Bangladesh Medical Research Council Bulletin (Vol. 48, No. 02, 2022)

Abstract

Background: Obesity seems to be a critical issue nowadays because of its high prevalence and its adverse effects on health. There is some evidence indicating the relationship between obesity and lower serum 25- hydroxyvitamin D concentration.

Objective: The objectives of this study were to assess the vitamin D status and estimate the response to vitamin D in obese and non-obese children after vitamin D supplementation.

Methods: This was a Quasi experimental study, done in Paediatric Endocrinology Clinic and Paediatric Outdoor, Bangabandhu Shiekh Mujib Medical University (BSMMU) from August 2018 to February 2019. Vitamin D was measured in 20 obese and 20 non-obese children aged 10-18 years. Hypovitaminosis D was observed in all (100%) obese children and 15 (75%) non-obese children. Four thousand IU was given orally daily in obese and non-obese vitamin D deficient children for 3 months. Serum levels of vitamin D, calcium, inorganic phosphate, Alkaline Phosphatase (ALP) and Parathormone (PTH) also measured before and after vitamin D supplementation.

Results: The mean age was 11.64±1.40 years in obese and11.15±2.40 years in non-obese children, and male female ratio was 1:1.3. Hypovitaminosis D was present in 100% in obese and 75% in non-obese children. Vitamin D deficiency (VDD) was observed in 85% and vitamin D insufficiency (VDI) was in 15% in obese children. In non-obese children VDD was observed in 86.7% and VDI in 13.3% cases. In both the groups serum vitamin D was increased, alkaline phosphatase and parathormone levels were decreased significantly, and serum calcium was increased and serum inorganic phosphatase was decreased but not statistically significant after four thousand IU daily vitamin D supplementation for three months. After vitamin D supplementation, vitamin D status were found normal in 60% obese and 53.3% non-obese children, VDI were in 30% obese/overweight and 26.7% in non-obese children, and VDD were in 10% obese/overweight and 20% in non-obese children.

Conclusion: VDD was observed in both obese and non-obese children. Therapeutic responses were observed with 4000 IU/day vitamin D supplementation for three months in both the groups.

Keywords: Vitamin D, overweight, obese, non-obese, vitamin D deficiency, vitamin D insufficiency.

Abstract

Background: Syzygium cumini (locally known as Kalo Jam) seed powder is being used as folk medicine in various diseases since unknown times in Bangladesh. However, data on the systematic studies in human subjects are rare.

Objective: To determine the effect of Syzygium cumini seed powder on the hepatic function-related enzymes of the alcoholic transport laborers.

Methods: Here, we investigated the effects of oral administration of Syzygium cumini seed powder on hepatic-function markers that included activities of Gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and renal-function markers such as creatinine and urea along with lipid profile, blood pressure and body mass index (BMI) upon chronic alcoholic human volunteers.

Results: The levels of serum ALT, AST and GGT levels decreased, respectively, by 15.0, 8.5 and 23.0% after oral administration of the S. cumini powder in the alcoholic subjects. However, the levels of creatinine and urea were not altered significantly. In contrast, the effects of administration of S. cumini on the hepatic ALT, AST and GGT enzymes in the non-alcoholic control subjects were less prominent than those found in the alcoholic subjects. Blood pressure decreased only by 5-4 mmHg, while BMI was not altered in either the alcoholic or the non-alcoholic groups. Furthermore, there were significant reduction in the levels of TC (by 10%) and LDL-C (by >20%) and elevation of HDL-C (by 11%) in the S. cumini-prescribed alcoholic subjects. TC and LDL-C levels also decreased in the non-alcoholic subjects, but the rate was not statistically significant.

Conclusion: Our results suggest that S. cumini seed extract ameliorated GGT, ALT and the atherosclerotic lipid parameters TC and LDL-C without having a significant side effect on the kidney functions, as indicated by the unaltered levels of serum creatinine levels in the alcoholic human subjects without any effect on BP and BMI of the same subjects. Thus, alcohol drinkers can be advised to intake S. cumini seed powder to protect against the oxidative hepatic damage.

Keywords: Syzygium cumini, Alcoholism, Hepatic enzymes, Herbal Medicine, Liver disease, Hyperlipidemia.

Abstract

Background: Major goal of orthodontic treatment is long term stability of the corrected teeth after orthodontic treatment. After orthodontic treatment there is always chance of relapse. To prevent relapse several appliances are available as a retention device such as bonded fixed retainers, vacuum formed retainers, removable Hawley retainer, Begg’s retainer. Now a days vacuum formed retainer has become more acceptable due to low cost, esthetic and easy fabrication.

Objective: The purpose of this study was to analyze the clinical success of bonded retainers with vacuumformed retainers, as far as keeping up the consequences of orthodontic treatment in the lower arch as long as a year after debond.

Methods: This was a randomized clinical trial (RCT) carried out at the department of Orthodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka. In the study a total of 40 subjects who had fulfilled the selection criteria were randomly allocated to one of two groups, receiving either a vacuum-formed retainer or a bonded retainer for the mandibular arch. Qualification criteria was patients approaching debond after treatment with preadjusted edgewise fixed orthodontic appliance whose pretreatment records and study models were accessible to confirm pretreatment labial segment crowding or spacing and who had clinically acceptable alignment after treatment. The principle purpose was to research the clinical adequacy of the 2 kinds of retainers regarding changes in incisor irregularity at one year of preservation of treatment outcome. The following measurements were documented at each time point (6 and 12 months) with a digital caliper: Little’s irregularity index, intercanine width, intermolar width, arch length, extraction space opening.

Results: The two groups were very much coordinated as for age, sex, clinical qualities, and treatment plans. Four patients did not attend in the follow up period and the study finished up in 36 patients. There was a statistically significant difference between the groups for changes in Little’s irregularity index and arch length. Vacuum-formed retainer group showed greater changes than the bonded retainer group (P value 0.035 and 0.022). There were also no statistically significant changes at any time for intercanine width and intermolar width.

Conclusion: Some relapse is likely after fixed orthodontic treatment regardless of retainer choice, and this is negligible in many patients after debond. Bonded retainers have a superior capacity to hold the mandibular incisor arrangement after orthodontic treatment than vacuum-formed retainers. Trial registration: not done.

Keywords: Retainers; Retention; Relapse; Vacuum formed retainer; Bonded retainer.

Abstract

Background: Autism spectrum disorders (ASD), a neurodevelopmental deficit, is often associated with epilepsy. Previous literature suggested that ASD and epilepsy share a common pathophysiological basis. Considering the scarcity of studies regarding ASD in children with epilepsy, this study was conducted with an aim to evaluate the association of ASD with epilepsy.

Methods: This case-control study was conducted in the Department of Pediatric Neurology, Institute of Paediatric Neurodisorder and Autism, Bangabandhu Sheikh Mujib Medical University, Dhaka, from September’ 2018 to December 2019. In total, 68 epileptic children, age ranged from five to 16 years, were enrolled as case. Similar number of non-epileptic, age, sex and socio-demographic status matched children were enrolled as control. Parent, teacher and self version of Bangla Development and Well-Being Assessment were used to assess the psychiatric disorders particularly ASD and diagnosis was assigned as Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Results: The mean age of cases and controls were 9.66±3.13 and 9.26±3.11 years respectively with slight male predominance in both groups (64.7 and 57.35%, respectively). Focal seizure was predominant seizure type (51.5%) among cases. Higher proportion of psychiatric illness was found among the cases compared to controls (83.82 vs 20.59%; p<0.001). Neurodevdevelopmental and emotional disorders were significantly more frequent among cases than controls (29.42 vs 1.5%, and 50 vs 8.82%, respectively, p value <0.001). ASD was prevalent among 8.83% epileptic children, while none of the controls had ASD. Most common types of seizure in ASD children was focal epilepsy .

Conclusion: This study observed the significant association of ASD with epilepsy in studied children. However, further larger multicenter study is recommended.

Keywords: Autism spectrum disorders (ASD), Epilepsy, Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Neurodevelopmental disorder.

Abstract

Background: Averrhoa bilimbi Linn. (Oxalidiaceae) is very popular in folk remedy because the plant has high medicinal value and majority parts of the plant such as leaf, fruit and flower are used to treat fever, mumps, pimple, inflammation, rheumatism, itches, boils, bilious colic, stomach ache, aphthous ulcer, cough, cold, syphilis, hypertension, diabetes etc. However, so far no scientific work has been performed which may support its use in pain.

Objectives: The present study was undertaken to evaluate possible analgesic actions of methanol extracts of Averrhoa bilimbi Linn. (Oxalidiaceae) leaf, bark and fruits in animal models to support its traditional use for first time.

Methods: The crude methanolic extracts of Averrhoa bilimbi Linn. (Oxalidiaceae) leaf, bark and fruits were investigated for the evaluation of analgesic potential in mice. Analgesic activity was assessed by using acetic acid induced writhing method, formaldehyde induced paw licking method and tail immersion method.

Results: Methanolic extract (250 and 500 mg/kg) of leaf demonstrated maximum analgesic effect in tail immersion suggesting it to be a centrally acting analgesic. On the other hand leaf extract (250 and 500 mg/kg) reduced acetic acid induced pain significantly (p<0.05) and bark extract (500 mg/kg) also reduced acetic acid induced pain significantly (p<0.05) but the effect is less than standard Diclofenac (100 mg/kg, 61.29% inhibition) (p<0.001). In the formalin induced paw licking time test, methanolic leaf extracts reduced nociception induced by formalin injection in both phases significantly (p<0.05-0.001) among which at higher dose (500 mg/kg) was most effective in later phase (41.81% inhibition) (p<0.001).The results demonstrate the analgesic properties of extracts.

Conclusion: The study indicates that methanolic extracts of Averrhoa bilimbi has significant analgesic action which support the traditional use of this plant.

Keywords: Analgesic; Averrhoa bilimbi; Diclofenac sodium; Methanolic extracts.

Abstract

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that usually begins at or before the age of 3 years. The etiology of these disorders, includes environmental factors such as vitamins which have important role in central nervous system functioning. Vitamin B12 and folate are involved in the methionine-homocysteine pathway and some studies have shown a relationship between folate, vitamin B12 and homocysteine and various psychiatric diseases including ASDs.

Objective: To evaluate the homocysteine, vitamin B12 and folate status in children with ASDs in Bangladesh.

Methods: This case control study included 50 ASD cases and 50 age matched healthy controls, according to inclusion criteria. After taking informed written consent from guardian, a structured questionnaire was filled up for each subject including socio-demographic history, family history, birth history and milestone of development. 5cc venous bloods were collected with all aseptic precautions in clot activator tube and serum homocysteine, vitamin B12 and folate levels were estimated. Collected data was checked, edited and processed with the help of SPSS (23).

Results: The mean age of autism children was 5.71±2.06 years and in control group, it was 6.00±1.99 years. Mean S.Vit B12 (pg/ml) and S.Folic acid (ng/mL) were found significantly lower in autism children compared to control children (241.46±60.51 Vs 302.58±76.66 and 7.12±2.16 Vs 9.72±2.96). On the other hand, the mean S. Homocystiene (µmol/L) was found significantly higher in cases than controls (8.08±2.11 Vs 6.12±1.71).

Conclusion: This study revealed that serum vitamin B12 and folate levels were significantly decreased, and serum homocysteine were significantly increased in children with autism spectrum disorders (ASDs) compared to normal healthy children. So, screening of serum homocysteine, vitamin B12 and folate in children with autism spectrum disorders is recommended for early management of complications related to the disease process.

Keywords: Autism spectrum disorders, Homocysteine, Vitamin B12 , Folate.

Abstract

Background: Chronic kidney disease (CKD) and Diabetes Mellitus (DM) are highly prevalent, morbid diseases in every population. They are even more common among patients presenting with acute coronary syndromes (ACS).

Objective: The present study was, conducted to see the outcome of ACS patients with concurrent DM and CKD.

Methods: The cohort study was carried out in the Department of Medicine, Dhaka Medical College Hospital, Dhaka over a period six months from July 2017 to December 2017. All acute coronary syndrome patients having DM with or without CKD admitted in Medicine and Cardiology (CCU) Departments were the study population. ACS patients with concurrent DM with CKD formed the cohort group (n = 75) and DM without CKD were termed as control group (n = 75).

Results: The study was concluded that the ACS patients with concomitant CKD and DM (cohort) are usually older and more often hypertensive than the ACS patients with CKD alone (control) (63.9 vs. 55.9 years, p < 0.001 and 92% vs. 64%, p < 0.001 respectively). The typical chest pain is less commonly observed (68% vs. 86.7%, p = 0.003) and dyspnoea is more often present in this cohort than those in the control (92% vs. 52%, p < 0.001). NSTEMI is significantly present in the cohort compared that in the control group (p < 0.001). Serum Troponin I, CKMB and eGFR were significantly higher in the former group than those in the latter group (p = 0.044, p = 0.050 and p < 0.001 respectively). Almost all the outcome parameters demonstrated their significance.

Conclusion: The diabetic with CKD (cohort group) is less likely to have ST elevations but is significantly prevalent having NSTEMI. Typical angina is less and dyspnea is more in cohort group.

Keywords: Acute Coronary Syndrome (ACS); Diabetes mellitus (DM); Chronic kidney disease (CKD)

Abstract

Background: Disseminated intravascular coagulation (DIC) has a high prevalence in critically ill neonates. In suspicion of DIC based on abnormal coagulation parameter is a common trigger to transfuse fresh frozen plasma (FFP), even in absence of bleeding. In past years, use of FFP has increased and has expanded to include prophylactic use in neonates especially in neonatal intensive care units (NICUs) as it contains several coagulation factors. Several studies suggest that, prophylactic use of FFP has no role to prevent bleeding in disseminated intravascular coagulation (DIC), but carries increase risk of transfusion related mortality and morbidity.

Objective: To assess the effectiveness of prophylactic use of FFP in critically ill neonate to prevent bleeding in DIC.

Methods: This randomized, open-label, blinded end-point study was conducted in Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital from July, 2019 to June, 2021. Term, critically ill neonates who had underlying disease, suspected to develop DIC were conveniently selected. Later, they were randomly allocated using software in intervention group, who received 10 ml/kg of FFP along with standard management and control group, who received only standard management. Coagulation parameters were checked before and 24 hour after intervention in both groups. Outcome was occurrence of bleeding as a indicator of DIC.

Results: The mean age was 8.55 ± 3.5 days in intervention and 8.92 ± 6.1 days in control group. Male patients were predominant. There was no significant difference in baseline characteristics between two groups. The difference of mean ± SD of coagulation parameters between two groups were nonsignificant before intervention. Even after FFP transfusion, DIC developed among 40.1% neonates in intervention and without FFP transfusion among 48.9% neonates in control group without any significant difference (P-value >0.05).

Conclusion: Study result found no role of prophylactic use of FFP in critically ill neonate to prevent bleeding in DIC.

Keywords: Prophylactic FFP, Critically ill, Term neonate, Coagulopathy, DIC, Randomized controlled trial.

Abstract

Background: Ovarian cancer is the seventh most common cancer and eighth most common cause of death of female. More than 75% patients are diagnosed at Stage (III - IV) and their 5-year survival rate is (25-50%) . Primary debulking surgery (PDS) followed by adjuvant chemotherapy is the cornerstone treatment for advanced ovarian cancer. Unfortunately, primary debulking surgery is not always feasible and not associated with optimal cytoreduction. Recently, neoadjuvant chemotherapy followed by Interval Debulking Surgery (NACT- IDS) is increasingly adopted. (NACT-IDS) improves optimal cytoreduction and reduces complications in comparison with PDS . However, a significant proportion of patients cannot be optimally cytoreduced even after NACT-IDS and causes futile laparotomy. So, it is necessary to develop a Predictive Score for Cytoreduction (PSC) after NACT for optimal cytoreduction at (IDS).

Objective: To find out a predictive score after NACT for optimal cytoreduction at IDS in advanced epithelial ovarian cancer.

Methods: This was a prospective observational study conducted among 55 patients of advanced ovarian cancer to develop a predictive score after NACT at IDS in department of Gynecological Oncology of BSMMU, from January 2020 to December 2020.

Results: Among the 55 patients with advanced epithelial ovarian cancer 44(80%) could be optimally cytoreduced whereas in 11(20%) suboptimal cytoreduction occurred. The sensitivity, specificity, Negative predictive value (NPV), Positive predictive value (PPV) and accuracy of CA-125 for prediction of optimal cytoreduction was 87.5%, 30.8%,85.7%,34.1% and 47.3% respectively. It was observed that 37 (84.1%) have peritoneal cancer index within 0-16 in optimal cytoreduction (R0) and 3 (27.3%) in non-R0 (p value 0.001). The sensitivity, specificity, NPV, PPV and accuracy of Peritoneal Cancer Index (PCI) for prediction of optimal cytoreduction was 62.5%, 89.7%, 85.4% 74.1% and 81.8% respectively. PSC after NACT for optimal cytoreduction at (IDS) was 3 and it indicates 83.3% Patients could be optimally cytoreduced limiting the rate of suboptimal cytoreduction in 16.7%.

Conclusion: The result of the present study showed that PSC after NACT influences Optimal cytoreduction (R <1cm) at (IDS). So, this study concluded that IDS after NACT should be performed in patients with a PSC up to 2 to avoid suboptimal cytoreduction.

Keywords: Neoadjuvant chemotherapy, Advanced Epithelial ovarian cancer (EOC), optimal cytoreduction (R0) suboptimal cytoreduction (non-R0), Predictive Score for Cytoreduction (PSC), Peritoneal Cancer Index (PCI)

Abstract

Background: The world is passing through a hard time due to the highly infectious COVID-19 pandemic. Like other countries in the world, the Bangladesh government has taken various preventive measures. As part of this, the availability and readiness of different health facilities is crucial.

Objective: The study aimed to assess availability and readiness based on logistics, workforce, clinical management, and IPC.

Methods: A cross-sectional quantitative study was conducted from August 20 to September 30, 2021, which comprised a health facility survey with a sample of 210. The health facilities included all three tiers of hospitals, covering 24 districts of eight divisions. All COVID-19 dedicated hospitals were included in this survey. The questionnaire consisted of a standard checklist developed by WHO, DGHS, and CDC.

Results: The overall scores for ICU, HDU, and ventilation service were 76.8%, 87.5%, and 85.7%, respectively, but they were almost missing in Upazila health complex and below the average in non-dedicated hospitals. All (100%) secondary and tertiary level hospitals had a 24-hour staffed emergency unit, with dedicated hospitals outperforming non-dedicated hospitals (99.2% vs 98.7%). Above 90% of hospitals in different tiers had hand hygiene supplies and respiratory hygiene supplies for staff and patients, 98% of the primary level hospitals displayed instructions on hand and respiratory hygiene practices. On the other hand, 94.9% of secondary level hospitals had clearly identified and separated COVID-19 isolation areas from non-COVID-19 areas; 82.1% of secondary level hospitals had service providers (MOs) who used PPE; 97.4% had routine cleaning and disinfection of ambulances done according to IPC guidelines; and 64.1% had staff of laboratory, laundry, food services, and waste management teams who used appropriate PPE. Secondary level hospitals had a better availability of PPE compared to primary and tertiary level hospitals, which consisted of protective gowns (87.8%), disposable latex gloves (examination) (92.5%), goggles, protective (82.9%), face shields (72.5%), respirator masks (N95 or FFP2) (75.0%), and masks, medical/surgical (97.6%) available for all health service providers. Almost 26.2% facility have PCR testing lab and almost all (96.7%) the facilities have specimen collection system in their facility.

Conclusion: The service availability and readiness regarding COVID-19 among different tiers of health facilities in Bangladesh are not adequate. We need more support for disease detection capacities through provision of technical expertise, laboratory equipment and increase capacity of the secondary and primary health care tier along with national capacity for covid-19 testing.

Keywords: COVID-19, Service availability, Readiness, Health facility, Bangladesh.