Comparison of the incidence of post-ERCP pancreatitis between combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is now widely accepted as a therapeutic modality for benign and malignant diseases of the pancreaticobiliary tree. Acute pancreatitis is the most common and feared complication of ERCP, associated with substantial morbidity and mortality. This study aimed to compare the incidence of post-ERCP pancreatitis in combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone. Methods: This was a randomized controlled trial conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2019 to September, 2020. In this study, 100 hospitalized patients of >18 years age undergoing ERCP based on clinical indication and proper investigation were included. The study population was randomly divided into two groups - group A (patients who were given indomethacin suppository plus sublingual glyceryl trinitrate) and group B (patients who were given indomethacin alone). Results: In this study, we found that PEP developed in 11 out of 100 patients (11%). Post-ERCP pancreatitis developed in 2 (4%) in group A and 9 (18%) in group B (p=0.025), which was statistically significant. Mild PEP developed in none in group A and 4 (8%) in group B whereas moderate in 2 (4%) in group A and 3 (6%) in group B. Severe pancreatitis occurred in none in group A and 2 (4%) in group B (p=0.231) which was not statistically significant. Conclusions: This study showed that the combination of indomethacin suppository and sublingual GTN is superior to indomethacin suppository alone in preventing post-ERCP pancreatitis.

Acute kidney injury in patients hospitalized with COVID-19 in HIMS, Hassan

Background: There is a growing need to understand the risk factors and prevalence of AKI in COVID-19 patients to better manage and prevent the condition. HIMS, Hassan is a hospital in India that has been treating COVID-19 patients since the onset of the pandemic. This study aimed to determine the prevalence of acute kidney injury (AKI) in COVID-19 patients admitted to a hospital in HIMS, Hassan, and to identify the associated risk factors. Methods: The study is a retrospective cohort study that investigates the clinical characteristics and laboratory parameters of hospitalized COVID-19 patients who met the inclusion criteria in HIMS teaching hospital, Hassan. 300 patients were included, and descriptive statistical analysis was performed using mean with standard deviation (SD) for continuous variables and proportions and percentages for categorical variables. Results: Out of 300 patients, 68% had AKI. The age distribution was similar between the two groups, with the highest proportion of patients in the age group of 40-49 years. The proportion of AKI was higher among males than females, but the difference was not statistically significant. The need for ICU admission, mechanical ventilation, and dialysis was strongly associated with AKI. Patients with comorbidities such as DM and DM+HTN were at a higher risk of developing AKI. Laboratory parameters such as D-dimer, LDH, ferritin, urea, creatinine, SGOT, SGPT, Neutrophils / Lymphocytes ratio, and chloride levels were significantly different between the two groups. Conclusions: These findings highlight the importance of monitoring patients with comorbidities closely and implementing preventive measures to reduce the incidence of AKI in COVID-19 patients.

Acute kidney injury in patients hospitalized with COVID-19 in HIMS, Hassan

Background: There is a growing need to understand the risk factors and prevalence of AKI in COVID-19 patients to better manage and prevent the condition. HIMS, Hassan is a hospital in India that has been treating COVID-19 patients since the onset of the pandemic. This study aimed to determine the prevalence of acute kidney injury (AKI) in COVID-19 patients admitted to a hospital in HIMS, Hassan, and to identify the associated risk factors. Methods: The study is a retrospective cohort study that investigates the clinical characteristics and laboratory parameters of hospitalized COVID-19 patients who met the inclusion criteria in HIMS teaching hospital, Hassan. 300 patients were included, and descriptive statistical analysis was performed using mean with standard deviation (SD) for continuous variables and proportions and percentages for categorical variables. Results: Out of 300 patients, 68% had AKI. The age distribution was similar between the two groups, with the highest proportion of patients in the age group of 40-49 years. The proportion of AKI was higher among males than females, but the difference was not statistically significant. The need for ICU admission, mechanical ventilation, and dialysis was strongly associated with AKI. Patients with comorbidities such as DM and DM+HTN were at a higher risk of developing AKI. Laboratory parameters such as D-dimer, LDH, ferritin, urea, creatinine, SGOT, SGPT, Neutrophils / Lymphocytes ratio, and chloride levels were significantly different between the two groups. Conclusions: These findings highlight the importance of monitoring patients with comorbidities closely and implementing preventive measures to reduce the incidence of AKI in COVID-19 patients.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan

Abstract Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitants age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

Resumo A medicina tradicional é mais barata e facilmente disponível à população local para cuidar das doenças mais frequentes nas áreas do norte do Paquistão. Nosso estudo teve como objetivo inventariar medicamentos de plantas locais, documentar seus usos e avaliar seu valor de mercado em 2015-2018 durante as temporadas de primavera, verão e inverno. Foram feitas 15 viagens, 5 em cada temporada. Foram realizadas entrevistas semiestruturadas com 165 moradores na faixa etária de 20 a 80 anos, com dados analisados por meio de frequência relativa de citação (RFC), valor de uso (UV), nível de fidelidade (FL), fator de consenso de informantes (CIF), e o índice de Jaccard (JI) para encontrar as espécies utilizadas mais frequentes e conhecidas na área. Um total de 86 espécies pertencentes a 39 famílias de plantas vasculares, 33 gêneros foram documentados como medicamente importantes. A família Asteraceae foi observada como a família dominante entre todas as famílias com 10 espécies, a folha foi a parte mais utilizada e a decocção 36% foi o tipo de preparação mais preferido. A erva foi a forma de vida predominante (67%). O UV máximo (0,92) foi demonstrado pelas espécies de J. adhatoda L., enquanto A. sativum L. mostra RFC máximo (0,58), o maior valor de ICF representado por diarreia e dermatite 0,92, e alto valor de FL é registrado 100%. De acordo com nossas coleções, as espécies selvagens foram 45%, as espécies invasoras 38% e as cultivadas 17% registradas, as espécies dicotiledôneas foram registradas mais 81%. Sete espécies medicinais estão sendo economicamente importantes e exportadas para o mercado local e internacional do mundo, enquanto as espécies de P. integrima L. foram as espécies mais exportadas de acordo com os comerciantes locais. A área investigada é rural e a população local depende das plantas da área para suas necessidades de saúde e outros usos como vegetal, lenha, forragem etc. O resultado atual de RFC, UV, ICF, FL e JI mostra que a flora medicinal precisa ser investigada farmacológica e fitoquimicamente para comprovar sua eficácia. A documentação do conhecimento medicinal é importante para preservar esse precioso conhecimento antigo antes que se perca para sempre, devido às mudanças tecnológicas e ambientais do mundo.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan / Conhecimento tradicional sobre plantas medicinais nas áreas remotas de Wari Tehsil, Dir Upper, Paquistão

Abstract Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

Resumo A medicina tradicional é mais barata e facilmente disponível à população local para cuidar das doenças mais frequentes nas áreas do norte do Paquistão. Nosso estudo teve como objetivo inventariar medicamentos de plantas locais, documentar seus usos e avaliar seu valor de mercado em 2015-2018 durante as temporadas de primavera, verão e inverno. Foram feitas 15 viagens, 5 em cada temporada. Foram realizadas entrevistas semiestruturadas com 165 moradores na faixa etária de 20 a 80 anos, com dados analisados ​​por meio de frequência relativa de citação (RFC), valor de uso (UV), nível de fidelidade (FL), fator de consenso de informantes (CIF), e o índice de Jaccard (JI) para encontrar as espécies utilizadas mais frequentes e conhecidas na área. Um total de 86 espécies pertencentes a 39 famílias de plantas vasculares, 33 gêneros foram documentados como medicamente importantes. A família Asteraceae foi observada como a família dominante entre todas as famílias com 10 espécies, a folha foi a parte mais utilizada e a decocção 36% foi o tipo de preparação mais preferido. A erva foi a forma de vida predominante (67%). O UV máximo (0,92) foi demonstrado pelas espécies de J. adhatoda L., enquanto A. sativum L. mostra RFC máximo (0,58), o maior valor de ICF representado por diarreia e dermatite 0,92, e alto valor de FL é registrado 100%. De acordo com nossas coleções, as espécies selvagens foram 45%, as espécies invasoras 38% e as cultivadas 17% registradas, as espécies dicotiledôneas foram registradas mais 81%. Sete espécies medicinais estão sendo economicamente importantes e exportadas para o mercado local e internacional do mundo, enquanto as espécies de P. integrima L. foram as espécies mais exportadas de acordo com os comerciantes locais. A área investigada é rural e a população local depende das plantas da área para suas necessidades de saúde e outros usos como vegetal, lenha, forragem etc. O resultado atual de RFC, UV, ICF, FL e JI mostra que a flora medicinal precisa ser investigada farmacológica e fitoquimicamente para comprovar sua eficácia. A documentação do conhecimento medicinal é importante para preservar esse precioso conhecimento antigo antes que se perca para sempre, devido às mudanças tecnológicas e ambientais do mundo.

Assessment of overweight, obesity and metabolic variables among students of a private medical college in Dhaka city.

Background: Overweight and obesity are recognized as recent threat which affecting both developing and developed countries. Obesity and its associated morbidities are leading cause of most non-communicable diseases. Few recent studies have indicated the presence of increase in overweight and obesity among children and adolescent but there is no study among adult groups. Method and material: This cross sectional study was done to assess the prevalence of overweight, obesity and metabolic variables with their relation among medical students. Result: Our result reveals that 8.6% & 1.9% male and 15% & 3.2% female are suffering from overweight and obesity (based on BMI) respectively. More females (31.3% and 65.2%) are centrally obese than males (3.5% and 34.8%) (According to Waist Hip ratio and Waist Height ratio respectively). But according to Waist circumference more males (30.7%) are obese than females (24%). There is also significant difference of male and female BP. DBP and SBP of male (79.22mmHg & 118.9 mmHg) have high normal level than female (72.71mmHg and 108.67mmHg) (P<0.001). There is no significant difference of glycaemic status (p<.286) and lipid profile (p<.347) with central obesity. Conclusion: Although male students have high upper level of blood pressure, female students are more obese than males (both according to BMI and central obesity). High blood pressure and obesity both acts as risk factors for the development of non communicable disease. Student’s awareness therefore should be increased to reduce central obesity and BP within normal range.

Serum Lipid Profile, Serum Magnesium and Fasting Serum Glucose in Newly Diagnosed Type 2 Diabetic Subjects.

Type 2 diabetes is considered as a major health burden due to its rising prevalence and disabling, life threatening complications. Dyslipidemia, often coexisting with T2DM as a feature of insulin resistance, is hypothesized to be linked with altered magnesium homeostasis. This study was designed to evaluate the serum magnesium levels and its influence on serum lipids in type 2 diabetics. Lipid profile, serum magnesium (Mg) and fasting serum glucose (FSG) were measured in 30 newly diagnosed normotensive type 2 diabetic patients chosen as cases (Group II) just before introducing any treatment, and was compared with that of 30 healthy controls (Group I). The serum magnesium was found to be significantly lower (p<0.001) and LDL-c was found to be significantly higher (p<0.01) in cases. The correlation analysis revealed a significant negative association of FSG to serum magnesium (r= -0.720), total cholesterol (r=-0.483) and a positive correlation to HDL-c (r=-0.440). However, serum magnesium showed a significant positive relation only with serum HDL-c (r =0.372, p<0.05). Serum magnesium and lipid fractions showed wide range of variation within the normal reference ranges in the newly diagnosed T2D subjects. Further large scale studies are needed to elucidate the association of serum magnesium with lipid profile changes. Estimation of serum magnesium level may prove useful in T2DM with normal or abnormal lipid levels or in those who are prone to develop dyslipidemia or certain complications associated with dyslipidemia. Key words: Lipid Profile, Type

Lipid Profile Status of Chronic Obstructive Pulmonary Disease in Hospitalized Patients.

The aim of this study was to evaluate the serum level of total cholesterol, triglycerides (TG), low density lipoproteins (LDL) and high density lipoproteins, (HDL) in chronic obstructive pulmonary disease (COPD) patients admitted in National Institute of Disease of Chest and Hospital, Mohakhali, Dhaka during. January 2009 to January 2010. Twenty two patients with COPD and 22 healthy controls were included in this study. Total cholesterol, HDL and TG levels were determined with ILAB 1800 Chemistry Analyzer using ILAB test Reagents. LDL concentration was calculated using the Friedewald Equation. The mean level of TG was 150.04±29.66 mg/dl and 126.14±13.28 in COPD patients and healthy control, respectively. A statistically significant difference was found between the two groups (p<0.001). The mean level of TC was 181.83±20.11 mg/dl and 176.28±15.35 mg/dl in COPD patients and healthy control respectively (p<0.001). LDL level mean value was 116.12±14.26 mg/dl and 108.95±10.39 in COPD patients and control respectively (p<0.001). The mean value of HDL showed 38.79±2.4 in COPD patients and 39.014±1.56 in control. A statistically significance was also found between the two groups (p<0.001). Our results showed that the values of TC, TG, LDL were higher than healthy control that is highly significant statistically. On the other hand, the was significantly decreased HDL level compared with controls.

Pacing in a Woman with Full Term Pregnancy: First Case Report in Bangladesh.

A 19-year-old primigravida was diagnosed to have complete heart block (CHB) during her antenatal checkup at 36 weeks. The patient had history of syncope a few years back. She was referred to the National Institute of Cardiovascular Diseases (NICVD). A temporary pacemaker was implanted at NICVD. She was then referred to Dhaka Medical College Hospital (DMCH), where a baby girl was delivered by cesarean section. A permanent pacemaker was implanted later at NICVD. To our knowledge this is the first case report of pace maker implantation in a pregnant woman from Bangladesh.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh.

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

Endometriosis association research center.

Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age. Pain syndrome, however, represents the major clinical problem of this disease, manifested as dysmenorrhea, pelvic pain, lower abdominal pain, and dyspareunia. About 32 literatures are reviewed in recent advancement for diagnosis of endometriosis. The magnifications of its managements are understood. In outdoor, the management is only depending on clinical findings and on some non invasive procedures without any definitive diagnosis. So, research activities should be done on the basis of recent advancement of endometriosis.

Geographical distribution & seasonal pattern of diarrhoeal diseases in Bangladesh.

The district wise distribution and seasonal pattern of diarrhoeal diseases from 1987 to 1989 of Bangladesh are compiled and reported. The districts of Lalmonirhat, Kurigram, Gaibandha, Rajbari and Banderban showed higher incidences of diarrhoeal diseases to mean range of 8 and above. Among the remaining districts, 18 districts were in the medium ranges of incidences between 4 to less than 8% and 41 districts with lower range of incidences i.e. less than 4%. Two peaks of diarrhoeal diseases were found, once during the months of September-October in the post monsoon period and other during April-May.