Hemithyroidectomy in the Treatment of Papillary Thyroid Carcinoma: A Prospective Study of 300 Patients

The correct approach to treat low-risk intra thyroidal papillary thyroid carcinoma (PTC) is still controversial. The traditional paradigm of treating all patients with thyroid cancer with total thyroidectomy, radioactive iodine and suppressive thyroid hormone therapy is no longer suitable. Many authors advocate unilateral thyroidectomy to minimize perioperative morbidity. The purpose of this study was to determine an effective treatment strategy for patients with small unilateral papillary thyroid carcinoma in a low risk group. This is a prospective study of 300 patients who were diagnosed as papillary thyroid carcinoma by preoperative FNAC or postoperative histopathology. The age of the patients' was ranged between 15 to 45 years. The criteria were: tumor ≤4cm, unilateral involvement, cytological non-aggressive subtype, absence of lymph node (LN) involvement and extra thyroidal extension (ETE) on ultrasonography (USG) and absence of clinical distant metastases. Duration of the study period was 30 years from 1989 to 2019. The study was conducted in tertiary care hospital in Bangladesh. All patients had undergone hemi thyroidectomy and followed up by a median period of 25 months (range, 6 to 166 months). Following hemithyroidectomy, among 300 patients, 267 patients (89.0%) did not show any recurrence of disease. Thirty three (33) patients (11.0%) came with locoregional recurrence of disease in clinical and USG findings without any distant metastasis. Maximum patients were between the ages 31-40 year followed by 21-30 years. Female was out number male in the ratio. Though further large scale study should require to determine the optimal treatment option for low risk PTC, but this study can lead to a result that hemi thyroidectomy is now-a-days a better surgical option for PTC even up to tumor size of ≤4cm.

Factors related to tuberculosis delays: Evidence from nationwide retrospective study in Portugal

Background

Globally, tuberculosis (TB) remains one of the top 10 causes of deaths and the leading cause from a single infectious agent. Delayed TB diagnosis and/or treatment may result in the transmission of bacilli, increasing infectivity, the risk of severe disease states, morbidity and mortality. It is essential to identify the factors that prolong delays in TB services so that health planners can initiate necessary measures to control TB infections.

Methods

A nationwide retrospective study was conducted from 2010 until 2013 to analyze tuberculosis delays under the setting of the Portuguese National Tuberculosis Control Programme. There were 16824 participants who were from 25 administrative districts under 7 regions and were originated from 70 countries in the world. The log-rank test, Cox's regression, and the Kaplan-Meier method have employed to analyze TB delay data.

Results

The median of patients` delay was 34 days with interquartile ranges (IQR) 50 days. Alcohol addicted people with TB infection were delayed by 40 days with 95% CI 37.73-42.28 whereas the non-addicted people took 33 days with 95% CI 32.35-33.65. The median diagnostic delay was 12 days with an IQR of 38 days. The female participants were delayed more than that of male (median delay for female 17 days with 95% CI 15.80-18.19) in TB diagnosis. Further, comorbidities e.g. lung cancer affected TB candidates were delayed more than their counterparts (median delay 37 days with 95% CI 23.29-50.70). The median of public health delays was 63 days with IQR 72 days. The females were delayed more than that of males (median delay 68 days with 95% CI 66.06-69.94). The adjusted Cox's regression identifies the features - older age, female, drug addiction, and community residence as potential factors that might affect TB delays.

Conclusions

It is essential to emphasize on the influencing dynamics - older age, female patients, HIV patients, alcohol addiction, and comorbidities to minimize TB delays.

Key messages

To minimize spreading risk of TB infections the dynamics of TB delays e.g. older age, female patients, drug, and alcohol addiction, comorbidities should be prioritized in the TB control programs. Special attention should be given to other lung diseases while diagnosing TB infections.

Bt Eggplant Project in Bangladesh: History, Present Status, and Future Direction

The purpose of this article is to provide information on the history, accomplishments, and future direction of the Bt brinjal (eggplant) program in Bangladesh, formerly under the Agricultural Biotechnology Support Project II, now the South Asia Eggplant Improvement Partnership (SAEIP). The India-based Maharashtra Hybrid Seed Company (Mahyco) developed an eggplant expressing Cry1Ac (EE-1) for control of the eggplant fruit and shoot borer (EFSB). In a partnership among Mahyco, USAID, Sathguru Management Consultants and Cornell University EE-1 was provided to the Bangladesh Agricultural Research Institute (BARI) who bred it into local varieties. After regulatory approval, four varieties were distributed to 20 farmers who harvested Bt brinjal in 2014. Adoption in subsequent years has increased rapidly so that, in 2018, 27,012 farmers used this technology. This article provides background information on the process leading up to current adoption levels, the level of control of EFSB achieved and the economic benefits of Bt brinjal. Efforts on stewardship, farmer training and communication are discussed. In order to ensure the long-term future of the partnership, we discuss the need to enhance involvement of the private sector in the production and stewardship of Bt eggplant. Bt brinjal is the first genetically engineered crop to be commercially released in Bangladesh, and other GE crops are in the pipeline. Hence, success of the Bt brinjal partnership is likely to affect the future of other GE crops in Bangladesh, as well as other parts of the world where biotechnology is needed for food security and environmental safety.

Overexpression of sonic hedgehog in the triple negative breast cancer: clinicopathological characteristics of high burden breast cancer patients from Bangladesh

Dysregulation of Hedgehog (Hh) signaling pathway has been documented in mammary gland development and breast cancer (BC) progression. Despite the remarkable progress in therapeutic interventions, BC related mortality in Bangladesh increased in the last decade. Triple negative breast cancer (TNBC) still presents a critical therapeutic challenge. Thus effective targeted therapy is urgently needed. In this study, we report the clinicopathological characteristics and prognosis of BC patients from Bangladesh. Routine immunohistochemical analysis and high throughput RNA-Seq data from the TCGA library were used to analyze the expression pattern and association of high and low level of Shh expression in a collection of BC patients with a long-term follow-up. High levels of Shh were observed in a subset of BC tumors with poor prognostic pathological features. Higher level of Shh expression correlated with a significantly poorer overall survival of patients compared with patients whose tumors expressed a low level of Shh. These data support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC. We propose that BC patients exhibiting a higher level of Shh expression, representing a subset of BC patients, would be amenable to Shh targeted therapy.

Major Variation in Branches of the Abdominal Aorta in New Zealand White Rabbit (Orycotolagus Cuniculus)

The aim of the present study was to investigate the arrangement and major vascular variation of abdominal aorta in NZW rabbit. A total of 28 healthy adult rabbits (14 males and 14 females) with an average (1.3 ± 0.5kg) body weight were used in this study. Deep surgical anaesthesia was done by using combination of xylazine and ketamine at the doses of 10mg/kg and 40mg/kg body weight respectively, and was sacrificed by bleeding through the right ventricle of the heart. Cannulation of the thoracic aorta and stained latex (added with ammonium water and red carmine stain) injection were performed, followed by 10% neutral buffered formalin. Asymmetry of the even branches with their distribution and the way of departure of the arteries from the abdominal aorta were observed. However, double pair ovarian arteries were found in a single animal. The diameter of the caudal mesenteric artery showed significant (p?0.05) difference between male and female. In case of male and female, the variability of the origin (number and level of origin) of testicular, ovarian and profound iliac circumflex arteries was also observed. DOI: http://dx.doi.org/10.3329/ijns.v2i4.13218 International Journal of Natural Sciences (2012), 2(4) 91-98

Anatomical study on origin, course and distribution of cranial and caudal mesenteric arteries in the White New Zealand rabbit (Orycotolagus cuniculus)

The present study was carried out on fifteen healthy adult White New Zealand rabbit (Orycotolagus cuniculus) to clarify the obscure mesenteric arteries, which and their branches which are usually involved in intestinal surgery. The mesenteric artery is a high caliber vessel, 2cm in length dependent on the abdominal aorta, right below the emergence of the vessels destined for the liver and stomach. The animals were sacrificed, injecting diazepam (30 mg/kg) in jugular vein. Cannulation of the abdominal aorta, perfusion with warmed water (40ºC) and stained latex injection (Neoprene 450, Capitol Scientific, Austin, U.S.A, Red carmine stain) were performed, followed by fixation. With formalin (10%) the dissection and photographic documents (Casio Cyber-shot, 12.1 mega pixels) made it possible to systemize the arteries and define the vascular patterns of the viscera. The results prone that the cranial mesenteric artery of the White New Zealand rabbit (Orycotolagus cuniculus) arose from the abdominal aorta, at the level of the second lumbar vertebra, entered the cranial mesentery forming its root, then proceeded caudoventrally in the mesojejunum and continued as the last cecal artery. The cranial mesenteric artery gave off: - Caudal pancreaticoduodenal artery to the right lobe of the pancreas and the descending and ascending parts of the duodenum. Middle colic artery, a small vessel (frequently two) arising from the left wall and passing to the transverse colon, Eighteen to twenty jejunal arteries, Ileocecocolic artery to the ileum, cecum, ascending colon, transverse colon and the cranial part of the descending colon. The caudal mesenteric artery arose from the abdominal aorta at the level of the caudal border of the root of the 6th lumbar transverse process, passed caudoventrally in the descending mesocolon, then divided into: left colic artery to the caudal two thirds of the descending colon, and cranial rectal artery to the cranial segment of the rectum. The obtained results were compared with their corresponding in the domestic animals, especially the domestic carnivores and laboratory animals. DOI: http://dx.doi.org/10.3329/ijns.v2i2.11386 International Journal of Natural Sciences (2012), 2(2):54-59

Central nervous system tuberculosis and adjuvant corticosteroid therapy

Tuberculous involvement of central nervous system is one of the important health issues causing high mortality and morbidity. Uncertainty and doubt dominate all aspects of CNS tuberculosis. Diagnosis is mainly based on clinical features, cerebrospinal fluid changes, and imaging characteristics. Few studies have shown that corticosteroids improve the clinical outcome, although the precise mechanism of action remains tentative. All the cases were selected on strong clinical suspicion of CNS tuberculosis. They were graded according to tuberculous meningitis (TM) severity grades. In this connection, we studied 13 patients in one medicine unit over 12 month's period to see the effect of corticosteroid as part of the outcome. Nine patients (69.23%) were in grade II, three (23.08%) patients were in grade III, and one (7.69%) was in grade I. Seven patients (53.85%) had tuberculous meningitis and six (46.15%) had tuberculoma (CT or MRI). Out of 13 cases 3 patients (23%) died in the hospital and 10 patients (77%) improved, of whom 2 patients (20%) recovered completely and 8 patients (80%) had residual neurological deficit. Our study suggests that the early detection of CNS tuberculosis is the most important prognostic factor. Timely started anti-Koch's treatment with adjuvant corticosteroid therapy has a direct bearing on patient outcome.

Effectiveness of montelukast in the treatment of atopic dermatitis

Leukotriene receptor antagonist ( montelukast) are recommended for the treatment of asthma, and have proved anecdotally successfully even in atopic dermatitis. In this open randomized clinical trial, the efficacy and safety of montelukast were assessed in the atopic dermatitis. Out of 31 enrolled patients all completed the study among which 16 in the montelukast group and 15 in the control group. No patient dropped from the study. Statistically significant SCORAD improvement (P = 0.003) was observed in montelukast group but in the control group SCORAD improvement was not statistically significant (P = 0.088). According to the patients impression pruritus was the most influenced SCORAD item by montelukast group immediately followed by sleep loss and inflammatory signs. On the contrary montelukast seemed to be completely devoid of activity on xerosis. No adverse effect of montelukast was observed in the present study.

Vaccination coverage survey in Dhaka District

A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.

Household aggregation of Strongyloides stercoralis infection in Bangladesh

Strongyloides stercoralis infections were shown to be aggregated in households in an urban slum community in Dhaka, Bangladesh. Parasitological data on 880 residents living in 280 households were analysed statistically using 3 different tests, each of which yielded significant evidence of household aggregation of S. stercoralis infection. One test was applied to the data after stratification for 4 variables were previously shown to be independently associated with infection. Evidence of household aggregation of infection remained after stratification, suggesting that aggregation is due not only to shared risk factors, but also to either familial genetic predisposition to infection or close contact person to person transmission of infection within households.

Strongyloides stercoralis in an urban slum community in Bangladesh: factors independently associated with infection

Stool samples from 880 residents in an urban slum in Dhaka, Bangladesh, were collected on 3 occasions over one year, and examined for intestinal parasites. Information on many potential risk factors for infection was obtained by questionnaire from a respondent in each household studied. In a crude univariate analysis of the data, several of the factors were found to be significantly associated with Strongyloides stercoralis infection. Most of these factors were co-variate with one another, and with poverty generally. Using Mantel-Haenszel chi 2 tests to control for confounding effects of each variable individually, the following 4 factors remained independently associated with S. stercoralis infection: respondent's use of a community latrine rather than a private latrine, living in a house with an earth floor rather than a cement floor, being of Bihari ethnicity, and being 7-10 years of age. Implications of these results for the epidemiology and control of strongyloidiasis are briefly discussed.

Molecular Characterization of 28 Mango Germplasm Using RAPD

Genetic variation and relationship among 28 mango germplasm were analyzed using Random Amplified Polymorphic DNA (RAPD). Out of 20 primers screened, four were selected, which gave 50 clear and bright fragments, out of which 48 fragments were considered polymorphic. The proportion of polymorphic loci and gene diversity values across all loci were 96% and 0.29, respectively. The UPGMA dendrogram based on genetic distance segregated the 28 mango germplasm into two main clusters. Sukul alone formed one cluster and the rest germplasm were grouped together into another cluster. Mallika and Amrapali cultivar pair was very close to each other with the highest intervarietal similarity index (87.30%) and lowest genetic distance (0.08). On the other hand, Sukul and Meghnath pair was more distant to each other with the lowest intervarietal similarity index (14.29%) and highest genetic distance (0.87). The results of the present study indicated that the RAPD analysis could be utilized by breeders for further improvement of mango varieties.Key words: Germplasm, Characterization, Mango, RAPDDOI = 10.3329/ptcb.v17i1.1123Plant Tissue Cult. & Biotech. 17(1): 71-77, 2007 (June)

Macro anatomical investigation of brachial plexus of the White New Zealand rabbit (Orycotolagus cuniculus)

In present study, the brachial plexus of the White New Zealand rabbit (Orycotolagus cuniculus) was investigated. Five adult rabbits were used and organizations of the brachial plexus of them were investigated. It was found that the brachial plexus of the rabbit was formed by rami ventralis of fifth cervical spinal nerve (C5), sixth cervical spinal nerve (C6), seventh cervical spinal nerve (C7), eighth cervical spinal nerve (C8), first thoracic spinal nerve (T1) and second thoracic spinal nerve (T2). The rami ventralis of C5 spinal nerve and T2 spinal nerve were divided into two branches. The caudal branch of C5 spinal nerve and cranial branch of T2 spinal nerve contributed to the brachial plexus. The caudal branch of C5 spinal nerve and C6 spinal nerve constituted the cranial trunk and the caudal trunk was formed by a branch which came from cranial trunk, rami ventralis of C7, C8, T1 spinal nerves and the cranial branch of ventral ramus of T2 spinal nerve. Contribution of caudal branch of ventral ramus of C5 spinal nerve and cranial branch of ventral ramus of T2 spinal nerve to the formation of the brachial plexus of rabbit and division of the brachial plexus to the caudal and cranial trunks resemble to porcupine and differ the brachial plexus of this species from those of rat, mouse and mammals.Key words: Spinal nerves; Orycotolagus cuniculus; Brachial plexus; Rabbits.DOI: http://dx.doi.org/10.3329/ijns.v1i3.8825International Journal of Natural Sciences (2011), 1(3):74-76