The HRCT Evaluation of 105 Suspected COVID 19 Patients of MMCH and RT-PCR Correlation.

In this study our main goal is to evaluate the HRCT evaluation of 105 suspected COVID 19 patients of MMCH and RT-PCR correlation. This experimental and observational study was done at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2020 to October 2020. Where 105 suspected COVID 19 patients of MMCH and RT-PCR correlation were included in the study. During the study, 43.05% of the patients exposed indirectly to the virus, followed by 44.1% didn't exposed any virus, 21% exposed directly. Diabetes mellitus was 35.7%, HTN - 46.2%, 82.95% had fever, 72.45% had cough, 78.75% had respiratory distress and 49.35% had no diseases. After CT scan diagnosis, positive to infection were found in 98 patients, among them 34 patients had mild type, 22 had severe type of infection where as in RT-PCR diagnosis 69 were positive and 36 were negative to infection. From our study we can conclude that, the most common pattern of COVID-19 pneumonia on HRCT images are pure GGO and GGO and Crazy Paving. Also GGO with consolidation with prominent distribution in the posterior and peripheral part of the lung. Further study is very much needed for better outcome.

Ultrasonographic Evaluation of Palpable Breast Mass and Correlation with Histopathology.

Breast cancer is the most common malignancy in women and the second most common cause of cancer-related mortality. The distinction by physical examination of physiologic nodularity from abnormal masses can be difficult, while the clinical differentiation of a malignant mass from a benign one is difficult; the medical as well as potential legal consequences of missing a palpable carcinoma are high. There are significant number of reported cases of false-negative findings on mammography and the great desire not to miss a malignant lesion in the early stage of disease lead to aggressive biopsy, but the biopsy rate for cancer is only 10.0% to 30.0%. This means that 70.0% to 90.0% of breast biopsies are performed for benign diseases, which induce unnecessary patients discomfort and anxiety in addition to increasing costs to the patient. Clearly, there is a great need for development of additional reliable methods to complement the existing diagnostic procedures to avoid unnecessary biopsy. This cross sectional study was carried out on 43 patients having palpable breast mass, attended in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st January 2012 to 31st December 2013 for the period of two year. These patients were evaluated by USG at the Department of Radiology and Imaging and histopathological examination at the Department of Pathology of the same College to confirm the diagnosis. In diagnosis of malignant mass by USG, 9(20.9%) cases were diagnosed as malignant and 34(79.1%) cases as other than malignant. Eight out of 9 were sonographically diagnosed as malignant lesions also proved as malignant lesion by histopathology and 1 other than malignant. Out of 34 sonographically diagnosed cases of other than malignant lesions 32 were proved histopathologically and 2 did not match with sonographic findings. USG, in diagnosis of malignant lesion, sensitivity was 80.0%, specificity 96.97%, positive predictive value (PPV) (88.89%), negative predictive value 94.12% and accuracy was 93.02% and comparable to other study. In diagnosis of benign lesion by USG, sensitivity was 96.97%, specificity 80.0%, positive predictive value (PPV) (94.12%), negative predictive value 88.89% and accuracy was 93.02%. So, USG is an appropriate imaging method for diagnosis & differential diagnosis of palpable breast mass.

Risk factors for gall bladder cancer in Karachi.

BACKGROUND: Frequency of gallbladder cancer in Karachi has been reported to be 8% and that from other parts of Pakistan varies between 6-7%. This is very high as compared with the Western studies. With this in mind a case control study was designed to identity risk factors responsible for gallbladder cancer. METHODS: This case control study included 107 histologically proven cases of gall bladder cancer from Jinnah Postgraduate Medical Center, Civil Hospital and two private hospitals of Karachi. Age and sex matched controls were of two types. Those with and without cholelithiasis screened sonographically. Demographic, socio-economic factors, life-style, dietary habits and dietary intake were recorded on a proforma. The cases and controls were compared for various factors using odds Ratio. RESULTS: Among 107 cancer cases 27 were males and 80 females (M:F = 1:3). Mean age of males was 59 years (range 35-82 years) and females 53 years (range 31-70 years). One hundred and five (98%) had associated choleliathiasis. Important risk factors appeared to be gallstones, high parity, young age at first delivery, low fiber and Vitamin A intake (p < 0.01), high fat intake (p < 0.01), prolonged fasting hours/habit of missing dinner (OR:6.8), using repeatedly boiled or improperly stored ghee or oil (OR:2.6). CONCLUSIONS: According to this case-control study major risk factors for gall bladder cancer were gallstones, dietary malpractices and poorly balanced diet. Poorly stored/processed food acts as a promoter in the presence of gall stones and may favour cancer development.

Gastrojejunocolic fistula following surgery for peptic ulcer complications: two case reports.

Two patients were admitted in the surgical unit--I of Mymensingh Medical College Hospital on January 2001 and March 2001 with the complaints of epigastric pain and discomfort, feculent eructation and fecal vomiting, diarrhoea with lienteric stools, weight loss and weakness. Both of them had previous history ulcer complications. The diagnoses of gastrojejunocolic fistula were made on the basis of history, barium enema examination and upper gastrointestinal endoscopy. Early resuscitation with correction of nutritional deficiencies, fluid and electrolyte imbalance was attempted along with blood transfusion, antibiotics and other supportive measures. But the first patient was too ill to cope up with the treatment and developed cardio-respiratory symptoms. A single stage procedure comprising of partial gastrectomy along with resection of the fistula and restoration of bowel continuity (by jejunojejunostomy, colocolostomy and closure of duodenal stump) was adopted in both patients. Early postoperative recovery was good in both but the first patient expired on 8th postoperative day from acute myocardial infarction, while the second one developed anastomotic leakage and wound infection, which were managed conservatively. On follow up the second patient was found in sound health till to date after his discharge from the hospital.

Bordetella pertussis autoregulates pertussis toxin production through the metabolism of cysteine.

Pertussis toxin (Ptx) expression and secretion in Bordetella pertussis are regulated by a two-component signal transduction system encoded by the bvg regulatory locus. However, it is not known whether the metabolic pathways and growth state of the bacterium influence synthesis and secretion of Ptx and other virulence factors. We have observed a reduction in the concentration of Ptx per optical density unit midway in fermentation. Studies were conducted to identify possible factors causing this reduction and to develop culture conditions that optimize Ptx expression. Medium reconstitution experiments demonstrated that spent medium and a fraction of this medium containing components with a molecular weight of <3,000 inhibited the production of Ptx. A complete flux analysis of the intermediate metabolism of B. pertussis revealed that the sulfur-containing amino acids methionine and cysteine and the organic acid pyruvate accumulated in the media. In fermentation, a large amount of internal sulfate (SO4(2-)) was observed in early stage growth, followed by a rapid decrease as the cells entered into logarithmic growth. This loss was later followed by the accumulation of large quantities of SO4(2-) into the media in late-stage fermentation. Release of SO4(2-) into the media by the cells signaled the decoupling of cell growth and Ptx production. Under conditions that limited cysteine, a fivefold increase in Ptx production was observed. Addition of barium chloride (BaCl2) to the culture further increased Ptx yield. Our results suggest that B. pertussis is capable of autoregulating the activity of the bvg regulon through its metabolism of cysteine. Reduction of the amount of cysteine in the media results in prolonged vir expression due to the absence of the negative inhibitor SO4(2-). Therefore, the combined presence and metabolism of cysteine may be an important mechanism in the pathogenesis of B. pertussis.

Antigenic determinants of Staphylococcus aureus type 5 and type 8 capsular polysaccharide vaccines.

Bacterial capsular polysaccharides (CP) are carbohydrate polymers comprised of repeating saccharide units. Several of these CP have side chains attached to their backbone structures. The side chains may include O-acetyl, phosphate, sialic acid, and other moieties. Those moieties represent the immunodominant epitopes and the most functional ones. The clinically significant Staphylococcus aureus type 5 CP (CP 5) and type 8 CP (CP 8) are comprised of a trisaccharide repeat unit with one O-acetyl group attached to each repeat unit. The immunogenicity of these CP and the functionality of antibodies to the backbone and the O-acetyl moieties were investigated. Immunization with the native CP conjugates (CP with 75% O-acetylation) elicited a high proportion of antibodies directed against the O-acetyl moiety. Nonetheless, all of the vaccinees produced antibodies to the backbone moieties as well. Conjugate vaccines made of de-O-acetylated CP elicited backbone antibodies only. Antibodies to both backbone and O-acetyl groups were found to be opsonic against S. aureus strains which varied in their O-acetyl content. Absorption studies with O-acetylated and de-O-acetylated CP showed that (i) native CP conjugates generated antibodies to both backbone and O-acetyl groups and (ii) O-acetylated isolates were opsonized by both populations of antibodies while the non-O-acetylated strains were predominantly opsonized by the backbone antibodies. These results suggest that S. aureus CP conjugate vaccines elicit multiple populations of antibodies with diverse specificities. Moreover, the antibodies of different specificities (backbone or O-acetyl) are all functional and efficient against the variations in bacterial CP that may occur among clinically significant S. aureus pathogenic isolates.

A Staphylococcus aureus capsular polysaccharide (CP) vaccine and CP-specific antibodies protect mice against bacterial challenge.

The efficacy of capsular polysaccharide (CP)-specific antibodies elicited by active immunization with vaccines composed of Staphylococcus aureus types 5 and 8 CP linked to Pseudomonas aeruginosa exoprotein A or with immune immunoglobulin G (I-IgG) obtained from vaccinated plasma donors was tested in lethal and sublethal bacterial mouse challenge models. A dose of 2 x 10(5) CFU of S. aureus type 5 CP per mouse administered intraperitoneally (i.p.) with 5% hog mucin was found to cause 80 to 100% mortality in BALB/c mice within 2 to 5 days. Mice passively immunized i.p. 24 h earlier or subcutaneously 48 h earlier with 0.5 ml of I-IgG showed significantly higher average survival rates than animals receiving standard IgG or saline (P < 0.01) following the bacterial challenge. Animals actively immunized with the monovalent type 5 CP-P. aeruginosa exoprotein A conjugate showed a survival rate of 73% compared with 13% in phosphate-buffered saline-immunized animals. The prechallenge geometric mean titer of type 5 CP antibodies in animals that died was significantly (P < 0.05) lower than that of animals which survived the challenge (95.7 versus 223.6 micrograms/ml, respectively). The IgG was further evaluated in mice challenged i.p. with a sublethal dose of 5 x 10(4) CFU per mouse. Serial blood counts were performed on surviving animals at 6, 12, 24, and 48 h. Surviving animals were sacrificed at 72 h, and bacterial counts were performed on their kidneys, livers, and peritoneal lavage fluids. Animals receiving I-IgG had lower bacterial counts in blood samples and lower bacterial densities in kidneys, livers, and peritoneal lavage samples than mice immunized with standard IgG (P < 0.05). These data suggest that S. aureus type 5 CP antibodies induced by active immunization or administered by passive immunization confer protection against S. aureus infections.

Characterization of an antigenically conserved heat-modifiable major outer membrane protein of Branhamella catarrhalis.

Branhamella catarrhalis is a common cause of otitis media in children and of respiratory infections in adults with chronic bronchitis. Little is known about the antigenic structure of the outer membrane proteins (OMPs). In this study, two murine monoclonal antibodies, 7D6 and 5E8, were developed and used to characterize the major heat-modifiable OMP (OMP C/D) of B. catarrhalis. Immunoblot assays indicated that OMP C/D is heat modifiable, having a molecular mass of 55 kDa at room temperature and a mass of 60 kDa when heated under reducing conditions. Expression of the epitopes is independent of growth phase and growth media. Both epitopes are present in 51 of 51 strains of B. catarrhalis tested and are highly specific for Branhamella strains, being absent from a variety of other gram-negative species. Antibody 5E8 recognizes an epitope which is expressed on the surface of the intact bacterium. We conclude that OMP C/D is a major, heat-modifiable OMP antigen that expresses at least one stable, conserved epitope on the surface of B. catarrhalis. Future studies should focus on the role of OMP C/D in pathogenesis and on its potential role as a vaccine antigen.

Strain-specific and immunodominant surface epitopes of the P2 porin protein of nontypeable Haemophilus influenzae.

The P2 porin protein is the major outer membrane protein of nontypeable Haemophilus influenzae. Five monoclonal antibodies to P2 of four strains of nontypeable H. influenzae were developed by immunizing mice with whole bacterial cells. All five antibodies recognized epitopes on P2 in immunoblot assays of whole organism lysates, purified outer membrane, and purified P2. Competitive enzyme-linked immunosorbent assays and immunoblot assays of cyanogen bromide-digested P2 showed that two antibodies to the P2 protein of strain 1479 recognized different epitopes on the molecule. Immunofluorescence and immunoelectron microscopy demonstrated that each of the five antibodies recognized epitopes that were abundantly expressed on the bacterial surface. Analysis of 120 H. influenzae strains indicated that three of the five antibodies were reactive exclusively with the homologous strain. The remaining two antibodies were reactive with less than 3% of the strains. These studies indicate that the P2 protein expresses a highly strain-specific and immunodominant epitope on the bacterial surface. The expression of strain-specific and immunodominant epitopes on the bacterial surface may represent a mechanism by which the bacterium induces antibodies that will protect against recurrent infection by the homologous strain but will not protect against infection by heterologous strains.