Nevin Manimala

Mymensingh Med J. 2021 Oct;30(4):1131-1138.

ABSTRACT

The objective of this study was to determine whether Magnetic Resonance Imaging is a sensitive and specific alternative method to clinical FIGO criteria in the staging of cervical carcinoma. This prospective cross-sectional study was conducted in the Department of Radiology and Imaging, BSMMU, Dhaka during the period of September 2018 to August 2020. A total of 60 patients were selected purposively and all are staged clinically by EUA. Then all samples underwent MRI in Department of Radiology and Imaging, BSMMU. Images of uterine cervix, corpus, vagina and parametrium were taken with a prefixed standard protocol (TIWI axial, T2WI axial and sagittal, DWI axial & DCE) and reporting was done by Radiologist. Comparison was done between the MRI and clinical FIGO criteria of staging of cervical carcinoma. P value <0.05 was considered as significant. Sensitivity & specificity of the MRI was measured. Data were analyzed by using Statistical Package for Social Sciences (SPSS) software version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Out of 60 patients in this study the mean age was found 47.5±10.1 years with range from 22 to 60 years. Positive correlation (r=0.993; p=0.001) between histopathological size and MRI size of tumour. Positive correlation (r=0.950; p=0.001) between histopathological size and FIGO size of tumour. MRI findings more correlates with histopathology than clinically detected tumor size. The sensitivity, specificity, accuracy, positive and negative predictive values of MRI diagnosis evaluation for vaginal extension was 100.00%, 95.20%, 100.00%, 98.30% and 97.50% respectively. Sensitivity, specificity, accuracy, positive and negative predictive values of MRI diagnosis evaluation for parametrial invasion was 100.00%, all. In this study we observed that MRI staging was more likely to be concordant with pathological stage in comparison to the clinical stage. There was a concordance rate of 95.00% in MRI and 65.00% in clinical staging respectively. Out of 3 non-concordant cases in MRI, 2 were upstaged and 1 case was down staged in histopathology. FIGO staging concurred with histopathology in 39(65.00%) cases and differed in 21(35.00%) cases. Magnetic resonance imaging (MRI) is a sensitive and specific modality for accurate staging of cervical carcinoma in comparison with clinical FIGO criteria considering histopathology as gold standard.

PMID:34605487

Mymensingh Med J. 2021 Oct;30(4):1079-1085.

ABSTRACT

Complete assessment of obstructive jaundice requires the use of various imaging modalities that are required to detect the cause and level of obstruction thus helping in treatment planning. Magnetic Resonance Cholangio Pancreatography (MRCP) is a current available technology which is a non-invasive technique that visualizes the gallbladder, biliary tree and pancreatic duct and also provides information about surrounding structures. This study was done to correlate the MRCP findings with post-operative result and thereby demonstrate the specificity, sensitivity and efficacy of MRCP as an accurate investigatory tool for biliary obstruction. Total of fifty (50) patients of clinically diagnosed obstructive jaundice were studied from March 2017 to August 2017 in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka, Bangladesh. In all these cases, USG was the initial screening investigation followed by MRCP. Cause and level of obstruction were evaluated using MRCP findings. MRCP results were correlated with surgical findings and few cases also with direct ERCP findings. Statistical analysis was done to see the sensitivity, specificity, accuracy, positive and negative predictive values of MRCP in diagnosis of biliary obstruction. In this study, USG detected level of obstruction in 56% (28 out of 50) cases. USG could detect causes of obstruction in 100% (02 out of 02) cases of choledocal cyst and 66.67% (02 out of 03) benign stricture, 60% (03 out of 05) cases of periampullary carcinoma, 57.70% (06 out of 14) cases of choledocholithiasis, and 42.86% (15 out of 26) cases of cholangiocarcinoma. On the other hand, MRCP detected level of obstruction in 98% (49 out of 50) cases. MRCP could detect causes of obstruction in 100% cases of cholangiocarcinoma, choledocholithiasis, benign stricture and choledocal cyst and 80% (04 out of 05) cases of periampullary carcinoma. In this study, ERCP could detect causes of obstruction in 32 cases of choledocholithiasis and benign stricture, but in case of cholangiocarcinoma ERCP was failed in 3 cases. In this study, for detection of cause of obstruction, ERCP had the highest sensitivity (97.79%); followed by MRCP (96.65%) and USG (60.25%). The overall diagnostic accuracy for detection of cause of obstruction was the highest for ERCP (95.50%); followed by MRCP (94.50%) and USG (64.50%). MRCP can be done in a short duration and is a noninvasive diagnostic modality compared to ERCP. MRCP needs to be advocated as a viable and non-invasive alternative with compararable sensitivity and specificity to ERCP.

PMID:34605480

Mymensingh Med J. 2021 Oct;30(4):1009-1015.

ABSTRACT

This prospective study was conducted to find the rate of deep and risk factors associated with vein thrombosis following major abdominal surgery in Sylhet MAG Osmani Medical College Hospital from 1st November 2017 to 30th April 2018. Total 103 patients aged above 20 years both male and female who got admitted in Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet for their disease requiring routine and emergency major abdominal operation during the study period and fulfilling the inclusion and exclusion criteria were selected in this study. Informed written consent was obtained from the patients after full explanation of the purpose of the study. After full investigations and proper preparation of each patient for operative procedure major abdominal surgery were done. Peroperative findings were noted and post-operative period were followed up routinely. Duplex scanning was done on 3rd POD in all cases. The age of the patients ranged from 25 to 74 years with the mean age of 49.5±13.8 years. There were 60(58.3%) male and 43(41.7%) female. Deep vein thrombosis (DVT) developed in 5(4.9%) of cases and not developed in 98(95.1%) cases. All the five cases were confirmed by color duplex scan. DVT was detected in 2(3.3%) of the 60 males and 3(7.0%) of the 43 females undergoing major general surgical procedures. Among 63 patients in whom the duration of surgery was up to 2 hours, none developed DVT, while among the 40 patients in whom the duration of surgery lasted more than 2 hours, 5(12.5%) developed DVT. Among 23 patients in whom the surgery for malignancy was done, 4(17.4%) developed DVT, while among the 80 patients in whom surgery for non-malignancy, 1(1.2%) developed DVT. The Incidence of DVT in patients undergoing major abdominal surgery is 4.9%. Patients undergoing major abdominal surgery for malignancy and duration of operation greater than 2 hours have higher risk of developing DVT. But there is no significant increase in risk of development of DVT relation to age and sex; and also in patients on oral contraceptives, diabetes mellitus, obesity and smoking. Clinical findings alone cannot be relied upon for the diagnosis of DVT. The study has to be continued with larger sample size to get statistically significant results.

PMID:34605471

Mymensingh Med J. 2021 Oct;30(4):913-920.

ABSTRACT

Peripheral neuropathy caused by diabetes mellitus (DM) and vitamin B12 deficiency may produce overlapping clinical pictures. Metformin use is a known cause of B12 deficiency in patients with type 2 DM (T2DM). This cross-sectional comparative study was conducted at two specialized endocrine outpatient clinics in Mymensingh and Cumilla cities of Bangladesh over one year from July 2019 to June 2020. Non-pregnant adults (≥18 years of age) receiving drug treatment for T2DM for at least six months were included in this study. The study subjects were divided into two groups: those with ongoing treatment with metformin and those who never received metformin in their lifetime. Out of 99 subjects evaluated, 66 (66.7%) were in the metformin group, and 33 (33.3%) were in the non-metformin group. Subjects in the metformin group had significantly lower B12 levels compared to the non-metformin group [448.5 (343.0-570.9) vs. 549.0 (487.5-847.0) pg/mL, median (IQR), p<0.001]. None of the study subjects in the non-metformin group were either borderline deficient or deficient of B12 compared to five borderline deficient and three deficient subjects in the metformin group. Among the study subjects, 88.9% had peripheral neuropathy (PN) (43.4% mild, 21.2% moderate and 24.2% severe PN); the two groups had similar frequencies of PN. Though median serum B12 levels were lower in mild [483.0 (411.2-620.0) pg/mL], moderate [492.0 (366.5-680.0) pg/mL] and severe PN [524.5 (363.5-654.2) pg/mL] groups compared to absent PN group [540.0 (340.0-685.0) pg/mL]; the difference in B12 levels across the four groups was not statistically significant. B12 levels had weak negative correlation (r = -0.061, p = 0.624) with gram-years of metformin use. Periodic screening for serum vitamin B12 levels should be done to identify metformin-induced B12 deficiency in T2DM, especially those with PN.

PMID:34605456

Acta Crystallogr D Struct Biol. 2021 Oct 1;77(Pt 10):1282-1291. doi: 10.1107/S2059798321009475. Epub 2021 Sep 29.

ABSTRACT

In 2020, cryo-EM single-particle analysis achieved true atomic resolution thanks to technological developments in hardware and software. The number of high-resolution reconstructions continues to grow, increasing the importance of the accurate determination of atomic coordinates. Here, a new Python package and program called Servalcat is presented that is designed to facilitate atomic model refinement. Servalcat implements a refinement pipeline using the program REFMAC5 from the CCP4 package. After the refinement, Servalcat calculates a weighted F_o – F_c difference map, which is derived from Bayesian statistics. This map helps manual and automatic model building in real space, as is common practice in crystallography. The F_o – F_c map helps in the visualization of weak features including hydrogen densities. Although hydrogen densities are weak, they are stronger than in the electron-density maps produced by X-ray crystallography, and some H atoms are even visible at ∼1.8 Å resolution. Servalcat also facilitates atomic model refinement under symmetry constraints. If point-group symmetry has been applied to the map during reconstruction, the asymmetric unit model is refined with the appropriate symmetry constraints.

PMID:34605431 | DOI:10.1107/S2059798321009475

Arch Esp Urol. 2021 Oct;74(8):762-767.

ABSTRACT

INTRODUCTION: Prostate cancer is thesecond most common neoplasm in men. The prostate biopsy is the fundamental support for the therapeutic decision, the histopathological results of the surgical piece differ from those obtained in the diagnostic prostate biopsy generating under-staging or over-staging inpatients.

MATERIALS AND METHODS: This study collects data from a total of 147 patients who under went radicalrobot-assisted prostatectomy at the Carlos Andrade Marín Hospital in the period January 2016 to December 2018, a statistical analysis is performed by the Chisquared test with a significance level of 5%.

RESULTS: The percentage agreement of prostate biopsy with the histopathological result of the surgical piece was 49%, over-staging was 14% and under-staging was 35%. The Gleason score most commonly found in this study was 6 (3 + 3) both in prostate biopsy and in the radical prostatectomy surgical piece. There were 3 patients with vanishing prostate cancer in this study group.

CONCLUSIONS: The agreement of the prostate biopsy in relation to the surgical piece of radical prostatectomy is in the context of that reported in international studies, over staging does not represent a major health problem since patients could benefit from the radical prostatectomy but under-Staging could lead to the decision not to provide the patient a curative treatment of his disease tobe referred to an active surveillance protocol. Vanishing prostate cancer in this study group is explained by the use of hormonal blockade with leuprolideacetate prior to surgical treatment in two patients and a low tumor invasion in the histopathology sample of the third patient.

PMID:34605416

Arch Esp Urol. 2021 Oct;74(8):747-751.

ABSTRACT

INTRODUCTION: The use of a temporaryor permanent catheter is very common in clinical practice. Between 15.0% and 25.0% of hospitalized patients have in-dwelling bladder catheters, the majority of which are short-term. Bladder catheter clamping before catheter removal was generally regarded as useful in the past. Today, its utility is questionable.

OBJECTIVE: To determine the association between bladder catheter clamping and spontaneous micturition or acute urinary retention (AUR) in postoperative patients with short-term indwelling bladder catheter.

MATERIALS AND METHODS: A descriptive, comparative,longitudinal study was conducted at a secondary care hospital center in a western Mexican state .AUR was the outcome variable. Two study groups wereformed: patients with bladder catheter clamping (n=43) and the control patients with no bladder catheter clamping (n=41). Descriptive statistical analyses were performed, and percentage comparisons were made with the chi-squaretest. Significant predictors were subsequently added to the multivariate model.

RESULTS: Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping, presented with AUR and 86% (n=72) did not. In the association analysis, there was no statistically significant difference between presenting with AUR and having or not having bladder catheter clamping (p=0.59). The associations of AUR with bladder re-catheterization (p=0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant.

CONCLUSION: Postoperative bladder catheter clamping was not associated with the presence of AUR.

PMID:34605414

Arch Esp Urol. 2021 Oct;74(8):736-746.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a multi-symptomatic systemic disease whose genitourinary symptoms are poorly known. The aim of this article is to study these symptoms in Spanish publications. MATERIALS AND METHODS: A retrospective study of descriptive type on the genitourinary symptoms of MCS is carried out in the Spanish publications between the years 2000 and 2019. The search in Medline was performed with MeSH terms “multiple chemical sensitivity Spanish” and in Google with free terms “sensibilidad química multiple España”. In the publications found, only those referring to genitourinary symptoms were selected, in which year, authors, type of article (clinical case, review, casuistry), genital symptoms, urinary symptoms, specialty, hospital or centre and city were studied. The results of these variables have been analyzed with descriptive statistics.

RESULTS: We found 45 Spanish publications on MCS of which 20 (44,4%) mentioned genitourinary symptoms. The 20 articles corresponded to 7 clinical cases, 6 reviews, 2 case series, 2 updates, 1 book chapter, 1 special article and 1 consensus document. We found 12 publications on female genital symptoms (60%), 12 on urinary symptoms (60%) and 4 on male genital symptoms (20%). The specialties with the highest number of publications were Family Medicine and Psychiatry with 3 (15%) and Neumology, Toxicology and Anesthesia and Resuscitation with 2 (10%). There are publications from 13 hospitals and 7 national centers, health agencies or foundations. The publications corresponded to 10 cities, the 2 with the most publications being Madrid with 6 (30%) and Barcelona with 6 (30%). CONCLUSIONS: The genitourinary symptoms of MCS are mentioned in about half of the Spanish publications. There is a clear predominance of these symptoms in women. This “genitourinary syndrome” should be taken into account in urological and gynecological patients with MCS.

PMID:34605413

Arch Esp Urol. 2021 Oct;74(8):790-795.

ABSTRACT

OBJECTIVE: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates.

PATIENTS AND METHODS: The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests.

RESULTS: A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy.

CONCLUSION: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.

PMID:34605408

Clin Nephrol. 2021 Oct 4. doi: 10.5414/CN110273. Online ahead of print.

ABSTRACT

BACKGROUND: Iodinated contrast medium exposure is associated with acute kidney injury (AKI). Patients with severe contrast-induced AKI (CI-AKI) may need renal replacement therapy (RRT). Prediction models exist for CI-AKI, but few need RRT. We aimed to establish a preprocedural score model to stratify patients at risk of unplanned postprocedural RRT following invasive coronary angiography (ICA) or percutaneous coronary intervention (PCI).

METHODS AND RESULTS: Between January 2010 and December 2015, a series of 3,469 patients were randomly divided into two cohorts at a 2 : 1 ratio for model development and validation, respectively. A total of 36 patients (1.0%) needed unplanned postprocedural RRT following ICA and/or PCI. Multivariable logistic regression was used to build the risk model. C-statistic and Hosmer-Lemeshow tests were used to evaluate the performance of the model. Five preprocedural variables – independently associated with unplanned postprocedural RRT – were identified as factors of the risk score model with different scores: age > 75 years (1), serum creatinine level ≥ 1.5 mg/dL (1), diabetes mellitus (1), hypotension (2), and acute myocardial infarction (2). The risk score model was demonstrated with high discrimination (C-statistic = 0.872) and goodness of fit (χ2 = 3.769, p = 0.438). Furthermore, the model allowed a hierarchical classification of low, intermediate, and high risk, within which the observed unplanned RRT rates were ~ 0.4, 3.0, and 20.0%, respectively.

CONCLUSION: Using preprocedural variables, we developed and validated a risk model for unplanned postprocedural RRT following ICA and/or PCI.

PMID:34605397 | DOI:10.5414/CN110273