Bangladesh Medical Research Council Bulletin (Vol. 50, No. 01, 2024)

Abstract

Background: In folk medicine, Averrhoa bilimbi Linn. (Oxalidiaceae) is widely used and most parts of the plant are utilized for medicinal purposes. A review of the literature on this species turned up no information about the phenolic content and antioxidant activity of the bark of the bilimbi plant and comparative study of antioxidant activity among the leaf, bark and fruit of A. bilimbi linn.

Objective: This research aimed to estimate the phenolic content and anti-oxidant properties of leaf, bark, and fruit methanolic extracts of A.bilimbi Linn. and make a comparative study among them.

Methods: The total phenolics content was determined according to the Folin- Ciocalteu method and antioxidant activity was assessed by using DPPH radical scavenging assay.

Results: The methanolic extract of bark demonstrated the highest phenolic content (180.5 mg/gm GAE). The greatest DPPH radical scavenging was shown by bark methanolic extract with IC ₅₀ value of 111.80 ìg/ml.

Conclusion: The study indicates that methanolic extracts of A. bilimbi are perhaps a potent origin of natural antioxidant that may have large significance as a remedy in inhibiting or showing the advance of aging and relevant oxidative stress associated degenerative illness.

Keywords: Phenolic, Antioxidant, Averrhoa bilimbi; Gallic acid, DPPH

Abstract

Background: Epithelial ovarian carcinoma (EOC) is the most lethal of all the gynaecological malignancies. Primary cytoreductive surgery is one of the mainstays in the management of women with epithelial ovarian carcinoma. Because of the silent nature of the condition, most patients present in advanced stage of the disease and malnutrition is common in them. Thus, preoperative evaluation of serum albumin in patients with EOC in regards to primary cytoreductive surgery seems to be of particular importance.

Objectives: The aim of this study was to evaluate the association between preoperative serum albumin level with postoperative complications up to 30-th postoperative day in patients with EOC underwent primary cytoreductive surgery.

Methods: This is a cross sectional study conducted on 60 patients with EOC who underwent primary cytoreductive surgery in the Gynaecological Oncology Department of NICRH, Mohakhali, Dhaka from March 2019 to February 2020. Hypoalbuminemia was defined as a serum albumin level <3.5g/dl. Postoperative complications were recorded up to 30-th postoperative day. Data were analysed by Chi-squared test or the Fischer exact test as feasible and p-value was calculated. P-value <0.05 was considered statistically significant.

Results: The median age was 50 years (range: 21 to 68 years). Out of total 60 patients, 25(42%) had hypoalbuminemia (<3.5g/dl) and 35(58%) had normal albumin (≥3.5g/dl). The mean (±SD) albumin value was 3.18 (±0.12) and 3.97 (±0.36) g/dl in hypoalbuminemia and normal albumin group respectively. Patients with hypoalbuminemia suffered more complications compared to normoalbuminemic patients ( p 0.001) and longer duration of hospital stay (p 0.039).

Conclusion: Preoperative hypoalbuminemia in patients with EOC who will undergo primary cytoreductive surgery is an important predictor of 30-day postoperative complications. Identification of this subset and preoperative optimization of nutritional status may improve surgical outcome.

Keywords: Hypoalbuminemia, Epithelial ovarian cancer Primary cytoreductive surgery, Postoperative, complications.

Abstract

Background: Febrile neutropenia (FN) is a significant complication of acute leukemia, leading to morbidity and mortality. Early detection of bacteremia is crucial for timely management, but traditional culture methods are time consuming. Previous studies have suggested that Interleukin-6 (IL-6) may serve as an early and convenient marker for predicting bacteremia in children with hematological malignancies and febrile neutropenia. This study aimed to investigate the role of IL-6 in predicting bacteremia among children with acute leukemia and febrile neutropenia.

Methods: A cross-sectional study was conducted at the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), over a 12-month period following ethical approval. A total of 50 children with acute leukemia and febrile neutropenia were enrolled based on specific criteria. Written informed consent was obtained from parents and detailed histories, clinical examinations, and relevant investigations were performed. Data were collected using a semi-structured questionnaire and analyzed using SPSS 22.0.

Results: The study included patients with a mean age of 5.96±3.69 (SD) years, with a male predominance 31(62%). Among the patients, 23(46%) had microbiologically documented infection (MDI),15(30%) had clinically documented infection (CDI), and12(24%) had fever without focus (FWF). Among the isolated organisms in MDI patients,16(69.56%) were gram-negative bacteria. The mean rank of IL-6 was higher in patients with MDI compared to CDI and FWF. IL-6 showed 87% sensitivity and 76% specificity at a cutoff value of 141.95 pg/mL in the ROC curve analysis, with an area under the curve of 0.843. Increasing IL-6 levels were associated with higher odds of bacteremia in both univariate and multivariate logistic regression analyses. No significant difference in IL-6 levels was observed between patients with gram-positive and gram-negative bacteremia

Conclusion: This study suggests that IL-6 may play a crucial role in predicting bacteremia in febrile neutropenic patients with acute leukemia. However, further multicenter case-control studies are recommended to validate these findings.

Keywords:Children, Febrile neutropenia, Interleukins, Malignancies, C-reactive protein

Abstract

Background: Recent research focused on iron stores’ impact on diabetes, highlighting ferritin as a key biomarker. Studies revealed elevated ferritin, indicating increased iron stores linked with insulin resistance (IR). However, the connection between ferritin and IR exhibits variability based on ethnicity, gender, and glycemic state, leading to inconclusive findings. So, there is a notable gap in existing data regarding the relationship between ferritin and IR among South Asian men and women, especially in Bangladesh. To our knowledge, This is the first time we are evaluating the relationship between body iron stores and insulin resistance markers in our population.

Objectives: The aim was to examine the relationship between IR markers (fasting insulin, glucose, and HOMA IR) and serum ferritin concentrations in Bangladeshi adults.

Methods: A cross-sectional analytical study was conducted at Sir Salimullah Medical College, Dhaka (March 2018 - February 2019). It involved 140 subjects aged 25-55. Among them, 92 were male and 48 were female. Multiple regression analysis was performed after determining ferritin levels, insulin levels, and fasting plasma glucose levels and calculating the homeostatic model assessment of IR (HOMA-IR in both genders after adjustment. Exclusion criteria were applied to eliminate individuals with inflammatory diseases, chronic conditions, major cardiovascular events, alcoholism, anemia, or specific medications that could affect ferritin levels.

Results: Females had lower mean ferritin (p<0.001) than males. After adjustment for covariates in men-fasting glucose, insulin and HOMA-IR were significantly increased with increasing serum ferritin levels (P for trend <.001). The highest tertile is associated with older age, higher BMI, FPG, serum insulin, and HOMA-IR in men. In females, serum ferritin correlated positively only with FPG, not other markers.

Conclusion: In Bangladeshi adult men, serum ferritin concentrations were positively associated with fasting glucose, insulin, and HOMA-IR, indicating an essential role of iron storage in the pathogenesis of IR, while this association was not observed in women.

Keywords: Gender Differences, IR Markers, Serum Ferritin, adult population.

Abstract

Background: Lymphovascular space invasion (LVSI) is the presence of tumor cells in a vascular space lined by endothelium. It is the crucial first step to tumor metastases. It has been suggested that LVSI is the strongest predictor of lymph node metastases, relapse of disease, and poor survival in endometrial carcinoma. Lymphovascular space invasion is an important predictor of lymph node involvement in endometrial carcinoma. Studies showed that LVSI can be predicted preoperatively by some biomarkers, which may be helpful regarding lymphadenectomy per-operatively in patients with endometrial carcinoma.

Objectives: The aim of this study was to predict the risk of lymphovascular space invasion (LVSI) in women with endometrial carcinoma.

Methods: This is a cross-sectional analytical study done in the gynecological Oncology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, between September 2018 and August 2019. A total of 35 patients with endometrial carcinoma admitted for surgery at the Department of Gynecological Oncology, BSMMU, were included in this study.

Results: Among 35 patients with endometrial carcinoma, 12 patients were positive for LVSI, and 23 patients were negative for LVSI. It was found that depth of myometrial invasion, FIGO tumor stage, histological tumor type, tumor grade, and positive pelvic lymph nodes were associated with LVSI (p l<0.05). However, age, patient’s occupation, socioeconomic status, educational level, tumor size, and cervical involvement were not associated with LVSI (p l<0.05). Receiver operating characteristic (ROC) curves revealed that the threshold values of CA- 125 and fibrinogen correlated with LVSI were 34.15 U/mL and 300 mg/dl, respectively. Statistical analysis showed that CA-125 >34 U/mL (p=0.026) and fibrinogen ≥300 mg/dl (p l<0.001) were significantly associated with LVSI.

Conclusion: There is a positive association between LVSI and preoperative serum CA-125 antigen and plasma fibrinogen in endometrial carcinoma patients. So, these biomarkers may help make decisions regarding lymphadenectomy during surgery for endometrial carcinoma patients.

Keywords: Endometrial Carcinoma; Lymphovascular Space Invasion; CA-125 Antigen; Fibrinogen.

Abstract

Background: Child malnutrition is one of the most serious public health challenges. Infant and young child feeding (IYCF) practices are crucial for early childhood growth and development.

Objectives: The current study was conducted to see the practice status of the elements of IYCF in the secondary and tertiary level hospitals in Bangladesh.

Methods: A descriptive type of cross-sectional study was conducted among 416 service receivers and 142 healthcare service providers in 32 randomly selected secondary and tertiary level hospitals in Bangladesh from 1^st February to 31^st May 2023 to assess the status of the four elements of IYCF in the secondary and tertiary level hospitals in Bangladesh. A purposive sampling technique was adopted and a pre-tested semi-structured questionnaire was used to collect data. Data were collected through face-to-face interviews.

Results: The mean age of the service receivers was 26.29±5.12 years and the majority of the respondents (98.1%) were female. Regarding the practices of IYCF, 86.3% of respondents initiated early breastfeeding, 72.1% exclusively breastfed their baby, 92.3% continued breastfeeding up to 24 months and 91.8% of respondents started complementary feeding after 6 months. About 86.3% of caregivers gave homemade complementary food to their babies. Around two-thirds of service providers were female and 36.6% of them had post-graduation degrees. The majority (85.2%) of the service providers didn’t get any IYCF-related training but 81.7% of them had work experience in the IYCF program. The majority of the respondents mentioned that they practiced IYCF activities like providing support for position and attachment (98.6%), counseling the mother (99.3%), and explaining to the caregiver how to feed a sick child (94.4%). Among service providers, 91.6% had good IYCF practice and 7.7% had average IYCF practice IYCF activities.

Conclusion: Majority of the service receivers initiated early breastfeeding, continued breastfeeding up to 24 months, started complementary feeding after 6 months and more than two-thirds exclusively breastfed their babies. The majority of the service providers had good IYCF practice level but most of them didn’t get any IYCF- related training.

Keywords: Status, IYCF, Secondary Hospitals, Tertiary Hospitals.

Abstract

Background: The purpose of the study was to characterize various trends in the treatment of maxillofacial fractures as well as to ascertain the pattern of oral and maxillofacial trauma. There may be some evidence from this study to support the suggestion of potential preventive actions.

Objectives: The cross-sectional, retrospective study was performed with the intention of identifying the pattern and various approaches to treating maxillofacial fractures.

Methods: A tertiary health care center has treated 213 consecutive occurrences of maxillofacial trauma in the last two years. Patient files and radiographic images were reviewed. We examined data regarding age, gender, anatomical location of fracture and available treatments.

Results: There were 213 participants, ranging in age from 2 to 76, with the age group between 21 and 30 having the highest prevalence. There were 5.25 times as many men as women. According to the study’s findings, road traffic accidents (RTAs) accounted for 65.26% (n = 139) of the instances, subsequently followed by falls (n = 40; 18.78%), assaults (n = 17; 8%), sports (n = 11; 5.17%), firearm injuries (n = 2; 0.93%), and industrial trauma (n = 2; 0.93%). Two incidents (0.93%) were linked to other reasons, such as bomb blasts and animal injuries. A total of 243 fractures were present in 213 patients. Among 213 individuals, 186 had single, isolated fractures, and the rest (n = 27) had multiple fractures. The mandible (62.92%) was the most commonly fractured area. The midface (15.5%), maxilla (4.7%), zygomatic complex (1.9%), nasal bone (1.4%), and nasoethmoidal fractures (0.94%) were the next most common areas. The most frequent location for mandibular fractures was the body (31%), followed by the condylar area (23.48%). Le Fort I was the most frequent fracture among maxillary fractures (40%). Approximately 19% of patients with mandibular fractures underwent open reduction surgery instead of the majority of patients who underwent closed reduction surgery (arch bars with IMF, eyelet wire, and lateral compression plate) (intraosseous and miniplate fixation). While Gillie’s technique (38.46%) was the most popular way of caring for zygomatic complex fractures, the majority of maxillary fractures were treated with plain arch bars.

Conclusion: The results of this research can be used as a model for developing preventative and rehabilitative activities because they illustrate patterns of trauma experienced by communities.

Keywords: Fractures, Maxillofacial trauma, Pattern, Road Traffic Accidents.

Abstract

Two cases of sialolithiasis are presented here. One patient presented with an acute inflammatory condition of left submandibular gland with secondary infection and facial cellulitis. CT Scan confirmed as cellulitis with secondary infection from ductal stone at mid left floor of the mouth. Another patient presented with repeated low-grade pain and swelling at left submandibular gland area with difficulty in swallowing that was confirmed by Sialogram. In order to allow the gland to operate normally, the duct was kept intact in the first case where ductal calculus was removed from floor of the mouth only. Sialoadenectomy and ductal calculi excision were performed in the second case due to the chronic infection of the non-functioning left submandibular gland.

Keywords: Sialolithiasis, Submandibular gland, Swallowing difficulty, Facial cellulitis, Sialoadenectomy, Excision of the calculi