Post-chemotherapy changes in retinal pigment epithelium in retinoblastoma eyes.

OBJECTIVE: Histopathological analysis of the retinal pigment epithelial (RPE) changes in retinoblastoma (RB) cases who received pre-surgical chemotherapy. DESIGN: Laboratory-based observational study. METHODS: Five-year analysis was performed to identify Retinoblastoma cases who underwent enucleation after receiving systemic chemotherapy. Grossly, RPE cells were observed in flat preparation in small calottes by staining with fluorescein stain in the raw specimens. They were documented under the objective of compound microscope and compared with hematoxylin and eosin-stained slides in the permanent tissue sections. RESULTS: Out of 51 cases of RB, post-chemotherapy enucleation was performed in 17 cases. Mean age of enucleation was 3.2 years. Endophytic RB (11 cases, 64.71%) was more common than the exophytic variety. Choroidal involvement was noted in 8 cases (47.06%), and optic nerve involvement was seen in 5 cases (29.4%). Focal and diffuse RPE changes were seen in one case each (5.88%). Central RPE cell changes near the cell nucleus were seen in all 17 cases (100%), which were documented by both fluorescein and Hematoxylin and eosin stain (100%). Drusens were observed in 8 cases (47.06%), and RPE proliferations were seen in 3 cases (17.65%). CONCLUSION: The study highlights the characteristic histopathological RPE changes after systemic chemotherapy in RB cases. These changes may be attributable to cell nucleus damage after chemotherapy.

Complete enucleation of a complicated solid pseudopapillary neoplasm of pancreas: A case report.

INTRODUCTION: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic tumor, usually affecting young females. It is categorized as a low-grade malignant tumor without any specific epithelial differentiation, which can occur anywhere in the pancreas. CASE PRESENTATION: Here, we present the case of a 35-year-old lady who presented to us with abdominal pain and a pancreatic mass. She had a prior laparotomy at a different center without any specific intervention for the lump. After presenting to our center, she was managed through proper evaluation and adequate preparation for surgery. The diagnosis was challenging, and so was the surgery. We had enucleated the lesion completely. Histopathology confirmed the diagnosis of SPN. There are no signs of recurrence after two years. DISCUSSION: Patients are either asymptomatic or usually present with abdominal pain, a large abdominal lump, or some vague symptoms. A high index of suspicion is the key to diagnosis. Complete resection is the gold standard of treatment. Enucleation is also a good option in difficult cases. The prognosis after surgery is excellent. CONCLUSION: Total enucleation of the SPN of the pancreas is a reasonable alternative in selected cases when performed by experienced hepatobiliary-pancreatic surgeons.

Neuroendocrine Tumor of the Ampulla of Vater: A Case Report.

Neuroendocrine tumors (NETs) of the ampulla of Vater are extremely rare. Here, we discuss the clinical presentation, diagnostic challenges, and treatment options of a recently experienced case of NET of the ampulla of Vater in light of the literature. A 56-year-old woman presented with recurrent upper abdominal pain. Ultrasonography (USG) of the whole abdomen showed multiple gallstones along with a dilated common bile duct (CBD). For evaluating the dilated CBD, a magnetic resonance cholangiopancreatography was performed, which revealed the double-duct sign. Subsequently, an upper gastrointestinal endoscopy showed a bulged-out ampulla of the Vater. Biopsy and histopathological examination of the growth yielded the diagnosis of adenocarcinoma. A Whipple procedure was performed. Macroscopically, a 2 cm growth was noted involving the ampulla of Vater, and microscopic findings were consistent with a well-differentiated NET, grade 1 (low grade). The diagnosis was further confirmed by immunohistochemical staining (pan-cytokeratin positive, synaptophysin positive, and focally chromogranin positive). Her postoperative course was uneventful except for delayed gastric emptying. A detailed evaluation and a high index of suspicion are required for the diagnosis of this rare tumor. Treatment is relatively easier after a proper diagnosis.

Intraocular and neuro-cysticercosis with diffuse stromal choroiditis.

Intraocular cysticercosis with central nervous system involvement is not that rare. We report a male child with a right-sided painful blind eye who had intraocular cysticercosis and granuloma in the left frontal lobe of the brain. There was an incidental finding of chronic inflammation in the choroid of that eye supported by histopathology. Immunohistochemistry for T-cells marker and B-cells marker was variable. The patient was treated with antiparasitic, anti-epileptic medications, and oral steroids subsequently.

Dietary supplementation of Bacillus-based probiotics on the growth performance, gut morphology, intestinal microbiota and immune response in low biosecurity broiler chickens.

A feeding trial was conducted to evaluate the effects of Bacillus-based probiotics on growth performance, intestinal histo-morphology, gut microbial population and immune response in broilers. A total of 2000 Hubbard Classic day-old chicks were randomly enrolled in four experimental groups and 4 replicates of 500 birds in each group, and reared for 35 days under a low- level of biosecurity measures. The trial groups were assigned treatment-1 (T1): basal diet(control), treatment-2 (T2): basal diet plus Bacillus licheniformis (DSM17236), treatment-3 (T3): basal diet plus Bacillus subtilis (PB6), and treatment-4 (T4) basal diet plus 4% Flavomycin. All four groups were fed with maize-soybean based prepared feeds (starter, grower and finisher). Dietary inclusion of B. licheniformis significantly improved body weight gain and lessened FCR in T2 compared to other groups (p < 0.05). Probiotics increased the population of Bacillus spp. and decreased the population of Clostrium perfringens, Salmonella spp. and Escherichia coli in the jejunum and ileum in broiler birds on day 21 and 35 (p < 0.05). The highest antibody production was observed in B. licheniformis treated group (T2) compared to other probiotic treated group (T1). Taken together, the study findings suggest that B. licheniformis probiotics could be used as a feasible alternative to antimicrobials in the broiler production considering beneficial impacts at low biosecurity broiler farms.

Effect of early and delay starting of enteral feeding in post-pancreaticoduodenectomy patients.

BACKGROUNDS/AIMS: This study was undertaken to see the effect of early starting of enteral feeding after pancreatoduodenectomy (PD). The results were compared with existing nutritional practice in which enteral feeding started, usually after 7 to 8 postoperative day (PODs) in our institute. METHODS: Thirty patients whome underwent a PD from January 2016 to December 2016 were included in the study. They were divided into two groups, I and II. In group I (n=15), enteral feeding was started from the 2nd POD through the nasojejunal feeding tube along with parenteral partial nutrition support. In group II (n=15), no enteral feeding was given up to seventh and eighth PODs, except the perenteral feeding. Post-operatively, serum albumin levels, total lymphocyte count, total bilirubin levels, serum alkaline phosphate levels were measured for two weeks postoperatively in all the patients for assessing nutritional, immunological and cholestasis status. The mortality, morbidity and lengths of post-operative hospital stay were also recorded. RESULTS: Postoperatively, the serum albumin level and lymphocyte count decreased from the pre-operative level on the third POD and it gradually increased from the seventh POD onwards in both groups. However, they remained persistently higher in group I than group II. The total bilirubin and alkaline phosphatase decreased to normal levels within the seventh POD in Group I. However, they remained higher than normal levels on POD 14 in Group II. The morbidity and hospital stay was significantly lower in group I than group II. CONCLUSIONS: Early enteral feeding should be considered after PD. This is because it will improve nutritional, immunological status and cholestasis. Therefore, it reduces morbidity and shortens the hospital stay.

Avian influenza surveillance in domestic waterfowl and environment of live bird markets in Bangladesh, 2007-2012.

Avian influenza viruses, including highly pathogenic strains, pose severe economic, animal and public health concerns. We implemented live bird market surveillance in Bangladesh to identify the subtypes of avian influenza A viruses in domestic waterfowl and market environments. We collected waterfowl samples monthly from 4 rural sites from 2007 to 2012 and environmental samples from 4 rural and 16 urban sites from 2009 to 2012. Samples were tested through real-time RT-PCR, virus culture, and sequencing to detect and characterize avian influenza A viruses. Among 4,308 waterfowl tested, 191 (4.4%) were positive for avian influenza A virus, including 74 (1.9%) avian influenza A/H5 subtype. The majority (99%, n = 73) of the influenza A/H5-positive samples were from healthy appearing waterfowl. Multiple subtypes, including H1N1, H1N3, H3N2, H3N6, H3N8, H4N1, H4N2, H4N6, H5N1 (clades 2.2.2, 2.3.2.1a, 2.3.4.2), H5N2, H6N1, H7N9, H9N2, H11N2 and H11N3, H11N6 were detected in waterfowl and environmental samples. Environmental samples tested positive for influenza A viruses throughout the year. Avian influenza viruses, including H5N1 and H9N2 subtypes were also identified in backyard and small-scale raised poultry. Live bird markets could be high-risk sites for harboring the viruses and have the potential to infect naive birds and humans exposed to them.

Phylogenetic analysis of Newcastle disease viruses from Bangladesh suggests continuing evolution of genotype XIII.

A total of 23 Newcastle disease virus (NDV) isolates from Bangladesh taken between 2010 and 2012 were characterized on the basis of partial F gene sequences. All the isolates belonged to genotype XIII of class II NDV but segregated into three sub-clusters. One sub-cluster with 17 isolates aligned with sub-genotype XIIIc. The other two sub-clusters were phylogenetically distinct from the previously described sub-genotypes XIIIa, XIIIb and XIIIc and could be candidates of new sub-genotypes; however, that needs to be validated through full-length F gene sequence data. The results of the present study suggest that genotype XIII NDVs are under continuing evolution in Bangladesh.

Rectovaginal Fistulae.

Rectovaginal fistulae are abnormal epithelialized connections between the rectum and vagina. Fistulae from the anorectal region to the posterior vagina are truly best characterized as anovaginal or very low rectovaginal fistulae. True rectovaginal fistulae are less common and result from inflammatory bowel disease, trauma, or iatrogenic injury. A very few patients are asymptomatic, but the symptoms of rectovaginal fistula are incredibly distressing and unacceptable. Diagnostic approach, timing, and choice of surgical intervention, including sphincteroplasty, gracilis flaps, Martius flaps, and special circumstances are discussed.

Investigating a crow die-off in January-February 2011 during the introduction of a new clade of highly pathogenic avian influenza virus H5N1 into Bangladesh.

We investigated unusual crow mortality in Bangladesh during January-February 2011 at two sites. Crows of two species, Corvus splendens and C. macrorhynchos, were found sick and dead during the outbreaks. In selected crow roosts, morbidity was ~1 % and mortality was ~4 % during the investigation. Highly pathogenic avian influenza virus H5N1 clade 2.3.2.1 was isolated from dead crows. All isolates were closely related to A/duck/India/02CA10/2011 (H5N1) with 99.8 % and A/crow/Bangladesh/11rs1984-15/2011 (H5N1) virus with 99 % nucleotide sequence identity in their HA genes. The phylogenetic cluster of Bangladesh viruses suggested a common ancestor with viruses found in poultry from India, Myanmar and Nepal. Histopathological changes and immunohistochemistry staining in brain, pancreas, liver, heart, kidney, bursa of Fabricius, rectum, and cloaca were consistent with influenza virus infection. Through our limited investigation in domesticated birds near the crow roosts, we did not identify any samples that tested positive for influenza virus A/H5N1. However, environmental samples collected from live-bird markets near an outbreak site during the month of the outbreaks tested very weakly positive for influenza virus A/H5N1 in clade 2.3.2.1-specific rRT-PCR. Continuation of surveillance in wild and domestic birds may identify evolution of new avian influenza virus and associated public-health risks.

Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on the Integrated Emergency Communication Response Service in India: Much more than just a number!

The proposal for an integrated national emergency number for India is garnering a lot of enthusiasm and stimulating debate. This ambitious project has a two-part paradigm shift to set in; the first being the integration into a single number and the infrastructure required for setting up and operating this number such that a call can be received and identified. The second is the submerged part of the iceberg: That of the ability to respond to a call and deliver the appropriate emergency service. The first part is more technical and has potential precedents like the 911 phone hotline, for example, to emulate. The main premise of this paper is that the second part is a rather subjective exercise largely determined by the realities of existing public infrastructure in a specific geographical area with respect to emergency services management, especially medical care. Consequently, we highlight the key areas of both precall preparedness and postcall execution that need to be reviewed prior to going live with an integrated number on a national scale.

Surgical treatment of type IV choledochal cysts.

The benefit of total resection of the dilated bile duct has remained unclear. We describe here our surgical management of 13 patients with type IV choledochal cysts. All six younger patients (25-35 years old) underwent resection of the extrahepatic bile duct (EHBD) and hepaticojejunostomy (HJ), whereas three of the seven older patients (50-68 years old) underwent resection of the EHBD resection and HJ, with the remaining four older patients undergoing total resection of the dilated bile duct and removal of a pancreatobiliary maljunction (PBMJ) in the form of a S4a+S5 hepatectomy (so-called Taj Mahal) and/or pancreas head resection with second portion pancreaticoduodenectomy. No malignancies were detected in the dilated bile duct after resection in the younger patients, but cancer of the gallbladder and/or the dilated bile duct was found in two (27.5%) of the older patients. No cancers were detected during the long-term follow up (1974-2008) in those patients who underwent EHBD resection plus partial hepatectomy, but cancer developed in the remnant duct in one of the older patients who underwent EHBD resection alone. Based on our findings, we recommend that type IV choledochal cysts should be treated by total excision of the dilated bile duct, including the PBMJ, due to its frequent association with malignancy, and to prevent the development of cancer in the remnant duct and improve the long-term survival rate.

Liver retransplantation with external biliary diversion for progressive familial intrahepatic cholestasis type 1: a case report.

PFIC1, originally described as "Byler disease," is characterized by cholestatic feature and chronic diarrhea. Many patients require LT for the cure, but intractable diarrhea and prolonged growth retardation after LT are serious complications limiting the ultimate outcome of LT for this disease. EBD has recently been shown to be a promising and effective treatment. Recently, we successfully treated a five-yr-old boy with PFIC1 employing EBD after re-transplantation. The patient received LDLT at the age of one yr. Six months after initial transplantation, he developed repeated attacks and diarrhea followed by the development of liver dysfunction and ascites. Liver biopsy at three yr after LDLT revealed the features of chronic graft rejection. With a diagnosis of chronic graft rejection with liver failure, we performed a repeat LDLT with EBD in which the jejunal loop used for hepaticojejunostomy was taken out of the body surface through the abdominal wall. Ten months after surgery, he is doing well, having no attack of diarrhea.

Conserving the zoological resources of Bangladesh under a changing climate.

It is now well recognized that Bangladesh is one of the world's most vulnerable countries to climate change and sea level rise. Low levels of natural resources and a high occurrence of natural disasters further add to the challenges faced by the country. The impacts of climate change are anticipated to exacerbate these existing stresses and constitute a serious impediment to poverty reduction and economic development. Ecosystems and biodiversity are important key sectors of the economy and natural resources of the country are selected as the most vulnerable to climate change. It is for these reasons that Bangladesh should prepare to conserve its natural resources under changed climatic conditions. Unfortunately, the development of specific strategies and policies to address the effects of climate change on the ecosystem and on biodiversity has not commenced in Bangladesh. Here, I present a detailed review of animal resources of Bangladesh, an outline of the major areas in zoological research to be integrated to adapt to climate change, and identified few components for each of the aforesaid areas in relation to the natural resource conservation and management in the country.

Inbreeding effects on the growth in stature among Telaga boys and girls of Kharagpur, West Bengal, India.

The present study is an attempt to understand the genetical effects of inbreeding on the process of growth. The inbred and non-inbred subjects were selected on the basis of extensive pedigrees of five generations in the Telaga, an endogamous population of Kharagpur, India. Preference was given to cousins belonging to the same kindreds while selecting control sample so that environmental variation was minimized. Altogether 633 boys and 614 girls of different inbreeding levels aged five to twenty years were measured for stature. Analysis has been done in different levels of inbreeding in each age and sex on mean annual increments and variances of increments. The results revealed that comparison of annual increment for each age between boys and girls with different degrees of inbreeding and application of the one-tailed t-test of significance does not provide any evidence of inbreeding effect on mean increment for stature studied in either sex. This might indicate the absence of marked dominant/recessive effects of genes determining annual increments in body size rather than the absence of genetical control of increments due to growth. Moreover, it is noteworthy that the variance of annual increment due to growth (which is estimated indirectly) consistently increases with increase of inbreeding level with only a few exceptions. The exceptions occur more often in girls than in boys, which can be explained by greater environmental stress and selection pressure and variation in X-linked inbreeding among girls. This would be worthwhile to verify in longitudinal growth data in future. Increased variances of annual increment with inbreeding, in the absence of change of mean increment on inbreeding, would indicate the influence of additive autosomal genes for the process of physical growth in children in either sex. A close scrutiny of the annual increments for the measurements in all the four levels of inbreeding in either sex fails to bring out any consistent trend of change in the age of adolescent spurt with inbreeding. This might suggest an underlying homozygosity of several genes with inbreeding in the population.

Inbreeding depression in anthropometric traits among Telaga boys of Kharagpur, West Bengal, India.

Inbreeding depression in phenotypic variations as well as reproductive capacity was reported in animals. Depression of physical measurements in human beings especially among infants and adults due to inbreeding has also been reported all over the world. The present study is an attempt to examine the nature of inbreeding effect on growing children at each yearly age with increase of inbreeding intensity in a local endogamous population based on pedigree data. In general, mean values of measurements appear to be smaller in higher levels of inbreeding from that of lower levels of inbreeding in each yearly age. These differences are even more marked when grouped as low and high inbreeding level. The percent of inbreeding depression tends to be larger in post adolescent boys than in younger children.

Long-term survival after treatment of gastric carcinoma with liver metastases. A case report.

A 58-year-old fish dealer presented with epigastric pain. Radiographic and endoscopic studies showed a Borrmann type I gastric carcinoma on the anterior surface of the body of the stomach near the greater curvature, and a metastatic work-up demonstrated two masses in the right lobe of the liver (segment 6 and 8). The preoperative diagnosis was gastric carcinoma with liver metastasis (stage IV). At laparotomy no tumors were found in the left lobe of the liver or the peritoneum, and subtotal gastrectomy, D2 lymph node dissection, and segment 6 and 8 partial resection was performed. Ligation of the right portal vein and intraoperative common hepatic artery chemotherapy (one shot) was performed to destroy any non-visible metastatic tumors in the right lobe of the liver. Histologically, both the gastric and the hepatic lesions were adenocarcinoma. An aneurysm of the common hepatic artery developed after another shot of chemotherapy through the celiac artery one month after the operation. The aneurysm ruptured, and a small fistula formed between the aneurysm and the duodenum. The aneurysm was successfully treated by aneurysmectomy, and the perforated duodenal wall was managed by catheter duodenostomy. The patient is alive and pursuing his previous occupation with no evidence of tumor recurrence. He has been attending the outpatient clinic for follow-up every 6 months for 17 years since the operation. Removal of the primary and metastatic lesions with portal vein ligation and intra-arterial chemotherapy is therefore effective as an active measure to prolong the survival time of gastric carcinoma patients with metastases limited to a single lobe of the liver.

Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies.

To evaluate our recent surgical policy regarding hilar bile duct carcinoma, we evaluated 62 cases treated between 1976 and 1993, and 25 cases treated between 1994 and 2000. In the late period we used percutaneous transhepatic portal vein embolization (PTPE) before extended right hepatectomy; S4a + S5 + S1 hepatectomy for elderly patients and those with poor liver function; and routine total caudate lobectomy including the paracaval portion and resection of the inferior portion of the medial segment (S4a). Sixty-five (74.7%) of the 87 patients underwent hepatectomy: 40 in the early period and 25 in the late period. Bile duct resection alone was performed in 22 patients, all in the early period. Resection was curative in 54.8% in the early period and 88.0% in the late period. The 3- and 5-year survival rates in the early period were 27.1% and 20.2%, respectively, as compared to 59.9% and 49.9% in the late period. Analysis of the 25 hepatectomies in the late period revealed improved survival times compared to patients treated by PTPE with extended right hepatectomy. No complications occurred after extended left hepatectomy or S4a + S5 + S1 hepatectomy, but four patients (16%) who underwent extended right hepatectomy plus PTPE died postoperatively. Our policy has resulted in improved outcome in patients with hilar bile duct carcinoma.

Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma.

BACKGROUND: This study elucidated the relationships between various clinicopathologic factors and the outcome of patients with intrahepatic cholangiocarcinoma (ICC) treated by hepatic resection. METHODS: A total of 37 ICC patients were treated by hepatic resection in our department between March 1979 and March 2001. Eleven clinicopathological variables (age, sex, preoperative jaundice, operative curability, number of tumors, UICC [Union Internationale Contre le Cancer] pT factor, UICC pN factor, UICC pM factor, histological tumor type, 10-year period during which they initially examined, and adjuvant therapy) were selected for univariate and multivariate analysis to evaluate their influence on the outcome. RESULTS: The actuarial 1-, 3-, and 5-year survival rates in the 37 resected cases were 54.1%, 34.0%, and 23.9%, respectively. The stage of the ICC influenced their overall survival rate. The univariate analysis revealed that curative resection (P = 0.0018), UICC pT factor (P = 0.0445), pN factor (P = 0.0029), pM factor (P = 0.0022), and histological type (P = 0.0030) were significant risk factors for survival. Multivariate analysis revealed that noncurative resection, lymph node metastasis, and less differentiated histological type were significant risk factors for poor outcome. All 6 of the 37 patients who survived more than 5 years had undergone curative resection, all of their tumors were well differentiated, and none had lymph node metastasis. CONCLUSIONS: Curative surgical resection remains the only effective approach to the treatment of ICC. Extensive resection is not indicated if lymph node metastasis can be identified preoperatively or intraoperatively. Current adjuvant therapy is ineffective, and it will be necessary to assess the efficacy of new adjuvant therapy strategies or the addition of new agents in terms of the outcome of ICC.