Comparison of P2Y12 receptor inhibition by clopidogrel and prasugrel in patients undergoing percutaneous coronary intervention.

Dual antiplatelet treatment (DAPT) with aspirin and clopidogrel is vital after percutaneous coronary intervention (PCI). Clopidogrel and prasugrel act on P2Y12 platelet surface receptors. Both these P2Y12 inhibitors are pro-drugs and depend on cytochrome system of the liver for their conversion to active metabolite. There is growing concern regarding suboptimal response in platelet inhibition by clopidogrel. Verify Now system got approval by Federal Drug Administration, USA, for assessing platelet function as its result is almost comparable to gold standard Light Transmission Aggregometry (LTA). There are no data on the prevalence of clopidogrel resistance in Bangladeshi population. Prasugrel, as an antiplatelet drug, is a newer introduction in this country. This study will show light on the efficacy of these drugs on our population especially in patients who undergo PCI where DAPT is mandatory. A total 120 (60 diabetics) patients with Acute Coronary Syndrome (ACS), were alternatively given 600 mg clopidogrel loading dose (LD) followed by 75 mg maintenance dose (MD) daily or 60 mg LD of prasugrel followed by 10 mg MD daily. Five samples of blood were taken at different time intervals over a period of 2 weeks. Measurement of percent inhibition of P2Y12 was done by VerifyNow. Patients who showed less than 20% inhibition (clopidogrel resistant) at any stage were switched to prasugrel. The outcomes of clopidogrel, prasugrel and clopidogrel switched to prasugrel groups were then compared. Nearly half (46.7%) of the patients in the clopidogrel group was found resistant to the drug as opposed to none in the prasugrel group. No difference was found between diabetic and non-diabetic subjects with respect to drug resistance. Intracoronary blood samples showed high degree of platelet inhibition with prasugrel. There was a gradual decline of platelet inhibition over two weeks with prasugrel. Almost fifty percent of the population is clopidogrel resistant in our study. Prasugrel is a much more potent antiplatelet drug and should be preferred in patients undergoing PCI. Prasugrel may also show resistance over time.

Serotype and serovar distribution of Neisseria gonorrhoeae isolated from high-risk populations in Bangladesh.

Neisseria gonorrhoeae, the causative agent of gonococcal infection, is known to frequently change their characteristics to evade host immune mechanism. Characterization of the clinical isolates of the organism can lead to identification of the circulating strains and often a sexual network in a community to help in designing the control strategy. Keeping in mind the above consideration, a total of 239 N. gonorrhoeae, isolated from high-risk populations, were characterized for serotypes and serovars by monoclonal antibodies against protein 1 of the organism. Majority of the serotypes were serotype B (142, 59.4%). Majority of the isolates showing resistance to at least one of the antibiotics tested were also serotype B (139, 59.2%), whereas, majority of the isolates showing resistance to any three of the antibiotics (multidrug resistant, MDR) (63%) was serotype A. A total of 41 different serovars were also identified and five of which (Arst, Bropt, Bopt, Arost, and Brop) included the highest percent (49.3%) of the isolates. Many serovars (23/41, 56.1%) were new emergent and included 58 (24.3%) of the isolates investigated. All of the new serovars were resistant to at least one of the antibiotics tested and the highest rate (40/102, 39.2%) was MDR. Serotyping and serovar determination was found contributory to understand the microepidemics of the N. gonorrhoeae isolates. Further studies including antibiogram and contact tracing can efficiently help in control of the disease.

Sexually transmitted diseases among the immigrants seeking jobs abroad.

PIP: To collect information on epidemiological attributes in relation to hepatitis B virus (HBV), syphilis, and HIV-positive cases among persons seeking jobs abroad, a descriptive cross-sectional study was conducted in selected health checkup centers of Dhaka, Bangladesh. Data were gathered through a structured interview schedule and blood samples were collected from 206 persons going abroad for jobs. The majority of the workers belonged to the age group 21-30 years (71.36%), followed by the age group 31-40 years (15.53%). The distribution of respondents according to profession was the following: agriculture, 77 (37.37%); business, 60 (29.13%); private service, 26 (12.62%); unemployed, 18 (8.74%); students, 15 (7.28%); housewives, 6 (2.91%); government service holders, 3 (1.46%). Of the 206 workers, 18 (8.74%) were found to be positive for the HBV antigen (HBsAg), 5 (2.43%) were positive for syphilis, and none was found positive for HIV. Among these workers, 34 (16.50%) were abroad, and 7 (20.59%) of them engaged in sex. 51 (24.75%) indicated a history of premarital and 15 (14.29%) a history of postmarital sex. Only 2 (0.79%) received transfusions and none had undergone surgery within the last 6 months. 79 (38.35%) and 66 (32.04%) reported a history of regular and occasional saloon shaving, respectively. These findings indicate that while the prevalence of HIV in Bangladesh is still low, the prevalence of HBsAg and sexually transmitted diseases is increasing in the country.^ieng

Comparative studies on IFAT, ELISA & DAT for serodiagnosis of visceral leishmaniasis in Bangladesh.

The purpose of the study was to estimate the specificity and sensitivity of different serological methods for the diagnosis of visceral leishmaniasis in Bangladesh. Blood samples from 155 suspected kala-azar patients together with 80 sick subjects and 50 healthy subjects from the endemic areas were collected. Out of the 155 suspected kala-azar patients, bone marrow were collected from 126 patients. All bone marrow samples were examined by direct microscopy. 92 bone marrow samples were also examined by culture method. Blood samples were examined by various serological tests. Out of 126 marrow samples, LD bodies were present by microscopy in 77 (61.1%) cases and out of 92 marrow samples, cultures for LD bodies were positive in 33 (35.9%) cases. All the three serological tests (IFAT, ELISA & DAT) were positive in all parasitologically positive kala-azar patients. They were also positive in seven (15.5%) out of 45 parasitologically negative cases and 10 (34.4%) out of remaining 29 cases in whom bone marrow samples were not available. Thus the serological tests proved to be simple, non-invasive, highly sensitive and specific methods for the diagnosis of visceral leishmaniasis. DAT is the simplest of these serological tests, although these tests did not differ in sensitivity and specificity.