The outcome of loop electrosurgical excision procedure following treatment of cervical intra-epithelial neoplasia 2 and 3

Background: In Bangladesh, loop electrosurgical excision procedure (LEEP) is an ongoing program of government health service for the management of cervical intra-epithelial neoplasia (CIN) 2 and 3. The aim of this study was to evaluate the outcome of loop electrosurgical excision procedure following treatment of cervical intra-epithelial neoplasia 2 and 3. Methods: This descriptive cross-sectional study was conducted in outpatient department (OPD), gynaecology and obstetrics department, Rangpur Medical College Hospital, Rangpur, Bangladesh during the period from July 2011 to June 2012. In total 75 patients, underwent LEEP following treatment of CIN 2 and 3 were selected for this study as study subjects. Data analysis was done by using statistical package for social science (SPSS) 16 version. Results: In this study, majority of the participants were from 30-39 years’ age group which was 57%. Besides this 23%, 19% and 1% patients were from <30, 40-49 and ≥50 age groups respectively. The mean parity of the patients was 3.68 with standard deviation of ±1.31 and range was 1 to 7. In analyzing the parity of the participants, we observed that, in 47% and 24% patients the party were 2 and 3 respectively which were noticeable. Besides these in 11%, 8%, 7%, 1% and 3% cases the parity were found as 1, 4, 5, 6 and 7 respectively. In analyzing the histopathology among patients, we found, 76% cases were with CIN-1 whereas the rest 24% cases were with CIN-2. Conclusions: Cervical cancer is the most common malignancy and a major cause of cancer death among Bangladeshi women. This may be due to lack of awareness, scarce of screening facility, poverty and illiteracy. The LEEP procedure has many advantages including high success rate, low cost and ease of use

The stress factors and pattern of psychiatric disorders among patients with deliberate self-harm: a study in a tertiary care hospital, Rangpur, Bangladesh

Background: Deliberate self-harm (DSH) is a complex behavior of maladaptive response to acute and chronic stress, and likely to be suffering from mental health problems as well as co-morbid general medical conditions, including several non-suicidal intentions to suicide. DSH is previously included in suicide. Sir Thomas Browne first used the word ‘suicide’ in 1642 in his religion Medici. The word suicide originated from SUI (of oneself) and CAEDES (murder). According to WHO ‘suicide’ refers to the act of killing oneself intentionally, performed by the person with full knowledge or expectation of the fatal outcome. This study aimed to analyze the stress factors and pattern of psychiatric disorders among patients with DSH. Methods: This descriptive cross-sectional study was conducted at the department of medicine; emergency and OPD, Rangpur medical college, Rangpur, Bangladesh. Study conducted for 1 year; July 2008-June 2009. A total of 116 DSH cases included in study as per inclusion criteria. Convenience sampling technique was undertaken in this study. Result: The majority of patients are in the age group of 20-39 years, with 70% in a psychiatric disorder, and in the 40-59 years age group 7.778% have a psychiatric disorder. Age has a significant relationship with DSH (p<0.001). The 90 patients were suffering from psychiatric disorders among them 61 (67.778%) were suffering from depressive episodes, 12 (13.333%) were suffering from a personality disorder, 8 (8.889%) were suffering from mental and behavioral disorders due to psychoactive substance abuse, 7 (7.778%) were suffering from schizophrenia, 1 (01.111%) were suffering from adjustment disorder, 1 (1.111%) suffering from bipolar disorder. Conclusions: Out of 116 responders 90 (77.586%) were suffering from a psychiatric disorder. Among the patients with psychiatric disorders, 61 (67.778%) patients were found to be suffering from a depressive episode, which was 52.568% of total DSH cases and is an almost treatable disorder.

HIV-1 Alters Intestinal Expression of Drug Transporters and Metabolic Enzymes: Implications for Antiretroviral Drug Disposition

This study investigated the effects of HIV-1 infection and antiretroviral therapy (ART) on the expression of intestinal drug efflux transporters, i.e., P-glycoprotein (Pgp), multidrug resistance-associated proteins (MRPs), and breast cancer resistance protein (BCRP), and metabolic enzymes, such as cytochrome P450s (CYPs), in the human upper intestinal tract. Intestinal biopsy specimens were obtained from HIV-negative healthy volunteers, ART-naive HIV-positive (HIV(+)) subjects, and HIV(+) subjects receiving ART (10 in each group). Intestinal tissue expression of drug transporters and metabolic enzymes was examined by microarray, real-time quantitative reverse transcription-PCR (qPCR), and immunohistochemistry analyses. Microarray analysis demonstrated significantly lower expression of CYP3A4 and ABCC2/MRP2 in the HIV(+) ART-naive group than in uninfected subjects. qPCR analysis confirmed significantly lower expression of ABCC2/MRP2 in ART-naive subjects than in the control group, while CYP3A4 and ABCG2/BCRP showed a trend toward decreased expression. Protein expression of MRP2 and BCRP was also significantly lower in the HIV(+) naive group than in the control group and was partially restored to baseline levels in HIV(+) subjects receiving ART. In contrast, gene and protein expression of ABCB1/Pgp was significantly increased in HIV(+) subjects on ART relative to HIV(+) ART-naive subjects. These data demonstrate that the expression of drug-metabolizing enzymes and efflux transporters is significantly altered in therapy-naive HIV(+) subjects and in those receiving ART. Since CYP3A4, Pgp, MRPs, and BCRP metabolize or transport many antiretroviral drugs, their altered expression with HIV infection may negatively impact drug pharmacokinetics in HIV(+) subjects. This has clinical implications when using data from healthy volunteers to guide ART