Phyto-metals screening of selected anti-diabetic herbs and infused concoctions

Objective To determine the levels of some selected heavy metals in both the selected anti-diabetic herbal plants and infused concoctions for diabetes treatment. Methods Ten anti-diabetic plant samples: pawpaw leaves (Carica papaya), bitter melon leaves (Momordica charantia), holy basil leaves (Ocimum sanctum), bitter leaf (Vernonia amygdalina), ginger rhizome (Zingiber officinale), garlic (Allium sativum), African red pepper fruits (Capsicum frutescens), negro pepper grain (Xylopia aethiopica), cashew leaves (Anacardium occidentale) and onion bulb (Allium cepa) were evaluated for heavy metals. These were digested using standard methods and analyzed for manganese, copper, nickel, chromium, zinc, cadmium and lead using atomic absorption spectrophotometer. The infused concoctions (I and II) prepared from these medicinal herbs administered to diabetic patients were also analyzed for these heavy metals. Concoction I contained all the plants and honey with the exception of Momordica charantia and Ocimum sanctum which constituted concoction II with water only. The data obtained were subject to descriptive (mean and standard deviation) and inferential (ANOVA and DMRT) statistics. Results Chromium and nickel levels were below detection limits in concoction I while manganese [(0.11 ± 0.01) μg/g] and zinc [(0.09 ± 0.01) μg/g] were detected in concoction II. Honey contained manganese [(0.10 ± 0.01) μg/g] and nickel [(0.70 ± 0.01) μg/g]. The anti-diabetic medicinal herbs and infused concoctions (I and II) were observed to contain heavy metals below the compared limits. Conclusions The study thus shows that the herbs and concoctions are safe from the heavy metals considered. However, right dosage of the anti-diabetic concoctions should always be considered to prevent possible chronic side effects from bio-accumulation of heavy metals.

Comparative Studies of Therapeutic Effect of Leaves, Stem Bark and Root Bark Extracts of Afzelia africana (Smith) in Mice Challenged with Trypanosoma brucei brucei.

Background: Traditional and complimentary health care is inarguably the system most close to homes, accessible and affordable. It is also culturally acceptable and trusted by large numbers of people. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health-care costs, neglect of orphaned/non profitable diseases and nearly universal austerity. Aim: Aqueous leaf, stem bark and root bark extracts were evaluated for their anti trypanosomal effect in experimental trypanosomiasis with a view to come up with a phytomedicine that is efficacious, available, accessible and non-toxic to both humans and animals. Study Design: Complete randomized clinical trial design was used in the experiment. Methodology: Ninety five (95) mice were grouped into three (I, II, III) of thirty mice each (with sub groups A, B, C, D, E, and F consisting of five mice each) to which the leaf, stem bark and root bark extracts were administered at a dose of 100, 200, 300, 400 mg/Kgbw, while the remaining five mice served as the control for all the groups. Results: The aqueous leaves extract at doses of 100, 200 and 300 mg/Kg bw portrayed very low activities except for the 400 mg/Kg bw that displayed a sustained Trypanostatic effect. The aqueous stem bark extract, at doses of 100 and 200 mg/Kg bw portrayed trypanostatic effect while doses of 300 and 400 mg/Kg bw effectively cleared the parasites from circulation on the 13th and 17th days into the treatment respectively. Three and two of treated mice survived and remained apparasitaemic for up to 120 days and beyond in the group treated with 300 and 400 mg/kg bw respectively. In the group treated with the root bark extract, the mice on a dose of 100 mg/Kg bw died some few days into the experiment (6th day) while the dose of 200 mg/Kgbw sustained the animals until the 19th day. Doses of 300 and 400 mg/Kg bw were observed to clear the parasites in circulation after sustained administration for 23 and 16 days respectively. Conclusion: This study has demonstrated the potency of the stem bark and root bark crude extracts of Afzelia africana in treating experimental trypanosomiasis and can thus be further purified and packaged as phytomedicine against this dreaded but neglected disease.

Development and evaluation of Methocel K15M based Theophylline floating tablets.

The purpose of the investigation highlights the formulation and optimization of floating tablets containing theophylline as a model drug. Formulations were optimized for different concentrations of cetyl alcohol, citrc acid and methocel K15M by direct compression method. The dissolution study of the tablet matrices of 9 different formulations were carried out in 0.1N HCl as the medium (pH 1.3) for 8 hours using USP type II dissolution apparatus. It was observed the floating lag time for the tablet was 30 seconds and the total floating time was more than 8 hours. The drug release pattern was simulated in different kinetic orders such as Zero Order, First Order, Higuchi, and Korsmeyer release kinetic model. From the study, we observed that Higuchi release kinetics was predominant over other release kinetics and diffusion was the drug release mechanism from the matrices. Korsmeyer-Peppas release kinetics suggests that formulation F3, F4 and F9 followed Fickian type release mechanism whereas formulation F1, F2, F5, F6, F7 and F8 followed Non-Fickian type release mechanism. Thus, it is possible to design theophylline loaded Methocel K15M sustained release matrix tablets with desirable release characteristics by judicious and critical combination of Methocel K15M with other hydrophilic materials.

Pattern of Drug Abuse among Patients in Some Selected Addiction Rehabilitation Centers in Dhaka City.

This study was done to find the pattern of drug abuse and its associated factors among the patients admitted in addiction rehabilitation centers. This descriptive cross sectional study was conducted among 150 drug addicted patients at the central drug addiction cure center at Tejgaon, Dhaka. Data were collected with a pre tested structured questionnaire. The study was conducted under the department of community medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka during March to May 2008. Among the 150 respondents, males constituted 87%, females 12.7%. Most of the respondents (49.3%) were in the age group twenty five to thirty five years. Ninety two percent (92%) of respondents were Muslims, 78.62% urban dwellers, 14.0% from rural areas and 7.33% came from nearby slums. Literacy rate of drug abusers was 81.3%. 33.3% were unemployed, mean family monthly income was ten thousand taka. Drug of initiation was ganja/cannabis in 48.0% and finally addicted to heroin. Inhalation was the route of choice (56.6%), oral route 30.9% and intravenous drug users (IDU's) 12.5% were remarkable. Peer pressure was a major contributing factor 55.5% for drug initiation. Black market (illegal spot) 77.3% was mainly the source of procurement of drug. Mean duration of drug intake was 4.2 years. Significant association was found between male sex and drug intake (p<0.05), and between age group 25-35 years and drug intake (P< 0.05). Drug dependence is highly prevalent among educated people. Familial confliction and peer pressure lead to different drug abuse.

Unmet Need for Family Planning among Married Women: Experience from Rural and Urban Communities.

Unmet need for family planning is the key indicator to achieve Millennium Development Goal by the year 2015. Bangladesh Government has a great success in family planning sector but population has almost doubled in recent years. This study was carried out among married women to compare the determinants of unmet need for family planning among rural and urban communities during the period from July 2010 to June 2011. Unmet need for family planning in rural community was found 18(12%) and in urban community it was 38(25.3%). Among rural women unmet need for limiter was 13(8.6%) and spacer was 5(3.4%) while limiter 29(19.4%) and spacer 9(5.9%) found among urban women. Mean age at marriage was found 17.97(SD±2.66) years and mean age at first child birth was 19.91(SD±2.71) years among rural women. Among urban women mean age at marriage was found 20.43(SD±4.08) years and mean age at first child birth was 22.55(SD±4.3) years. Current contraceptive users among rural women was 79(52.7%) while it was 61(40.7%) among urban women. In this study, association between unmet need for family planning and freedom of choice of contraceptives was highly significant (p=0.001). To increase contraceptive prevalence rate and reduction of unplanned pregnancy, more emphasis should be given on unmet need for family planning.

Risk factors of bronchial asthma in two contrasting settings–metropolitan and coastal areas of Bangladesh: A case control study.

Background. Seven million people are suffering from bronchial asthma in Bangladesh. But scanty data is available to explain the risk factors for asthma in Bangladesh. Methods. This population-based, age, sex, and economic status matched case-control study was conducted to identify the risk factors responsible for the development of bronchial asthma in two contrasting settings, the metropolitan capital city and coastal area of Bangladesh. A structured pre-tested questionnaire was filled up by face-to-face interviews with the patients or parents of patients with bronchial asthma and the normal controls after a respiratory physician confirmed the diagnosis on the basis of history, physical examination and spirometry. Results. Presence of allergic problems was recognised as risk factors for the development of bronchial asthma. Concomitant existence of atopic diseases, like allergic rhinitis, eczema and allergic conjunctivitis were found to be significant risk factors in both the settings. History of early childhood lung infections, like pneumonia, bronchiolitis and intake of antibiotics and paracetamol in last 12 months were also observed to be the risk factors in both the areas. Though most of the so-called allergic foods were statistically found to be a protective factor in both the settings [odds ratio (OR) 0.48, 95% confidence intervals (CI) 0.37-0.63 in city area and OR 0.80, 95% CI 0.66-0.96 in coastal area], this was considered to be an artifact. Conclusions. Several common risk factors for the development of bronchial asthma were identified in both city and coastal areas of Bangladesh. Bronchial asthma prevention campaign in Bangladesh may focus on sensitising the people on these risk factors.

Clinicopathological correlation of blistering diseases of skin.

Blistering diseases are alarming skin conditions where blister formation occurs in various ways and cannot be differentiated clinically. For confirmation of diagnosis, along with routine histological examination, immunofluorescence study is essential. Tzanck smear may be used as a rapid diagnostic tool. We included here 34 cases of different blistering lesions. Other than routine Hematoxylin and Eosin stain, direct immunofluorescence test was done in 31 cases, indirect immunofluorescence in 28 cases and Tzanck smear in 33 cases. Direct immunofluorescence stain was also applied on Tzanck smears. The most frequent diagnoses were pemphigus (n = 16), bullous pemphigoid (n = 11) and linear IgA dermatosis (n = 3). Clinical findings and histological examination were sufficient for the diagnosis of most cases. Direct immunofluorescence study is essential in many cases, and indirect immunofluorescence study is a useful method for diagnosis of some of the blistering diseases, especially in pemphigus. Direct immunofluorescence staining on Tzanck smear is a novel technique for the diagnosis of pemphigus.

Prevalence of exclusive breastfeeding in Bangladesh and its association with diarrhoea and acute respiratory infection: results of the multiple indicator cluster survey 2003.

The objective of this study was to investigate the association between the prevalence of exclusive breastfeeding and morbidity (diarrhoeal diseases and acute respiratory infection) in infants aged 0-3 month(s) using the Multiple Indicator Cluster Survey (MICS) 2003 data from Bangladesh. The study population included 1633 infants aged 0-3 month(s). The prevalence of diarrhoea and acute respiratory infection was compared using the chi-square tests between infants aged 0-3 month(s) who were exclusively breastfed and infants who were not exclusively breastfed. Logistic regression was used to adjust for confounders and for calculating adjusted odds ratios. To adjust for cluster sampling and reduced variability, the adjusted chi-square value was divided by the design effect, and a re-estimated p value was calculated. The prevalence of diarrhoea and acute respiratory infection in this sample of 0-3-month old infants in Bangladesh was 14.3% and 31.2% respectively. The prevalence of both illnesses was significantly associated with lack of exclusive breastfeeding. The adjusted odds ratio for diarrhoea was 0.69 (95% confidence interval [CI] 0.49-0.98, p = 0.039), and the adjusted odds ratio for acute respiratory infection was also 0.69 (95% CI 0.54-0.88, p = 0.003). Only 192 infants (11.7% of total sample) were exclusively breastfed at the time of interview, and 823 infants (50.3%) were never exclusively breastfed. The prevalence of prelacteal feeding was 66.6%. The results confirmed a protective effect of exclusive breastfeeding against infectious diseases-related morbidity in infancy and showed that frequently-collected cross-sectional datasets could be used for estimating effects. The low prevalence of exclusive breastfeeding in Bangladesh needs to be improved to decrease child morbidity.

Chemotherapy induced toxicities in therapeutic trials of Acute Lymphoblastic Leukaemia.

It is common practice in therapeutic trials in Acute Lymphoblastic Leukaemia (ALL) to treat chemotherapy induced toxicities. In this study, 50 newly diagnosed ALL patients were enrolled and the median age was 14.5 years. 32 patients were male and 18 female. Prognostic factors were analysed. Remission induction, consolidation and maintenance therapy with conventional combination chemotherapy and CNS prophylaxis with intrathecal methotrexate and radiotherapy were instituted to all patients for long term event free survival. Results of induction therapy and overall outcomes of treatment were observed. Chemotherapy induced toxicities were also detected and treated accordingly. These toxicities were described in 4 groups depending on the frequency of their development in chemotherapy received patients. Haematological and gastrointestinal side effects and alopecia were expected i.e., developed in >75% of patients. Prednisolone and vincristine induced toxicities were common i.e., observed in >25% of patients. Hepatic complications and anthracycline induced tachycardia were occasional i.e., occurred in <25% and localized phlebitis and/ or soft tissue necrosis were rare and accidental i.e., developed in 5% of patients.

Thoracic actinomycosis.

Thoracic actinomycosis represents about one-fourth of all cases of the disease. Isolated pleural effusion due to Actinomycosis is rare. We report a case of right sided pleural effusion with discharging sinus in the right anterior chest wall. Actinomycosis was suspected and confirmed by microscopic identification of "sulfur granules" in the discharge of the sinus tract and also identification of gram-positive filamentous bacteria in the specimen of discharging sinus. The patient improved clinically and radiologically after treatment with intravenous penicillin G followed by oral penicillin and aspiration of pleural fluid.

Effect of targeted food supplementation and services in the Bangladesh Integrated Nutrition Project on women and their pregnancy outcomes.

Monitoring data from the Bangladesh Integrated Nutrition Project and new data collected for this purpose were analyzed to assess the effects of targeted project services, including supplementation of food, on malnourished pregnant women (women with a body mass index [BMI] of < or = 18.5 in early pregnancy). Monitoring data on 456 women--195 receiving food supplement and 261 not receiving supplement--were collected from 17 upazilas (sub-districts) in four districts of Bangladesh. The assessment found that, despite lower economic status, the women with low BMI receiving supplementation of food and intensified services were more likely to have adequate pregnancy-related weight gain than the more economically-advantaged women with higher BMI. Primigravidae receiving supplementation were also more likely to have adequate pregnancy-related weight gain than the better-off non-supplemented primigravidae (85.7% vs 51.9%, p = 0.044). The mean birth-weights of infants of the supplemented women with low BMI were comparable to those of the better-off, non-supplemented women.

Prognostic factors analysis in a therapeutic trail of acute lymphoblastic leukaemia (ALL).

It is common practice in therapeutic trials in Acute Lymphoblastic Leukaemia (ALL) to analyse the impact of prognostic factors on clinical outcome. In this study, 30 newly diagnosed ALL patients were enrolled and the median age was 14.5 years. 22 patients were male and 8 patients were female. Prognostic factors analysed include age, sex, lymphomatous presentations (bulky peripheral lymphadenopathy, mediastinal mass and enlargement of spleen and liver), initial leucocyte count, blast cell morphology and bone marrow response to chemotherapy. Remission induction and maintenance therapy with conventional combination chemotherapy and CNS prophylaxis with intra thecal methotrexate and radiotherapy were instituted to all patients for long term event free survival. Results of induction therapy and overall outcomes of treatment were observed. The impacts of analyzed prognostic factors on clinical outcomes were assessed. 3 patients (10%) failed to go into remission after 12 weeks of therapy. 27 patients (90%) obtained remission. Among 27 patients those obtained remission, 17 patients continued event (failure to remit, relapse and death) free survival, 7 patients suffered relapse of their leukaemia and 3 patients died during maintenance therapy. Events were observed more among patients age group > or = 20 yrs (84%), initial WBC count > or = 50 x 10(9)/L (58%) and FABL2 morphology (80%).

Acquired pure red cell aplasia--a case report.

A married female patient of 36 years with chronic anaemia, because of pure erythroid aplasia with a haemolytic component and hypothyroidism due to antithyroid auto-antibodies, was subsequently discovered as a case of systemic lupus erythematosus (SLE). She was treated with corticosteroid and immunosuppressive therapy and her anaemia was corrected. The response of erythroid aplasia to corticosteroid and other immunosuppressive agents suggests that immunological factors play a role in erythroid aplasia in SLE. The occurrence of red cell aplasia in association with a variety of immune phenomenon supports the concept that in SLE, erythroid aplasia may be of immune aetiology.

Cancer morbidity.

In the present study, 1736 cases of cancer has been analysed by major sites, sub-sites and mortality trend. The most common cancerous lesion in the male was in the lungs and in the female in the uterine cervix. The second common lesion in male and female were larynx and breast respectively. In children, retinoblastoma was the commonest type of cancer.