ABSTRACT
Background: Peptic ulcer disease is a global burden of disease associated with potentially life-threatening complications, including bleeding, perforation and obstruction. Perforated peptic ulcer (PPU) is a frequent emergency condition worldwide with associated morbidity and mortality. Variations in the clinical presentation, as well as delay in diagnosis and work-up at admission to the hospital, may potentially cause a worsening of symptoms and a deterioration of the clinical condition, with a detrimental outcome. Therefore, accurate and early identification of high-risk surgical patients with perforated peptic ulcers (PPUs) is important for triage and risk stratification. Currently, the ASA score and the Boey score are the most frequently used prognostic scoring systems in patients with PPU. Yet, the ASA score is a general surgical risk score not intended for PPU patients in particular. Moreover, the external validation of the Boey score is uncertain. PULP score appears to have the greatest predictability of the outcome of perforated PUD. Aim of the study: The objective of the study was to evaluate the role of the PULP score in the prediction of outcomes in patients with a perforated ulcer.Material & Methods:It is an observational cross-sectional study, carried out in the Department of Surgery, Dhaka Medical College Hospital, Dhaka. Ethical approval was obtained from the Dhaka Medical College ethical review board. Patients aged 18 to 60 years admitted to the emergency department with a clinical diagnosis of perforated peptic ulcer disease, confirmed by different investigation modalities, e.g, imaging, sonography, laboratory test, etc were enrolled in the study. The data regarding sociodemographic, clinical, biochemical, radiological and surgical profiles were recorded. The operation was done by upper midline incision under general anesthesia. A modified Graham’s patch technique was used to repair the duodenal ulcer. Postoperative follow up was conducted meticulously. Patient outcome was assessed during their hospital stay and then OPD follow-up or by telephone interviews up to 30 days after the intervention. All the information is recorded in the data collection sheet. All collected questionnaires were checked very carefully to identify the error in the data. Data processing work consisted of registration schedules, editing computerization, preparation of dummy tables, and analyzing and matching data. Data was processed and analysed with the help of the computer program SPSS and Microsoft excel. Quantitative data are expressed as mean and standard deviation and qualitative data as frequency and percentage. The comparison was done by tabulation and graphical presentation in the form of tables, pie charts, graphs, bar diagrams, histograms &charts etc.Results:Present study demonstrates that the maximum number of patients (43.0%) was between 51-60 years of age group, mean age of the patient was 49.35 ± 11.7 years. The male and female ratio was 3.54:1. Maximum (57%) patients came from urban, (36%) rural and (7%) urban non-slum areas. In this study, the most common signs were tachycardia (100%), abdominal tenderness (100%), abdominal rigidity (100%), absence of vowel sound (86.2%), and obliteration of liver dullness (78.7%), dehydration (67.5%). The time lapse between the onset of symptoms and admission to the hospital varied from 4 hours to 4 days. Most of the patients (76.0%) were admitted after 24 hours. In this study, PULP score was assessed according to the operational definition of optimal cut-off point 7, below this considered as low-risk patients. in this study 85% were 0-7 PULP scores and 15% were PULP scores 8-18. Patients’ condition after proper treatment, symptoms, degree of abnormalities or dependence on the daily physiological activity and the clinical outcome had evaluated and measured by follow up and close monitoring. The study shows that 69.0% of the patients recovered completely, but 24.0% of patients had developed complications. The mortality rate in this study was 7.0%. Finally, a correlation of the PULP score with mortality of perforated PUD was carried out. Among the 7 expired cases the, PULP score was correlated with 6 cases like high risk. In 93 cases of recovered, the PULP score was predicted in 84 cases as low risk. So the effectiveness of PULP has proven significant in the prediction of mortality in perforated PUD patients. The Sensitivity and Specificity of the Peptic Ulcer Perforation (PULP) score was 85.7% and 90.3% respectively. Similarly, the positive predictive value and accuracy rate for the same was 40.0% and 90.0% respectively.Conclusion: Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Several prognostic scoring systems have been suggested to identify high-risk surgical patients with perforated peptic ulcers accurately and early. The present study demonstrates that the PULP score can be used to predict 30-day mortality accurately in patients operated for PPU. The prognostic predictors included in the PULP score can be readily identified prior to surgery. The PULP score can assist in the accurate and early identification of high-risk patients with PPU.
ABSTRACT
This study was designed to inspect the association between tumor necrosis factor (TNF)-α-308G/A (rsl800629)polymorphism with diabetes mellitus type-2 (DMT2) in Bangladeshi population. Besides, the role ofTNF-α-308G/A in early proliferation of DMT2 has been investigated. The allelic frequency of TNF-α-308G/Aand their association with DMT2 was studied using high resolution melting (HRM) analysis and confirmedusing sequencing. A few demographic risk factors associated with DMT2 were also investigated routinely.The significance of these risk factors was analyzed statistically. We have analyzed 657 individuals who weredistributed into two groups: 330 non-diabetic controls and 327 DMT2 individuals. HRM analysis showsthat 11 individuals bare G/A and 2 bare A/A genotype in DMT2 patients. Within non-diabetic individual,we found only one with G/A genotype. The frequency of TNF-α-308G>A are within the Hardy–Weinbergequilibrium (0.00482) at 95% confidence level. TNF-α-308G>A frequency in two age group based on firsttime diagnosed, we found association with early proliferation of DMT2 with a p-value of 0.008965 in Fisher’stest at 95% confidence level. Our result suggested that the single nucleotide polymorphisms TNF-α-308G>Ais closely associated with DMT2 patients in Bangladeshi population. Besides, presence of TNF-α-308G>Apolymorphism increases the risk of early proliferation of DMT2.
ABSTRACT
Zika virus (ZIKV) is an aedes mosquito borne pathogen belonging to the member of flaviviridae subgroup is the causative agent of an emerging disease called Zika fever, known as a benign infection usually presenting as influenza like illness with cutaneous rash. Due to recent epidemic outbreaks it is realized as a major health risk which need enhanced surveillance, but no attempt has been made to design an epitope based peptide vaccine against Zika virus. Viral envelope proteins are derived from host cell membrane proteins with some viral glycoproteins and are used to cover their protective protein capsid, help the viruses to enter host cells and help them to avoid the host immune response. In this study, amino acid sequence of ZIKV envelope glycoprotein was obtained from a protein database and examined with in silico approaches to determine the most immunogenic epitopes for B cell and T cell which could induce humoral as well as cell mediated immune response. Both the linear and conformational epitopes for B cell were predicted by immunoinformatics tools housed in IEDB resources. The peptide sequence DAHAKRQTVVVLGSQEGAV from position 121 and peptide sequence from 117-137 amino acids were predicted as most potential B cell linear and conformational epitopes respectively. Epitopes for CD4+ and CD8+ T cell were also predicted by using tools within IEDB resource and peptide sequence MMLELDPPF from position 250-258 amino acids was predicted as most immunogenic CD8+ T cell epitope with immune response evoking ability prediction score (I pMHC) of 0.09139 and conservancy of 52.17%. The innate immune response for ZIKV envelope glycoprotein was determined by interferon (IFN)-gamma effectuation and mimicking capacity by immunoinformatics and molecular docking study respectively. However, this is an introductory approach to design an epitope based peptide vaccine against Zika virus; we hope this model will be very much helpful in designing and predicting novel vaccine candidate.
ABSTRACT
Cassia senna leaves belonging to the family Fabaceae have been investigated for the presence of its secondary metabolites and evaluation of biological activities of the crude extracts with special emphasis to the antimicrobial activity, cytotoxic activity and thrombolytic activity. The antimicrobial activities of n-hexane, chloroform, ethyl acetate & methanolic extracts of C. senna leaves were screened against five gram(+) bacteria, eight gram(-) bacteria and three fungi by ‘disc diffusion method’. The methanol extract possesses no antimicrobial activity but chloroform and n-hexane fractions exhibited moderate to less activity against some organisms tested compared with the standard antibiotic Kanamycin. Brine shrimp lethality bio-assay was done using brine shrimp Nauplii and dimethyl sulfoxide as a solvent for the methanol extracts of C. senna. The LC50 value (1.5625) of methanol extract of the plant indicated that the cytotoxicity was very significant. The percentages found in thrombolytic tests are 41.46%, 53.22%, 33.33%, 4.08% and standard 92.85%. So, in comparison with standard, C. senna can be further use as mild thrombolytic agent.