Pattern of Childhood Malignant Tumour in the Paediatric Surgery Department of Bangabandhu Sheikh Mujib Medical University

Background: Childhood malignancy is fast becoming an important paediatric problem in Bangladesh. They differ markedly from adult malignancy in their nature and distribution. This is a 5 years retrospective study of childhood malignant tumour as seen at the paediatric surgery department of Bangabandhu Sheikh Mujib Medical University (BSMMU). Objectives: The objective of this study is to determine the types of malignant patients admitted in the paediatric surgery department of BSMMU and also to know their age and sex distribution. Methods: This is a 5 years retrospective study from January 2005 to December 2009 in the paediatric surgery department of BSMMU, Dhaka, Bangladesh. All admitted malignant patients, aged up to 15 years diagnosed by means of histological or cytological examination included in this study. Results: Seventy (70) malignant patients were admitted during the study period, 65.7% patients were male and 34.3% patients were female with a male female ratio of 1.9:1. Fifty two (74.3%) patients were below 5 years and eighteen (25.7%) patients were between 5 to 15 years. The Wilms’ tumour was the most common malignant tumour which accounted for 42.8%. Hepatoblastoma was the second most common (24.2%). The other malignant tumours were neuroblastoma (15.7%), Non-Hodgkins lymphoma (5.7%), Rhabdomyosarcoma (4.2%), malignant fibrous histocytoma (1.4%), Fibroscarcoma (1.4%), Osteosarcoma (1.4%), malignant sacrococcygeal teratoma (1.4%), carcinoma of the rectum (1.4%0. Conclusion: Based on the result of this study, Wilms’ tumour is the commonest paediatric solid malignancy in our country. Carcinoma of the rectum may rarely occur in paediatric age group. Key words: Frequency; malignant solid tumor; children. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8638 BSMMU J 2011; 4(2):99-10

Eosinophils and tissue remodeling: relevance to airway disease

The ability of human tissue to reorganize and restore its existing structure underlies tissue homeostasis in the healthy airways, but in disease can persist without normal resolution, leading to an altered airway structure. Eosinophils play a cardinal role in airway remodeling both in health and disease, driving epithelial homeostasis and extracellular matrix turnover. Physiological consequences associated with eosinophil-driven remodeling include impaired lung function and reduced bronchodilator reversibility in asthma, and obstructed airflow in chronic rhinosinusitis with nasal polyps (CRSwNP). Given the contribution of airway remodeling to the development and persistence of symptoms in airways disease, targeting remodeling is an important therapeutic consideration. Indeed, there is early evidence that eosinophil attenuation may reduce remodeling and disease progression in asthma. This review provides an overview of tissue remodeling in both health and airway disease with a particular focus on eosinophilic asthma and CRSwNP, as well as the role of eosinophils in these processes and the implications for therapeutic interventions. Areas for future research are also noted, to help improve our understanding of the homeostatic and pathological roles of eosinophils in tissue remodeling, which should aid the development of targeted and effective treatments for eosinophilic diseases of the airways

Post-operative sonological evaluation of pelvi-ureteric drainage of unilateral A-H pyeloplasty in children

Background: Pelvi-ureteric junction obstruction is the most common cause of pediatric hydronephrosis where A-H pyeloplasty with D-J stent is the established treatment option with a high success rate. We observed the predictive value of sonological parameters for early detection of postoperative obstruction at the new pelvi-ureteric junction in children following unilateral A-H pyeloplasty. Methods: This cross-sectional study included 12 children who underwent unilateral A-H pyeloplasty. Post-operative follow-up was done after D-J stent removal and completed within six months. Maximum antero-posterior pelvic diameter (APPD), cortical thickness (CT), and pelvi-cortical (P/C) ratio were compared. Results: Mean APPD was 32.7 mm at the day after removal of the stent, 24.4 mm at one month, and 19.7 mm at four months. Mean CT was 5.2 mm at the day after removal of the stent, 6.1 mm at one month and 8.0 mm at four months. P/C ratio was 8.3 mm at the day after removal of the stent, 5.2 mm at one month, and 3.4 mm at four months. Increased CT and reduced P/C ratio were significant at four months (P= 0.05). Conclusion: CT value and P/C ratio can be used as an early marker of success for pelvi-ureteric drainage following A-H pyeloplasty.

Contrasting the Percutaneous Nerve Evaluation Versus Staged Implantation in Sacral Neuromodulation

Sacral neuromodulation is increasingly used for the treatment of voiding dysfunction, pelvic pain syndromes, and gastrointestinal disorders. While increased use of this technology has led to a greater understanding of its potential as well as its limitations, difficulty persists in identifying the patients that will benefit most. Either of two trial stimulation techniques is performed before placement of a permanent neuromodulator: the monopolar percutaneous nerve evaluation and the tined quadripolar staged trial. The preponderance of recent literature asserts the superior sensitivity of the staged trial over percutaneous nerve evaluation. However, the techniques offer disparate advantages, and other issues, such as cost-effectiveness, remain largely unexplored. The role of sacral neuromodulation will continue to expand as physicians and patients become increasingly aware of its therapeutic potential. Widespread adoption of this clinically superior technique will most rapidly help the greatest number of patients

Risk factors of gallbladder cancer in Karachi-a case-control study

<p>Abstract</p> <p>Background</p> <p>Gallbladder carcinoma (GC) is a relatively rare malignancy worldwide but is the second commonest gastrointestinal cancer in Pakistani women. Gallstones have a positive association with GC but other factors also influence in causation.</p> <p>Methods</p> <p>This is a retrospective case control study over a period of 19 years. The cases (Group A) were patients with histopathological proven carcinoma gallbladder (N = 60) and controls were patients with cholelithiasis but no carcinoma gallbladder on histopathology (N = 120). Multivariate regression analysis was done to calculate the odds ratio, 95% confidence interval and P-Value. A positive relationship was found between size of stone > 1 cm, solitary stone, age > 55 years and multi-parity in women.</p> <p>Results</p> <p>There were 60 patients in Group A and 120 patients in Group B. mean age of diagnosis in Group A patients was 57 ± 2.4 years while mean age of diagnosis in Group B patients was 48 ± 1.35 years. Sixty seven percent of cancer group patients were female as compared to 78% females in non-cancer group. In Group A, 69% of female patients were multiparous (parity of more than 5) while 43% of group B patients were multiparous. For body mass index (BMI), both groups were not very different in our study population i.e. around 78% patients in each group has BMI of more than 23 Kg/m2. In Group A, 37% (n = 22) have solitary stones as compared to 15% (n = 18) in group B. similarly Group A patients has larger stone size as compared to Group B i.e.59% (n = 36) patients in Group A have stones of more than 1 cm when compared to 35% (n = 41) patients in Group B. After using multivariate regression analysis, age more than 55 years (OR - 7.27, p value- < 0.001), solitary stone (OR - 3.33, p value - 0.002) and stone of more than 1 cm (OR - 2.73, p value - 0.004) were found to be independent risk factors for development of gallbladder cancer.</p> <p>Conclusion</p> <p>Most of the patients (78%) with GC were female, and the statistically significant risk factors were older age, solitary stones and stones size more than one centimeter. A case can be made for prophylactic cholecystectomy in such a high risk group. However a population based study is required to calculate the true incidence of GC in Karachi and a prospective multi center study is needed to produce strong evidence for screening and prophylactic cholecystectomy.</p> <p>Trial Registration</p> <p>As this was a retrospective review of medical records, as per institution policy, its gives waiver from any registration (ethical/trial).</p

On the relation between action selection and movement control in 5- to 9-month-old infants

Although 5-month-old infants select action modes that are adaptive to the size of the object (i.e., one- or two-handed reaching), it has largely remained unclear whether infants of this age control the ensuing movement to the size of the object (i.e., scaling of the aperture between hands). We examined 5-, 7-, and 9-month-olds’ reaching behaviors to gain more insight into the developmental changes occurring in the visual guidance of action mode selection and movement control, and the relationship between these processes. Infants were presented with a small set of objects (i.e., 2, 3, 7, and 8 cm) and a large set of objects (i.e., 6, 9, 12, and 15 cm). For the first set of objects, it was found that the infants more often performed two-handed reaches for the larger objects based on visual information alone (i.e., before making contact with the object), thus showing adaptive action mode selection relative to object size. Kinematical analyses of the two-handed reaches for the second set of objects revealed that inter-trial variance in aperture between the hands decreased with the approach toward the object, indicating that infants’ reaching is constrained by the object. Subsequent analysis showed that between hand aperture scaled to object size, indicating that visual control of the movement is adjusted to object size in infants as young as 5 months. Individual analyses indicated that the two processes were not dependent and followed distinct developmental trajectories. That is, adaptive selection of an action mode was not a prerequisite for appropriate aperture scaling, and vice versa. These findings are consistent with the idea of two separate and independent visual systems (Milner and Goodale in Neuropsychologia 46:774–785, 2008) during early infancy

Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets

<p>Abstract</p> <p>Background</p> <p>As the number of persons with diabetes is projected to double in the next 25 years in the US, an accurate method of identifying diabetic foot ulcers in population-based data sources are ever more important for disease surveillance and public health purposes. The objectives of this study are to evaluate the accuracy of existing methods and to propose a new method.</p> <p>Methods</p> <p>Four existing methods were used to identify all patients diagnosed with a foot ulcer in a Department of Veterans Affairs (VA) hospital from the inpatient and outpatient datasets for 2003. Their electronic medical records were reviewed to verify whether the medical records positively indicate presence of a diabetic foot ulcer in diagnoses, medical assessments, or consults. For each method, five measures of accuracy and agreement were evaluated using data from medical records as the gold standard.</p> <p>Results</p> <p>Our medical record reviews show that all methods had sensitivity > 92% but their specificity varied substantially between 74% and 91%. A method used in Harrington et al. (2004) was the most accurate with 94% sensitivity and 91% specificity and produced an annual prevalence of 3.3% among VA users with diabetes nationwide. A new and simpler method consisting of two codes (707.1× and 707.9) shows an equally good accuracy with 93% sensitivity and 91% specificity and 3.1% prevalence.</p> <p>Conclusions</p> <p>Our results indicate that the Harrington and New methods are highly comparable and accurate. We recommend the Harrington method for its accuracy and the New method for its simplicity and comparable accuracy.</p

Post-operative sonological evaluation of pelvi-ureteric drainage of unilateral A-H pyeloplasty in children

Background: Pelvi-ureteric junction obstruction is the most common cause of pediatric hydronephrosis where A-H pyeloplasty with D-J stent is the established treatment option with a high success rate. We observed the predictive value of sonological parameters for early detection of postoperative obstruction at the new pelvi-ureteric junction in children following unilateral A-H pyeloplasty. Methods: This cross-sectional study included 12 children who underwent unilateral A-H pyeloplasty. Post-operative follow-up was done after D-J stent removal and completed within six months. Maximum antero-posterior pelvic diameter (APPD), cortical thickness (CT), and pelvi-cortical (P/C) ratio were compared. Results: Mean APPD was 32.7 mm at the day after removal of the stent, 24.4 mm at one month, and 19.7 mm at four months. Mean CT was 5.2 mm at the day after removal of the stent, 6.1 mm at one month and 8.0 mm at four months. P/C ratio was 8.3 mm at the day after removal of the stent, 5.2 mm at one month, and 3.4 mm at four months. Increased CT and reduced P/C ratio were significant at four months (P= 0.05). Conclusion: CT value and P/C ratio can be used as an early marker of success for pelvi-ureteric drainage following A-H pyeloplasty. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 58-61

Post-operative sonological evaluation of pelvi-ureteric drainage of unilateral A-H pyeloplasty in children

Background: Pelvi-ureteric junction obstruction is the most common cause of pediatric hydronephrosis where A-H pyeloplasty with D-J stent is the established treatment option with a high success rate. We observed the predictive value of sonological parameters for early detection of postoperative obstruction at the new pelvi-ureteric junction in children following unilateral A-H pyeloplasty. Methods: This cross-sectional study included 12 children who underwent unilateral A-H pyeloplasty. Post-operative follow-up was done after D-J stent removal and completed within six months. Maximum antero-posterior pelvic diameter (APPD), cortical thickness (CT), and pelvi-cortical (P/C) ratio were compared. Results: Mean APPD was 32.7 mm at the day after removal of the stent, 24.4 mm at one month, and 19.7 mm at four months. Mean CT was 5.2 mm at the day after removal of the stent, 6.1 mm at one month and 8.0 mm at four months. P/C ratio was 8.3 mm at the day after removal of the stent, 5.2 mm at one month, and 3.4 mm at four months. Increased CT and reduced P/C ratio were significant at four months (P= 0.05). Conclusion: CT value and P/C ratio can be used as an early marker of success for pelvi-ureteric drainage following A-H pyeloplasty. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 58-61

Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates.</p> <p>Methods</p> <p>Three hundred and sixty-six mother-infant pairs, with infants aged <b>≤ </b>6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses) was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health.</p> <p>Results</p> <p>Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81) in DPT-3/Hepatitis B completion rates in the intervention group.</p> <p>Conclusion</p> <p>A simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.</p