Diagnosis of cervical lesion by colposcopy, VIA, pap smear tests, and their correlation with histopathology in a tertiary level laboratory in Chattogram, Bangladesh

Background: Cervical carcinoma is one of the most common causes of mortality among women. This mortality rate can be reduced by early detection of cervical neoplasm by different screening tests. The main objective of this study was to diagnose cervical diseases by colposcopy, by pap smears for cytological examination as well as correlate these findings as screening tests with histopathological diagnosis. Methods: In this cross-sectional observational study, total 143 cases were included. History was taken and clinical examination was done. Colposcopy and VIA test was done, pap smear sample was collected and reporting was made. Cytological findings were correlated with histopathology. Results: Mean age of the study cases was 41.2±11.5 years. VIA test was positive in 98 study cases (68.5%). On colposcopy, most of the cases show neoplastic proliferation (80 cases, 55.9%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). Sixty-three (63) cases (44.1%) were non-neoplastic. Most of the biopsies was diagnosed histopathologically as cervical intraepithelial neoplasia-I (CIN-I) (20 cases, 14.0%). Association of colposcopy findings with histopathological diagnosis was done which was significant. Sensitivity of diagnosis of cervical malignancy by colposcopy was 33.33% and specificity was 98.57%. Conclusions: The study provides good cyto-histopathology correlation in detecting different cervical lesions and malignancy with colposcopy. Although colposcopy sensitivity was low but it can be increased by adequate training and avoiding technical errors. Bethesda system is strongly recommended for adequacy of sampling to minimize inconsistency. Early and regular screening should be advised for reduction of mortality rates from cervical carcinoma.

Mitral Annular Calcification is Associated with Severe Coronary Artery Disease in Patients Under 65 Years Old.

Background: Mitral annular calcification (MAC) is degenerative, fibrous calcification of the mitral valve annulus. It is more common in people over 70 years old. It is a marker of increased cardiovascular risk which occurs in a graded fashion by MAC severity. The aim of this study was to evaluate the association of Mitral annular calcification with severity of coronary artery disease (CAD) in patients under 65 years old. Methods: A total of 140 patients with IHD were enrolled by purposive sampling. Study populations were divided into MAC group and non MAC group. MAC was detected by Trans-thoracic echocardiography as an intense echo-producing structure located at the junction of the atrio-ventricular groove and posterior mitral leaflet in parasternal long axis view. MAC is measured in millimeters from the leading anterior to the trailing posterior edge and quantified as mild to moderate (1 to 4 mm) and severe (>4 mm) considering its thickness. Assessment of angiographic severity of CAD was done in the same hospital stay by Vessel score, Friesinger score and Leaman score. Results: Patients of MAC and non MAC groups were similar in terms of age and sex. Smoking (p=0.001) and family history of IHD (p=0.03) were significantly higher in MAC group. Anterior MI was significantly higher in MAC group (p=0.03). Left main and TVD were significantly higher in MAC group (p=0.001, p=0.01) whereas normal vessels were more in non MAC group (p=0.001). Intermediate and high Friesinger score (e”5) were significantly higher in MAC group whereas low Friesinger score (<5) were more in non MAC group. There was significant (p=0.01) positive correlation between MAC and CAD severity in terms of vessel score (r=0.76) Friesinger score (r=0.75) and Leaman score(r=0.42). Multivariate logistic regression analysis showed that MAC was independent predictors of significant CAD (p=0.02, OR= 2.84). Conclusion: Echocardiographically detected mitral annual calcification (MAC) can be an independent predictor of significant coronary artery disease. There is positive correlation between severity of MAC and severity of CAD. Cheap, available and radiation free nature of the echocardiographic detection of MAC may be a marker of significant CAD.

Abundance of Road Traffic Accidents among Medicolegal Postmortem Cases..

This retrospective study was conducted at the Dhaka Medical College (DMC) morgue during the period of Jan 2008 to Dec 2008. The objective of this study was to find out the abundance of Road Traffic Accidents (RTA) cases among medicolegal post mortem examinations performed at DMC morgue and in this relation to evaluate the present situation of RTA in our country. It has been observed that RTA cases are the most common cases among various types of medicolegal post mortems. A total of 2714 postmortems were conducted during the study period and out of which 813 (29.95%) cases were of RTA, among the victims 545 (67.03%) were male and 268 (32.96%) were female. Highest incidence (30.38 %) of RTA was observed among the age group 21 to 30 yrs. Most accidents occurred at daytime 282 (34.68%), followed by night 233 (28.66%). Greater number of accidents occurred during September 90 (11.07%), followed by January 85 (10.45%) and December 83 (10.20%). Commonest victims were pedestrians 564 (69.37%). Most accidents took place on highways 650 (79.95%) and buses were the most dangerous vehicle causing highest number of accidents 307 (37.76%), followed by truck 141 (17.34%). Among the cases 100% victims had multiple abrasion and bruise, laceration were present in 654 (80.44%), and intra cranial injury 527 (64.82 %).

Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus.

Background- People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome. People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes. We investigated the prevalence of metabolic syndrome in patients with newly diagnosed diabetes mellitus. Methods- It was a cross sectional study. The study was conducted in Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet & Diabetic Hospital, Sylhet. The study was conducted From July 2008 to June 2009 among 200 patients with newly diagnosed type 2 diabetic patients with age >20 years. Along with blood glucose, different components of metabolic syndrome was assessed, i.e. serum triglyceride level, serum HDL level, blood pressure and waist circumference. Results- Prevalence of metabolic syndrome was 73.5% according to NCEP-ATP III criteria, 81.0% according to modified NCEP-ATP III criteria, 82.5% according to modified WHO criteria and 61.0% according to IDF criteria. All variables other than waist hip ratio and fasting blood sugar had statistically significant higher mean values among patients with metabolic syndrome than patients without metabolic syndrome. Conclusion- It may be concluded that prevalence of metabolic syndrome is considerable in newly diagnosed type 2 diabetic patients in our population. The considerable prevalence of metabolic syndrome in our population is implicative of an alarming risk of cardiovascular disease in future.

Choledochal cyst.

Choledochal cyst, a congenital anomaly, is a premalignant condition. Progressive damage to the bile ducts and to the liver parenchyma may also have association with the condition. Subsequent risk of developing cholangiocarcinoma may be lessen by early diagnosis and prompt definitive surgical treatment, that may even permanently correct the condition. A young lady was admitted into Mymensingh Medical College Hospital and was presented with pain in the upper abdomen associated with intermittent vomiting for several months. Her per abdominal examination revealed an ill defined mass in the epigastrium and right hypogastrium with diffuse tenderness. Patients may also present with attacks of jaundice of obstructive type, but this was absent in this particular case. Diagnosis of choledochal cyst was confirmed by the ultrasound. On exploration, the cyst was excised and Hepatico-jejunostomy and jejuno-jejunostomy was done by Roux-en-Y method. Her post operative period was uneventful and followed up till to date. Purpose of this presentation is to emphasize early diagnosis and definitive treatment of this developmental anomaly that may predispose to malignancy.

Serum total protein, albumin and A/G ratio in different grades of protein energy malnutrition.

The serum total protein, albumin and serum A/G ratio was studied on 20 healthy children and 30 children suffering from protein energy malnutrition of different grade such as grade-I grade-II and grade-III. Serum total protein and albumin levels in grade-I grade-II and grade-III PEM were significantly lowers than control. Serum total protein between different grades of PEM was changed but not significantly. Serum A/G ratio of grade-1 & grade-II PEM were high than that of control, but not significantly. Serum A/G ratio of grade I and grade II PEM were higher than that of control, but not significantly. But in grade-III PEM this values were significantly higher than that of control. When comparison were done within the different grades of PEM, it was found that their A/G ratio were changed but not significantly.