What is known to us About Renal Function of our Retired Peoples?

Background: Bangladesh is one of the twenty countries in the world with the largest elderly populations, and by 2025, along with four other Asian countries, will account for 44% of world's total elderly population. This rapidly increasing population is a new and important group in terms of social and health policy in the country. As retired geriatric population is increasing day by day and there is a striking increase in their life expectancy and a decrease kidney function recognized as risk factor for morbidity and mortality in the elderly so evaluation of the renal function of retired persons are essential. Objective: To assess the renal function of retired geriatric population by estimation of creatinine clearance by Cockcroft-Gault formula. Design: This was a cross-sectional study. Participant: Retired persons aged 57 years and above without known hypertension, diabetes, renal diseases as study group and healthy adult aged 18-55 years as control group were included in this study. All were obtained from different areas of greater mymensingh districts. Intervention: Under strict aseptic precaution, venous blood was collected and serum creatinine of all were measured by deproteinization method and then calculation of creatinine clearance was done by using Cock-croft Gault formula. Outcome measures: Serum Creatinine, Creatinine clearance. Result: Significant decrease of creatinine clearance was found in the study group (57 years and above) in comparison to control group (p<0.001). There is progressive decrease of creatinine clearance values by age. Limitation: Calculation of Creatinine clearance by Cock-croft formula is not unambiguous and still not accepted unanimously globally. The other tests of renal function were not done. Conclusion: Though the mean creatinine clearance values were significantly decreased in 57 years and above which was progressively decreased by age, yet values were within normal physiological limits. So the retired geriatric population has good renal function in our setting.

What We Know About Cardiac Function of Our Retired People.

Background: Bangladesh is one of the twenty countries in the world with the largest elderly populations, and by 2025, along with four other Asian countries, will account for 44% of world’s total elderly population. This rapidly increasing population is a new and important group in terms of social and health policy in the country. As retired geriatric population is increasing day by day and there is a striking increase in their life expectancy and age is a key risk factor for coronary artery disease and because morbidity and mortality from coronary artery diseases increase with age. so evaluation of the cardiac function of retired persons are essential. Objective: To analyze the cardiovascular function of retired geriatric population in terms of measurement of ejection fraction by echocardiography. Design: This was a cross-sectional study. Participants: 70 Retired persons aged 57 years and above without known hypertension, diabetes, renal diseases as study group and 70 healthy adult aged 18-55 years as control group were included in this study. All were obtained from different areas of greater Mymensingh districts of Bangladesh. Intervention: Ejection fraction by echocardiography. Out come measures: Ejection fraction fraction %. Results: Significant decrease of ejection fraction was found in the study group( 57 years and above) in comparison to control group.(P<0.01) The mean ejection fraction in different age group shows that there is decrease in ejection fraction of study groups than the control groups irrespective of age. Limitation: There was scarcity of Echocardiography at Mymensingh Medical College Hospital. Color doppler echocardiograph was poorly available at the present settings. So diastolic function can not be assessed. Conclusion: Though the mean ejection fraction value was significantly decreased in 57 years and above, which was progressively decreased by age, yet nearly all the values(2.72%) were within normal physiological limits. So, it seems that the retired geriatric population was having good cardiac function in our setting.

Drug abuse and addiction.

Among the social and medical ills of the twentieth century, substance abuse ranks as on one of the most devastating and costly. The drug problem today is a major global concern including Bangladesh. Almost all addictive drugs over stimulate the reward system of the brain, flooding it with the neurotransmitter dopamine. That produces euphoria and that heightened pleasure can be so compelling that the brain wants that feeling back again and again. However repetitive exposure induces widespread adaptive changes in the brain. As a consequence drug use may become compulsive. An estimated 4.7% of the global population aged 15 to 64 or 184 million people, consume illicit drug annually. Heroin use alone is responsible for the epidemic number of new cases of HIV/AIDS, Hepatitis and drug addicted infant born each year. Department of narcotic control (DNC) in Bangladesh reported in June 2008 that about 5 million drug addicts in the country & addicts spend at least 17 (Seventeen) billion on drugs per year. Among these drug addicts, 91% are young and adolescents population. Heroin is the most widely abused drugs in Bangladesh. For geographical reason like India, Pakistan and Myanmar; Bangladesh is also an important transit root for internationally trafficking of illicit drug. Drug abuse is responsible for decreased job productivity and attendance increased health care costs, and escalations of domestic violence and violent crimes. Drug addiction is a preventable disease. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives. Most countries have legislation designed to criminalize some drugs. To decrease the prevalence of this problem in our setting; increase awareness, promoting additional research on abused and addictive drugs, and exact implementation of existing laws are strongly recommended. We should also deserve renewed attention on prescription drug abuse. It is imperative that as a nation we make ourselves aware of the consequences associated with drug abuse. Otherwise devastating effects of drug will destroy the manpower and economic growth of the country.

Histomorphological study of lymphoid follicle of vermiform appendix.

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).

Anticholesterol antibody: the way for reduction of hypercholesterolemia.

Antibodies specific to cholesterol was first reported in 1925. It may develop in the body naturally and it is believed that this antibody has a protective role against harmful forms of cholesterol, such as LDL & VLDL. An immunoglobulin protein, anticholesterol may be found in both circulation as well as digestive tract. Many studies have been done on anticholesterol antibody. Our immune system may produce anticholesterol antibodies in response to elevated levels of cholesterol rich particles, such as LDL & VLDL. It can be induced in animals by conjugating or incorporating the cholesterol antigen into a variety of structures. Immunization markedly decreases the risk of developing atherosclerosis. In comparison to non-tumorous normal subject, the antibody is found to be significantly higher in non-small cell lung cancer (NSCLC). Elevated anti-cholesterol antibodies might be applicable for the serodiagnosis of NSCLC. Some studies showed that LDL immunization induces T-cell dependent antibody formation that protects atherosclerosis. Origo Biosciences scientists had identified a dietary antibody to cholesterol. This protein, when ingested, binds to cholesterol in the human digestive tract and blocks its absorption into the bloodstream. These studies may lead to us to realize the importance of anticholesterol and to find the way for reduction of hypercholesterolemia and thereby reduction of morbidity and mortality.

Persistence of low serum iron and high total iron binding capacity in pregnant women.

A cross sectional descriptive type of study was done in 98 women of reproductive age. Among them 25 were in control group of non pregnant women and 73 were pregnant women of 1st, 2nd and 3rd trimester of pregnancy with and without iron supplementation. The period of study was July 2004 to June 2005. The main objective of our study was to compare serum iron and total iron binding capacity in pregnant and non pregnant women. In present study serum iron was significantly increased in 2nd and 3rd trimester of pregnancy that was supplemented with iron when compared with the same category of women who were not supplemented with iron. On the other hand serum total iron binding capacity (TIBC) was significantly increased in 3rd trimester of pregnancy that was not supplemented with iron when compared with the same category of women who were supplemented with iron. It is evident that the significantly low serum iron and high TIBC in pregnant women is due in part to dietary iron deficiency. Therefore, iron therapy in pregnancy is helpful to maintain the serum iron and TIBC nearer to that of non pregnant normal women.

Serum HDL-cholesterol in women using low dose oral contraceptives.

This study was done to appraise the effects of low-dose oral contraceptives (OCs) containing 30microgm ethinyl estradiol and 150microgm levonorgestrel on lipid metabolism by a lipid variable-serum HDL-cholesterol (HDL-C). HDL-C has been identified as a lipoprotein that protects against atherosclerosis and its levels are inversely proportional to the risk for developing ischemic coronary disease and venous thromboembolic disorders. Ninety young women within reproductive age group were picked for this study. Sixty women using low-dose oral contraceptives served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCs users for last one-year group, three-year group and five-year group. The result showed that there was no significant difference on serum HDL-cholesterol levels between users & non-users women. It is concluded that low-dose oral contraceptives regimens did not significantly affect the lipid metabolism. It can be safely used as contraceptive & non-contraceptive purposes. The value of studied parameter for serial longer duration of OCs uses needs to be assessed.

Studies on serum lipid profile in hypertensive patient.

The study was carried out to appraise the serum total cholesterol, triglyceride, HDL-C and LDL-C values in hypertensive patients for providing information to the health-policy planners and also to the clinical practitioners about the importance of routine monitoring of lipid profile in hypertensive patients for prevention of coronary heart disease and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. It was a cross-sectional study. The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital and in the community of Sadar, Mymensingh District. The period of the study was January 2005 to December 2005. A total number of seventy subjects were included in this study. Out of them 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Most of the hypertensive patients (65%) were taking treatment irregularly. Serum total cholesterol, serum triglyceride and serum LDL cholesterol were greater in hypertensive than those of normotensive .The differences of mean of serum total cholesterol, serum LDL cholesterol in between two groups were statistically significant and in case of serum triglyceride it was statistically highly significant. Serum HDL cholesterol was less in hypertensive than those of normotensive. The differences of mean of serum HDL cholesterol in between two groups were statistically highly significant. Among 40 hypertensives the number of "Getting treatment- regular" & "Getting treatment-irregular" was 14 (35%) & 26 (65%) respectively and the values are not statistically significant. Similarly in patients "suffering less than 5 years" and "suffering 5 years & above" the differences are also not statistically significant. Conclusion: The observations of this study has revealed that most of the hypertensive patients are taking treatment irregularly and there was significant alteration of serum cholesterol, triglyceride, HDL-C and LDL-C in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the coronary heart disease (CHD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.

Effects of long term iodized table salt consumption on serum T3, T4 and TSH in an iodine deficient area of Bangladesh.

The effect of iodized and non-iodized table salt in goiter hyper-endemic area on the thyroid gland and its hormones T3, T4 and Thyroid Stimulating Hormone (TSH) were studied in two hundred subjects from the Center for Nuclear Medicine and Ultrasound, Mymensingh. Iodized and non-iodized salt users were called study and control groups respectively. The mean concentration of T3 were 2.38 nmol/L and 2.22 nmol/L & T4 concentration were 128.67 and 123.72 nmol/L in the study and control group respectively. The mean TSH concentration was 1.52 mIU/L and 1.62 mIU/L in study and control group. The data indicated that continuous and long term use of iodized salt increased both T3, T4 and decreased TSH in such a limit which was not statistically deferent at P< 0.05 level as compared to the control group. There was no significant change in occurrence of (hypo and hyper thyroidism or iodinated salt induced thyrotoxicosis) adverse effect, following iodine supplementation. The study shows that, mandatory mass iodination of table salt consumption in a hyper-endemic iodine deficient area is safe and does not cause any side effect. We suggest close regular monitoring of T3, T4, and TSH and further evaluation by specifically designed studies for any probable link between iodine induced hypo or hyperthyroidism and mass iodination of table salt consumption.

Healthy aged persons had a better adrenocortical function.

The present study was carried out in the department of physiology, Mymensingh Medical College, Mymensingh, Bangladesh during the period of July 2004 to June 2005 to estimate basal cortisol level in healthy aged persons and to explore association between aging and antiaging and adreno cortical status. A total number of 60 healthy subjects aged 60 and above 60 years old were included in this study. Twenty three (23) normal healthy subjects of aged 20-30 years were taken as control group. Estimation of serum cortisol level of both study and control group was done by radioimmunoassay (RIA) in centre for nuclear medicine and ultrasound, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Statistical analysis was done by SPSS program using unpaired students't' test between two groups. The results showed that there is no statistically significant difference in mean serum cortisol level of study group when compare to control group. The study depicts that subjects possessed better adrenocortical function and seems to be associated with good health and a high level of function despite advancing age.

Summative assessment of under graduate medical student's performance in physiology by structured oral examination.

To evaluate the importance and efficiency of structured oral examination (SOE). This is a retrospective study, has been designed to compare the newly adopted structured oral examination (SOE) with that of the traditional oral examination (TOE). This study was conducted at the department of physiology during the year 2006, on 607 2nd year medical students of Mymensingh Medical College and 106 students from some other medical colleges who appeared in the first professional examination under Dhaka University from 2003-2006. For this purpose, scores achieved by the students in physiology in first professional examination for 4 successive years (2003-2006) were analyzed. The examinations in (2003-2004) and (2005-2006) were conducted under TOE and SOE respectively. Mean score achieved in SOE and TOE was 67+/-.02 and 57+/-.003 respectively. The difference is statistically significant. The pass percentage in SOE is 94.70% and 90.3% in TOE and the difference is significant. Maximum number of students in SOE attained score in the range of 60-69 but in TOE scores attained by maximum frequency fall in the range of 50-59. This observation indicates improvement in student's performance by quality and success rate in SOE. Therefore SOE is a more effective, skill full technique and superior to TOE in assessing student's competency and cognitive ability. The need and skill of SOE over the TOE in assessing oral part of examination has been proved.

Studies on Serum Creatinine and Creatinine Clearance in Hypertensive Patients.

Objectives: To assess the serum creatinine and creatinine clearance values in hypertensive patients for providing information to the health-policy planners, clinical practitioners about the importance of routine monitoring of serum creatinine and creatinine clearance in hypertensive patients for prevention of ESRD and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. Study design: It was a cross-sectional study. Setting: The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital. Study period: The period of the study was January 2005 to December 2005. Participants: A total number of seventy subjects were included in this study. Out of 70 subjects, 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Intervention: The subjects were selected on the basis of history and clinical examination. Convenient sampling technique was applied. During visit the available hypertensive patients and controls (normotensive & healthy) those who were present were selected. Having received their written consent they were interviewed & examined by prepared personal data sheet and sample of blood (after overnight fasting) was drawn for biochemical examination. Main outcome measure: Mean values of serum creatinine and creatinine clearance. Result: Serum creatinine was greater in hypertensive than those of normotensive. Creatinine clearance was less in hypertensive than those of normotensive. Serum creatinine & creatinine clearance in between males hypertensive & control shows that CrCl were statistically significant but not the serum creatinine. In females of hypertensive & control shows no differences in case of SCr & CrCl. Among 40 hypertensive the number of “Getting treatment - regular” & “ Getting treatment-irregular” was 14 (35%) & 26 (65%) respectively. Similarly in patients “suffering less than 5 yrs” and “suffering 5 yrs & above” the differences are also not statistically significant. Conclusion: The observations of this study revealed that most of the hypertensive patients were taking treatment irregularly and there was significant alteration of biochemical parameters in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the end stage renal disease (ESRD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.

Studies on Serum Total Cholesterol, in Second and Third Trimester of Pregnancy.

Study was carried out in the department of physiology, Mymensingh Medical College, Mymensingh, Bangladesh during the period of July 2006 to June 2007 to investigate the effect of pregnancy on serum total cholesterol. The serum concentrations of total cholesterol was measured in 100 cases of 2nd and 3rd trimester of pregnancy and in a control group of 100 cases of non pregnant women which was matched on reproductive age. Data were analyzed by computer with SPSS program using unpaired student‘t’ test. The results showed that the pregnant women had significantly higher concentrations of serum total cholesterol. Higher concentration of total cholesterol was more common in pregnant than control and reaching maximum at 3rd trimester of pregnancy. This may be a purely physiological response to pregnancy or it may be indication of pathology in some women. These results deserve a follow up study to investigate whether the hypercholesterolemia persists after parturition.

Risk of cardiovascular diseases with oral contraceptives.

Oral contraceptive pills (OCs) are widely used method of contraception for its effectiveness and easier compliance. However, adverse effects associated with OCs use notably the increased risk of cardiovascular diseases (CVD), manifesting as ischaemic and haemorrhagic stroke, myocardial infarction (MI) and venous thromboembolic diseases were reported soon after their introduction to the market in the early 1960s. Various modifications were made in an attempt to lower these risks including a reduction in the estrogen dose and changes in the progestogen compound. Currently used OCs containing the new progestin (Levonorgestrel, Desogestrel, gestodene or norgestimate) classified as low dose because all contain less than 35 microg of ethinyl estradiol. Despite their low steroid content, all have proved to be highly effective. The rationale of this reviewed study based upon cardiovascular risks in relation to these monophasic low-dose oral contraceptives. To review all relevant articles it is concluded that the risk for cardiovascular disease is lower with current preparations of oral contraceptives. Cardiovascular diseases occur mainly among oral contraceptive users who smoke or have predisposing factors--such as age more than 35 years, overweight, diabetes & hypertension.

Effects of stresses on serum cortisol level in Bangladeshi people.

The present study was undertaken to estimate serum cortisol level in control experimental groups in Bangladeshi people. For this purpose a total number of 55 subjects of age range (18-55) years were selected from Mymensingh Medical College Hospital during July 2003 to June 2004. Subjects included in this study were divided in to two main groups: control (n=13) and experimental (n=42). According to different types of stress the experimental group was further divided in to four subgroups: infection, psychiatric, pre and post surgery. Blood samples were collected from all subjects with aseptic precautions at 8 AM and serum cortisol concentration was measured by Radioimmunoassay method. Statistical analyses were done by using Student's 't' test. A distinct and statistically significant increased serum cortisol level was observed in infection, psychiatric disorders and post surgical group in comparison to control group (P< 0.001). While no significant difference was observed in pre surgery when compared to that of control group.

Pregnancy associated complications of mothers with gestational diabetes mellitus.

This study was conducted in Mymensingh Medical College and Hospital, Mymensingh. It lasted for one year commencing in July 2003, and was designed to find out and compare the outcomes of gestational diabetes mellitus (GDM) with a view to reducing the complications. Forty cases of GDM with single pregnancy were selected as experimental group, while forty other cases of pregnant women without GDM constituted the control group. Questionnaire and observation chart were the research instrument in this study. Statistical analyses were done manually. It was found that the GDM mothers had a higher risk of complications like pre-eclampsia, hypertension, urinary tract infection and cesarean delivery. On the basis of these findings, however, appropriate measures for prevention, treatment and management of GDM may be adopted for better pregnancy outcomes.