[Show abstract][Hide abstract] ABSTRACT: Background: Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. Objective: To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. Materials and Methods: This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. Results: Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. Conclusions: VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.
Asian Pacific journal of cancer prevention: APJCP 12/2013; 14(12):7607-11. DOI:10.7314/APJCP.2013.14.12.7607 · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dyslipidemia is a major risk factor for macro-vascular complications in patients with type 2 diabetes mellitus (T2DM). Present study explored pattern and predictors of dyslipidemia in Bangladeshi T2DM patients. The cross-sectional study is conducted among 366 consecutive eligible T2DM patients aged >30 years, BIRDEM diabetic hospital, during July-to-December 2010. Physical examination, diabetic profile, lipid profile and serum createnine was performed. Adjusted odds ratio and confidence limit were generated through binary logistic regression. Most frequent form (59.3%) of dyslipidemia is low HDL. Duration of T2DM is significantly correlated with TC (P<0.05), HDL (P<0.05) and LDL (P<0.05) in both male and female. Glycemic control in terms of HbA1c >7% appeared as predictor of dyslipidemia (P<0.01). Duration T2DM is associated with increased risk of having higher TC (P<0.05), LDL (P<0.05) and lower HDL (P<0.01) and does not seem to affect triglyceride (P>0.05). T2DM with comorbid hypertension seems to predict hyper tri-glyceridemia and lower HDL. Both TC-HDL ratio and LDL-HDL ratio appeared as good predictor of all four parameters of dyslipidemia (P<0.01). The characteristic features of diabetic dyslipidemia are low HDL, high triglyceride and LDL cholesterol level. Low HDL level is the most frequent type of abnormality. Poor glycemic control, prolonged duration, coexisting hypertension predicts dyslipidemia in T2DM.
[Show abstract][Hide abstract] ABSTRACT: Bangladesh has the highest level of incidence and mortality rates due to cervical cancer among women. The prevalence of cervical cancer in Bangladeshi women is 25-30/100,000. Human papillomavirus is an important cause of cervical cancer. The study was conducted to assess the immunogenicity and safety profile of human papillomavirus-16/18 AS04-adjuvanted cervical cancer vaccines in healthy Bangladeshi girls aged 9-13 years. Procedure This was a randomized (3:1) controlled trial with two parallel groups, the vaccine and control groups, that included 67 participants in Bangladesh. Subjects were given GlaxoSmithKline human papillomavirus-16/18 AS04-adjuvanted cervical cancer vaccine (and controls no vaccine) at the first day of vaccination (Day 0), at 1- and 6-month schedule and followed up until 7 months. Blood samples were taken for human papillomavirus antibody at enrollment and 1 month post-schedule at Month 7 from both subjects and controls. Safety data were gathered throughout the study period.
Fifty subjects received vaccine at Day 0, 1 month and 6 months. All subjects were initially sero-negative in the vaccine group, and developed sero-conversion for human papillomavirus-16 and -18 antibodies except for one at Month 7. Seventeen controls did not receive vaccine. Clients were followed up for serious medically important events and blood samples were taken for human papillomavirus antibody detection at Day 0 and Month 7. Sero-conversion was found in 97.5% of subjects and no sero-conversion was found in the controls. Bivalent human papillomavirus vaccine was generally well tolerated, with no vaccine-related serious adverse experiences.
The human papillomavirus-16/18 AS04-adjuvanted vaccine was generally well tolerated and highly immunogenic when administered to young adolescent females and could be a promising tool for the prevention and control of cervical cancer in Bangladesh.
Japanese Journal of Clinical Oncology 01/2012; 42(1):36-41. DOI:10.1093/jjco/hyr173 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early detection of ovarian malignancy is of great clinical importance. The high mortality rate is due to the difficulties with the early detection of ovarian cancer. Current research attempted to assess the accuracy of Color Doppler Sonography and serum CA-125 level as diagnostic tool of ovarian tumor.
In this cross-sectional study, 60 consecutive patients with ovarian tumor attending the Department of Obstetrics and Gynecology of BSMMU were recruited. Of the study participants 23.3% belong to 16-25 year age group, 20% belong to 26-35 years age group and 23.30% each were of 46-55 years and > 55 years age group. All the patients recruited were from in-patient department and had undergone surgery. Following excision, routine histopathology revealed 43.30% malignant (n=26) and 56.7% (n=34) benign ovarian lesion. Data were collected from the clinical history form and bimanual pelvic examination, serum CA 125 levels, estimation of Resistance index (RI), Pulsatility Index (PI), Novel Index by CDS and post-operative histo-pathological findings were then recorded. Sensitivity, specificity, accuracy, positive and negative predictive value of the diagnosis made by CDS, CA125, in the discrimination of the benign and malignant ovarian tumors was calculated. Using Receiver operative characteristics analysis the accuracy of RI, PI, CA 125 and Novel Index in the diagnosis of ovarian tumor (benign or malignant) were assessed.
With the Cut-off of < .5, Resistance Index is found to be capable of detecting 92% of malignant cases (sensitivity 91.7), and could detect 89% (specificity 88.9) of benign cases correctly which translates in to 90% accuracy in the diagnosis of ovarian tumor. Predictive values for positive (84.6) and negative (94.1) tests were also found to be quite high. Pulsatility index was found to be moderate accuracy (63.3%) with cutoff <1 for malignancy, however low predictive value for a positive test (38.5) questions its use. Both CA-125 and Novel Index showed similar level of sensitivity and specificity. Although Novel Index is derivative of CA125, Novel Index demonstrated better diagnostic accuracy and negative predictive value. The cutoff for CA 125 was mandated as 83.58. With the value the sensitivity is 76.9% and the specificity is 94.1%. RI is found to be more sensitive in detection of positive cases (Malignant) and CA125 is found to be more accurate in detection of negative cases (Benign). However a combination could be tried to make a better detection.
Color Doppler ultra-sonography and CA125 excels in different tasks, the study concludes in favor of concurrent use of the methods for improving efficacy and thus early detection of ovarian malignancy.
Bangladesh Medical Research Council Bulletin 08/2010; 36(2):68-73. DOI:10.3329/bmrcb.v36i2.6991
[Show abstract][Hide abstract] ABSTRACT: Cervical cancer is the most common cancer among women in many developing countries constituting 20%-30% of female cancers. The etiological factors of cervical cancer include environmental, social, sexual and sexually transmitted agents including human papilloma virus (HPV).HPV has identified in 99.7% invasive cancer .Objective of the study was to find out the prevalence of HPV-DNA virus among diagnosed cases of preinvasive and invasive diseases and to find out different sociodemographic parameters related to carcinoma cervix. This was a cross sectional study. The study has conducted in the department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University. Duration of study was from May 2005 to May 2006. Samples were collected from diagnosed cases of CIN I, II, III and CIS and invasive cancer. Thirty cases were recruited for collection of cervical scraping. Sample were collected of in a specially designed sampler containing liquid transport medium and preserved in minus 20 Degree Celsius and sent to the DNA laboratory for processing and identification of HPV by hybrid capture II method. The results were analyzed by using SPSS version 11.0 and shown in tables and diagrams. The risk factors for HPV infection identified from the result. These are early sexual activity, years of sexual activity, urban people, and higher number of pregnancies. The test could identify HPV-DNA in 100 % of invasive and 50 % of preinvasive cancer. In this study HPV infection was found as a strong determinant for the development of cervical carcinoma and its precursors. Poor socio-economic condition, lower level of education, early marriage and first delivery, multi-parity, years of sexual activity are the risk factors for developing HPV infection. New guidelines for cervical cancer screening strategies could be able to develop from the information obtained from this study. A population-based study with larger sample will be required for the evaluation of cervical cancer screening strategies.
[Show abstract][Hide abstract] ABSTRACT: levonorgestrel-releasing intrauterine system (IUS) Mirena is a long-acting, fully reversible method of contraception. It is one of the most effective forms of contraception available, and combines the advantages of both hormonal and intrauterine contraception. Mirena also gives the users many non-contraceptive benefits: the amount of menstrual bleeding and the number of days of menstrual bleeding are reduced, which makes it suitable for the treatment of menorrhagia. Dysmenorrhoea and premenstrual symptoms are also relieved. It is now used for therapeutic benefits in fibroids, adenomyosis and endometriosis. In addition, Mirena provides protection for the endometrium during hormone replacement therapy. The local release of levonorgestrel into the uterine cavity results in a strong uniform suppression of the endometrial epithelium as the epithelium becomes insensitive to estradiol released from the ovaries. This accounts for the reduction in menstrual blood loss. All possible patterns of bleeding are seen among users of the Mirena; however, most of the women who experience total amenorrhoea continue to ovulate. The first months of use are often characterized by irregular, scanty bleeding, which in most cases resolves spontaneously. The menstrual pattern and fertility return to normal soon after the levonorgestrel-releasing IUS Mirena is removed. The contraceptive efficacy is high with 5-year failure rates of 0.5-1.1 per 100 users 2 . The absolute number of ectopic pregnancies at 5 years is around 0.02 per 100 women years 1 . Mirena is equally effective in all age groups and the bodyweight of the user is not associated with failure of the method. In Western cultures continuance rates among users of Mirena are comparable with those of other long-term methods of contraception. Premature removal of the device is most often associated with heavy menstrual bleeding and pain, as with other long-term methods of contraception, and is most common in the youngest age group. When adequately counseled about the benign nature of oligo- or amenorrhoea, most women are very willing to accept life without menstruation. The risk of premature removal can be markedly diminished with good pre-insertion counseling, which also markedly increases user satisfaction. User satisfaction is strongly associated with the information given at the time of the levonorgestrel-releasing IUS Abstract Mirena is a levonorgestrel-releasing intrauterine system. Apart from being a reliable contraception, Mirena is now widely indicated for its non contraceptive benefits which include treatment of menorrhagia, dysmenorrhoea, premenstrual symptoms, fibroids, adenomyosis, endometriosis etc. It is now used even for hormone replacement therapy. This review article tries to explore different aspects of Mirena for treatment of menorrhagia compared to other available methods based on recent trials.