Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study

PURPOSE

Growth hormone-secreting pituitary adenomas (GH-PAs) with a low Knosp grade are typically associated with a good postoperative biochemical remission (BR) rate. However, a proportion of patients do not achieve remission. In this study, we aimed to investigate predictive factors of postoperative remission for lower Knosp GH-PAs.

METHODS

In this retrospective study, we enrolled 140 patients who were diagnosed with lower Knosp (0-2) GH-PAs and received trans-sphenoidal surgery between December 2016 and June 2021 from the largest pituitary tumor surgery center in southern China. The univariate, binary Logistic regression, and receiver operating characteristic curve (ROC) analyses were employed to determine independent predictors and cutoff values of remission. The postoperative outcome was defined as remission using the 2010 consensus criteria of acromegaly.

RESULTS

One hundred and thirty six patients (97.1%) achieved gross total resection. The postoperative long-term BR was 68.6%. Empty sella, tumor maximum diameter and postoperative GH levels were independent factors predicting remission. ROC revealed that postoperative 24 h GH ≤ 1.3 ng/mL and  ≤ 1.23 ng/mL were valuable predictors for 3-month and long-term remission respectively, and that postoperative 3-month GH ≤ 1.6 ng/mL and tumor maximum diameter  ≤ 17 mm were predictors for delayed remission.

CONCLUSION

Early postoperative GH levels can be used as predictors of remission. However, BR was not associated with preoperative somatostatin analogs therapy or Knosp grade (0-2). For patients without residual tumor or recurrence and whose GH levels are slightly elevated within 1 year after surgery, adjuvant treatments may not be necessary.

Association of Modified Sequential Organ Failure Assessment (MSOFA) Score and C-reactive protein (CRP) With the Outcome of Patients under Mechanical Ventilation

Different scoring systems has been discovered in medical practice, more specifically for ICU treatment, are designed to objectively quantify physiologic derangements and comorbid conditions for estimating mortality, length of stay and ICU resource use. This observational and descriptive study was carried out in the ICU, BSMMU, Dhaka, during March 2014 to May 2016, to determine the association of MSOFA score, CRP level with the outcome of patients on mechanical ventilation as well as compare the MSOFA and CRP combined with MSOFA alone. For this purpose, a total of 60 critically ill patients admitted in the above hospital were included in this study. Patients with an ICU stay of less than 48 hours, readmissions not considered, known case of neuromuscular disease, connective tissue disorder, renal disease and pregnancy and Patients refused to give written consent were excluded from the study. Patients who had MSOFA ≥7, their mean duration of ICU stay were 10.9±6.7 days and mean duration of mechanical ventilation 7.63±5.2 days. Patients who had CRP >11mg/L, their mean duration of ICU stay was 10.8±7.2 days and mean duration of mechanical ventilation was 7.35±5.1 days. Patients who had MSOFA score ≥7 and CRP ≥11mg/L with mean duration of ICU stay was 10.82±7.2 days and mean duration of mechanical ventilation was 7.12±5.2 days. 69.2% patients were CRP status positive (≥11) in death group and 33.3% had alive group. 92.3% patients were Positive (CRP ≥7 or MSOFA ≥11) in death group and 14.3% had alive group. MSOFA identified true positive 32 cases for death, false positive 5 cases, false negative 7 cases and true negative 16 cases confirmed by patient's outcome. CRP level identified true positive 27 cases for death, false positive 7 cases, false negative 12 cases and true negative 14 cases confirmed by patients outcome. Combined (CRP ≥11mg/L and MSOFA score ≥7) identified true positive 33 cases for death, false positive 1 case, false negative 6 cases and true negative 20 cases confirmed by patient's outcome. We concluded that there is a positive correlation (r=0.323; p=0.014) between CRP status with MSOFA score, positive correlation (r=0.402; p=0.002) between MSOFA score with MSOFA score and CRP combined and a positive correlation (r=0.999; p=0.001) between CRP level with MSOFA score and CRP combined.

Serum Iron Profile and Red Cell Indices in Children with Severe Acute Malnutrition in A Tertiary Level Hospital

This cross-sectional analytical study was conducted in the department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from March 2017 to August 2018 to assess the pattern of serum iron profile and red cell indices in children with severe acute malnutrition. Seventy children having severe acute malnutrition were compared with 70 age matched children those had normal growth. Age range of the studied children was 6 months to 59 completed months. Male was found predominant (54.3%) in both study group and comparison group. Mean serum iron, serum ferritin, serum total iron binding capacity and transferrin saturation in severely malnourished children were 45.3±19.3μg/dl, 26.5±20.0ng/ml, 246.3±47.5μg/dl and 16.4±2.0% respectively which were significantly lower than that of healthy children (p<0.05). Mean Hb level in children with severe acute malnutrition was found 8.3±1.6gm/dl which was also found significantly lower than that of normal children (p<0.05). Anaemia was found in all (100%) severely malnourished children compared to 25.7% of children in comparison group. Mean MCV, MCH and MCHC in children with severe acute malnutrition was found 71.7±13.5fl, 24.0±5.8pg and 31.4±4.0gm/dl respectively which were significantly lower than that of comparison group (p<0.05). Serum iron profile and red cell indices should be routinely done in severely malnourished children for early intervention and management of iron deficiency anaemia.

A multi-centre, cross-sectional study on coronavirus disease 2019 in Bangladesh: clinical epidemiology and short-term outcomes in recovered individuals

Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic. This study aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -associated epidemiology and clinical outcomes in Bangladesh in order to understand the future course of the COVID-19 pandemic and develop approaches to prevention. A cross-sectional study based on retrospective interviews was conducted on 1021 individuals with RT-PCR-confirmed COVID-19 admitted in six different hospitals in Bangladesh and who recovered 4 weeks before the interview date. Of the 1021 patients, 111 (10.9%) were asymptomatic and the other 910 (89.1%) were symptomatic. Higher prevalence of COVID-19 was found in the male population (75%), in cohorts with B-positive blood group (36.3%) and in the 31-40 years age group. Common symptoms observed in our study participants were fever (72.4%), cough (55.9%), loss of taste (40.7%) and body ache (40%); whereas among the biochemical parameters, neutrophil count (46.4%), D-dimer (46.1%) and ferritin (37.9%) levels were elevated. Among the recovered individuals, short-term outcomes including pains and aches (31.8%), weakened attention span (24.4%) and anxiety or depression (23.1%) were also significantly prevalent in the symptomatic cases with comorbidities. Our study showed that in Bangladesh, adult males aged between 31 and 40 years were more vulnerable to developing COVID-19. It also indicated a rising trend of asymptomatic cases as the pandemic progressed. As a consequence, deployment of interventions to curb further spread of community infection is necessary to avoid grave outcomes of COVID-19 in Bangladesh.

Antimicrobial Sensitivity Pattern in Neonatal Sepsis in Neonatal Intensive Care Unit of Mymensingh Medical College Hospital

This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.

Prevalence and Predictors of Depression among Patients with Type 2 Diabetes: A Multicenter Cross-sectional Study from Bangladesh

Depression is a common comorbidity of type 2 diabetes mellitus (T2DM) which adversely affects diabetes management and outcome. Identifying and treating comorbid depression may improve diabetes care. This cross-sectional study was conducted in several tertiary hospitals throughout Bangladesh from July 2017 to April 2018. Nine hundred (900) adult patients with T2DM aging ≥25 years having diabetes for at least 6 months and equal numbers of non-diabetic otherwise healthy controls were recruited from the outpatient departments of these centers. Depression was assessed in all consenting patients and controls by administering the Bangla (local language) version of the PRIME-MD Patient Health Questionnaire (PHQ-9); participants obtaining a score of 5 or more were labeled to have depression. Depression was present in 60.3% of T2DM patients and in 29.4% of controls. Statistically significant difference was found in age, marital status, occupation, body mass index (BMI), waist circumference, systolic blood pressure (BP), diastolic BP and PHQ-9 score between diabetic and non-diabetic subjects (<0.001). T2DM subjects had 4.71-fold higher odds of depression in comparison to the controls (95% CI: 3.76-5.90; p<0.001). Age ≥50 years, unmarried status, years of schooling ≤10 years, underweight, abdominal obesity, and hypertension appeared to be the significant predictors of depression in the study subjects. In T2DM subjects, diabetes in the family members, the presence of other comorbidities, diabetic complications, diabetes duration >5 years, insulin use, using insulin syringe for injection, albuminuria and CKD were the important predictors of depression. Our study found higher prevalence and risk of depression in T2DM patients than their non-diabetic counterparts. T2DM patients should be screened for depression in order to achieve and maintain the treatment goals.

Thyroid Dysfunction and Autoimmunity in First Trimester of Pregnancy, Single Center Experience in Bangladesh

Study on thyroid function and thyroid autoantibody status in pregnancy considering the trimester specific range, is scarce in Bangladesh. This cross sectional study done in Bangabandhu Sheikh Mujib Medical University, Bangladesh from August 2012 to June 2013 encompassed 186 pregnant women of first trimester for study of thyroid function (TSH, FT₄) and anti-thyroid antibodies (anti-TPO, anti-TG). Age of the subjects was 25.4±4.9 years (mean±SD), median gestational age was 9 weeks. Applying the trimester-specific normal reference range set by American Thyroid Association (ATA), 48(25.8%) of the women were found to have thyroid dysfunction; 40(21.5%) subclinical hypothyroid (SCH), 1(0.5%) overt hypothyroid (OH) and 7(3.8%) hyperthyroid; 40(21.5%) women had goiter. If non-pregnant adult normal rage is used, 22 of SCH women as per ATA criteria will be labeled as normal and 19 normal women as per ATA cut off will be labeled as hyperthyroid. There was statistically significant disparity for functional status defined by these two references cut off value (p<0.001). 29(15.6%) women had thyroid autoimmunity and the autoantibody positivity was more frequent in women with thyroid dysfunction than euthyroid women (22.92% vs. 13.04%, p<0.001). Even though universal screening for thyroid dysfunction is not yet a recommendation, it should be considered in our population.

Vitamin D Status in Newly Diagnosed Type 2 Diabetes Patients Attending in a Tertiary Hospital of Bangladesh

Vitamin D deficiency is common in patients with type 2 diabetes mellitus (T2DM). Vitamin D status may have a causal role in the onset of T2DM and may influence glycaemic control in these patients. However, data on vitamin D status among Bangladeshi T2DM patients are scarce. The present cross-sectional study was done among newly diagnosed 50 T2DM patients attending outpatient department of Comilla Diabetic Hospital, Bangladesh to address this lacuna. Serum 25(OH)D was measured in all and classified as normal (≥30ng/mL), insufficient (>20 to 29.9ng/mL), and deficient (≤20ng/mL). Mean serum 25(OH)D level was 27.91±2.58ng/mL (mean±SEM). Among the study subjects, 30% were D-deficient, 36% were D-insufficient and 34% had normal 25(OH)D. There was no statistical difference of 25(OH)D level between the younger (age <40 years) and older (≥40 years) patients (28.31±4.3 vs. 27.44±2.6ng/mL, mean±SEM; p=0.869); males and females (26.79±2.1 vs. 31.09±8.2ng/mL, mean±SEM; p=0.470); among smokers, non-smokers and ex-smokers (26.86±4.31, 27.10±2.49 and 42.62±1.71ng/mL respectively, mean±SEM; p=0.363); among normal weight, overweight and obese (30.61±6.16, 35.61±9.52 and 24.27±1.71ng/mL respectively, mean±SEM; p=0.191); and among normotensive, borderline hypertensive and hypertensive (25.29±2.46, 32.57±5.32 and 20.84±3.66ng/mL respectively, mean±SEM; p=0.277) patients. 25(OH)D level showed significant negative correlation with body mass index (r= -0.391, p=0.017) and positive correlation (r=0.334, p=0.044) with fasting plasma glucose in male subjects. Age, sex, smoking status, BMI, systolic BP, diastolic BP, family history of DM and smoking status were not found to influence vitamin D level independently. Our study found high frequency of subnormal vitamin D in newly diagnosed T2DM patients. Screening for vitamin D status may be beneficial in T2DM patients.

A 7 years old girl with abdominal lump and per-vaginal bleeding of hypothyroidism

Hypothyroidism is a common endocrine disorder resulting from decreased secretion of thyroid hormone. The diagnosis of hypothyroidism is suggested from the clinical and laboratory findings. Here we present a case report on this disease with rare presentation of abdominal lump and pervaginal bleeding in childhood. A 7 years old girl admitted in a tertiary level hospital with abdominal lump and irregular per vaginal bleeding. Abdominal swelling was gradually increasing in size & associated with lower abdominal pain for last 5 months. On examination the girl was moderately anaemic, mildly oedematous, distended lower abdomen and a mass in left iliac region. Her thyroid function test, serum FSH, serum LH, serum Prolactin was done and high FSH, LH, Prolactin levels were found. Ultrasonography of lower abdomen revealed bulky uterus and bilateral ovarian cysts. MRI of Brain showed feature of pituitary microadenoma. Finally the patient was diagnosed as primary hypothyroidism and bilateral follicular ovarian cyst with pituitary adenoma developed as its consequence. The case is reported for clinical awareness & to share our experience.

Melioidosis in an adult male

Infection with Burkholderia pseudomallei has been described, albeit rarely, patients in Bangladesh. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, which is present in soil and surface water in the endemic region. A 35-year-young male farmer presented with prolonged fever and significant weight loss. Patient gradually deteriorated despite getting different antibiotics including intravenous ceftriaxone and metronidazole. Panels of investigations were done which revealed no diagnostic confirmation except uncontrolled diabetes and multiple abscesses in different organs. Melioidosis was suspected and serum samples were positive for Burkholderia pseudomallei antibody. The case illustrates the importance of non-specific nature of the clinical presentation and high index of suspicion of uncommon diseases like melioidosis where the disease has not been considered as an endemic.

Effects of Nishyinda, black pepper and cinnamon extract as growth promoter in broilers

An extract of nishyinda (Vitex negundo) leaves, black pepper (Piper nigrum) and cinnamon (Cinnamomum verum) (polyherbal extract) were used as growth promoter in broilers. A total of 20 day-old broiler chicks were purchased and after seven days of acclimatization randomly divided into two equal groups. No vaccination schedule was practised and no antibiotics were added in rations. Group A served as control while group B was supplemented with polyherbal extract 1 mL/litre in drinking water. Weekly body weight gain up to six weeks was measured and blood tests were performed at 21 and 42 days. Polyherbal extract significantly (P<0.05) improved weight gain. There was no change in haematological parameters. It can be concluded that the polyherbal extract was safe as a growth promoter in broiler production without adverse effects on chicken health. DOI: http://dx.doi.org/10.3329/bvet.v29i2.14345 Bangl. vet. 2012. Vol. 29, No. 2, 69-77