Treating Asthma in Pregnancy - An Update.

Asthma is one of the most common chronic medical conditions affecting the lungs during pregnancy. At any given time, up to 8% pregnant women have asthma. During pregnancy, asthma not only affects the woman, but it can also cut back on the oxygen to fetus. But this does not mean that having asthma will make pregnancy more difficult or dangerous to fetus. Pregnant women who have asthma that is properly controlled generally have normal pregnancies with little or no increased risk to pregnant women or their developing babies. Currently available national guidelines for the treatment of asthma during pregnancy emphasize the objective measurement of control, patient education, motivation, caution and medication adherence. The article reviews the available literature highlighting the appropriate selection of medications in the treatment of asthma during pregnancy, and to identify those factors which may influence the asthma care provider's ability to successfully manage this condition, and also illustrate that maintaining asthma control with long term medications in pregnancy is safer than the risk of uncontrolled asthma or untreated exacerbations for both the mother and the fetus. Women's drug treatment during pregnancy should be regularly assessed in the light of asthma control criteria.

Sturge-Weber syndrome-A Case report.

Sturge-weber syndrome is a disease characterized by capillary or cavernous haemangionsm (Port-wine stain) along the cutaneous division of Trigennial nerve. There is venous haemangionsm in subjacent leptomeninges, which may spread causing atrophy of cortex. The patient Md. Zobair Hossain, 11 years old boy, nondiabetic, nonhypertensive presented to us on 20.05.2011 with the complaints of repeated bleeding from a swelling over the outer aspect of right eye ball for 1 month, weakness of left half of body for 1 year and repeated convulsion for 7 years. Diagnosis was confirmed vy CT scan of brain. Through treatment is unsatisfactory, he was advised for laser theraphy for coetaneous lesion and anti-convulsant drug epilepsy.

Management of Inflammation in Chronic Obstructive Pulmonary Disease-Update.

Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory condition, the earliest manifestation of which is airway obstruction which is only partially reversible and the treatment rationales are provided accordingly. Research has shown that COPD-inflammation involves multiple inflammatory cells and mediators and the underlying pathology differs from asthma inflammation.For these reasons, therapeutic agents that are effective in asthma patients may not be optimal in COPD patients. COPD exacerbations are intensified inflammatory events compared with stable COPD. The clinical and systemic consequences believed to result from the chronic inflammation observed in COPD, suggest that inflammation intensity is a key factor in COPD and exacerbation severity and frequency. Although inhaled corticosteroids are commonly used and are essential in asthma management, their efficacy in COPD is limited, with only a modest effect at reducing exacerbations. The importance of inflammation in COPD needs to be better understood by clinicians, and the differences in inflammation in COPD versus asthma should be considered carefully to optimize the use of anti-inflammatory agents. Current COPD management focuses predominantly on symptom relief by optimizing bronchodilatation. The role of phosphodiesterase type 4 inhibitors (PDE4), statins, angiotensin converting enzyme inhibitors, theophylline and tumor necrosis factor inhibitors in COPD management will be reviewed. Targeting COPD inflammation with the goal of reducing exacerbations is a major focus of current clinical practice & outcome research.

Outcome of Upper Gastro Intestinal Haemorrhage - a Hospital Based Prospective Study.

Upper GI bleeding is a common medical emergency with a significant mortality, outcome of which depends upon the cause, appropriate and early intervention in a specialized center. This study was carried out to see the outcome of patient with Upper GI haemorrhage. Fifty cases with episode of upper gastrointestinal haemorrhage, admitted into medicine units of Faridpur Medical College Hospital from January 2011 to December 2011, were studied. Duodenal ulcer was the commonest cause of haematemesis and melaena followed by oesophageal varices, gastric ulcer and erosive gastritis. The peak incidence was among 35 to 45 years of age. Over all male female ratio was 4.55:1 but in case of duodenal ulcer it was 9:1. During hospital stay recurrent bleeding was noted in 10% of patients and during subsequent follow up it was 10% of the total and 50% in case of variceal bleeding group. Over all hospital mortality was 4% .

A Case Report on Recurrent Lepra Reaction-Type 2.

Lepra Reactions (LR) comprises immunologically mediated inflammatory states that cause considerable morbidity. Type-2 LR occurs exclusively in patients with the lepromatous end of the leprosy spectrum (BL-LL). In 90% of the cases it follows during or after completion of chemotherapy, generally within 2 years. Here we report a case of type-2 LR. He is a twenty years old fisherman with history of hypopigmented skin lesion 3 years back and was treated as a case of lepromatous Leprosy (LL). After six months of completion of treatment he developed type-2 LR presenting with recurrent bouts of fever, polyarthritis, erythema nodusum, orchitis, mononeuritis multiplex and was treated in Faridpur Medical College Hospital (FMCH) on three occasions within last one and half years.

Evaluation of Prescribing Pattern of the Private Practitioners in Bangladesh.

A prescription order is a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines. This study was undertaken to observe the prescribing patterns of the private practitioners in Bangladesh, 430 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 3.40 drugs per prescription. Drugs were prescribed in generic name only in 0.20%. About 46.31% drugs were prescribed from the Essential Drug List, only 19% of prescriptions were complete in respect to patient medication information. Antibiotics were prescribed in 70.33% of the prescriptions; injections were prescribed in about 8.35% of the prescriptions.

Effects of Methanol Extract of Piper chaba Stem Bark on Acute Inflammation in Rats.

The plant Piper chaba Hunter (Piperaceae), a climbing glabrous shrub grows in plenty in southern Bangladesh. Popularly known as 'Choi' it is used as spices and believed to have medicinal value in a wide variety of disease conditions including arthritis, asthma, bronchitis and piles. In the present study, effect of methanol extract of Piper chaba stem bark on acute inflammation has been reported. The anti-inflammatory effect was studied in rats by injecting 0.1ml of 1% carrageenan suspension into the planter surface, where oedema of the rat's hind paw was used as an index of acute inflammation. Methanol extract of Piper chaba stem bark given orally 1 hour before injection at doses of 125 and 250 mg/kg body weight, produced significant (p< 0.05) anti inflammatory effect compared to control and the percentage of inhibition of oedema formation was 33% and 35% respectively, which however was less compared to aspirin (46%) and hydrocortisone (56%). The result suggest that in case of acute inflammation, Piper chaba stem bark possess mild to moderate anti inflammatory effect compared to that of aspirin and hydrocortisone.

Familial Hypoparathyroidism with Pregnancy- Challenging Issue for Patient as well as for Physician.

Familial hypoparathyroidism is a rare cause of hypoparathyroidism. It may be x-linked recessive, autosomal dominant or autosomal recessive. In autosomal dominant hypoparathyroidism there is activating mutation of the calcium sensing receptor leading to inhibition of Parathormone (PTH) secretion at inappropriately low serum ionized calcium level. The disease often manifests in the first decade but may appear later. Clinical signs primarily involving neuromuscular disturbances including generalized seizure. Management of pregnancy in hypoparathyroidism is challenging as both under treatment and over treatment is dangerous for fetus. Treatment of hypoparathyroidism in pregnancy includes combination of oral calcium supplementation with calcitriol with an aim to keep serum calcium within normal range. Here we discussed a case of 21 year pregnant lady with familial hypoparathyroidism with successful delivery of a healthy baby.

Improper Inhalation Technique-A Barrier to Good Asthma Control.

Bronchial Asthma (BA) is a chronic airway disorder with significant morbidity and mortality but due to recent advances in the field of medicine most patients with BA can have complete symptom control and live a normal life. There are various routs of drug delivery for asthma control but among them aerosol inhalation is considered the optimal route. A number of pressured Metered Dose Inhalers (MDI) & Dry Powder Inhalers (DPI) are available for this purpose. However inhalation of therapeutic aerosols is not without difficulty, it requires precise instructions on the inhaler maneuvers, which is different from spontaneous normal breathing. Also, the characteristics of the inhaler device have to be suitable for the user. Available data indicate that, lack of knowledge demonstrated by health professionals & patients on the inhalation maneuvers & handling of inhalers resulting in a reduction of therapeutic benefit. The paper reviews the literature concerning the fundamental aspects of inhaler devices, inhalation maneuvers & device selection, in an attempt to increase the knowledge of and to optimize the clinical use of therapeutic inhalers. As a result of which Asthmatics can be kept under good control.

Prospective Study of Bronchial Asthma.

Bronchial asthma is an atopic disease characterized by chronic airway inflammation and hyper-responsiveness. Severe acute asthma is a medical emergency and sometimes difficult to treat. This prospective study was done at Dhaka Medical College Hospital from January 1997 to January 1998. Total 30 patients of bronchial asthma were included in this study. Diagnosis was established on the basis of symptoms, evidence of airflow obstruction and its reversibility by bronchodilator therapy. The age range was 18 to 80 years with a mean 36.64±4.91. Of them, 63% were male and 37% were female. It revealed that all patients had classical triad of dyspnoea, wheeze and cough. Almost all patients (80%) had some precipitating agents for their attack. Regarding treatment of severe acute asthma - Nebulized salbutamol is superior to conventional intravenous aminophylline, as p value of nebulized salbutamol group is <0.001 which is significant. So, severe acute asthma should be managed with nebulized salbutamol instead of intravenous aminophylline.

Demographic Profile, Clinical Presentation & Angiographic Findings in 637 Patients with Coronary Heart Disease.

Cardiovascular diseases are the commonest cause of death globally and are the major contributor to the burden of premature mortality and morbidity. This study analyses various clinical presentations, conventional risk factors, pattern and severity of coronary heart disease on angiography among 637 patients with coronary heart disease and adult congenital heart disease who underwent cardiac evaluation at National Institute of Cardiovascular Disease (NICVD), Dhaka between January 2007 to December 2008. Among them 547 (85.9%) were male and 90 (14.1%) were female. All of them were between 22 to 76 years of age with mean age 50.15±8.8. One hundred sixty nine (25.9%) patients had chronic stable angina & 398 (62.48%) patients subjected for coronary angiography for acute coronary syndrome and or old myocardial infarction and 74 (11.62%) patients with vascular and adult congenital heart disease prior to surgical treatment. Most prevalent risk factors were smoking (60%) and dyslipidaemia (60%). Thirty five percent patients were hypertensive and 10% patient had diabetes. Normal epicardial coronaries were documented in 25.59% patients which includes the patients who underwent coronary angiography prior to surgical treatment. Ninety three (14.6%) had single vessel disease, 119 (18.68%) had double vessel disease, 259 (40.66%) had triple vessel disease and 3 (0.47%) had isolated left main disease.

Clinical Presentation, Histological Findings and Prevalence of Helicobacter pylori in Patients of Gastric Carcinoma.

Carcinoma stomach is the second leading cause of cancer death worldwide. This study was undertaken to determine the clinical and pathological profile of carcinoma stomach in Bangladesh and to find out the prevalence of H. pylori infection in carcinoma stomach subjects. Patients with carcinoma stomach confirmed on histopathology were included in the study. Data were recorded regarding demography, clinical features, blood group of the patients, location and macroscopic type of the cancer at endoscopy. Three to five biopsies from non-necrosed region and two paired biopsies from non-cancerous part of stomach were taken. One piece of each paired specimen was placed in the urea-agar media for CLO test and the other piece was used for histological examination. Out of 50 patients, 64% were male and 36% were female. The mean age was 51.05±14.98 years. Common presenting complains were dyspepsia/ abdominal pain, vomiting and dysphagia; abdominal mass, metastatic lymph node and ascites were predominant signs. About one third (34%) patients had blood group A. About 50% cancer was located in antrum followed by antrum and body (24%), then body (18%), fundus and body (4%) and fundus (4%). In 56% cases the lesion was ulcerative followed by polypoid (34%) and ulceroinfiltrative (10%). Histopathologically 52% was intestinal type, 28 % was diffuse type 20% was poorly differentiated adenocarcinoma. The prevalence of H. pylori in overall carcinoma stomach cases was 60% but individually in intestinal type 88%, in diffuse type 57% and in poorly differentiated type 50%.

" Lutembacher's Syndrome " - A Case Report.

Lutembacher's Syndrome is a rare heart disease comprises ASD (congenital) secundum with Mitral stenosis (Rheumatic origin). The patient Md. Mosharraf Hossain, 72 years old man, non diabetic, non hypertensive, smoker admitted in FMCH on 10.10.2010 with the complaints of respiratory distress and chest pain for 10 days. He had a previous history of Rheumatic fever in early childhood. There was history of recurrent attack of Rheumatic fever. Subsequently he developed MS from Rheumatic carditis. ASD was congenital in origin. If diagnosis could be done earlier, surgical closure of ASD with replacement of mitral valve bears a good prognostic value. Our patient is in elderly age and already developed pulmonary hypertension, operative procedure is not suitable. So the patient should be kept in conservative treatment.

Incretin-Based Antidiabetic Agents: A New Option for Type-2 Diabetes Mellitus.

Type 2 Diabetes Mellitus (T2DM) is a complex disease with the co-existence of several pathophysiological abnormalities. Both microvascular and macrovascular complications are the main causes of morbidity and mortality, which develops due to endothelial dysfunction. Upregulation of reactive oxygen species, chronic inflammatory and hypercoagulable states are the pathologic basis of vascular dysfunctions in T2DM. To overcome all these abnormalities, different classes of antihyperglycaemic agents have developed. Unfortunately none is able to show satisfactory glycaemic control and to modulate vascular dysfunction. Incretin hormones are secreted from intestine during meal, which enhance insulin secretion and inhibit glucagon secretion from the pancreas. The incretin effect is severely reduced or absent in T2DM. Incretin-based new antidiabetics, both Dipeptidyl Peptidase-4 (DPP-4) inhibitors (Saxagliptin, Sitagliptin, Vildagliptin) and Glucagon Like Peptide-1 (GLP-1) analogs (Exenatide) are now being used globally. They are almost equally effective as conventional antidiabetics like Sulphonylureas (SU), Metformin (MET), Thiazolidinediones (TZD) and insulin when given as monotherapy or combined with SU, MET or TZD as second line agent. Incretin-based agents do not cause hypoglycaemia, produce weight loss in spite of weight gain and do not retain salt or water and almost no gastrointestinal (GIT) symptoms. The agents correct vascular dysfunctions and dyslipidaemia and can be given in elderly and renal impaired patients.