Pattern of Tumor Lysis Syndrome in Patients with Acute Lymphoblastic Leukemia

Background: Prevention and treatment of tumor lysis syndrome (TLS) depends on immediate recognition of patients at risk. Therefore, we conducted this study to determine the frequency and risk factors of TLS in patients with acute lymphoblastic leukemia (ALL). Objective: The aim of the study was to observe the frequency of Tumor lysis syndrome in patients with Acute Lymphoblastic Leukemia.Material & Methods:This cross-sectional study was conducted at the department of Haematology in Bangabandhu Sheikh Mujib Medical University (BSMMU), over a period of 12 months following approval of this protocol. Total 50 patients admitted with ALL were included in this study after careful history taking, examination and appropriate investigations fulfilling inclusion and exclusion criteria, irrespective of their gender, race, ethnic group and age. Ethical issues were ensured properly. After briefing the aims and objectives and potential risk and benefits, written informed consent was taken from each subject. Interviews were done by investigator herself using separate case record form. After editing and encoding, data was analyzed by computer with the help of SPSS 24.Results:The mean age of patients was 21.24�.83 (SD) years with majority aged less than 20 years (54%) and male gender (62%). Prevalence of TLS was found to be 26% (n=13), wherein spontaneous onset (n=8, 61.54%) and lab TLS (n=9, 69.23%) was more frequent than therapy induced TLS (n=5, 38.46%) and clinical TLS (n=4, 30.77%). The most common biochemical changes occurred within 3 days before chemotherapy and 7 days after initiation of chemotherapy among TLS patients was hyperuricemia (69.23 and 76.92% respectively) and hyperkalaemia (61.54 and 69.23% respectively) with significant differences compared to non-TLS patients (p value <0.05). Initial WBC count and serum LDH of all patients was 52.51�.70 x109/L and 1591.53�95.47 U/L respectively, wherein majority patients with TLS had significantly higher WBC count ?50 x109/L (61.54%) and serum LDH ?1000 U/L (92.31%) compared to non-TLS patients (16.22 and 21.62% respectively, p value <0.05). Multivariate analysis showed that serum LDH ?1000 U/L was the significant independent predictors of developing TLS (OR=13.07, 95% CI: 1.93-101.23).Conclusions:TLS was commonly found in patients with ALL, wherein spontaneous onset and lab TLS was more common than therapy induced TLS and clinical TLS. However, a large multicenter study is needed to corroborate these findings.

Homozygous sequence variants in the WNT10B gene underlie split hand/foot malformation

Abstract Split-hand/split-foot malformation (SHFM), also known as ectrodactyly is a rare genetic disorder. It is a clinically and genetically heterogeneous group of limb malformations characterized by absence/hypoplasia and/or median cleft of hands and/or feet. To date, seven genes underlying SHFM have been identified. This study described four consanguineous families (A-D) segregating SHFM in an autosomal recessive manner. Linkage in the families was established to chromosome 12p11.1-q13.13 harboring WNT10B gene. Sequence analysis identified a novel homozygous nonsense variant (p.Gln154*) in exon 4 of the WNT10B gene in two families (A and B). In the other two families (C and D), a previously reported variant (c.300_306dupAGGGCGG; p.Leu103Argfs*53) was detected. This study further expands the spectrum of the sequence variants reported in the WNT10B gene, which result in the split hand/foot malformation.

Dimensional change in soft tissues with complete dental prosthesis and its effect on airway space and natural head position.

Background: Insertion of the intraoral prosthesis causes deflection of the tongue, soft palate affecting the patency of the airway. Aims: To evaluate the cephalometric soft tissue variation in tongue, soft palate, and its effect on posterior airway space in edentulous patients with the insertion of the denture. Settings and Design: Randomized controlled trial. Materials and Methods: Complete denture (CD) prosthesis was fabricated for first time denture wearers comprising 22 males and 18 females within the age range of 50–65 years. Lateral skull radiographs were taken for each of the subjects in their resting position without CDs (T0), with CDs (T1) at least 1‑week postinsertion and after 6 months of usage (T2), respectively. The reference points, lines, and angles on the cephalometric films were used to evaluate the position or inclination of the head, variations in tongue position and length, the changes in the anteroposterior dimension of the soft palate, and posterior airway space variations. Intra‑investigator error variance was not found to be statistically significant (P < 0.05). Statistical Analysis Used: Using Statistical Package for the Social Sciences (SPSS) v16.0 the significant difference in the paired samples (without CD and with CD) was found using the paired t‑test. The probability value P = 0.05 is considered as a significant level. Results: On comparison of T1 and T0, the heads were more extended with the downward position of the tongue with an increase in its length and the posterior airway space was decreased in T1. Significant differences in values were not observed between T1 and T2. Conclusions: With CDs, the change in airway space was related to alteration in soft palate and tongue dimension. There were no changes in dimension at 6 months follow‑up.

Platelet Rich Fibrin and Nanocry stalline Hydroxyapatite with Collagen Combination in Treatment of Periapical Lesion: A Novel Clinical Approach.

Aims: To use platelet rich fibrin (PRF), which is an autologous platelet concentrate, along with nanocrystalline hydroxyapatite with collagen for treatment of periapical lesion and negotiation of calcified canal of adjacent tooth. Case Presentation: A 19-year-old female reported to the Department of Conservative Dentistry and Endodontics with chief complaint of pain in maxillary right central incisor. Past dental history revealed trauma which she sustained 10 yrs back in the same region. On intraoral examination, there was a draining sinus, in relation to the apex of 11. Also discolouration and crown fracture was found in relation to 11. Periapical radiograph revealed a large diffused periapical radiolucency in relation to 11 and 12, open apex of 11 and calcified root canal in relation to 12. Technique Used in the Study: A periapical surgery under local anaesthesia was planned in the region of maxillary right anterior region in relation to tooth no 11 and 12. Before surgery calcified canal of tooth no 12 was negotiated. PRF and nanocrystalline hydroxyapatite with collagen combination were placed in bony cavity. Follow up of the case was done for period of 6 months. Discussion: In present case combination of nanocrystalline hydroxyapatite with collagen and PRF is used, as it helps in faster bone regeneration. Graft material is osteoconductive and collagen network provides a better scaffold for clot formation and bone regeneration. Conclusion: The combination of PRF and nanocrystalline hydroxyapatite with collagen has been demonstrated to be an effective approach to induce faster periapical healing in present case with large periapical lesion.

Role of documentary films in development of cultural awareness of adults

Aims: The study aims to find out documentary films in the development of cultural awareness and health education especially among adults and the nature of the materials and templates used by audio and visual effects, which depend on business documentaries and density patterns show documentary films

Methods: This study of descriptive studies, and used the survey methodology and the study population is all the programs presented to the National Geographic Abu Dhabi TV and sample analytical represented in the documentary films presented at the period from 1-1-015 to 31-1-2015 consisted study tools in the analysis of Form Group secured

Results: The study found that The intensity patterns show National Geographic Channel documentary health programs amounted to 82 hours of broadcast hours of total broadcast hours, which amounted to 744 hours by 11.02% during the study period, More documentary formats commonly used during the study period, the documentary program where the ratio was at 65%, then the chains 19% mold films 16% and relied on the moving image by 96% natural photo realism 100% and used drawings and graphics by 43% and visual effects by 73% and ranged Programs for between [30-45] sec. in 55% of them were moving the camera in 95% of the business and relied on foreign filming locations by 97%, and the idea was used in realistic business by 93% and more topics are the environmental, social and economic ValalmahValtarichah and Oktralohdav which sought to achieve is Althagavyah 85% and entertainment 40%, education 24%. Other elements of cultural awareness used is the use of technology, 47%, and preservation of the environment 36%, then 35% and affiliation were Allghalmstkhaddma in most foreign language programs are dubbed in Arabic and 84% due to the nature of the channel, which depends on the re-broadcast the National Geographic channel dubbed programs. The study concluded that it can Documentary Film to play an important role in the cultural awareness directing people to gain health and cultural information and urging them to change health concepts and directing them to follow proper behavior desired and contain documentary material health that exposure to teenagers on the scientific information simplified development progress in the mold programmatic interesting camera uses nature and the environment movements and visual and sound effects appropriate

Correlation between serum ferritin level and liver function tests in thalassemic patients receiving multiple blood transfusions.

Background: Multiple blood transfusions are the mainstay of thalassemic patients in order to combat the severe anemia. These frequent blood transfusions result in the excessive iron deposition, leading to multiple injuries to a variety of organs in the body. In response to these injuries, the levels of various enzymes are disturbed. The whole phenomena usually involve the interrelation of one parameter with some other. The present study aimed to estimate the levels of serum ferritin and hepatic enzymes and to find out any possible correlation between them in thalassemic patients receiving multiple blood transfusions. Methods: A total number of 90 thalassemic patients of both sexes ranging from 10-15 years, receiving multiple blood transfusions were included in the present study. Blood samples from all the patients were withdrawn and analyzed for the values of serum ferritin, hemoglobin and hepatic enzymes (serum alanine transaminase, serum aspartate transaminase, serum alkaline phosphatase). Pearson correlation coefficient was applied to observe correlation between serum ferritin level and hepatic enzymes. A P value of ≤0.05 was considered statistically significant. Results: The overall values of serum ferritin, and hepatic enzymes (serum Alanine Transaminase, serum Aspartate Transaminase, serum Alkaline Phosphatase) were remarkably increased than their normal values. However, hemoglobin level was considerably decreased in thalassemic patients. A weak positive insignificant correlation was observed between serum ferritin with hepatic enzymes and hemoglobin in thalassemic patients. Conclusion: Multiple blood transfusions cause iron overload in the body, which in turn, lead to increased serum ferritin levels in thalassemic patients. High levels of hepatic enzymes are somewhat correlated to serum ferritin concentration. However, the exact reason of elevated levels is still unclear. Further detailed studies should be conducted in order to identify the exact mechanism behind this and to search for the promising correlations of various parameters in thalassemic patients receiving multiple blood transfusions.

Antinociceptive and anti-inflammatory activity of the extract of lycopus europaeus on laboratory animals.

Aims: To evaluate the analgesic and anti-inflammatory effects of methanolic extract of Lycopus europaeus on experimental animal models. Methodology: The analgesic activity was evaluated by hot plate, acetic acid induced writhing and formalin induced writhing method in Swiss Albino mice divided into 4 different groups (control, standard diclofenac sodium and extract at two different doses of 250 and 500 mg/kg BW). The extract was also investigated for the anti-inflammatory effect on Long Evans rats using carrageenan induced rat paw edema method. For anti-inflammatory study, 24 rats were divided into 4 different groups each receiving either distilled water, standard drug or the extract at the doses of 250 and 500 mg/kg BW. Results: Phytochemical analysis of the extract revealed the presence of tannins, flavonoids and terpenoids. The extract elicited a highly significant (p<0.001) analgesic activity in a dose dependent manner on hot plate method, acetic acid induced writhing test and also on both the early and late phases of formalin test at the doses employed. In the hot plate method, the extract increased the reaction time of heat sensation to 60.81% and 66.52% at the doses of 250 and 500 mg/kg BW respectively while that of the standard drug was 57.40% at the 3rd hour of study. In acetic acid induced writhing test, the percent inhibition of writhing response by the extract was 62.87% and 70.66% at 250 and 500 mg/kg doses respectively (p<0.001) which were even better than the standard drug diclofenac sodium (50.30%). The extract also significantly inhibited the licking response at the dose of 500 mg/kg in both the early phase (55.11%, p<0.01) and the late phase (66.43%, p<0.01) of formalin test while the standard drug inhibited by 52.27% and 72.03%, respectively. The oral administration of the extract significantly (p<0.001) inhibited inflammatory response induced by carrageenan in a dose dependent fashion. The most prominent inhibition of 61.68% (250 mg/kg) and 73.65% (500 mg/kg) were observed at the 4th hour of study. Conclusion: The central and peripheral analgesic as well as anti-inflammatory effect of the methanolic extract of Lycopus europaeus may be due to the presence of various chemical constituents specially flavonoids, tannins, alkaloids or terpenoids. These experimental findings would further establish the scientific basis of the traditional uses of the plant in the management and/or control of pain as well as inflammatory conditions.Keywords: Basic needs, biodiversity conservation, women’s basic understanding.

Antipyretic study of methanolic bark extract of plumeriarubra, linn. in various pyrexia induced models.

To provide pharmacological evidence of plumeria rubra as antipyretic agent in practice many parts of Pakistan. Antipyretic effect of methanolic extract of the bark of plumeria rubra was investigated.on yeast , dinitrophenol and E-coli induced model. Intraperitoneal administration of yeast, dinitrophenol and E-coli in albino rabbits leads to pyrexia. Intraperitoneal administration of methanolic extract of the bark of plumeria rubra at a dose 100mg/kg body weight were shown significantly reduce the elevated body temperature of rabbit in yeast induced model which was compared with aspirin (Standard Drug) and solvent used. In dinitrophenol induced pyrexia, mixture of verapamil (2mg/kg) and Plumeria rubra (50mg/kg), while in In E-coli induced pyrexia, mixture of Ciproflaxacin (10mg/kg) and Plumeria rubra (50mg/kg), significantly reduced the elevated temperature in all models as compared to the standard drug Aspirin.

Presence of Helicobacter pylori Detected by PCR in Saliva of Male Smokers and Non Smokers with Chronic Periodontitis.

Aims: To assess the comparative presence of Helicobacter pylori (H. pylori) in saliva of smokers and nonsmokers with chronic periodontitis. Study Design: Male individuals diagnosed with chronic periodontitis with and without smoking habits were enrolled in the study. The unstimulated whole saliva was subjected to H. pylori DNA detection using real time PCR. The percent presence of H. pylori DNA among the groups, were statistically compared. Place and Duration of the Study: Department of Biochemistry and Department of Dentistry, Grant Medical College and Sir JJ group of Hospitals, Mumbai and Department of Microbiology, Sinhgad Dental College, Pune, between January 2010 and June 2010. Materials and Methods: A total of 48 males with severe chronic periodontitis (CAL≥5mm) were divided into two groups, Group I (n=30, mean age=44.2±5.88 yrs) with smoking habit, Group II (n=18, mean age 41.72±4.36yrs) without any smoking habit. Nonsmokers with slight chronic periodontitis (CAL<3mm) were enrolled as controls, Group III (n=16, mean age 39.64±5.04 yrs). Periodontal status was evaluated by measuring gingival index (GI), plaque index (PI), probing depth (PD) and clinical attachment loss (CAL). Salivary samples were subjected to real time PCR for detection of H. pylori DNA. Result: Periodontal parameters were significantly different between Group I and II compared to Group III (P=.001). Overall, H. pylori was not detected in Group III (100% negative), whereas 5.5% of Group II and 13.3% in Group I patients showed presence of H. pylori. Chi-square test showed a significant difference (P=.003) between Group I and Group III however it was seen that there was an insignificant difference between Group I and Group II (P=.312) and between Group II and Group III (P=.186). Conclusion: The smokers with chronic periodontitis may be at a relatively higher risk of H. pylori presence in the oral cavity, than non smokers. The study needs validation on a larger sample size.

Biaxial flexural strength of Turkom-Cera core compared to two other all-ceramic systems

Advances in all-ceramic systems have established predictable means of providing metal-free aesthetic and biocompatible materials. These materials must have sufficient strength to be a practical treatment alternative for the fabrication of crowns and fixed partial dentures. OBJECTIVES: The aim of this study was to compare the biaxial flexural strength of three core ceramic materials. MATERIAL AND METHODS: Three groups of 10 disc-shaped specimens (16 mm diameter x 1.2 mm thickness - in accordance with ISO-6872, 1995) were made from the following ceramic materials: Turkom-Cera Fused Alumina [(Turkom-Ceramic (M) Sdn Bhd, Puchong, Selangor, Malaysia)], In-Ceram (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany) and Vitadur-N (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany), which were sintered according to the manufacturer's recommendations. The specimens were subjected to biaxial flexural strength test in an universal testing machine at a crosshead speed of 0.5 mm/min. The definitive fracture load was recorded for each specimen and the biaxial flexural strength was calculated from an equation in accordance with ISO-6872. RESULTS: The mean biaxial flexural strength values were: Turkom-Cera: 506.8±87.01 MPa, In-Ceram: 347.4±28.83 MPa and Vitadur-N: 128.7±12.72 MPa. The results were analyzed by the Levene's test and Dunnett's T3 post-hoc test (SPSS software V11.5.0 for Windows, SPSS, Chicago, IL, USA ) at a preset significance level of 5 percent because of unequal group variances (P<0.001). There was statistically significant difference between the three core ceramics (P<0.05). Turkom-Cera showed the highest biaxial flexural strength, followed by In-Ceram and Vitadur-N. CONCLUSIONS: Turkom-Cera core had significantly higher flexural strength than In-Ceram and Vitadur-N ceramic core materials.

Dyspepsia: Family physician's view

Dyspepsia is a common problem with a variety of presentations. It is described as upper abdominal [epigastric] pain or discomfort and is often associated with fullness, belching, bloating, heartburn, food intolerance, nausea and vomiting. There are different causes of dyspepsia and there are different options of treatment as well. The introduction of new modalities of treatment has revolutionized the management of dyspepsia