Acupuncture Treatment in Rheumatoid Arthritis Patients in a Specialized Acupuncture Center in Dhaka Bangladesh: A Case Report

Background: Two recognized antibodies, Rheumatoid Factor (RF) and Anti-Citrullinated Peptide Antibody (ACPA), are produced in rheumatoid arthritis to target common autoantigens that are expressed in and around the joints. Tobacco and microorganisms, as well as the relationship between genetics and environment, play a critical role in the progression of the illness (e.g. Porphyromonas gingivalis). Rheumatoid arthritis is visualized as a Th1 and Th17 illness in the first stages of the disease. There is a significant role for inflammatory cytokines in the hierarchy of RA processes. Additionally, RA-related joint degradation is mediated by the Wnt system and osteoprotegerin抯 impact on osteoclasts, as well as the matrix synthesis dysregulation that causes cartilage degeneration. Rheumatoid arthritis is a disease in which both innate and adaptive immunity have been shown to play a key role, thanks to the development of effective therapies for TNF-, IL-6 receptor, IL-1, CD20 B cells, and T-cell/Dendritic cell interactions.

Effect of superdisintegrants and their mode of incorporation on disintegration time and release profile of carbamazepine from immediate release tablet.

In this experiment the effect of mode of incorporation of some superdisintegrants such as sodium starch glycolate, croscarmellose sodium, crospovidone (kollidon CL), ludiflash and Xanthan gum (XG) on dissolution profile and disintegration time of carbamazepine (CBZ), apoorly water soluble drug was studied. The superdisintegrants were incorporated by extragranularly, intragranularly and in direct compression method. Different amount of superdisintegrants (1%, 3% and 6%) was incorporated in different formulations whereas all the other excipients as well as the active drug remained same. The results indicated that sodium starch glycolate, when incorporated extragranularly in wet granulation method significantly enhanced the release profile of CBZ. Kollidon CL was the most effective superdisintegrant in decreasing disintegration time of different tablet formulations (1.95 minutes when extragranularly incorporated). On the other hand, tablets prepared with SSG were found most effective in % drug release irrespective of its mode of incorporation (99.99% when extragranularly incorporated and 99.75 when intragranularly incorporated within one hour). Tablets prepared by direct compression method also showed similar drug release with other methods but tablet hardness was found lower. So addition of superdisintegrants in tablet formulation may be an effective technique to comply compendial drug release.

Anthelmintic and diuretic activity of bark extracts of Sterculia villosa.

The study was evaluated for diuretic and anthelmintic activity of the ethanolic extract of the barks of Sterculia villosa Roxb, (Sterculiaceae). The diuretic assay was done on both healthy wistar rats and rabbits. The dose used for the diuretic assay was 100, 200 & 400mg/kg of the extract. Compared to the control and standard drug furosemide (20mg/kg), the result of diuretic study showed dose dependent activity of the extracts. The result also indicated higher excretion of Na+, K+ & Cl- in urine. Pheretima posthuma, adult earthworms were used for anthelmintic activity and the results of anthelmintic assessment at the dose of 50, 100 & 200mg/ml showed significant activity compared with control and standard drug albendazole (10mg/ml).

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.

Formulation and Evaluation of Bi-layered Sustained Release Matrix Tablets of Tramadol Hydrochloride.

Bi-layer tablets of tramadol hydrochloride were prepared by direct compression technique incorporating an immediate release layer and a sustained release layer. An immediate release layer was successfully designed to release the bolus dose instantaneously. Water soluble Xanthan gum, water insoluble Kollidon SR and Eudragit L 100 were used as carriers in the sustained release layer of the matrix tablet. All the tablets were evaluated for thickness, diameter, weight variation, hardness and friability. The in vitro drug release was studied for eight hour, first two hours dissolution in acidic medium followed by six hour dissolution in buffer medium. Matrix tablet showed a sustained release rate with a controlled fashion as a function of the quantity of polymer used. The in vitro drug release data were fitted with several mathematical models and mean dissolution time along with fractional dissolution time values (T25%, T50% and T80%) were calculated. Xanthan gum was found to be the most effective rate retarding agent compared to Kollidon SR and Eudragit L 100, when used at same ratio in the formulations.

Pattern and treatment of Gout in Bangladesh: a hospital based survey at Dhaka city, Bangladesh.

Gout is a common metabolic disorder which occurs due to excessive deposition of uric acid in different bone joints. Increasing life expectancy, life style change, changes in diet are causing an increased incidence of the disease nowadays. The present study was aimed to understand the pattern and treatment of gout in Bangladesh. 150 patients at four tertiary care hospitals in Dhaka city were surveyed. The findings of the present study suggests that both male and female are suffering from the disease and age seems to be related to the disease as 62% of gout patients were found over 50 years of age. Body weight may be a contributing factor of the disease. Most of the gout patients under the survey were suffering from high blood pressure (65.33%). Primary gout was found more prevalent in this investigation (70.66%) and viral hepatitis was found to be the most common cause of the disease (50%). The patients presented common sign and symptoms of gout.

Comparative in vitro dissolution study of Aceclofenac Marketed Tablets in Two Different Dissolution Media by Validated Analytical Method.

In this study five marketed brands of aceclofenac 100 mg tablets have been evaluated using dissolution test in two different media with the aim to assess bioequivalence and to select a proper dissolution medium. Other general quality parameters of these tablets like weight variation, hardness, friability, disintegration time were also determined according to established protocols. All the brands complied with the official specification for friability, uniformity of weight, disintegration time and drug content. UV spectroscopic and RP-HPLC methods were validated for the parameters like linearity, accuracy, precision and robustness. Potency was determined by using these two methods. Potency obtained from UV method and HPLC methods were found similar with paired t test. Dissolution test results were subjected to further analysis by difference factor (f1), similarity factor (f2) and dissolution efficiency (% DE). Higher drug release was found in phosphate buffer pH 6.8 than in 0.05% sodium lauryl sulphate solution. All brands were found similar in respect of drug release in phosphate buffer pH 6.8 but they differ in respect of drug release in 0.5% sodium lauryl sulphate. So phosphate buffer pH 6.8 may be a suitable media for dissolution study of aceclofenac tablets.

Development of Sustain Release Matrix Tablet of Ranolazine Based on Methocel K4M CR: In Vitro Drug Release and Kinetic Approach.

In this study an attempt was made to design and evaluate oral sustained release matrix tablets of ranolazine using Methocel K4M CR as the retardant polymer. Tablets were prepared by conventional wet granulation technique. Tablets were evaluated for parameters such as weight variation, hardness, friability and drug content. All the formulations showed compliance with pharmacopieal standards. In vitro release studies were performed using USP type II apparatus (paddle method) in 900 mL of 0.1N HCl at 50 rpm for 8 hours. The release kinetics was analyzed using the zero-order, first order, Higuchi, Hixson-Crowell and Korsmeyer-Peppas equations to explore and explain the mechanism of drug release from the matrix tablets. In vitro release studies revealed that percent drug release decreased with increase of polymer loading. Based on the dissolution data comparison with innovator brand F-5 formulation (16% Methocel K4M CR w/w of drug) was elected as the best formulation. The drug release profile of the best formulation was well controlled and uniform throughout the dissolution studies. The drug release of optimized formulation follows the Higuchi kinetic model (R2 = 0.99) and the mechanism is found to be non-Fickian/anomalous according to Korsmeyer–Peppas equation. All the formulations were checked for stability as per ICH guidelines and formulations were found stable during the study.

Development and Validation of RP-HPLC Method for the Simultaneous Estimation of Domperidone and Naproxen in Tablet Dosage Form.

A simple, selective and rapid reversed phase High Performance Liquid Chromatographic (RP-HPLC) method has been developed and validated for the simultaneous analysis of domperidone and naproxen in tablet dosage form. The chromatographic system consisted of two LC-20 AT pump, SPD-20A UV detector, SIL-20A auto-sampler and CTO- 10ASVP column oven. Chromatographic separation of drugs was achieved on an Shim-Pack C18 column (250 mm x 4.6 mm, 5 μm) as stationary phase with a mobile phase comprising of phosphate buffer (pH adjusted to 3.00 with sodium hydroxide): methanol in the ratio 30:70 (v/v) at a flow rate of 1.0 ml/min with UV detection at 280 nm. Retention time was 3.17 minutes for domperidone and 5.42 minutes for naproxen. The method was found selective and peaks of domperidone and naproxen were well separated (resolution 10.72). The proposed method is linear (r2 = 0.999 for domperidone and naproxen), accurate with 99.5% recovery for domperidone and 99.39% recovery for naproxen and precise (%RSD < 1%). The method has been used to determine potency of commercial product and potency was found within limit. The method can be used for the analysis of domperidone and naproxen in tablet dosage form.

ABO and Lewis Blood Grouping with ABH Secretor and Non-secretor Status: A Cross Sectional Study in Dhaka.

A cross sectional study was done with 42 apparently healthy persons aged 6 years and above from both sexes. Most of them are blood donors in the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Few, other than blood donor, were selected from the same locality. Five ml venous blood was collected with all aseptic precautions. ABO blood grouping and Lewis phenotyping were done by tube method. ABO reverse grouping was also done from serum. With all precautions 2 ml of saliva was collected from all subjects. Secretor status was detected from the saliva by haemagglutination inhibition method. ABO blood grouping shows 36% 'O' group, 24% 'A' group, 33% 'B' group and 7% 'AB' group. Distribution of Lewis phenotype are Le(a+b-) 19%, Le(a-b+) 53%, Le(a-b-) 26% and Le(a+b+) 2% only. 60% of study population was ABH secretor and 40% non-secretor.

Abundance of Road Traffic Accidents among Medicolegal Postmortem Cases..

This retrospective study was conducted at the Dhaka Medical College (DMC) morgue during the period of Jan 2008 to Dec 2008. The objective of this study was to find out the abundance of Road Traffic Accidents (RTA) cases among medicolegal post mortem examinations performed at DMC morgue and in this relation to evaluate the present situation of RTA in our country. It has been observed that RTA cases are the most common cases among various types of medicolegal post mortems. A total of 2714 postmortems were conducted during the study period and out of which 813 (29.95%) cases were of RTA, among the victims 545 (67.03%) were male and 268 (32.96%) were female. Highest incidence (30.38 %) of RTA was observed among the age group 21 to 30 yrs. Most accidents occurred at daytime 282 (34.68%), followed by night 233 (28.66%). Greater number of accidents occurred during September 90 (11.07%), followed by January 85 (10.45%) and December 83 (10.20%). Commonest victims were pedestrians 564 (69.37%). Most accidents took place on highways 650 (79.95%) and buses were the most dangerous vehicle causing highest number of accidents 307 (37.76%), followed by truck 141 (17.34%). Among the cases 100% victims had multiple abrasion and bruise, laceration were present in 654 (80.44%), and intra cranial injury 527 (64.82 %).

Surgical Outcome Of Spontaneous Intracerebral Haematoma Through Keyhole Craniectomy.

Management of spontaneous intracerebral haematoma (SICH) is divided into two groups - medical and surgical interventions. Although surgical management is controversial, it can be life saving when patient is deteriorating. Surgical techniques varies from large craniotomy, burr hole aspiration, stereotactic & endoscopic evacuation of haematoma. Forty eight patient of SICH were treated surgically using keyhole craniectomy technique, small craniectomy of 2-2.5 cm diameter. Surgical outcome assessed by Glasgow Outcome Score (GOS). Post-operative CT scan was done in all cases. Good recovery was achieved in 2 cases (4%), moderate disability in 20 cases (42%), 5 patients remain in vegetative state. Good evacuation of haematoma was seen in 42 patients except 6 cases deteriorated by post-operative CT scan. Surgical evacuation of SICH through keyhole technique is minimally invasive, safe and can achieve desired result. Patient with a GCS > 9 prior to surgery demonstrate a better outcome with this minimally invasive method.

A Comparative Study Between Efficacy Of Esmolol And Lignocaine For Attenuating Haemodynamics Response Due To Laryngoscopy And Endotracheal Intubation.

Haemodynamic stability is an integral and essential goal of any anaesthetic management plan. Laryngoscopy and intubation can cause striking changes in haemodynamics. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic and vagal discharge in response to laryngotracheal stimulation, which in turn leads to increased plasma norepinephrine concentration. This study was designed to compare efficacy of esmolol and lignocaine for attenuating haemodynamics response due to laryngoscopy and endotracheal intubation. The aim of this study was to compare the effects of Esmolol with that of Lignocaine to attenuate the detrimental rise in heart rate and blood pressure during laryngoscopy and tracheal intubation. One hundred and twenty adult patients randomized into group-L and group-E, were received lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg I.V. respectively. Heart rate and blood pressure in each minutes for the 10 minutes after intubation was recorded. Time span around intubation up to 4 minutes has been looked specifically to isolate the effect of the study drugs at the time of intubation. For statistical analysis Student's 't' test was used for comparing means of quantitative data and chi-square test was used for qualitative data. Difference was considered statistically significant if p<0.05. The mean heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product before starting anesthesia were similar in group-L (Lignocaine group) and in group-E (Esmolol group) (p>0.05). The mean values of heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product at 2, 3 and 4 minutes after intubation were significantly lower in group-E than group-L (p<0.05). In conclusion, esmolol 1.5 mg/kg is superior to lignocaine (1.5 mg/kg) for attenuation of haemodynamic response to laryngoscopy and endotracheal intubation.

Giant penoscrotal filariasis.

A 42 year old male individual having a hugely distended scrotum and barely perceptible penis, unable to maintain his livelihood on account of his handicap and socially withdrawn for the fear of humiliation, got admitted into the Surgery department of Mymensingh Medical College Hospital in August 5, 2007. The person had been carrying the so called curse for the last four years. On the basis of clinical, serological and haematological examinations, diagnosis was established as lymphatic filariasis causing elephantiasis of the scrotum. After assessment for operative feasibility, the patient underwent an operation in August 20, 2007 during which, ligation of both the spermatic cords, excision of the scrotum along with the testicles and reposition of the penile shaft into the anterior pelvic wall in the subcutaneous plane (Fleying procedure) was performed. The scrotum measured about 36 inches in diameter and weighed 40 kgs after excision. Histopathological examination of the scrotal skin confirmed the diagnosis. The patient was released without any complication, on the 11th post operative day after removal of stitches, with indwelling urethral catheter. He was prescribed Doxicycline for the next 8 weeks, a drug which has been found to be effective in treating filariasis in a number of studies, and acts by killing a symbiotic bacteria necessary for the survival of the worm. Follow up after 3 months was uneventful.

High resolution ultrasound of ophthalmic patients in a tertiary hospital.

The study was done to find out pathologic processes in ophthalmic patients in different age group to understand the use, role and limitations of ultrasonography in the diagnosis of ocular pathology in this locality. A prospective study was done on total 143 patients from September 2004 to January 2006 who attended Centre for Nuclear Medicine & Ultrasound, Mymensingh for ultrasound evaluation of eye. Total 100 (69.93%, n=100) cases were male and 43 (30.06%, n=43) cases were female. The age ranges were 2 months to 80 years. A variety of ocular pathology was diagnosed with the help of high resolution ultrasound (HRUS) with unique ultrasound appearance. Bulk of the referral patients had history of ocular trauma (38.46 %, n= 38) and most commonly detected pathology in these group are vitreous hemorrhage (34.44%, n=34) and cataract formation (28.28%, n=28). Almost all of the patients did not have conclusive diagnosis clinically and by conventional means available before ultrasonography were performed. High resolution sonography may be used as a valuable tool for evaluation of ophthalmic pathology as a well suited, noninvasive method, and only practical imaging modality for assessing those cases particularly when light conducting media are opaque.

Tc-99m DTPA scintigraphy in soft tissue tumor.

Tc99m-DTPA scintigraphic study were done in Centre For Nuclear Medicine and Ultrasound (CNMU) Mymensingh presented with palpable soft tissue mass. All the patients referred to CNMU for ultrasonic evaluation of the mass. Taking proper consent form patient and we did the Tc-99m DTPA scanning of the masses. The study was carried out using Tc-99m DTPA in three phases dynamic, blood pool after 5 min, followed by a late scan after 2 hr. The uptake was categorized as consistently positive, initially positive but latter (progressively) negative, initially negative but latter (progressively) positive and consistently negative. Among our studied cases there were both benign and malignant lesion that were proved by histopathology after excisional biopsy. Two cases were inconclusive. Histologically proven lipoma showed no uptake of DTPA considered as consistently negative. Two cases of rhabdomyosarcoma showed consistently positive.

Placenta previa and it's relation with maternal age, gravidity and cesarean section.

The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

Ultrasound guided fine needle aspiration cytology for diagnosis of mass lesions of liver.

The therapeutic and prognostic evaluation of malignant neoplasia of liver depends mostly on morphologic diagnosis. Ultrasound guided fine needle aspiration cytology (FNAC) of liver has been proved to be a rapid, reliable and cost-effective method for cytological diagnosis of hepatic mass lesions. This study was undertaken to find out the frequency of different benign and malignant space occupying lesions (SOL) of liver from patients attending for FNAC in Mymensingh. Ultrasound guided FNAC was performed on 108 patients with hepatic mass lesions from September 2, 2001 to August 19, 2003. There were 67 (62.0%) males and 41 (37.96%) females with a mean age 53 year (SD +/- 14) ranging from 2 to 83 years. Samples were adequate in 101 (93.5%) and inadequate in 7 (6.5%). Out of 101 adequate samples only one was benign (liver abscess) and 100 were malignant. Of the malignant lesions hepatoblastoma was in 1 (1%), hepatocellular carcinomas in 8 (8%), metastatic adenocarcinomas in 73 (73%) and unclassified malignancies were in 18 (18%). Most of the hepatocellular carcinomas occurred in males (7 in 8). The frequency of metastatic adenocarcinoma was more in males (39 vs. 34) but the difference is not significant (p > 0.05). Ultrasound guided FNAC of liver is a rapid, reliable and cost-effective diagnostic method. It can be practice in any centres where ultrasound facility and specialist pathologists are available.

Gall stone in pregnancy.

Gallbladder disease is four times as common in women as in men, and pregnancy appears to contribute to the development of gallstones. During pregnancy, most women receive ultrasound scans, which are highly sensitive in detecting gallstones. The study was undertaken to evaluate the prevalence of gallstones among the pregnant woman. The aim was to determine any significant difference in the prevalence of gallstone among the pregnant woman compared to the generalized prevalence of gallstone in our community. METHODS: The maternal gallbladder was examined in 1336 consecutive obstetric ultrasound scans performed for medical indications at 3rd trimester of pregnancy. The study was conducted in Centre for Nuclear Medicine and Ultrasond (CNMU) Mymensingh on randomly selected subjects, among those who came here for ultrasound evaluation of pregnancy. 500 control were taken from age group between 20-30 yrs who came here for ultrasound examination of lower abdomen other than pregnancy. RESULTS: Gallstone were found in total one hundred eight cases. Prevalence of gallstone in pregnant woman was 8.08% (n=108). The age ranges were 20 to 45 yrs with mean age of 28.21 +/- 4.95 (mean +/- SD) yrs. The highest prevalence (12.71%) were seen in 3rd or higher gravida group with mean age of 30.32 +/- 4.74 yrs. Significantly higher cases of gallstone were found in multiparity compared to control population of same age group. CONCLUSIONS. Repeated pregnancy causes increased gallstone formation due to changes in gallbladder kinetics leading to stasis and stone formation.

Hydrops fetalis: report of 3 cases.

Ultrasound is a well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. Reported cases are hydrops fetalis diagnosed during ultrasonic evaluation of fetal condition in the Center for Nuclear Medicine and ultrasound (CNMU), Mymensingh. Only fetal ascites was detected in one case of 26 +/- 2 wks of gestation, fetal ascites with hydramnios and thick placenta was seen in another case of 28 +/- 2 wks of gestation. In third case, there was fetal ascites, scalp edema, hydrothorax and myelomeningocele with oligohydramnios at 20 +/- 2 wks of gestation; sonographic diagnosis was hydrops fetalis with myelomeningocele. Follow up was advised in first two cases and third case was terminated electively. To decrease the mortality rate and to improve the outcome of hydrops fetalis cases appropriate prenatal investigations and therapy is needed. Recent advances in prenatal ultrasound have made possible the early detection of hydrops fetalis which is helpful for proper management in time.