Diagnosed hematological malignancies in Bangladesh - a retrospective analysis of over 5000 cases from 10 specialized hospitals

Background The global burden from cancer is rising, especially as low-income countries like Bangladesh observe rapid aging. So far, there are no comprehensive descriptions reporting diagnosed cancer group that include hematological malignancies in Bangladesh. Methods This was a multi-center hospital-based retrospective descriptive study of over 5000 confirmed hematological cancer cases in between January 2008 to December 2012. Morphological typing was carried out using the “French American British” classification system. Results A total of 5013 patients aged between 2 to 90 years had been diagnosed with malignant hematological disorders. A 69.2% were males (n = 3468) and 30.8% females (n = 1545), with a male to female ratio of 2.2:1. The overall median age at diagnosis was 42 years. Acute myeloid leukemia was most frequent (28.3%) with a median age of 35 years, followed by chronic myeloid leukemia with 18.2% (median age 40 years), non-Hodgkin lymphoma (16.9%; median age 48 years), acute lymphoblastic leukemia (14.1%; median age 27 years), multiple myeloma (10.5%; median age 55 years), myelodysplastic syndromes (4.5%; median age 57 years) and Hodgkin’s lymphoma (3.9%; median age 36 years). The least common was chronic lymphocytic leukemia (3.7%; median age 60 years). Below the age of 20 years, acute lymphoblastic leukemia was predominant (37.3%), followed by acute myeloid leukemia (34%). Chronic lymphocytic leukemia and multiple myeloma had mostly occurred among older patients, aged 50-over. Conclusions For the first time, our study presents the pattern and distribution of diagnosed hematological cancers in Bangladesh. It shows differences in population distributions as compared to other settings with possibly a lower presence of non-Hodgkin lymphoma. There might be under-reporting of affected women. Further studies are necessary on the epidemiology, genetics and potential environmental risk factors within this rapidly aging country

Original Article HIGH PREVALENCE OF HCV AND DIABETES MELLITUS IN MULTI-TRANSFUSED SUBJECTS

The characteristics of the multitransfused patients remain unknown. They are exposed to chronic physiological and psychosocial stress. They bear the risk of many infectious diseases like malaria, hepatitis B and C, HIV etc. They are also exposed to chronic psychosocial stress that may lead to Type 2 diabetes mellitus (T2DM). This study was designed to address two important diseases in the multitransfused patients – hepatitis C virus (HCV), an infectious disease and T2DM, a noncommunicable but stress related one. The study was conducted in two tertiary care centers in Dhaka City. These centers have the standard facilities for blood transfusion. The study was conducted from July 2006 to July 2007. Detect-HCV (V.3), an Anti-HCV was used for detecting HCV while oral glucose tolerance test (OGTT) was done for diagnosing T2DM. The WHO criteria of 1997 for diagnosing T2DM and impaired glucose tolerance (IGT) were employed. A total of 125 multitransfused patients were investigated. Overall, the crude prevalence of HCV was 15%, T2DM was 28 % and IGT was 13%. Of the diabetic subjects, 31.4 % were positive for HCV and among the IGT subjects 12.5 % were HCV positive. In contrast, of the total 74 non-DM and non-IGT subjects, only 8.1% were found to be positive for HCV. This study suggests that, the prevalence of diabetes mellitus and HCV are higher in multitransfused patients. This study also revealed that the prevalence of HCV is much higher in T2DM and IGT subjects than observed in non-DM, and non-IGT subjects. Further study is needed to determine other communicable and non-communicable diseases in the multitransfused population

High prevalence of HCV and diabetes mellitus in multi-transfused subjects

The characteristics of the multitransfused patients remain unknown. They are exposed to chronic physiological and psychosocial stress. They bear the risk of many infectious diseases like malaria, hepatitis B and C, HIV etc. They are also exposed to chronic psychosocial stress that may lead to Type 2 diabetes mellitus (T2DM). This study was designed to address two important diseases in the multitransfused patients – hepatitis C virus (HCV), an infectious disease and T2DM, a non-communicable but stress related one. The study was conducted in two tertiary care centers in Dhaka City. These centers have the standard facilities for blood transfusion. The study was conducted from July 2006 to July 2007. Detect-HCV (V.3), an Anti-HCV was used for detecting HCV while oral glucose tolerance test (OGTT) was done for diagnosing T2DM. The WHO criteria of 1997 for diagnosing T2DM and impaired glucose tolerance (IGT) were employed. A total of 125 multitransfused patients were investigated. Overall, the crude prevalence of HCV was 15%, T2DM was 28% and IGT was 13%. Of the diabetic subjects, 31.4% were positive for HCV and among the IGT subjects 12.5% were HCV positive. In contrast, of the total 74 non-DM and non-IGT subjects, only 8.1% were found to be positive for HCV. This study suggests that, the prevalence of diabetes mellitus and HCV are higher in multitransfused patients. This study also revealed that the prevalence of HCV is much higher in T2DM and IGT subjects than observed in non-DM, and non-IGT subjects. Further study is needed to determine other communicable and non-communicable diseases in the multitransfused population. Ibrahim Med. Coll. J. 2009; 3(2): 67-7

A Complex Case of Haemoglobin E Disease with Immune Thrombocytopenia and Combined Iron, Folate and Vit B12 Deficiency

This is a case report of a 13 years old indigenous ‘Garo’ girl who presented with purpuric spots and ecchymotic patches all over the body with menorrhagia, mild jaundice, severe anaemia, marked thrombocytopenia, moderate neutrophil leucocytosis and reticulocytosis. Investigations revealed this as a complex case of Haemoglobin E disease with immune thrombocytopenia (ITP) and combined iron, folate and vitamin B12 deficiency. The case is discussed thoroughly. Ibrahim Med. Coll. J. 2012; 6(1): 31-3

Distribution of phenotypic and genotypic ABO and rhesus blood groups among Bangladeshi population

The present study is a retrospective analysis of allelic frequency of ABO and Rhesus (D) blood groups of donors attending the Deaprtment of Transfusion Medicine of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. BIRDEM IS a 625 bed hospital, where patients and blood donors come from all parts of Bangladesh. A total of 1, 28,506 blood donors of both genders were included in the study over fourteen years from June 1995 to June 2009 for analysis. Blood group was determined by performing the both tube and slide method blood grouping method. The distribution of blood groups in our population was B>O>A>AB in Rh positive groups donors and O>B>A>AB among Rh negative donors. Blood group B was more common among the males (37.42%) while O was predominant among female donors (33.83 %). On the other hand, blood group O negative was predominant in both genders (36.88%). In this study, Hardy- Weinberg equilibrium law was used to calculate the allelic frequency for ABO/ Rh system. Homozygous allelic frequency for Rh negative population was only 0.0007. Although phenotypically B group was dominant and AB was rare in our population, but according to Hardy- Weinberg equilibrium law the estimatedallelic frequency of A (0.3694) and O (0.3040) showed higher frequency than B type (0.2300) in Bangladeshi population in both homozygous and heterozygous state. So, with increasing population of Bangladesh, this changing trend in estimated blood group in ABO system may play an important role in our genetic pattern. Ibrahim Med. Coll. J. 2011; 5(2): 59-6

Vaginal Schwannoma

Vaginal Schwannoma is very rare and till now few cases have been reported in the literature. A case of vaginal Schwannoma is reported here. The patient was a 59 years old woman with the complaints of per vaginal bleeding with an attempt of D&C failure. Ultimately hysterectomy was done and the diagnosis of Vaginal Schwannoma was made on histopathological examination of the excised tumor. Clinicians should be aware and bear in mind about the differential diagnosis of vaginal Schwannoma in case of any per vaginal bleeding. Ibrahim Med. Coll. J. 2010; 4(2): 90-9

Impaired acylcarnitine profile in transfusion-dependent beta-thalassemia major patients in Bangladesh

Patients with beta-thalassemia major (BTM) suffer from fatigue, poor physical fitness, muscle weakness, lethargy, and cardiac complications which are related to an energy crisis. Carnitine and acylcarnitine derivatives play important roles in fatty acid oxidation, and deregulation of carnitine and acylcarnitine metabolism may lead to an energy crisis. The present study aimed to investigate carnitine and acylcarnitine metabolites to gain an insight into the pathophysiology of BTM. Dried blood spots of 45 patients with BTM and 96 age-matched healthy controls were analyzed for free carnitine and 24 acylcarnitines by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Although medium chain acylcarnitine levels were similar in the patients with BTM and healthy controls, free carnitine, short chain acylcarnitines, long chain acylcarnitines, and total acylcarnitine levels were significantly lower in patients with BTM than in the healthy controls (P < 0.05). Moreover, an impaired fatty acid oxidation rate was observed in the patients with BTM, as manifested by decreased fatty acid oxidation indicator ratios, namely C2/C0 and (C2 + C3)/C0. Furthermore, an increase in the C0/(C16 + C18) ratio indicated reduced carnitine palmitoyltransferase-1 (CPT-1) activity in the patients with BTM compared with that in the healthy controls. Thus, a low level of free carnitine and acylcarnitines together with impaired CPT-1 activity contribute to energy crisis-related complications in the patients with BTM. Keywords: Beta-thalassemia major, Carnitine-acylcarnitine levels, Impairment in fatty acid oxidation, Carnitine Palmitoyltransferase-1 activit