Natural course of fulminant hepatic failure: the scenario in Bangladesh and the differences from the west

Fulminant hepatic failure [FHF] is a devastating complication of acute viral hepatitis, leading to death in most cases. The etiology and predictors of outcome differ according to the geographical region. This study was conducted with the aim of evaluating the etiology, complications, and outcome of FHF in Bangladesh. In this prospective study, we included 67 consecutive cases of FHF presenting to the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, between November 2003 and May 2008. Thirty-nine of the patients were male and 28 were female. Data was analyzed using SPSS, version 13.0. The mean age of the subjects was 31.9 +/- 11 .7 years. Hepatitis E virus [HEV] was the commonest etiological factor for FHF [50 cases, 74.6%]; of the 50 cases with HEV infection, 43 [64.2%] were not coinfected with any other virus, four cases were Hepatitis B virus [HBV] carriers, and three had coinfection with hepatitis A virus [HAV]. HBV was the cause of FHF in nine [13.4%] patients. HCV, paracetamol, and alcohol were not responsible for any of the cases. Most of the patients [57 patients, 85%] developed FHF within 2 weeks of the onset of jaundice. Of the 67 patients, 49 [73.1%] died. Cerebral edema was the single most common cause of death [48 patients, 71.6%]. Other complications were renal failure [23 patients, 34.3%], sepsis [15 patients, 22.4%], electrolyte imbalance [12 patients 17.9%], and bleeding tendency [7 patients, 10.4%]. Occurrence of cerebral edema, longer prothrombin time, higher grade of encephalopathy, and longer jaundice-to-encephalopathy interval had significant negative influence on outcome. The etiology of FHF in Bangladesh is different from that in the West. Prolongation of prothrombin time and occurrence of cerebral edema are predictors of the worst prognosis

Parotidectomy--a prospective study.

Preservation of facial nerve is a real challenge in parotidectomy. Total conservative parotidectomy and superficial parotidectomy are the commonly practised operations for parotid diseases. Twelve patients have undergone total conservative parotidectomy and 52 patients have undergone superficial perotidectomy with preservation of integrity and function of the facial nerve and its branches. Fifty-eight patients were suffering from neoplastic conditions of which 46 had pleomorphic adenoma, 7 had muco-epidermoid carcinoma, 3 had carcinoma ex-pleomorphic adenoma, and 2 had adenoid cystic carcinoma. Non-neoplastic conditions were seen in 6 cases of which 3 had chronic parotitis and 3 had congenital parotid fistula. The aim of the study was to observe the efficacy of preservation of facial nerve in parotidectomy done in 64 patients.

Anticonvulsant and sedative effect of ethanolic extract of Centella asiatica on albino mice

This research work has been designed to show the CNS neurotransmitter receptors activity especially anticonvulsant and sedative activity of ethanolic extracts of Centella asiatica on a number of pharmacological model in mice. Phenobarbitone and diazepam induced sleeping time model was used to demonstrate the sedative activity and the ethanolic extract of Centella asiatica significantly prolonged [p<0.00 1] phenobarbitone and diazepam induced sleeping time in mice as compared with the control suggesting possible interaction with GABA-BNZ receptors complex to mediate sedative action. According to Nikethamide induced convulsion model where tonic and clonic convulsion as well as mortality and morbidity rate was considered and the extracts of Centella asiatica were shown to be delayed the Nikethamide [300 mg/kg, i.p.] induced convulsion indicating a possible action involving GABA and glutamate receptors to mediate anti-convulsant effects. Therefore, this plant may have the potential in the treatment of various CNS disorders like anxiety, depression, insomnia and convulsion as well as this data can also be used in the development of novel psychopharmatherapeutic agents