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Background: Biliary tract carcinoma is highly fatal and one of the commonest cancers in Bangladesh. Chemotherapy is the mainstay of treatment as it is present in an advanced stage. Gemcitabine-Cisplatin association has been a standard of care for first-line regimens in advanced biliary tract cancer. Nevertheless, the Gemcitabine-Oxaliplatin regimen is frequently preferred. There has been no nationwide study to compare the effectiveness of these two platinum groups. Therefore, this study compared the efficacy and toxicities of Gemcitabine-Cisplatin (Gem-Cis) with Gemcitabine-Oxaliplatin (GEMOX) combination chemotherapy for the treatment of ABTC.Material & Methods:In this quasi-experimental study, a total number of eighty patients (40 patients in arm A and 40 patients in arm B), who had histopathologically or cytopathological proven ABTC with no history of previous treatment were included. The study has done between the periods of January 2019 to June 2020. The patients received Gemcitabine (1000 mg/m2 i.v. on day 1 and day 8) plus Cisplatin (25 mg/m2 i.v. on day 1 and 8) every 3 weeks for 6 cycles in Arm A. In another group, Gemcitabine (1000 mg/m2 i.v. on day 1) plus Oxaliplatin (100 mg/m2 i.v. on day 2) every 2 weeks for 6 cycles in Arm B was given. All the patients were followed up according to the set follow-up criteria up to 6 weeks after completion of treatment.Results:At the end of the treatment, Response rates (CR+PR+SD) were analyzed. No patient from both the arms showed Complete Response (CR). 37.5% and 45% of patients of the Arm A and Arm B groups showed Partial Response (PR) respectively. Meanwhile, 45% and 40% of patients from Arm A and B showed Stable Disease (SD) respectively. P-value was 0.410 (>0.05). Seven patients (17%) in Arm A and six patients (15%) in Arm B developed Progressive disease (PD). The most common treatment-related grade 3 toxicities were more experienced in the Arm A group. For Arm A versus Arm B that were as follows: neutropenia (15% versus 5%), anemia (15% versus 8%), thrombocytopenia (10% versus 2.5%), nausea (10% versus 5%), vomiting (5%versus 2.5%), peripheral neuropathy (0% versus 15%) and renal toxicity (7.5% versus 0%). For none of them, the p-value was <0.05 except for neutropenia, anemia, thrombocytopenia, renal toxicity, and peripheral neuropathy in which the p-value was 0.042, 0.001, 0.014, 0.0001, and 0.00001 respectively. For both Arms, there were no treatment-related Grade 4 toxicities.Conclusion:The study exhibited that treatment with the Gemcitabine-Oxaliplatin regimen was well tolerated, less toxic, and convenient with similar effectiveness compared to the Gemcitabine-Cisplatin regimen in loco regional control of advanced biliary tract cancer.
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Background: Biliary tract carcinoma is highly fatal and one of the commonest cancers in Bangladesh. Chemotherapy is the mainstay of treatment as it is present in an advanced stage. Gemcitabine-Cisplatin association has been a standard of care for first-line regimens in advanced biliary tract cancer. Nevertheless, the Gemcitabine-Oxaliplatin regimen is frequently preferred. There has been no nationwide study to compare the effectiveness of these two platinum groups. Therefore, this study compared the efficacy and toxicities of Gemcitabine-Cisplatin (Gem-Cis) with Gemcitabine-Oxaliplatin (GEMOX) combination chemotherapy for the treatment of ABTC.Material & Methods:In this quasi-experimental study, a total number of eighty patients (40 patients in arm A and 40 patients in arm B), who had histopathologically or cytopathologically proven ABTC with no history of previous treatment were included. The study has done between the periods of January 2019 to June 2020. The patients received Gemcitabine (1000 mg/m2 i.v. on day 1 and day 8) plus Cisplatin (25 mg/m2i.v. on day 1 and 8) every 3 weeks for 6 cycles in Arm A. In another group, Gemcitabine (1000 mg/m2 i.v. on day 1) plus Oxaliplatin (100 mg/m2 i.v. on day 2) every 2 weeks for 6 cycles in Arm B was given. All the patients were followed up according to the set follow-up criteria up to 6 weeks after completion of treatment.Results:At the end of the treatment, Response rates (CR+PR+SD) were analyzed. No patient from both the arms showed Complete Response (CR). 37.5% and 45% of patients of the Arm A and Arm B groups showed Partial Response (PR) respectively. Meanwhile, 45% and 40% of patients from Arm A and B showed Stable Disease (SD) respectively. P-value was 0.410 (>0.05). Seven patients (17%) in Arm A and six patients (15%) in Arm B developed Progressive disease (PD). The most common treatment-related grade 3 toxicities were more experienced in the Arm A group. For Arm A versus Arm B that were as follows: neutropenia (15% versus 5%), anemia (15% versus 8%), thrombocytopenia (10% versus 2.5%), nausea (10% versus 5%), vomiting (5%versus 2.5%), peripheral neuropathy (0% versus 15%) and renal toxicity (7.5% versus 0%). For none of them, the p-value was <0.05 except for neutropenia, anemia, thrombocytopenia, renal toxicity, and peripheral neuropathy in which the p-value was 0.042, 0.001, 0.014, 0.0001, and 0.00001 respectively. For both Arms, there were no treatment-related Grade 4 toxicities.Conclusion:The study exhibited that treatment with Gemcitabine-Oxaliplatin regimen was well tolerated, less toxic, and convenient with similar effectiveness compared to Gemcitabine-Cisplatin regimen in loco regional control of advanced biliary tract cancer.
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Background: Migraine headache is a common neurologicalepisodic condition originating from the central nervous systemthat can significantly impair the lives of otherwise normallyfunctioning people. Pharmacologic options for migraineprophylaxis include beta blockers, calcium channel blockers,antidepressants and anticonvulsants; all of which have varyingdegrees of adverse effects that may significantly limit their usein this disease.Objectives: To observe whether low dose Topiramate is moreeffective compared to Propranolol in migraine prophylaxis.Methods: This clinical trial was carried out in the Out PatientDepartment (OPD) & Headache Clinic, Department ofNeurology, Bangabandhu Sheikh Mujib Medical University,Dhaka. A total of 120 patients around the age range of 18 to 50years diagnosed as migraine (with aura or without aura)according to ICHD-3 criteria, were recruited as the studypopulation. By simple random sampling procedure, using odd& even number, 60 patients were administered by Tab.Topiramate 50 mg/ day named as group-I and rest 60 patientswere administered by Tab. Propranolol 80 mg /day named asgroup-II. Out of them in total 96 patients had completed thestudy due to drop out of 13 patients in group-I & 11 patients ingroup-II in different steps of follow up. Finally 47 patientsremain in group-I and 49 patients in group-II. During trial, threefollow up visits were taken for both group, 1st follow up after 4weeks of baseline information (Before starting prophylacticmedication), 2nd follow up after 4 weeks of treatment, 3rdfollow up after 8 weeks of treatment. Efficacy of treatment wasmeasured by headache frequency, duration and Severity ofheadache as measured by the VAS.Results: The mean (SD) age of group-I (topiramate) andgroup-II (propranolol) group were found 29.72 (9.58) yearsand 30.96 (10.11) years respectively. Female sex was foundpredominant in both groups. At final follow up, there wasstatistically significant difference in mean (SD) value offrequency of migraine attack between topiramate andpropranolol group [4.72 (2.80) vs. 3.48 (2.20); p=0.024].Propranolol appeared statistically significant than topiramate[TPM 5.53 (2.98) vs. PRO 4.36 (1.55); p=0.047]. RegardingSeverity of headache, better results also were observed in thepropranolol group than topiramate (p < 0.05). Both drugsappeared significant in efficacy measurement (p < 0.001).Patient drop out was more in the topiramate group than thepropranolol group (21.68 % vs. 18.34%). Furthermore, in thetopiramate group, patients complained of more adverse effectsthan propranolol group (23.4% vs. 14.3%), which wasstatistically significant.Conclusion: The present study suggests that low doseTopiramate and Propranolol are effective for migraineprophylaxis in reduction of frequency, Severity and duration ofmigraine headache individually and propranolol appears moreeffective compared to that of topiramate.
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Background: The pathogenic mechanism of AmyotrophicLateral Sclerosis (ALS) remains indistinct. However, increasingevidence has indicated that uric acid (UA) may play aprotective role in the pathogenesis of ALS as well as in that ofother neurodegenerative diseases. Low serum uric acid (UA)levels are found in many neurodegenerative diseases. It hasbeen suggested that oxidative stress is one of the pathogenicmechanism for amyotrophic lateral sclerosis (ALS), and thusantioxidants such as UA that could reduce oxidative stressmight be beneficial in the early detection of progression of thedisease. The objective of this study was to prospectivelyinvestigate serum UA levels in ALS patients and to relate themto disease process and disease status.Methods: ALS patients and healthy controls who wereindividually well-matched for age, sex, and body mass index(BMI) underwent blood testing for serum UA levels, andanalyzed whether UA levels were correlated with the diseasestatus of the patients, severity of the disease as defined by theALS Functional Rating Scale-Revised (ALSFRS-R) andduration of illness.Results: The study included 37 ALS patients and 37 matchedcontrols. The serum UA level was lower in the ALS patients(4.29 mg/dl ±1.35 mg/dL, mean±SD) than in the controls (6.26mg/dL±1.22 mg/dL; p<0.001). Female ALS patients hadsignificantly lower (3.55 mg/dl± 0.89 mg/dL) than Male ALSpatients (4.53 mg/dl±1.4 mg/dL; p<0.05). Among the ALSpatients, the lower level of UA acid was strongly correlated withthe rate of disease progression (decrease in ALSFRS-R score)p<0.001. Uric acid level is inversely correlated with the durationof the disease (r -0.32). Respondents with smoking historygroup showed more likely to develop ALS than therespondents with no smoking history.Conclusion: ALS patients had lower serum UA levels than didhealthy individuals and it is significantly lower in Female ALSpatients than Male ALS patients. Uric acid levels in ALS werepositively correlated with the ALSFRS-R (severity) andnegatively associated with duration of illness. UA levels couldbe considered a biomarker of disease progression in the earlyphase in ALS patients
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Objective: In this study our main aim is to evaluate impact ofSerum Total IgE and Disease Severity in Patients with AllergicAsthma.Method: This cross-sectional study was conducted at NIDCH,Mohakhali, Dhaka from one year (July 2012 - June2013).Among 150 asthma patients, 50 mild asthma patients, 50moderate and 50 severe asthma were selected in this study.Result: In our study among 150 patients, patients with midasthma belong to 15-19 years age group, where as patientswith moderate asthma and severe asthma belong to 25-29years and 35-39 years age group.21% patients with mildasthma unusually visit for regular checkup to doctor whereas48% patients with moderate asthma unusually visit regularly todoctor.47% patients with severe asthma level had >400 IU/mLserum level where as 19% patients with moderate asthma had>400 IU/mL serum level.Conclusion: From our study we can conclude that, serum totalIgE levels in adult patients with persistent allergic asthma fromBangladesh were high (two-thirds with levels >150 IU/mL) andvaried significantly. Further study is highly appreciated forbetter outcome.
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Juvenile localized scleroderma (JLS) is a rare chronic inflammatory and fibrosing disorder. It can result in significant morbidity, disfigurement, and severe functional, aesthetic and psychological disabilities. Patients with JLS should be identified early, evaluated extensively, treated aggressively, and monitored carefully. Here the case of a 2 year old boy is reported who was admitted into the department of Paediatrics of Delta Medical College & Hospital, Dhaka, Bangladesh with painful swelling of all fingers of both hands for 6 months and blackish patches over the fingers for the last one and half months. Left little finger was the first finger affected and there was flexion contracture of both left little and index fingers. The boy was diagnosed as a case of juvenile localized scleroderma and was confirmed by skin biopsy. We treated the child with methotrexate and prednisolone. It is very essential to raise awareness about this disease among clinicians and also parents for early diagnosis and treatment.
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Aims: The study was carried out to assess the analgesic, anti-inflammatory and CNS depressant activity of the methanolic extract of Abelmoschus esculentus Linn. Seeds. Study Design: The Present study was designed to observe pharmacological activities of the crude extract of the plant Abelmoschus esculentus seeds. The study consisted of hot extraction of the seeds of the A. esculantus with methanol. Afterwards, Methanolic crude extract was filtered and the filtrate was evaporated. Finally, screening of analgesic, antiinflammatory and CNS depressant activity of crude extracts of A. esculantus on Swiss Albino mice. Place and Duration of Study: Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka, Bangladesh. January, 2013- July 2013. Methodology: The animals are divided into Four groups and each group consists of five mice. Analgesic activity was performed by acetic acid-induced writhing model and formalin induced licking and biting in mice. Anti-inflammatory effects of Abelmoschus esculentus seed extract were done by carrageenan induced anti-inflammatory method at the dose of 100 and 200 mg/kg b.wt., (p.o). The CNS depressant activity was evaluated by observing the reduction of locomotor and exploratory activities in the hole cross and opens field tests at the dose of 100 and 200 mg/kg body weight. Results: In statistical analysis, the dose (200 mg/kg) was found to exhibit (significant p=0.05) better analgesic activity (65.16% and 54.38%) against both acetic acid and formalin induced pain in mice which is about similar to standard drug Indomethacin. The extract of A. esculentus (100 and 200mg/kg) also showed sustained inhibition (54.97% and 65.56%) of paw edema at the 4th hour compared to Indomethacin (74.17%). Besides this A. esculentus (significant p=0.05) seed extract (100 and 200mg/kg p.o.) also possesses depressant activity at 90min in both methods. Conclusion: this study recommends that the methanolic extract of the Abelmoschus esculentus seeds has significant CNS depressant, analgesic and anti-inflammatory properties.
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Urinary tract infection (UTI) is one of the most common paediatric infections. By the time children are 5 years old, about 8% of girls and about 1-2% of boys have had at least one episode of UTI. UTIs are caused mainly by colonic bacteria, such as Escherichia coli, followed by Klebsiella and Proteus. However, any organism that gains access to the urinary tract system may cause infection, including fungi (Candida species) and viruses. In some instances, UTI results in recognition of an important underlying structural abnormality of the urinary tract. The febrile infant or child with clinically significant bacteriuria and no other site of infection to explain the fever, even in the absence of systemic symptoms has UTI. Signs and symptoms of UTIs vary depending on the child's age and on which part of the urinary tract is infected. The diagnosis of UTI is based on routine microscopic examination and culture of a properly collected urine specimen. Imaging studies are done in selected patients to identify anatomic abnormalities. Most cases of uncomplicated UTI respond readily to outpatient antibiotic treatment without further sequelae. All patients should have close follow-up to evaluate response to antibiotics and to prevent the development of long term complication.
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Bifidobacteria finds optimal living conditions for growth and overgrowth in the colonized part of the bowel when the chyme is rich in malabsorbed carbohydrate and poor in protein. Such condition is fulfilled with breastfeeding. Though the bifidogenic principle of human milk is attributed to the protein free fraction, the quality and quantity of its protein play an important role in the origination and maintenance of microflora .The low concentration of protein in human milk, the properties of this protein and the presence of specific proteins that inhibit competing microbes in the intestinal microflora are essential components of the bifidogenic principle of human milk. Due to the presence of immunological factors in breast milk like antimicrobial agents, anti-inflammatory agents, and immunomodulatory agents, human milk plays vital protective and defensive role when the infant’s immune apparatus is immature. It also contributes early childhood growth and development when the infant is absolutely dependent on his/her caregivers for provision of nutrition.
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Morbidity and mortality data are important for planning and implementing healthcare strategies of a country. To understand the major causes for hospitalizations in rural Bangladesh, demographic and clinical data were collected from the hospital-records of five government-run rural health facilities (upazila health complexes) situated at different geographical regions of the country from January 1997 to December 2001. During this period, 75,598 hospital admissions in total were recorded, of which 54% were for male, and 46% were for female. Of all the admissions, diarrhoeal disease was the leading cause for hospitalization (25.1%), followed by injuries (17.7%), respiratory tract diseases (12.6%), diseases of the gastrointestinal tract (10.5%), obstetric and gynaecological causes (8.5%), and febrile illnesses (6.7%). A considerable proportion (8.3%) of the hospitalized patients remained undiagnosed. Despite the limitations of hospitalbased data, this paper gives a reasonable insight of the important causes for hospitalizations in upazila health complexes that may guide the policy-makers in strengthening and prioritizing the healthcare needs at the upazila level in Bangladesh.