Undiagnosed Isolated Systolic and Diastolic Hypertension Subtypes and Their Correlates in Bangladesh: A Nationwide Survey

OBJECTIVES: This study was performed to identify the distribution of undiagnosed isolated hypertension subtypes and their correlates amongst adults aged 35 years and older in Bangladesh using data from the Bangladesh Demography and Health Survey 2011. METHODS: Out of a total of 17,964 selected households, 7,880 were included in the final analysis for this study. Systolic and diastolic blood pressure (BP) were measured 3× at 10-minute intervals. Hypertension subtypes were defined for individuals not under antihypertensive treatment as systolic-diastolic hypertension (SDH): systolic BP (SBP) ≥ 140 mm Hg and diastolic BP (DBP) ≥ 90 mm Hg; isolated diastolic hypertension (IDH): SBP < 140 mm Hg and DBP ≥ 90 mm Hg, and isolated systolic hypertension (ISH): SBP ≥140 mm Hg and DBP < 90 mm Hg. RESULTS: The predominant hypertension subtypes were SDH and IDH [5.2%; 95% confidence interval (CI): 4.7–5.1] followed by ISH (3.8%; 95% CI: 3.4–4.2). Multiple logistic regression showed that age and gender were significant predictors of ISH. SDH was associated with females [odds ratio (OR): 1.8; 95% CI: 1.3–2.6], the older age group (OR-7.4; 95% CI: 4.3–12.7), and overweight or obese individuals (OR: 1.6; 95% CI: 1.1–2.4). Non-manual work (OR: 1.5; 95% CI: 1.0–2.0]) and being overweight or obese (OR: 1.9; 95% CI: 1.4–2.8) were factors associated with IDH. CONCLUSION: ISH, IDH and SDH represent salient subtypes of hypertension in Bangladesh. To identify preventive intervention for averting adverse cardiovascular events, further research is needed.

Effect of VKORC1 and CYP2C9 polymorphisms on warfarin dose requirement in Bangladeshi population

Warfarin, an oral anticoagulant is one of the most widely prescribed drugs in modern medicine. Large interindividuals variability due to age, gender, diet, concurrent drug interactions and variations in CYP2C9 and VKORC1 genes make the management of warfarin therapy challenging and yet no study has been conducted on the Bangladeshi population. The aim of the study was to identify the role of VKORC1 and CYP2C9 polymorphisms in Bangladeshi population in dose requirement of warfarin. We studied 87 heart valve replacement patients who were prescribed warfarin for minimum of 6 months with a target International normalized ratio of 2.0-3.5. Genotyping of VKORC1rs9923231 [-1639 G>A], CYP2C9[asterisk]2 and CYP2C9[asterisk]3 was performed by Polymerase Chain Reaction- Restriction Fragment Length Polymorphism. The frequencies of GG, AG and AA genotypes of VKORC1rs9923231 in the studied population were 87.4%, 8%, and 4.6% respectively whereas the frequencies of the CYP2C9[asterisk]1/3 and CYP2C9[asterisk]3/3 were 4.6% and 3.4% respectively. The CYP2C9[asterisk]2 was not found in the studied population. The results of this study indicate that comparatively higher daily maintenance doses of warfarin were required to achieve the target INR for patients carrying both GG genotype of VKORC1rs9923231 and wild type variant of CYP2C9[asterisk]3 whereas minimum dose were required for patient having AA genotype of VKORC1rs9923231 and [asterisk]3/[asterisk]3 variant of CYP2C9

Genetic polymorphisms of GSTM1, GSTP1 and GSTT1 genes and lung cancer susceptibility in the Bangladeshi population

Objective: To verify possible associations between polymorphisms of glutathione S-transferase Mu (GSTM1), glutathione S-transferase θ (GSTT1) and glutathione S-transferase Pi (GSTP1) genes and susceptibility to lung cancer. Methods: A total of 106 lung cancer patients and 116 controls were enrolled in a case-control study. The GSTM1 and GSTT1 were analyzed using PCR while GSTP1 was analyzed using PCR-restriction fragment length polymorphism. Risk of lung cancer was estimated as odds ratio at 95% confidence interval using unconditional logistic regression models adjusting for age, sex, and tobacco use. Results: GSTM1 null and GSTT1 null genotypes did not show a significant risk for developing lung cancer. A significantly elevated lung cancer risk was associated with GSTP1 heterozygous, mutant and combined heterozygous+mutant variants of rs1695. When classified by tobacco consumption status, no association with risk of lung cancer was found in case of tobacco smokers and nonsmokers carrying null and present genotypes of GSTM1 and GSTT1. There is a three-fold (approximately) increase in the risk of lung cancer in case of both heterozygous (AG) and heterozygous+mutant homozygous (AG+GG) genotypes whereas there is an eightfold increase in risk of lung cancer in cases of GG with respect to AA genotype in smokers. Conclusions: Carrying the GSTM1 and GSTT1 null genotype is not a risk factor for lung cancer and GSTP1Ile105Val is associated with elevated risk of lung cancer.

Immunoglobulin levels in panic disorder patients

The study was conducted to evaluate the serum immunoglobulin levels in patients suffering from panic disorder and to assess the relationship between the changes of immunoglobulin levels and the socioeconomic parameters, as well as nutritional status. 54 panic patients were randomly selected from the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University [BSMMU] and Dhaka Medical College Hospital, Bangladesh. Fifty two, age and gender matched healthy volunteers [42 males and 10 females, mean age of 30 +/- 6 yrs] were also enrolled in this study. Immunoglobulin levels were measured by turbidimetry method using immunoglobulin kits. It was found that the mean serum immunoglobulin concentrations of IgG, IgM and IgA of panic disorder patients were 0.999 +/- 0.26 [g/L], 0.1 +/- 0.028 [g/L] and 0.194 +/- 0.066 [g/L] respectively whereas the values were 1.24 +/- 0.39 [g/L], 0.096 +/- 0.022 [g/L], 0.194 +/- 0.053 [g/L] in healthy volunteers. IgG level in panic disorder patient was found significantly [p <0.05] lower than that of the controls but the change in concentration of IgM and IgA were not significant [p=0.497, p=0.962]. Socioeconomic data reveals that most of the patients were from lower income group and educated. BMI [Mean +/- SD] of the patients [22.62 +/- 3.74 kg/m[2]] and controls [23.74 +/- 2.71 kg/m[2]] were well within the normal range. From correlative analysis it has been found that income has significant effect [p=0.047] on the change of the serum IgG level in panic disorder patient and it was also been justified by the regression analysis [p=0.049]. This finding may play a key role in the diagnosis and treatment of the panic disorder patients. Further studies have been suggested with a large number of populations to confirm these findings

Immunoglobulin levels of vitiligo patients

In the present study, the serum immunoglobulin profiles of vitiligo patients were compared with that of cohort control and evaluated the correlation between immunoglobulin level with their socioeconomic factors and nutritional status. Thirty vitiligo patients were recruited randomly from the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh for this study. Thirty healthy individuals as control group matched by age, sex, education and socioeconomic factors to the patient group were selected. Serum immunoglobulin concentrations were determined by turbidimetry method using immunoglobulin kit. The concentration of IgG and IgA decreased significantly [P<0.05], but the change of IgM was not significant. Socioeconomic data revealed that most of the patients were young and female. Moreover statistical analysis revealed that there was significant correlation between immunoglobulin [IgG and IgA only] concentrations and BMI and number of depigmented patches with IgG concentrations. Finally it can be concluded that the change of serum immunoglobulin concentration in vitiligo patients could be due to the disease condition as pathomechanism suggested the aberrations in cellular immunity. But study with larger number of population is required for further evaluation of the relationship between the immune response and disease state to confirm these findings

Interaction study between levofloxacin and omeprazole using urinary pharmacokinetic data

The objective of this study was to observe the drug interaction between levofloxacin and omeprazole using urinary excretion data. Levofloxacin tablet and omeprazole capsule were administered separately as well as in combination in fasting condition with a wash out period of two weeks after each administration. Urine was collected at different time intervals of 0, 0-2, 2-4, 4-8, 8-12, 12-24, 24-36 and 36-48 hr post-dose and analyzed using a validated HPLC with UV detection. Different pharmacokinetic parameters for both drugs were determined using non-compartmental method. The maximum rate of excretion [R[max]] of levofloxacin was not decreased significantly when co-administered with omeprazole [p>0.05]. Similarly no significant difference [p = 0.350] was observed for R[max] of omeprazole when co-administered with levofloxacin. Again the fraction of levofloxacin excreted [f[e]/f] was not changed significantly [p = 0.953] due to the co-administration of omeprazole. Similarly fraction of omeprazole excreted [f[e] /f] also remained unaffected [p = 0.672] when co-administered with levofloxacin. No significant change was observed for the area under the rate of excretion versus midpoint of time interval curve from zero to 48 hours [AURC[0-48] for levofloxacin and omeprazole [p = 0.816 and 0.792 respectively] when administered separately and co-administered with each other. The study clearly revealed that levofloxacin and omeprazole do not undergo any kind of interactions when administered together. So it can be concluded that these two drugs can be prescribed together to achieve optimum therapeutic activity

Effect of tamarindus indica fruits on blood pressure and lipid-profile in human model: an in vivo approach

Fruits of Tamarindus indica were evaluated for their effects on lipid profile, systolic and diastolic blood pressure and body weight in human subjects. Dried and pulverized pulp of T. indica fruits, at a dose of 15 mg/kg body weight, was found to reduce total cholesterol level [p = 0.031] and LDL-cholesterol level [p = 0.004] to a significant extent. Though the fruits exerted no conspicuous effect on body weight and systolic blood pressure, it significantly reduced the diastolic pressure as confirmed by independent sample t-test at 5% significance level