An update on osteoporosis research: effect of calcium plus vitamin D supplementation

Osteoporosis is the most common systemic skeletal disease characterized by increased bone fragility. There lies an incongruity among research regarding combined supplementation of calcium (Ca) plus vitamin D and loss of bone health. Hence, the present review is aimed to highlight the current development of osteoporosis research and try to solve the inconsistency among the present knowledge. Electronic databases like PubMed, Cochrane Library, and EMBASE were searched from their inception to December 2018 using terms “calcium,” “vitamin D,” and “osteoporosis.” A systemic approach was followed to reach a final of 23 studies assessing the synergetic effect of calcium and vitamin D on osteoporosis and fractures risk. Among the included studies, nineteen have revealed that calcium and vitamin D decrease bone resorption, reduce the incidence of fractures, increase bone mineral density (BMD) and overall bone health. However, no significant osteogenic response was reported in five trials after supplementation with calcium and vitamin D together. Osteoporosis results in a reduced quality of life, increased disability-adjusted life span, and big economic burden to health care systems of countries. Early diagnosis before the occurrence of fractures and by assessing BMD and with early treatment, osteoporosis can be prevented. It is not entirely possible to draw a conclusion regarding beneficial effects of calcium plus vitamin D supplementation; future research based on the fundamentals of bone biology focusing on molecular genetics, and influencing factors of the acquisition of bone mass during growth and bone loss can alleviate present controversies.

Rupture Ectopic Pregnancy in Early Gestation Due to Mifepristone & Misoprostol Abuse

Ectopic pregnancy is a significant health problem in the world,which affect 1.2% of women of reproductive age; causingsignificant morbidities and mortality. Most ectopic pregnanciesare located in the ampullary, fimbriae or isthmic part of thefallopian tube. Mifepristone (antiprogesteron) followed by a lowdose of Misoprostol (prostaglandin E1, analogue) has beenused for medical termination of early pregnancy after embryoreaching endometrial cavity. But there have been many reportsof misuse of this combination drug. Here we report- fifteencases of rupture ectopic pregnancy after misuse ofcombination drug in very early pregnancy as an over thecounter drug without looking for ectopic pregnancy.

Introduction of Zika virus in Bangladesh: An impending public health threat

Objective To explore the presence of Zika virus (ZIKV) in Bangladesh and to understand the associated risk factors. Methods A retrospective sero-surveillance was performed on stored serum samples of dengue surveillance conducted from 2013 to 2016. Real time RT-PCR was performed on randomly selected acute serum samples to detect the Zika virus nucleic acid. Results Of 200 samples screened, one was found positive for ZIKV by real time RT-PCR and further confirmed by genome sequencing. The case was a 65 years old male from a metropolitan city of Bangladesh who had no history of travel outside Bangladesh. Phylogenetic analysis of partial E gene sequences from Bangladeshi isolates demonstrated a close relationship with ZIKV from Brazil and current South American strains clustering within a monophyletic clade distinct from African lineage. Conclusions Presence of ZIKV raises serious public health concerns in Bangladesh owing to its association with congenital anomalies/neurological-manifestations. We, therefore, recommend every suspected viral fever patient, particularly pregnant women be screened for ZIKV infection to rule out yet another emerging infection in Bangladesh.

Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh

Background: Acute meningoencephalitis is an important cause of morbidity and mortality around the globe. The objective of this study was to examine the distribution of acute meningoencephalitis and its aetiological agents among children admitted to a tertiary hospital in southern Bangladesh. Methods: This prospective study was carried out in Khulna Medical College Hospital from 2007 to 2009. All of the admitted children between 1 month and 12 years of age were enrolled over a 2-year period if they met the inclusion criteria of having an acute onset of fever (≤ 14 days) and any of the following 3 signs: neck stiffness, convulsion, or altered mental status. Cerebrospinal fluid (CSF) was collected within hours and sent to the laboratory for cytological and biochemical analyses. CSF was examined by Gram staining and a latex agglutination test to detect common bacteria. Serum and CSF were also tested for Japanese encephalitis virus antibodies. Results: A total of 140 children were included in the study, which accounted for 2.5% of admissions between 2007 and 2009. The number of acute meningoencephalitis cases was relatively higher (37.9%) during the monsoon season. The CSF report revealed a pyogenic form in 24 (18.5%) and a viral form in 13 (10.0%) cases. Altered mental status was significantly less frequent (P < 0.001) in cases of pyogenic meningoencephalitis (62.5%) than in cases of non-pyogenic meningoencephalitis (93.4%). Bacterial causes were identified in 11 (8.5%) children; the causative agents included Streptococcus pneumoniae (n = 8), Neisseria meningitides (n = 2), and Haemophilus influenzae (n = 1). Three (2.3%) patients were positive for Japanese encephalitis virus. Conclusion: S. pneumoniae was the most common bacteria causing acute meningoencephalitis among the study subjects, and Japanese encephalitis virus was present in few patients.