Low Dose Aspirin for Primary Prevention of Adverse Pregnancy Outcome

Background: Pregnancy is associated with various complications such as pre-eclampsia, SGA, preterm birth etc. Low dose aspirin is a possible medication to minimize these adverse outcomes. The aim of this study was to evaluate the use of low dose aspirin for primary prevention of adverse pregnancy outcome. Material & Methods: This cross-sectional study was conducted in department of Gynaecology, North Bengal Medical College Hospital, Mirjapur Bkash Hospital, Mirjapur, Tangail, Bangladesh, during the period from June 2021 to August 2022. Total 200 pregnant women were included in this study. Results: In this study, the mean (±SD) age of the study subjects were 25.12 ± 5.49 years and 25.00 ± 4.83 years in LDA group and control group, respectively. There was no statistically significant (p>0.05) difference in age between the groups. The rate of caesarean section was higher in control group (68%) compared to LDA group (59%) but there was no statistically significant (p>0.05) difference among the groups. In our study, 8% pregnant women in LDA group and 19% pregnant women in control group had gestational hypertension, pre-eclampsia was seen in 6% and 13% pregnant women in LDA group and control group, respectively, preterm birth was seen in 8% and 17% pregnant women in LDA group and control group, respectively, SGA was seen in 19% and 32% pregnant women in LDA group and control group, respectively, and fetal distress was seen in 2% pregnant women in both LDA group and control group. There were statistically significant (p<0.05) differences in complications except fetal distress. Mean (±SD) neonatal birth weight was 2.88±1.03 kg and 2.74±0.85 kg in LDA group and control group, respectively and there was no statistically significant (p>0.05) difference. Conclusion: We found that low dose aspirin could significantly reduce the risk of adverse outcomes, especially for pre-eclampsia, SGA and preterm birth.

Prevalence, Risk Factors and Clinical Features of Post Dural Puncture Headache (PDPH): A Prospective Study

Background: Post-dural puncture headache (PDPH), formerly known as post-lumbar puncture headache, is a well-known adverse event that follows diagnostic and/or therapeutic puncture of the dura, or accidentally, following spinal anesthesia. Material & Methods: This prospective study was carried out on 152 patients at Shaheed Ziaur Rahman Medical College Hospital in Bogura, from 2013 to 2015 and North Bengal Medical College from 2016 to 2022, Bangladesh. Results: A total of 152 patients were enrolled into the study where 122(80.3%) were aged between 18-28 years, 30(19.7%) were 29-39 years, 38(25%) were male and 114(75%) were female. 122(80.3%) patients were non obese (<25) and 30(19.7%) were obese (>25). 17(11.2%) patients had previous history of anaesthesia and 17(11.2%) had previous history of PDPH. On majority 100 patients were used big size needle (18-23 G) and rest of the patients were used small (23-25G). 146 (96.1%) patients position was lateral and 92(60.5%) were used less than two or equal three drops. 61(40.1%) patients were needed one attempt, 64(42.1%) were needed two and 27(27.8%) were needed greater than two. The prevalence of PDPH was found in 44(28.9%) cases out of 152 where severity of 29(65.9%) percent was mild, 20(45.5%) cases headache onset were at the first day and mean duration of headache was 2.6. There was a statistically significant association between development of PDPH and younger age (26.3±8.7 years vs 32.6±7.4, p< 0.001), female gender (p=00.009), previous history of PDPH (p<0.001), number of attempts (3.1±1.2 vs 1.2±0.8, p<0.001), small needles (p=0.04), pre LP headache (p<0.001) and CSF RBS (2.6±2.1 vs 13.8±1.3, p= 0.48). Conclusion: This study recommends that the neurologists should be treating this population in the manner so that it may help to prevent this painful adverse event, and identification of risk variables is vital in predicting PDPH.

Atherogenic index of plasma and its association with cardiovascular disease risk factors among postmenopausal rural women of Bangladesh

Objectives There is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting. Methods This cross-sectional study recruited 265 postmenopausal women aged 40–70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the ‘noncommunicable disease risk factors survey Bangladesh 2010’. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis. Results Overall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist–hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p < 0.001), low-density lipoprotein cholesterol (β = −1.044, p < 0.001), and metabolic equivalent of tasks (β = −0.171, p = 0.003) showed a significant association with AIP. Conclusion High AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.

Prescribing Behavior of Diabetes Treating Physicians in Selected Health Care Facilities of the Diabetic Association of Bangladesh.

Background: Practicing behavior of the physicians varies from population to population due to diverse socioeconomic, cultural, and professional factors. Evidence on these issues is almost nonexistent in the developing countries. Objective: The prescribing behavior of diabetes treating physicians working in selected hospitals of the Diabetic Association of Bangladesh was studied along with the factors affecting those behaviors. Materials and Methods: This was an observational study on 818 prescriptions given by 49 physicians working in 16 health care facilities, which were photocopied by a portable photocopier. The various components of the prescription were scrutinized for presence and absence, and evaluated independently by two expert Diabetologists for their qualitative aspects. Results: The mean ± standard deviation of the total prescribing score (expressed as percentage) was 60 ± 11. Physicians scoring around or below 60% belonged more to lower age (<40 years), less experienced (<7 years) and mid-position (Senior Medical Offi cers) groups. Most of them also had public medical college background. Physicians with Certifi cate Course on Diabetology (CCD) had signifi cantly higher score compared with the Non-CCD group (P < 0.001). Direction and duration of drug use were absent in majority of prescriptions (72.0% and 61.6%), respectively. Symptoms were not written in 78.0% and the family histories were not recorded in 98.5% prescriptions. Diet (49.4%) and exercise (51.0%) related advices were not mentioned in a large number of prescriptions. Appropriate change of drug (78.2%) and proper use of drug (99.1%) and brand (93.8%) were found rational, but still, 22.4% of the prescriptions found illegible. Conclusion: A large proportion of prescriptions in Bangladesh related to diabetes care still lack standardization and acceptable quality. Nondrug related issues (such as history, symptoms, and dietary/exercise-related advices) are the most neglected ones in a prescription.

Non-adherence to Life-style Modification and its Factors Among Type 2 Diabetic Patients.

Non-adherence to preventive and therapeutic life-style recommendations among patients with diabetes is special challenge in the management of these patients. This study aimed to measure the proportion of non-adherence to lifestyle modifi cation and factors associated with these among a group of Bangladeshi type 2 diabetic patients. Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were selected from different health care centers operated by the Diabetic Association of Bangladesh. Non-adherence rate were assessed for: Diet (88%), exercise (25%), routine blood glucose testing (32%), foot care (70%), smoking (6%) and betel quid chewing habit (25%). Binary logistic regression suggests that higher education group (P = 0.013), rural area (P = 0.013) and attendance to diabetes education classes (P = 0.043) showed good adherence to diet and non-attendance to diabetes education class (P = 0.014), older age (P = 0.037) are associated to non-adherence to exercise. Unemployed patients showed more non-adherence to blood glucose testing (P = 0.045) than others. Nonattendance to diabetes education class (P = 0.037) and business occupation group (P = 0.039) showed signifi cant association to smoking and betel quid intake habit respectively.

Study of the Hypoglycemic Effect of Tamarindus indica Linn. Seeds on Non-Diabetic and Diabetic Model Rats.

Aim: The present study was undertaken to evaluate the antidiabetic effects of the Tamarindus indica Linn seed in normal (non-diabetic), type-I and type-II model rats and to investigate their effect on gastrointestinal motility and intestinal glucose absorption. Methodology: T. indica seed powder was used at a dose of 1.25g/kg bw/10 ml water. Male Long-Evans rats (160-210g body weight) were used for the experiment. Experiments were done in non-diabetic and streptozotocin-induced diabetic model rats with a single feeding in different prandial states and blood was collected. An intestinal perfusion technique was used to study the effects of T. indica seed powder on intestinal glucose absorption in normal and type-II model rats. Gut motility was evaluated using barium sulfate milk. Glucose was measured by Glucose oxidase-peroxidase (GOD-POD) method. Result: The screening results showed that T. indica seed powder had no effect on fasting or postprandial serum glucose level of normal and type-I diabetic rat. The seed powder also showed no hypoglycemic effect in the fasting state and no antihyperglycemic effect in type-II model rats when fed simultaneously with oral glucose load, but it exhibited significant antihyperglycemic effect when the seed powder was fed 30 minutes prior to the glucose load at 105 minutes (p<0.03). Glibenclamide significantly lowered postprandial serum glucose levels of non-diabetic and type-II diabetic model rats (p<0.02-0.001). T. indica exerted inhibition on glucose absorption in type-II rats during the whole perfusion period when compared with control. On the other hand, T. indica seed powder significantly inhibited the gastrointestinal motility in type-II rats. Conclusion: The present data suggest that T. indica possesses antihyperglycemic properties in type-II rats which are at least partly due to its inhibitory effect on intestinal glucose absorption. This effect cannot be attributed to the acceleration of intestinal transit.

Association of Human Papilloma Virus Infection and Oral Squamous Cell Carcinoma in Bangladesh.

Oral squamous cell carcinoma is the sixth most common malignancy worldwide. In Bangladesh, it comprises 20% of the whole body malignancies. Several studies found that 15% to 25% of oropharyngeal cancer cases are associated with human papilloma virus (HPV). This study is done to find the association of human papilloma virus subtypes, particularly HPV type 16 and HPV type 18, with the oral squamous cell carcinoma in Bangladeshi patients. In total, 34 diagnosed patients of oral squamous cell carcinoma were included in the study. Extracted DNA from the cancerous tissues was checked for PCR reaction to detect the subtypes of human papilloma virus. Data of the present study suggest that oral squamous cell carcinoma are almost absent in Bangladeshi patients with human papilloma virus, particularly HPV 16 and 18.

Glycemic and Insulinemic Responses to Commonly Consumed Potatoes in Bangladeshi Type 2 Diabetic Subjects.

Glycemic indices (GIs) and insulin responses are useful for measuring biological effects and consequences of carbohydrates when designing healthy diets, particularly for people with or at risk of developing diabetes and others disorders such as metabolic syndrome. In this study, we investigated GIs and insulin (as measured by C-peptide) responses of patients with type 2 diabetes mellitus (T2DM) to Bangladeshi potatoes and sweet potatoes. Using a cross-over design, ten T2DM subjects consumed equivalent carbohydrate amounts (50 g of total carbohydrate) of either the vegetables or white bread (WB) (as reference food). Serum glucose levels were determined after 0, 15, 30, 45, 60, 90, 120, 150 and 180 minutes, and C-peptide levels were determined at 0 and 180 minutes. Glycemic Indices and Glycemic Loads (GLs) were calculated. Both plain and sweet potatoes showed a significantly higher serum glucose response compared to the reference food. The similar glycemic response between plain and sweet potatoes was reflected in their GI values: 162  50 and 191  66, respectively. The GL values were 8 and 11, respectively. The substantially higher glycemic response and GI values of the two potatoes were not the consequence of a suppressed insulin response. Compared to the mean values of the international table, Bangladeshi potatoes and sweet potatoes are very high GI foods. However, based on the dietary practices in our society, potatoes and sweet potatoes may be used as low and medium GL foods, respectively. This work may help create a better food exchange table for diabetic patients.