First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique

Introduction

While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach.

Methods

Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed.

Results

The analysis included five patients [median age: 73 years; BMI: 27.2 kg/m²; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission.

Conclusion

We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-021-03920-1.

New emerging roles of the novel hepatokine SERPINB1 in type 2 diabetes mellitus: Crosstalk with β-cell dysfunction and dyslipidemia

Diabetes mellitus (DM) is a devastating metabolic disease. Recently, the cross-talk between insulin-secreting-β-cells and various organs has sparked much interest. SerpinB1 emerged as a novel hepatokine inducing β-cell proliferation. However, its role in type-2-DM (T2DM) patients has not been adequately studied. This study was designed to investigate its circulating levels in subjects with/without T2DM, and to study its association with β-cell function, as well as various glycemic-control and lipid-profile parameters. Anthropometric data and biochemical markers including fasting plasma glucose (FPG), HbA_1C % and lipid profile parameters were measured in 55 T2DM patients, as well as 30 healthy nondiabetic subjects. Serum serpinB1, insulin and C-peptide levels were measured by ELISA. The homeostasis model assessment of both β-cell function (HOMA2-β%) and insulin resistance (HOMA-IR) were calculated. SerpinB1 levels were found to be significantly lower in T2DM patients 0.7 (0.2-12.4) ng/mL, compared to nondiabetic subjects 1.2 (0.94-24) ng/mL, P < 0.001, regardless of glycemic control, obesity, or insulin resistance. Additionally, serpinB1 levels were found to be positively associated with C-peptide, HOMA2-β% in all subjects; and BMI only in non-DM subjects; while negatively associated with FPG, HbA_1C% and lipid-profile parameters. Higher serum serpinB1 levels were found to be associated with lower susceptibility for T2DM. Conclusively, serpinB1 is associated with various aspects of β-cell dysfunction, glycemic-control, and dyslipidemia with a possible role in β-cell compensation in obese nondiabetic subjects. The results of the current study shed lights on potential novel roles of serpinB1 in T2DM besides its action as an inducer for β-cell proliferation.

Global change of surgical and oncological clinical practice in urology during early COVID-19 pandemic

Objectives

While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic.

Methods

In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated.

Results

235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21–24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02).

Conclusion

The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.

Electronic supplementary material

The online version of this article (10.1007/s00345-020-03333-6) contains supplementary material, which is available to authorized users.

REST-DRD2 mechanism impacts glioblastoma stem cell-mediated tumorigenesis

BACKGROUND

Glioblastoma (GBM) is a lethal, heterogeneous human brain tumor, with regulatory mechanisms that have yet to be fully characterized. Previous studies have indicated that the transcriptional repressor REST (repressor element-1 silencing transcription factor) regulates the oncogenic potential of GBM stem cells (GSCs) based on level of expression. However, how REST performs its regulatory role is not well understood.

METHODS

We examined 2 independent high REST (HR) GSC lines using genome-wide assays, biochemical validations, gene knockdown analysis, and mouse tumor models. We analyzed in-house patient tumors and patient data present in The Cancer Genome Atlas (TCGA).

RESULTS

Genome-wide transcriptome and DNA-binding analyses suggested the dopamine receptor D2 (DRD2) gene, a dominant regulator of neurotransmitter signaling, as a direct target of REST. Biochemical analyses and mouse intracranial tumor models using knockdown of REST and double knockdown of REST and DRD2 validated this target and suggested that DRD2 is a downstream target of REST regulating tumorigenesis, at least in part, through controlling invasion and apoptosis. Further, TCGA GBM data support the presence of the REST-DRD2 axis and reveal that high REST/low DRD2 (HRLD) and low REST/high DRD2 (LRHD) tumors are specific subtypes, are molecularly different from the known GBM subtypes, and represent functional groups with distinctive patterns of enrichment of gene sets and biological pathways. The inverse HRLD/LRHD expression pattern is also seen in in-house GBM tumors.

CONCLUSIONS

These findings suggest that REST regulates neurotransmitter signaling pathways through DRD2 in HR-GSCs to impact tumorigenesis. They further suggest that the REST-DRD2 mechanism forms distinct subtypes of GBM.

Effect of Intravenous Paracetamol with Bupivacaine Scalp Nerve Block on Haemodynamics Response as Well as Anaesthetic Requirements during Supratentorial Craniotomies

Noxious stimuli during craniotomy may encourage hypertension and tachycardia, which may rise to morbidity in patients with intracranial hypertension. After craniotomy a moderate level of postoperative pain observed. The objective of this study was to observe the effect of intravenous paracetamol with bupivacaine scalp nerve block (SNB) on haemodynamics response as well as anaesthetic & analgesic requirements during supratentorial craniotomies. This is a single-blind, placebo-controlled, randomized clinical trial carried out in the Neurosurgery operation theatre from August 2015 to July 2017 under supervision of Department of Anaesthesia, Analgesia and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 40 patients aged 18-60 years with supratentorial space occupying lesion undergoing craniotomy under general anaesthesia who were attended in the department of Neurosurgery, BSMMU were enrolled in this study and they were divided randomly into two groups, 20 patients in each. The Group A received 100ml normal saline infusion and 0.25% bupivacaine (20ml) in scalp block, while the Group B received intravenous injection paracetamol (1gm) and 0.25% bupivacaine (total 20ml) in scalp block. Statistical analyses were obtained Statistical Packages for Social Sciences (SPSS-22). The mean systolic blood pressure varied within the normal range in both groups. The mean DBP of Group B remained significantly lower than that of Group A in different follow up except at 30 minutes and 60 minutes after dura incision. However, mean MAP of Group B remained significantly lower than that of Group A in different time interval. The mean heart rate of Group B remained significantly lower than that of Group A. The mean intraoperative propofol as well as fentanyl requirements were significantly decreased in Group B in comparison to Group A. The combination of intravenous paracetamol with bupivacaine scalp nerve block provides better intra-operative haemodynamic stability and neurosurgical compliances for the patients undergoing supratentorial craniotomies under general anaesthesia.

Evaluation of Post Guillain-Barre Syndrome (GBS) Patients: A Cross Sectional Study

Guillain-Barre syndrome (GBS) is related with significant morbidity and also mortality. Little is known about the long term outcome of GBS patients who survived. The objective of this study is to determine the lasting outcome and consequences of GBS patients. This is a cross-sectional study of patients who diagnosed GBS and managed at the Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2004 to December 2017. All survived patients were invited for a structured interview, questionnaires, and full neurologic exam to record their current clinical condition focused on complaints and symptoms, neurological deficits, disabilities, behaviour, and quality of life. Thirty-eight patients participated, with a median age of 20 years (range 4-39 years) and a median interviewed time of 7 years (range 1-13 years). Residual complaints were reported by 24(63%) patients, including paresthesias (10.5%), unsteadiness of gait (37%), painful hands or feet (29%), and severe fatigue (13%). Questionnaires identified a wide range of behavioural problems. Most Patients showed good recovery of neurological deficits after GBS, but many have persisting long-term residual complaints and symptoms that may lead to psychosocial problems interfering with participation in daily life.

Environmental and maternal factors associated with gross placental morphology in dairy cattle

This article reports on a study of gross placental morphology of 282 expelled placentas from 89 primi- and 193 multiparous Holstein dams immediately after calving and examines associations with environmental factors such as typical herd features and season of calving, and maternal factors such as age at calving, level of milk yield at conception and cumulative amount of milk produced during gestation. The highest correlation between calf measurements and placental characteristics was found between the weight of the calf and the total cotyledonary surface (r = .643; p < .001), confirming the high importance of the cotyledonary surface available for nutrient transfer to the developing foetus. Younger age in adolescent and smaller heart girth in multiparous dams were associated with a higher cotyledon number, suggesting placental compensation in dams with lower capacities in terms of dry matter intake. No significant association between milk yield during gestation in multiparous animals and gross placental morphometrics could be detected, indicating that factors such as the amount of milk produced during gestation affect placental development less than foetal weight close to term. Therefore, placental growth may be sustained at the expense of other tissues in an attempt to maintain pregnancy and minimize the adverse consequences for the foetus. This study offers evidence concerning factors affecting the placental surface size for nutrient transfer from dam to calf in dairy cattle based on gross morphometrics, but needs confirmation from studies in which this surface size is more profoundly assessed by measuring the branches present in the cotyledonary villi.

Cutaneous anthrax in a school teacher

Cutaneous anthrax is an infection of the skin caused by Bacillus anthracis. This is a report of a case of cutaneous anthrax attending outpatients of Mymensingh Medical College Hospital in October, 2010. The infected person was a retired school teacher with a very good body build. He reported to handle cow flesh about 4-5 days ago, developed few painless papules over shin of right leg, which gradually became large bullae and blackish eschar developed over the lesion. Smears from the lesions were investigated which confirmed the causative agent B. anthracis. The patient was treated with oral Ciprofloxacin (500mg) twice daily for seven days which cured the infection as observed on his subsequent follow up visits on 7 and 14 days later. Oral Ciprofloxacin is found effective as recommended by the World Health Organization.

Sonographic evaluation of thyroiditis with color flow study

This cross sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Bangladesh in collaboration with the Department of Endocrinology and Department of Histopathology of the same hospital during the period of March 2007 to February 2008 to determine efficacy of ultrasonogram in the evaluation of thyroiditis and to compare its results with color flow Doppler study. For this purpose, a total of 50 patients having clinical suspicion of thyroiditis were enrolled in this study. Ultrasound and color Doppler were done in all these patients. Then all patients underwent for FNAC in the Histopathology department. Correlation between sonographic diagnosis and histopathological diagnosis were observed. Out of these 50 patients 10(20%) were male and 40 (80%) were female with age ranging from 12 to 50 years, highest between 21 to 30 years. The mean age of the patients was 30.42±9.57 years. On unltrasonographic findings of thyroid gland 42.0% patients had regular and 58.0% had irregular margin. Seventy percent had fibrosis, 14.0% had feature of necrosis, 48.0% had lymphadenopathy. Out of all patients 6.0% had normal echogenic feature, 16.0% had increased and 78.0% decreased echogeneic feature. Twelve percent (12.0%) patients had homogeneous and 88.0% had heterogeneous pattern of echogenecity. Thirty eight percent (38%) patients had focal nodules. Sixty percent (60.0%) patients had focal swelling and 40.0% had diffuse swelling. On color flow Doppler 28.0% had normal, 38.0% had increased and 34.0% decreased vascular flow pattern. USG reports revealed that 48.0% had thyromegaly, 36.0% had thyroid nodule, 10.0% had multinodular goiter and 6.0% had thyroid abscess. FNAC diagnosis revealed that 34.0% patients had Hashimoto's thyroiditis, 24.0% had lymphocytic thyroiditis, 18.0% had granulomatous thyroiditis, 6.0% had abscess, 8.0% had goitre and 10.0% nonspecific. USG and CFD are recommended modalities for the diagnosis of thyroiditis as these cost-effective and non invasive procedures.

Metastatic squamous cell carcinoma of spleen: a case report

Metastatic squamous cell carcinoma of spleen is a very rare occurrence and a very small number of cases have been reported so far, mostly in autopsy series. More commonly observed metastasis to the spleen are from breast, lungs, colorectal organs and ovaries. Interestingly enough the spleen is very unusual site of metastasis from an esophageal malignancy, only very few cases (four cases up to 2005) being reported in the literature. A case of splenic metastasis from carcinoma of the esophagus in a 60 years old woman is presented in this report. Extraordinary merit of this case is that carcinoma of the esophagus was diagnosed after the patient had been operated for splenic abscess and was histologically diagnosed as metastatic squamous cell carcinoma of spleen. The patient underwent splenectomy and recovered well. Only during post operative period endoscopic examination of upper GIT with biopsy revealed carcinoma of the esophagus. Further investigations failed to delineate any other organ involvement. So, this case is being reported as metastatic squamous cell carcinoma of spleen from carcinoma of esophagus.

PATHOLOGICALSTUDY ON COLIBACILLOSIS IN CHICKENS AND DETECTION OF ESCHERICHIA COLI BY PCR

    The aim of the present study was to detect the pathogenic Escherichia coli (E. coli) through pathological study of the colibacillosis affected birds. These isolated E. coli were further confirmed by PCR using specific primer. For this purpose, a total of 20 swabs (10 from lung and 10 from intestine of 10 dead birds) were collected in sterile nutrient broth. The histopathological samples were collected in 10% buffered neutral formalin. The used methods were histopathology, isolation and identification of E. coli by conventional methods and as well as by PCR method. A total of 10 isolates of E. coli from 20 swabs of lung and intestine was characterized by conventional routine methods of bacteriology. Gross pathological lesions of all lungs in the present investigation were congested and consolidated. Duodenum showed congestion and hemorrhages with excess mucus in the luminal surface of it. Microscopically, all the lungs showed severe congestion, infiltration of heterophils, macrophages and lymphocytes in the wall of bronchus as well as in the peribronchial alveoli. E. coli infected all the duodenum showed severe infiltration of leukocytes mainly heterophils, lymphocytes and macrophages in the submucosa of the duodenal wall. In this study, DNA of 8 isolates out of 10 isolated E. coli organisms was amplified by PCR using ECO-f and ECO-r primer targeting 16S ribosomal DNA and found 585 bp amplicon which is specific for E. coli with enteroinvasive type confirmed by histopathological lesions in duodenum. Further investigation should be focused on serotyping and detection of genes of E. coli which are responsible for pathogenicity of the organism.DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11205Bangl. J. Vet. Med. (2011). 9(1): 17-25 

Pattern of mental illness on substance abusers

The aim of this study was to investigate mental illnesses among the substance abuse dependent populations. A total of 1076 substance abusers were recruited from the Outpatient Department of the Central Drug Addiction Treatment Center, Tejgaon, Dhaka from July 2008 to June 2009. They sought detoxification therapy voluntarily at this centre. The research participants were selected consecutively following the defined selection criteria. Research instruments were interviewer-administered questionnaire and standard mental state examination scales. Of the 1076 substance abusers, 82.6% had been using heroin currently and rest of them used phensedyl followed by injection drugs and cannabis with a period ranged 2-30 years. Results showed that 91.3% of the substance abusers had been suffering from insomnia and 75.0% had altered food habit. About 49.0% showed disturbed behaviors and 45.2% had been suffering from sexual dysfunctions. Around 32.0% of the substance abusers had been suffering from nonspecific generalized anxieties and 72.7% were found in abnormal mood/affects. A striking finding was that 7.3% of the substance abusers had been suffering from perceptual and/or thought disturbances. In conclusion, 7.3%-92.5% of the substance abusers had been suffering from mental illnesses. Insomnias, decreased intake of food and taste preference, irritable mood/affects, loss of interest in sex and non-specific anxieties were highly prevalent among them. Medical management and altering lifestyle are still the only applicable way to control this human catastrophe.

Palliative care out patient consultation service in a teaching hospital in Bangladesh

Palliative care is a newly emerging subspecialty in Bangladesh. The aims of this study were i) to determine the characteristics, types of referral, disease pattern and insight about the disease and ii) to estimate the prevalence of pain and other common symptoms in a population of patients with advanced incurable state of cancer and attending the newly established palliative care out patient clinic. The data were collected at the outpatient clinic during first consultation using a modified structured data collection sheet from the Institute of Palliative Medicine (IPM) in Calicut, Keralla, India. Two hundred and three patients with mean age 50 years, diagnosed as suffering from incurable cancer were seen during a period of 21 months from October 2007 to June 2009. Most of the patients were from less privileged socioeconomic group (86%), stays with family (99%), already know about their disease status and prognosis (62%). Referred from other disciplines formed the major group (72%) of this population. All of them had been under treatment for variable period ranging from one month to four years. The most common five symptoms noted by the service providers were pain (89%), loss of appetite (61%), sleeplessness (55%), lack of energy (47%) and constipation (44%). Population based studies are required to determine the actual magnitude of sufferers and suffering in spite of the availability of global knowledge and skill to reduce these sufferings of the incurably ill members of the society.

Iodized salt induced thyrotoxicosis: Bangladesh perspective

The effects of iodized and non-iodized salt on the thyroid gland and its hormones T3, T4 and thyroid stimulating hormone (TSH) were studied in 200 individuals who were the residents of plain areas of greater Mymensingh district. The subjects were collected from the Center for Nuclear Medicine and Ultrasound, Mymensingh. Out of 200 individuals 150 were using iodized salt and 50 were using non-iodized salt. The iodized and non-iodized salt users were marked as study and control groups respectively. Blood samples were taken from both the groups and T3 and T4 in blood serum were determined by radioimmunoassay (RIA) while TSH was determined by immunoradiometricassay (IRMA). The mean concentration of T3 were 2.633 nmol/L and 2.223 nmol/L and T4 concentration were 122.444 nmol/L and 110.355 nmol/L in study and control group respectively. The mean TSH concentration was 5.044 mIU/L and 9.622 mIU/L in study and control group respectively. The data indicated that continuous and long term use of iodized salt increased both T3 and T4 and decreased TSH in study group. The results were significant (p<0.05) when compared to that of the control. The results suggested that mandatory mass consumption of iodized table salt without T3, T4 and TSH screening of blood may produce iodinated salt induced thyrotoxicosis (ISIT) in peoples living in plain areas of Bangladesh. We suggest close regular monitoring of T3, T4 and TSH and urinary excretion of iodine of individuals who are using iodized salt for better management of iodinated salt program in our setting.

Effects of long term iodized table salt consumption on serum T3, T4 and TSH in an iodine deficient area of Bangladesh

The effect of iodized and non-iodized table salt in goiter hyper-endemic area on the thyroid gland and its hormones T3, T4 and Thyroid Stimulating Hormone (TSH) were studied in two hundred subjects from the Center for Nuclear Medicine and Ultrasound, Mymensingh. Iodized and non-iodized salt users were called study and control groups respectively. The mean concentration of T3 were 2.38 nmol/L and 2.22 nmol/L & T4 concentration were 128.67 and 123.72 nmol/L in the study and control group respectively. The mean TSH concentration was 1.52 mIU/L and 1.62 mIU/L in study and control group. The data indicated that continuous and long term use of iodized salt increased both T3, T4 and decreased TSH in such a limit which was not statistically deferent at P< 0.05 level as compared to the control group. There was no significant change in occurrence of (hypo and hyper thyroidism or iodinated salt induced thyrotoxicosis) adverse effect, following iodine supplementation. The study shows that, mandatory mass iodination of table salt consumption in a hyper-endemic iodine deficient area is safe and does not cause any side effect. We suggest close regular monitoring of T3, T4, and TSH and further evaluation by specifically designed studies for any probable link between iodine induced hypo or hyperthyroidism and mass iodination of table salt consumption.

Differential pulse and square-wave cathodic stripping voltammetry of xanthine and xanthosine at a mercury electrode

The surface activity of xanthine (Xan) and xanthosine (Xano) at a hanging mercury drop electrode (HMDE) was studied using out-of-phase ac and cyclic dc voltammetry. The results show that Xan and Xano were strongly adsorbed and chemically interacted with the charged mercury surface, which is the prerequisite step for applying the cathodic adsorptive stripping voltammetric determination of such biologically important compounds. Differential pulse cathodic adsorptive stripping voltammetry (DPCASV) and square-wave cathodic adsorptive stripping voltammetry (SWCASV) were applied for the ultratrace determination of Xan and Xano compounds. Moreover, a rapid and sensitive controlled adsorptive accumulation of Cu(II) complexes of both compounds provided the basis of a direct stripping voltammetric determination of such compounds to submicromolar and nanomolar levels. Operational and solution conditions for the quantitative ultratrace determination of Xan and Xano were optimized in absence and presence of Cu(II). The calibration curve data were subjected to least-squares refinements. The effects of several types of inorganic and organic interfering species on the determination of Xan or Xano were considered.

Comparison of the voltammetric studies at mercury and glassy carbon electrodes for the interaction of lumichrome with DNA and analytical applications

The determination of the interaction between lumichrome (LC), one of the products of decomposition of the biologically important flavins, and calf thymus double-stranded DNA was performed by using cyclic voltammetry (CV) and differential pulse stripping voltammetry (DPSV) in connection with a hanging mercury drop electrode (HMDE) or glassy carbon electrode (GCE). The nature of the process taking place at both electrode surfaces was clarified. It was found that the addition of DNA to a buffered LC solution results in the decrease of redox peak currents with changes in the peak potentials at both electrodes. We assume that LC interacting with DNA produces an electrochemically inactive supramolecular complex via intercalation. There was a difference between the electrochemical parameters determined at the HMDE and those at the GCE. The binding constants ( K) of the LC-DNA complex at HMDE and GCE were determined through the changes of peak currents and their values at the 10(5) level and 10(4) level with each nucleotide residue of DNA binding one LC molecule, respectively. Furthermore, the calibration graph for the determination of DNA was obtained by the decrease in the DPSV peak current of LC in the presence of DNA. Different variables, such as the concentration of LC, the accumulation time and solution conditions, were studied and optimised to maximize the sensitivity; in addition, the detection limit and the reproducibility were determined.

Efficacy of a modified Ultra Fast Papanicolaou (UFP) stain for breast aspirates

The chief limitation of Ultra Fast Papanicolaou (UFP) stain, suggested by Yang and Alvarez (1995), is that, Richard Allan Haematoxylin (RA-H) and Richard Allan Cytostain (RA-C), used in the staining procedure are not universally available. It has not been established so far, whether, changes in the reagents and their proportions depending on the local availability, influence the performance of the stain. The objective of this study was to assess the feasibility and applicability of a modified UFP stain to suit our local laboratory supplies of chemical dyes, as applied to the permanent smears prepared from Fine Needle Aspiration (FNA) of breast lumps. In the present study, smears from FNA from 100 breast lumps were stained by the modified UFP stain. The modification consisted of following two changes: use of Gill's Haematoxylin instead of RAH and omission of Orange G from cytostain. Eighty Six breast aspirates were adequate for interpretation. Smears showed transparent cells with crisp nuclear features, equal to and even better than the conventional Papanicolaou stain, in a blood free background. There was an increase in total staining time by 40 seconds. We recommend the use of this modified UFP stain, only if similar reagents are being used in other laboratories. Otherwise situation specific modifications may be needed. If the UFP stain is to be used for tissues where the chances of cytoplasmic keratinization are negligible, then the use of Orange G component of the stain may become redundant.

Improvement of the Mair scoring system using structural equations modeling for classifying the diagnostic adequacy of cytology material from thyroid lesions

The scoring system developed by Mair et al. (Acta Cytol 1989;33:809-813) is frequently used to grade the quality of cytology smears. Using a one-factor analytic structural equations model, we demonstrate that the errors in measurement of the parameters used in the Mair scoring system are highly and significantly correlated. We recommend the use of either a multiplicative scoring system, using linear scores, or an additive scoring system, using exponential scores, to correct for the correlated errors. We suggest that the 0, 1, and 2 points used in the Mair scoring system be replaced by 1, 2, and 4, respectively. Using data on fine-needle biopsies of 200 thyroid lesions by both fine-needle aspiration (FNA) and fine-needle capillary sampling (FNC), we demonstrate that our modification of the Mair scoring system is more sensitive and more consistent with the structural equations model. Therefore, we recommend that the modified Mair scoring system be used for classifying the diagnostic adequacy of cytology smears. Diagn. Cytopathol. 1999;21:387-393.

Developing and testing of an Egyptian version of Children's Health Locus of Control scale

The purpose of this study is to develop and test the reliability and validity of an Egyptian version of the Children's Health Locus of Control scale. A cross sectional study design was applied using a stratified random sample of 930 students from the final two grades of primary and all grades of the preparatory schools. A further convenience sample of 120 students was selected to examine test-retest reliability of the scale. A preliminary instrument was developed and consisted of 40 statements having one of two response forms; a Yes/No format and a 4-point Likert scale format From data analysis the later format showed higher validity and reliability than the former one. Construct validity of the scale is evidenced by the factor analysis which revealed five factors (Internal, Chance, Powerful Others, Fate and Self blame) consistent with the previous theoretical model of HLC. As indicated by eta coefficient the scale and the subscales showed strong discriminating power between subjects. The known group comparison indicated a good criterion validity of the scale and the subscales. The scale showed a considerable reliability as alpha coefficient was 0.73 with test-retest reliability of 0.65. Comparison of different groups of students indicated that the scale could be used with confidence for all age groups, though it was more reliable for the preparatory phase, for private and governmental schools for males and females and for different social strata. Further testing of the developed scale is indicated among Egyptian children in different cultures.

Cognitive predictors of self-management behavior of asthmatic children and their families in Alexandria

The aim of this work was to study self-management behavior (SMB) of asthmatic children and their parents, its cognitive predictors as well as its effect on the child stress and health care utilization. Data was collected by interviewing 500 asthmatic children aged 9-18 years and 500 of their parents. The study revealed that very low percentage of the respondents had good asthma management behavior. The most frequent behaviors were taking medication, going to doctor and avoiding asthma triggers. The least practiced behaviors were breathing exercises and bronchial hygiene practices. The main predictor for children's SMB which constituted 36.3% of its variance was parental management behavior. Most of the studied cognitive factors were proved as predictors for children's SMB including knowledge, self-efficacy, health locus of control, perceived seriousness and barriers. Socioeconomic status was the main predictor of parental SMB, together with knowledge, powerful others health locus of control, health value, perceived barriers and father's education shared by 46.4% in explanation of its variance. Child knowledge, parental SMB, and socioeconomic status were significantly predicting health care utilization and level of child stress. A need was highlighted for initiation an asthma management educational program to families of asthmatic children.

Evaluation of fine needle capillary sampling in superficial and deep-seated lesions. An analysis of 670 cases

OBJECTIVE

To study the efficacy and merits of a simplified cytologic technique of fine needle capillary (FNC) sampling in 670 cases.

STUDY DESIGN

FNC sampling was tested on a consecutive series of 600 superficial palpable masses and 70 deep-seated lesions during the period January 1993-September 1993. Among superficial masses, sampling was done on 380 lymph nodes, 88 breast lesions, 56 thyroids, 12 salivary glands and 64 miscellaneous sites. Fifty-five lung lesions were sampled using 8 computed tomography, while 15 abdominal masses were sampled using ultrasonography. Cell samples were assessed as diagnostically adequate or inadequate.

RESULTS

The diagnostic adequacy in lymph node, breast and thyroid lesions was 95%, 91.07% and 90.09%, respectively. The diagnostic adequacy for deep-seated lesions was 91.42%.

CONCLUSION

The procedure gives a better perception of tumor consistency and control of the hand. FNC resulted in a high yield of good-quality material with retention of cellular architecture. It is recommended that the operator become familiar with the macroscopic slide appearance of a cellular smear. Doubts persist with respect to fibrotic and cystic lesions.

Adsorptive stripping voltammetric analysis of 2,4,6-tri(2'pyridyl)-1,3,5-triazine at a mercury electrode

The redox behaviour of adsorbed species of 2,4,6-tri(2'-pyridyl)-1,3-5-triazine (TPTZ) at the surface of a mercury electrode was examined using cycling voltammetry. Based on the adsorption and accumulation of TPTZ at the charged mercury surface cathodic adsorptive stripping voltammetry (CSV) is applied for the trace determination of TPTZ using a differential pulse (DP) technique. Experimental and operational parameters for the quantitative analysis of TPTZ are optimized and the detection limit was found to be 3x10(-9) mol/l. The effect of some interferences, e.g. organic compounds, cations and anions, are investigated.

Rhinosporodiosis. Diagnosis by scrape cytology

OBJECTIVE

To determine the utility of the simple technique of scrape cytology for obtaining a morphologic diagnosis of Rhinosporodium seeberi.

STUDY DESIGN

The study included nine patients presenting with a nasal polyp alone and one patient presenting with a skin ulcer with a recurrent nasal polyp. Scrape smears from all 10 nasal polyps and skin ulcers were collected. Periodic acid-Schiff (PAS) stain was used on smears from three cases. Histopathology of all the nasal polyps and the excised skin ulcer was done.

RESULTS

The scrape smears showed characteristic spores of R seeberi mixed with an acute and chronic inflammatory exudate and metaplastic cells. PAS stain showed positivity for the capsule. Histopathology confirmed the cytologic diagnosis.

CONCLUSION

Since mature sporangia rupture either on the surface or within the mucosa of polyps, scrape smears reliably and safely retrieve abundant spores. Therefore, this technique, offers immense potential for a rapid and correct preoperative diagnosis of rhinosporodiosis. It thereby facilitates the planning of surgical interventions to prevent recurrences.

Cytomorphology of subcutaneous cysticercosis. A report of 10 cases

The findings of fine needle aspiration cytology (FNAC) of subcutaneous cysticercosis are described. Nine patients had a single subcutaneous nodule. One patient had multiple skin and cerebral nodules that were clinically suspected due to cysticercus. Patients with a single nodule in the extremities and trunk were clinically diagnosed as having lipoma (1), fibroma (3) and neurofibroma (3). Tuberculous lymphadenitis was suspected in two cases with a single cervical nodule. The characteristic cytomorphology of parasitic tegument and parenchyma helped identify the larvae in the cytological smears, as did a polymorphous inflammatory reaction. Biopsy was done in four cases. Six patients were lost to follow-up. Histopathology of the nonaspirated nodule from the case with multiple skin nodules showed cysticercus. The other three biopsies showed a parasitic granuloma only. Of the four biopsied cases, only two underwent computed tomographic scans, which showed cerebral involvement. In a developing country like India, a rapid, safe and reliable cytologic diagnosis of subcutaneous cysticercus by FNAC on an outpatient basis proves to be a cost-effective procedure since it obviates the need for open biopsy.

Aspiration cytology of salivary gland lesions advantages and pitfalls

FNAC of the major salivary glands was performed on 72 patients during a period of two and a half years. In 64 patients samples were satisfactory. The cytologic diagnosis was correlated with histology available in 36 cases. 21 out of 22 benign lesions and 12 out 4 malignant lesions were correctly identified rendering a diagnostic accuracy of 91 percent. The pitfalls of FNAC of salivary gland lesions are reflected by the overall false positive rate of 5.5 percent of false negative rate of 2.7 percent. Diagnostic pitfalls are due to variability of tumor morphology which makes sampling & interpretation difficult. Multiple sampling and increasing experience help to minimize errors.

Schistosomiasis and sarcoma of the urinary bladder

A young male patient with schistosomiasis and sarcoma of the urinary bladder is presented. Total cystectomy followed by radiotherapy was performed. The gross appearance, microscopic findings of the tumor and an outline of the disease are discussed.

Supplementation of maize-based concentrates and milk production in indigenous cows

The effect of feeding maize-based concentrates on milk yield in cows with cost-benefit analysis was done at smallholder farms in four districts of northern Bangladesh. Concentrate mixtures containing wheat bran, rice polish and sesame oil cake were supplied to 40 indigenous (Desi) cows (20 in Group A and 20 in Group B) for 30 days before intervened feeding. Cows were given 1 kg maize-based concentrates/100 kg body weight twice daily for a further 60 days after feeding intervention. Cows' body weight, milk yield and farm income were recorded before and after maze-based concentrate supplementation. Milk production is increased by 30% for Group A and 90% for Group B. The difference in milk yield before and after supplementation of maize-based concentrate in Group B was significant (P<0.05). The cows' average body weights in Group A increased by 4.7 kg and in Group B by 1.8 kg. In both groups, net income increased and the income increase in A was significantly (P<0.01) greater than in B. Maize-based concentrated feeding in cows led to better milk yield with good economic return. DOI: 10.3329/bvet.v26i2.4950 Bangl. vet. 2009. Vol. 26, No. 2, 48-53

Prevalence and risk factors of mastitis in dairy cows

Identification of risk factors is important for the design of control programmes for mastitis in cows. Information about farms and management was collected at a farm visit. California Mastitis Test (CMT) was performed to assess sub-clinical mastitis, and cows, udder and milk were examined for clinical mastitis. A total of 347 lactating cows from 83 farms in the dry season (November - February) and 388 lactating cows from 89 farms in the wet season (June - October) were studied. The overall prevalence of mastitis was 19.9% and 44.8% in dry and wet seasons, respectively. The prevalence of mild mastitis was 17.3% and 40.7%, whereas that of moderate mastitis was 2.6% and 4.1% in dry and wet seasons, respectively. The prevalence of mastitis was higher (P<0.01) in wet than in dry season. On average, 18.7% quarters had mastitis during the wet season and 6.9% in the dry season. In the dry and wet seasons, respectively, 63.9% and 11.2% had completely dry floors, and the prevalence of mastitis was 22.6% and 30.0%. On the other hand, 88.8% and 36.1% of 83 farms had partly or completely wet and soiled floor and the prevalence of mastitis was 40.0% and 59.5% in the dry and wet seasons, respectively. Udder cleanliness, milk yield and peri-parturient diseases significantly (P<0.01) increased the risk of mastitis. The prevalence of mastitis is regarded as quite high. Dry and clean floor to keep cow's udder and teat clean would help control mastitis in the dairy farms of Bangladesh. DOI: 10.3329/bvet.v26i2.4951 Bangl. vet. 2009. Vol. 26, No. 2, 54-60

EPIDEMIOLOGICAL STUDY OF UDDER AND TEAT DISEASES IN DAIRY COWS

An epidemiologic study was conducted on 581 dairy cows (indigenous and its crosses 371, exotic crosses 210) of 4 government establishments to find prevalence of udder and teat diseases and their association with udder and teat characteristic, milk yield and milk flow rate in dairy cows. Mastitis (25.5%) was most common disease followed by udder skin diseases (15.0%) and teat diseases (12.6%). Prevalence of injuries and other lesions was higher in the skin of fore left udder quarter (22.7%) and teat (17.7%) and rear left teat end (4.5%). Mastitis was found to be associated with Sahiwal and Sindhi cross cow, poor body condition, bottle shaped teat, teat with round end, injuries and other lesions to the udder and teat skin and teat diseases. Udder skin diseases were strongly associated with indigenous cows, cow aged 5-10 years, small milk vein, larger front udder, and bottle shaped teats and flat end teats. Milk flow rate was higher in Sahiwal and Sindhi cross cows, large milk vein, larger front udder, funnel and cylindrical teats and pointed teat ends. Risk factors of udder and teat diseases, milk yield and milk flow rate in high yielding indigenous and its cross cows were not similar to those of exotic cows and their crosses. The relationship of udder and teat diseases; and udder and teat characteristics varies with the genetic composition of the dairy cows. Therefore, further genomic study needs to confirm association of udder and teat diseases with host characteristics.