Granulocytic sarcoma also called myeloid sarcoma (MS) is an extramedullary tumour of immature granulocytic cells. It is a rare entity and most frequently associated with acute myeloid leukaemia (AML) but can occur with other myeloproliferative disorders. It may occur at any site, leading to very varied clinical presentations. Although it can occur in a number of areas of the body, the involvement of the breast is uncommon. We present a rare case of MS in a 14?year?old boy with a non-tender lump in the left breast that had been apparent for five months. Available diagnostic techniques, including ultrasound and magnetic resonance imaging were systematically performed. After mastectomy, biopsy and immunohistochemistry was done. Immuno-histochemical stains were positive for CD45 (haematological marker) and myeloid markers, such as myeloperoxidase (MPO), and CD68, CD43 suggesting the diagnosis of MS. Although MS is a rare tumour in breast and its diagnosis is usually difficult, the clinician must know about its existence to make differential diagnosis.
Background: Iron deficiency anaemia (IDA) is a common haematological complication with potentially serious clinical consequences that may require intravenous iron therapy. Parenteral iron therapy results faster and higher replenishment of iron stores and correction of Haemoglobin (Hb) levels with better compliance. The study was to compare the efficacy of intravenous ferric carboxymaltose with intravenous iron sucrose to treat iron deficiency anaemia. Methods: 188 patients were included in the study. 100 patients were given iron sucrose. After a 25 mg test dose on the first infusion only, this was given at a dose of 300 mg by intravenous infusion diluted in 100 ml of normal saline, every alternate day. 88 patients were treated with ferric carboxymaltose at a dose of 500 mg diluted in 100 ml of normal saline by intravenous infusion. Hb level and serum Ferritin of both groups were done before iron therapy and 3 weeks after iron therapy. Results: The mean±SD rise of haemoglobin concentration 3 weeks after iron therapy in iron sucrose group was 11.0±0.61 g/dL, while in ferric carboxymaltose group was 11.2±0.64 g/dL. The mean±SD ferritin 3 weeks after iron therapy in iron sucrose group was 76.0±14.28 ng/mL, while in ferric carboxymaltose group was 80.0±15.16 ng/mL. No serious adverse events were reported in either the ferric carboxymaltose group or iron sucrose group. Conclusions: Ferric carboxymaltose causes higher rise in Hb level as compared to parenteral iron sucrose.
Barind Tract, located in the North-West region of Bangladesh is a drought prone water stressed area. Barind Multipurpose Development Authority (BMDA) has made this desert like zone into a granary one through various activities including irrigation as major. Now, the agricultural pattern, cropping intensity, methods of cultivation, crop variety and yields -all show a positive change. The BMDA has significant impacts of reducing environmental impact as well as changing the living standard and socio-economic conditions of the rural people in Barind Tract. The present study aims to find out the environmental challenges faced by the farmers in the Barind Tract and the mitigation measures took by the BMDA as a large development partner for the sustainable development in the Barind Tract. As on environmental issue respondent in Puthia, Paba and Godagari zones identifies that low rainfall, extraction of ground water by DTWs (Deep Tubewells) and STWs (Shallow Tubewells), very thin flow of water in the rivers and also losses of groundwater from the aquifer to the river as base flow during dry season are the major causes of the scarcity of ground water in the Barind Tract. Droughts, high temperatures, less rainfalls, cyclones and thunderstorms and lightning also have been identified by respondents as the natural hazards affect their crop production and daily livelihood. To reduce the environmental challenges, no more new DTWs are being installed by BMDA (though private initiatives are still going on), emphasize on using more surface water from rivers and canals through low lift pumps, community based tree plantation programs in the project area, use renewable energy produced by solar panels and re-excavate canals and ponds for conservation of surface water. This study suggests that scientific assessment of groundwater resources with zoning for proper planning, increase augmentation of surface water as well as harvesting of rain water, crop zoning, increase cultivation of low water consuming crops and enhance groundwater recharge are now the demand of time for the study area.
Background: Iron deficiency anaemia (IDA) is one of the most widespread nutritional deficiency and common medical conditions seen in everyday clinical practice. IDA has a substantial haematological complication with potentially serious clinical consequences that often may require iron therapy. In most patients, body stores of iron can be restored by oral iron therapy but parenteral iron therapy results rapid correction of haemoglobin levels, faster and higher replenishment of iron stores with better compliance. The study was to compare the efficacy of oral iron (ferrous sulphate) with parenteral iron (iron sucrose) to treat iron deficiency anaemia. Methods: 221 patients were included in the study. 101 patients were given oral iron in the form of ferrous sulphate containing 67 mg of elemental iron three times daily. 120 patients were treated with iron sucrose. After a 25 mg test dose on the first infusion only, this was given at a dose of 300 mg by intravenous infusion diluted in 250 ml of normal saline, every alternate day. Haemoglobin level and serum ferritin of both groups were done before iron therapy, 3 weeks and 12 weeks after iron therapy. Results: The mean±SD rise of haemoglobin concentration 3 weeks after iron therapy in iron sucrose group was 11.2±0.60 g/dL, while in ferrous sulphate group was 9.0±0.58 g/dL. The mean±SD ferritin 3 weeks after iron therapy in iron sucrose group was 81.0±15.18 ng/mL, while in ferrous sulphate group was 27.0±12.22 ng/mL. The mean±SD haemoglobin concentration 12 weeks after iron therapy in iron sucrose group was 12.2±0.60 g/dL, while in ferrous sulphate group was 11.0±0.58 g/dL. The mean±SD ferritin 12 weeks after iron therapy in iron sucrose group was 82.0±16.17 ng/mL, while in ferrous sulphate group was 52.0±12.22 ng/mL. No serious adverse events were reported in either the ferrous sulphate group or iron sucrose group. Conclusion: Iron sucrose causes higher rise in haemoglobin level and serum ferritin as compared to oral iron therapy.
Background: Haematopoietic stem cell transplantation (HSCT) is the standard consolidation therapy for a variety of malignant and non-malignant diseases in children and adults. Our experience of HSCT in 26 patients with various indications is shared in this article. Materials and methods: This was a retrospective analysis of first 26 patients who had undergone autologous and allogeneic transplant at our center, with M:F=2.7:1. The mean age for autologous transplant was 45 years (range 23-57 years). The median follow-up period was 23 months 25 days (range 3to 47 months).The data was obtained carefully from medical records of the BMT center. Indications for autologous HSCT were Multiple Myeloma (12 patients), Non- Hodgkin’s lymphoma (7 patients), Hodgkin’s lymphoma (4 patients). Allogeneic HSCT were for Acute Myeloid Leukaemia (3 patients). Results: The mean time for WBC engraftment was 12 days (range: 9-19 days) and for platelet engraftment was 16 days (range: 11-35 days) in our autologous transplant cases and for allogeneic transplant mean time for WBC engraftment was12 days (range: 11-15 days) and for platelet engraftment was 14 days (range: 12-17 days). Irradiated blood components were given in the pre, peri and post-transplant period to maintain Hb>8 gm/dl and platelet count >20X109/L. Mean single-donor platelet requirement was 4 units (range 1-7), and mean packed red cell requirement was 1.5 units (range 1-6). The post-transplant complications encountered were mucositis, infections and diarrhoea. Oral mucositis was the most common complications. Twenty three (88.46 %) out of our 26 HSCT patients had developed mucositis , among them grade 1 in 5 patients, grade 2 in 11 patients, and grade 3 in 7 patients. There were 21(80.76%) cases of febrile neutropenia. Out of 26 patients 13 (50.0%) bacterial infection were documented with culture positivity. One (3.84%) case of viral infection was documented. Major bacterial infections were culture positive with Pseudomonas, Escherichia coli and Klebsiella followed by other species like acinatobacter, burkholderia and coagulase negative staphylococcus. One case of Cytomegalovirus was noted with significant viral copies that required Ganciclovir. Average duration of hospital stay after autologous HSCT was 23 days (range of 14-54 days) and allogeneic HSCT was 35 days (range of 30-57 days). 19 out of our 23 autologous transplant patients were in complete remission and all 03 cases of allogeneic HSCT were in remission. Conclusion: We believe our center has made a remarkable progress within short period of time to develop both autologous and allogeneic HSCT and is comparable with nationally and internationally renowned HSCT centers in terms of standard, quality and safety of care, and the ultimate outcomes. J Bangladesh Coll Phys Surg 2022; 40: 146-152
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