Efficacy and Safety of Hydroquinone, Kojic Acid and Glycolic Acid Combination in the Treatment of Melasma.

Background & Methodology: It was an opened clinical trial. The study was carried out from March 2009 to February 2011, in the outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh to evaluate the efficacy and side effects of the combination therapy of hydroquinone(HQ), kojic acid(KA) and glycolic acid(GA) for the treatment of melasma. Patients suffering from melasma were selected as study population. Within the period of data collection, thirty patients of melasma were assigned purposively. The efficacy was evaluated using Melasma Area and Severity Index (MASI) Score. The severity of melasma of each of the four regions (forehead, right malar region, left malar region and chin) are assessed based on three variables, percentage of the total area involved (A), darkness (D) and homogenicity (H). Results:The study showed that majority (30%) of the cases were between 20 to 25 years, majority (77%) of patients were female, (50%) patients were housewives, (50%) were in graduation level of education, (50%) of patients was found as upper class and negative family history was present in majority (80%) of cases. It was seen that highest (93%) number of patients were malar type and 7% were centro-facial type. The study showed the change in MASI Score after treatment with combination therapy (GA 2%, HQ 2% and KA 1%). After 12 weeks of treatment, the average MASI score was decreased by 24.20% indicating mild reduction of the severity of melasma and 18%, 18%, 9% and 55% patients developed side -effects like itching, burning sensation, scaling, and erythema respectively. Conclusion: Combination therapy (GA 2%, HQ 2% and KA 1%) has a few lightening effect on melasma, with no remarkable side effects. Further Further study should be conducted with large number of sample and longer follow up.

Characteristics of Insulin and Androgen Status in Polycystic Ovary Syndrome.

Polycystic Ovary Syndrome (PCOS) was originally described as a syndrome of amenorrhea, hirsutism and obesity associated with enlarged polycystic ovaries. There is increased androgen level and in some, insulin resistance (IR). Etiological relationship of androgen excess and IR in PCOS is not established. Influence of obesity on PCOS is controversial. This study was designed to see the androgen and insulin status in PCOS among obese and non-obese patients. It was a case-control study. Of total 80 study subjects, 60 primary infertile women suffering from PCOS were cases (30 obese and 30 non-obese). Age and BMI matched 20 healthy women having normal menstrual cycles were controls (10 obese and 10 non-obese). Age range of all were 20-40 years. Fasting plasma glucose, fasting S. Insulin and free Testosterone were measured. Insulin resistance (IR) was assessed by fasting glucose to insulin ratio (<4.5). Subjects with DM or known endocrine disorders that may be associated with abnormal S.Insulin or plasma glucose concentration were excluded. No significant difference of fasting plasma glucose between PCOS (obese or non-obese) and respective controls (P>0.5, in each) were observed. Significant difference of fasting S. Insulin and testosterone were observed between PCOS (both obese and non-obese) and respective controls (P<0.01 in each), but there was no significant difference between obese and non-obese PCOS (P>0.05). There was no significant difference of S.Testosterone between obese and non-obese PCOS(P>0.05). There was also no significant difference of IR between obese and non-obese PCOS, but the ratio was <4.5 (indicating IR in both). There were no significant correlation of S.Insulin with Testosterone in any group of PCOS (obese and non-obese) (P>0.05). Increased S.Insulin and Testosterone was seen in PCOS irrespective of BMI. Further studies with larger sample size is recommended to assess etiological relationship between insulin and testosterone in PCOS.

Pattern of psychiatric morbidity among the patients admitted in a private psychiatric clinic.

Background: Mental health problem is a major public health issue in the world across the developed and developing countries. However, data in most of the developing countries including Bangladesh are scarce. In Bangladesh, socio-political situation is insecure and unstable with poverty and vulnerable to natural disaster which causes psychiatric morbidity. The pattern of psychiatric morbidity in private clinic is quite different from that in government hospital. Objective: This study was aimed to assess the diagnostic pattern of psychiatric morbidity among the admitted patients in a private psychiatric clinic. Methodology: The study was carried out in a 20 bedded private psychiatric clinic in the heart of Dhaka city. All the information including longitudinal histories of patients was recorded in files and the diagnosis was confirmed by psychiatrist. Admission and discharge notes were recorded in register. Socio-demographic parameters and family history of mental illness were collected from the record file of individual patient. Results: Among 304 patients 184 (60.53%) were males and 120 (36.47%) were females. More than 50% of patients were in the age group of 18 to 37 years. Most common psychiatric disorders were schizophrenia and other psychotic disorders (39.4%), mood disorder (18.75%), borderline personality disorder (3.6%), conduct disorder (2.3), somatoform disorder (1.6%), anxiety disorder (0.7%), organic psychiatric disorder (2%), impulse control disorder (1.3%) and adjustment disorder (0.7%). Conclusion: Major forms of psychiatric disorders are common both in urban and rural areas of Bangladesh.

Circulating monocytes; HLA-DR expression in healthy and sick neonates

This study was conducted to measure Monocytes HLA-DR expression in neonatal sepsis in comparison to other diseases with systemic inflammation and high risk of infection [respiratory distress syndrome [RDS] and prenatal asphyxia] and this may be helpful in early diagnosis of infection and therapeutic intervention. This study was carried out on 2007 and it conducted on 38 sick neonates, 22 with proven sepsis diagnosed clinically and by positive blood culture and 16 [8 had RDS and 8 had prenatal asphyxia] with possible infection i.e. they had 2 or fewer clinical signs of sepsis and negative blood culture. Those Patients with possible infection were followed up [for 48 h]. Seven out of the 8 RDS Babies developed sepsis as evidenced clinically and by positive blood culture and they considered as patients with early sepsis at the time of admission. Forty healthy age and sex matched newboms were studied as controls. All Babies were subjected to complete blood count [CBC], C-reactive protein [CRP] and flow cytometeric determination of HLA-DR expression on monocytes. Neonates with proven sepsis and those with early sepsis [7/8 of RDS] had significantly lower HLA-DR% [15.9 +/- 7.8 and 11.4 +/- 5.9 respectively] than controls [61.0 +/- 20.6]. HLA-DR% was reduced below the lowest cut off values in all septicemic neonates [neonates with proven and those with early sepsis]. At the time of admission CRP was positive in 91% of neonates with proven sepsis and in only 57% of the neonates of early sepsis. In addition, there was no significant difference between HLA-DR percent in neonates with prenatal asphyxia when compared to control group. Monocytes HLA-DR% had higher sensitivity, specificity, positive and negative predictive values [100%, 85%, 87.5% and 100% respectively] compared to CRP [57.1%, 77.8%, 66.7%, 70% respectively] for neonatal sepsis at its early stages before evident clinical and laboratory diagnosis. HLA-DR% expression on monocytes is a sensitive test for both diagnosis of neonatal sepsis and its early stage and exclusion of neonatal infection in high risk neonates to reduce the unnecessary antibiotic use and the costs of neonatal intensive care units

Efficacy of combination therapy for the management regime of Alopecia areata.

Alopecia areata is a world wide cosmetic problem. Cases are seen in Bangladesh. Due to financial constraint and lack of modern facilities the patients of this country needs cheap, easily available and conveniently usable treatment modality. The present study revealed that the oral administration of prednisolone for 06 weeks followed by topical application of 02% minoxidil for another period of 14 weeks is noninvasive and could act as better remedy for alopecia areata. It is claimed that steroid could induce hair growth through immunosuppression rather than a direct effect on hair growth promotion. When applied together steroid it induced regrowing hair gave more encouraging result. The combination therapy indicated that the gradual loss of hair could be minimized and regrowth of hair could be made possible. To fulfill the demand for the best compliance of treatment modality further study should be directed and dictated amongst a large group of population.

Role of cardiac troponin I in staging and prognosis of congestive heart failure subjects.

Congestive heart failure is the one of the major cardiovascular disorder that is increasing in incidence and cause of death globally. Mortality rate has increased 40%-50% in advanced cardiac failure and 15%-25% in mild to moderate cardiac failure within one year of diagnosis. There is no established biochemical marker for the diagnosis, prognosis and staging of heart failure. Cardiac Troponin I may be a novel useful tool in identifying patients with Heart failure who are at increased risk for progressive ventricular dysfunction and death. Thirty six congestive heart failure cases and thirty six healthy controls were included in this study and serum cardiac troponin I and Ejection fraction were measured. All the study subjects were grouped according to the NYHA class they belong. Cardiac troponin I was significantly higher in CHF cases than the controls. Troponin I also significantly differed among groups. EF of cases was significantly lower than the controls and also differed among groups. A significant negative correlation between cardiac troponin I and progressive decline of ejection fraction was evident in this study. Cardiac troponin I increased progressively with progression of heart failure. Thus, Cardiac troponin I could be used to stratify patients undergoing heart failure in to high and low risk groups for future cardiac events. Cardiac troponin I could also be used as a very important marker for the prognosis of the patients with congestive heart failure.

Spot morning urine protein creatinine ratio and 24 hour urinary total protein excretion rate.

Proteinuria helps to establish the diagnosis of most renal diseases and also to predict the outcome of such diseases. Proteinuria is biochemically represented by measuring the protein concentration in timed collection of 24 hour urine. But, 24-hour timed urine collection is time consuming, cumbersome and often unreliable due to collection errors and also results in undue delay on diagnostic process. An alternate approach avoiding arduous and inaccurate timed urine collection can be the measurement of protein creatinine ratio in spot morning urine. This study was aimed to evaluate whether the spot morning urine protein creatinine ratio can be a reliable alternative to 24-hour urinary total protein (UTP) estimation. The study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka on 50 (fifty) non-diabetic Chronic Renal Disease (CRD) patients with an age ranging from 18 -70 years. The study subjects were grouped into mild, moderate and severe CRD on the basis of GFR. Urinary protein and creatinine concentrations were measured in spot morning urine samples and their ratios were calculated. Urinary protein measured in 24-hour timed collected urine samples gave the 24-hour UTP excretion rate. In our study, spot morning urine protein creatinine ratio significantly correlated with 24-hour UTP excretion rate in all CRD patients. Severe CRD patients gave significant positive correlation (p<0.05), whereas mild and moderate CRD patients gave very highly significant positive correlation (p<0.001). Therefore, it may be suggested that protein creatinine ratio in spot morning urine can be accepted as a reliable and alternative to 24-hour UTP excretion rate in non-diabetic chronic renal disease patients. This simple and inexpensive procedure will thus simplify the way of establishing the severity of renal disease along with its prognosis.

Necessity of antibiotics prophylaxis during extracorporeal shock wave lithotripsy.

A total of 360 patients with renal and ureteral calculi who had sterile urine before extracorporeal shock wave lithotripsy (ESWL) and did not have any increased risk of infection received Tab.Ciprfloxacin (500 mg) 12 hourly for the next 5 days or no prophylaxis were included in this prospective study. Patients were followed by urinalysis and culture together with clinical evaluations. In antibiotic prophylactic group 10 (6.4%) had post ESWL urine culture positive while in without prophylaxis 13 (8.8%) had positive urine culture. The incidence of urinary tract infection after ESWL is extremely low, provided that patients have sterile urine before the procedure.

Serum homocysteine concentration in patients with acute MI and chronic IHD.

This was an observational study carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka; with the active co-operation of Coronary Care Unit (CCU) of BSMMU & National Institute of Cardiovascular Disease (NICVD), Dhaka. This study was carried out from March 2002 to January 2003. Total seventy (70) subjects were studied. Out of them 20 were of Acute MI, 20 were Chronic ischemic heart disease (CHD) and 30 were age and sex matched healthy controls. Hospitalized diagnosed patients were selected by taking history, clinical examination and several investigations like ECG. Echocardiogram, Angiogram and several enzymes assay. Several studies in many countries showed that serum homocysteine (Hcy) was elevated in IHD Patient. Cardiovascular disease is alarmingly increasing in Bangladesh. So our aim and objective of the study was to find out the association of serum Hcy with Acute MI and chronic ischemic heart disease (CHD) patients in our population. Mean Hcy level of Acute MI were 21.16 +/- 4.56 (micromol/l), 27.55 +/- 10.40 (micromol/l) and that of control was 13.03 +/- 10.51(micromol/l). Serum Hcy was significantly higher in both cases than control. But insignificant difference was found between AMI vs CHD (P> 0.05). Quantitative measurement of serum Hcy was measured by fluorescence polarization Immunoassay (FPIA) in IMX analyzer (Abbott-USA).

study of group a streptococcal bacteria isolation from children less than 12 years with acute tonsillitis, pharyngitis and healthy primary school children

Aim: This study was carried out to assess the prevalence of Group A Streptococcal [GAS] bacteria in the throat specimens of children with tonsillitis and pharyngitis compared to healthy children of the same age group. Methodology: The study was a prospective one. Throat swabs were obtained from 73 children aged 1 - 12 years diagnosed with acute tonsillitis and pharyngitis [sore throat and pyrexia > 38.5°C] visiting a pediatric outpatient clinic between December,1999 and April, 2000. In the some period throat swabs were obtained from 465 healthy primary school children aged 6 - 12 years. GAS from patients was tested for sentivity to penicillin, erythromycin, and cefaclor. In children with tonsillitis and pharyngitis GAS was found in 29 out of 73 [40%]. In healthy school children GAS was found in 15 out of 465 [3%]. In the patients group GAS was sensitive to penicillin in 14[48%], erythromycin in 27[93%], and cefaclor in 28[96%]. Although the prevalence of GAS among healthy children was similar to international studies, the GAS infection was high among children with acute tonsillitis and pharyngitis. Sensitivity to penicillin was less than 50% and more than, 90% for erythromycin and cefaclor. We recommend routine throat swab for children with acute tonsillitis and pharyngitis and the proper treatment of GAS positive patients to prevent further complications