Interdigitated versus sequential high-dose-rate intracavitary brachytherapy with external beam radiotherapy in locally advanced carcinoma cervix

Aims: To decrease overall treatment time (OTT) and to compare the clinical outcome of interdigitated high-dose-rate intracavitary brachytherapy (HDRICBT) versus sequential HDRICBT with external beam radiotherapy (EBRT) in the treatment of locally advanced carcinoma cervix. Methods: Eighty-two patients with histologically confirmed carcinoma of the cervix, untreated International Federation of Gynecology and Obstetrics Stage IIB–IIIB, were included and randomized into two groups. The study group received EBRT 50 Gy/25 fractions with interdigitated HDRICBT 8 Gy/fraction weekly a total of three fractions. Patients in the control group received EBRT 50 Gy/25 fractions with sequential HDRICBT 8 Gy/fraction weekly a total of three fractions. At the end of the study, results of both groups compared in terms of OTT, acute and late toxicities, and response to therapy clinically. Results: A total of 82 patients were enrolled 41 in each arm. Seventy-two patients completed treatment and were analyzed. Mean OTT in study group and control group was 40 and 60 days, respectively. The median follow-up duration was 10 months (3–18). Most of the acute and late toxicities were of Grade 1 and 2 type and comparable in both study and control groups. Treatment interruption due to treatment-related toxicity was slightly higher in the study group than the control group, but it was statistically insignificant. Os negotiability was not found to be a limiting factor for interdigitated HDRICBT. Conclusion: Interdigitated HDRICBT has equivalent response and toxicities as sequential HDRICBT with the advantage of significant reduction in OTT

Treatment Seeking in Reproductive Age Women with RTIs/STIs : A Community based Cross-sectional Study.

The socio-cultural and economic contexts in developing countries influence the epidemiology or STls and helps in making them an important public health priority. This study was carried out to explore the health care seeking pathway of the women suffering from RTls/STls. influence or major socio-demographic variables on treatment seeking pattern. This cross sectional study was carried out comprising or eight hundred reproductive age (15-49 years) women selected following a multistage sampling procedure. The information pertaining to health seeking behaviour were collected from them using a pre-designed pretested interview schedule. Quantum of RTls/STls in the study group was estimated and symptomatics were asked specially about time lag between appearance of symptoms and seeking acre; reason for not seeking care; outcome of treatment they have taken if any. Out of total 359 subjects with symptoms of RTls/STls only about one-third (37.3%) had sought treatment. Only a few (4.5%) had sought treatment within 1 month of appearance of symptoms. Considering it to be physiological about half of the subjects (45.3%) did not seek treatment. The treatment seeking pattern was highly associated with the level of education (p=0.000). Reluctance in seeking treatment, delay in its initiation, prelerencc for unqualified practitioners in first consultation and significant association between education and treatment seeking pattern emphasize BCC and service provision for control and prevention of RTls/STls.

Drug abuse and addiction.

Among the social and medical ills of the twentieth century, substance abuse ranks as on one of the most devastating and costly. The drug problem today is a major global concern including Bangladesh. Almost all addictive drugs over stimulate the reward system of the brain, flooding it with the neurotransmitter dopamine. That produces euphoria and that heightened pleasure can be so compelling that the brain wants that feeling back again and again. However repetitive exposure induces widespread adaptive changes in the brain. As a consequence drug use may become compulsive. An estimated 4.7% of the global population aged 15 to 64 or 184 million people, consume illicit drug annually. Heroin use alone is responsible for the epidemic number of new cases of HIV/AIDS, Hepatitis and drug addicted infant born each year. Department of narcotic control (DNC) in Bangladesh reported in June 2008 that about 5 million drug addicts in the country & addicts spend at least 17 (Seventeen) billion on drugs per year. Among these drug addicts, 91% are young and adolescents population. Heroin is the most widely abused drugs in Bangladesh. For geographical reason like India, Pakistan and Myanmar; Bangladesh is also an important transit root for internationally trafficking of illicit drug. Drug abuse is responsible for decreased job productivity and attendance increased health care costs, and escalations of domestic violence and violent crimes. Drug addiction is a preventable disease. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives. Most countries have legislation designed to criminalize some drugs. To decrease the prevalence of this problem in our setting; increase awareness, promoting additional research on abused and addictive drugs, and exact implementation of existing laws are strongly recommended. We should also deserve renewed attention on prescription drug abuse. It is imperative that as a nation we make ourselves aware of the consequences associated with drug abuse. Otherwise devastating effects of drug will destroy the manpower and economic growth of the country.

The Dominance Pattern of Coronary Artery of Adult Bangladeshi People- A Postmortem Morphological Study.

Background: Incidence of the heart disease increases day by day in Bangladesh. Recent advances in cardiac surgery and the search for new techniques toward investigation of the heart are demanding a review of the anatomy of the coronary arteries. Method: The present study was performed on sixty (60) adult postmortem human hearts of Bangladeshi people. The samples were divided into 3 age groups: Group A (20 to 40 years) consists of 35 male & 7 female samples, Group B (41 to 60 years) consists of 3 female samples and Group C (61 to 75 years) consists of 7 male samples. Results: In the present study, dominance pattern of the coronary artery was right for male in-group A, B, C were 32 (91.4%), 7(87.5%), 6(85.7%), respectively and for female were 6 (85.7%). 3 (100%) respectively. It was left for male in-group A, B, C were 3 (8.6%), 1 (12.5%), 1(14.3%), respectively and for female was 1 (14.3%). Conclusion: The results of the present study can be helpful to the cardiologists and cardiovascular surgeons in the proper diagnosis and management of the heart diseases.

Serum HDL-cholesterol in women using low dose oral contraceptives.

This study was done to appraise the effects of low-dose oral contraceptives (OCs) containing 30microgm ethinyl estradiol and 150microgm levonorgestrel on lipid metabolism by a lipid variable-serum HDL-cholesterol (HDL-C). HDL-C has been identified as a lipoprotein that protects against atherosclerosis and its levels are inversely proportional to the risk for developing ischemic coronary disease and venous thromboembolic disorders. Ninety young women within reproductive age group were picked for this study. Sixty women using low-dose oral contraceptives served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCs users for last one-year group, three-year group and five-year group. The result showed that there was no significant difference on serum HDL-cholesterol levels between users & non-users women. It is concluded that low-dose oral contraceptives regimens did not significantly affect the lipid metabolism. It can be safely used as contraceptive & non-contraceptive purposes. The value of studied parameter for serial longer duration of OCs uses needs to be assessed.

An in vitro microleakage study of different filling materials using dye penetration method.

In the present study, the marginal integrity of different filling materials was evaluated in invitro. Furthermore, the effect of manipulation technique on their microleakage was also investigated. A total of sixty standard prepared class V cavities were filled with glass ionomer cement (both auto-cured and light-cured), light cured packable variety composite resin pretreated with echant and bonding agent and dental amalgam (both mechanically and conventional hand mixed) with or without pretreatment by cavity varnish. Cavities were then subjected to microleakage test following thermocycling. Statistical analysis was performed by One way ANOVA and Sheffe's multiple comparison tests. The results showed that mechanically mixed Silver Amalgam pretreated with cavity varnish showed the least microleakage, whereas, autocured glass ionomer showed highest marginal leakage. Light-cured packable composite was superior in resisting microleakage than both types of glass ionomer but was inferior to dental amalgam in the same respect. From this study, it can be concluded that composite resin can be used to fill class V cavities for esthetic reason but their properties should be improved.

Genetic fine structure analysis of helicobacter pylori isolates before and after treatment.

BACKGROUND: Eradication of H. pylori infection cures peptic ulcer disease and conversely, relapse is associated with reappearance of H. pylori infection. However, it is not clear whether the recurrence of ulcers following H. pylori eradication is due to recrudescence (identical strain) of the previous infection or as a result of exogenous reinfection (different strain) by another strain. The aim of the present study was to analyze the FAFLP patterns of pre and post treatment H. pylori samples to check if the recurrence was due to recrudescence or reinfection. MATERIALS AND METHODS: 24 of 30 duodenal ulcer (DU) subjects screened for H. pylori infection were positive for H. pylori infection. The treatment regime included pantoprazole, ciprofloxacin and amoxicillin. The patients were called for a repeat endoscopy after one month and screened for H. pylori infection. FAFLP analysis and PCR for the cagA and vacA gene was performed for the pre and post treatment samples. RESULTS: Of the 24 positive H.pylori patients, only 6 were negative after treatment and the remaining 18 were positive for H.pylori infection. The analysis of the pre and post treatment samples of the 18 patients showed that the FAFLP profiles of the initial and follow-up pools were similar to one another. CONCLUSION: It can be concluded that in the present series of patients, reinfection was due to recrudescence of infection due to incomplete eradication. The study also suggests that DNA fingerprinting by FAFLP provides discriminatory and complementary data for identifying strains of H. pylori while monitoring therapy.

Effect of oestrogen replacement therapy on bone mass in post-menopausal Bangladeshi women.

The female population comprises 48.66% of our total population, of which 10.30% are above the age of 49, many of whom are post-menopausal. Menopause is associated with bone-loss and its consequences. Hormone replacement therapy (HRT), particularly replacement of estrogen, prevents bone-loss. We undertook this prospective case-controlled study to find out whether or not HRT is beneficial to our women. A total of 106 patients were studied, amongst them 60 were cases and 46 were controls. The women in the first group were given either conjugated equine estrogen alone (surgical menopause group) or conjugated equine estrogen plus cyclical progesterone (natural menopause group). Results showed that there was 4.29% increase in bone mineral density in women who received hormone replacement therapy (HRT). This increase was 5.23% in early and 3.56% in late menopause group. Women with natural menopause gained more bone mass (4.22%) than women with surgical menopause (3.9%). Our results also showed that women who denied HRT (controls) lost bone mass (5.26%), the loss was more in those with surgical menopause (6.24%) than those with natural menopause (4.87%). Therefore it can be concluded that post-menopausal hormone replacement therapy prevents bone-loss. However, to evaluate the beneficial effect of long-term HRT, further studies with larger samples are recommended.

Incidence of cancer breast at Aligarh.

Breast cancer is a worldwide problem but its frequency varied from place to place. One hundred twenty-four breast cancer cases were reported during the ten years of survey at Aligarh constituting 12.4% of all malignant lesions. Peak incidence was found between the age of 41 and 50 years. More patients were from lower socio-economic group belonging to both Hindu as well as Muslim communities. Nearly 90% of cases had their menarche by the age of 14 years. Male breast cancer was 4%. Right breast was more commonly affected than that of the left. The upper and outer quadrant was involved in more than one-third cases and more than half the lesions occurred in upper half. There were 97.6% of epithelial and 2.4% of stromal tumours. Among epithelial tumours, highest incidence (72.38%) was that of invasive duct carcinoma followed by medullary, colloid and Paget's disease.

Stromal cellular response in breast tumours and allied lesions.

Histopathological study for stromal cellular response was made on 200 cases of benign and dysplastic lesions and malignancy of breast. Infiltrations with lymphocytes and plasma cells were observed in 64% cases of fibroadenoma, 66.6% cases of giant fibroadenoma, 61% cases of mammary dysplasia and 33.3% cases of gynaecomastia. While mast cell infiltration was not observed in giant fibroadenoma, its presence was observed in 92% cases of fibroadenoma, 77.8% cases of mammary dysplasia and 33.3% cases of gynaecomastia. Lymphocytes and plasma cells infiltrations were observed in 100% of cases of invasive duct carcinoma, medullary carcinoma and fibrosarcoma. Comedocarcinoma showed infiltration with these cells in 75% of cases while that for colloid carcinoma and Paget's disease of breast were observed in 50% of cases of each. Infiltrations with mast cells were observed in 92.3% cases of invasive duct carcinoma, 75% cases of comedocarcinoma and 25% cases of medullary carcinoma. Other malignant conditions of breast did not show mast cell infiltration. Degree of infiltration with lymphocytes and plasma cells was mainly of low grade in benign and dysplastic lesions compared to high degree of infiltration in malignancy. Mast cell infiltration was of low degree in both the types of lesions.

Study of food habits, food practices and taboos in Bangladesh: their implications in nutrition education.

The paper reports the findings of a retrospective study conducted to determine the prevailing food habits, food taboos and practices among 381 mothers selected randomly from twelve villages situated in 4 administrative divisions of Bangladesh. Undesirable food taboos and practices, maldistribution of food, lack of understanding of the nutritional needs of the vulnerable groups and bad cooking practices were found to be widespread in rural Bangladesh. Nutritional and health implications of these are discussed and remedial measures suggested.

Studies on the nutritional status of expectant mothers and newborn babies.

Heights, weights, haemoglobin, total proteins and albumin-globulin (A/G) ratio of 157 pregnant women in their last trimester of pregnancy are reported along with heights, weights, haemoglobin and albumin-globulin ratio of newborn babies. The results have been discussed.

The causal role of hypoalbuminemia in human nephrotic hyperlipidemia.

Serum lipids and their lipoprotein fractions were measured in 16 nephrotic syndrome patients. All component of lipids and beta-lipoprotein fractions (LDL) showed an increase in all uncomplicated patients. The increase in serum lipids were inversely proportional to the albumen level in these patients. In 3 patients, lipids and beta-lipoprotein fractions returned to near normal after treatment, the proteinuria diminished and serum albumen became normal. Most of these patients did not need any treatment for hyperlipidemia.