Ibrahim Cardiac Medical Journal

Expression of p53 and ki-67 in Breast Carcinomas and Their Association with Histopathological Type, Grade, and Stage

Saba Binta Kabir, Shah Md Badruddoza, S M Asafuddllah — Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Recently many laboratories are evaluating the usefulness of determining p53, and Ki67 proliferation activities using immunohistochemical techniques in cancer. Although the available studies suggest that these factors might help make treatment decisions in cancer patients, their clinical usefulness is still controversial. The present study was undertaken to see the expression of p53 and Ki-67 in breast carcinoma and their associations with histopathological variables.

Methods: This cross-sectional analytical study was conducted in the Department of Pathology, in collaboration with the Department of Surgery, Rajshahi Medical College Hospital and the Department of Pathology, Bangobandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of one and a half year from July 2018 to December 2019. Resected specimens of breast tissue, histopathologically confirmed as breast carcinoma, were the study population. Histological grading of breast carcinoma was done according to Nottingham modification of the Bloom-Richardson system, while staging was done using Tumor-Node-Metastasis (TNM) classification of malignant tumors, as recommended by the Union for International Cancer Control (UICC). The Ki67 and p53 expressions were assessed by immunohistochemistry. Based on the Ki67 labeling index (Ki67-LI), the patients were divided into two groups – Ki 67 > 30% (considered as over-expressed) and ≤ 30% (considered as less expressed). Likewise, p53 immuno-expression was grouped as over-expressed (score ≤ 8) and low-expressed (score > 8). The histological grade, type, and stage were then compared between patients with tumours of high and low proliferating activities to find the associations of Ki67 and p53 with tumor grade, type, and stage.

Result: In the present study, almost three-quarters (74%) of the specimen of the breast had high Ki67-LI and 26% intermediate and low Ki67-LI. The p53 was found to be highly expressed in the majority (86%) of the cases. Analyses of the association of biomarkers with histological grade, stage, and type revealed that advanced-stage breast cancers (Stage-IIIA) were more likely to be associated with high Ki67-LI than the early-stage breast cancers (Stage-IIA and Stage-IIB) (p = 0.023). Poorly differentiated (G3) carcinoma also more often tends to be associated with high Ki67-LI than with low and intermediate Ki67-LI (p = 0.066). Likewise, stage IIIA tumors and poorly differentiated carcinoma were also considerably higher in the p53 over-expressed group (23.3%) than in the low p53 expression group (14.3%) (p = 0.023).

Conclusion: The study concluded that a substantial proportion of breast carcinomas demonstrates high Ki67-LI. The p53 overexpression is also found in the majority (86%) of the breast carcinoma cases. Both Ki67 and p53 proliferation activities show their significant presence in high-grade and advanced-stage tumours.

Ibrahim Card Med J 2023; 13 (1&2): 11-18

Factors Associated with Overweight/Obesity among Rural Secondary School Children in Bangladesh

Wed, 19 Jun 2024 00:00:00 +0000

Background & Objective: Unhealthy dietary patterns in combination with a sedentary lifestyle could be contributing to some major health issues worldwide. Obesity in children and adolescents can have short- and long-term adverse health consequences including early mortality. Although previously limited to urban areas, with the rapid adoption of urban lifestyle by the rural people the problem is now ubiquitous. It is difficult to develop a policy for promoting health and reducing obesity among adolescents living in rural regions since there is a lack of information on the factors that contribute to this problem. The present study was, therefore undertaken to evaluate the factors influencing overweight and obesity among rural adolescents.

Methods: This cross-sectional study was done based on data collected by students of Rajshahi Medical College as part of their RFST (Rural Field-site Training) in 2019 from a rural area of Rajshahi, Bangladesh. A total of 535 students from two rural secondary schools participated in the study. Every alternate student of those schools from class VI-X was then included in the study as a respondent. The weight and height of the selected students were first taken followed by data collection on variables of interest. Using weight and height data, the body mass index (BMI) of the respondents was first determined and was plotted on a growth chart (recommended by CDC, Atlanta) to find the percentile. Then the nutritional status of the individual respondents was determined based on their percentile status and was classified as underweight, normal, overweight, or obese.

Results: Almost one-fifth (18.2%) of the respondents was found overweight or obese. Upon comparing respondents’ demographic characteristics, food and exercise behaviour between overweight & obese and normal & underweight groups, the former group was found younger than the latter group. Respondents’ socioeconomic status (SES) was associated with their nutritional status with overweight & obese adolescents being significantly higher in the Middle- and rich SES group (78.4%) than in the poor and lower middle-class (61.4%). Neither dietary nor exercise behaviour was associated with the nutritional status of the respondents. Although the majority (84.2%) of normal & underweight adolescents preferred low to medium-calorie snacks, overweight and obese adolescents were more likely to choose high-calorie snacks. Fast walking and running were the more common forms of exercise behaviour and of longer duration among the overweight & obese cohort than those among normal & underweight cohorts.

Conclusion: The study concluded that the period of early adolescence is vulnerable to developing obesity. Adolescents belonging to middle and well-off SES are more prone to be overweight or obese than those belonging to lower middle & poor SES. However, exercise, physical activity, and dietary habits of adolescents do not influence their nutritional status.

Ibrahim Card Med J 2023; 13 (1&2): 19-25

Cigarette Smoking and its Association with Dyslipidemia among Middle-aged Population in Rajshahi District

Farhana Yasmin, Parvez Hassan, Md Jawadul Haque — Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Dyslipidemia is one of the major risk factors for ischemic heart disease. Many factors contribute to the development of dyslipidemia. Smoking is one of them. Smoking and dyslipidemia are claimed to interact with each other and synergistically increase the risk of heart disease. The present study is, therefore, intended to find the association between smoking and dyslipidemia in the context of the Bangladeshi population.

Methods:The present cross-sectional study was conducted in the Department of Biochemistry, Rajshahi Medical College (RMC), Rajshahi in collaboration with the Institute of Biological Science, Rajshahi University, Rajshahi over a period of five years between 2017 and 2022. A total of 230 adult (ranging from 30 to 60 years) male subjects who attended at Biochemistry Lab of RMC to have their blood tested for lipid profile were consecutively included in the study. However, individuals with the habit of chewing tobacco, ex-smokers, or those having any diseases influencing lipid profile, taking drugs (like β-blockers, thiazide, statins, fibric acid derivatives, and nicotinic acid) that may influence lipid profile, or obese persons under dietary restrictions were excluded from the study. The subjects who exhibited either serum TC: HDL ratio > 4.5 or serum Tg: HDL ratio > 3.5 or both conditions were considered as cases and the subjects who did not have either of the conditions were considered as controls in the present study.

Result: In the present study, over one-third (34.8%) of subjects had a smoking habit with the mean duration of smoking being 13.6 ± 5.0 years. Dyslipidaemia (as defined by serum TC: HDL > 4.5) was found in 33% of subjects, while the same condition, defined by serum Tg: HDL > 3.5, was found in 42.6% of the subjects. While either of the two conditions was present in 13% of subjects, both conditions were concurrently observed in 31.3% of subjects. Of the total 230 subjects, 102(44.3%) were dyslipidaemic. Smoking habit was observed to be significantly higher in the case group (54.9%) than that in the control group (18.8%). The risk of having dyslipidaemia in smokers was > 5-fold (95% CI = 2.9 – 9.5) higher than that in non-smokers (p < 0.001). However, as the duration of smoking was correlated with different lipid profiles, it was not found to be significantly correlated with any of the lipid profiles.

Conclusion: The study concluded that smokers are more likely to have dyslipidaemia than non-smokers. The risk of having dyslipidaemia in smokers is much higher than that in non-smokers. While serum total cholesterol, low-density lipoprotein (LDL) and serum triglycerides are increased, serum high-density lipoprotein (HDL) is reduced.

Ibrahim Card Med J 2023; 13 (1&2): 26-31

Iron Status in Male Type 2 Diabetic Patients and Its Association with Their Glycemic Status

Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Alteration in iron metabolism may occur in diabetic patients especially those who have poor glycemic control. Serum iron is involved in free radical formation associated with hyperglycemia and causes diabetic complications. The present study was undertaken to observe the iron status and its relation with glycemic control in male type 2 diabetic patients.

Methods: This cross-sectional analytical study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from July 2017 to June 2018. A total of 48 diagnosed male type 2 diabetic patients (cases) were recruited from the Out-patient Department (OPD) of Endocrinology based on predefined eligibility criteria. Of them, 24 had good glycemic control (HbA1c level < 7%) (Group B1) and 24 had poor glycemic control (HbA1c level ≥ 7%) (Group B2). To compare the outcome (serum iron status) of these diabetic patients, another 48 age- and BMI-matched healthy non-diabetic male subjects were selected from personal contact as control. While diabetes and glycemic status (fasting blood glucose level, and HbA1c) of the diabetic patients were exposure variables, serum iron, serum total iron binding capacity (TIBC), transferrin saturation, and serum ferritin were the outcome variables.

Results: The mean age of the subjects of either study group was around 43 and there was no significant difference between the groups concerning age (p = 0.610). The distribution of BMI and serum creatinine between groups was also similar (p = 0.135 and p = 0.134 respectively). The cases had a significantly higher level of serum iron, transferrin saturation, and an insignificantly lower total iron binding capacity (TIBC) than their non-diabetic peers (p = 0.045, p = 0.036, and p = 0.061 respectively). A comparison of outcome variables among the three groups shows that the groups were significantly heterogeneous in terms of serum iron, TIBC, transferrin saturation, haemoglobin level (p = 0.032, p = 0.012, p = 0.008 and p = 0.018 respectively). The associations were more conspicuous in patients with poor glycemic status. Correlation analyses revealed that while there was a significant linear correlation between serum iron and HbA1c (r = + 0.376, p < 0.01), it was negatively correlated with serum TIBC (r = -0.478, p < 0.001). The glycemic status (HbA1c) was also found to be linearly correlated with serum ferritin and transferrin saturation (r = + 0.354, p = 0.013 and r = + 0.462, p < 0.001 respectively).

Conclusion: The study concluded that type 2 diabetic patients have a significantly higher level of serum iron, transferrin saturation, and a lower total iron binding capacity (TIBC) than the non-diabetic healthy subjects, all of which may lead to reduced synthesis of hemoglobin. The compromised iron metabolism is even more evident as the hyperglycemia aggravates.

Ibrahim Card Med J 2023; 13 (1&2): 32-39

Effects of Aloe Vera Gel on Red Blood Cell-parameters in Phenylhydrazine-induced Anaemic Wistar albino Rats

Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Anaemia is the most significant disorder of the blood. Many researchers have developed the concept of using medicinal plants as an alternative source of treatment for anaemia with fewer side effects. Aloe vera, being a medicinal plant, is popularly used as a natural drug in haematological disorders. The present study was intended to observe the effects of Aloe vera gel on red blood cell parameters in phenylhydrazine (PHZ)-induced anaemic Wistar albino rats.

Methods: This Experimental study was conducted in Dhaka Medical College, Dhaka from July 2021 to June 2022. A total of 24 healthy Wistar albino rats were selected for the study. After procurement, the rats were initially kept in a standard laboratory condition on a 12/12-hour light/dark cycle for 14 days of acclimatization before 21 days of the experiment. All the rats had free access to basal diet and normal saline during the period of acclimatization and experiment. After acclimatization for 14 days, the rats were divided into three groups-Group A (baseline control group, n = 8), Group B (PHZ-treated group, n = 8), and Group C, the Experimental Group (PHZ-induced and Aloe vera gel treated group, n = 8). To induce anaemia, Group B and Group C received intraperitoneal injection of PHZ at a dose of 0.5 ml/100 g body weight on days 1, 3, 5 and day 7. Moreover, the experimental group (Group C) received Aloe vera gel orally at a dose of 0.6 ml/kg body weight from Day 8 to Day 21. On day 22, rats were sacrificed to test their blood samples for haematologic variables (RBC count, Hb conc., and PCV) and haematological indices (MCV, MCH and MCHC).

Result: All the haematological parameters and indices were almost similar among the study groups at baseline (on Day 1). On Day 8, rats of groups B and C demonstrated a drastically reduced count of RBC (2.66 ± 0.53 and 2.69 ± 0.52 million/μl respectively) compared to the rats of group A (8.16 ± 0.76 million/μl). On Day 22, the RBC count in rats of Group C staggeringly increased to 7.63 ± 0.64 million/μl; however, the RBC count in rats of Group B remained almost the same as was found on Day 8. A significant decrease in Hb conc. and PCV in PHZ-induced control on Day 8 compared to that on Day 1 was also observed. The mean MCV in all the study groups on Day 1 was around 50 fl, which abnormally increased to 85 and 87 fl in Groups B and C respectively on Day 8. On Day 22, Group B further exhibited an increase in MCV to > 87 fl. Meanwhile, the MCV in Group C (Aloe vera-treated group) favourably decreased to 55 fl. On the 8th Day of intervention, the MCH level significantly decreased in Groups B and C. Although no significant change in MCH was observed in Group B from Day 8 to Day 22, group C demonstrated a significant increase in the mean MCH to nearly 18 pg during the same period. The mean MCHC significantly dropped to < 23% in Groups B and C on Day 8 from the baseline figure of 34%. While no significant change in MCHC was evident in Group B from Day 8 to Day 22, it significantly improved to about 28% in Group C during the same period.

Conclusion: From the study, it can be concluded that Aloe vera has significant erythropoietic potentials which result in the improvement of red blood cell parameters (RBC count, Hb conc., PCV, MCV, MCH and MCHC) in PHZ-induced anaemic rats.

Ibrahim Card Med J 2023; 13 (1&2): 40-46

Profile of Stroke Patients Admitted to the Medicine Unit of Dhaka Medical College Hospital

Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Stroke is a leading cause of death and a serious disability for adults. However, it is preventable and manageable, provided a complete updated profile (incidence, prevalence, and long-term outcome) of the disease is in our hands. The present study was therefore undertaken to assess the demographic, clinical characteristics, and outcome of the stroke patients admitted to the Dhaka Medical College Hospital.

Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, over a period of 12 months between January 2004 and December 2004 at the Dhaka Medical College Hospital (DMCH), Dhaka. The study sample consisted of 101 stroke patients who were admitted to the Green Medicine Unit of DMCH. However, stroke patients who were too severely debilitated or in a state of stupor were not allowed to participate in the study. Through pertinent clinical laboratory and imaging tests, stroke risk variables were evaluated. The outcome was evaluated in terms of the number of patients cured, died, or remained static.

Result: There was no significant difference between ischemic and haemorrhagic stroke patients in terms of age (p = 0.658), sex (p = 0.276) and diurnal variation of its occurrence (p = 0.490). While diabetes mellitus and ischaemnic heart diseases were generally associated with haemorrhagic stroke (p = 0.039 and p = 0.056 respectively), hypertension was more or less common in ischemic stroke (p = 0.176). In both groups, hemiplegia was the most frequent cause of admission, after coma. While seizures were more common in the ischemia group, vomiting was a more common manifestation in the hemorrhagic group. The majority of patients in both groups maintained a steady pulse and normal blood pressure. The total cholesterol level was relatively greater in the ischemic group than in the hemorrhagic group. The mean HDL level in the hemorrhagic group was significantly higher than in the ischemic cohort. However, there was no appreciable difference in serum LDL and Tg levels across the groups. A substantial proportion of patients in both groups had to stay in the hospital for a brief period (10 or < 10 days). After receiving treatment, nearly 85% of the patients in the hemorrhagic group and 76.3% of the patients in the ischemic group were cured; some 5.5% in the ischemic group and 4.3% in the haemorrhagic group died of the disease.

Conclusion: The study concluded that smoking, uncontrolled hypertension, and diabetes mellitus are the three main risk factors for stroke. After a median treatment of 7 days, most patients in both the hemorrhagic and ischemic groups recovered, leaving a few to die of the disease. The risk of stroke can significantly be reduced by lowering blood pressure, treating diabetes, and giving up smoking.

Ibrahim Card Med J 2023; 13 (1&2): 47-52

Antidiabetic Effects of Foeniculum vulgare in Alloxan-induced Diabetic Male Rats

Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Diabetes mellitus (DM) has become one of the most challenging health problems of the 21st century. Foeniculum vulgare (Mouri in Bengali), an ancient culinary herb, is known to reduce blood glucose levels thus reducing the risk of diabetes. This study was done to observe the antidiabetic role of Mouri in alloxan-induced diabetic male rats.

Methods: This experimental study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from July 2018 to June 2019. A total of 30 healthy Wistar albino male rats, 90-120 days old, weighing between 150-180g were included in the study. After acclimatization for 14 days, they were divided into two groups: the control group (Group A) and the experimental group (Group B – diabetic rats treated with Mouri). The control group was again subdivided into Group A1 (normal control group) and Group A2 (alloxan-induced diabetic control group). Each of these groups consisted of 10 rats. All the rats received a basal diet for 21 days. In addition to the basal diet, Group A2 and Group B received a single intraperitoneal injection of alloxan 140 mg/kg on day 1 to induce diabetes. Moreover, Group B received Mouri extract 150 mg/kg/day orally for 21 consecutive days starting from day 1 of the study period. After 12 hours of fasting, blood samples were collected from the tail veins of every rat on day 1 for estimation of Fasting Blood Glucose (FBG) and serum ALT levels. On day 4 FBG levels of all the rats were measured once again. Then all the rats were sacrificed on day 22 and their blood samples were collected from the heart. The outcome variables, such as FBG level, serum levels of insulin, were measured and compared among the study groups. The pancreatic tissue was also collected and histopathology was done by standard laboratory procedure to study their histologic architecture.

Result: In this study, fasting blood glucose level in diabetic rats treated with Mouri at the endpoint of the study (on day 22) was significantly lower (5.51 ± 0.47 mmol/L) than that in alloxan-induced diabetic control (13.52 ± 0.76 mmol/L) (p < 0.001) and was almost equal to that in normal control (5.38 ± 0.55 mmol/L) (p = 0.891). The serum insulin level in diabetic rats treated with Mouri (11.52 ± 0.84 mmol/L) was almost similar to that of normal control (12.46 ± 1.07 mmol/L) on day 22, whereas it was much higher than that in alloxan-induced diabetic control (8.51 ± 0.68 mmol/L) (p < 0.001). Histological study of pancreases of the rats, revealed extravasation of blood in the pancreatic acini, reduced area of islets of Langerhans with atrophy, vacuolation, degeneration, and pyknosis of β-cell nuclei and centrilobular necrosis in the alloxan-induced diabetic control rats.

Conclusion: Mouri (Foeniculum vulgare) improves the glycemic status of the alloxan-induced diabetic rats.

Ibrahim Card Med J 2023; 13 (1&2): 53-59

Risk Factors for Urinary Tract Infection in Children

Mana Banik, Golam Muin Uddin, Nayar Sultana — Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Urinary tract infections (UTIs) are a common cause of febrile illness in young children. Due to the absence of overt clinical features in young children, appropriate collection of urine samples, and basic diagnostic tests at first-level health facilities in our country, UTIs are not generally reported as a cause of childhood morbidity. Due to a lack of studies on the epidemiology, risk factors, diagnosis, treatment, prognosis, and prevention of UTI in children in our country, the exact picture of this disease is yet unknown. This study is intended to identify the risk factors of UTI in children in our country.

Methods: The present cross-sectional study was carried out in the Department of Pediatrics (both indoor and outdoor) of Bangabandhu Sheikh Mujib Medical University, BIRDEM, and Dhaka Medical College Hospital over a period of 1½ years from January 2015 to June 2016. A total of 201 children with signs and symptoms suspected of having urinary tract infections were subjected to urine culture; of them, 98 had definitive UTI and the rest 103 had no UTI or possible UTI. Several factors such as circumcisional status, constipation, encopresis, previous hospital admission, and premature birth were investigated whether they had any role in contributing to the development of UTI.

Result: The children with UTIs were relatively young compared to those without UTIs. However, the age incidence of UTI was found to differ by sex. About one-third of UTI cases in boys were found in the first year of life, one-third between 2nd to 3rd year of life, and the rest one-third in 3rd year onwards. However, the peak age incidence in girls was observed to be 3rd year and onwards. In terms of clinical presentation, fever, and anorexia were more or less common (52% and 43.7% respectively), abdominal pain was less common (18%), and irritability and vomiting were seldom observed. The presence of constipation was significantly associated with UTI in children (p = 0.001). Encopresis was considerably higher in the UTI group than in the non-UTI group (p = 0.169).

Conclusion: Children with UTI usually present with fever with or without dysuria, frequency, anorexia, and abdominal or loin pain. While boys more often acquire the disease in their infancy, girls usually present with the problem from 3 years during their toilet training. Thus, the children presented with unexplained febrile illness or any other signs and symptoms should be suggested for a urine culture to find the clue of febrile illness. Identification of risk factors of UTI will go a long way in preventing the same illness in the future.

Ibrahim Card Med J 2023; 13 (1&2): 60-65

Knowledge Attitudes and Practices (KAP) of Hand Washing among Selected School Children of Dhaka City

Syeda Khaleda Ferdousi, Rifat Hannan — Wed, 19 Jun 2024 00:00:00 +0000

Background & objective: Communicable diseases like diarrhoea and acute respiratory tract infection are the commonest cause of morbidity and mortality in children of developing countries. Children are more vulnerable to food and water-borne diseases. Hand washing is an effective method for preventing communicable diseases particularly water-borne diseases. The purpose of this study is, therefore to evaluate the knowledge, attitudes, and practices (KAP) of hand washing among selected primary-level school children of Dhaka City as a mode of disease prevention.

Methods: From January 1st to June 30th, 2016, primary school students (only those in the fifth grade) in Dhaka City participated in this descriptive, cross-sectional survey. Following ethical approval from the school authority, the local guardian of the children, a total of 252 children were purposively enrolled from various elementary schools in Dhaka City. The knowledge of hand washing included in this study comprises information on cleaning hands before meals, after urinating, defecating, and playing, procedures for washing hands, information about World Hand Washing Day, instructions for washing hands, facilities for washing hands, and materials for washing hands. We offered each respondent ten questions, with a mark of 1 for each accurate response, to gauge their degree of expertise.

Results: Over 70% of the respondents were 11-12 years old with the mean age of the respondents being 10.8 ± 0.7 years. The boy-to-girl ratio was roughly 11:9. While respondents’ fathers were primarily service-holder (about 55%) mothers were generally housewives (70%). Sixty percent of the respondents had 3-4 members in their family. The majority (98%) of the respondents knew about hand-washing. However, over two-fifth (42.2%) of them were completely unaware of the steps of hand-washing, and nearly 70% did not know the minimum hand-washing time to wash out the bacteria attached to the hand surface. Overall, 55.2% of the respondents had good knowledge, 32.5% had adequate knowledge, and 12.3% had excellent knowledge about hand-washing.

Conclusion: The study concluded that most of the students usually wash their hands in critical times; however, they do not know the correct way and steps of hand washing. So, more attention is to be paid to training children to adopt healthy hand-washing behavior. The importance of hand washing should be included in their regular curriculum.

Ibrahim Card Med J 2023; 13 (1&2): 66-70

Type 2 Diabetes: Facts and Fallacies

Md Nurul Amin — Wed, 19 Jun 2024 00:00:00 +0000

Abstract not available

Ibrahim Card Med J 2023; 13 (1&2): 5-10