Quality of life in transfusion-dependent thalassaemia patients on desferrioxamine treatment.

INTRODUCTION: The quality of life of transfusion-dependent thalassaemia patients is affected by the disease itself and iron overload complications from repeated blood transfusion. Desferrioxamine has been used to remove the excess iron, resulting in decreased mortality and morbidity. In Malaysia, a significant proportion of the transfusion-dependent thalassaemia patients are not prescribed desferrioxamine, due to its high cost, especially as it is not subsidized by the government. The aim of this study was to measure the quality of life of thalassaemia patients on desferrioxamine treatment. METHODS: A cross-sectional study was performed on all transfusion-dependent thalassaemia patients on follow-up at two tertiary hospitals in Kuala Lumpur, Malaysia, in 2005. Quality-of-life scores were measured by using the translated MOS SF-36 questionnaires, while diseases related to iron overload complications were obtained from the medical records. Use of desferrioxamine was elicited through interviews and validated by drug records. Quality-adjusted life-years (QALYs) presented were formulated from residual life-years and quality-of-life scores. RESULTS: A total of 112 transfusion-dependent thalassaemia patients were recruited, with 54 (48 percent) and 58 (52 percent) patients on sub-optimum and optimum desferrioxamine treatments, respectively. QALYs were higher in patients on optimum desferrioxamine (9.04, standard deviation [SD] 2.46) than patients on sub-optimum desferrioxamine (5.12, SD 2.51). QALYs were associated with the level of serum ferritin, iron overload complications and total family income. CONCLUSION: Optimum desferrioxamine usage reduces iron overload complications and provides a better quality of life.

Cytological grading of duct cell carcinoma, NOS of breast and its correlation with histological grading.

Fine needle aspiration cytology is a widely practiced technique in the diagnosis of breast carcinoma and it is the only, diagnostic procedure performed before definitive treatment, at most institutions. While the histological grading of Duct Cell Carcinoma (DCC), NOS is done routinely in many centers worldwide the cytopathological grading of DCC, NOS is not commonly done. Grading of breast carcinoma, while the tumour is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of appropriate therapy for the patient. This study was undertaken with the aim to determine the grade of DCC, NOS by simple cytological scoring system as a method of predicting histological grade. We selected 80 cases of DCC, NOS which were initially diagnosed by Fine Needle Aspiration Cytology (FNAC) with subsequent histological confirmation. For cytological grading Papanicolou's stained smears and for histological grading Haematoxylin and Eosin stained sections were examined under light microscope. For histological grading Scraff Bloom Richardson's grading and for cytological grading Robinson's grading were followed. In both system grading were grade I, grade II and grade III of DCC, NOS. On cytological grading 39 (48.8%) cases were grade-I, 38 (47.5%) cases were grade-II and 3 (3.8%) cases were grade-III. On histological grading 33 (41.3%) cases were grade-I, 39 (48.8%) cases were grade-II and 8 (10%) cases were grade-III. In this study cytological grade correlated with histological grade in 69 (86.3%) cases. For grade-I tumour, sensitivity was 96.96%, efficiency was 94%. For grade-II tumour the sensitivity was 87.18% and efficiency was 77%. For grade-III tumour the sensitivity was 37.50% and efficiency was 23%. The overall accuracy was 96.3%. Significant association between histological and cytological grading of breast carcinoma, NOS was noted. Our observations in this study revealed that grading of duct cell carcinoma, NOS on FNAC material can be a useful in preoperative assessment of DCC, NOS prognosis and can be useful as an alternative to histological grading when neoadjuvant therapy is planned.

Role of fine needle aspiration cytology (FNAC) in the diagnosis of prostatic lesions with histologic correlation.

This study was carried-out to evaluate the diagnostic accuracy of fine needle aspiration cytology (FNAC) and the role of FNAC in the diagnosis of prostatic lesions. FNAC was performed on 64 patients presented with enlarged prostate. Cytological diagnosis by fine needle aspiration (FNA) of the prostate was compared with histological diagnosis in 60 patients. Of these, 42 cases were cytologically diagnosed as benign lesions, 18 cases as malignant. In remaining 4 cases, materials were inadequate for diagnosis in one case and biopsy materials were not available in 3 cases. On histological examination, 42 cases which were cytologically diagnosed as benign, 40 cases were found to be benign and 2 cases were malignant histologically leading to 2 false negative diagnoses. Of the 18 cases diagnosed cytologically as malignant (considering atypical hyperplasia and carcinoma as malignant), 15 cases were proved to be so by histological examination. So there were false positive diagnoses in 3 cases. No patient suffered from any complication following the aspiration biopsy. The sensitivity of this study for detection of prostatic carcinoma was 88 percent; specificity was 93 percent and diagnostic accuracy 91.7 percent. In this prospective study, FNAC of prostate was found to be associated with high diagnostic yields. These data support the value of transrectal FNAC as sensitive, easy to perform method for sampling of an enlarged prostate. The procedure may be used as an efficient primary screening tool in the diagnosis of prostatic lesions. Frequent use of this technique in our country should be encouraged.

A study of histopathological pattern of neuromuscular disorders with clinico-pathologic correlation.

Neuromuscular disorders are frequently seen in our clinical practice, though no certain data are available in this regard. This prospective, observational study which was done as a partial fulfillment of M.Phil (Pathology) degree in BSMMU. The study was undertaken at the Department of Pathology of Bangabandhu Shiekh Mujib Medical University from August 1999 to December 2000 to study the histomorphological pattern of neuromuscular disorders in a selected group of patients attending the neuromedicine, paediatrics and medicine departments of BSMMU. Another purpose of this study was to evaluate the diagnostic utility of muscle biopsy and clinico-pathologic correlation in the diagnosis of neuromuscular disorders. In this study, 55 cases of clinically diagnosed neuromuscular disorders of different kinds were included. Detail clinical history was obtained in all the cases. Clinical diagnosis were made on the basis of history, physical examination, reports of routine and special laboratory tests whenever available. Muscle biopsy was performed in all the cases and histological changes could be identified in 42 cases. In the remaining thirteen undiagnosed cases; eight cases revealed 'essentially normal muscle tissue' and five cases were inadequate for histological evaluation. So, the later two categories were not included for further analysis. Among the histologically diagnosed 42 cases of neuromuscular disorders, basically two different classes of diseases were identified; 1) Dystrophic type of muscular diseases 64.28% and 2) Non dystrophic (acquired) type of neuromuscular diseases such as Inflammatory myopathy 21.82% and Neurogenic muscular atrophy 7.14%. Within the dystrophic group the maximum number of diseases were diagnosed as Duchenne muscular dystrophy 21.49%, Primary myopathy-unclassified 19.04%, Baker muscular dystrophy 4.76% and Limb girdle muscular dystrophy 4.76% etc. Properly executed muscle biopsy is usually the most useful and effective technique for diagnosis of neuromuscular diseases in cases where immunohistochemical, genetic and electron microscopic examination is not possible.

Spermatic cord metastasis from a medulloblastoma.

A 4-year-old boy presented with metastases in the spermatic cord and ribs 2 years after treatment for a primary medulloblastoma (MB). The testis was free of tumor. A MB presenting with a metastasis to the spermatic cord has not been reported to date. The role of a ventriculo-peritoneal shunt in promoting such spread should be considered in planning management.

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.

Assessment of a mobile training programme on nutrition for Bangladesh rural development board (BRDB) women's programme in Bangladesh.

About half of the total population of the country are women and without their active participation no development programme can be achieved. This study involved a total number of 690 trainees from 23 upazilas of different districts in Bangladesh. The results obtained from both pre and post tests were compared and analyzed to find out the impact of the mobile training programme on nutrition. The mean age of the trainees was 29.54. The mean number of children per trainee was 3.73 and the mean income was close to Taka 1048.26. Analysis of the results regarding knowledge of the training about nutrition at pre and post training stages reveal that at post training stage they were more aware of the importance of nutrition. The difference in knowledge level at pre and post training stages was statistically significant (P less than .001).

Visceral leishmaniasis and its control in Bangladesh.

Visceral leishmaniasis, which is also known as kala-azar, reappeared in Bangladesh during the 1980s, approximately 7-8 years after large-scale use of DDT had been abandoned by the malaria eradication programme in the country. Pabna, Mymensingh and Rajshahi were the regions most affected with kala-azar. The article presents a historical review and information about the present status of leishmaniasis in Bangladesh together with control strategies and a proposed plan of operation.

DDT--susceptibility status of Anopheles philippinensis--a mosquito vector of malaria in Bangladesh.

DDT-susceptibility tests conducted on An. philippinensis Ludlow in 1979 and 1980 and several previous years of observations made during malaria programmes in different areas of Bangladesh have been reported. The LC50 value for 1980 was found to be 0.74% DDT showing 2.96 and 1.85 fold increase of tolerance level from 1961 (0.25%) and 1976 (0.4%) respectively. The tests showed that the species continues to be susceptible to DDT in Bangladesh. However, the changes in LC50 over the years may indicate a slight acquisition of "vigour tolerance."