Current knowledge of dengue pathogenesis and potential role of Carica papaya and vitamins in dengue fever

A number of biological molecules such as inflammatory enzymes and cytokines are altered during dengue virus (DENV) infection, many of which are attributed to the pathogenesis of the DENV infection. Papaya (Carica papaya) based extracts (PBE) and certain vitamins have been proven beneficial for dengue fever (DF) patients. The extract of papaya leaves were shown to improve platelet count in dengue patients. Extracts of papaya pulp based was also shown to induce in vitro IL-6 and stem cell factor in human peripheral blood mononuclear cells and stem cells of mesenchymal origin. Different vitamins such as D, E, and C have shown promise to treat dengue disease when taken in small supplementation trials. However, the exact molecular mechanisms on the beneficial roles of either PBE or vitamins are yet to be defined. Hence, the aim of this review is to link the cellular and molecular responses of DENV pathogenesis and pharmacological actions of the bio-active components of PBE or vitamins. It has also been shown that the beneficial roles of PBE and vitamins in DF are linked to thrombopoiesis, prevention of the viral entry and replication, decrease in oxidative damage assisted thrombocytopenia, and the reduction in vascular leakage. The DENV mediated fatalities are expected to expand it’s geographic boundary whilst an efficient drug and the most likely candidate vaccine against DENV are still in progress. Findings on the molecular mechanisms of food and nutrient supplement might reinforce ongoing research to treat the increasing number of DENV infected patients using natural products while waiting for the right drug and vaccine.

Health and healing in Islam: links and gaps with (post)modern practices.

Therapeutic interventions deal with healthy living i.e., maintenance of good health, dealing with conditions that requires special care such as child birth and healing i.e., treatment and cure of the sickness. Islam guides mankind to have ultimate faith on Allah Almighty’s approval for healthy living and healing as well as provides guidelines for cleanliness, healthy eating/drinking habits and controlled physical and mental stress. Thus, holistic view of healthy living and healing in Islam is founded both on the faith on the oneness and the almighty authority of Allah as well as physical, social, psychological factors. Revealed scriptures before Qur`an, gave equal emphasis on the same faith and factors. At the same time, different schools of thought of therapeutic interventions deal either with the physical or the metaphysical means of health and healing. This paper will discuss the links and gaps between Islamic principles and practices for health and healing and similar practices in other faith and therapeutic interventions observed in (post)modern community.

Association of Aortic Pulse Wave Velocity with the Severity of Coronary Artery Disease in Patients with Acute ST Elevation Myocardial Infarction.

Background: Arterial stiffness assessed noninvasively with aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional analytical study was conducted over 200 acute STEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Assessment of aortic PWV was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with high fidelity micromanometer on the day before angiogram. Study subjects were subdivided into two groups on the basis of PWV. In group I: aortic PWV was d” 10 m/sec and in group II: aortic PWV was> 10 m/sec. One hundred patients were included in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 0 and 1 were significantly higher in group I (p<0.05) where vessel score 2 and 3 were significantly higher in group II (p<0.05).The mean PWV in the group with normal angiographic result was 8.10±2.9 m/sec, and in patients with single vessel disease it was 11.65±3.46m/sec. In those with double and triple vessel disease the mean value of PWV was found 13.85±3.80 and 15.70±4.66 m/sec respectively. The mean value of PWV increased in proportion with the number of vessel involved by CAD and the differences were statistically significant(p=0.001).The mean value of PWV was observed 8.5±2.3 and 12.5±3.7m/sec in insignificant and significant CAD respectively using Friesinger score and the difference was statistically significant (p<0.05).There was statistically significant positive linear relation between the values of PWV and vessel score(r=.62, p=0.01), Friesinger score(r=.64, p=0.01) and Leaman score(r=.45, p=0.01). Conclusion: Aortic PWV is associated with the extent and severity of CAD. This noninvasive, cheap, radiation free method may be considered as risk stratification tool beyond other investigations.

Increased Arterial Stiffness Correlates with the Severity of Coronary Artery Disease in Patients with acute ST Elevation MI.

Background: The aim of this study was to evaluate the association between arterial stiffness determined noninvasively by pulse wave analysis (PWA) and the severity of coronary artery disease in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional study was conducted in the National Institute of Cardiovascular Disease, Dhaka over a period of ten months starting from July 2011 to April 2012. Patients were purposively selected from those who were admitted in NICVD with acute STEMI myocardial infarction agreed to do coronary angiography. Total 99 patients (male: 81, female: 18) were included in this study. Assessment of arterial stiffness was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with a high-fidelity micromanometer. Augmentation index (AIx), Augmentation pressure (AP) and Augmentation index corrected for heart rate 75beats/min (AIx@75) were derived from this with the technique of PWA. Coronary angiography was performed in those patients during the same hospital stay and severity was assessed by vessel score, Friesinger score and Leaman score. Results: It was found that 9 (9.1%) patients had score 0, 42 (42.4%) had score 1, 23 (23.2%) had score 2 and 25 (25.3%) had score 3. However higher the number of vessels is involved, the greater is the AIx @75. Mean score in single, double and triple vessel disease was 24.50, 33.57 and 34.60 respectively. The mean level of AIx @75 was observed 23.97±11.47 and 31.76±11.26 in insignificant and significant CAD respectively using Friesinger score. The difference was statistically significant (p<0.05). Spearman correlation analysis demonstrated a positive correlation between the AIx@75 and the severity of coronary artery disease (p= <0.05, r=0.40). Conclusion: In conclusion, the results presented herein indicate that augmentation pressure (AP), augmentation index (AIx), and augmentation index corrected for heart rate 75/minute (AIx@75), measures closely related to wave reflections and arterial stiffness, are predictors of severity of CAD. It may be considered as a recommended test for the evaluation of CV risk in addition to other routine investigations.

Extent of ST-Segment Depression Predicts In- Hospital Outcome in Non ST-Segment Elevation Acute Coronary Syndrome.

Background: The presence of ischemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined. The severity of ST-segment depression on admission ECG has a strong association with adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. The study was done to observe the extent of ST-segment depression and in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. Methods: This study was conducted in the Department of Cardiology in NICVD Dhaka, from January 2006 to December 2007. Considering inclusion and exclusion criteria, a total of 183 patients were evaluated. All the patients were evaluated clinically after admission. ECG, blood biochemistry and echocardiography were done. Patients were categorized into three groups according to the extent of ST- segment depression. Results: In this study, analysis of the baseline parameters revealed no statistically significant difference among the three groups of patients (p>0.05). Mean sum of the ST-segment depression analysis was done and all mean values were more in group III patients. 41.0% patients developed complications during the study period. Acute LVF (22.9%) was the most common complication followed by arrhythmia (11.5%), cardiogenic shock (4.4%) and STEMI (2.2%). All the complications were more in group III patients. During this period 6% patients died and more death (12.3%) was observed in group III patients. Conclusion: The amount of ST-segment depression is a powerful predictor of adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome.

Early Risk Assessment In Right Ventricular Infarction By TIMI Risk Score.

Background: Inferior myocardial infarction complicated by right ventricular infarction is associated with a greater risk of in-hospital mortality and cardiovascular related complications. Early risk stratification of patients with right ventricular infarction is crucial for appropriate management and reduction of adverse cardiac events. The development of TIMI risk score has provided a useful tool to quickly and easily stratify patients with right ventricular infarction. We conducted this study to evaluate the prognostic value of TIMI Risk Score analysis in patients with right ventricular infarction. Methods: This observational study was conducted in the department of Cardiology in NICVD, Dhaka, from July 2006 to June 2008. Considering inclusion and exclusion criteria, a total of 60 patients with right ventricular infarction were evaluated. All the patients were evaluated clinically and ECG was done after admission. Patients were categorized into two groups by TIMI risk scoring. Patients with low TIMI risk score(0-3) were in Group-I and patients with high TIMI risk score(4- 14) were in Group-II. Results: The study revealed no statistically significant difference among the patients of two groups (p>0.05) in relation to sex, weight, risk factors and presenting complaints. Analysis revealed statistically significant difference among the patients of two groups (p<0.05) in relation to age, duration of chest pain, clinical parameters, Killip class of heart failure and LVEF. Regarding inhospital outcome, 51.7% patients developed complications during the study period and all the complications were more in group II patients with high TIMI risk score(4-14). Death (18.3%) was the most common complication followed by cardiogenic shock (15.0%), complete heart block(6.6%),cardiac arrest(6.6%),VT(3.3%)and 2nd degree heart block(1.6%). Conclusion: This study indicates that on admission - TIMI risk score analysis can identify patients with right ventricular infarction at higher risk for in-hospital mortality and morbidity.

A Case of Severe Tricuspid Stenosis of Rheumatic Origin.

Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. It’s relatively a rare condition. It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis.Other rare causes include carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus erythematosus, right atrial myxoma and congenital tricuspid atresia. Here we describe a patient with history of prior CMC presented with severe Tricuspid Stenosis with Tricuspid Regurgitation (Grade-IV), Mitral Restenosis (Severe), Mitral Regurgitation (grade-1+), Aortic Stenosis (Mild) and Aortic Regurgitation (Grade-2).

In Hospital Outcome of Myocardial Infarcton in Nondiabetic Patients with High on Admission Blood Glucose Level.

Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). Our aim was to evaluate the impact of admission hyperglycemia on in hospital outcome of non-diabetic patients admitted for acute coronary syndromes. Methods: The retrospective study was conducted in National Institute of Cardiovascular Diseases among the patients with acute myocardial infarction without history of diabetes. 50 patients with ST elevation MI (STEMI) with complications, 50 patients with STEMI without complications, 50 patients with non-ST elevation MI (NSTEMI) with complications and 50 patients without complications were included in the study. Every patient got the treatment as per protocol of the institute. On admission blood glucose of the patients was recorded. Level of blood glucose was correlated with the frequency of complications. Results : Average on admission blood sugar level was higher in patients who developed complications with STEMI (11.4 vs 8.78 mmol/L). On admission blood sugar level was also significantly higher in patients with NSTEMI with complications (10.6 vs 8.6 mmol/L). The frequency of individual complications had no significant relation with the blood sugar level. Conclusion : Higher level of admission blood glucose is related to poor in hospital outcome in both STEMI & NSTEMI even in nondiabetic patients. It may be used as a predictor of poor outcome of patients with myocardial infarction.

Infective Endocarditis by Pseudomonas Species Following Percutaneous Transluminal Mitral Commissurotomy.

Infective mitral valve endocarditis developed in a 35-year-old male patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated vegetation in the anterior leaflet of the mitral valve and blood culture showed growth of Pseudomonas species which was sensitive to Ceftazidime, Ciprofloxacin, Cotrimoxazole and Imipenem and resistant to Amikacin, Ceftriaxone, Gentamycin and Nitilmycin. The patient underwent treatment with intravenous ceftazidime and ciprofloxacin for six weeks and patient improved significantly and got cure of the disease. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of antibiotics and operation are discussed

Histopathological changes of pancreas in patients with fibrocalculous pancreatopathy.

A total of 20 pancreatic biopsy samples taken from Fibrocalculous Pancreatopathy previously known as Fibro Calculus Pancreatic Diabetes (FCPD) patients, a variant of Malnutrition Related Diabetes Mellitus (MRDM) or under 30 young diabetes attending hepatobiliary, surgical and out patient department of Bangladesh Diabetes, Endocrine and Metabolic (BIRDEM) hospital were processed for light microscopic examination. Four samples were subjected to Immunohistochemistry (IHC) staining using antibodies to T cell marker (CD3), B cell marker (CD20), anti apoptotic markers (bcl-2) and tumour suppressor gene marker p53. Light microscopic findings and IHC indicate an immune mediated injury of pancreatic tissue and increased evidence of apoptosis which possibly results in the development of diabetes in these patients.

Complementary and Alternative Medicine in Cardiovascular Care.

Complementary and alternative medicine (CAM) refers to a broad set of health care practices that are not part of a country’s own tradition and are not integrated into the dominant health care system. Herbal remedies, dietary supplements, acupuncture, homeopathy, ayurveda, unani, traditional Chinese medicine, prayer, yoga and meditation are the common examples. CAM therapies often represent an enormous area of unregulated and widely practised therapeutics with an inadequate scientific literature. However, there is emerging evidence that some of the CAM therapies are effective in certain clinical conditions. Presently, throughout the world, there is rampant growth of CAM industries, and increasing number of reputed pharmaceutical companies are producing herbals and dietary supplements. Herbal products used for cardiovascular purposes include garlic, hawthorn, ginkgo, horse chestnut and arjun. These substances are often popularly believed to be ‘natural’, hence safe. But adverse reactions including deaths have been reported with some of the CAM products. There is also growing concern for significant drug interaction among commonly used herbals, dietary supplements and cardiovascular drugs. At present, CAM therapies may best be regarded as an adjunct to standard medical care. More scientific research and strict regulation by standard national and international authorities are needed to ensure their efficacy and safety in cardiovascular care.

Seropositivity and pattern of dengue infection in Dhaka city.

Bangladesh is experiencing resurgence of' dengue endemic since 2000. In an attempt to see the pattern of' dengue infection we analyzed retrospectively results of 225 blood samples from patients having fever and clinically suspected to have been suffering from dengue fever who were tested for dengue IgM and IgG in Health Care Development Project (HCDP), Dhaka, an enterprise of Diabetic Association of Bangladesh (DAB) one of the largest private health care facility provider in Bangladesh. Out of 225 samples tested, a total of 156(69.33%) cases were serologically positive for dengue and 69(30.67%) were negative. Of the positive cases, 70(44.87%) were positive for Dengue IgM and 86(55.13%) were positive for Dengue IgG. which showed statistical difference between male and female (p<0.05). Both IgM and IgG, were positive in 23(14, 74%) cases. The mean age +/-SD of affected is 36.86+/-17.60 years and the maximum number of positive cases 114(73.08%) diagnosed were in the months between July-December. It is evident from the present study that dengue is endemic in Dhaka city particularly during monsoon and rainy season. Secondary dengue is more common than primary dengue and both preventive and curative measures are needed to combat this menace.

Oral histoplasmosis presenting as oral ulcer in a non-HIV patient.

A 40-year-old man presented with chronic mouth ulcer for the last six months. Histopathological examination of the biopsy from the lesion confirmed a diagnosis of histoplasmosis. Although histoplasmosis commonly manifests in immunocompromized patients, like HIV, the present case was negative for HIV. Histoplasmosis is endemic in certain parts of the world and it is comparatively rare in the South Asian region, particularly Malaysia. Thirty-seven cases of histoplasmosis were reported from Malaysia (Ng and Siar, 1996), between July 1967 and October 1997. Despite the apparent rarity of the disease, clinicians and pathologists should be aware of the possibility of histoplasmosis when cases of oral ulcer are encountered.

Gallstone disease in a rural Bangladeshi community.

BACKGROUND: The prevalence of gallstone disease (GSD) in Bangladesh is not known. We evaluated the prevalence of GSD and its relation with certain factors in a rural community in Bangladesh. METHODS: A total of 1332 persons aged 15 years and above from two villages were invited to participate in the study; 1,058 (80%) subjects responded after three invitations. Each subject answered a questionnaire, including demographic features, and underwent an upper abdominal ultrasound examination. RESULTS: GSD (current cholelithiasis and history of cholecystectomy) was detected in 5.4% of subjects. The prevalence was higher in women (7.7%) than in men (3.3%; p=0.002) The prevalence rates increased from 0.9% to 10% (p=0.0124) from those aged <30 years to those >50 years. A larger proportion of obese subjects (25/52; 48.1%) had GSD than non-obese subjects (32/1006; 3.2%). Prevalence in low, middle and high socio-economic classes was 1.5%, 5.7% and 13.4%, respectively (p=0.000). A majority (71.9%) of subjects with GSD were asymptomatic. CONCLUSION: Approximately 5% of the Bangladeshi rural community evaluated have GSD. Higher age, female gender, presence of obesity and higher socio-economic class were associated with higher prevalence of GSD.

Seroprevalence of Helicobacter pylori among the diabetic population in Bangladesh: a comparative serological study on the newly diagnosed and older diabetics.

This prospective study was designed to find out the prevalence of H. pylori infection among the diabetic population in Bangladesh with a comparison between the newly diagnosed and older diabetics. For this study 520 diabetic patients: 152 (29%) newly diagnosed and 368 (71%) older diabetics of both sexes (250 male, 270 female) with a mean age of 58.5 +/- 12.04 years (range 10-70 years), were selected randomly from out and in-patient departments of BIRDEM, Dhaka. Mean fasting and 2 hours post load blood glucose level of the studied population was 10.53 +/- 4.08 mmol/L and 18.35 +/- 9.44 mmol/L respectively. The mean duration of the newly diagnosed diabetics was 0.44 +/- 0.35 years (range 2 days-1 year) and 6.78 +/- 5.45 (range 1-30) years for the older diabetics. H. pylori infection was defined as a true positive ELISA test result of > 1.5 standard deviation above the cut-off values of 15 AU/ml for adults and 10 AU/ml for children for anti H. pylori IgG. Of the studied population 441 (84.8%)--132 newly diagnosed and 309 (83.96%) older diabetics were seropositive for H. pylori infection. No significant differences were observed between the newly diagnosed and older diabetics (86.84% Vs 83.96%; p > 0.05).

Predictors of duodenal ulcer healing in sucralfate treated patients.

The objective of the study was to assess the efficacy of sucralfate in promoting duodenal ulcer healing and to assess the value of some variables in predicting outcome of such therapy. Following variables were tested for predicting the outcome: age at onset, age at presentation, duration of symptoms, sex, periodicity, smoking, nocturnal pain, relief by food, relief by antacid, gastric stasis like symptoms, associated irritable bowel syndrome, site, size and number of ulcers and degree of deformity of bulb. Sixty patients with uncomplicated DU confirmed at endoscopy were treated with sucralfate one gram before three major meals and 1 g at bedtime for two months. Endoscopy was repeated at the end of the trial. There were four drop-outs. Complete, partial and no healing occurred in 45 (80.36)%, 3 (5.36%) and 8 (14.28%) subjects. Ulcer healing rate was higher in those without gross bulbar deformity (41/46) than in those with gross deformity (4/10), (Odd's ratio 12.3, 95% ci 1.98 to 78.44). Other variables were not found to be associated with ulcer healing.

Sucralfate in the prevention of duodenal ulcer relapse and factors influencing the relapse rate.

Forty three subjects with DU confirmed at endoscopy and healed after eight weeks of sucralfate therapy were subjected to a randomized double-blind controlled trial for six months. Twenty one subjects received sucralfate (1 g one hour before breakfast and dinner). Twenty two subjects received placebo. Symptoms were evaluated every month. The subjects were endoscoped at the end of the trial or earlier in case symptoms recurred. Sucralfate was found to be significantly more effective than placebo (6/21 vs. 17/22, p < 0.005) in preventing DU relapse. Age at presentation, age at onset, duration of illness, sex, periodicity, smoking, gastric stasis like symptoms, associated irritable bowel syndrome, degree of deformity of the bulb and initial presence of duodenitis were the factors examined for their effect upon the relapse. In the placebo group relapsers had significantly shorter mean duration of illness indicating that DU may relapse more frequently in earlier part of its natural course. Other factors did not influence the relapse rate. In the sucralfate group, higher ages at onset and at presentation were associated with significantly higher relapse rate. Sucralfate may be less effective in preventing relapse in elderly and late onset DU patients.

Factors influencing development of bulbar deformity in duodenal ulcer disease.

Sixty subjects were carefully interrogated and repeatedly endoscoped with a view to studying the effect of sucralfate on healing and recurrence of duodenal ulcer disease. Degree of bulbar deformity was noted during each endoscopy. During the trial it appeared that deformity progressed more rapidly in late onset subjects (onset at or above 30 years of age). In eight subjects deformity became gross over a period of three years. Seven of them belonged to the late onset subgroup. Two subject had large ulcers and both belonged to the late onset subgroup, one had rapidly progressive disease. Out of six subjects with multiple ulcers four belonged to the late onset subgroup, two of the later had rapidly progressive disease.