Pregnancy with chronic myeloid leukemia: case report and literature review

Chronic myeloid leukemia (CML) is a rare condition during reproductive age. Still, women may present with pre-existing or newly diagnosed CML during pregnancy. The management of chronic myeloid leukemia during pregnancy requires balancing the well-being of the mother with that of fetus. Tyrosine Kinase inhibitors are considered the most effective drug against CML but they are still not considered safe during pregnancy and breast feeding. So, there is a need for management of CML with alternate drugs during pregnancy. Here we report a case of a 26-year-old lady who was diagnosed with chronic myelogenous leukemia (CML) at 20 weeks of gestation and had an atypical chromosome translocation t (9:22). She was managed jointly by obstetrician and haemato-oncologist for the remainder of her pregnancy and eventually she delivered a healthy baby at term.

Hysterosalpingography in Infertility.

Background: Infertility is a common medical problem. It can be due to problems in either partner, or both. Ovulatory dysfunction, tubal and peritoneal factors comprise the majority of female factor for infertility. Hysterosalpingography (HSG) plays an important role in the evaluation of abnormalities related to the uterus and fallopian tubes. Objective: The aim of this study was to evaluate the hysterosalpingographic findings of women with infertility in our setting. Materials and method: This cross sectional study was carried out in the infertility centre at BIRDEM, Dhaka, Bangladesh during the period of September 2002 to February 2003. Out of 100 infertile patients 50 infertile women of reproductive age (21-40 years) indicated for HSG were enrolled in this study. Results: Sixty percent patients had secondary infertility. Majority of the subjects of both primary and secondary infertility (55% and 60%) were in 26-30 years age group. On HSG any sort of uterine pathology was found in 10% cases and unilateral and bilateral tubal block were present in 24% and 20% cases respectively. Conclusion: Hysterosalpingography, a safe, less invasive procedure, has an important role in diagnosing uterine and tubal factors of infertility.

Time Required to Document Temperature by Electronic Skin Thermometer in a Healthy Neonate.

We studied the actual time taken to document temperature in a stable neonate by an electronic digital skin thermometer with automatic time beeper. We studied 100 neonates after initial stabilization. The mean time required for documenting the temperature by a electronic thermometer in axilla was 56.34±1.54 secs for term neonates (>2500g) and 54.87±1.23 secs for low birth weight (<2500g). The skin temperature measured simultaneously by the ordinary mercury thermometer kept for traditional 3 minutes supported the electronic measurement (P< 0.01).

Post operative diagnosis of osteopetrosis.

Osteopetrosis is a rare hereditary disease that was first described by a German Albert Schonberg in 1904. At least five types of osteopetrosis have been described. Among them osteopetrosis congenita (autosomal recessive) and osteopetrosis tarda (autosomal dominant) are most common. Here we are reporting a case of osteopetrosis tarda, who is a female of fifty years of age presented with fracture femur. Preoperatively there was no suspicion of osteopetrosis.She was only suspected while introducing an IM Nail during her fracture reduction. Diagnosis of osteopetrosis was confirmed post operatively by histopathology of medullary cavity of her femur.

Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis.

Modified Alvarado scoring system was evaluated regarding its usefulness in the early diagnosis of acute appendicitis and in reduction of the incidence of negative appendicectomies. One hundred and ten patients with a provisional diagnosis of acute appendicitis were studied prospectively at R G Kar Medical College and Hospital, Calcutta over a period of 10 months. High score was found to be a dependable aid both in the pre-operative diagnosis of acute appendicitis and in the reduction of negative appendicectomies in men and children but the same was not true for women who had a high false positive rate for acute appendicitis.

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.

Effect of black tea on teeth.

Dental caries is the prime cause of premature loss of teeth in children. Tea contains high percentage of fluoride along with polyphenolic constituents which act on GTF of S. mutans in plaque synthesis. Combination of fluoride and polyphenolic constituents inhibit caries activity.

Effect of Norplant on liver function.

Combined pills have known adverse effects on liver function. Progesterone based contraceptives are thought to be safer in this regard. The effect of Norplant, a levonorgestrel contraceptive implant, on liver function was evaluated in 149 Bangladeshi women of reproductive age in this study. Liver function tests and ultrasonography of hepato-biliary system were done before and after the implantation. The patients were followed upto two years. There were non-significant transient rise of serum bilirubin and slight enlargement of liver during the first year. There was no significant change in the levels of AST, ALT, alkaline phosphatase, total protein, albumin-globulin ratio and prothrombin time. The results suggest that Norplant has no adverse effect on liver function.

A clinicopathological study of infections in burn patients and importance of biopsy.

Thirty-four patients with burns were subjected to the clinicopathological study with special reference to culture of the wound and histological examination of the burned tissue. The commonest cause of burn was thermal burn (91.18%) followed by electric burn (5.88%) and chemical burn (2.94%). The maximum number of patients belonged to second and third decades of life (61.78%). Females were commonest victims, with male:female ratio was 1:1.6. On the 1st to 3rd postburn day (PBD) most of the wound remained sterile and Strept haemolyticus was first bacteria isolated on 1st PBD. Gram-positive and Gram-negative bacteria, specially pseudomonas, invaded the burn wound as early as 3rd PBD, it was more so with the patients of extensive burn. Among the Gram-positive bacteria Staph aureus was most notorious and invaded burn wound very early. Pseudomonas had maximum growth followed by klebsiella and Esch coli, multidrug resistance was more common with pseudomonas. Among the fungal infections Candida albicans had maximum incidence. Positive blood cultures for bacteria were seen during 2nd, 3rd and 4th postburn weeks. Pseudomonas was the commonest bacteria isolated. Biopsies were done in 17 patients and showed maximum incidence of bacterial infection followed by fungal infection. Patients with burn more than 60% of total body surface area (TBSA) had 100% mortality, while patients with 20-30% of TBSA burn had 20% mortality, the overall mortality was 50%. Biopsies of the burn wound played an important role in the accurate diagnosis and thus helped in starting early specific therapy to prevent death from sepsis.

Periampullary carcinoma following biliary ascariasis--a case report.

A 42 year old man presented with obstructive jaundice and cholangits. Ultrasonography (USG) revealed dilated intrahepatic biliary radicals and common bile duct (CBD). The bile duct also showed a curvilinear parallel intraluminal structure suggesting biliary ascariasis. The CBD was explored and a dead worm removed but jaundice persisted. Endoscopic retrograde cholangio pancreaticography (ERCP) was done showing a periampullary mass which on biopsy showed a villous adenoma with highly dysplastic changes. A Whipple's pancreaticoduodenectomy was performed and the growth proved to be a well differentiated periampullary adenocarcinoma.

HLA phenotype frequencies in pulmonary tuberculosis.

Susceptibility and/or immune response to tuberculosis may or may not be associated with particular histocompatibility leucocyte antigen (HLA) phenotype frequencies. The present study was undertaken to north eastern Indian population to verify any association between HLA phenotypes and immune response to mycobacterial antigen. HLA-typing was done in 60 well Tarasaki trays and T-cell subsets in each group were measured using Ficoll-hypaque nylon wool columns and dynabeads (M-450). No universal association with particular HLA-type and pulmonary tuberculosis has been confirmed.

Clinical down staging of cancer cervix with cytology.

A prospective study was carried out on 1500 patients attending the Gynaecology outpatient department of three referral hospitals in Dhaka City. These patients were selected on some selected clinical criteria to correlate several clinical markers (clinical down staging) with that of Pap's smear for early detection and secondary prevention of cancer cervix. Speculum examination and Pap's smear were done in all cases. Among 1500 women, 224 had abnormal Pap's smear. Histologic examination of specimens from these cases showed chronic cervicitis in 45 cases, dysplasia in 84 and squamous cell carcinoma in 95. Carcinoma was found in 130. Thus, there were 297 Pap's smear negative cases were biopsied on clinical ground. 225 cases of invasive carcinoma. From this study, it seems that clinical downstaging with cytology programme has to be started immediately throughout the country for diagnosis of carcinoma of the cervix in its preinvasive and potentially curable stage.

Hepatitis B virus infection in pregnant mothers and its transmission to infants.

Screening for serological markers of hepatitis B virus infection was done on 500 pregnant mothers. HBsAg, AntiHBs and HBeAg were done. HBsAg was positive in 3.6%, AntiHBs in 17.4% and HBeAg in 0.4% cases. The infants born to the asymptomatic HBsAg carrier mothers were followed up to 6 months to determine the vertical transmission of HBV infection. Rate of transmission of infection from HBsAg positive mothers to infants were 16.66% irrespective of HBeAg status, whereas it was nearly 100% in case of HBeAg positive mothers. All of the HBsAg positive infants developed the antigenemia between 3-6 months of age, supporting the hypothesis that intrapartum transmission is the major mode of vertical transmission.

General yeast infection in Bangladeshi women using contraceptives.

A study on the vaginitis due to candida infection among Bengali women using different contraceptives was carried out. A total of 368 patients using three different contraceptives (Pills, Injectables, IUD) and 316 age and parity matched women as control were studied. The incidence of vaginal yeast infection was highest (17.6%) among pill user. In control group, the incidence is lower (6.7%). The difference is statistically significant (P less than 0.05). No significant difference in vaginal yeast infection in women using other two types of contraceptives (Injection, IUD) in contrast to control group was found (P greater than 0.5). Candida albicans was the most common type of yeast infection (91.8%). No Torulopsis glabrata was isolated in this study. we did not find any relationship between duration of contraceptive usages and higher incidence of vaginal candidiasis (P greater than 0.5). This study also indicated that culture examination is much more sensitive than microscopic examination of vaginal swab in detecting yeast infection.

Male factors in infertility--a preliminary report.

Findings in 325 consecutive primary seminal analysis done at the Infertility Treatment Centre of IPGMR, are discussed. The clinical profile of the infertile couples was recorded. Semen was examined for quantity, sperm density, motility and morphology. An attempt was also made to correlate past illnesses with the quality of semen. 65 patients (20%) showed azoospermia, while 29 (8.9%) showed sperm count of less than 10 million/ml. History of past illnesses which contribute to azoospermia/oligospermia was obtained in 46% of azoospermia cases compared to only 10% in subjects showing sperm count of over 10 million/ml. Commonest association between azoospermia and past illness was found in the case of small-pox, where out of 31 subjects with past history of small-pox, 15 showed complete azoospermia, one showed sperm density of less then 10 million/ml.