Pregnancy with Invasive Carcinoma of the Cervix- A Case Report

Carcinoma of the cervix is a preventable female malignancy. Recently, a 30 years old 5th gravid lady was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU) from Jahurul Islam Medical College & Hospital, Bajitpur, Kishorganj after diagnosing as a case of 32 weeks pregnancy coupled with invasive carcinoma of the cervix. Histopathology of cervical tissue showed moderately differentiated squamous cell carcinoma. Her cervical growth was confined in the anterior lip of the cervix and clinical stage was 1B. She was severely anemic. Her anemia had been corrected by blood transfusion. Injection dexamethasone was given for fetal lung maturity. Renal function tests and all other investigations for surgical fitness were done. At her 34th weeks of pregnancy caesarean section followed by Wertheim's hysterectomy was performed. Baby was alive, birth weight was 2.3 kg, Apgar score was good. Postoperative period was un-event full. At her 23rd postoperative day she was discharged from Obs and Gynae department and referred to Oncology institute for further management. At the time of discharge her baby was healthy. Key Words: Cervical cancer, pregnancy, Wertheim's hysterectomy.DOI: 10.3329/bsmmuj.v2i1.3712 BSMMU J 2009; 2(1): 47-4

Evaluation of the role of perceived quality and satisfaction of beneficiaries about the health care services and benefits of community clinics in Bangladesh

Introduction Bangladesh provides free healthcare to its citizens through 10,723 community clinics which provide one-stop healthcare services that is vital in ensuring primary healthcare. Measuring beneficiary' contentment is crucial to improve the quality of care and the perceived service quality have a significant impact on how often people use those health services. This study focuses on perceived quality and satisfaction of beneficiaries about the primary health care services and benefits of community clinics in Bangladesh. Methods A quantitative descriptive survey was conducted from March 2019 to April 2019 in the catchment area of 80 community clinics located at 16 Upazila under eight districts of eight divisions in Bangladesh. The survey compiled local data on client’s experience on health care service of community clinics. Besides, Sixteen Upazilas from eight districts were randomly selected for conducting interviews. Results Data was provided by a total of 760 female participants, among them majority (41%) belonged to the age group of 18-24 years old, and this very group showed more satisfaction than others (Odds Ratio 1.44). Besides, childless married women were also found to be content with the community clinic services compared to the remaining types of clients (Odds Ratio 1.64). However, gender, education, and economic perspective were positive aspects of getting service from community clinics. Conclusions Although there is a challenge balancing psychosocial and medical care, promoting client-oriented care with a focus on the cultural factors of the area is vital. This can be done through community-focused training together with explaining written prescriptions to the beneficiary, including the signs, symptoms, treatment, and referral points. The study findings will enable responsible authority to improve quality of primary health care services, realizing beneficiary’ ideas of community clinic service quality

Natural selection shapes the evolution of SARS-CoV-2 Omicron in Bangladesh

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved to give rise to a highly transmissive and immune-escaping variant of concern, known as Omicron. Many aspects of the evolution of SARS-CoV-2 and the driving forces behind the ongoing Omicron outbreaks remain unclear. Substitution at the receptor-binding domain (RBD) in the spike protein is one of the primary strategies of SARS-CoV-2 Omicron to hinder recognition by the host angiotensin-converting enzyme 2 (ACE2) receptor and avoid antibody-dependent defense activation. Here, we scanned for adaptive evolution within the SARS-CoV-2 Omicron genomes reported from Bangladesh in the public database GISAID (www.gisaid.org; dated 2 April 2023). The ratio of the non-synonymous (Ka) to synonymous (Ks) nucleotide substitution rate, denoted as ω, is an indicator of the selection pressure acting on protein-coding genes. A higher proportion of non-synonymous to synonymous substitutions (Ka/Ks or ω > 1) indicates positive selection, while Ka/Ks or ω near zero indicates purifying selection. An equal amount of non-synonymous and synonymous substitutions (Ka/Ks or ω = 1) refers to neutrally evolving sites. We found evidence of adaptive evolution within the spike (S) gene of SARS-CoV-2 Omicron isolated from Bangladesh. In total, 22 codon sites of the S gene displayed a signature of positive selection. The data also highlighted that the receptor-binding motif within the RBD of the spike glycoprotein is a hotspot of adaptive evolution, where many of the codons had ω > 1. Some of these adaptive sites at the RBD of the spike protein are known to be associated with increased viral fitness. The M gene and ORF6 have also experienced positive selection. These results suggest that although purifying selection is the dominant evolutionary force, positive Darwinian selection also plays a vital role in shaping the evolution of SARS-CoV-2 Omicron in Bangladesh

56 Pregnancy with Invasive Carcinoma of the Cervix- A Case Report

Carcinoma of the cervix is a preventable female malignancy. Recently, a 30 years old 5th gravid lady was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU) from Jahurul Islam Medical College & Hospital, Bajitpur, Kishorganj after diagnosing as a case of 32 weeks pregnancy coupled with invasive carcinoma of the cervix. Histopathology of cervical tissue showed moderately differentiated squamous cell carcinoma. Her cervical growth was confined in the anterior lip of the cervix and clinical stage was 1B. She was severely anemic. Her anemia had been corrected by blood transfusion. Injection dexamethasone was given for fetal lung maturity. Renal function tests and all other investigations for surgical fitness were done. At her 34th weeks of pregnancy caesarean section followed by Wertheim’s hysterectomy was performed. Baby was alive, birth weight was 2.3 kg, Apgar score was good. Postoperative period was un-event full. At her 23rd postoperative day she was discharged from Obs and Gynae department and referred to Oncology institute for further management. At the time of discharge her baby was healthy

Development of ceramic grade red iron oxide pigment from waste iron source

Ceramic grade red iron oxide (α-Fe2O3) nanoparticles pigments have been synthesized from waste condensed milk containers which contain a prominent amount of iron (93.2%). The synthesis method comprised of two steps: in the first step ferrous sulfate was prepared following an acid leaching method; while the second step was oxidation and calcination of ferrous sulfate to produce desired α-Fe2O3 in nano form. The structure, functional groups, chemical state, morphology, particle size, surface area, elemental, thermal analysis and magnetic properties of the samples were investigated using XRD, FTIR, XPS, SEM, BET, EDS, TG-DT and VSM respectively. Pure hematite (α-Fe2O3) phase was confirmed by XRD and the average crystal sizes were in the range 34–126 nm have been performed by Debye-Scherer's formula, which are consistent with the results as achieved from SEM images. Agglomerated irregular spherical nanoparticles (45–149 nm) were found in SEM image. The surface chemistry and the chemical state (Fe3+) of the hematite nanoparticles was also confirmed by XPS. The mesoporous nature of the nanoparticles with high surface area were measured by BET and it has been revealed that the BET specific surface area (33.55 m2/g) was marginally higher than the commercial one. The magnetic nature of the nanoparticles was portrayed by VSM and the nanoparticles showed the ferromagnetic behavior. Moreover, particle size distributions and zeta potential values have been also measured by DLS

Assessment of disease specific immune responses in enteric diseases using dried blood spot (DBS).

BackgroundBlood collection, transportation and storage remain a problem in countries where infrastructure, laboratory facilities and skilled manpower are scarce. This limits evaluation of immune responses in natural infections and vaccination in field studies. We developed methods to measure antigen specific antibody responses using dried blood spot (DBS) in cholera, ETEC and typhoid fever patients as well as recipients of oral cholera vaccine (OCV).Methodology/principle findingsWe processed heparinized blood for preparing DBS and plasma specimens from patients with, cholera, ETEC and typhoid as well as OCV recipients. We optimized the conventional vibriocidal method to measure vibriocidal antibody response in DBS eluates. We measured responses in DBS samples and plasma (range of titer of 5 to 10240). Vibriocidal titer showed strong agreement between DBS eluates and plasma in cholera patients (ICC = 0.9) and in OCV recipients (ICC = 0.8) using the Bland-Altman analysis and a positive correlation was seen (r = 0.7, p = 0.02 and r = 0.6, p = 0.006, respectively). We observed a strong agreement of lipopolysaccharide (LPS) and cholera toxin B (CTB)-specific antibody responses between DBS eluates and plasma in cholera patients and OCV recipients. We also found agreement of heat labile toxin B (LTB) and membrane protein (MP)-specific antibody responses in DBS eluates and plasma specimen of ETEC and typhoid patients respectively.ConclusionOur results demonstrate that dried blood specimens can be used as an alternate method for preservation of samples to measure antibody responses in enteric diseases and vaccine trials and can be applied to assessment of responses in humanitarian crisis and other adverse field settings

Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city.

The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1-5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P<0.0001). Human rhinovirus, HPIV-3, adenovirus, Streptococcus pneumonia, and Klebsiella pneumaniae had significant involvement in coinfections with P values of 0.0001, 0.009 and 0.0001, 0.0001 and 0.001 respectively. Further investigations are required to better understand the clinical roles of the isolated pathogens and their seasonality

Age-Specific Cut-off Values of Amino Acids and Acylcarnitines for Diagnosis of Inborn Errors of Metabolism Using Liquid Chromatography Tandem Mass Spectrometry

Liquid Chromatography tandem mass spectrometry (LC-MS/MS) is used for the diagnosis of more than 30 inborn errors of metabolisms (IEMs). Accurate and reliable diagnosis of IEMs by quantifying amino acids (AAs) and acylcarnitines (ACs) using LC-MS/MS systems depend on the establishment of age-specific cut-offs of the analytes. This study aimed to (1) determine the age-specific cut-off values of AAs and ACs in Bangladesh and (2) validate the LC-MS/MS method for diagnosis of the patients with IEMs. A total of 570 enrolled healthy participants were divided into 3 age groups, namely, (1) newborns (1-7 days), (2) 8 days–7 years, and (3) 8–17 years, to establish the age-specific cut-offs for AAs and ACs. Also, 273 suspected patients with IEMs were enrolled to evaluate the reliability of the established cut-off values. Quantitation of AAs and ACs was performed on an automated LC-MS/MS system using dried blood spot (DBS) cards. Then the specimens of the enrolled clinically suspected patients were analyzed by the established method. Nine patients came out as screening positive for different IEMs, including two borderline positive cases of medium-chain acyl-CoA dehydrogenase deficiency (MCAD). A second-tier test for confirmation of the screening positive cases was conducted by urinary metabolic profiling using gas chromatography- mass spectrometry (GC-MS). Out of 9 cases that came out as screening positive by LC-MS/MS, seven cases were confirmed by urinary GC-MS analysis including 3 cases with phenylketonuria, 1 with citrullinemia type II, 1 with methylmalonic acidemia, 1 with isovaleric acidemia and 1 with carnitine uptake defect. Two borderline positive cases with MCAD were found negative by urinary GC-MS analysis. In conclusion, along with establishment of a validated LC-MS/MS method for quantitation of AAs and ACs from the DBS cards, the study also demonstrates the presence of predominantly available IEMs in Bangladesh

Comparison of pathogen detection rates between asymptomatic and symptomatic cases of under five children.

<p>Comparison of pathogen detection rates between asymptomatic and symptomatic cases of under five children.</p