Thyroid Dysfunction in Adults with Newly Detected Type 2 Diabetes Mellitus: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Thyroid disorders and diabetes mellitus are common endocrine disorders that often coexist and can significantly impact each other’s management. The American Diabetes Association recommends that people with diabetes be periodically screened for thyroid dysfunction due to the strong link between the two conditions. It is important for individuals to be aware of the risk factors for both conditions and to seek appropriate medical care if necessary, and for healthcare providers to consider testing for thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. The aim of the study was to find out thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. Material & Methods: This cross-sectional, descriptive study was conducted at the Departments of Medicine and Endocrinology at Sir Salimullah Medical College and Mitford Hospital in Dhaka. The study period lasted six months, from May to October 2019. A total of 102 adult patients (above 20 years old) with newly diagnosed type 2 diabetes mellitus who were attending the Endocrinology and Medicine Outpatient Department participated in the study. Results: Out of 102 adults with newly detected type 2 diabetes mellitus, the majority (86.3%) had normal thyroid function (euthyroid), while a smaller number (13.7%) had thyroid dysfunction. The most common subgroup of thyroid dysfunction was subclinical hypothyroidism (7.8%), followed by hypothyroidism (3.9%), subclinical thyrotoxicosis (1.0%), and hyperthyroidism (1.0%). The majority of the study population was male (66%) and from urban areas (88%), with a mean age of 45.1 years, a mean BMI of 25.0 kg/m2, and a mean waist circumference of 98.4 cm. About 45% had a family history of diabetes mellitus and 37% were smokers. The blood pressure of the study population was within normal limits. A minority (30%) had co-morbidities such as hypertension, dyslipidemia, and ischemic heart disease. The predictors of thyroid dysfunction were observed Age (OR=0.785), F/H of thyroid disorder (OR=0.495) BMI (OR=1.059), Anti-TPO Ab(OR= 0.021). Conclusion: Thyroid dysfunction and diabetes are commonly associated with each other and can impact clinical presentation and laboratory results. It is important to routinely screen for thyroid function in all patients with type 2 diabetes mellitus to detect, treat, and prevent complications of both these conditions.

Cardiovascular Comorbidity and its Impact on Patients with COVID-19 in a Tertiary Care Hospital, Bangladesh

Background: People with cardiovascular issues have been shown to be at an elevated risk of acquiring the 2019 new corona virus infection, according to studies (COVID-19). This study’s objective was to determine if cardiovascular disease has any effect on the severity of COVID-19.Material & Methods:Between January 2020 and December 2020, 210 comorbid patients aged over 40 years old diagnosed with COVID-19 admitted in BIRDEM hospital in Bangladesh were recruited purposively for a cross sectional study as per inclusion criteria. A baseline study was created for each patient based on their medical history, physical examination, biochemical tests, and the amount of care they needed (intensive care vs. ward-based care). SPSS 26 was used to analyze the data.Results:Among the 210 comorbid individuals, 74 had cardiovascular comorbidities and the remaining 136 had other comorbidities. Among the respondents, 48% were serious cases and required ICU support within 30 days. Cases with up to 2 comorbidities did not require ICU support. The severity of COVID-19 was predicted by factors such as age above 80 years (OR 35.5, 95 percent CIs 18.7,98.5), male gender (OR 3.14, CI 1.16, 3.50), and a high troponin level in the patient’s blood (OR 1.34, CI 0.84,3.54). It was shown that cardiovascular comorbidities (CI=1.8,3.0) were 2.9 times more likely to be linked to severity. The risk factors also included a history of diabetes, hypertension, and chronic obstructive pulmonary disease. Conclusions:Cardiovascular patients, who were previously grouped together as high risk due to the nature of their ailment, need more tailored counseling and treatment from public health authorities and clinicians.

Demographic and Clinical Profile Analysis of Acute Viral Hepatitis

Background: Acute viral hepatitis (AVH) is a major health concern in developing countries like Bangladesh regarding morbidity as well as mortality. Usually, acute infections are caused by A, E, hepatitis viruses, and occasionally hepatitis B virus. Infection caused by the hepatitis C virus is usually asymptomatic. Prior knowledge of the demographic and clinical profile of acute viral hepatitis may be helpful for treatment professionals in the management of such patients. Aim of the study: The aim of this study was to assess the demographic and clinical profile of acute viral hepatitis patients in Bangladesh.Material & Methods:This prospective observational study was conducted in the Department of Gastroenterology, US-Bangla Medical College & Hospital during the period from March 2018 to February 2019, in Bangladesh. A total of 59 suspected patients with acute viral hepatitis were included as the study subjects for this study. Ethical approval of the study had been taken from the ethical committee of the mentioned hospital. A predesigned questionnaire was used in data collection. Collected data analyzed by using MS Office and SPSS version 23.0 programs as per need. A P-value, of <0.05 was considered significant.Results:Among 59 participants, the male-female ratio was 3.2:1 and the mean (±SD) age was 23.88±14.83 years. Analyzing hepatitis infection, we found hepatitis E was the highest in number 32(54.24%), followed by hepatitis E virus 20(33.9%), and hepatitis B virus 5(8.47%). In this study, we did not find any patients with hepatitis C virus, and 2 participants didn’t have any hepatotropic virus. The mean (±SD) Serum bilirubin (mg/dl) was 6.35±1.63, and the mean (±SD) serum alkaline phosphatase (IU/L), serum. creatinine (mg/dl), serum albumin (gm/dl) and plasma glucose random (mg/dl) were found 366.81±257.20, 6.97±14.96, 19.75±22.98 and 10.08±5.49 respectively. Considering dual viruses among the total of 5 patients along with hepatitis E & A viruses in this study, we found all were hepatitis B viruses. Among them, 3 with hepatitis E and the rest 2 were with hepatitis A virus consequently. Among them 3(60%) with hepatitis A and the rest 2(40%) with hepatitis E. In the issue of patients attended with clinical complaints, vomiting was the highest among hepatitis A patients 19(86.4%) followed by jaundice 8(36.4%) and fever8(36.4%). On the other hand, among hepatitis E patients’ jaundice was highest at 19(61.3%) followed by vomiting at 17(54.8%), and fever at 6(19.4%) respectively.Conclusions:The incidence of HEV is found as the most predominant among all the acute viral hepatitis patients and vomiting and jaundice were the most common presenting complaints.

Use of Red Cell Distribution Width Index for Screening and Differentiation of Iron Deficiency Anemia and Beta Thalassemia Trait

Background: Iron deficiency anemia (IDA) is one of the common nutritional disorders in the world. In the subcontinent Microcytic hypochromic anemia is usually caused by beta thalassemia trait (BTT) and iron deficiency anemia (IDA). IDA may be confused with BTT. It is important to distinguish between the above conditions to avoid unnecessary iron therapy in thalassemia carriers. Red cell distribution width index (RDWI) are a simple, easy, and cost effective method to get a primary and valuable information regarding the diagnosis of IDA and BTT. Objective: To assess the predictive value of Red cell distribution width index (RDWI)) for differentiation of Iron Deficiency Anaemia and Beta Thalassaemia Trait.Material & Methods:The study was a cross-sectional descriptive study which was conducted in Department of Clinical Pathology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh. Over a period of April 2019 to September 2020. The newly clinically diagnosed cases of BTT and IDA were selected for this study. The sample size was 110. Among them 46 cases were identified as BTT and 64 were IDA. Data were analysed using a computer programme SPSS 25.0 version.Results:Total 110 respondents were included in the study. Among them 46.4% were female and 53.6% were male. About 72.72 % of respondents were aged 1 to 10 years old, while 10% were aged 11 to 20 years old and 10% were aged 21 to 30 years old. 4.54 % were between the ages of 31 to 40, as well as those over 40. The average age (SD) was 22.0 � 32.52. Mean (盨D) age was 22.0 � 32.52. RDWI had both sensitivity and specificity more than 80% in detection of BTT and IDA. Sensitivity, specificity of RDWI index for detection of BTT was found 81.0%, 83.8%. In case of IDA, sensitivity and specificity was found 83.8% and 81.0% respectively.Conclusions:The current study found that multiple discriminants can be used to differentiate between iron deficiency anemia and the Beta Thalassaemia Trait. RDWI could be a better way to tell the difference between BTT and IDA.

Adenotonsillectomy Operation in Children is Effective to Improve Otitis Media with Effusion

Background: OME usually present because of the associated hearing impairment, defective speech and sometimes with a preceding history of fever and otalgia consequent on an episode of acute otitis media. Objective: The aim of the study was to evaluate adenotonsillectomy operation in children is effective to improve otitis media with effusion.Material & Methods:This was a clinical study done in the otolaryngology department of medical college for women and hospital, Uttara, Dhaka from January 2003 to December 2005 for three years. Children with 4 to 15 years of age admitted with chronic tonsillitis and enlarged adenoid having otitis media with effusion were included in the study. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22).Results:All of these patients underwent adenotonsillectomy operation and were followed up for up to six months. The overall success rate of resolution of middle ear effusion was 81% at six months post operatively.Conclusions:Our findings demonstrated that adenotonsillectomy operation is effective for the treatment of persistent otitis media with effusion due to chronic tonsillitis with enlarged adenoid.

​A Comparative Study of Changes in Left Ventricular Function after Mitral Valve Replacement in Patients with Severe Rheumatic Mitral Regurgitation with and without Mild Mitral Stenosis

Introduction: Presently off- pump CABG has proved itself tobe a safe, cheaper and effective alternative of on- pump CABG.However, it requires manipulation, displacement, positioning& mechanical stabilization of the heart during grafting whichmay cause haemodynamic alteration. Study was done withthe objective of finding out the changes in Central VenousPressure (CVP); Mean Arterial Pressure (MAP); MeanPulmonary Arterial Pressure (MPAP); Right Ventricular EndDiastolic Pressure (RVEDP) & Left Ventricular End DiastolicPressure (LVEDP) while grafting the anterior, lateral &inferior surfaces of heart during off-pump CABG.Material and methods: Over one year time, 50 patients withLVEF ≥40%, undergoing off-pump CABG were monitoredfor the above parameters at various stages of their operation,namely:- 1. During manipulation & shunt introduction,2.During anastomosis without shunt, 3.During anastomosiswith shunt & 4.After anastomosis; while grafting the anterior,lateral & inferior surfaces of heart. These results werecompared with the baseline values of CVP, MAP, MPAP,RVEDP & LVEDP, to look for statistical significance.Results: During manipulation & shunt introduction; CVP(mmHg) significantly increased during Ramus grafting - 12±1.8(p<0.047); and also during OM grafting – 12.6±1.9 (p<0.045),when compared to a baseline value of 9±1.8. The MAP(mmHg) was significantly decreased during manipulation &shunt introduction in Diagonals - 70±5.8 (p<0.046), Ramus- 70±5.8 (p<0.048), OMs - 65±5.8 (p<0.028) & in the Rightterritory - 69±5.9 (p<0.032); as compared with baselineMAP of 76±11.7. During anastomosis without shunt also, theMAP(mmHg) significantly decreased while grafting LAD- 70±3.8 (p<0.048), Diagonals - 68±3.8 (p<0.039), OMs –71.8±4.8 (p<0.039) & Right sided arteries 70.8±4.6 (p<0.039),as compared with baseline MAP values. The MPAP(mmHg)was significantly increased – 18.3±3.7 (p<0.047) as comparedto the baseline value of 16±2.4 during manipulation & shuntintroduction in the OMs.Conclusion: During OPCABG there will be significantalterations in haemodynamics mostly due to mobilizationof the heart, which is necessary to visualise the targetvessels properly & stabilisation of the concerned areawith stabiliser. However, by observing the haemodynamicvariations constantly & by making necessary mechanical &pharmacological adjustments, unnecessary conversion to Onpump technique can be avoided.

Cystectomy With or Without Capitonnage: Analysis of Outcome of 73 Cases in the Management of Hydatid Cyst of Lung

Introduction: Sporadic cases of lung hydatid cyst is commonin India apart from its endemicity in Mediterranean regionsand other rural areas of developing countries. The patients ofHydatid cyst (HC) of lungs are often diagnosed incidentally.The definitive treatment of such lesions is surgery. Lungpreserving surgery in such cases is generally the preferredtechnique unless there is considerable destruction ofpulmonary parenchyma. Cystotomy and capitonnage arethe two preferred techniques and generally followed. In thisretrospective observational study it was attempted to analyzeoutcomes of cystotomy and capitonnage with regard topostoperative morbidity and mortality.Material and Methods: Between 1st May 2014 and 31stMay 2019, a total of 73 patients with lung Hydatid cyst wererandomly selected from all the hydatid cyst cases operated in atertiary centre and the results and outcome analyzed. Out of 73cases 39 (Group A) were operated by Cystotomy and closureof bronchial opening and 34 (Group B) were operated withCystotomy, closure of bronchial opening and Capitonnage.Results: The mean chest tube removal time for Group A andB was 5.94 ± 3.17 and 3.41 ± 2.61 days respectively. Themean hospital stay was 10.02 ± 4.53 days for group A and7.55 ± 2.66 days for group B. Prolonged air leak (>7days)was found in 15 patients in group A, 14 of which requiredprolonged chest tube drainage and 1 required surgical closure.4 patients in group B had prolonged air leak and all closedwith prolonged chest tube drainage. No abscess formation ormortality was observed in any group in this study. There wasa significant difference between group A and group B withregard to chest tube removal time (P=0.000836), hospital stay(P = 0.047585), and all complications (P= 0.008214).Conclusion: In surgical management of pulmonary Hydatidcyst, capitonnage is superior to cystotomy without capitonnagebecause it reduces morbidity and hospital stay.

Analysis of Surgical Resection and Prognostic Factors of Primary Chest Wall Chondrosarcomas

Introduction: Primary chest wall tumours are very rare.Chondrosarcoma represents 40% of all chest wall tumours.Wide local excision with tumour free margins has been thegold standard therapy. We evaluated this therapy in relationto various prognostic factors for anticipating the recurrenceof the tumour.Material and methods: 22 cases of Primary chest wallchondrosarcoma was operated upon from 2009 to 2019 withwide local excision with adequate margins. Male constituted77.27% and females 22.73% with the tumour size rangingfrom 5 to 30 cm in size(median 7cm).Results: 19 patients were subjected to lateral chest wallresection. 3 cases underwent partial sternectomies. Resectionwas extended to lungs in 7 cases, diaphragm in 2 cases,vertebral body in 2 cases and clavicle in 2 cases. Reconstructionwas done with polypropylene or titanium mesh and a muscleflap coverage. There was no perioperative mortality. Postoperative complications occurred in 13.6%(n=3). Therewas recurrence in 4 cases within 5 years. 5year disease freesurvival rate was 81.81%.Conclusions: Wide local excision with tumours free marginsstill remains the standard form of therapy. The reconstructiveprocedures have evolved largely to cover the huge defectsfollowing surgery. Post operative adjuvant therapy is guidedby various prognostic factors.

Surgical Treatment of Cardiac Tumors: A Single Institutional Experience Over 12 Years

Introduction: Tumors of the heart represent an exceedinglyrare entity in cardiac surgery and literature regardingmanagement and outcome is less in comparison to other fieldsof cardiac surgery. 12 years of our experience in both diagnosisand optimal surgical treatment of this small but rare collectionof patients was formed into a detailed analysis of patientprognosis, mean survival and risk of tumor relapse matchedto the corresponding pathology. The overall objective of thepresent study was a thorough characterization of both primarycardiac tumor or tumor like mass and secondary malignanttumor mass in cardiac chambers, their nature as well as ageand gender distribution and management.Material and methods: 17 patients with cardiac tumors,who underwent open-heart surgery at Medical College andHospitals, Kolkata, for tumor excision between 2007 and2019 were analyzed retrospectively. Mean follow-up wasfrom 11 to 1 years.Results: There were 2 males and 15 female patients rangingin age from 7 years to 60 years, median age being 47 years.12 of these tumors were primary left atrial myxoma, 2 wereright atrial myxoma, 1 was right ventricular fibroma, 1 wasintravenous extension into right atrium of renal cell carcinomaand 1 was multiple inflammatory pseudo tumors in leftventricle. Overall operative survival was 88.3%. Operativemortality was 11.7%.Conclusion: Cardiac tumors remain challenging in theclinical setting. Early operation is recommended afterechocardiographic diagnosis as such patients can have suddendeath or severe cardiac failure during preoperative waitingperiod. Follow up should be maintained based upon thehistopathological diagnosis.

Gross Motor Function Classification System (GMFCS) For Children With Cerebral Palsy

Objectives: The objectives were to find out the sociodemographic characteristics, comorbidities, types of CP, level of GMFCS and to determine the association between GMFCS with age, gender, types of CP and topographic distribution among children with cerebral palsy. Methods and Materials: A retrospectives study was done in children with cerebral palsy. Total 384 participants were included in this study. The study setting was Paediatric Department, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh. The samples were collected through convenient sampling. The Chi-Square was used to find out the association between GMFCS with age, gender, types of CP and others. Results: Males were affected than female among all participants. The majority participants came from rural area. The children were more in 2 to 4-year age band in GMFCS. The majority participants (81%) had visual problem, 11% hearing and 31% had convulsion. The common levels were II and III. The age bands, topographic classification was associated with GMFCS (p<0.05) but gender and types of CP were not statistically associated (p>0.05). Conclusion: The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP).

Status of neurodevelopmental impairments among children using rapid neurodevelopmental assessment attending a tertiary care hospital

Background: Developmental and childhood neuropsychiatric disorders have a large burden throughout the world, including the developing countries. Many children with clinically identifiable developmental problems present late for medical help due to lack of simple measures for their early recognition. These missed opportunities increase the level of dependence and disability of an individual and decrease the productivity of the community at large. So simple measures are needed to determine NDIs at an early age where professional expertise is sparse. Authors objective was to estimate the proportion of children having NDIs in a tertiary care hospital, and to estimate the specific types of NDIs, and their grades of severity, within the study population.Methods: It was a cross sectional study conducted at the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh and the duration of the study was six months. Children aged 0-2 years who were attending Pediatric OPD were included in the study. Sample was collected by lottery method and who fulfilled the inclusion criteria. A two-stage design was followed for detection of NDIs. Stage I was consisted of screening of all children in the sample by Development Screening Questionnaire (DSQ). Stage II consisted of neurodevelopmental assessment using a validated RNDA method of evaluation of all children with DSQ positive screening result.Results: 7.26% children were found to have DSQ positive for NDIs. Cognition and speech was the mostly affected domain. By RNDA, NDIs were found in all DSQ positive cases. Severe impairment was 35.29% of the affected children in speech by RNDA. Detection of NDIs was more in gross motor (52.94% vs 35.29%), fine motor (94.18% vs 17.65%), speech (76.47% vs 64.71%), cognition (94.18% vs 64.71%), behavior (58.82% vs 5.89%) respectively by RNDA than the DSQ.Conclusions: The frequency of NDIs is 7.26% of all children. In certain developmental domain (i.e. gross motor, fine motor, cognition, speech, behavior) RNDA is more effective than DSQ as found in the small-scale study.

TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? / TpTe e TpTe/QT: novos marcadores para prever morte súbita cardíaca na DRT?

ABSTRACT Introduction: Reliable markers to predict sudden cardiac death (SCD) in patients with end stage renal disease (ESRD) remain elusive, but echocardiogram (ECG) parameters may help stratify patients. Given their roles as markers for myocardial dispersion especially in high risk populations such as those with Brugada syndrome, we hypothesized that the Tpeak to Tend (TpTe) interval and TpTe/QT are independent risk factors for SCD in ESRD. Methods: Retrospective chart review was conducted on a cohort of patients with ESRD starting hemodialysis. Patients were US veterans who utilized the Veterans Affairs medical centers for health care. Average age of all participants was 66 years and the majority were males, consistent with a US veteran population. ECGs that were performed within 18 months of dialysis initiation were manually evaluated for TpTe and TpTe/QT. The primary outcomes were SCD and all-cause mortality, and these were assessed up to 5 years following dialysis initiation. Results: After exclusion criteria, 205 patients were identified, of whom 94 had a prolonged TpTe, and 61 had a prolonged TpTe/QT interval (not mutually exclusive). Overall mortality was 70.2% at 5 years and SCD was 15.2%. No significant difference was observed in the primary outcomes when examining TpTe (SCD: prolonged 16.0% vs. normal 14.4%, p=0.73; all-cause mortality: prolonged 55.3% vs. normal 47.7%, p=0.43). Likewise, no significant difference was found for TpTe/QT (SCD: prolonged 15.4% vs. normal 15.0%, p=0.51; all-cause mortality: prolonged 80.7% vs. normal 66.7%, p=0.39). Conclusions: In ESRD patients on hemodialysis, prolonged TpTe or TpTe/QT was not associated with a significant increase in SCD or all-cause mortality.

RESUMO Introdução: Marcadores confiáveis para predizer morte súbita cardíaca (MSC) em pacientes com doença renal terminal (DRT) permanecem elusivos, mas os parâmetros do ecocardiograma (ECG) podem ajudar a estratificar os pacientes. Devido a seus papéis como marcadores para a dispersão miocárdica, especialmente em populações de alto risco, como aquelas com síndrome de Brugada, nós hipotetizamos que o intervalo pico da onda T ao final da onda T (TpTe) e TpTe/QT são fatores de risco independentes para MSC na DRT. Métodos: Revisão retrospectiva do prontuário foi realizada em uma coorte de pacientes com DRT iniciando a hemodiálise. Os pacientes eram veteranos de guerra americanos que utilizavam os centros médicos do Veterans Affairs para atendimento médico. A idade média de todos os participantes foi de 66 anos e a maioria era do sexo masculino, consistente com uma população veterana dos EUA. ECGs que foram realizados dentro de 18 meses após o início da diálise, e foram avaliados manualmente para TpTe e TpTe/QT. Os desfechos primários foram MSC e mortalidade por todas as causas, e estes foram avaliados até 5 anos após o início da diálise. Resultados: Após o critério de exclusão, foram identificados 205 pacientes, dos quais 94 com TpTe prolongado e 61 com intervalo TpTe/QT prolongado (não mutuamente exclusivo). A mortalidade geral foi de 70,2% em 5 anos e a MSC foi de 15,2%. Nenhuma diferença significativa foi observada nos desfechos primários ao se avaliar o TpTe (MSC: prolongado 16,0% versus normal 14,4%, p = 0,73; mortalidade por todas as causas: prolongado 55,3% vs. normal 47,7%, p = 0,43). Da mesma forma, nenhuma diferença significativa foi encontrada para TpTe/QT (MSC: prolongado 15,4% vs. normal 15,0%, p = 0,51; mortalidade por todas as causas: prolongado 80,7% vs. normal 66,7%, p = 0,39). Conclusões: Em pacientes com insuficiência renal terminal em hemodiálise, TpTe ou TpTe/QT prolongados não foram associados a um aumento significativo da morte súbita ou mortalidade por todas as causas.

Isolation, identification, and antibiogram studies of Salmonella species and Escherichia coli from boiler meat in some selected areas of Bangladesh.

Background: The present study was carried out for the isolation, identification of Salmonella and Escherichia coli from broiler meat samples (leg muscle, breast muscle and drumstick) which were collected from different upazilla markets of Mymensingh, Gazipur, and Sherpur districts during the period of January 2015 to May 2015. Methods: A total of 60 samples were subjected to bacterial isolation and identification by using cultural, biochemical, and polymerase chain reaction assays. Results: Using standard bacteriological techniques E. coli was isolated from 50 (83.33%) samples and Salmonella spp. from 18 (31.66%) samples. Furthermore, the isolates were subjected to antibiogram studies by disk diffusion method using eight commonly used antibiotics. Antibiogram studies revealed that gentamicin, ciprofloxacin, and norfloxacin were highly sensitive against all the isolated bacteria, whereas most of the isolates were resistant to amoxicillin, erythromycin, and tetracycline. Out of all the isolates, 5 isolates of E. coli and 3 isolates of Salmonella were found multidrug resistant. Conclusions: The study revealed the presence of multidrug resistant Salmonella and E. coli in broiler meat sold in live bird market of different upazilla.

Quality analysis of different marketed brands of paracetamol available in Bangladesh.

Paracetamol is a widely used analgesic and antipyretic drug worldwide. The present study was conducted to analyze the quality of seven marketed brands of paracetamol tablet formulation manufactured by different multinational and national companies. The tablet formulations of different brands were tested for various parameters like weight variation, hardness, friability, disintegration time and dissolution profile using standard techniques to evaluate their quality. The values were compared with the standards. Weight variation value requirement was complied by all brands. All studied samples except two local products complied with the standard specification for tablet hardness. All brands showed impressive friability values and products of multinational companies comparatively exhibited the highest values. Disintegration time for all brands was within 15 minutes also complying the USP (United State of Pharmacopeia) recommendation. Moreover, the release rate of different brands of paracetamol was satisfactory within 45 minutes and ranged from 79.82% to 103.53%. Therefore, it can be concluded that almost all the brands of paracetamol that are available in Bangladesh meet the USP specification for quality control analysis.

Comparative Study Of Oxidant Antioxidants And Inflammatory Markers Between Obese And Non Obese Newly Diagnosed COPD Patients.

COPD has widespread systemic manifestations. Inflammation plays important role in its pathophysiology. Aim of the present study was to compare markers of oxidative stress and inflammation between obese and non obese COPD patients. The levels of pro inflammatory cytokines CRP, IL6 and TNF α were compared between obese and non-obese subjects by applying student’s t test. Oxidative imbalance was assessed by analyzing MDA and FRAP assay in same subjects. Correlation of BMI with the above study parameters was analyzed using Pearson’s test. Results indicated that levels of CRP, IL6 and TNF α were elevated in obese group as compared to non-obese group (p<0.001). Total antioxidant capacity estimated by FRAP assay was lower (p=0.005) but the levels of oxidants estimated indirectly by MDA was higher (p=0.01) in obese COPD patients. In all COPD patients included in present study BMI correlated inversely with FRAP (r=-0.546, p=0.013), FVC (r=0.548, p=0.012) and FEV1 (r=-0.865, p<0.001). Similarly BMI correlated positively with markers of inflammation namely CRP(r=0.526, p=0.017), IL6(r=0.865, p<0.001), TNF α (r=0.653,p=0.002). Positive correlation of BMI was found with MDA(r=0.536, p=0.015). Conclusion: there is higher inflammation in obesity resulting in oxidant antioxidant imbalance and lung function decline.

Association of Streptococcus with Plaque Type of Psoriasis.

Background: Guttate psoriasis has a well-known association with streptococcal throat infections, but the effects of these infections in patients with chronic plaque type of psoriasis remains to be evaluated. In Bangladesh several studies were done on psoriasis but no data about association between streptococcal throat infection and plaque type psoriasis are available so far. Considering the co-morbidities of psoriasis patients, it might be justifiable to find out the events that provoke the initiation or exacerbation of psoriatic disease process. Objective: To observe the association of streptococcus with plaque type of psoriasis. Materials and Methods: This observational study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Forty seven patients clinically and histopathologically diagnosed as having plaque psoriasis were selected as cases and patients with skin diseases other than psoriasis were selected as controls. Results: In this study majority of subjects (55%) were diagnosed as chronic plaque psoriasis. Among the subjects with guttate flare of chronic plaque psoriasis 64.2% gave a positive history of sore throat. ASO titer was raised (>200 IU/mL) in 28 (59.5%) patients of chronic plaque psoriasis and 7 (17.9%) patients of non-psoriatic respondents. The difference between two groups was significant (p<0.05). Streptococcus pyogenes was found in 12 (25.5%) in chronic plaque psoriasis patients versus in 4 (10.2%) in controls (p>0.05). Conclusion: This study shows that streptococcal throat infections are associated with plaque psoriasis and early treatment of throat infections may be beneficial for plaque type of psoriasis patients.

Phytochemical and biological investigations of methanol extract of leaves of ziziphus mauritiana lam / Investigaciones fitoquímicas y biológicas de extractos metanólicos de hojas de ziziphus mauritiana lam

Seven compounds were isolated from the methanol extract of leaves of Ziziphus mauritiana. The structures of the isolated compounds were elucidated as y-fagarine (1), beta-sitosterol (2), stigmasterol (3), alfa-amyrin (4), lupeol (5), beta-amyrin (6) and betulin (7) by extensive spectroscopic studies and by co-TLC with authentic samples. This is the first report of isolation of compounds 1-7 from this plant species. The extractives from leaves were investigated for thrombolytic, membrane stabilizing, antimicrobial, antidiarrheal and analgesic potentials along with sleep inducing property on animal model. The thrombolytic and membrane stabilizing activities were assessed by using human erythrocyte comparing with standard streptokinase and acetylsalicylic acid, respectively. The methanolic extract reduced frequency of diarrheal faeces when compared to the standard loperamide. In castor oil induced diarrhea in mice a dose dependent decrease of gastrointestinal transits were observed. In radiant heat tail-flick method the methanol extract showed moderate antinociceptive activity, compared to standard morphine.

Siete compuestos fueron aislados del extracto metanólico de hojas de Ziziphus mauritiana. Las estructuras de los compuestos aislados fueron identificadas como y-fagarina (1), beta-sitosterol (2), estigmasterol (3), alfa-amirina (4), lupeol (5), beta-amirina (6) y betulina (7 ) por medio de extensivos estudios espectroscópicos y por co-TLC con muestras auténticas. Este es el primer informe de aislamiento de los compuestos 1-7 a partir de esta especie vegetal. Los extractos de las hojas fueron investigados por efectos trombolíticos, estabilizadores de membrana, antimicrobianos, antidiarreicos y potenciales analgésicos junto a la propiedad de inducir sueño en el modelo animal. Las actividades trombolíticos y la estabilización de la membrana se evaluaron mediante el uso de eritrocitos humanos comparando con estreptoquinasa estándar y el ácido acetilsalicílico, respectivamente. El extracto metanólico redujo la frecuencia de las heces diarreicas en comparación con el estándar de loperamida. En la inducción por aceite de ricino de diarrea en ratones, se observó una disminución dosis dependiente de los tránsitos gastrointestinales. En el método del coletazo producido por calor radiante, el extracto metabólico mostró una actividad antinociceptiva moderada, en comparación con la morfina estándar.

In vitro Plantlet Regeneration of Four Local Garlic (Allium sativum) Accessions of Bangladesh.

Aims: The genetic improvement of garlic can be achieved by biotechnological manipulations as breeding in this vegetatively propagated crop is limited. The current research was conducted with a view to develop an efficient in vitro regeneration protocol for four local garlic accessions namely, G121, G122, G123 and G124. Place, Duration and Design of Study: The experiment was conducted in the Tissue Culture Laboratory of the Department of Genetics and Plant Breeding, Bangladesh Agricultural University during the period from June 2013 to June 2014 using three-factorial experimental design. Methodology: The root tips, basal disc and leaf base were cultured in MS medium supplemented with 2, 4-Dichlorophenoxyacetic acid (2, 4-D) alone, and with both 2, 4-D and 6-Benzylaminopurine (BAP) together for callus induction and the later for subsequent sub-culturing and proliferation of callus. MS medium supplemented with 1-Naphthaleneacetic acid (NAA) and BAP was used for plantlet regeneration. Results: The percentage of callus induction increased with the increase in the concentration of 2,4- D, starting from 0.5 mg L-1 till 2.0 mg L-1 and declined with further increase in the concentration of 2,4-D. The MS medium supplemented with 2,4-D and BAP showed higher percentage of callus induction and callus proliferation compared to that of with 2,4-D alone. The highest percentage of callus induction was observed in the genotype G124 from the explant basal disc (85%) and in the genotype G121 from the explant leaf base (80%) with 2.0 mg L-1 2,4-D and 2.0 mg L-1 BAP. MS medium supplemented with 2 mg L-1 2,4-D + 0.5 mg L-1 BAP showed highest percentage of callus proliferation (90%) in almost all the genotypes. The highest percentage of plantlet regeneration were observed in the genotype G124 for the explants basal disc (63.33%) in MS medium supplemented with 2 mg L-1 NAA + 1 mg L-1 BAP. The survival rate of the plantlets after acclimatization varied from 40% (in G123) to 70% (in G121). Conclusion: The optimized protocol of plant regeneration from local garlic accessions will be useful for any future garlic improvement programs using biotechnological means.

Association of Glycosylated Haemoglobin Level with the Severity of Coronary Artery Disease in NSTEMI Diabetic Patients.

Background: Relation between diabetes mellitus and ischemic heart disease is well established. But the effect of HbA1C on severity of coronary artery disease remains uncertain in non-ST elevation myocardial infarction and diabetic patient. Objective of our study was to know the relationship of HbA1C with the severity of coronary artery disease. Methods: In this cross sectional analytical study a total of 104 NSTEMI diabetic patients were enrolled by purposive sampling. They were divided into two groups according to the level of HbA1C, Group-I patients having HbA1C<7% and Group-II patients having HbA1C >7%. Vessel score and Gensini score was calculated from coronary angiogram and compared between groups. Results: Single vessel disease were significantly higher in group-I compared to Group-II( 38.5% vs 7.7% in Group-I vs Group-II,p<0.05). Double vessel disease were higher in group-II compared to Group-I but the difference was statistically not significant (42.3% vs 48.1% in Group-I vs Group-II respectively (p>0.05). Triple vessel disease were significantly higher in group-II compared to Group- I (19.2% vs 44.4% in Group-I vs Group-II,p<0.05). Mean Vessel score was higher in Group-II compared to Group-I(1.73 ± 0.86 vs 2.50 ±0.70 in Group-I vs Group-II, p<0.05). Mean Gensini score was higher in Group-II compared to Group-I (44.6 ± 38.4 vs 76.9 ± 44.6 in Group-I vs Group-II, p<0.05). There were significant positive linear correlation between HbA1C and Vessels score and Gensini score (p<0.05). Conclusion: This study may be concluded that the presence of HbA1C >7% are associated with of severe coronary artery disease in NSTEMI with diabetes mellitus

Quality analysis of different marketed brands of paracetamol available in Bangladesh.

Paracetamol is a widely used analgesic and antipyretic drug worldwide. The present study was conducted to analyze the quality of seven marketed brands of paracetamol tablet formulation manufactured by different multinational and national companies. The tablet formulations of different brands were tested for various parameters like weight variation, hardness, friability, disintegration time and dissolution profile using standard techniques to evaluate their quality. The values were compared with the standards. Weight variation value requirement was complied by all brands. All studied samples except two local products complied with the standard specification for tablet hardness. All brands showed impressive friability values and products of multinational companies comparatively exhibited the highest values. Disintegration time for all brands was within 15 minutes also complying the USP (United State of Pharmacopeia) recommendation. Moreover, the release rate of different brands of paracetamol was satisfactory within 45 minutes and ranged from 79.82% to 103.53%. Therefore, it can be concluded that almost all the brands of paracetamol that are available in Bangladesh meet the USP specification for quality control analysis.