Association of duodenal eosinophilia with Helicobacter pylori-negative functional dyspepsia.

BACKGROUND AND STUDY AIMS: The pathogenesis of functional dyspepsia (FD) is complex and still remains to be established. Recent studies support duodenal inflammation with increased infiltration of eosinophils and a higher level of systemic cytokines among patients with FD. These findings may help to understand the underlying pathophysiology of FD. The aim of this study was to evaluate the association between duodenal eosinophilia and FD. PATIENTS AND METHODS: A total of 84 patients (42 cases of FD and 42 subjects without dyspepsia as control, mean age 31 years, 56% female) were recruited for this prospective observational study. FD was diagnosed by validated Bangla version of the ROME III criteria. Patients with no symptoms of FD who were referred for upper gastrointestinal endoscopy for other reasons were included as control. Biopsy specimens were taken from the second part (D2) of the duodenum of all participants. The eosinophil count was quantitatively evaluated by hematoxylin and eosin staining and expressed in numbers per 5 HPF. The association between duodenal eosinophilia (defined as ≥22/5HPF a priori) and FD was assessed. RESULT: Significantly increased duodenal eosinophil count was found in patients with FD than patients without dyspepsia (p = 0.001). 57.1% of patients with FD had duodenal eosinophilia. A significant positive association was found between duodenal eosinophilia and FD (OR = 5.67, 95% CI 1.92-17.2, p = 0.001). A positive association was also observed between duodenal eosinophilia and postprandial distress syndrome (OR = 5.54, 95% CI 0.86-45.24, p = 0.036). A higher odds ratio was noticed among those who complain of early satiety. CONCLUSION: A significant positive association was found between duodenal eosinophilia and FD especially among those with postprandial distress syndrome. It requires further large scale multicenter studies to establish duodenal eosinophilia as a biomarker of FD.

Effects of Spirulina platensis on pain and inflammation in long Evans rats.

Spirulina platensis (S. platensis) is a traditional herb that has been reported to have a lot of medicinal values. This study was designed to observe the effects of S. platensis on different types of pain and inflammation in comparison to diclofenac sodium. Three groups of Long Evans rats (n=21in each group) of both sexes were used. Group I was treated orally with normal saline (5ml/kg/day for 21 days), group II was treated with diclofenac sodium (10mg/kg/day for 7 days) and group III with S. platensis (400mg/kg/day for 21 days). Effects of S. platensis on pain were assessed by tail immersion test (nociception pain), formalin test (nociception and inflammatory pain), Von Frey test (neuropathic pain) and the effects on inflammation were assessed by formalin induced paw edema test. Macroscopic and microscopic examinations of rats' stomachs were done to observe anti-ulcerogenic effect. S. platensis showed potent (statistically significant) analgesic effects in all 3 models of pain (tail immersion test, formalin tests, Von Frey test) as well as anti-inflammatory effects in formalin induced paw edema test. Interestingly, anti-ulcerogenic effect of S. platensis was almost similar to that of negative control and was significantly different with positive control. In conclusion, these data indicate that S. platensis possess analgesic, anti-inflammatory and anti-ulcerogenic potential.

The colon and terminal ileum in patients with ankylosing spondylitis and controls in Bangladesh: a macroscopic and microscopic study.

OBJECTIVE: Little is known about gut lesions in AS patients in a developing country, such as Bangladesh. METHODS: Full colonoscopy, including the terminal ileum, was performed in 60 AS patients and 20 controls, without diarrhoea, to study macroscopic and microscopic lesions. RESULTS: In the colon, in 60 AS patients 17 macroscopic lesions were found, of which 11 were in the rectum; only one lesion was found in 20 controls. The prevalence of microscopic lesions in the ascending colon, sigmoid colon and rectum was 51, 44 and 50 in patients, respectively, and 13, 9 and 8 in controls. In the terminal ileum, macroscopic and microscopic lesions were seen in 21/56 and 43/56 AS patients, respectively, and in 1/20 and 9/20 controls. In the AS group, macroscopic (38.5 vs 5%, P < 0.01) and microscopic (76.8 vs 45%, P = 0.009) lesions were more frequent than in controls; no IBD was diagnosed. Findings were comparable in the axial AS group (n = 25) and the mainly peripheral group (n = 35). In AS patients, marked eosinophilic infiltration was observed in the ascending colon and sigmoid colon but not in the rectum, and this infiltration was more than in controls. The colonic mucosa in controls was otherwise comparable with western studies. Anaemia was seen in 18/60 cases. No association was found between anaemia or HLA-B27 status and gut lesions. CONCLUSION: There was an equal percentage of microscopic lesions in the whole gut in AS cases and healthy controls. Previous helminth invasions might have played a role. Lesions differ significantly between AS and controls only in the ileum; therefore, the ileal lesions might be more disease related than the colonic ones.

Rare subtype(s) and frequency of multi-viral subtype high-risk human papilloma virus infection in high-grade squamous intraepithelial lesion and squamous cell carcinoma in a cervical carcinoma prevalent developing country: a multiplex real-time polymerase chain reaction-based pilot study.

BACKGROUND: Bangladesh, with a population of 160 million and nearly half being women, has the 4th highest rate of cervical carcinoma deaths in the world. It is projected that ∼500,000 of these women would die of this entirely preventable cancer by 2030. HPV vaccination is not widely offered in Bangladesh. This pilot study is designed to find out the prevalence of rare and multi-viral high-risk HPV (hrHPV) subtype(s) infection which may help strategize a large scale vaccination program in tackling cervical carcinoma in the country. METHODS: Forty cases of cervical High-Grade squamous intraepithelial lesion (HSIL) and Squamous cell carcinoma (SqCa) were collected. DNA was extracted from tissue representing HSIL and SqCa and multiplex PCR was run to identify all 15 hrHPV subtypes along with known positive controls. RESULTS: Of the total, 27 cases were biopsies/cones and 13 were hysterectomies including 5 HSIL and 35 SqCa. Infection caused by rare subtypes, hrHPV 45 and 52, were found in only two cases. Multi-subtype infection, detected in 28 % cases, was limited to HPV16/18 in all cases but one; one case showed hrHPV16/52 combination. CONCLUSION: A remarkable homogeneity of hrHPV 16 infection is noted in women with HSIL & SqCa in this country in these limited samples. This finding is in sharp contrast to the reports from western countries of frequent multi-viral and rare subtype hrHPV infection. This pilot study suggests that a vaccination program may be highly effective in controlling cervical cancer there. A larger study, however, is required to ratify the findings.

Isolated Intracranial Rosai-Dorfman Disease.

Background. Rosai-Dorfman disease (RDD) is a benign histiocytic proliferative disorder of unknown etiology. This rare condition commonly causes massive cervical lymphadenopathy. Intracranial RDD without any nodal involvement is extremely rare. Case Report. A young Bangladeshi male complained of bilateral complete blindness with left sided deafness for about three years. There was no lymphadenopathy. MRI and CT scan of brain suggested an inflammatory/neoplastic (?meningioma) lesion located at left parasellar region which extended frontally to encircle both optic nerves and also to left prepontine area. Histopathologically the lesion was diagnosed as RDD. The patient was treated with steroid and significant clinical improvement observed. Conclusion. The prognosis of intracranial RDD is not poor. It can be treated with surgery with or without corticosteroids, chemotherapy, and so forth. But as the condition is extremely rare and often misdiagnosed, the clinician, radiologist, and histopathologist should have a suspicion in their mind about the possibility of RDD.

A clinicopathological study on lupus nephritis; experience of 34 cases from Bangladesh.

Introduction: The clinicopathological findings of lupus nephritis (LN) are responsible for the ultimate prognosis of systemic lupus erythematosus (SLE). But these findings show geographical variations. Data on LN of Bangladeshi patients are extremely rare in the literature and most of them describe mostly clinical features rather than the pathological findings. Objectives: This study was carried out in an effort to find out the clinicopathological characteristics and correlations of LN patients from this region. Patients and Methods: A total of 34 patients were included in the study; all these underwent renal biopsy. Each biopsy was classified according to International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 LN classification system and compared with the clinical, biochemical and immunological findings. Results: Arthralgia and edema were found to be the most common clinical presentations and both were present in 28 (82.4%) cases. Out of 34 cases, 22 (64.7%) belonged to ISN/RPS class IVG. Among clinical and biochemical findings, arthralgia and serum creatinine showed significant association with the ISN/RPS 2003 classification system of LN. The most common deposited immunoglobulin was IgG. This was present in 29 (85.29%) cases. Conclusion: Observations made from the present study suggest that clinical and laboratory parameters of Bangladeshi patients do not predict the histological findings; though, some of the clinical and biochemical parameters correlated with histological findings in the present study. It was also found that these findings are different from other regional studies on LN.

Bimodal Multiparameter-Based Approach for Benign-Malignant Classification of Breast Tumors.

Proposed here is a breast tumor classification technique using conventional ultrasound B-mode imaging and a new elasticity imaging-based bimodal multiparameter index. A set of conventional ultrasound (US) and ultrasound elastography (UE) parameters are studied, and among those, the effective ones whose independent as well as combined performance is found satisfactory are selected. To improve the combined US performance, two new US parameters are proposed: edge diffusivity, which assesses edge blurriness to differentiate malignant from benign lesions, and the shape asymmetry factor, which quantifies tumor shape irregularity by comparing the tumor boundary with an ellipse fitted to the lesion. Then a new bimodal multiparameter characterization index is defined to discriminate 201 pathologically confirmed breast tumors of which 56 are malignant lesions, 79 are fibroadenomas, 42 are cysts and 24 are inflammatory lesions. The weights of the multiparameter bimodal index are optimally computed using a genetic algorithm (GA). To evaluate the performance variation of the index on different data sets, the tumors are categorized into three classes: malignant lesion versus fibroadenoma, malignant lesion versus fibroadenoma and cyst and malignant lesion versus fibroadenoma, cyst and inflammation. The test results reveal that the proposed bimodal index achieves satisfactory quality metrics (e.g., 94.64%-98.21% sensitivity, 97.24%-100.00% specificity and 96.52%-99.44% accuracy) for classification of the aforementioned three classes of breast tumors. Its performance is also observed to be better in totality of the quality metrics sensitivity, specificity, accuracy, positive predictive value and negative predictive value as compared with that of a conventional bimodal index as well as unimodal multiparameter indices based on US or UE. It is suggested that the proposed simple bimodal linear classifier may assist radiologists in better diagnosis of breast tumors and help reduce the number of unnecessary biopsies.

Polypoid nodular histiocytic hyperplasia associated with endometrioid adenocarcinoma of the endometrium: report of a case.

A 45 year old woman underwent Laparoscopy-assisted total hysterectomy with staging procedure following a diagnosis of endometrial endometrioid adenocarcinoma on her endometrial biopsy. The hysterectomy specimen showed a FIGO I stage 1a, endometrioid carcinoma. A separate polypoid lesion in the endometrium, distinct from the carcinoma, was also identified. Microscopically the polypoid lesion was "nodular histiocytic hyperplasia". The H&E, immunohistochemical staining findings and the differential diagnoses are discussed in this report. Although description of similar lesions is available in the literature, the current lesion is unique as it is identified in a hysterectomy specimen in its entirety and its association with an endometrial endometrioid carcinoma. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1060511915121922.