Prevalence of cervical cancer among village women: a study in an Upazilla Health Complex in Bangladesh

Background: Cervical cancer arises when cells in the cervix undergo abnormal changes, leading to tumor formation. Although preventable, it remains the fourth most commonly diagnosed cancer and the leading cause of cancer-related deaths among women. This study aimed to assess the prevalence of cervical cancer among village women. Methods: This prospective observational study was conducted at Upazilla Health Complex (UHC), Sariakandi, Bogura, Bangladesh from January 2023 to December 2023. As the study subjects, a total of 1186 village women who participated in the cervical cancer screening program of the mentioned UHC were enrolled purposively. For data analysis, MS Office tools were applied. Results: In this study, the majority of participants belonged to the >40 years’ age group (53.2%), were housewives (73%), married at the age of 20 or younger (59%), and reported negative vaginal discharge (53%). Among the total participants, the prevalence of cervical cancer, as determined by visual inspection with acetic acid (VIA) tests, was found to be 1.18%. Conclusions: In comparison to other South Asian or African countries, the prevalence of cervical cancer among village women in Bangladesh is relatively low. However, housewives aged over 40 years, experiencing negative vaginal discharge, and marrying at age 20 or younger are particularly susceptible to such diseases here

Role of frozen section biopsy in the diagnosis of ovarian masses

Background: Ovarian malignancy is an important cause of mortality among women with most cases being diagnosed late and requiring aggressive management. The association between the final diagnosis on standard conventional histopathological sections and the examination of intraoperative frozen sections is an important tool for quality control. Therefore, this study aimed to assess the role of frozen section biopsy in diagnosing ovarian masses. Methods: This was a cross-sectional study conducted in the department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from January 2020 to December 2020. In our study, we included 50 diagnosed cases of ovarian masses who attended the department of obstetrics and gynecology in Dhaka Medical College Hospital for surgery. Results: The mean age of the patients was 31.68±11.04 years. On the frozen section, forty-one patients (82%) were diagnosed as benign cases while nine patients (18%) were identified as malignant. The final histopathologic diagnosis revealed 38 (76%) as benign tumors and 12 (24%) as malignant tumors. Frozen section biopsy (FSB) was found to be 75% sensitive and it showed 100% specificity.  The PPV, NPV, and diagnostic accuracy of FSB were found to be 100%, 92.6%, and 94% respectively. Among the three discordant cases, two were mucinous adenocarcinoma and one was papillary serous cyst adenocarcinoma. Conclusions: This study showed a diagnostic accuracy of 94%, which is an eye-opener for gynecological oncologists regarding the usefulness of frozen section biopsy. Frozen section diagnoses can be extremely helpful in the clinical management of ovarian cancers

Evaluation of β-hCG regression after evacuation of molar pregnancy as a predictive factor for malignant GTN

Background: Gestational trophoblastic disease (GTD) is a group of disorders identified by abnormal proliferation of trophoblastic tissue. The general term GTN is used to describe a wide range of trophoblastic diseases including invasive mole, choriocarcinoma, epithelioid trophoblastic tumor, and placental site trophoblastic tumor. The persistence of GTN post-molar pregnancy can be efficiently detected with serial measures of the β subunit of hCG, or β-hCG. Therefore, this study aimed to evaluate the β-hCG regression after evacuation of molar pregnancy as a predictive factor for malignant GTN. Methods: This was a prospective analytical study conducted in the Gynaecological Oncology Unit and Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from January 2022 to December 2022. In our study, we included 50 patients with molar pregnancies attending the Gynaecological Oncology Unit and Department of Obstetrics & Gynecology of DMCH. Result: The mean age of participants was 23.5 years. The GTN was diagnosed among 24% of patients. In 2nd week, the mean β-hCG was found 91027.50±24430.53 miU/ml in the persistent GTN group and 19339.68±13978.59 miU/ml in the remission group. The mean Β-hCG significantly decreased to 64399.33±23404.81 and 4.47±2.57miU/ml in the persistent GTN and remission group respectively in the 15th week (p<0.05).                 Conclusion: This study found that serum β-hCG levels in the 2nd, 3rd, and 4th weeks following molar evacuation can predict over 24% of patients who developed GTN after molar evacuation. The decline in serum β-hCG levels during weeks was statistically linked to the development of GTN

Pattern of high-risk human papilloma virus infection among women with cervical intraepithelial neoplasia

Background: Cervical cancer ranks as the fourth most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths in women. The purpose of this study was to assess the pattern of high-risk human papillomavirus (HPV) infection in women diagnosed with cervical intraepithelial neoplasia (CIN). The aim of the study was to evaluate the pattern of high-risk human papillomavirus (HPV) infection among women with cervical intraepithelial neoplasia (CIN). Methods: This descriptive observational study involved 100 patients diagnosed with cervical intraepithelial neoplasia (CIN) at the gynecological oncology unit, department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, Bangladesh, from January 1, 2020, to December 31, 2020. Inclusion criteria comprised married women aged 30 to 60 years with colposcopically diagnosed CIN. Socio-demographic data, medical history, and clinical findings were collected and analyzed using SPSS 22.0. Results: The mean age of the patients was 39.26 years (±6.99), with most being housewives (87%) and a large proportion residing in Dhaka (29%). HPV strains were detected in 67% of histopathologically diagnosed CIN cases, with HPV 16 being the most common strain, found in 67.34% of HPV-positive cases. Additionally, mono-infection was more prevalent than co-infection among HPV-positive patients (61.22% versus 38.8%), with the difference being statistically significant (p<0.05). Conclusions: HPV genotypes 16 and 18, being the most prevalent in this study, highlight the need for targeted HPV vaccines and screening programs tailored to the Bangladeshi population to effectively prevent cervical cancer

Prognostic role of platelet lymphocyte ratio in advanced epithelial ovarian cancer

Background: The platelet lymphocyte ratio (PLR) is an important prognostic biomarker in various cancers. Study was undertaken to determine the association between PLR and prognosis of advanced epithelial ovarian cancer. Methods: The prospective observational study was carried out gynecological oncology unit, department of gynecology and obstetrics Dhaka Medical College Hospital. Dhaka. Total 50 cases of diagnosed advanced epithelial ovarian cancer where enrolled during period from January 2021 to December 2021. Results: The mean age of participants was 52.8±11.5 years, with 68.0% being postmenopausal and 94.0% multigravida. Tumor grade III was most prevalent (58.0%), and the majority (62.0%) had serous carcinoma. Pre-operative CA-125 levels were <1000 in 72.0% of patients. The platelet-lymphocyte ratio (PLR) was <200 in 58.0% of patients, with no significant association between PLR and chemotherapy response (p=0.121). Progression-free survival was observed in 30.0%, with an overall survival of 58.0%. A significant association was found between PLR and survival outcomes (p=0.013). ROC analysis indicated an area under the curve of 0.726, establishing a cutoff value of ≥171.5 ng/ml for PLR, with 86.2% sensitivity and 66.7% specificity for predicting overall survival. Conclusions: This study suggested that the significant association was found between PLR with survival outcome. No significant association between PLR with before and after operation and chemotherapy

Assessment of diagnostic performance of HE4 and CA125, individually and combined in epithelial ovarian cancer screening

Background: Epithelial ovarian cancer (EOC) is one of the most lethal gynecological malignancies worldwide, often referred to as a "silent killer" due to its asymptomatic nature in the early stages. Proper diagnosis at early stage of Ovarian malignancy using biomarker is extremely important. The aim of this study was to evaluate the diagnostic accuracy of Human Epididymis Protein 4 (HE4) and Cancer Antigen 125 (CA125). Methods: This descriptive observational study was conducted in Dhaka Medical College Hospital from January 2021 to December 2021. Data were collected using a pre-designed data collection sheet encompassing demographics, clinical examination, and investigation results. After obtaining informed written consent, clinical examinations and ultrasound of the abdomen were conducted, followed by the collection of venous blood samples. Results: In our study predominant age group was 41-50 years (32.5%). Serum HE4 and CA125 concentrations were significantly higher in the ovarian cancer patients compared with those seen in patients with benign disease or in the healthy controls (p<0.05 in both). In patients with an adnexal mass, the area under the ROC curve was higher when the combination of the markers was used compared with use of CA125 only. Using ROMA, patients could be successfully classified into high- and low-risk group, with 57.7% sensitivity at a specificity of 63.9%. Conclusions: These findings suggest that measuring serum HE4 concentrations along with CA125 concentrations may provide higher accuracy for detecting early stage of Epithelial ovarian cancer

Assessment of CA-125 levels and imaging findings in women with suspected malignant ovarian tumors

Background: Ovarian cancer diagnosis is growing due to the prudent use of investigational methods. Imaging techniques and molecular biomarkers are the commonly used. A correct ovarian cancer staging assists gynecological oncologists in determining whether the patient required primary debulking surgery or neoadjuvant chemotherapy. The aim of the study was to evaluate the accuracy of CA-125 titre, USG of whole abdomen imaging and CT scan for diagnosis of ovarian malignancy. Methods: A prospective, observational study was conducted Gynae Oncology Unit, Department of Obs and Gynae, Dhaka Medical College Hospital, Dhaka during January 2022 to December 2022. Total 96 patients who were diagnosed clinically as malignant ovarian tumor were included in the study. Results: The sensitivity of malignant ovarian tumors by USG was calculated to be 89.4%, specificity was 76.7%, accuracy was 85.4%, PPV was 89.4%, and NPV was 76.7%. The validity of CA-125 in malignant ovarian tumors was demonstrated by calculating sensitivity of 75.8%, specificity of 90.0%, accuracy of 80.2%, PPV of 94.3%, and NPV of 62.8%. The sensitivity of malignant ovarian tumors by CT was calculated to be 90.9%, specificity was 86.7%, accuracy was 89.6%, PPV was 93.8%, and NPV was 81.3%. Using histology as the gold standard. Conclusion: The results of this study demonstrate the superior diagnostic capabilities of two distinct imaging modalities (USG and CT) in determining the degree of malignant spread

A new approach to children’s work that prioritises resilience, wellbeing, and agency:emerging findings from a ‘cash plus’ intervention in Bangladesh

Background Criticism of mainstream approaches to child labour is widespread and well-established. The Child Labour Action Research in South and Southeast Asia (CLARISSA) Cash Plus pilot sought to address these critiques through an innovative programme that prioritised the development of household resilience and well-being, and through increasing household capacity to make alternative choices around children’s work.Research Funded by the UK’s Foreign, Commonwealth and Development Office, this pilot delivered unconditional cash transfers (UCTs) and needs-based case management and community mobilising across an entire slum neighbourhood in Dhaka, Bangladesh. Cash worth about 20% of household monthly income was delivered to all households for 7 months, with case work and community organising wrapped around for 21 months. The intended outcomes were that families would be able to increase their economic resilience and develop alternative capacities to meet their needs, with the intended goals of increasing well-being and the ability to make choices other than difficult or dangerous work for children. Research into impact was rooted in contribution analysis and combined bimonthly monitoring surveys administered by the community mobilisers; surveys at multiple time points; three rounds of targeted focus group discussions; three rounds of key informant interviews with case study households; community mobiliser diaries; and ethnographic observation.Results and conclusions The results strongly suggest that UCTs reduce poverty, increase economic resilience; improve well-being; and generate various household-level improvements that relate directly and indirectly to children’s work. They further suggest that case work and community organising act as a beneficial form of social protection and a tool for developing locally appropriate micro-responses to collective problems that commonly impact directly on well-being and indirectly on children’s work. These results point to the potential for this intervention to be scaled-up in efforts to achieve the eighth Sustainable Development Goal of ensuring decent work for all, including the elimination of child labour

A new approach to children’s work that prioritises resilience, wellbeing, and agency:emerging findings from a ‘cash plus’ intervention in Bangladesh

Background Criticism of mainstream approaches to child labour is widespread and well-established. The Child Labour Action Research in South and Southeast Asia (CLARISSA) Cash Plus pilot sought to address these critiques through an innovative programme that prioritised the development of household resilience and well-being, and through increasing household capacity to make alternative choices around children’s work.Research Funded by the UK’s Foreign, Commonwealth and Development Office, this pilot delivered unconditional cash transfers (UCTs) and needs-based case management and community mobilising across an entire slum neighbourhood in Dhaka, Bangladesh. Cash worth about 20% of household monthly income was delivered to all households for 7 months, with case work and community organising wrapped around for 21 months. The intended outcomes were that families would be able to increase their economic resilience and develop alternative capacities to meet their needs, with the intended goals of increasing well-being and the ability to make choices other than difficult or dangerous work for children. Research into impact was rooted in contribution analysis and combined bimonthly monitoring surveys administered by the community mobilisers; surveys at multiple time points; three rounds of targeted focus group discussions; three rounds of key informant interviews with case study households; community mobiliser diaries; and ethnographic observation.Results and conclusions The results strongly suggest that UCTs reduce poverty, increase economic resilience; improve well-being; and generate various household-level improvements that relate directly and indirectly to children’s work. They further suggest that case work and community organising act as a beneficial form of social protection and a tool for developing locally appropriate micro-responses to collective problems that commonly impact directly on well-being and indirectly on children’s work. These results point to the potential for this intervention to be scaled-up in efforts to achieve the eighth Sustainable Development Goal of ensuring decent work for all, including the elimination of child labour