Evaluation of maternal and perinatal outcomes in pregnancy with preeclampsia at Aljala Maternity Hospital

Hypertensive disorders of pregnancy (HDP) accounts for 18% of maternal deaths worldwide, with an estimated number of about 62, 000­77, 000 deaths occur each year. The current study aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Aljala Maternity Hospital. A retrospective, descriptive, case series analysis for four hundred patients was done on the outcome of hypertensive disorder among pregnant women who admitted and were managed at Aljala teaching hospital with preeclampsia during the years 2019 and 2020. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally, delivery route, indications of cesarean section, fetal and maternal complications were determined. The current finding reported high prevalence of perinatal and maternal mortality among pregnant women with preeclampsia. Moreover, other severe maternal and perinatal complications such as Hemolysis Elevated Liver Enzyme Platelet (HELLP) syndrome, placental abruption, eclamptic fits, as well as low birth weight were also commonly reported. The current study showed early onset of preeclampsia was associated with increased risk of developing adverse maternal-fetal/neonatal outcomes compared to lateonset after 36 weeks. Our findings call for special consideration and close surveillance of those women with early-onset diseases

Prevalence, Risk Factors and Clinical Features of Post Dural Puncture Headache (PDPH): A Prospective Study

Background: Post-dural puncture headache (PDPH), formerly known as post-lumbar puncture headache, is a well-known adverse event that follows diagnostic and/or therapeutic puncture of the dura, or accidentally, following spinal anesthesia. Material & Methods: This prospective study was carried out on 152 patients at Shaheed Ziaur Rahman Medical College Hospital in Bogura, from 2013 to 2015 and North Bengal Medical College from 2016 to 2022, Bangladesh. Results: A total of 152 patients were enrolled into the study where 122(80.3%) were aged between 18-28 years, 30(19.7%) were 29-39 years, 38(25%) were male and 114(75%) were female. 122(80.3%) patients were non obese (<25) and 30(19.7%) were obese (>25). 17(11.2%) patients had previous history of anaesthesia and 17(11.2%) had previous history of PDPH. On majority 100 patients were used big size needle (18-23 G) and rest of the patients were used small (23-25G). 146 (96.1%) patients position was lateral and 92(60.5%) were used less than two or equal three drops. 61(40.1%) patients were needed one attempt, 64(42.1%) were needed two and 27(27.8%) were needed greater than two. The prevalence of PDPH was found in 44(28.9%) cases out of 152 where severity of 29(65.9%) percent was mild, 20(45.5%) cases headache onset were at the first day and mean duration of headache was 2.6. There was a statistically significant association between development of PDPH and younger age (26.3±8.7 years vs 32.6±7.4, p< 0.001), female gender (p=00.009), previous history of PDPH (p<0.001), number of attempts (3.1±1.2 vs 1.2±0.8, p<0.001), small needles (p=0.04), pre LP headache (p<0.001) and CSF RBS (2.6±2.1 vs 13.8±1.3, p= 0.48). Conclusion: This study recommends that the neurologists should be treating this population in the manner so that it may help to prevent this painful adverse event, and identification of risk variables is vital in predicting PDPH.

Extraction of chitin from edible crab shells of Callinectes sapidus and comparison with market purchased chitin / Extração de quitina de cascas de caranguejo comestíveis de Callinectes sapidus e comparação com quitina adquirida no mercado

Chitin and its derived products have immense economic value due to their vital role in various biological activities as well as biomedical and industrial application. Insects, microorganism and crustaceans are the main supply of chitin but the crustaceans shell like shrimp, krill, lobsters and crabs are the main commercial sources. Chitin content of an individual varies depending on the structures possessing the polymer and the species. In this study edible crabs’ shells (Callinectes sapidus) were demineralized and deproteinized resulting in 13.8% (dry weight) chitin recovery from chitin wastes. FTIR and XRD analyses of the experimental crude as well as purified chitins revealed that both were much comparable to the commercially purchased controls. The acid pretreatment ceded 54g of colloidal chitin that resulted in 1080% of the crude chitin. The colloidal chitin was exploited for isolation of eighty five chitinolytic bacterial isolates from different sources. Zone of clearance was displayed by the thirty five isolates (41.17%) succeeding their growth at pH 7 on colloidal chitin agar medium. Maximum chitinolytic activity i.e. 301.55 U/ml was exhibited by isolate JF70 when cultivated in extracted chitin containing both carbon and nitrogen. The study showed wastes of blue crabs can be utilized for extraction of chitin and isolation of chitinolytic bacteria that can be used to degrade chitin waste, resolve environmental pollution as well as industrial purpose.

A quitina e seus produtos derivados têm imenso valor econômico devido ao seu papel vital em várias atividades biológicas, bem como em aplicações biomédicas e industriais. Insetos, microrganismos e crustáceos são o principal suprimento de quitina, mas a casca dos crustáceos como camarão, krill, lagosta e caranguejo são as principais fontes comerciais. O conteúdo de quitina de um indivíduo varia dependendo das estruturas que possuem o polímero e da espécie. Neste estudo, as cascas de caranguejos comestíveis (Callinectes sapidus) foram desmineralizadas e desproteinizadas, resultando em 13,8% (peso seco) de recuperação de quitina a partir de resíduos de quitina. As análises de FTIR e XRD do bruto experimental, bem como das quitinas purificadas, revelaram que ambas eram muito comparáveis aos controles adquiridos comercialmente. O pré-tratamento com ácido cedeu 54 g de quitina coloidal que resultou em 1.080% da quitina bruta. A quitina coloidal foi analisada para isolamento de 85 isolados bacterianos quitinolíticos de diferentes fontes. A zona de eliminação foi exibida pelos 35 isolados (41,17%) que sucederam seu crescimento a pH 7 em meio de ágar de quitina coloidal. A atividade quitinolítica máxima, ou seja, 301,55 U / ml, foi exibida pelo isolado JF70 quando cultivado em quitina extraída contendo carbono e nitrogênio. O estudo mostrou que resíduos de caranguejos azuis podem ser utilizados para extração de quitina e isolamento de bactérias quitinolíticas que podem ser usadas para degradar resíduos de quitina, resolver a poluição ambiental e também para fins industriais.

Extraction of chitin from edible crab shells of Callinectes sapidus and comparison with market purchased chitin

Abstract Chitin and its derived products have immense economic value due to their vital role in various biological activities as well as biomedical and industrial application. Insects, microorganism and crustaceans are the main supply of chitin but the crustaceans shell like shrimp, krill, lobsters and crabs are the main commercial sources. Chitin content of an individual varies depending on the structures possessing the polymer and the species. In this study edible crabs shells (Callinectes sapidus) were demineralized and deproteinized resulting in 13.8% (dry weight) chitin recovery from chitin wastes. FTIR and XRD analyses of the experimental crude as well as purified chitins revealed that both were much comparable to the commercially purchased controls. The acid pretreatment ceded 54g of colloidal chitin that resulted in 1080% of the crude chitin. The colloidal chitin was exploited for isolation of eighty five chitinolytic bacterial isolates from different sources. Zone of clearance was displayed by the thirty five isolates (41.17%) succeeding their growth at pH 7 on colloidal chitin agar medium. Maximum chitinolytic activity i.e. 301.55 U/ml was exhibited by isolate JF70 when cultivated in extracted chitin containing both carbon and nitrogen. The study showed wastes of blue crabs can be utilized for extraction of chitin and isolation of chitinolytic bacteria that can be used to degrade chitin waste, resolve environmental pollution as well as industrial purpose.

Resumo A quitina e seus produtos derivados têm imenso valor econômico devido ao seu papel vital em várias atividades biológicas, bem como em aplicações biomédicas e industriais. Insetos, microrganismos e crustáceos são o principal suprimento de quitina, mas a casca dos crustáceos como camarão, krill, lagosta e caranguejo são as principais fontes comerciais. O conteúdo de quitina de um indivíduo varia dependendo das estruturas que possuem o polímero e da espécie. Neste estudo, as cascas de caranguejos comestíveis (Callinectes sapidus) foram desmineralizadas e desproteinizadas, resultando em 13,8% (peso seco) de recuperação de quitina a partir de resíduos de quitina. As análises de FTIR e XRD do bruto experimental, bem como das quitinas purificadas, revelaram que ambas eram muito comparáveis aos controles adquiridos comercialmente. O pré-tratamento com ácido cedeu 54 g de quitina coloidal que resultou em 1.080% da quitina bruta. A quitina coloidal foi analisada para isolamento de 85 isolados bacterianos quitinolíticos de diferentes fontes. A zona de eliminação foi exibida pelos 35 isolados (41,17%) que sucederam seu crescimento a pH 7 em meio de ágar de quitina coloidal. A atividade quitinolítica máxima, ou seja, 301,55 U / ml, foi exibida pelo isolado JF70 quando cultivado em quitina extraída contendo carbono e nitrogênio. O estudo mostrou que resíduos de caranguejos azuis podem ser utilizados para extração de quitina e isolamento de bactérias quitinolíticas que podem ser usadas para degradar resíduos de quitina, resolver a poluição ambiental e também para fins industriais.

Comparison of multistranded wire and fiber-reinforced composite retainers effects on periodontium: A randomized clinical trial

ABSTRACT Introduction: Fixed orthodontic retainers are very important for treatment stability; however, adverse effects on the health of periodontium can be caused as a result of deposition of plaque and calculus. Objectives: To compare and determine the effects of two mandibular fixed lingual retainers on the periodontal status, and to test the null hypothesis that there would be no significant difference on the periodontium health between the patients using fiber-reinforced composite (FRC) or multistranded wire (MSW) fixed retainers. Methods: A total of 60 subjects were recruited, out of which 6 were excluded and 2 dropped out during the study. Hence, 52 subjects with mean age of 21.5 ± 3.6 years were included in the study. The sample was composed by 8 males (15.4%) and 44 females (84.6%). The participants were randomly divided into two groups: Group 1 received fiber-reinforced composite retainer, while Group 2 received multistranded wire retainer. After insertion, plaque index, calculus index, gingival index and bleeding on probing were compared, after three months (T1), six months (T2), nine months (T3) and twelve months (T4), using Mann-Whitney test with p-value ≤ 0.05 as significant. Results: It could be seen that the health of periodontium deteriorated with the passage of time from T1 to T4 in both group of retainers. However, no statistically significant differences were found between the two groups (p> 0.05). Conclusion: The results of the study indicate that there was no significant difference on the health of periodontium between the patients with FRC and MSW fixed retainers, hence, the null hypothesis was accepted.

RESUMO Introdução: As contenções ortodônticas fixas são muito importantes para a estabilidade do tratamento; no entanto, elas podem causar efeitos adversos na saúde do periodonto, como resultado da deposição de placa e cálculo. Objetivos: Comparar e determinar os efeitos na saúde periodontal de duas contenções inferiores coladas por lingual, e testar a hipótese nula de que não haveria diferença significativa na saúde periodontal entre os pacientes usando contenções fixas de compósito reforçado com fibra (FRC) ou de fio multitrançado (MSW). Métodos: No total, 60 indivíduos foram recrutados, dos quais 6 foram excluídos e 2 desistiram durante o estudo. Assim, foram incluídos no estudo 52 indivíduos com média de idade de 21,5 ± 3,6 anos. A amostra foi composta por 8 homens (15,4%) e 44 mulheres (84,6%). Os participantes foram divididos aleatoriamente em dois grupos: O Grupo 1 recebeu contenção de compósito reforçado com fibra, enquanto o Grupo 2 recebeu contenção de fio multitrançado. Após três meses (T1), seis meses (T2), nove meses (T3) e doze meses (T4) da colagem, foram comparados os índices de placa e de cálculo, índice gengival e sangramento à sondagem, usando o teste de Mann-Whitney com p ≤ 0,05 como significativo. Resultados: Pôde-se observar que a saúde periodontal piorou com o passar do tempo, de T1 a T4, em ambos os grupos de contenções. No entanto, não foram encontradas diferenças estatisticamente significativas entre os dois grupos (p> 0,05). Conclusão: Os resultados do estudo indicam que não houve diferença significativa na saúde periodontal entre os pacientes com contenções fixas FRC e MSW; portanto, a hipótese nula foi aceita.

Healthy aging and care of the older adult with chronic disease: a qualitative needs assessment in 14 eastern and southern Caribbean islands / Envejecimiento saludable y atención de las personas mayores con enfermedades crónicas: evaluación cualitativa de las necesidades en 14 islas del Caribe oriental y meridional / Envelhecimento saudável e atenção à pessoa idosa com doença crônica: avaliação qualitativa das necessidades em 14 ilhas do Caribe oriental e meridional

ABSTRACT The objectives of this qualitative needs assessment were to assess perceived needs of health and social services professionals in the Caribbean Region to enhance services supporting healthy aging and care of older adults and to assess perceived facilitators and barriers to increasing capacity to serve their aging populations. The assessment, informed by the Consolidated Framework for Implementation Science, was conducted in 14 islands in the eastern and southern Caribbean. The results demonstrated need for education of professionals and the general population about the prevention and treatment of non-communicable diseases (NCDs), assessment and services for individuals with dementia, Alzheimer's disease, depression, and harmful alcohol use, all of which pose significant challenges for older adults. Education of health and social services professionals, families, and the public on the risk factors for NCDs and common mental and physical health problems is critical. Barriers to implementation of educational programs include lack of community awareness and resources within the islands. The needs assessment findings are foundational to planning educational interventions. These will be developed by local health providers with the collaboration and support of external resources including those of the Pan American Health Organization/World Health Organization Collaborating Centre in Gerontological Nursing Education.

Resumen Los objetivos de esta evaluación cualitativa de las necesidades fueron evaluar las necesidades que perciben los profesionales de la salud y de los servicios sociales en el Caribe a fin de mejorar los servicios de apoyo al envejecimiento saludable y el cuidado de las personas mayores, así como evaluar los factores percibidos como facilitadores y como obstáculos para mejorar su capacidad de atender a la población que está envejeciendo. La evaluación, basada en el marco consolidado para la ciencia de la implementación, se realizó en 14 islas del Caribe oriental y meridional. Los resultados mostraron la necesidad de capacitar a los profesionales y educar a la población en general acerca de la prevención y el tratamiento de las enfermedades no transmisibles (ENT), la evaluación y los servicios para las personas con demencia, alzhéimer, depresión y problemas de consumo nocivo de alcohol, todos los cuales plantean importantes desafíos para las personas mayores. Es imprescindible capacitar a los profesionales de la salud y de los servicios sociales, así como educar a las familias y al público en general sobre los factores de riesgo de las ENT y los problemas de salud mental y física más habituales. Entre los obstáculos a la aplicación de los programas educativos se encuentran la falta de concientización de la comunidad y la falta de recursos en las islas. Los resultados de la evaluación de las necesidades son fundamentales para planificar las intervenciones educativas, que serán formuladas por los prestadores de atención de salud locales con la colaboración y el apoyo de recursos externos, incluidos los del Centro Colaborador de la Organización Panamericana de la Salud/Organización Mundial de la Salud en Educación en Enfermería Gerontológica.

RESUMO Os objetivos desta avaliação qualitativa das necessidades foram avaliar as necessidades percebidas do pessoal da saúde e dos serviços de assistência social na região do Caribe, visando a melhorar os serviços de apoio ao envelhecimento saudável e de atenção às pessoas idosas e determinar os facilitadores e as barreiras percebidos, com vistas a melhorar a capacidade de prestar assistência às populações idosas. Esta avaliação foi realizada com base na Consolidated Framework for Implementation Science em 14 ilhas do Caribe oriental e meridional. Os resultados obtidos demonstraram que é necessário prover conhecimento aos profissionais e à população geral sobre a prevenção e o tratamento de doenças não transmissíveis, e a avaliação de pessoas com demência, doença de Alzheimer, depressão e uso prejudicial de álcool e os respectivos serviços, visto que são enormes desafios enfrentados pelas pessoas idosas. É fundamental que o pessoal da saúde e dos serviços sociais, os familiares e o público em geral conheçam os fatores de risco para doenças não transmissíveis e os problemas comuns de saúde mental e física que afligem a população idosa. A falta de sensibilização da comunidade e a escassez de recursos são barreiras à implementação de programas educacionais. As conclusões desta avaliação servem de base para o planejamento de intervenções educacionais a serem desenvolvidas localmente pelo pessoal da saúde, com a colaboração e o apoio de entidades internacionais, como o Centro Colaborador da Organização Pan-Americana da Saúde/Organização Mundial da Saúde para Educação em Enfermagem Gerontológica.

Clinical and Biochemical Profile of Hepatitis A Virus infection in Children

Background: Acute hepatitis A virus infection in children in developing countries is a matter of concern though the incidence has come down in developed countries.To observe the clinical presentation and biochemical profile of hepatitis A virus infection in children hospitalized in a tertiary care center in Bangladesh.Material & Methods:In this cross-sectional observational study, data were collected from the records of pediatric patients who were admitted due to acute hepatitis. Demographic data were collected, and complete physical examination findings and laboratory data were also taken. Serum samples were tested for LFT, Anti-HAV IgM and other viral markers among them Anti-HAV IgM positive children were included in the study.Results:Among the total of 40 patients suffering from Acute Viral Hepatitis (AVH), male predominated over female with 57.5% vs. 42.5%. The majority of the study population (65%) came from the urban area. In this study, 65% of the patients used tap water and 35% used tube well water for drinking purposes while the majority 70% used boiled water. Most of the patients (80%) consumed both homemade and outside foods and drinks while 20% consumed only homemade food. Positive family history of viral hepatitis was found in 12.5% of cases. Common presentations were fever (100%), jaundice (100%), anorexia, nausea (95%), vomiting (85%), abdominal pain (50%) etc. On examination Jaundice (100%) and hepatomegaly (95%), splenomegaly (5%), and ascites (7.5%). Only 7.5% of patients developed complications like cholestasis,7.5% showed ascites,5% had relapsed and 2.5% develop liver failure.Conclusions:This study showed that poor sanitation and poor hygiene are the main risk factors for hepatitis A. The common presenting features which should alert the clinicians include fever, jaundice, anorexia, nausea, vomiting, diarrhea, abdominal distension, hepatosplenomegaly and ascites. In Bangladesh, safe water supplies and proper sanitation will constitute the best solution to eliminate endemic hepatitis A.

High Risk Foot Among Type-2 Diabetes Mellitus Patients in a Tertiary Care Hospital

Background: Feet of diabetic persons are at a high risk of developing complications and their prevalence is very high. Uncontrolled diabetes i.e. hyperglycemia particularly chronic hyperglycemia plays the most critical role in developing all forms of macro and microvascular complications in foot. The 揾igh risk foot� can be identified by simple clinical examination. A structured screening program for 揌igh Risk Foot� integrated with all diabetic care units is essential. Objectives: The study was initiated to determine the frequency of 揾igh-risk foot� among Type 2 diabetic patients.Methods:It was a cross-sectional observational study, conducted among 324 Type 2 diabetic patients attending BIRDEM General Hospital, Dhaka, Bangladesh. All participants were interviewed by an administered questionnaire, underwent clinical examination and review of medical records from the diabetic guide book of the patients and hospital records.Results:Among a total of 324 patients, 198(61%) patients were having high-risk feet. Of the diabetics with high risk foot- loss of protective sensation 73.2%; absent pedal pulse 23.2%; history foot ulcer 25.3%; limited joint mobility 15.2%; foot deformity 11.1% and previous foot amputation 3.5%. The study population had poor glycemic status (HbA1c 10.81+5.23%). Other variables age 55.43 (� 11.062) years; BMI: 25.33+5.7 kg/m� duration of diabetes 14.24+7.25 years; sex ratio (M: F) 1.3:1; family history of DM 71.9%; hypertensive 53.1%; smoker 73.5%; dislipidemia 52.8%, albuminuria 58.6%, and retinopathy 53.7%. Males are significantly higher in the high-risk foot.Conclusion:This study documented a very high frequency of high risks foot in our diabetic population. Peripheral Neuropathy (PN) and PVD are two common forms of high risk foot and these are influenced by a longer duration of diabetes, the presence of albuminuria for PN, and retinopathy. Male sex, longer duration of diabetes, presence of hypertension and smoking for PVD. Regular foot examination and treatment to target patients will modify the modifiable risk factors and thereby prevent foot ulcers and amputation.

Evaluation of Epididymo-Orchtis-A Study of 100 Cases

Background: Acute epididymo-orchitis is a common clinical problem in urological practice. It is not an uncommon disease in our country to cause work loss particularly in active group of people. Aim of the study: The aim of this study was to see the predisposing factors involved, aetiopathology and progression of disease process.Methods:This prospective study was conducted in department of surgery, Kumudini Women抯 Medical College Hospital, Tangail from April 2008 to March 2009. Hundred patients of inflammation of epididymis and testis were included in this study.Results:Out of 100 patients, majority (48%) were in monogamous relationship. All patients (100%) had scrotal pain, 22% had scrotal swelling, 59% had fever, 32% had dysuria and 11% had urethral discharge. All patients presented with tenderness of the testis and epididymis and 82% cases had both epididymal and testicular swelling. Thirty two percent cases had urinary tract infection, trauma and promiscuous sexual contact were associated with the disease in 2% and 18% cases, respectively. History of masturbation was noted in 18% cases. By urine routine microscopy 28% had pus cell and 03% had RBC in urine, 16 cases were positive in urine culture, among 15% were E.coll and 01% were found Klebsiela. Forty patients were tested Chlamydial CFT and 16(40%) were found positive, out of 12 Filarial CFT tested 01(8.33 %) was found positive, Gram staining of urethral discharge revealed Neisseria gonorhhoae in 02(18.18%) cases. In maximum cases no actiological factor was found. Majority cases under 35 years were infected with Chlamydia and patients older than 35 years were mostly infected with E.coli.Conclusion:This study reflects that maximum of our study patients report to hospital nearly at right time with relatively better health status and outcome of available treatment facilities are satisfactory

Treatment of Infertility in Women with Polycystic Ovary Syndrome in a Single Center Study

Background: Anovulatory infertility is caused by polycystic ovarian syndrome in 80 percent of patients. Preconception guidelines, such as lifestyle modification (weight loss) to avoid fetal neural tube abnormalities, and quitting smoking and drinking alcohol, are all part of the early treatment. A clomiphene citrate medication for timed intercourse is the first-line pharmacological treatment for producing ovulation. Exogenous gonadotropins or laparoscopic ovarian surgery are two options for second-line pharmaceutical treatment (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective, with a 70 % cumulative live birth rate. When laparoscopy is necessary, ovarian drilling should be done; this operation is usually successful in around half of the instances. Finally, when the previous interventions have failed, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is recommended. There is no evidence that metformin should be used routinely in the treatment of infertility in anovulatory women with polycystic ovary syndrome. Aromatase inhibitors show promise, but more research is needed to confirm their safety.Methods:This study was conducted in Department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, from January 2019 to December 2019. A total number of 100 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 24.0.Conclusion:PCOS is a frequent syndrome and the most frequent cause of infertility. PCOS is defined as a syndrome with at least two of three of the Rotterdam criteria. A complete evaluation of the infertility is needed to exclude other causes of infertility..

Evaluation of chemopreventive and chemotherapeutic effect of Artemisia vulgaris extract against diethylnitrosamine induced hepatocellular carcinogenesis in Balb C mice / Avaliação dos efeitos quimiopreventivo e quimioterápico do extrato de Artemisia vulgaris contra carcinogênese hepatocelular induzida por dietilnitrosamina em camundongos Balb C

The main objective of current study was to investigate the chemopreventive and chemotherapeutic activity of Artemisia vulgaris extract on diethylnitrosoamine induced hepatocarcinogenesis in Balb C mice. Diethylnitrosoamine (DEN: 0.9%) was prepared to induce hepatocarcinoma in Balb C mice. The extract Artemisia vulgaris (AV) was prepared by maceration technique. Mice were classified into four groups as follows: Group 1 a control group (N=7) received saline solution (3.5 l/mg), group 2 (N=14) received diethylnitrosoamine (3.5 l/mg) intraperitoneally once in a week for eight consecutive weeks, group 3 (N=7) received only plant extract (AV: 150 mg/kg (Body weight) once in a week, while group 4 (N=7) was given in combination of diethylnitrosoamine (3.5 l/mg) and plant extract (AV: 150 mg/kg (body weight). After eight weeks of DEN administration, mice of group 2 were divided into two subgroups containing seven mice each; subgroup 1 was sacrificed while subgroup 2 was treated with plant extract only (150 mg/kg (body weight)) once in a week for eight consecutive weeks. The DEN injected mice significant decline in levels of albumin with concomitant significant elevations such as aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, alpha feto protein, gamma glutamyl transferase, 5 nucleotidase, glucose-6-phosphate dehydrogenase and bilirubin. The administration of A. vulgaris significantly decreased the DEN induced hepatotoxicity. Present study revealed the potential anti-cancerous nature of Artemisia vulgaris, both in case of chemopreventive and post-treatment of A. vulgaris. Further studies are needed to explore the mechanism of prevention and therapy.

O objetivo principal do presente estudo foi investigar as atividades quimiopreventiva e quimioterápica do extrato de Artemisia vulgaris em hepatocarcinogênese induzida por dietilnitrosoamina (DEN) em camundongos Balb C. Dietilnitrosoamina (DEN: 0,9%) foi preparada para induzir hepatocarcinoma em camundongos da linhagem Balb C. O extrato de A. vulgaris (AV) foi preparado pela técnica de maceração. Os camundongos foram classificados em quatro grupos conforme os seguintes: grupo 1, grupo controle (N=7) recebeu solução salina (3,5 µl/mg); grupo 2 (N=14) recebeu dietilnitrosoamina (3,5 µl/mg) por via intraperitoneal uma vez por semana durante oito semanas consecutivas; grupo 3 (N=7) recebeu apenas o extrato vegetal (AV: 150 mg/kg (peso corporal) uma vez por semana; enquanto no grupo 4 (N=7) foi administrado uma combinação de dietilnitrosoamina (3,5 l/mg) com extrato vegetal (AV: 150 mg/kg (peso corporal). Após oito semanas de administração de DEN, os camundongos do grupo 2 foram divididos em dois subgrupos, contendo sete camundongos cada um; no subgrupo 1, os animais foram sacrificados, enquanto no subgrupo 2, os animais foram tratados apenas com extrato vegetal (150 mg/kg (peso corporal)) uma vez por semana durante oito semanas consecutivas. Os camundongos nos quais foram injetados DEN apresentaram declínio significativo nos níveis de albumina, mas elevações significativas concomitantes de: aspartato aminotransferase, alanina aminotransferase, lactato desidrogenase, alfa-fetoproteína, gama-glutamiltransferase, 5 nucleotidase, glicose-6-fosfato desidrogenase e bilirrubina. A administração de A. vulgaris diminuiu significativamente a hepatotoxicidade induzida pelo DEN. O presente estudo apresentou a potencialidade anticancerosa da A. vulgaris, tanto nos casos de quimioprevenção quanto no pós-tratamento da A. vulgaris. Mais estudos são necessários para explorar o mecanismo de prevenção e a terapia.

Recurrent pregnancy loss at gynecology and obstetrical hospital in Duhok Province

Background: Recurrent pregnancy loss is physically and emotionally harmful for mothers. This study aimed to find out the prevalence and associated factors of recurrent pregnancy loss (RPL) in pregnant women in Duhok province.Methods: In this retrospective study, the medical records of the patients who had pregnancy loss and registered in Duhok Maternity Hospital were reviewed for the period of January - December 2019. Accordingly, 300 women aged 18 years and older with pregnancy loss were included in this study.Results: The prevalence of EPL was 16.3%. The study found that patients with RPL were statistically older compared to those patients without RPL, (39.27 vs. 33.24 years; P<0.001), respectively. Besides, the RPL group had a significantly higher percentage of family history of pregnancy loss (12.24% vs. 1.20%; P<0.001). The patients with RPL had significantly higher prevalence of Chlamydia trachomatis (14.29% vs. 3.59%; P=0.002), cervical incompetence (8.16% vs. 0.80%; P=0.002), structural abnormalities of uterus (14.29% vs. 4.8%; P=0.012), and polycystic ovary syndrome (PCOS) (40.82% vs. 11.95%; P<0.001). There was no significant association of RPL with smoking (P=0.261).Conclusions: This study revealed a high prevalence of RPL in patients with pregnancy loss. Also, the study showed that the patients in the RPL group were significantly older and had a higher prevalence of medical illnesses; including chlamydia trachomatis, cervical incompetence, structural anomalies of the uterus, and polycystic ovarian syndrome.

Evaluation of chemopreventive and chemotherapeutic effect of Artemisia vulgaris extract against diethylnitrosamine induced hepatocellular carcinogenesis in Balb C mice / Avaliação dos efeitos quimiopreventivo e quimioterápico do extrato de Artemisia vulgaris contra carcinogênese hepatocelular induzida por dietilnitrosamina em camundongos Balb C

Abstract The main objective of current study was to investigate the chemopreventive and chemotherapeutic activity of Artemisia vulgaris extract on diethylnitrosoamine induced hepatocarcinogenesis in Balb C mice. Diethylnitrosoamine (DEN: 0.9%) was prepared to induce hepatocarcinoma in Balb C mice. The extract Artemisia vulgaris (AV) was prepared by maceration technique. Mice were classified into four groups as follows: Group 1 a control group (N=7) received saline solution (3.5 μl/mg), group 2 (N=14) received diethylnitrosoamine (3.5 μl/mg) intraperitoneally once in a week for eight consecutive weeks, group 3 (N=7) received only plant extract (AV: 150 mg/kg (Body weight) once in a week, while group 4 (N=7) was given in combination of diethylnitrosoamine (3.5 μl/mg) and plant extract (AV: 150 mg/kg (body weight). After eight weeks of DEN administration, mice of group 2 were divided into two subgroups containing seven mice each; subgroup 1 was sacrificed while subgroup 2 was treated with plant extract only (150 mg/kg (body weight)) once in a week for eight consecutive weeks. The DEN injected mice significant decline in levels of albumin with concomitant significant elevations such as aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, alpha feto protein, gamma glutamyl transferase, 5 nucleotidase, glucose-6-phosphate dehydrogenase and bilirubin. The administration of A. vulgaris significantly decreased the DEN induced hepatotoxicity. Present study revealed the potential anti-cancerous nature of Artemisia vulgaris, both in case of chemopreventive and post-treatment of A. vulgaris. Further studies are needed to explore the mechanism of prevention and therapy.

Resumo O objetivo principal do presente estudo foi investigar as atividades quimiopreventiva e quimioterápica do extrato de Artemisia vulgaris em hepatocarcinogênese induzida por dietilnitrosoamina (DEN) em camundongos Balb C. Dietilnitrosoamina (DEN: 0,9%) foi preparada para induzir hepatocarcinoma em camundongos da linhagem Balb C. O extrato de A. vulgaris (AV) foi preparado pela técnica de maceração. Os camundongos foram classificados em quatro grupos conforme os seguintes: grupo 1, grupo controle (N=7) recebeu solução salina (3,5 µl/mg); grupo 2 (N=14) recebeu dietilnitrosoamina (3,5 µl/mg) por via intraperitoneal uma vez por semana durante oito semanas consecutivas; grupo 3 (N=7) recebeu apenas o extrato vegetal (AV: 150 mg/kg (peso corporal) uma vez por semana; enquanto no grupo 4 (N=7) foi administrado uma combinação de dietilnitrosoamina (3,5 μl/mg) com extrato vegetal (AV: 150 mg/kg (peso corporal). Após oito semanas de administração de DEN, os camundongos do grupo 2 foram divididos em dois subgrupos, contendo sete camundongos cada um; no subgrupo 1, os animais foram sacrificados, enquanto no subgrupo 2, os animais foram tratados apenas com extrato vegetal (150 mg/kg (peso corporal)) uma vez por semana durante oito semanas consecutivas. Os camundongos nos quais foram injetados DEN apresentaram declínio significativo nos níveis de albumina, mas elevações significativas concomitantes de: aspartato aminotransferase, alanina aminotransferase, lactato desidrogenase, alfa-fetoproteína, gama-glutamiltransferase, 5' nucleotidase, glicose-6-fosfato desidrogenase e bilirrubina. A administração de A. vulgaris diminuiu significativamente a hepatotoxicidade induzida pelo DEN. O presente estudo apresentou a potencialidade anticancerosa da A. vulgaris, tanto nos casos de quimioprevenção quanto no pós-tratamento da A. vulgaris. Mais estudos são necessários para explorar o mecanismo de prevenção e a terapia.

Factors Responsible for Work Stress among Health Care Providers and Frequency of Antidepressant Medicine Use

Objective:To assess the contributing factors of occupational stress and frequency of antidepressant medicine use among healthcare providers working at Isra University Hospital.Study Setting: IsraUniversity Hospital, Hyderabad Sind Pakistan.Study Design: Cross-sectional.Materials and Methods:All the health care providers of Isra University Hospital, Hyderabad of either gender formed the sample of the study. A structured questionnaire in English language was designed to gather data on factors contributing to occupational stress. Data was analyzed by using SPSS version 20.Results:The impact of work stress on work performance was explored in 100 study participants. The results indicated that 87% of study sample affirmed that stress lead topoor performance. Out of all participants, 79% were female and 21% were males. The analysis of stress elevating factors showed that 56% study participants had stress due to low salary, 17% felt stress due to seniors ‘negative attitude’ and 15% due to low job satisfaction. Result showed that 27.0% subjects reduce stress by sharing with theirfriends, 25% by prayers, 21% use the music during stress, 19.0% share with family and 8% using the antidepressant medicine during stress.Conclusion:It was concluded that low job satisfaction, lesser pay and seniors’ attitude are common contributing stress factors. Sharing with family and friends, music, prayers and use of the antidepressant medicine were the common methods of stress reduction

Clinical Profile and Outcome of Neonates Requiring Mechanical Ventilation

Background: Mechanical ventilation is one of the importantadvancement which has contributed to the decline of neonatalmortality in the various parts of the world. Many sick neonatesadmitted to neonatal intensive care unit (NICU) requiremechanical ventilation for different clinical conditions but it isassociated with various complications and the outcome ofthese neonates is unpredictable.Objective: To find out the clinical conditions and immediateoutcome of neonates requiring mechanical ventilation.Methods: This prospective observational study was conductedin Neonatal Intensive Care Unit (NICU), Department ofNeonatology of Bangabandhu Sheikh Mujib Medical University,Dhaka during the period of August 2015 to July 2016.Neonates required to put on mechanical ventilation wereconsecutively enrolled. All babies were monitored for clinicalprofile and outcome as well as complications. The enrolledneonates were divided into two groups. Neonates whoremained successfully extubated for >48 hours and did notrequire re-intubation were grouped as survivors and who diedduring mechanical ventilation or within 48 hours of extubationwere grouped as non-survivors. Clinical, biochemical, ventilatorparameters and occurrence of complications were analyzed tofind out the factors associated with mortality of ventilatedneonates.Results: During the study period 53(8.6%) of admittedneonates in NICU received mechanical ventilation. Out ofthese 53 neonates 69.8% were male with male to female ratio2.3:1.Inborn babies were more (58.5%) than out born (41.5%).Mean age, gestational age and birth weight were3.58±5.45days 33.34±3.40 weeks and 1852.55±513.48grespectively. Commonest condition for initiating mechanicalventilation was refractory apnea (35.8%) followed by severerespiratory distress with Downe score >6 (20.8%) and SpO2<accepted level (17.0%). Disease pattern were sepsis (35.8%),RDS (20.8%), congenital pneumonia (18.9%), perinatalasphyxia (15.1%), meconium aspiration syndrome (3.8%), TTN(1.9%) and Meningitis (3.8%). The survival rate was 35.8%.Factors significantly different in non-survivors were meangestational age, mean birth weight, initial arterial pH, age atadmission and age at initiation of ventilation (p<0.05). Themean maximum PIP requirement was significantly higher innon-survivors (p<0.05). Hospital acquired sepsis (67.9%) wasthe most common complication during mechanical ventilationfollowed by tube block (52.8%) and ventilator associatedpneumonia (26.4%). Shock (64.2%) was the commonest comorbidity followed by dyselectrolytemia (52.8%), sepsis(35.8%) and DIC (28.3%). Hospital acquired sepsis, shock andDIC were associated with mortality (p<0.05). Shock was foundindependent predictor of mortality (p=0.001).Conclusion: The most common condition for initiatingmechanical ventilation was refractory apnea. Sepsis was thecommonest disease for which ventilation required. The survivalrate of ventilated neonates was 35.8% and percentage ofsurvival was more in babies with RDS. Hospital acquiredsepsis was the major complication of ventilated neonates.Presence of hospital acquired sepsis, shock and DIC wassignificantly high in non-survivors. Shock was found asindependent predictor of mortality.

Correlation of Transcutaneous Bilirubin with Serum Bilirubin in Term and Preterm Neonates with Jaundice

Background: Jaundice is a very common neonatal problemand contributes a lot to the admission into neonatal care unitsand hospitals. Early estimation of TcB may help identifyingneonates with significant jaundice requiring serum bilirubinestimation. This may help avoiding unnecessary estimation ofserum bilirubin by invasive method in preterm and termneonates. TcB has been practised mostly in the whitepopulation and studies in the nonwhite population is relativelyscarce. In Bangladesh, estimation of TcB is a very newapproach and not in practice in most of the centres; andinvolves only term and near-term neonates sparing pretermones.Objective: To evaluate the correlation of transcutaneousbilirubin with serum bilirubin in term and preterm neonates withjaundice.Methods: This cross sectional study was conducted in thedepartment of Neonatology, Bangabandhu Sheikh MujibMedical University (BSMMU) from September 2015 to August2016. Jaundiced neonates ranging from 28 to 42 weeks ofgestation were studied. JM-103 device and DichlorophenylDiazonium method were used to measure TcB and TSBrespectively. TcB measurements were obtained over thesternum 30 minutes prior or after blood sampling for TSB.Pearson’s correlation coefficient and linear regression analysiswere used to determine the correlation between TcB and TSB.Bland-Altman plot was used to analyse the agreement betweenTcB and TSB. ROC curve was constructed both for term andpreterm infants to determine the best cut-off values with theirsensitivity and specificity.Results: A total of 148 paired TcB-TSB readings for 102jaundiced term and preterm infants were obtained. Correlationcoefficient in total population, term and preterm neonates were0.83, 0.92 and 0.69 respectively. Bland-Altman plot showedreasonable agreement in term newborns but not in pretermbabies. Overall best sensitivity and specificity of TcB in termneonates was 90% and 73%, and in preterm neonates 65%and 60% respectively. Area under the curve for TcB was 86%in term neonates, whereas it was 63% in preterm neonates.

Shyness and Psychological Well-Being as Predictors of Problematic Internet Use Among Students in Pakistan / La timidez y el bienestar psicológico como predictores del uso problemático de Internet entre estudiantes en Pakistán / Timidez e bem-estar psicológico como preditores do uso problemático da Internet entre estudantes no Paquistão

Abstract: This research was aimed to study the relationship between the variables of shyness and psychological well-being as the predictors of problematic internet use (PIU). The study was carried out on a sample of 400 students. The sample included 191 men (47.8%) and 209 women (52.2%) from University of Sargodha. The age range of participants in the sample was 18 to 24 years (M= 21,S.D= 4.24). The three variables of the study including shyness, psychological well-being, and problematic internet use were assessed with the shyness questionnaire, flourishing scale, and internet addiction test scale (IAT), respectively. To determine the psychometric soundness of instruments, descriptive and internal consistency levels of all the study variables were measured. The main statistical analyses included correlation, t-test, and regression analysis. The correlational analysis of overall results revealed the significant positive correlation of shyness and a significant negative correlation of psychological well-being with problematic internet use. The t-test revealed that problematic internet use and psychological well-being were significantly different according to gender. Furthermore, the results of linear regression analysis divulged that shyness positively predicts problematic internet use, while psychological well-being negatively predicts problematic internet use. Also, regression analysis on the gender indicated that being male was a predictor of greater PIU. Implications of the study along with its limitations were discussed and recommendations for further research were highly suggested.

Resumen: Esta investigación tuvo como objetivo estudiar la relación entre las variables de timidez y bienestar psicológico como predictores del uso problemático de Internet. El estudio se realizó en una muestra de 400 estudiantes. La muestra incluyó 191 hombres (47,8%) y 209 mujeres (52,2%) de la Universidad de Sargodha. El rango de edad de los participantes de la muestra fue de 18 a 24 años (M = 21, SD = 4,24). Las tres variables del estudio, incluida la timidez, el bienestar psicológico y el uso problemático de Internet, se evaluaron con el cuestionario de timidez, la escala de florecimiento y la escala de prueba de adicción a Internet (IAT), respectivamente. Para determinar la solidez psicométrica de los instrumentos se midieron los niveles de consistencia descriptiva e interna de todas las variables de estudio. Los principales análisis estadísticos incluyeron correlación, prueba t y análisis de regresión. El análisis correlacional de los resultados generales reveló la correlación positiva significativa de la timidez y una correlación negativa significativa del bienestar psicológico con el uso problemático de Internet. La prueba t reveló que el uso problemático de Internet y el bienestar psicológico eran significativamente diferentes según el género. Además, los resultados del análisis de regresión lineal divulgaron que la timidez predice positivamente el uso problemático de Internet, mientras que el bienestar psicológico predice negativamente el uso problemático de Internet. Además, el análisis de regresión sobre el género indicó que ser hombre era un predictor de mayor uso problemático de internet. Se discutieron las implicaciones del estudio junto con sus limitaciones y se sugirieron encarecidamente recomendaciones para futuras investigaciones.

Resumo: Esta pesquisa teve como objetivo estudar a relação entre as variáveis timidez e bem-estar psicológico como preditores do uso problemático da internet. O estudo foi realizado em uma amostra de400) alunos. A amostra incluiu 191 homens (47,8%) e 209 mulheres (52,2%)da Universidade de Sargodha. A faixa etária dos participantes da amostra foi de 18 a 24 anos (M = 21, S.D = 4,24). As três variáveis do estudo, incluindo timidez, bem-estar psicológico e uso problemático da internet, foram avaliadas com o questionário de timidez, escala de florescimento e escala de teste de vício em internet (IAT), respectivamente. Para determinar a solidez psicométrica dos instrumentos, foram medidos os níveis de consistência descritiva e interna de todas as variáveis ​​do estudo. As principais análises estatísticas incluíram correlação, teste t e análise de regressão. A análise correlacional dos resultados gerais revelou a correlação positiva significativa da timidez e uma correlação negativa significativa do bem-estar psicológico com o uso problemático da internet. O teste t revelou que o uso problemático da Internet e o bem-estar psicológico foram significativamente diferentes de acordo com o gênero. Além disso, os resultados da análise de regressão linear divulgaram que a timidez prediz positivamente o uso problemático da Internet, enquanto o bem-estar psicológico prediz negativamente o uso problemático da Internet. Além disso, a análise de regressão sobre o sexo indicou que ser do sexo masculino foi um preditor de maioruso problemático da internet. As implicações do estudo juntamente com suas limitações foram discutidas e recomendações para pesquisas futuras foram altamente sugeridas.

In vivo induction of hepatocellular carcinoma by diethylnitrosoamine and pharmacological intervention in Balb C mice using Bergenia ciliata extracts / Indução in vivo de carcinoma hepatocelular por dietilnitrosoamina e intervenção farmacológica em camundongos balb c usando extratos de Bergenia ciliata

Abstract Background Hepatocellular carcinoma is the most frequent primary malignancy of liver and accounts for as many as one million deaths worldwide in a year. Objectives The aim of the present study was to evaluate the anti-cancerous efficiency of Bergenia ciliata rhizome against diethylnitrosoamine induced hepatocarcinogenesis in Balb C mice. Methods One percent diethylnitrosoamine was prepared by using 99 ml of normal saline NaCl (0.9 percent) solution to which was added 1 ml of concentrated diethylnitrosoamine (DEN) solution (0.01 μg/μl). Extract of Bergenia ciliata was prepared by maceration technique. Mice were classified into four groups as follows: Group 1 a control group (N=7) received saline solution (3.5 μl/mg), group 2 (N=14) received diethylnitrosoamine (3.5 μl/mg) intraperitoneally once in a week for eight consecutive weeks, group 3 (N=7) received plant extract (150 mg/kg (Body weight)) once in a week, while group 4 (N=7) was given combination of diethylnitrosoamine (3.5 μl/mg) and plant extract (150 mg/kg (Body weight)). After eight weeks of DEN induction group 2 mice were divided into two subgroups containing seven mice each, subgroup 1 was sacrificed while subgroup 2 was treated with plant extract (150 mg/kg (Body weight)) once in a week for eight consecutive weeks. Results The model of DEN injected hepatocellular carcinomic (HCC) mice elicited significant decline in levels of albumin with concomitant significant elevations in tumor markers aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alpha feto protein (AFP), gamma glutamyl transferase (Y-GT), 5 nucleotidase (5NT), glucose-6-phosphate dehydrogenase (G6PDH) and bilirubin. The intraperitoneal administration of B. ciliata as a protective agent, produced significant increase in albumin levels with significant decrease in the levels of tumor markers aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alpha feto protein (AFP), gamma glutamyl transferase (Y-GT), 5 nucleotidase (5NT), glucose-6-phosphate dehydrogenase (G6PDH) and bilirubin. Conclusion Bergenia ciliata has potent antioxidant activity, radical scavenging capacity and anticancerous properties. Bergenia ciliata extracts may provide a basis for development of anti-cancerous drug.

Resumo Antecedentes O carcinoma hepatocelular é a neoplasia primária mais frequente do fígado e é responsável por até um milhão de mortes em todo o mundo em um ano. Objetivos O objetivo do presente estudo foi avaliar a eficiência anticancerígena do rizoma de Bergenia ciliata contra a hepatocarcinogênese induzida por dietilnitrosoamina em camundongos balb c. Métodos Um por cento de dietilnitrosoamina foi preparado usando 99 ml de solução salina normal (0,9 por cento) à qual foi adicionado 1 ml de solução concentrada de dietilnitrosoamina (DEN) (0,01 μg / μl). O extrato de Bergenia ciliata foi preparado pela técnica de maceração. Os ratos foram classificados em quatro grupos: Grupo 1 grupo controle (N = 7) recebeu solução salina (3,5 mL / mg), grupo 2 (N = 14) recebeu dietilnitrosoamina (3,5 mL / mg) por via intraperitoneal uma vez por semana para oito semanas consecutivas, o grupo 3 (N = 7) recebeu extrato vegetal (150 mg / kg (peso corporal)) uma vez por semana, enquanto o grupo 4 (N = 7) recebeu combinação de dietilnitrosoamina (3,5 μl / mg) e extrato (150 mg / kg (peso corporal). Após oito semanas do grupo de indução DEN 2 ratos foram divididos em dois subgrupos contendo sete ratos cada, subgrupo 1 foi sacrificado enquanto subgrupo 2 foi tratado com extrato vegetal (150 mg / kg)) uma vez por semana durante oito semanas consecutivas. Resultados O modelo de camundongos hepatocelulares carcinômicos (CHC) injetados com DEN provocou declínio significativo nos níveis de albumina com elevações significativas concomitantes nos marcadores tumorais: aspartato aminotransferase, alanina aminotransferase (ALT), lactato desidrogenase (LDH), proteína alfa feto (AFP), gama glutamiltransferase (Y-GT), 5 nucleotidase (5NT), glicose-6-fosfato ehidrogenase (G6PDH) e bilirrubina. A administração intraperitoneal de B. ciliata como agente protetor produziu um aumento significativo nos níveis de albumina com uma diminuição significativa nos níveis dos marcadores tumorais: aspartato aminotransferase, alanina aminotransferase (ALT), lactato desidrogenase (LDH), proteína alfa feto (AFP), gama glutamiltransferase (Y-GT), 5 nucleotidase (5NT), glicose-6-fosfato desidrogenase (G6PDH) e bilirrubina. Conclusão Bergenia ciliata possui atividade antioxidante potente, capacidade de eliminação de radicais livres e propriedades anticancerígenas. Extratos de Bergenia ciliata podem fornecer uma base para o desenvolvimento de drogas anti-cancerígenas.

Approaches for preparation methods of Murakkab, an Unani formulation

Murakkab drugs of Unani medicine have remained an important aspect of disease treatment since antiquity. Physicians prepared different formulations for various diseases. The formulations thus preparedhave always been of two categories. One category of Murakkab drugs was those which were formulatedempirically and remained in use without conceptual framework behind these formulations. These formulations were categorized as Mujarrab (tested) formulations. The other category of formulations wasprepared in consideration with theoretical framework of Mizaj (temperament) and Usoole ilaj (treatmentstrategy) and then tested by physicians. This category forms a large chunk of formulations in the formulary sections of the literature of Unani medicine. Present paper explores various approaches forformulating Murakkab drugs of the second category keeping in view the actions of the ingredients of thedrug formulation, and treatment strategy of the disease for which the formulation was prepared. Itelucidates the approaches of formulating compound drug formulations with the logic of includingvarious individual ingredients. The study exemplifies two compound formulations to illustrate the approaches used to formulate compound formulations of Unani medicine.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Frequency, Risk Factors and Outcome of Clinical Management of Intrauterine Growth Restricted Infants in a Tertiary Care Hospital in Bangladesh

Background: Fetal growth is a complex process whichdepends on nutrient and oxygen availability and transport fromthe mother to the fetus across the placenta. This involveshormones and growth factors as well as maternal and fetalgenes. The failure of the fetus to reach his or her full potentialfor growth is called intrauterine growth restriction (IUGR) andimplies risk for adverse short- and long-term outcomes.Objective: To study the frequency, risk factors and outcome ofthe clinical management of IUGR infants in the NICU of atertiary care hospital.Methods: This case control study was conducted from August2015 to July 2016 in the department of Neonatology,Bangabandhu Sheikh Mujib Medical University (BSMMU). Priorapproval from Institutional Review Board (IRB) for this researchwork was taken.After taking consent from parents/Guardians, particulars of theneonates, antenatal, natal and postnatal history were recordedin a data collection form. All Newborn in the NICU during studyperiod were the study population. Newborn who meet theinclusion criteria were divided into two groups as case group(IUGR babies) and control group (AGA babies). The riskfactors were identified by taking face to face interview ofmother regarding prenatal period whereas the outcome ofclinical management was observed by the caution and carefulNICU follow up of the baby. Data were analyzed by statisticalpackage for social sciences (SPSS) version 20. At firstfrequency of IUGR was found among all admitted newborn.Risk factors were analyzed to calculate the odds ratio. Thenrisk factors were analyzed with chi square test to find outsignificant risk factors. P values less than 0.05 (95% CI) wereconsidered statistically significant.Results: The frequency of IUGR babies in this one year studywas found 11.86%. Congenital malformation (p=0.02) wasfound as significant fetal risk factor. Congenital CMV infectionwas found in 16.3 % case of IUGR babies. Maternal weight(p=<0.001), height (p=<0.001), socioeconomic status of mother(p=0.001), Inter pregnancy Interval (p=0.04), placentalinsufficiency (p=0.001), Pregnancy Induced hypertension(p=0.001) are significant maternal risk factor. Hypoglycemia(p=0.007) and hyperbilirubinemia (p=<0.001) were foundsignificant co-morbidities. Length of hospital stay wassignificantly higher among IUGR babies (p= 0.001) thatproclaim the outcome of clinical management. In case group16.3% and in control 8.2% babies expired even after providingall available standard clinical management. Most of thepatients died due to sepsis in both the groups. But the mortalityshowed no significant differences as outcome of clinicalmanagement.Conclusion: IUGR babies in BSMMU was 11.86%. Maternalweight, height, inter pregnancy interval, socioeconomic status,Pregnancy induced hypertension, placental insufficiency, lessANC visits were maternal risk factors for IUGR babies.