Captopril in Congenital Chloride Diarrhoea: A Case Study.

An 11 months 22 days old girl presented with a history of watery diarrhoea since birth, failure to thrive, and developmental delay. Her diagnosis was congenital chloride diarrhoea (CCD) with raised level of chloride (>90 mmol/L) in stool in the absence of cystic fibrosis. Management of CCD included replacement of NaCl, KCl, and correction of dehydration. Diarrhoea of the patient was resolved with Captopril, which was initially provided to the patient for managing heart failure. To our knowledge, this is the first reported case of CCD that shows the beneficial effect of Captopril. Therefore, we suggest that further study is warranted as to the potential for Captopril as additional option in the treatment for CCD. We present this case report with the informed consent of the patient’s guardian.

The Pattern of Cardiac Disease at Coronary Care Unit of Dhaka Medical College Hospital.

Background: Epidemiological transition which is taking place in every part of the world, among all races, ethnic groups and cultures has resulted in the global rise in cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality throughout the world. We tried to assess the pattern of cardiac disease at coronary care unit (CCU) of tertiary care hospital. Methods: A cross sectional study conducted among the patients admitted at CCU of Dhaka Medical College Hospital (DMCH) during the period of 1st January 2010 to 31st December 2010. A total of 2415 patients were included in the study. Results: A total 2415 patients in the year 2010, were admitted at CCU of DMCH, among them 56% (n=1346) were male and 44% (n=1069) were female. Out of total admitted patients 220 (9%) were below 30 years of age and 588 ( 24%) & 1607 (67 %) were the age group of 31 to 44 years and 45 years and above age group respectively. Among the disease group ischemic heart disease( IHD) (45%) was the most common cause of hospitalization followed by heart failure (HF) (16%) valvular heart disease (9%), hypertension (7%) and arrhythmia (2%). Acute myocardial infarction (30 %) was the leading cause of IHD followed by unstable angina (15%). Conclusion: This study has found that almost three-quarters of cardiac disease were due to IHD, HF and valvular heart disease in decreasing order of frequency. Countries like Bangladesh can be able to spend very little resources to address those cardiovascular diseases. Along with public as well as private sector efforts, public awareness about the risk factors for cardiovascular diseases should be improved to reduce this sort mortality and morbidity.

Observational Follow-up Study on a Cohort of Children with Severe Pneumonia after Discharge from a Day-care Clinic in Dhaka, Bangladesh.

Compliance, morbidity, mortality, and hospitalization during fortnightly follow-up were evaluated by an observational study on a cohort of children with severe and very severe pneumonia after day-care treatment at an urban clinic. The primary outcome measures were proportions of success (compliance) and failure (non-compliance) of follow-up visits at the day-care clinic. In total, 251 children were followed up, with median (IQR) age of 5.0 (3.0-9.0) months, and their compliance dropped from 92% at the first to 85% at the sixth visit. Cough (28%), fever (20%), and rapid breathing (13%) were common morbidities. Successful follow-up visits were possible in 180 (95.2%) and 56 (90.3%) of the children with severe and very severe pneumonia respectively. Eleven (4.4%) needed hospitalization, and four (1.6%) died. Majority (≈90%) of the children could be successfully followed up; some failed to attend their scheduled follow-up visits due to hospitalization and death. The common morbidities indicate the importance of follow-up for detecting medical problems and early treatment, thus reducing risk of death.

16S rRNA Gene-targeted TTGE in Determining Diversity of Gut Microbiota during Acute Diarrhoea and Convalescence.

The human gut microbiota play a vital role in health and nutrition but are greatly modified during severe diarrhoea due to purging and pathogenic colonization. To understand the extent of loss during and after diarrhoea, faecal samples collected from children (n=21) suffering from acute diarrhoea and from their healthy siblings (n=9) were analyzed by 16S rRNA gene-targeted universal primer polymerase chain reaction (PCR), followed by temporal temperature gradient gel electrophoresis (TTGE). The gut microbiota decreased significantly as indicated by the number of TTGE bands at day 0 of acute diarrhoea [patients vs healthy siblings: 11±0.9 vs 21.8±1.1 (mean±standard error), p<0.01]. The number of bands showed a steady increase from day 1 to day 7; however, it remained significantly less than that in healthy siblings (15±0.9, p<0.01). These results suggest that appropriate therapeutic and post-diarrhoeal nutritional intervention might be beneficial for the early microbial restoration and recovery.

Salovum Egg Yolk Containing Antisecretory Factor As an Adjunct Therapy in Severe Cholera in Adult Males: A Pilot Study.

Cholera involves stimulation of intestinal secretory process in response to cholera toxin leading to profuse watery diarrhoea that might cause death due to dehydration unless timely rehydration therapy is initiated. Efforts to identify and test potential antisecretory agents are ongoing. Antisecretory factor (AF) is a naturally-occurring protein produced in the human secretory organs, including the intestine, with antisectory properties demonstrated in animal and human models of secretory diarrhoea. Salovum egg yolk powder contains proteins with antisecretory properties in a much higher (500 times) concentration than that of normal hen eggs. This is achieved by feeding hens with specially-processed cereals, capable of inducing proteins with antisecretory properties in the yolk. The aim of the study was to examine the effect of Salovum egg yolk powder containing AF in the treatment of adult cholera patients. In an open, randomized controlled trial (pilot study), 40 adult male patients with severe cholera were studied: 20 received standard treatment (oral rehydration solution, antibiotic, and usual hospital diet) plus Salovum egg yolk powder (study group) and 20 received standard treatment alone (control group). All the patients received tablet doxycycline (300 mg) once immediately after randomization. Written informed consent was obtained from each subject before enrollment. The main outcome measures were stool weight and duration of diarrhoea. The demographic and baseline clinical characteristics of the study patients were comparable between the groups. No significant differences were found in the mean stool weight, g/kg of body-weight during the first 24 hours [study vs control group, mean±standard deviation (SD), 218±119 vs 195±136], second 24 hours (mean±SD, 23±39 vs 22±34), and cumulative up to 72 hours (mean±SD, 245±152 vs 218±169). The duration (hours) of diarrhoea after admission in the hospital was also similar in both the groups (mean±SD, 33±14 vs 32±10). No adverse effect was observed. Salovum egg powder containing AF as an adjunct therapy in the treatment of severe cholera could not demonstrate any beneficial effect. Further studies with higher doses of Salovum egg yolk powder might be considered in future to establish its antisecretory effect.

A comparative study of thyroid hormone levels in diabetic and non-diabetic patients.

Diabetic patients have a higher prevalence of thyroid disorders than the general population, this may influence diabetic management. In this study, we investigated thyroid hormone levels in uncontrolled diabetic patients. This comparative study was conducted at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM). Fifty-two diabetic patients were consecutively selected from diabetic patients attending the out-patient department of BIRDEM. Fifty control subjects were selected from non-diabetic patients who attended the out-patient department of BIRDEM for routine check-ups as advised by their attending physicians. The subjects in both groups were above 30 years of age. The concentration of thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and thyroxine (FT4) were evaluated using a Microparticle Enzyme Immunoassay (MEIA) procedure. Patients with type 2 diabetes had significantly lower serum FT3 levels (p = 0.000) compared to the control groups. There were no significant differences observed in serum FT4 (p = 0.339) and TSH (p = 0.216) levels between the control and study subjects. All the diabetic patients had high fasting blood glucose levels (12.15 +/- 2.12). We conclude that FT3 levels were altered in these study patients with uncontrolled diabetes.

Intestinal enzymes during malnutrition & infection in rabbits.

BACKGROUND & OBJECTIVES: Malnutrition plays an important role in the intestinal absorption of nutrients. However, reports are not consistent whether intestinal enzymes are decreased in the presence of malnutrition. It is also not clear whether simultaneous presence of malnutrition and infection adds to the problem of malabsorption of nutrients. The aim of the present study was to determine intestinal functions in terms of concentrations of disaccharidase enzymes during diarrhoea and protein energy malnutrition. METHODS: Concentrations of three disaccharidase enzymes, namely maltase, sucrase and lactase were measured in nine energy-restricted and five control rabbits during diarrhoea induced by rabbit diarrhoeagenic Escherichia coli (RDEC-1). Malnutrition was achieved in the rabbit model by feeding the animals for 30 days with half the amount of food fed to well-nourished control rabbits. Both the energy-restricted and the control groups were challenged by RDEC-1. Diarrhoea occurred on day 1-7 after administration of the strain. After onset of diarrhoea, both groups of rabbits were sacrificed and their intestinal mucosa was examined to determine the concentration of lactase, maltase and sucrase. RESULTS: The energy-restricted animals and controls did not differ significantly for concentrations (units/mg proteins) of lactase (0.65 +/- 0.28 vs 0.56 +/- 0.17 ), maltase (6.20 +/- 2.70 vs 6.47 +/- 1.90) and sucrase (5.42 +/- 2.30 vs 5.13 +/- 1.40) measured during acute infectious diarrhoea. INTERPRETATION & CONCLUSION: The results suggested that the enzymatic functions of the intestinal brush border were not statistically different during diarrhoea among malnourished rabbits compared with their well-nourished counterparts.