Outcome of Single Intra-Articular Injection of High- Molecular-Weight Hyaluronic Acid in Patients with Knee Osteoarthritis

Background: Osteoarthritis (OA) is the most common type of rheumatic disease and a leading cause of disability. Current treatments aim at alleviating these symptoms by several different methods: non-pharmacological and pharmacological treatments and invasive interventions. Among the regenerative methods, hyaluronic acid (HA) is popular now-a-days where differences exist in concentration, molecular weight, dosage, expected duration of effects and added formulations. Based on HA molecular weight, these products are classified in two groups (high and low). Due to cost effectiveness, low molecular weight HA is commonly used. To find out the outcome of single intra-articular injection of high-molecular- weight HA in patients with knee osteoarthritis.Material & Methods:This was a randomized clinical trial conducted among purposively selected 55 patients suffering from Knee OA attending at the Physical Medicine and Rehabilitation outpatient department, DMCH during July 2020 to June 2021. Patients were randomly allocated into two groups; group A received single dose of high molecular weight HA and designed exercise program and group B received same exercise program only. Pre-treatment and 3 weekly post treatment assessment were done up to 12 weeks in each group. In each follow up visit, pain, and functional status were measured in Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) respectively and compared between group A and group B where was considered as significant (p value <0.050.Results:The mean age of the participants in group A and group B were 56.8 (±9.8) and 53.3 (±7.4) years respectively where majority of the patients in both groups were female patients with overweight. In group A, VAS and WOMAC significantly decreased from base line to each follow up till 12th weeks after treatment with high-molecular-weight HA (P<0.001). In group B, VAS and WOMAC significantly decreased from base line to each follow up till 12th weeks after treatment with conservative management (P<0.001). After 6 weeks of intervention, the mean VAS scores of the patients became 4.9 ±1.1 and 6.0±1.0 in group A and group B respectively which showed significant statistical difference (P<0.001). At the end of 12 weeks, the VAS score was significantly decreased in group A (2.8±1.3) than group B (4.9±1.7) (P<0.001). After 3 weeks of intervention, the mean WOMAC scores of the patients became 71.2±6.6 and 75.0 ±4.9 in group A and group B respectively which showed significant statistical difference (P<0.001). At the end of 12 weeks, the WOMAC score was significantly decreased in group A (61.9±6.6) than group B (68.1±4.6) (P<0.001). Conclusion:Single intra-articular injection of high-molecular-weight Hyaluronic Acid is effective in patients with knee osteoarthritis in reducing pain and improving functional impairment. Long term and large scale research studies are needed to establish the effectiveness and safety of this procedure in patients with knee osteoarthritis.

Clinical and Aetiological Pattern of Cervical Lymphadenopathy in Bangladesh

Objective: In this study our main aim is to evaluate clinical andaetiological pattern of cervical lymphadenopathy inBangladesh.Method: This cross-sectional analytical study was done Total260 patients with cervical lymphadenopathy, persisting for >2weeks either localized or generalized attending inpatient andoutpatient department (particularly surgical, medical, pediatrics,ENT, dermatology) of Dhaka Medical College Hospital, fromJuly 2009 to December 2011.Result: In the majority (85%) of patients had anorexia followedby 76.5% fever, 69.2% weight loss, 34.6% cough, 15% pain,7.7% haemoptysis, 4.6% discharging sinus, 2.6% change ofvoice and 2.3% dysphagia. Of the 82 patients diagnosed asmetastatic carcinoma (by tissue diagnosis), the commonestprimary site was lung (41.5%) followed by stomach (14.6%),thyroid (12.2%), nasopharynx and oral cavity (each 7.3%),breast 4.9%, testes 2.4%. In 9.8% of the cases the primary sitewas not discovered.Conclusion: From our result, we can conclude that, anorexia,fever and weight loss were common clinical feature intuberculosis, secondary metastasis and lymphoma. Furtherstudy is needed for better outcome.

Bioaccumulation of heavy metals in different tissues of Nile tilapia (Oreochromis niloticus) in Bangladesh

@# Introduction: The culture of Nile tilapia (Oreochromis niloticus) has become wide spread because of its high productivity over a short period of time. Its production partially fulfills the demand for food in rural people in Bangladesh. However, the accumulation of toxic heavy metals in the human body through consumption of fish contaminated by it causes various diseases. The aim of this study was to evaluate the bioaccumulation of five heavy metals, namely, cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni) and copper (Cu) in cultured Nile tilapia in the Noakhali region of Bangladesh. Methods: Fish were collected from three different fish farms in the Noakhali region and samples of gill, muscles and liver of tilapia were assayed for Cd, Cr, Pb, Ni and Cu using atomic absorption spectroscopy. Proximate composition of the tilapia was also determined. Results: Metal accumulation in different tissues was as follows: liver > gill > muscle. The accumulation of metals in the muscle, gill and liver was Ni > Pb > Cr > Cu > Cd, Pb > Ni > Cu > Cr > Cd and Pb > Cu > Ni > Cr > Cd, respectively. The bioaccumulation of lead was significantly increased in liver and gill while muscle showed the lowest value. Conclusion: It can be concluded that bioaccumulation of Pb, Cr and Ni in Nile tilapia in this study exceeds the permissible limits set for heavy metals by Food and Agriculture Organization (FAO) and International Atomic Energy Agency (IAEA)-407. This is potentially risky for consumers.

Melatonin ameliorates H2O2-induced oxidative stress through modulation of Erk/Akt/NFkB pathway

BACKGROUND: Improper control on reactive oxygen species (ROS) elimination process and formation of free radicals causes tissue dysfunction. Pineal hormone melatonin is considered a potent regulator of such oxidative damage in different vertebrates. Aim of the current communication is to evaluate the levels of oxidative stress and ROS induced damage, and amelioration of oxidative status through melatonin induced activation of signaling pathways. Hepatocytes were isolated from adult Labeo rohita and exposed to H2O2 at three different doses (12.5, 25 and 50 µM) to observe peroxide induced damage in fish hepatocytes. Melatonin (25, 50 and 100 µg/ml) was administered against the highest dose of H2O2. Enzymatic and non-enzymatic antioxidants such as malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) was measured spectrophotometrically. Expression level of heat shock proteins (HSP70 and HSP90), HSPs-associated signaling molecules (Akt, ERK, cytosolic and nuclear NFkB), and melatonin receptor was also measured by western blotting analysis. RESULTS: H2O2 induced oxidative stress significantly altered (P < 0.05) MDA and GSH level, SOD and CAT activity, and up regulated HSP70 and HSP90 expression in carp hepatocytes. Signaling proteins exhibited differential modulation as revealed from their expression patterns in H2O2-exposed fish hepatocytes, in comparison with control hepatocytes. Melatonin treatment of H2O2-stressed fish hepatocytes restored basal cellular oxidative status in a dose dependent manner. Melatonin was observed to be inducer of signaling process by modulation of signaling molecules and melatonin receptor. CONCLUSIONS: The results suggest that exogenous melatonin at the concentration of 100 µg/ml is required to improve oxidative status of the H2O2-stressed fish hepatocytes. In H2O2 exposed hepatocytes, melatonin modulates expression of HSP70 and HSP90 that enable the hepatocytes to become stress tolerant and survive by altering the actions of ERK, Akt, cytosolic and nuclear NFkB in the signal transduction pathways. Study also confirms that melatonin could act through melatonin receptor coupled to ERK/Akt signaling pathways. This understanding of the mechanism by which melatonin regulates oxidative status in the stressed hepatocytes may initiate the development of novel strategies for hepatic disease therapy in future.

Addition of Zinc to Soaking Water during Parboiling Increases the Zinc Content of Bangladeshi Rice.

Objectives: In Bangladesh, zinc deficiency affects 45% of preschool children and 57% of women. As zinc deficiency is linked to child growth stunting, diarrheal disease, pneumonia, and increased risk of child mortality, large-scale programs for its prevention are required. Most rice produced in Bangladesh is parboiled and this presents a technical opportunity to increase rice zinc content by adding zinc during soaking. The objective of this study was to evaluate the increase in zinc content achievable by this strategy in milled Bangladeshi rice using local parboiling conditions, and its potential effect on adequacy of zinc intakes. Methods: A major local rice variety (BR29) and zinc sulfate were used. Paddy was steamed for 2 minutes, soaked in distilled, deionized water for 9 hours with addition of 0, 100, 150, 200, or 300 mg zinc/kg paddy. Drained paddy was steamed in a pressurized autoclave before drying and milling. Zinc content was determined by X-Ray Fluorescence. Results: Rice zinc content was 12.3, 16.0, 16.7, 21.6, and 23.6 mg/kg dry weight, respectively, where the highest level represents a 92% increase over the control. Using existing dietary intake data from two districts, we estimated that if parboil-fortified rice with 300 mg/kg zinc were consumed by 70% of the population, the prevalence of inadequate intakes would decrease from 34 to 16% among preschool children and 98 to 43% among women. Conclusions: This strategy has potential to substantially decrease the prevalence of dietary zinc deficiency in Bangladesh, although the technical feasibility of implementing in large-scale mills requires further study.

Non obstetric causes and presentation of acute abdomen among the pregnant women

To identify the non-obstetric causes and presentation of acute abdomen among pregnant women. This was a cross sectional hospital-based study among 128 pregnant women by face to face interview using a semi-structured questionnaire. This study was conducted at the Gynecology and Obstetric Ward of 250 Bed General Hospital, Noakhali, Bangladesh, from January to August 2013. Data were analyzed by a software package used for statistical analysis [SPSS] version 11.5 [SPSS, Inc., Chicago, IL, USA]. Mean age of participants was 25 +/- 4 years. Our findings showed that 81% were Muslim, 67% were lower middle income group, as well as 47% completed primary level of education. The results revealed that 28% had biliary ascariasis, 24% had peptic ulcer disease and 10% had lower urinary tract infection. We also found that 6% had acute pyelonephritis, 6% had acute gastroenteritis, 6% had acute cholecystitis, 6% had acute appendicitis, 2% had acute pancreatitis, 3% had choledocolithiasis, 2% had ovarian solid mass, 2% had twisted ovarian cyst, 4% had renal colic, and 1% had renal calculus. In non-obstetrical presentation of acute abdomen, the study found that 84% of respondents complained their pain lasting more than 24 hours. Besides, half of respondents felt pain in epigastrium and right hypochondrium. Cramping, prickling and aching type of pain were more, while 66% suffered from continuous pain. Our results also showed that 73% did not explain any aggravating factor and relieving factor, and the rest said food, fasting state and position change aggravated pain as well as relieved pain. The study concludes that precise diagnosis of the acute abdomen in pregnant women by continual updating of abdominal assessment knowledge, and clinical skills is necessary in the management of abdominal pain in obstetric settings

Evaluation of antidiabetic phytochemicals in Syzygium cumini (L.)Skeels (Family: Myrtaceae).

Traditionally the leaves of Syzygium cumini (Myrtaceae) are widely used for treating diabetes. The present study was carried out to identify the putative antidiabetic constituents from the S. cumini leaves. From the NMR data four different compounds, Lupeol, 12-oleanen-3-ol-3ß-acetate, Stigmasterol, ßsitosterol were identified from n-hexane fraction of plant extract. These compounds have potential antidiabetic activities which support the traditional use of the leaves as being remedy for treating diabetes.

Antidiuretic and antidiarrhoeal activities of polar and non-polar extract of Brassica oleracea.

Diuretic activities of both polar and non-polar extract of leaves of Brassica oleracea were investigated on male white rabbits and male Sprague-Dawley rats. Anti diarrheal activity of the same extract was investigated on male and female swiss albino mice. Both polar and non-polar extract exhibited anti diuretic activities on both rats and rabbits. Polar and Non-polar extract also showed anti diarrheal activity on male and female mice. Anti diarrheal activity affects both latent period and number of stools.

Assessment of Acute Kidney Injury in Patients Undergoing Elective Coronary Angiography and Percutaneous Coronary Intervention.

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction. Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development, Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN.

Pulmonary Hypertension in Hemodialysis Patients.

Background: Pulmonary hypertension (PH) has been reported to be high among maintenance dialysis patients. There is a paucity of data on the incidence and prevalence of pulmonary hypertension in chronic kidney disease(CKD) in Bangladeshi patients. Materials and Methods: A total 70 CKD patients (male 47,female 23), who were on conservative management and maintenance hemodialysis were studied for the presence of pulmonary hypertension. The variables studied were hypertension, diabetes, duration of dialysis and the hemoglobin, serum creatinine and serum bicarbonate levels. Results: 68.6% of the patients on maintenance hemodialysis had pulmonary hypertension compared to 8.6% of the prediadysis CKD patients. 97.1% of maintenance dialysis patients had anaemia (Hb <10gm/dl) and 42.9% of patients had metabolic acidosis. Conclusion: The incidence of pulmonary hypertension was highest in the hemodialysis group. Significant Pearson’s correlation was found between pulmonary arterial systolic pressure with the duration of hemodialysis, hemoglobin level, serum creatinine, blood sugar and serum bicarbonate level in maintenance hemodialysis patients.

Exclusive Breastfeeding among Preterm Low Birth Weight Infants at One Month Follow-up after Hospital Discharge.

Background: Establishment and maintenance of breastfeeding in preterm low birth weight (PT LBW) neonates after discharge from hospital is challenging and may be affected by multiple factors. We designed this study to find out the association of these factors with breastfeeding in our population. Objectives: To observe the rate of exclusive breasrfeeding (EBF) among the PT LBW neonates at one month follow up and to identify the factors that are related with the maintenance of EBF. Materials and Methods: This observational study was conducted during the period from July 2009 to October 2011 in Enam Medical College Hospital (EMCH). Preterm infants ≤ 34 wks gestation, stayed in the NICU for >3 days and discharged home were eligible. Mothers were interviewed at one month follow-up after discharge. Infants who were given only breast milk up to 4 weeks were termed as “Exclusively breastfed (EBF)” and who were given formula milk in addition were labeled as “Nonexclusively breastfed (NEBF)”. Baseline information regarding maternal demography, delivery of the baby, feeding during discharge was taken from database of neonatal ward. Results: Among 89 infants, 37 (42%) were female and 52 (58%) were male, including 5 twins. Gestational age ranged from 29 to 34 weeks (mean 32±2), and birth weight ranged from 1100 to 2200 grams (mean 1763±20 g). At one month follow up visit 19% (17/89) were found to be NEBF and 81% were EBF. Factors significantly associated with EBF were shorter duration of hospital stay (p=0.001), method of feeding at discharge (p=0.001), mode of delivery (p=0.004), below average socio-economic status (p=0.03), maternal education (p=0.02), number of antenatal visits (p=0.02) and larger birth weight (p=0.038). Conclusion: A variety of factors may affect EBF in PT LBW babies. Extensive counseling of the mothers during antenatal visits, counseling of the family members regarding the advantages of exclusive breastfeeding is necessary. Support should be provided for the mothers both in the hospital and also outside the hospital for a long period.