Risk stratification of newly diagnosed multiple myeloma patients

Background: Multiple Myeloma is a neoplastic proliferation of plasma cells, associated with an M (monoclonal) protein in serum and/or urine and evidence of organ damage. Despite advances in treatment, the disease remains heterogeneous, necessitating a comprehensive understanding of its risk stratification. Risk-adapted initial therapy, maintenance therapy, refractory disease management and prognosis varies according to risk group. The aim of our study is to categorize the newly diagnosed MM patients according to their risk groups. Methods: This cross-sectional observational study was conducted at the Department of Haematology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2019 to July 2020. A total of 31 newly diagnosed MM patients were enrolled based on specific inclusion and exclusion criteria. Risk stratification was performed using ISS, R-ISS, mSMART criteria and Avets risk group categorization. Result: The majority of the patients were male (64.52%) and aged between 55-64 years (45.16%). Clinical features predominantly included low back pain (74.19%) and general weakness (38.71%). Cytogenetic abnormalities were noted in 38.7% of the patients, with del (13q) being the most common (32.30%). Most patients were in ISS Stage III (70.97%) and R-ISS Stage II (48.39%). According to mSMART criteria, 80.65% were at standard risk while Avet's risk stratification identifies 58.06% were at intermediate risk. Conclusion: The study reveals a high prevalence of patients in advanced ISS stages and intermediate to high-risk categories, emphasizing the need for early and personalized intervention strategies.

Pattern of antibiotic sensitivity of bacteria causing urinary tract infection in a private Medical College Hospital in Dhaka.

Background: Urinary tract infections (UTI), being the most common infections diagnosed in community and hospital, are to be treated scrupulously considering the type of infecting organism and its antibiotic sensitivity and resistance pattern. Aims and objectives: The aim of the present study was to observe the antibiotic sensitivity pattern of isolated uropathogens from urine samples of patients attending at Shahabuddin Medical College & Hospital, Dhaka, during the period of July 2008 to June 2009. Result: A total of 555 urine samples were studied; of which 84 (15.13%) were culture positive. Among 84 culture positive cases, 84 isolates were identified. Among the isolates, E.coli was the most predominant 61 (62.88%) followed by Enterococci 11 (11.34%), proteus 4 (4.13%) and Pseudomonas 3 (3.09%). Whereas Staphylococcus saprophyticus and Klebsiella showed frequency rate of 2 (2.06%) for each. However Gram positive cocci showed lowest frequency rate of 1 (1.03%). All of the isolates were sensitive to Netilmicin. The majority of isolates were sensitive to Imipenam (92.3%) followed by Amikacin (91.1%), Meropenam (83.3 %), Tetracycline (70%). Sensitivity & resistance rate were same (50%) in Vancomycin & Cefodoxime. Where complete (100%) resistance was shown to Ampicillin, Azithromycin and Cefoxitin. However all isolates were poorly sensitive to cotrimoxazole (35.7%), ciprofloxacin (43%) and nitrofurantoin (44.8%). Conclusion: So, routine urine culture and susceptibility before therapy should be encouraged and periodic evaluation of predominant organisms and their antimicrobial susceptibility pattern should be studied for appropriate selection of antibiotic for effective management of UTI cases.

ABO and Lewis Blood Grouping with ABH Secretor and Non-secretor Status: A Cross Sectional Study in Dhaka.

A cross sectional study was done with 42 apparently healthy persons aged 6 years and above from both sexes. Most of them are blood donors in the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Few, other than blood donor, were selected from the same locality. Five ml venous blood was collected with all aseptic precautions. ABO blood grouping and Lewis phenotyping were done by tube method. ABO reverse grouping was also done from serum. With all precautions 2 ml of saliva was collected from all subjects. Secretor status was detected from the saliva by haemagglutination inhibition method. ABO blood grouping shows 36% 'O' group, 24% 'A' group, 33% 'B' group and 7% 'AB' group. Distribution of Lewis phenotype are Le(a+b-) 19%, Le(a-b+) 53%, Le(a-b-) 26% and Le(a+b+) 2% only. 60% of study population was ABH secretor and 40% non-secretor.

Burns during pregnancy: a socio-cultural disease.

Burns during pregnancy poses a serious threat to the life of baby, as well as to the mother. More severely it is associated with various social and economical problems, as well as associated with illiteracy and poverty which many cases complicate its prevention. Burns during pregnancy influence maternal as well as foetal outcome. Keeping this in view a comprehensive task was undertaken to assess the maternal and foetal outcome in relation to burn extent and gestational age of foetus. A total of thirty two cases of burn females with pregnancy were analyzed. There were 23 maternal and 26 foetal deaths. Percentage of abortion during the third trimester was highest. Rate of maternal mortality increased with percentage of Total Body Surface Area (TBSA) burnt. Maximum incidence of maternal mortality rate was with cases of burns involving more than 50% TBSA.

Glucose-6-Phosphate Dehydrogenase (G6PD) Status in Neonatal Jaundice and Its Relationship with Severity of Hyperbilirubinemia.

Background: G6PD deficiency is one of the common inherited enzymatic disorder associated with high incidence of severe neonatal hyperbilirubinemia. Objectives: To observe G6PD status in male, term neonates with jaundice and its correlation with serum level of bilirubin. Methods: This cross sectional study was conducted on 90 male, term neonates with jaundice, age ranged from 3 to 12 days (Group B) in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) between July 2007 to June 2008. On the basis of total serum bilirubin (TSB) level, study group was further divided into B1(TSB <15mg/dl), B2(TSB 15-20mg/dl) and B3 (TSB>20mg/dl). For comparison age and sex matched 30 apparently healthy neonates (Group A) were also included in the study. Erythrocyte G6PD level was measured by Spectrophotometric method by using kit of Randox. Serum bilirubin level was measured by standard laboratory technique. For statistical analysis ANOVA, independent sample “t” test and Pearson’s correlation coefficient test were performed as applicable by using SPSS windows version-12. Results: In this study, erythrocyte G6PD levels were significantly lower in moderate (p<0.01) and severe (p<0.001) hyperbilirubinemic group in comparison to that of control group . However, this enzyme level was lower in mild group compared to that of control but the difference was statistically non significant. Again, this enzyme levels were significantly lower in moderate (p<0.05) and severe (p<0.01) group than that of mild group and also between severe and moderate hyperbilirubinemic group (p<0.05). In this study, G6PD enzyme deficient were found in 1(3.33%) and 6(20%) subjects of group B2 and B3 respectively. Though, percentage of the subjects with enzyme deficiency were higher in severe group ( B3 ) compared to that of moderate group( B2 ) but the difference was statistically not significant. However, no enzyme deficient patient were found in control group (A) and mild hyperbilirubinemic group (B1). Serum bilirubin level showed significant (p<0.05) positive (r=+.429) correlation with erythrocyte G6PD level in control group (A). On the other hand, this level was negatively correlated with G6PD enzyme in groups B1 (r= -.127), B2 (r=-.120) and B3( r= -.671) but significant negative correlation in group B3 (p<0.01). Conclusion: The results of the study revealed that severity of hyperbilirubinemia depends on degree of G6PD deficiency. Therefore, early detection of this enzymopathy and close surveillance of the affected neonates may be important in reducing the complications of severe hyperbilirubinemia.

Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition.

The present study has been designed to estimate serum total protein and albumin levels in different grades of protein energy malnutrition and this will be helpful in early diagnosis, management and rehabilitation of PEM. The serum total protein and albumin levels were studied on 20 healthy children and 30 children suffering from protein energy malnutrition of different grades. Serum total protein and albumin levels of different grades of protein energy malnutrition were significantly lowered than that of control. Lowering being maximum in grade III PEM. This lowering of total protein and albumin occur in any form of PEM and related to severity of the disease.

Comparative study between clinical and sonographic estimation of fetal weight in third trimester of pregnancy and its relationship with actual birth weight.

This prospective study was undertaken to assess the accuracy of clinical and sonographic estimated fetal weight (EFW) in Bangladeshi population. The study protocol consisted of achieving clinical followed by sonographic estimated fetal weight (uEFW) using Shepard formula and then its correlation with actual birth weight (BW). A total of 140 pregnant women participated in this study. The study was conducted in the department of Radiology & Imaging and in the department of Gynae & Obs., Bangladesh Medical College Hospital (BMCH) from January 2005 to December 2005.Maximum number of patients belonged to 26-30 years age group and the mean +/-SD age of the study patients was 26.8+/-4.7 years. Maximum number of women (41.4%) was primigravida and 24.3% women were second gravida. The mean+/-SD gestational age of the patient was 35.9+/-2.8 weeks. We found, clinically EFW was 3432.1+/-410.1 gm (mean+/-SD) and uEFW was 2715.4+/-509.1gm (mean+/-SD) with difference 716.7+/-278.5 gm (mean+/-SD), (P<0.001), which is highly significant. Babies who were delivered within 1st week of clinical and sonographic EFW were selected and their weights were compared with actual BW. The Pearson correlation chi square test and student 't' test were the statistical analysis used. It was found that the P value of clinical versus actual BW was <0.05, this was significant. P value of sonographic versus actual BW was >0.05, this was not significant. Percent error (PE) was found 2+/-7.33% in calculating uEFW from actual BW with minimum error -23.9% and maximum error 11.81%. This study conducted on Bangladeshi fetus using the Shepard formula showed that the actual BW recorded after delivery of the fetus is more close to uEFW than clinically EFW.

Prenatal diagnosis of achondroplasia.

A 25 years old lady came to Centre for Nuclear Medicine and Ultrasound, Mymensingh for ultrasonographic evaluation of gestational condition. Transabdominal ultrasonogram showed mal development of skeletal system with abnormally shortened limbs. This seems to be a case of achnodroplasia, which was proved subsequently true after termination of pregnancy.

Placenta previa and it's relation with maternal age, gravidity and cesarean section.

The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

Prevalence of antithyroid microsomal antibody in thyroid patients of endemic goitre area.

The region of greater Mymensingh known for iodine endemicity, recently came under iodine supplementation as a result of mandatory universal iodination of salt program. Autoimmune thyroid diseases (AITD) are among the most common human autoimmune disorders & presence of autoantibodies to the microsomal antigen (AntiMCAb) is a hallmark of disease activity. Both iodine deficiency & iodine supplementation precipitate increase rate of autoimmunity to the thyroid gland. Study was undertaken to determine prevalence of AntiMCAb positive cases among patients with various thyroid diseases. High resolution ultrasound (HRUS), serum thyroid hormone assays & scintiscan were used to classify the thyroid patients into 8 categories. 221 patients were studied during the stipulated period of 3 months. Male patients were 60 & female patients were 161. Age ranged from 11 to 65 years with median age 29.4 years. AntiMCAb test were done with radioimmunoassay (RIA). 126 patients had antimicrosomal antibody (57.01%). All form of hypothyroid (atrophic, goitrous, Hashimoto's) have very high rate of AntiMCAb positive cases. Highest 89.28% were seen in patients showing feature of Hashimoto's thyroiditis or generalized feature of AITD in HRUS with hypothyroidism, followed had 61.29% positive cases, However, antithyroid antibody was found in all form of thyroid disorders. Nodular goiter had 21.73% antiMCAb positive cases. AntiMCAb found positive at the rate of 33.33% in euthyroid patients with HRUS feature of AITD & diffuse euthyroid goiter, 40% in subclinical hypothyroid, 40% in subclinical hyperthyroid. Female rated higher in range of antimicrosomal antibody positivism. 59% of all thyroid patients among female subjects were AntMCAb positive, where as 51.67% male thyroid patients were positive. Highest number of positive cases found in the 30-35 age group. No definite pattern, however, was observed among age distribution. 20 age matched sample from patients unsuspected of thyroid disease shows 10% AntiMCAb positive compared to 73.33% of the same among same age group of thyroid patients. Frank Hashimoto's thyroiditis with positive antiMCAb and hypothyroidism were all detected by HRUS.

Hydrops fetalis: report of 3 cases.

Ultrasound is a well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. Reported cases are hydrops fetalis diagnosed during ultrasonic evaluation of fetal condition in the Center for Nuclear Medicine and ultrasound (CNMU), Mymensingh. Only fetal ascites was detected in one case of 26 +/- 2 wks of gestation, fetal ascites with hydramnios and thick placenta was seen in another case of 28 +/- 2 wks of gestation. In third case, there was fetal ascites, scalp edema, hydrothorax and myelomeningocele with oligohydramnios at 20 +/- 2 wks of gestation; sonographic diagnosis was hydrops fetalis with myelomeningocele. Follow up was advised in first two cases and third case was terminated electively. To decrease the mortality rate and to improve the outcome of hydrops fetalis cases appropriate prenatal investigations and therapy is needed. Recent advances in prenatal ultrasound have made possible the early detection of hydrops fetalis which is helpful for proper management in time.

Abdominal wall defect: a case report and review.

Ultrasound is well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. However, precise diagnosis of fetal anomaly with gray scale ultrasound may not be possible at times. Color Doppler ultrasound compliments gray scale ultrasound in accurately diagnosing fetal anomaly. We report a case of an omphalocele with short lower limbs, diagnosed during 3rd trimester on the basis of color Doppler ultrasound. Gray scale ultrasound failed to diagnose the condition initially. Color Doppler sonography helped in accurate diagnosis. Findings were confirmed after termination of pregnancy.

Multiple papilloma of the larynx in an adult--a case report.

Multiple papilloma of the larynx commonly affects the juvenile subjects. Only a few adult cases have been reported. Such a rare case in Bangladesh, is reported here. Twenty five years old one male patient was admitted into Sir Salimullah Medical College & Mitford Hospital with the complaints of hoarseness of voice & dysponea. He was diagnosed as papilloma clinically and histopathologically, and treated with tracheostomy & microlaryngoscopic excision of the masses. The patient was readmitted after 3 months with recurrence of papilloma at the same site and the growth was excised under anaesthesia. The past history of his illness revealed that he underwent to more surgeries for the same condition. The patient was lost to follow up.

Effect of norethisterone oenanthate-a long acting injectable contraceptive on cervical mucus changes in adult female virgin rats.

The effect of Norethisterone-oenanthate (NET-OEN), a long acting injectable contraceptive on cervical spinnbarkeit and protein content were studied in adult female virgin rats. A single injection of NET-OEN (1 mg/rat) and sacrificed after 3 vaginal cycles produced a highly significant reduction (P less than 0.001) in the spinnbarkeit and a non-significant increase in the protein content of the cervical mucus. But two successive injections of NET-OEN (1 mg/rat each) produced a highly significant decrease (P less than 0.001) in the spinnbarkeit as well as a significant increase (P less than 0.01) in the protein content. The increased protein content of cervical mucus corroborates the hypothesis that NET-OEN exerts its contraceptive effect primarily through effect on cervical mucus.

Effect of norethisterone oenanthate-a long acting injectable contraceptive on cervical mucus changes in adult female virgin rats.

The effect of Norethisterone-oenanthate (NET-OEN), a long acting injectable contraceptive on cervical spinnbarkeit and protein content were studied in adult female virgin rats. A single injection of NET-OEN (1 mg/rat) and sacrificed after 3 vaginal cycles produced a highly significant reduction (P less than 0.001) in the spinnbarkeit and a non-significant increase in the protein content of the cervical mucus. But two successive injections of NET-OEN (1 mg/rat each) produced a highly significant decrease (P less than 0.001) in the spinnbarkeit as well as a significant increase (P less than 0.01) in the protein content. The increased protein content of cervical mucus corroborates the hypothesis that NET-OEN exerts its contraceptive effect primarily through effect on cervical mucus.