College Hospital Research Articles

Essence of Establishing Fully Equipped Emergency Medicine Department for Medical Professionals: Key Informants Interview

Background: Medical profession is a combination of multi- sectoral and multi-departmental approach. Emergency department is such type of service area which deals with emergent condition of patients by skilled professionals, staffs and necessary equipment. So, it is important to find out the necessity of establishment of fully equipped Emergency Medicine and Causality Department in health professional training institutes. Methods: This qualitative section representing a larger cross-sectional study that was conducted from July 2022 to June 2023 to identify current status of emergency care among interns and medical students of Bangladesh. This information were obtained by conducting in-depth interviews with 10 emergency physicians of eight medical college hospitals to find out essence of Emergency Medicine and Causality Department. Results: Most (80%) of the interviewees mentioned that learning Emergency Medicine is very vital for medical students and interns. They also mentioned that due to identity crisis of the Emergency Medicine, creating challenges for medical graduates to trained upon emergent cases. Majorities (70%) of the interviewees clearly defined that medical professionals are continuously losing skills to handle medical emergencies due to improper training facility by proper trainer and staffs. Many (60%) of the interviewees mentioned a hopeless situation that the learners’ skills not up to mark to deal emergency cases. It’s not only the learner fault, it’s also for lacking in our educational policy. Majorities (70%) of the interviewees agreed that if we want to flourish the essence of emergency Medicine care for our learners it is mandatory to establish separate Emergency Medicine Department by skilled trainers, staffs and required equipment. Conclusion: This study recommended to produce competent medical graduates by fully equipped of separate Emergency Medicine Department. CME J 2024; 3(2); 38-42

ALT in Preeclampsia

Background: Preeclampsia is the most frequent cause of abnormal liver function test in pregnancy. Women with preeclampsia and raised serum alanine aminotransferase (ALT) have chance of greater proteinuria and more maternal complications than those with normal liver function. Objective: The present study was designed to assess the association of serum ALT with preeclampsia. Materials and method: A case control study was conducted in the Department of Biochemistry, Dhaka Medical College,Dhaka, Bangladesh, from July 2010 to June 2011. From the pregnant women in third trimester of pregnancy attending in Obstetrics and Gynecology Department of Dhaka Medical College Hospital, 50 diagnosed cases of preeclampsia were selected purposively as cases and 50 normal healthy pregnant women as controls. Serum ALT concentration was measured in all the study subjects. Results: The mean serum ALT concentration in cases and controls were 57.92±20.99 U/L and 15.46±2.66 U/L respectively. The level was significantly higher in cases than that of controls (p=0.001). Conclusion: The study revealed that increased serum ALT concentration is associated with preeclampsia. Delta Med Col J. Jan 2021;9(2): 65-68

Characterization and Long-Term Prognosis of Patients with Different Phenotypes of Dilated Cardiomyopathy.

Long-term prognosis of dilated cardiomyopathy (DCM) in the Chinese population is lacking, and the left ventricular (LV) hypertrabeculation phenotype usually overlaps with DCM. The study aims to investigate whether the presence of the LV hypertrabeculation phenotype confers additional adverse prognostic information for DCM patients. We retrospectively reviewed all DCM patients (≥18 years of age at diagnosis) hospitalized in the Peking Union Medical College Hospital between September 2002 and September 2022. The eligible patients were divided into two groups based on echocardiography at diagnosis: the isolated DCM (n = 353), and DCM with the LV hypertrabeculation phenotype (n = 97). The primary endpoint was major adverse cardiac events (MACEs), and multivariate Cox hazards regression models were used to compare the endpoints between the two groups. During a mean follow-up time of 4.6 years, there was no significant difference in the primary endpoint between the isolated DCM and DCM with the LV hypertrabeculation phenotype (p = 0.19). The risk of MACEs in the first 5 years was significantly higher in DCM with the LV hypertrabeculation phenotype than isolated DCM (adjusted HR [95%CI]: 1.83 [1.21-2.77]) and after 5 years the effect of the LV hypertrabeculation phenotype as a prognostic attenuated. Subgroup analysis found a significant interaction for the incidence of MACEs between sex and DCM subtypes (p for interaction = 0.01). DCM with LV hypertrabeculation phenotypes had a higher early (first 5 years) risk of MACEs. For males, the presence of LV hypertrabeculation phenotypes might be an important clue for identifying high-risk DCM patients.

Pattern of Cholelithiasis and Cholecystitis among Obese Patients

Introduction: Obesity is a major health problem in western society with rapidly increasing prevalence in most countries. The healthcare burden of obesity is far reaching but many of the consequences are yet to be fully understood. While there is a perception that obesity negatively impacts on health and stone formation in gall bladder there is conflicting evidence for this. Aims & Objectives: To assess whether obesity impacts on the blood cholesterol level which leads to dislipidaemia and gall stone formation. To identify whether dislipidaemia causes cholelithiasis and cholecystitis among obese patient. Methods: Between 1st December, 2018 and 31thMay, 2019, patients admitted in dept of surgery at Shaheed Ziaur Rahman Medical College Hospital in Bogura, Bangladesh were enrolled. Following informed consent, BMI was assessed. High risk patients and complications were identified according to established criteria. Patients were grouped according to BMI categories as Normal, overweight, Obese grade-I and Obese grade-II. Various disease of gall bladder including stone formation and its complications were analysed on all obese patients treated at Shaheed Ziaur Rahman Medical College Hospital using a SQL database. Results: Total 59 people were available and consented for this study. 09 patients were excluded; 4 patient were obese but no cholelithiasis or cholecystitis, 3 patients were not agree to investigations and 2 patients declined study). The remaining 50 patients, 29 females and 21 males, included for analysis. The median age was 48 with a range from 18-55. A literature review found evidence of increased risk of dyslipidemia which induce stone formation in GB and inflammation of gall bladder associated with obesity. Conclusion: It is an important issue that obesity is increasing in our new generations. This study should take into account for the future health care researcher. This study has summarized the current body of literature and added to it by demonstrating in our cohort that obese patients were at increased risk of formation of gallstones. I have also provided the evidence that patients with increased BMI with cholelithiasis or cholecystitis or other comorbidities are associated with significantly greater cost to the healthcare system.

Liver fibrosis as a predictor of liver failure and outcome following ALPPS among patients with primary liver cancer

The influence of liver fibrosis on the rate of liver regeneration and complications following ALPPS has yet to be fully understood. This study aimed to scrutinize the effects of liver fibrosis on the postoperative complications, and prognosis subsequent to ALPPS. Clinical data were collected from patients with primary liver cancer who underwent ALPPS at Peking Union Medical College Hospital between May 2014 and October 2022. The degree of liver fibrosis was assessed using haematoxylin–eosin staining and Sirius red staining. This study encompassed thirty patients who underwent ALPPS for primary liver cancer, and there were 23 patients with hepatocellular carcinoma, 5 with cholangiocarcinoma, and 2 with combined hepatocellular-cholangiocarcinoma. The impact of severe liver fibrosis on the rate of liver regeneration was not statistically significant (P = 0.892). All patients with severe complications belonged to the severe liver fibrosis group. Severe liver fibrosis exhibited a significant association with 90 days mortality (P = 0.014) and overall survival (P = 0.012). Severe liver fibrosis emerges as a crucial risk factor for liver failure and perioperative mortality following the second step of ALPPS. Preoperative liver function impairment is an important predictive factor for postoperative liver failure.

Coexistence of Iron Deficiency Anaemia (IDA) and Beta Thalassaemia Trait (B-TT)

Background: The WHO estimates that about 7% of the world population are thalassaemia trait and increasing number of cases are being detected. The world population of carrier of b thalassamia is reported to be more than 100 million. Bangladesh also lies in thalassaemic Belt. A conservative world health report estimates that 3% of our populations are carrier of b thalassaemia which means that there are 3-6 million of b thalassaemia are in Bangladesh. To manage thalassaemia and thalassaemia trait, our traditional concept is not to give iron or iron conaining food. But concomitant iron deficiency anaemia in thalassaemia trait patient may be fatal. Those patients should be evaluated by serum ferritin or by the iron profile and treatment should be supplemented with rational amount of iron. Methodology: This cross sectional observational study was carried out on 75 patients from 03 to 59 years of age of both sex of Beta Thalassaemia Trait, in the department of Medicine and Haematology of Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from January, 2015 to December, 2015. The patients previously diagnosed as Beta Thalassaemia Trait was included in study population. Result: In this study out of 75 Beta Thalassaemia Trait patients, 21 had evidence of Iron Deficiency Anaemia (IDA) and 54 patiens had no evidence of IDA. Thus the frequency of coexistent Beta Thalassaemia Trait and IDA in this study is 28%. The mean Hb concentration was 9.66 gm/dL (±1.54) which is 8.48 gm/dL (±1.43) and 10.12 gm/dL(±1.34) in Beta Thalassaemia Trait with IDA patients and Beta Thalassaemia Trait without IDA patients respectively. So the Hb concentration is significantly lower in b-TT with IDA patients than those without IDA (p-value < 0.001). The mean of Hb A2 level was 4.87(%) (±0.54) which is 4.44(%) (±0.40) and 5.03(%) (±0.50) in Beta Thalassaemia Trait with IDA patients and Beta Thalassaemia Trait without IDA patients respectively. So the Hb A2 level is significantly lower in Beta Thalassaemia Trait with IDA patients than those without IDA (p-value < 0.001). Conclusion: From this study, it could be concluded that the frequency of IDA in Beta Thalassaemia Trait is about 28%. The degree of anaemia is more severe and the level of Hb A2 is much lower in Beta Thalassaemia Trait with IDA patients than Beta Thalassaemia Trait without IDA. J Dhaka Med Coll. 2022; 31(2) : 182-186

Knowledge, Attitude and Practice of Parents of Children with Childhood Asthma in a Tertiary Care Hospital

Back ground: Asthma is one of the most common reasons that children visit doctors, miss days at school or are admitted to hospital. If asthma is well managed, child should be able to lead a healthy and active life. Methods: The study aims to investigate parental knowledge, attitudes about childhood asthma, and practices regarding the management of their children’s asthma. An observational cross-sectional study was conducted among parents of children aged between 2 and 12 years with asthma who had visited the outpatient or inpatient department of Pediatrics at Dhaka Medical College Hospital over a period of approximately 6 months. Data were collected using a preformed Knowledge, Attitude, and Practice (KAP) questionnaire. Results: Total 110 parents of children with childhood asthma were interviewed in this study. There were 63 (57.3%) male and 47 (42.7%) female with M:F ratio 1.34:1 (Slightly male predominance). Most of the patients 57(87.6%) visited in out-patient department (OPD). Almost half of the parents (52.7%) knew their children had asthma. Most of the parents (80.9%) thought oral form of drug (syrup/ tablet) is better than inhaler. Almost two-third parents believed asthma can be cured and they did not know the importance of adherence with asthma medications. The overall parental knowledge was poor (49.09%). Nearly half of them (49.09%) had negative attitude about childhood asthma & 50.9% parents had poor practice about avoidance of allergens, use of asthma medications and regular follow up of their children. Knowledge, attitude and practice are significantly associated with education, socioeconomic condition and living area. Statistically significant positive correlation has been found between knowledge and practice, but knowledge and attitude has not showed significant positive correlation. J Dhaka Med Coll. 2022; 31(2) : 194-200

Comparison of patient-controlled epidural analgesia and epidural morphine for post-cesarean section analgesia: experience from a tertiary center in China.

To compare patient-controlled epidural analgesia (PCEA) and epidural morphine (EM) for post-cesarean section analgesia in real-world experience from China. Parturients receiving one dose of EM (1-2mg), PCEA, or both EM and PCEA from Peking Union Medical College Hospital were retrospectively recruited. Logistic models were used to identify risk factors. Of 1079 parturients enrolled, 919 (85.2%) parturients received only EM, 105 (9.7%) parturients received PCEA, and 55 (5.1%) parturients received both EM and PCEA. Significantly more parturients from EM group requested supplementary analgesia than those from PCEA and PCEA + EM group (583, 63.4% vs 52, 49.5% vs 25, 45.5%, P = 0.001) with more times of supplementary analgesia (1, IQR: 0-2 vs 0, IQR: 0-1 vs 0, IQR: 0-1 times, P < 0.001) and larger amounts of nonsteroidal anti-inflammatory drugs (NSAIDs) (50, IQR: 0-100mg vs 0, IQR: 0-50mg vs 0, IQR: 0-50mg, P < 0.001). In multivariable Logistic regression for the supplementary analgesia risk, the application of PCEA (OR: 0.557, 95%CI 0.396-0.783, P = 0.001) and the use of NSAIDs intraoperatively (OR: 2.996, 95%CI 1.811-4.957, P < 0.001) were identified as independent predictors. A total of 1040 (96.4%) patients received prophylactic antiemetic therapy during surgery. Only 13 (1.2%) and 7 (0.6%) patients in our cohort requested antiemetic and antipruritic drugs, respectively. The use of PCEA was an independent protective factor for supplementary analgesia during the post-cesarean section. Prophylactic antiemetic therapy may reduce the side effects of post-cesarean analgesia.

Comparative Outcome Following Introduction Of Chest Physiotherapy At Hospital Setting After Major Abdominal Surgery

Background: Postoperative respiratory complications are still a matter of ‘folds in forehead’ for surgeons. Though optimum pre-operative preparation and good surgical technique, we always observe that there are some sorts of post-operative chest complications after major abdominal surgery. Now-a-days, chest physiotherapy is usually advised by the surgeons in the immediate postoperative period. But still it is not in a constructive way. There is no well-documented study regarding the effectiveness of chest physiotherapy in an immediate post-operative period of major upper abdominal surgery. So, this is a time demanding study in this regard. Objectives: To evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective major abdominal surgery. Methods: All patients who underwent major abdominal surgery were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 100 patients were finalized. Among them, 50 were enrolled under control group and rest 50 were enrolled under study group. This experimental study was conducted in department of Surgery, Dhaka Medical College Hospital, Dhaka, from March 2017 to December 2017. Results: The mean age of the participants in control and study groups were 49.73±15.91 year and 53.77±12.21 year respectively. The female to male ratio in these groups was 1:2.13 and 1:3.17 respectively. Two groups presented similar levels of pain before and after surgery. The group receiving chest physiotherapy presented a lower pain score on the immediate postoperative day. The preoperative spirometry values (expressed as a percentage of the predicted values) were almost similar in two groups and presented average decreases of 20% in FVC, FEV, and PEF on the 14th post-operative day. It was observed that the measurements of oxygen-hemoglobin saturations were different for the control (96.7±1.6 vs 95.2±1.8; p=0.005) and study group (97.3±1.8 vs 94.6±2.5; p=0.03). Respiratory distress was not significantly higher in control group but interestingly there were statistically significant differences observed between the control and study group regarding fever, Surgical site infection (SSI) and mean hospital stay. Conclusion: Chest physiotherapy in major abdominal surgery shows an excellent outcome that accelerates the overall recovery. J Dhaka Med Coll. 2022; 31(2) : 177-181

Clinical Spectrum of Upper Gastrointestinal Bleeding in Pediatric Age Group: An Experience From a Tertiary Care Hospital of Bangladesh

Background: The bleeding occurring proximal to the ligament of the treitz is known as Upper GI bleeding. The patient may present with hematemesis or melena. Upper gastrointestinal bleeding in children can result in complex and perhaps fatal clinical circumstances. It fluctuates significantly depending on changes in the patient’s demographics and other diseases. Methods: This was a cross sectional study conducted at the Department of Paediatrics, Dhaka Medical College Hospital, Dhaka. The study was conducted during the period of Jan’2020 to July 2022. The total number of study patients was 92. Result: The most extensive prevalence of UGIB is found in children aged 5 to 10 years (71.4%), followed by those aged 1 to 12 years (26.8%). Varices accounted for 67 (72.8%) of the UGIB causes, followed by erosive gastritis (6.5%), stomach ulcers (3.3%), esophagitis (2.2%), and Mallory Weiss tears (1.1%), with 13 (14.1%) of them being judged to be normal. Pallor was the most common presenting symptom, making up 82 (89.1%), then hematemesis 61(66.3%) and melena 30.4%, splenomegaly 55(59.8%), hematemesis plus melena (30.4%), hepatomegaly (28.3%), jaundice (15.6%), and melena (3.3%). Conclusion: Hematemesis is the most common presenting symptom of upper GI haemorrhage, which is more common in kids between the ages of 5 and 10. Esophageal varices were the most common source of intestinal bleeding. J Dhaka Med Coll. 2022; 31(2) : 215-219

Demographic Profile and Outcome of Covid- 19 Obstetric Patients Undergoing Caesarean Section in a Tertiary Care Government Hospital in Dhaka, Bangladesh

Background: Pregnancy itself is a hypercoagulable state. COVID-19 infection makes it more deleterious. As a consequence of exaggerated inflammatory response in COVID 19 infected mothers, there is alterations of coagulation system occurs, causing thrombi (micro and macro) in various organs reducing blood flow in capillaries , followed by emboli formation mainly in lung, heart, brain and kidney, resulting in multiple organ failure even death. The present study aims to observe retrospectively the clinical outcome of parturients with COVID-19 infection undergoing caesarean sections. Methods: This observational study was done in the COVID dedicated operation theatre of Department of Anaesthesia, Pain, Palliative and Intensive Care, Dhaka Medical College Hospital, Bangladesh, between May 2020 and December 2021. A total 640 obstetric patients undergoing caesarean section (both COVID positive and suspected) were observed. The demographic and outcome data of mothers ( transferred from post-operative ward to parent ward/ICU) were collected. Informations of ultimate fate (alive/death) of operated mothers were also noted. Demographic (sex) data and outcome data of newborn baby (alive/dead) were also included. The statistical analysis was carried out by using the Statistical Package for Social Sciences version 22.0 for Windows. Results: In this study, the age of the most (n=532, 83.13%) of the pregnant mothers belongs to 18-30 years of age group, remaining 16.86% patients are within the age group of 31-45 years (n=108). Although 18.75% study subjects were illiterate below class VIII(31.25), SSC(17.97%), HSC(16.40%), Graduate(12.5%), masters(3.13%)], miscellaneous type of occupational status [home-maker(70%), service holder(19.85%), entrepreneurship(1.56%) &amp; others(8.59%. and came from different category of social class[ most of the patients belong to lower(54.68%) and lower middle class (27.81%) socioeconomic status]. Among total study sample (n=640), 55.63% (n=356) patients were infected with COVID 19 virus confirmed by RT-PCR and 44.38% (n-284) mothers were clinically COVID infected or suspected cases. The majority of the pregnant mothers (n=565. 88.28%) experienced sub-arachnoid block or spinal anaesthesia whereas only 6.09% (n=39) patients got experience of general anaesthesia. Apparently, 93.44% (n=598) of mothers come back to the parent ward after observing in post-operative ward. Of them, (n=640), 2.19% of mothers were not survived in operation theatre or post-operative ward and 4.34% (n=21)of patients had to go to Covid dedicated Intensive Care Unit. Survivors mothers (n=619, 96.72%) were greater than that of non-survivors (n=21, 3.28%). Among the delivered new born babies, the number of female babies (n=330, 51.56%) were slightly higher than that of male (n=310, 48.44%). In a total 640 babies, 560 babies (87.50%) were survived but 12.50% (n-=80 ) of babies were not survived. Conclusions: This observational study represents that among 640 number of COVID positive or suspected pregnant mothers who were undergoing caesarean section , 93.44% of mothers come back to the parent ward, 2.19% of mothers were expired in operation theatre or post operative ward because of complications. Unfortunanely, 4.34% of mothers had experience to go to Intensive Care Unit. Survivors mothers were greater than that of non-survivors. New born babies of confirmed and suspected COVID mothers were slightly female predominant. Total of them, 87.50% of babies were survived. J Dhaka Med Coll. 2022; 31(2) : 187-193

Hypothyroid Patients Show Significant Association with Antithyroid Antibodies: A Cross Sectional Study in Khulna

Background and Objectives: A high prevalence of thyroid disorder is found worldwide and it is a serious public health problem. A community‑based investigations showed that; overall occurrence of thyroid disease was 20.43%, highest incidence of diffuse goiter (7.35%), followed by sub-clinical hypothyroidism (6.59%), hypothyroidism (4.97%), hyperthyroidism (0.86%) and sub-clinical hyperthyroidism (0.65%) in Khulna, Bangladesh. Antithyroid autoantibodies are one of the most important causes of thyroiditis resulting hypothyroidism. The aim of this study was to investigate the prevalence of antithyroid antibody to hypothyroid patients in Khulna region. Methods: This cross‑sectional study was done on Hypothyroid patients of Khulna Medical College Hospital and Institute of Nuclear Medicine and Allied Science (INMAS), Khulna, from July 2023 to December 2023. After having informed written consent of adult sixty hypothyroid patients, was interviewed and examined the blood sample for relevant information; data recorded in a preformed, semi-structured data collection sheet (Patient particulars form) and analyzed. Results: About 20 percent had positive family history of hypothyroidism, 27 percent patient was associated with other autoimmune diseases and about 80 percent was associated with anti-thyroid antibody. Out of the sixty hypothyroid patients about fifty percent was obese, eighty percent was female of 30-60 years age group. Ninety percent of them belongs to poor socioeconomic conditions and came from rural area of Khulna district. Conclusions: Most of the patients were rural female of low socioeconomic back ground of reproductive age groups. There was very significant association of anti-thyroid antibody with these patients. They also associated with chronic autoimmune diseases and poverty.

Risk Factors and Outcome of Early Puerperium Following Caesarean Section

Introduction: The postpartum period, or puerperium, typically lasts six weeks following childbirth and is crucial for the reversal of pregnancy-induced anatomical and physiological changes. This period is often divided into three stages: immediate, early, and remote puerperium. Early puerperium, the first week after childbirth, is critical due to the heightened risk of complications, especially following cesarean sections (CS). Objective: This study aims to investigate the prevalence and types of early puerperal complications in women undergoing elective and emergency cesarean sections. Methods: A retrospective observational study was conducted in the Obstetrics and Gynecology department at Enam Medical College Hospital, Savar, Dhaka, Bangladesh. Hospital records from January 2015 to December 2015 were reviewed, including 100 women who had undergone cesarean sections. Data on demographic characteristics, antenatal care, risk factors, and types of early puerperal morbidities were collected and analyzed using SPSS version 20. Results: The study found that 55% of the participants were aged 21-30 years, 70% belonged to poor socioeconomic backgrounds, and 90% were housewives. A significant 70% of the women had not received any antenatal care. The most prevalent risk factors for early puerperal morbidities were obstructed labor (40%) and prolonged labor (30%). Common complications included wound infections (50%), endomyometritis (45%), and urinary tract infections (35%). Conclusion: Early puerperal complications are prevalent among women who undergo cesarean sections, particularly those from low socioeconomic backgrounds with inadequate antenatal care. Addressing these issues through improved prenatal and postnatal care and better access to skilled birth attendants can potentially reduce these complications and enhance maternal health outcomes.

Clinicopathological features of breast cancer with HER2 low expression: a real-world retrospective study

Objective: To investigate the clinical and pathological characteristics of breast cancer with HER2 low expression. Methods: The data from 3 422 patients with invasive breast cancer which archived in Peking Union Medical College Hospital between April 2019 and July 2022 were retrospectively reviewed. Among them, 136 patients were treated with neoadjuvant chemotherapy. The tumor size, histological type, tumor differentiation, lymph node metastasis, Ki-67 index, the status of estrogen receptor, progesterone receptor and HER2 as well as pathological complete response (pCR) rate were collected. Results: The HER2 status of 3 286 patients without neoadjuvant therapy, 616 (616/3 286, 18.7%) score 0, 1 047 (1 047/3 286, 31.9%) score 1+, 1 099 (1 099/3 286,33.4%) score 2+ and 524 (524/3 286,15.9%) score 3+ by immunohistochemistry (IHC). Among the 1 070 IHC 2+ cases, 161 were classified as HER2 positive by reflex fluorescence in situ hybridization (FISH) assay. In our cohort, 1 956 cases of HER2-low (IHC 1+ and IHC 2+/FISH-) breast cancer were identified. Compared to the HER2 IHC 0 group, HER2-low tumors more frequently occurred in patients with hormone receptor (HR) positive (P<0.001), Ki-67 index below 35% (P<0.001), well or moderate differentiation (P<0.001) and over the age of 50 (P=0.008). However, there were no significant differences in histological type, tumor size, and lymph node metastasis between HER2-low and HER2 IHC 0 group. For patients who had neoadjuvant therapy, the pCR rate in the patients with HER2-low was lower than those with HER2 IHC 0 (13.3%, 23.9%), but there was no significant difference. Although HER2-low breast cancers showed a slightly lower pCR rate than HER2 IHC 0 tumors, no remarkable difference was observed between tumors with HER2-low and HER2 IHC 0 regardless of hormone receptor status. Conclusions: The clinicopathological features of HER2-low breast cancers are different from those with HER2 IHC 0. It is necessary to accurately distinguish HER2-low breast cancer from HER2 IHC 0 and to reveal whether HER2-low tumor is a distinct biological entity.

A retrospective study of prognostic factors and treatment outcome in advanced-stage Mycosis Fungoides and Sezary Syndrome

ABSTRACT Background: Mycosis fungoides (MF) and Sezary Syndrome (SS) comprise over half of all Cutaneous T-cell lymphoma diagnoses. Current risk stratification is largely based on TNMB staging, few research investigated the prognostic value of clinical exams. Current systemic therapy for advanced disease includes immunomodulatory drugs, chemotherapy, and HADC inhibitors. Few clinical trials or retrospective research compared the efficacy of different drugs. Method: Here, we performed a retrospective analysis of prognostic factors and treatment outcomes of 92 patients diagnosed with MF/SS at the Peking Union Medical College Hospital from 2013-2023. Results: Cox regression analysis identified that age ≥ 50 years, WBC ≥ 8 × 109/L, serum LDH ≥ 250U/L, β2-MG ≥ 4.50 mg/L, and stage IV were associated with reduced overall survival, age ≥ 50 years, serum LDH ≥ 250U/L and stage IV were associated with reduced progression free survival. Kaplan-Meier analysis established that immunomodulatory therapy was associated with longer progression free survival. Conclusion: These results suggested new factors in predicting prognosis and selecting appropriate treatments in patients with advanced MF/SS.

Clinicopathological features and prognosis of sporadic mismatch repair deficient colorectal cancer

Objective: To investigate the clinicopathological characteristics and prognostic factors of sporadic mismatch repair deficient (dMMR) colorectal cancer. Methods: A total of 120 cases of sporadic dMMR colorectal cancer from July 2015 to April 2021 were retrospectively collected in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Patients with Lynch syndrome; synchronous multiple colorectal cancers; preoperative anti-tumor treatments such as chemotherapy and radiotherapy; and those with incomplete follow-up information were excluded based on family history and next-generation sequencing (NGS) test results. Immunohistochemical stains were used to detect the expression of mismatch repair proteins, methylation-specific PCR for methylation testing, and fluorescent PCR for BRAF V600E gene mutation detection. The clinical and pathological data, and gene mutation status were analyzed. Follow-up was done to assess survival and prognosis including progression-free survival and overall survival rate. Results: Sporadic dMMR colorectal cancer occurred more frequently in the right side of the colon, in females, and in the elderly. Morphologically, it was mostly moderately-differentiated, and most patients had low-grade tumor budding. In terms of immunohistochemical expression, MLH1 and PMS2 loss were dominant, and there were age and location-specificities in protein expression. MLH1 methylation was commonly detected in elderly female patients and rare in young male patients; while MLH1 and PMS2 deficiency, and BRAF V600E mutation occurred more often on the right side (P<0.05). The 3-year and 5-year progression-free survival rates were 90.7% and 88.7% respectively, and the 3-year and 5-year overall survival rates were 92.8% and 90.7% respectively. Tumor budding status was an independent risk factor affecting patient recurrence (hazard ratio=3.375, 95% confidence interval: 1.060-10.741, P=0.039), patients with low-grade tumor budding had better prognosis, and those with medium or high-grade tumor budding had poor prognosis. Conclusion: For dMMR colorectal cancer patients, tumor budding status is an independent risk factor for recurrence.

Endometrioid Carcinoma Four Years After Hysterectomy: A Rare Case Report

It is quite a fascinating case as we have recently experienced in Mugda Medical College Hospital, a tertiary level teaching hospital in Dhaka, Bangladesh, that a woman was diagnosed and treated for endometrioid adenocarcinoma four years after her vaginal hysterectomy had been done. Our patient was presented with abdominal pain for nearly 2 weeks along with nausea, vomiting and generalized weakness. Ultrasound evaluation revealed a complex pelvic mass (8.6cm × 4.9cm). Chest x-ray revealed a left sided pleural effusion, while CT scan of the abdomen revealed heterogeneously enhancing complex pelvic mass and mild ascites. After a clinical correlation with all the pathological investigations, the patient was advised for a core biopsy. Ultrasonogram guided core biopsy was done. Histopathological examination showed a malignant ovarian epithelial tumor. Then she underwent an interventional or surgical procedure, which included an exploratory laparotomy, bilateral salpingo-oophorectomy with bilateral pelvic lymph node dissection and infracolic omentectomy done under general anesthesia. The final histopathological examination of the removed mass showed an endometrioid adenocarcinoma (Grade 2). Meanwhile, she was referred for radiation therapy (both vaginal brachytherapy and external pelvic radiation) after the patient had recovered from surgery. We will discuss this case as a part of our clinical interest and continuing education for our clinicians and residents. Mugda Med Coll J. 2024; 7(1): 53-55

PheoSeg: A 3D transfer learning framework for accurate abdominal CT pheochromocytoma segmentation and surgical grade prediction

Pheochromocytoma is a rare urological disease. Accurate segmentation of pheochromocytoma and its surrounding abdominal organs is crucial for surgical planning and preoperative diagnosis. However, current clinical datasets typically include tumor labels but lack comprehensive multi-organ abdominal labels, and detailed descriptions of the spatial relationships between the tumor and adjacent organs are insufficient. To address the challenge of automatic multi-organ segmentation in the abdomen without comprehensive labels around pheochromocytoma, we propose a novel method for automatic multi-source migration segmentation and preoperative diagnostic grading of pheochromocytoma and its surrounding organs. This method utilizes nnUNet to extract data fingerprint information from the target domain (Clinical Pheochromocytoma dataset of Peking Union Medical College Hospital, PPGL) as prior knowledge, which is then transferred to two source domains (FLARE2022 and AMOS2022). We trained 10 models and incorporated them into a "Model Bank". Additionally, we employed an improved CC-FV method to screen the models in the "Model Bank," identifying the model with the highest mobility (class consistency and feature diversity). This selected model served as a pre-trained model for abdominal multi-organ segmentation and was subsequently adapted for tumor segmentation. To address the issue of limited clinical data, we introduced a data enhancement technique for 3D medical images. The enhanced dataset was used to fine-tune the pre-trained model, resulting in a model capable of segmenting multiple organs and tumors in the abdomen. From the segmentation results, we extracted the spatial relationships between the tumor and surrounding abdominal organs and constructed a radiomic model to predict and analyze the surgical grading. Experimental results demonstrate that our proposed method achieves a Dice coefficient that is, on average, 10.18 % higher on FLARE2022 and AMOS2022 datasets compared to segmentation frameworks such as Swin-Unet, UNETR, CoTr, nnformer, and nnUNetv2. For the PPGL dataset, the Dice coefficient for pheochromocytoma and surrounding organs was 87.27 %. In summary, our method effectively realizes efficient and automatic segmentation of pheochromocytoma and surrounding organs, as well as preoperative diagnostic classification.

Visual Outcome of Occlusion Therapy in Anisometropic Amblyopia

Background: Amblyopia is a common visual disorder in children, often treated with occlusion therapy. This study aimed to assess the visual outcomes following occlusion therapy in children with anisometropic amblyopia, focusing on improvements in best-corrected visual acuity (BCVA) over a six-month period. Methods: This cross-sectional study was conducted in Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh during the period from January 2015 to August 2015. Participants underwent occlusion therapy, where the better-seeing eye was covered for varying durations based on initial BCVA. Visual acuity was measured using the Snellen chart and converted to logMAR units at baseline, and after 1, 3, and 6 months of therapy. Statistical analysis was performed using Pearson’s correlation test. Results: The mean BCVA improved significantly from 0.88±0.28 at baseline to 0.55±0.21 after 1 month, 0.42±0.15 after 3 months, and 0.23±0.12 after 6 months (p &lt; 0.001 for all comparisons). Among the participants, 68% had hypermetropia, 22% had astigmatism, and 10% had myopia. The majority of participants (68%) had anisometropic amblyopia in the right eye. The age distribution was 32% aged 5-7 years, 47% aged 8-9 years, and 21% aged 10-11 years, with a mean age of 8.64 years. Gender distribution was 64% male and 36% female. Conclusion: Occlusion therapy significantly improves visual acuity in children with anisometropic amblyopia, with early and consistent treatment yielding the best results. These findings support the continued use of occlusion therapy as an effective treatment modality, even when initiated later in childhood. Future research should explore long-term outcomes and complementary treatment approaches.

Assessment of Antibody Titers after 6 Months of Vaccination against SARS-COV-2 in Patients with CKD Stage 4, 5 and CKD 5d

Background: Since the pandemic of COVID-19 started from December 2019, remarkable numbers of infections and deaths associated with COVID-19 have been recorded worldwide. Chronic kidney disease patients are particularly at high risk of infections due to impairments in the innate and adaptive immune systems. Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against this specific pathogen. COVID-19 prevention through successful vaccination is therefore paramount in chronic kidney disease population. But vaccination efficacy is diminished in these patients because premature ageing of the immune system and chronic systemic low- grade inflammation are the main causes of immune alteration in these patients. Therefore, it is urgently necessary to establish a different vaccination strategy for chronic kidney disease and dialysis patient in terms of the dose and administration time. Aims: This study aimed to assessment of antibody titers after vaccination against SARS-COV-2 in patients with chronic kidney disease stage 4, 5 on conservative management and maintenance haemodialysis. Methods: This prospective observational comparative was conducted in Nephrology department of Dhaka Medical College Hospital. Selectionof patients was done by purposive sampling according to inclusion and exclusion criteria. Total 135 patients distributed in three groups: 45 patients of chronic kidney disease (CKD) stage 4, 5 on conservative management, 45 patients on maintenance haemodialysis (MHD) and 45 healthy controls were approached for the study who were receiving SARS-COV-2 vaccination. Demographic, clinical and laboratory data were collected initially. At first a pre vaccination sample or 1st sample was taken for antibody measurement. Then participants from all groups were given 2 doses MODERNA vaccine containing 100 µg in 0.5 ml each in 28 days apart. Then after 14 days of 1st dose of vaccination the 2nd samples were taken, 3rd samples were taken 14 days after the 2nd dose vaccination. Study populations were subdivided into two groups according to pre vaccination SARS-COV-2 antibody titer; seropositive- positive response before vaccination and seronegative- negative response before vaccination. They were also divided into two groups according to quantitive antibody response; positive response- values ≥10 DU/mL were positive Negative response- values of &lt;10 DU/mL were negative. Result: Seroconversion rate was around 20% among study participants before vaccination. 14 days after the 1st dose of vaccination, 90.04% patients had positive immune response in CKD stage 4, 5 on conservative management group whereas in MHD group 84.82% responded to vaccination and immune response in control group was 100%. Immune response is 100% among all the groups after 14 days of 2nd dose of vaccination but the concentration of antibody differs significantly among the study groups. Responders were comparatively younger with normal BMI. Conclusion: Haemodialysis patients as well as patients with chronic kidney disease stage 4, 5 on conservative management showed a favorable but profoundly lower early antibody response, which decreased substantially during follow-up.