Comparison of Characteristics among Suspected ACS Patients by Normal and Elevated Hs-Troponin Levels

Background: Acute coronary syndrome (ACS) is a life-threatening condition that requires prompt diagnosis and treatment. However, some patients with ACS may have normal levels of high-sensitivity cardiac troponin (hs-cTn), a biomarker of myocardial injury, at presentation. This study aimed to compare the characteristics and outcomes of ACS patients with normal and elevated hs-cTn levels using different assays and thresholds. Material & Methods: This 2-year retrospective observational study was conducted in Bangladesh, using data from hospital records of 420 suspected ACS patients. Patients were divided into two groups based on their Hs-Troponin levels, with group 1 having 60 patients with Hs-Troponin ?0.014 ug/L, and group 2 having 360 patients with Hs-Troponin >0.014 ug/L. Patients less than 18 years old and those with incomplete records were excluded. Ethical approval was obtained, and SPSS v.25 was used for analysis. Results: Group 1 had a significantly younger mean age of 41.8±14.3 compared to Group 2’s mean age of 68.4±12.6, with a p-value less than 0.001. Group 2 had a higher percentage of male patients (70.56%) compared to Group 1 (31.67%), with a p-value of less than 0.01. Group 2 had a significantly higher mean heart rate of 80.18±20.64 beats per minute compared to Group 1’s mean heart rate of 71.02±12.21, with a p-value less than 0.001. There were no significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, BMI, history of smoking, history of AMI, hypertension, and diabetes mellitus. Group 1 had a significantly lower percentage of patients with hypercholesterolemia (55.00%), but a higher percentage of patients with a history of ACS (25.00%), and a family history of CAD (70.00%) compared to Group 2, with p-values less than 0.001. Group 2 had a significantly higher percentage of patients with known renal failure (21.67%) compared to Group 1 (1.67%), with a p-value less than 0.001. Creatinine levels were significantly higher in Group 2 (98±53 µmol/L) compared to Group 1 (76±17 µmol/L) with a p-value of less than 0.001, and eGFR was significantly lower in Group 2 (76±27 mL/min/1.73 m2) compared to Group 1 (97±23 mL/min/1.73 m2) with a p-value of less than 0.001. The cardiac Troponin T (cTnT) levels were significantly higher in Group 2 (0.28±1.68 ug/L) compared to Group 1 (0.01±0.01 ug/L) with a p-value of less than 0.001, indicating worse kidney function and cardiac damage in Group 2 compared to Group 1. Conclusion: The study found that very few patients presenting with ACS symptoms had normal Hs-Troponin levels, and ultimate diagnosis proved that they did not have ACS, indicating the usability of Hs-Troponin as a biomarker for ACS. Significant differences were observed in age, gender, heart rate, hypercholesterolemia, family history of ACS, family history of CAD, and renal failure between the two groups. The study also found a consistent association between elevated creatinine levels and lower eGFR with higher Hs-Troponin levels.

Association of Liver Histology with Sonological Grading and Liver Stiffness Measured by Fibroscan in Patients with NAFLD

Background: Non-alcoholic fatty liver disease (NAFLD) is theterm for a range of situations caused by a build-up of fat inthe liver. It's usually seen in people who are obese.Objective: In this study our main goal is to evaluate theassociation of liver histology with sonological grading and liverstiffness measured by Fibroscan in patients with NAFLD.Methods: This cross-sectional study was done at Departmentof Hepatology, Bangabandhu Sheikh Mujib Medical Universityfrom July 2007 to June 2009. Total 45 patients of fatty liverdisease were studied. All collected data was recorded in astructured questionnaire and was analyzed by SPSS version20. Values were expressed either as mean + SD or infrequency or in percentages.Results: During the study majority of the patients were 30-50years old (73.33 %), which indicates that the patients weresomewhat younger and out of 45 of study population 21(46.7%) patients was grade I fatty liver, 23(51.1%) were gradeII fatty liver and only one (2.2%) was grade III fatty liver. Thisstudy also showed that correlation between fibroscan of liverand grading of fibrosis in liver histology reveals significantassociation.

Translation and Validation of Enhanced Asian Rome III Questionnaires in Bengali Language for Diagnosis of Functional Gastrointestinal Disorders

BACKGROUND/AIMS: Functional gastrointestinal disorders (FGIDs), diagnosed by symptom-based criteria due to lack of biomarkers, need translated-validated questionnaires in different languages. As Bengali, the mother tongue of Bangladesh and eastern India, is the seventh most spoken language in the world, we translated and validated the Enhanced Asian Rome III questionnaire (EAR3Q) in this language. METHODS: The EAR3Q was translated in Bengali as per guideline from the Rome Foundation. The translated questionnaire was validated prospectively on Bengali-speaking healthy subjects (HS, n = 30), and patients with functional dyspepsia (FD, n = 35), irritable bowel syndrome (IBS, n = 40) and functional constipation (FC, n = 12) diagnosed by clinicians using the Rome III criteria. The subjects were asked to fill-in the questionnaire again after 2 weeks, to check for its reproducibility. RESULTS: During translation, the original and the backward translated English versions of the questionnaire demonstrated high concordance. Sensitivity of the Bengali questionnaire to diagnose patients with FD, IBS, FC, and HS was 100%, 100%, 75%, and 100%, respectively, considering diagnosis by the clinicians as the gold standard. On test-retest reliability analysis, Kappa values for FD, IBS, FC, and HS were 1.0, 1.0, 0.83, and 1.0, respectively. The Bengali questionnaire detected considerable overlap of FD symptoms among patients with IBS, IBS among patients with FD, and FD among patients with FC, which were not detected by the clinicians. CONCLUSIONS: We successfully translated and validated the EAR3Q in Bengali. We believe that this translated questionnaire will be useful for clinical evaluation and research on FGIDs in the Bengali-speaking population.

Maternal Socio-demographic Factors and Nutritional Status as Predictors of Caesarean Delivery at Hospitals in Rajshahi City, Bangladesh

Introduction: A caesarean delivery is a major surgery with risks of severe bleeding, scarring, infections, reactions to anesthesia and long-lasting pain. The aim of the study was to determine the predictors of caesarean delivery at hospitals in Rajshahi city, Bangladesh. Methods: Data was collected from 194 women who delivered at three private and one public hospital maternity wards in Rajshahi city between January and March 2013. A questionnaire was used to collect socio-demographic background of the mothers. Body mass index was computed to determine overweight and underweight status of the women. Results: The prevalence of caesarean delivery at the hospitals studied was 77.3%. Socio-demographic factors and nutrition status that were significantly associated with the type of birth delivery were considered as independent variables in a logistic regression model. Multiple logistic regression analysis showed that older women (age z 25 year) were more likely to undergo caesarean delivery than younger women. Women with higher education were more likely to have caesarean delivery as compared to women without formal schooling. Overweight women had a higher likelihood of caesarean delivery than women with normal weight and underweight. Conclusion: The study recorded a high prevalence of caesarean deliveries at the hospitals in Rajshahi city. Age, educational level and BMI status of the women were associated with caesarian deliveries.

Comparative Phytochemical Screening and In vitro Evaluation of Biological Activities between Aqueous and Ethanolic Extract of Momordica charantia L. Fruits.

Aims: The study was conducted to compare the presence of different phytochemicals and biological activities like cytotoxicity, anthelmintic activity, antioxidant and free radical scavenging activities between aqueous and ethanolic extract of Momordica charantia L. Fruits. Methodology: The cytotoxic assay was undertaken using brine shrimp lethality test (BSLT) while the anthelmintic activity was carried out with the determination of time of paralysis and death of earthworm (Pheritima posthuma) at five different concentrations. Antioxidant and free radical scavenging activities were measured by 1,1-diphenyl-2-picrylhydrazyl (DPPH) method and determining the total phenolic contents. Results: Study revealed that several phytochemicals were found common for both of the extracts, though proteins and amino acids were only found in ethanolic extract. Both the extracts showed mild cytotoxic activity where the ethanolic extract showed better potency (LC50=24.245 μg/ml) than aqueous extract (LC50=24.515 μg/ml). In case of anthelmintic activity, ethanolic extract was also found significantly potent than aqueous extract at five different concentrations. IC50 values for the total antioxidant activity were 304.41±0.903 μg/ml and 479.05±1.393 μg/ml for ethanolic and aqueous extract, respectively. Ethanolic extract contained a significantly higher concentration of total phenols (71.08 ± 0.380 mg of GAE/g of extract) in comparison to aqueous extract (57.33±0.520 mg of GAE/g of extract). Conclusion: Therefore, in all aspects of the study, ethanolic extract was found more potent than aqueous extract. It can be concluded that M. charantia fruits are abundant of various phytochemicals and possess versatile biological activities.

Phytochemical Screening and Antipyretic Effect of Curcuma zedoaria Rosc. (Zingiberaceae) Rhizome.

Aims: To investigate the antipyretic effect of ethanol extract of Curcuma zedoaria Rosc. (Zingiberaceae) rhizome in animal model. Study Design: Extraction of plant constituents and evaluation of elevated body temperature lowering activity. Place and Duration of Study: Department of Pharmacy, North South University, Dhaka between October 2012 and August 2013. Methodology: We have performed phytochemical screening and evaluated antipyretic activity of ethanol extract of the rhizome of Curcuma zedoaria by yeast-induced pyresis method. Ethanol extract of Curcuma zedoaria rhizome was administered to healthy rats. Results: The results showed that the ethanol extract of Curcuma zedoaria significantly reduced yeast-induced elevated body temperature in rats in a dose dependent manner and the antipyretic effect at a dose of 750 mg/kg was comparable to that of the standard antipyretic drug paracetamol (10 mg/kg). Phytochemical screening of ethanol extract showed presence of tannins, flavonoids, saponins, alkaloids, terpinoids, carbohydrates and steroids as main constituents in Curcuma zedoaria extract some of which may possess antipyretic activity. Conclusion: The results justify the traditional use of the ethanol extract of Curcuma zedoaria in the treatment of fever.

Prevalence of Underweight and Effect of Nutritional Status on Academic Performance of Primary School Children in Chapainawabganj District, Bangladesh

The high prevalence of underweight among children is a serious health concern in Bangladesh. Nutritional status influences students' academic performance directly or indirectly. This study aimed to determine factors that affect the academic performance of students in primary schools. Methods: Data were collected from several schools and madrasahs in Chapainawabganj district, Bangladesh using multistage stratified sampling with proportional allocation technique. Results: The prevalence of underweight children was 32.3%, with 43.0% of them being girls and 21.4% boys. Multiple logistic regression analysis demonstrated that normal weight children were more likely (p3.50) than underweight children. Children with gestational age of 39 to 41 weeks were more likely to obtain good results than those whose gestational age was 37 and 38 weeks. Children who were breastfed for 3.50) compared to their counterparts. Children whose parents had a higher income or higher education had a significantly better chance of obtaining good results compared to their counterparts. Conclusion: These results suggest that childhood nutritional status, parents' education and economic level are significant common factors which affect children's academic performance. Consequently, under-nutrition and poverty can be considered as the major problems for good academic performance of Bangladeshi children and requires attention

Antioxidant, antimicrobial, toxicity and analgesic properties of ethanol extract of Solena amplexicaulis root

BACKGROUND: This study was subjected to investigate different pharmacological properties of ethanol extract ofSolena amplexicaulis root. RESULTS: The extract contains flavonoid, alkaloid, saponin and steroid compounds. The extract exhibited excellent antioxidant activity in DPPH radical scavenging activity. The extract also showed potent activity in brine shrimp lethality bioassay. The LC50 value was found to 44.677 µg/ml. The extract showed better anti-bacterial activity against gram-negative bacteria. In antifungal assay, the maximum 79.31% of anti-mycotic activity was observed against Aspergillus ochraceus while minimum 44.2% against Rhizopus oryzae. MIC value ranged between 1500 - 3000 µg/ml. The extract was found moderately toxic with a 24-hr LD50 value of 81.47 mg/kg in Swiss albino mice. The degree of inhibition by the ethanolic extract of the root was found less than that of standard analgesic drug diclofenac sodium. The extract also showed moderate anti-inflammatory and antinociceptive activity and anti-diabetic property. Reducing power of the extract was comparable with standard ascorbic acid. Moderate in vitro thrombolytic activity, lipid peroxidation inhibition property, metal chelating ability and stress-protective activity was also observed. CONCLUSION: Ethanol extract of Solena amplexicaulis root can be valuable for treatment of different diseases.

Protective Effect of Methanolic Extract of Hylocereus polyrhizus Fruits on Carbon Tetra Chloride-Induced Hepatotoxicity in Rat.

Aims: This research investigated the Protective effect of methanolic extract of Hylocereus Polyrhizus fruits on carbon tetra chloride-induced hepatotoxicity in Swiss-albino rat. Place and Duration of Study: Department of Pharmacy, IIUC, Chittagong, Bangladesh and Functional Food Center, Korea Institute of Science and Technology (KIST), Gangneung Institute, Gangneung, Korea, between August 2011 to October, 2012. Methodology: Hepatoprotective potential was evaluated in carbon tetrachloride (CCl4) induced liver injured animal model using male albino rats. Carbon tetrachloride significantly elevated the serum levels of biochemical markers like ALT, AST, ALP, bilirubin, total protein, total cholesterol, triglycerides. Results: The methanolic extract of Hylocereus polyrhizus at a dose of 300 mg/kg body weight (p.o.) significantly protected the carbon tetrachloride (CCl4) induced liver toxicity in albino rat model. The activity of extract was also comparable to that of silymarin, a known hepatoprotective drug. Conclusion: The study suggests that oral intake of Hylocereus polyrhizus fruits extract enhances the defense status against liver injury.

Multiple regression analysis of anthropometric measurements influencing the cephalic index of male Japanese university students

<p><b>INTRODUCTION</b>Cephalic index (CI), the ratio of head breadth to head length, is widely used to categorise human populations. The aim of this study was to access the impact of anthropometric measurements on the CI of male Japanese university students.</p><p><b>METHODS</b>This study included 1,215 male university students from Tokyo and Kyoto, selected using convenient sampling. Multiple regression analysis was used to determine the effect of anthropometric measurements on CI.</p><p><b>RESULTS</b>The variance inflation factor (VIF) showed no evidence of a multicollinearity problem among independent variables. The coefficients of the regression line demonstrated a significant positive relationship between CI and minimum frontal breadth (p < 0.01), bizygomatic breadth (p < 0.01) and head height (p < 0.05), and a negative relationship between CI and morphological facial height (p < 0.01) and head circumference (p < 0.01). Moreover, the coefficient and odds ratio of logistic regression analysis showed a greater likelihood for minimum frontal breadth (p < 0.01) and bizygomatic breadth (p < 0.01) to predict round-headedness, and morphological facial height (p < 0.05) and head circumference (p < 0.01) to predict long-headedness. Stepwise regression analysis revealed bizygomatic breadth, head circumference, minimum frontal breadth, head height and morphological facial height to be the best predictor craniofacial measurements with respect to CI.</p><p><b>CONCLUSION</b>The results suggest that most of the variables considered in this study appear to influence the CI of adult male Japanese students.</p>

Prevalence, belief and awareness of preferring traditional healthcare system in urban and rural people of Noakhali district, Bangladesh.

Healthcare systems contribute a major role in maintaining good health. The study was conducted to analyze the prevalence, belief and awareness of preferring traditional healthcare systems in urban and rural people of Noakhali district of Bangladesh. Data were collected randomly from 400 respondents aging 20 to 60 years by personal inter-viewing with a well structured questionnaire during October 20, 2011 to December 20, 2011. Study stated that, overall 79% of the respondents were found to feel comfortable in using traditional healthcare system whereas only 21% prefer the modern system. Urban people showed their belief mostly in homeopathy (23%), ayurvedic/unani (18%) and herbal medicine (17%) of traditional healthcare system whereas Kaviraji (27%), herbal medicine (18%) and spiritual healing (11%) were the systems on which rural people showed their much faith and belief for the treatment of different ailments. Jaundice and sexual problems were the two dominant disease conditions for which traditional healthcare systems were most preferred by the respondents. Beside these 68% of urban and 88% of rural as well as 57.64% of educated and 97.82% of uneducated respondents were not aware about the appropriate healthcare system for different diseases. Belief in no side effect and safe remedy, mass population of the study area preferred different traditional healthcare systems but most of them were not aware about the exact therapy.

In-vitro comparative evaluation of quality control parameters between paracetamol and paracetamol/caffeine tablets available in Bangladesh.

Paracetamol is a widely used non-prescription analgesic and antipyretic medicine. The study was conducted to assess the comparative in-vitro quality control parameters through the evaluation of weight variation, hardness, friability, disintegration time and dissolution profile between the commercially available tablet brands of paraceta-mol and paracetamol/caffeine combination in Bangladesh. Tablets of five top level manufacturers those have both of the formulations were evaluated in two groups. Both similarities and dissimilarities were found between the groups. All tablets either paracetamol (1.07 to 2.14%) or paracetamol/caffeine (0.98 to 2.09%) showed acceptable weight variation and friability (below 1%). Formulations were somewhat different in their hardness, disintegration time and dissolution profile. All tablets of paracetamol/caffeine were found harder than paracetamol tablets of the same manufacturer. 1 out of 5 for paracetamol and 3 out of 5 for paracetamol/caffeine tablets exceeded the limit of tablet hardness or crushing strength. The disintegration time in 0.1N HCl of paracetamol tablet brands (24 seconds to 4 minutes 52 seconds) were less than the paracetamol/caffeine (6 minutes 33 seconds to 17 minutes 43 seconds) brands. On the other hand in phosphate buffer, pH 7.4, paracetamol/caffeine tablets dissolved quickly and showed better release profile than tablets containing only paracetamol. It can be concluded that standard quality control parameters always should be maintained not only for paracetamol or its combination but also for all kinds of medicine for getting better drug products.

Prevalence, belief and awareness of preferring traditional healthcare system in urban and rural people of Noakhali district, Bangladesh.

Healthcare systems contribute a major role in maintaining good health. The study was conducted to analyze the prevalence, belief and awareness of preferring traditional healthcare systems in urban and rural people of Noakhali district of Bangladesh. Data were collected randomly from 400 respondents aging 20 to 60 years by personal inter-viewing with a well structured questionnaire during October 20, 2011 to December 20, 2011. Study stated that, overall 79% of the respondents were found to feel comfortable in using traditional healthcare system whereas only 21% prefer the modern system. Urban people showed their belief mostly in homeopathy (23%), ayurvedic/unani (18%) and herbal medicine (17%) of traditional healthcare system whereas Kaviraji (27%), herbal medicine (18%) and spiritual healing (11%) were the systems on which rural people showed their much faith and belief for the treatment of different ailments. Jaundice and sexual problems were the two dominant disease conditions for which traditional healthcare systems were most preferred by the respondents. Beside these 68% of urban and 88% of rural as well as 57.64% of educated and 97.82% of uneducated respondents were not aware about the appropriate healthcare system for different diseases. Belief in no side effect and safe remedy, mass population of the study area preferred different traditional healthcare systems but most of them were not aware about the exact therapy.

In-vitro comparative evaluation of quality control parameters between paracetamol and paracetamol/caffeine tablets available in Bangladesh.

Paracetamol is a widely used non-prescription analgesic and antipyretic medicine. The study was conducted to assess the comparative in-vitro quality control parameters through the evaluation of weight variation, hardness, friability, disintegration time and dissolution profile between the commercially available tablet brands of paraceta-mol and paracetamol/caffeine combination in Bangladesh. Tablets of five top level manufacturers those have both of the formulations were evaluated in two groups. Both similarities and dissimilarities were found between the groups. All tablets either paracetamol (1.07 to 2.14%) or paracetamol/caffeine (0.98 to 2.09%) showed acceptable weight variation and friability (below 1%). Formulations were somewhat different in their hardness, disintegration time and dissolution profile. All tablets of paracetamol/caffeine were found harder than paracetamol tablets of the same manufacturer. 1 out of 5 for paracetamol and 3 out of 5 for paracetamol/caffeine tablets exceeded the limit of tablet hardness or crushing strength. The disintegration time in 0.1N HCl of paracetamol tablet brands (24 seconds to 4 minutes 52 seconds) were less than the paracetamol/caffeine (6 minutes 33 seconds to 17 minutes 43 seconds) brands. On the other hand in phosphate buffer, pH 7.4, paracetamol/caffeine tablets dissolved quickly and showed better release profile than tablets containing only paracetamol. It can be concluded that standard quality control parameters always should be maintained not only for paracetamol or its combination but also for all kinds of medicine for getting better drug products.

Serum lactate dehydrogenase level in childhood acute lymphoblastic leukemia.

Serum lactate dehydrogenase (LDH) level was estimated in 44 childhood (age range 1-15 years) acute lymphoblastic leukemia (ALL) on admission, day 14 and day 29 of induction. Another 25 children without ALL were included as control. On admission, the level of serum LDH was significantly high in ALL cases than control (p < 0.001). Total WBC count was significantly decreased along with serum LDH level at day 14 and day 29 of induction (p < 0.001). A significant rise of platelet count was observed at day 29 of induction in relation to significant decrease of serum LDH level (p < 0.001). A significant decrease of peripheral and bone marrow blast cell percentages were also observed at day 29 of induction along with significant decrease level of serum LDH (p < 0.001). So, the measurement of serum LDH level can be accepted as an enzymatic tool for presumption of childhood ALL and the response to chemotherapy during induction of remission.

Common transfusion-transmitted infectious agents among thalassaemic children in Bangladesh.

Transfusion-dependent children are more prone to acquiring various transfusion-transmitted infections (TTIs), such as hepatitis B (HBV), hepatitis C (HCV), HIV, and others. Since the magnitude of these infections among thalassaemic children in Bangladesh is not well-known, this study was conducted to assess the prevalence of TTIs among them (who received more than three blood transfusions) compared to their age- and sex-matched controls (non-thalassaemics and those who had never had a transfusion). Seromarkers for HBV, HCV, HDV, Treponema pallidum, and HIV were tested, and the results were analyzed using SPSS/Windows 10.5. Of 259 children studied, 152 (58.69%) were thalassaemic (mean age 6.8 +/- 3.6 years), and 107 were controls (mean age 6.7 +/- 3.53 years). The HBV and HCV-markers were found significantly more often among multi-transfused thalassaemic children than among the controls in terms of HBsAg (13.8% vs 6.5%, p < 0.04), anti-HBc total (39.5% vs 9.4%, p < 0.0001), and anti-HCV (12.5% vs 0.9%, p < 0.0001). HBeAg did not differ (p = 0.82) between the thalassaemics (9.52%) and the controls (14.28%), whereas anti-HBe differed (0% vs 57.14%, p < 0.003). Neither the thalassaemics nor the controls were positive for HDV, HIV, or T. pallidum. Since more thalassaemic children acquired hepatitis B and C infections through multiple blood transfusions, it is recommended that the safe blood-transfusion programme be strengthened and mass vaccination against HBV (even who suffer from HCV) in Bangladesh be undertaken.