent need to prioritise service development and research in this area.

Synchronous presentation of cholesteatoma and tympanomastoid paraganglioma is extremely rare. Due to the overlapping clinical features, the clinical diagnosis of coexistence is difficult. Only two cases of tympanomastoid paraganglioma coexisting with middle ear cholesteatoma have been reported in the literature, but simultaneous presentation of primary external auditory canal cholesteatoma and tympanomastoid paraganglioma has not been reported till date. Coexistence of external auditory canal cholesteatoma and paraganglioma is an incidental diagnosis in this current case. The advancement of imaging techniques could help the diagnosis of this very rare clinical coexistence in preoperative assessment., Competing Interests: Conflict of interestThe author declares that there are no conflicts of interest regarding the publication of this article., (© Association of Otolaryngologists of India 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Globally, more than 97% of children needing palliative care reside in low- and middle-income countries, where there is very limited access to palliative care. Several community-based palliative care programs focused on adults, have been described in resource limited settings, suggesting a simple and low-cost approach to providing palliative care. The implementation of community-based palliative care for children has not previously been described., Context: This community case study describes the implementation of an innovative model of community-based palliative care program in and urban informal settlement, (Korail Slum, Bangladesh). The program is led by a local government hospital, with experience in community-based palliative care, in partnership with the local community., Problem: Children with serious conditions in an urban unformal settlement do not have access to health services which address their medical, psychosocial and spiritual needs. This gap leads to a significant burden of preventable suffering for them and their families., Solution: A community-based palliative care program was implemented, which includes home care by trained community health workers, with support and supervision from palliative care nurses and physicians. The program's objective is to provide effective symptom management, clear communication about the child's condition with parents, and psychosocial support including support for basic needs. The program was free for families including medications, medical equipment, physiotherapy, and speech therapy. The program was monitored through regular assessments of quality of life using standardized tools (PedsQL Family Impact Module), as well as interviews and focus group discussions., Conclusion and Lessons Learned: A model of community-based palliative care for children can be implemented in an urban informal settlement. Program effectiveness is enhanced by community health workers who share language, culture, and life-experiences with the individuals they serve. Partnerships with local health care facilities and community groups strengthen the program's sustainability. Ensuring financial sustainability remains a challenge., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Breast cancer is one of the leading cancers among the Bangladeshi women. Coping helps these patients to adjust with this life-changing disease. Each individual has unique and different coping mechanism. But we know a little regarding their coping strategies. This study aims to explore the different coping strategies adopted by the women with metastatic (stage IV) breast cancer attending the palliative care unit and their relationship with the common mental health issues like anxiety and depression., Methods: This cross-sectional study was conducted among 95 patients with metastatic (stage IV) breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire adapted from Hospital Depression and Anxiety Scale (HADS), Brief COPE inventory and Eastern Cooperative Oncology Group (ECOG) performance scale. Pearson correlation test was used to find the relationships between various domains of coping strategies and psychological variables. Correlation matrix was done to observe the internal correlation among different coping strategies. Kruskal-Wallis H test was done to find the relationship between different coping strategies and ECOG performance status., Result: The mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), Muslim (92.6%) and homemakers (82.1%). Commonly used coping strategies by the patients were: acceptance (median 10; IQR 10), religion (median 9; IQR 8-10) and instrumental support (median 9; IQR 6-10). Significantly strong positive correlation was found between emotional and instrumental support (R = 0.7; p = 0.01), planning, acceptance and active coping (R = 0.7; p = 0.01); behavioral disengagement, self distraction and denial (R = 0.5; p = 0.01). Significantly fair negative correlation was observed between active coping and depression (R = -0.4, p <0.001). Patients with better performance status on ECOG scale (Grade 0-2) leaned more on the positive coping strategies like instrumental support, emotional support, positive reframing and venting., Conclusion: Different coping strategies, especially positive coping helps the patients to adapt with their disease over time. All women suffering from breast cancer should be routinely screened and assessed for psychological distress and ensure early intervention and management to promote a better quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Islam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Aims: Advanced breast cancer patients suffer from various psychological issues including depression and anxiety. This study aims to explore these psychological issues and their relationship with the performance status., Methods: This cross-sectional study was conducted among 95 patients with metastatic breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire along with Hospital Depression and Anxiety Scale. The performance status of the patients was determined by the Eastern Cooperative Oncology Group (ECOG) performance scale. The association between different variables were assessed by χ 2  test and Fisher Exact test., Result: Mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), muslim (92.6%) and homemakers (82.1%). More than half (52.6%) of the patients were evaluated having ECOG performance status grade II. Four out of ten  (44.2%) patients had moderate to severely anxiety, and almost one-third (36.9%) patients were suffering from moderate to severe depression. The patients with high educational status were found to have less depression. In addition, patients faring better on ECOG performance scale (Grade 0 to I) had significantly ( p  < 0.05) less depression and anxiety., Conclusion: Depression and anxiety are one of the major psychological sufferings among the women with metastatic breast cancers. All women suffering from breast cancer should be routinely screened and assessed for phychological distress and ensure early intervention., Competing Interests: Dr. Md. Maruf Ahmed Molla is an Editorial Board member of Health Science Reports, and a coauthor of this article. To minimize bias, he was excluded from all editorial decision‐making related to the acceptance of this article for publication. The remaining authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Aims: The study aimed to explore the quality and impact of care provided through an innovative palliative care project to improve the quality of life of older people in an urban informal settlement in Bangladesh., Methods: Center for Palliative Care (CPC) at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, in collaboration with the Worldwide Hospice Palliative Care Alliance (WHPCA) has been operating this community project since 2015. A cross-sectional observational design was used in this program evaluation study. A total of 594 people received services including 227 patients (Group-1) receiving regular and intensive palliative care and 367 patients with less intense needs (Group-2) receiving relatively less support based on need. In addition, current group-1 patients (total 114) and a matched cohort of 58 group-2 patients were interviewed with an experience of care survey questionnaire. Baseline and demographic data were presented in tables. The Z -test was used to measure mean statistical differences between two groups., Results: Multiple comorbidities were common. Pain was the most frequently noted physical symptom along with anxiety, sadness, and depression as common psychological concerns. Compassionate palliative care for the older people had significant ( p  < 0.05) impact on psycho-social and spiritual care, caregiver training, responding to emergencies, and reduction of out of pocket healthcare expenditure among the intensive intervention group., Conclusion: Using a community-based approach following this model may play a significant part in expansion of palliative care throughout Bangladesh to meet the huge need and scarcity of such services., Competing Interests: Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2021.)

We describe the palliative care needs of children with chronic conditions and their caregivers in an urban slum in Bangladesh. In this cross-sectional study, we interviewed 25 caregivers whose children receive support from a community-based program lead by community health workers, that provides medication, medical supplies, food, caregiver training, and psychological support free of charge. The chronic conditions of children in the program included cerebral palsy (80%), congenital heart disease (8%), neurodegenerative conditions (4%), cancer (4%), and intellectual disabilities (4%). Common symptoms included cough or breathing problems (64%), fever (56%), and pain (56%). Most caregivers (96%) reported they were unable to do any paid work due to their child's needs and in all families, the child's condition had a significant impact on their financial situation. Community-based palliative care programs can be developed to support children with chronic conditions who may not access care from acute care facilities., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder usually diagnosed by using symptom-based diagnostic criteria. Recent evidence suggests the presence of organic diseases in some patients fulfilling the diagnostic criteria of IBS which may be missed unless investigations are performed. The aim of this cross-sectional study is to find out the prevalence of organic colonic lesions at colonoscopy in patients with IBS fulfilling the Rome III criteria.The study was conducted in the department of Gastroenterology OPD of the North East Medical College, Sylhet, Bangladesh from December 2016 to December 2017. Consecutive 153 patients of IBS diagnosed by validated Bangla version of ROME III criteria were included in this study. Colonoscopy was done for each patient and findings were recorded. Prevalence of colonic disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype. A substantial number of patients 43(28.1%) fulfilling the Rome III criteria were found to have organic colonic lesions at colonoscopy. No significant difference was found regarding colonic lesions among patients with IBS symptoms with or without alarm features (p=0.876). Colonic polyp was the commonest findings in 19(12.1%) subjects at colonoscopy, followed by colonic ulcers in 16(10.5%) subjects. Organic colonic lesions are found to be more common among relatively older age group patients (p=0.011). A significant number of patients with symptoms compatible with IBS exhibited colonic lesions following investigation with a predilection towards older age. Careful clinical evaluation and relevant investigations are necessary to reduce diagnostic uncertainty.

The MDM2 gene is a negative regulator of p53, which has been linked to lung cancer. Here, we have evaluated the association of MDM2 SNP 285 G>C (rs117039649) and SNP 354 A>G (rs769412) with lung cancer risk in Bangladeshi population at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2015 to June 2017. We have genotyped 126 lung cancer patients and 133 healthy controls from Bangladesh by PCR-RFLP method for this study. Statistical analyses were performed to define the associations. Multivariate logistic regression revealed that MDM2 SNP 285 decreases the risk of lung cancer (GC+CC vs. GG: OR = 0.29, 95% CI = 0.15-0.56, p<0.005). A stratification analysis confirmed that this protective status is extended to younger people, male, overweight people, and smokers (GC+CC vs. GG: OR = 0.25-0.29, 95% CI = 0.11-0.69, p<0.01). However, we did not find any association of SNP 354 with lung cancer risk in Bangladeshi population (p>0.05). The present data indicated that MDM2 SNP 285 G>C (rs117039649) reduces the chance of lung cancer development in Bangladeshi population. However, MDM2 SNP 354 A>G (rs769412) has no such association in the same population.

Globally Vitamin D deficiency is a burning issue for the last two decades. Though the very high prevalence of hypovitaminosis D is worldwide even in the South-East Asia but there is very limited data in Bangladesh. This observational study was designed to assess the status of Vitamin D deficiency among the clinically apparent healthy population in the district of Jessore, Bangladesh from January 2017 to June 2017. Both the male and female clinically healthy participants between the age of 10 and 70 years residing more than 3 years in Jashore were included in this study, while those having renal or liver failure or any other chronic diseases and using drugs that could potentially interfere the metabolism of vitamin D were excluded from the study. Here we leveled serum 25(OH)D concentration of ≤20ngm/dl as deficient, >20-30ngm/dl graded as insufficient and >30ngm/dl graded as sufficient. Among 160 participants 43.1% (n=69) were male and 56.9% (n=91) were female. And 102(63.7%) participants had deficient vitamin D, 50(31.3%) had insufficient vitamin D and only 8(5%) had sufficient vitamin D. The mean serum 25(OH)D levels in our study was 18.60±6.59ngm/dl. The mean serum 25(OH)D level in case of male participants was 19.72±7.10ngm/dl whereas in female the corresponding figure was 17.74±6.07gm/dl and no significant difference observed among the man and women (p=0.059). Sun exposure play a vital role in the vitamin D deficiency and we observed only 1-2 hours/day sun exposure was sufficient for normal vitamin D level (p=0.001). In case of women who used veil had significantly lower level of vitamin D (p=<0.001) due to lack of adequate sun exposure. Urban participants who also had significant low level of vitamin D due to the same reason (p=0.009). There was no deficiency observed in farmers and only 5(3.1%) had insufficient vitamin D. No significant difference observed in deficiency of vitamin D among the different age, sex, education level, skin complexion or BMI. But the obese participants had significant (p=0.041) lower vitamin D level. It was concluded with the high rate of vitamin D deficiency in this small scale study conducting in a district of Bangladesh demands a nationwide survey of vitamin D.

Despite improved haematological care, multi-endocrine dysfunction is a common complication in thalassemia. Iron overload is thought to be the most likely mechanism in thyroid dysfunction in these patients. Moreover, chronic tissue hypoxia might havedirect toxic effect on thyroid gland resulting in hypothyroidism. This study was designed to evaluate the thyroid status of children with Hb-E β-thalassemia. This cross sectional analytic study was conducted among thepatients with Hb-E β-thalassemia attending both in-patient & out-patient department of Paediatrics, Dhaka Medical College & Hospital, Dhaka, Bangladesh from April 2012 to March 2013. The children who attended inpatient and outpatient department of Paediatrics for some other illness were screened out for thalassaemia and were recruited as comparison group. Thyroid function tests (TSH & FT₄ level) were performed in both thalassaemic patients and comparison group. Serum ferritin level was also measured for assessing iron status of thalassaemic patients and their pre-transfusion Hb levels were recorded in the pre-formed data collection form. Of the 50 thalassaemia patients, 13(26%) had subclinical hypothyroidism. This proportion of subclinical hypothyroidism was significantly high, compared to that (2.5%) of non thalassaemia comparison group. Among the subclinically hypothyroid thalassaemia subjects, 8 were males and 5 were females and their mean age was 102.38±33.29 months. The mean serum ferritin levels in hypothyroid and euthyroid thalassaemia cases were 2387.87±1642.85ng/ml and 1822.95±1345.33ng/ml respectively (normal level upto 300ng/ml). This difference was not statistically significant (p=0.279); but the pre-transfusion Hb level wasfound significantly different (p=0.02) among the two groups. It was 5.57±0.98g/dl in hypothyroid & 6.37±0.09g/dl in euthyroid thalassaemic cases. Subclinical hypothyroidism was quite high among the children with transfusion dependent Hb-E β-thalassaemia. Their hypothyroid status had no significant correlation with their serum ferritin level but had significant correlation with low haemoglobin status.

Primary sclerosing cholangitis (PSC) is a liver disease characterized by inflammation and fibrosis of both intrahepatic and extrahepatic bile ducts resulting in cholestasis. Due to nonspecific symptoms it is difficult to diagnose until complication arises. It is common in male and usually associated with other autoimmune diseases. Here, we report a case of PSC in a young female which was initially thought to be drug induced cholestasis without presence of any other autoimmunity.

Type 2 diabetes (T2D) is a global pandemic. Currently, the drugs used to treat T2D improve hyperglycemic symptom of the disease but the underlying mechanism causing the high blood glucose levels have not been fully resolved. Recently published data showed that salt form of niclosamide improved glucose metabolism in high fat fed mice via mitochondrial uncoupling. However, based on our previous work we hypothesised that niclosamide might also improve glucose metabolism via inhibition of the glucagon signalling in liver in vivo. In this study, mice were fed either a chow or high fat diet containing two different formulations of niclosamide (niclosamide ethanolamine salt - NENS or niclosamide - Nic) for 10 weeks. We identified both forms of niclosamide significantly improved whole body glucose metabolism without altering total body weight or body composition, energy expenditure or insulin secretion or sensitivity. Our study provides evidence that inhibition of the glucagon signalling pathway contributes to the beneficial effects of niclosamide (NENS or Nic) on whole body glucose metabolism. In conclusion, our results suggest that the niclosamide could be a useful adjunctive therapeutic strategy to treat T2D, as hepatic glucose output is elevated in people with T2D and current drugs do not redress this adequately.

The relationship between allergic rhinitis and asthma is now established, and most of the clinical, epidemiological and biological data recommend integrated management. This review discusses rhinosinusitis as a co-morbid condition, a precipitating or triggering condition, and an epiphenomenon as an integrated part of the disease. A better understanding and a more pragmatic method of diagnosis and management is needed using cost-effective long-term strategies. Allergic Rhinitis, though a non-life threatening disease, its pathogenesis reveals that Bronchial Asthma also develops by the same aetiopathogenesis. The United airway disease hypothesis proposes that the upper & lower airway diseases are both manifestations of a single inflammatory process and studies have already proved it. Allergic Rhinitis when once develops if not treated vigorously, can later turn up to Asthma. As chronic inflammation is the central process which is actually continuously changing pathologically the lower respiratory tract & helping to develop Bronchial Asthma. The conventional therapies for Allergic Rhinitis such as antihistamines & decongestants are only symptom relievers, to stop the ongoing pathogenesis of Bronchial Asthma to develop it, the chronic inflammatory process should have to be stopped. This can be done by corticosteroid nasal sprays. Also Asthma with Rhinitis is better controlled by them. Even Bronchial Asthma treatment should be started with inhaler corticosteroid therapy rather than getting it after intermittent use of only bronchodilators (salbutamol) only.

Objectives: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the world. This study was carried out to see the epidemiological and clinicopathological profile of sporadic cases of CRC in Bangladesh., Materials and Methods: The patients diagnosed to have colorectal carcinoma in two private medical centers of Bangladesh from January 2012 to December 2014 were enrolled in this study. Demographic data, clinical presentations, site of lesions, and histological types were analyzed., Results: Total 158 patients were included in this study. The mean age was 50.77 years and male to female ratio was 1.55:1. Rectal bleeding was the commonest symptom irrespective of age and sex followed by abdominal pain (33, 20.9%), weight loss (29, 18.3%), abdominal mass (26, 16.4%), and altered bowel habit (22, 13.9%). Common histological type was adenocarcinoma (156, 98.7%)., Conclusion: Colorectal cancer commonly affects males >40 years of age. Most common site of involvement is rectum, which is followed by left colon., How to Cite This Article: Saha M, Shil BC, Saha SK, Banik RK, Perveen I, Chowdhury MKS, Nazmul Islam ASM, Saifullah ANM. Study of Clinicopathological Profile of Sporadic Cases of Colorectal Cancer. Euroasian J Hepato-Gastroenterol 2016;6(2):134-136., Competing Interests: Source of support: Nil Conflict of interest: None

Recently, it has been found that glucagon is able to activate the β-catenin signalling pathway leading to increased cyclin D1 and c-Myc expression in liver. Therefore the main aim of the present study is to determine whether the effect of glucagon activating β-catenin signalling leading to increased target gene expression is mediated through cAMP activation of PKA (protein kinase A). Primary rat hepatocytes were incubated with insulin, glucagon or adrenaline (epinephrine) and a range of inhibitors of PI3K (phosphoinositide 3-kinase), Wnt, mitochondrial uncoupler (niclosamide) or PKA inhibitors to dissect out the pathway leading to increased Ser(552) phosphorylation on β-catenin following glucagon exposure. In primary rat hepatocytes, we found that short exposure to glucagon or adrenaline caused a rapid increase in Ser(552) phosphorylation on β-catenin that leads to increased cyclin D1 and c-Myc expression. A range of PI3K and Wnt inhibitors were unable to block the effect of glucagon phosphorylating β-catenin. Interestingly, both niclosamide and the PKA inhibitor H89 blocked the glucagon effect on β-catenin signalling, leading to a reduction in target gene expression. Likewise, niclosamide inhibited cAMP levels and the direct addition of db-cAMP (dibutyryl-cAMP sodium salt) also resulted in Ser(552) phosphorylation of β-catenin. We have identified a new pathway via glucagon signalling that leads to increased β-catenin activity that can be reversed with the antihelminthic drug niclosamide, which has recently shown promise as a potential treatment of T2D (Type 2 diabetes). This novel finding could be useful in liver cancer treatment, particularly in the context of T2D with increased β-catenin activity., (© 2016 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.)

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

The mechanism underlying the increased rate of endogenous glucose production from the liver during exercise remains unknown. The cytokine interleukin-6 (IL-6) is known to be released during exercise and is thought that either IL-6 directly or via a "contraction factor" stimulates the release of stored glucose from the liver. Here we show that IL-6 does not directly increase hepatic glucose output (HGO). Moreover, IL-6 infused at the same time as glucagon caused a significant reduction in HGO. IL-6 infused with epinephrine caused no synergenic increase in HGO. To test if an unknown "contraction factor" was needed along with IL-6 to increase HGO, we used human fasted and exercised plasma perfused with or without IL-6 in our isolated liver system. We found that exercised plasma increased HGO, as expected, but when infused with IL-6, reductions in HGO were found. Our results provide evidence that IL-6 works as a negative regulator of HGO.

In the last 20 years the prevalence of metabolic disorders, in particular type 2 diabetes (T2D), has more than doubled. Recently, a strong link between T2D and cancer, in particularly liver cancer has been reported. However, the mechanism connecting the development of type 2 diabetes and cancer remains unknown. One of the biggest drivers of liver cancer is alterations in the Wnt/β-catenin pathway. In this study, we aimed to identify the effect of glucagon on β-catenin in the isolated rat liver. We found glucagon, which is substantially raised in patients with T2D, rapidly phosphorylates β-catenin on serine 552 that is associated with increased expression of genes cyclin D1 (CCND1) and c-Myc (MYC), which are known to be involved in liver cancer. This finding may explain the increased risk of liver cancer in people with T2D.

Poland's Syndrome is a rare congenital condition. It is classically characterised by absence of unilateral chest wall muscles and sometimes ipsilateralsymbrachydactyly (abnormally short and webbed fingers). The condition typically presents with unilateral absence of the sternal or breast bone portion of the pectoralis major muscle which may or may not be associated with the absence of nearby musculoskeletal structures. Most of the Poland Syndrome is sporadic. We report a 19-year-old patient with variant of Poland Syndrome. To the best of our knowledge, this is one of the few documented cases of a patient with Poland Syndrome reported from Bangladesh.

Objective: To assess associations between codon 72 polymorphisms (Pro or B and Arg or b alleles) of the TP53 gene and lung cancer risk among Bangladeshis., Materials and Methods: The distribution of the BB, Bb, and bb genotypes and the frequencies of the B and b alleles were determined by PCR-RFLP method using DNA extracted from leucocytes of 50 confirmed lung cancer patients and 50 age-matched controls and the data were analysed., Results: The ratio of BB, Bb, and bb genotypes were in Hardy-Weinberg equilibrium except for the male patients (χ2=4.6). The B allele is overrepresented among all patients (OR=2.0, p=0.02) and the female patients (OR=4.1, p≤0.01) compared to the controls. The BB/bb ratio was also higher among the patients (OR=3.0, p=0.03). The relative risk of cancer for having BB over bb genotype was 1.8 (p=0.04) but no effect was observed for the Bb genotype. The B allele was overrepresented among patients with adenocarcinomas (OR=2.4, p≤0.01) and squamous cell carcinomas (OR=2.7, p≤0.01) over the controls but the difference was not significant for those with small cell lung carcinomas (OR=1.1, p=0.66). The B allele was overrepresented among patients age 50 or younger (OR=2.7, p≤0.01), but not for older patients (OR=1.7, p=0.07), and among smokers compared to the controls (OR=1.8-10.0, p≤0.01-0.03). However, no correlation between increasing pack-years and lung cancer was observed., Conclusions: The Pro/Pro (BB) genotype and the B allele are risk factors for lung cancer among Bangladeshis, particularly for people under age 50, women and smokers.

Tyrosyl-DNA phosphodiesterase 1 (Tdp1) is a DNA repair enzyme that processes blocked 3' ends of DNA breaks. Functional loss of Tdp1 causes spinocerebellar ataxia with axonal neuropathy type 1 (SCAN1). Based on the prominent cytoplasmic expression of Tdp1 in the neurons presumably affected in SCAN1, we hypothesized that Tdp1 participates in the repair of mitochondrial DNA. As a step toward testing this hypothesis, we profiled Tdp1 expression in different human tissues by immunohistochemistry and immunofluorescence respectively and determined whether Tdp1 was expressed in the cytoplasm of tissues other than the neurons. We found that Tdp1 was ubiquitously expressed and present in the cytoplasm of many cell types. Within human skeletal muscle and multiple mouse tissues, Tdp1 partially colocalized with the mitochondria. In cultured human dermal fibroblasts, Tdp1 redistributed to the cytoplasm and partially colocalized with mitochondria following oxidative stress. These studies suggest that one role of cytoplasmic Tdp1 is the repair of mitochondrial DNA lesions arising from oxidative stress.

Rhinosporidiosis is a non-contagious chronic granulomatous disease that is prevalent in southern India and Sri Lanka. It has been known for centuries, but the details of the disease and the precise manner of its transmission have, until recently, remained unknown. Our institution sees many cases of this disease and we investigate the management protocol and its recent advances and include a review of the published literature. A total of 152 patients who were treated at Bankura Sammilani Medical College were studied between 2005 and 2011. The most common age group affected were those aged between 11 and 20 years of age and the male-to-female ratio was 1.9:1. Three patients suffered recurrent disease - one experienced it on the same site and the others on distant sites. Eleven patients with inadequate excision in which the margins were not free from disease were treated with dapsone therapy without any reported recurrence. It is a common disease in southwestern West Bengal. Surgical excision with electrocoagulation of the base is the main treatment, and dapsone therapy is recommended in order to prevent recurrences in multiple sites of affection and inadequate surgically excised cases. Although the disease occurs sporadically in most parts of the world, we see many patients in our area.

Urachal adenocarcinoma arising in the dome of the bladder or at the pre-existing urachal remnant is rare. An early case of urachal cyst harboring adenocarcinoma, clinically diagnosed as ovarian tumor, which was surgically removed with a good prognosis is reported.

The urogenital tract is the most severe and common site of associated defects in anorectal malformations (ARM). Urogenital anomalies and their complications significantly increase the morbidity in these children after the ARM is corrected. The purpose of this study was to estimate the incidence of different types of urogenital anomalies with various types of anorectal malformations and to discuss the possible management and outcome. A retrospective study of patients with ARM and associated urogenital abnormalities admitted in the department of paediatric surgery of Sylhet MAG Osmani Medical College Hospital between 1998 and 2002 was undertaken. A total of 155 patients with Anorectal malformations were admitted of which 47 (30.32%) patients had associated anomalies involving other systems. Urogenital abnormalities were found in 25 (16.13%) patients. Patients of Anorectal malformations with urogenital abnormalities require careful assessment and well-timed intervention to minimize the morbidity.

Chondroid lipoma is a rare fatty tumor of soft tissues, especially in limbs and limb girdles. Though it is clinically benign, the main importance lies in its histological similarity with myxoid liposarcoma and chondrosarcoma, which have poorer prognosis. In our study, classical histological pattern of chondroid lipoma was confirmed on H&E and PAS stains with low mitotic count.

Menstrual disorder is one of the most frequently encountered and perplexing conditions in adult women. Dysfunctional uterine haemorrhage (DUH) includes scanty, excessive or irregular bleeding, the primary cause of which is yet to become clear. A total of 100 cases of DUH were studied by histological and histochemical evaluation of endomertium with an object to find out the pathophysiology of DUH. Twenty cases of the similar age group without DUH acted as control. Irregular excessive bleeding was found to be the highest in multiparous women in their 4th decade of life. The material from endometrium was studied by haematoxylin and eosin statin, alcian blue, periodic acid Schiff's reaction and alkaline phosphatase activity. Histological examination of the study group revealed normal endometrium in 66% of cases and abnormal in 34% cases while histochemical behaviour was normal in 54% cases and abnormal in 46% cases. Hormonal imbalance is the chief factor in the pathogenesis of DUH and this abnormal hormonal status can better be revealed by a combined study of histological and histochemical evaluation of endometrium.

The close relationship between the maternal malnutrition and consequent birth of low birth weight babies and the perinatal mortality is now an accepted fact and has been studied extensively in developed countries, though the problem is more acute in developing countries. The present study was proposed to find out relationship between the maternal nutritional status and the perinatal mortality. Autopsy was performed on 100 babies dying perinatally and pathological examination of different foetal organs in both well and malnourished mothers was also undertaken. Maternal nutritional status was evaluated by estimating haemoglobin level and total serum protein level. A mother with haemoglobin level below 11 g/dl and/or serum protein level below 5 g/dl was considered as malnourished. Pathological findings in the dead babies included low birth weight (500-1,999g), haemorrhage in multiple organs, atelectasis of the lungs, fatty changes in the liver, cystic changes of the kidneys and ill developed parenchyma of the pituitary.

Background: Although calcium channel blockers are a useful therapy in relieving angina, lowering blood pressure, and slowing conduction of atrial fibrillation, growing evidence has cast doubt on their safety in patients with coronary disease., Objective: To examine the association between calcium channel blocker therapy at hospital discharge and mortality in a population-based sample of elderly patients hospitalized with acute myocardial infarction., Design: Retrospective cohort study using data from medical charts and administrative files., Setting: All acute care hospitals in 46 states., Patients: All Medicare patients with a principal diagnosis of acute myocardial infarction consecutively discharged from the hospital alive during 8-month periods between 1994 and 1995 (N = 141,041)., Main Outcome Measure: Mortality at 30 days and 1 year., Results: Calcium channel blockers were widely prescribed at hospital discharge to elderly patients with myocardial infarction between 1994 and 1995 (n = 51,921), the most commonly prescribed being diltiazem (n = 21,175), nifedipine (n = 12,670), amlodipine (n = 11,683), and verapamil (n = 3639). After adjusting for illness severity and concomitant medication use, patients who were prescribed calcium channel blockers at hospital discharge did not have increased risk for 30-day or 1-year mortality, with the exception of the few (n = 116) treated with bepridil. Bepridil differs from other calcium channel blockers because of its tendency to prolong repolarization, and its association with proarrhythmic effects in elderly patients., Conclusion: We did not identify a mortality risk in a large consecutive sample of elderly patients with myocardial infarction, which supports the need for additional prospective trials examining calcium channel blocker therapy for ischemic heart disease.

This article investigates the interrelationship of socioeconemic status, anthropometric status and mortality of young children in rural Bangladesh. Data for this study come from Matlab, the vital registration area of the International Centre for Diarrhoeal Disease Research, Bangladesh, where anthropometric and socioeconomic data concerning 1976 children aged 12-23 months were collected in November-December 1975. From these data, anthropometric indices are created, and the relationships of socioeconomic status measured by dwelling space and anthropometric indices with mortality during the 2 years following measurement of these children are investigated. It is found that both socioeconomic status and anthropometric indices are related to mortality. However, the relationship of anthropometric indices is much stronger. Among the anthropometric indices considered, weight-for-age, height-for-age and arm circumference reflect socioeconomic status better than weight-for-height does; and, the first three indices are equally good, and individually better than weight-for-height, as predictors of mortality. The degree of the effect of socioeconomic status (dwelling space) on mortality explained by the best performing anthropometric index, weight-for-age, was not more than 25%. It is concluded that an anthropometric index that can classify socioeconomic status more efficiently is a better predictor of 2-year mortality than any other anthropometric index.