Showing papers by "Chittagong Medical College Hospital published in 2019"

Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming.

Abstract: In one of his final essays, statesman and former United Nations secretary general Kofi Annan said, ‘Snakebite is the most important tropical disease you’ve never heard of’ [1]. Mr. Annan firmly believed that victims of snakebite envenoming should be recognised and afforded greater efforts at improved prevention, treatment, and rehabilitation. During the last years of his life, he advocated strongly for the World Health Organisation (WHO) and the global community to give greater priority to this disease of poverty and its victims.

Mapping imported malaria in Bangladesh using parasite genetic and human mobility data

Abstract: For countries aiming for malaria elimination, travel of infected individuals between endemic areas undermines local interventions. Quantifying parasite importation has therefore become a priority for national control programs. We analyzed epidemiological surveillance data, travel surveys, parasite genetic data, and anonymized mobile phone data to measure the spatial spread of malaria parasites in southeast Bangladesh. We developed a genetic mixing index to estimate the likelihood of samples being local or imported from parasite genetic data and inferred the direction and intensity of parasite flow between locations using an epidemiological model integrating the travel survey and mobile phone calling data. Our approach indicates that, contrary to dogma, frequent mixing occurs in low transmission regions in the southwest, and elimination will require interventions in addition to reducing imported infections from forested regions. Unlike risk maps generated from clinical case counts alone, therefore, our approach distinguishes areas of frequent importation as well as high transmission.

In vivo and in vitro pharmacological activities of Tacca integrifolia rhizome and investigation of possible lead compounds against breast cancer through in silico approaches

Abstract: The study was conducted to evaluate the analgesic, anti-inflammatory, antipyretic properties of ethanolic extract of Tacca integrifolia rhizome (EETI) in mice and cytotoxic effects in brine shrimp nauplii followed by a PASS prediction study for some isolated compounds of T. integrifolia. Additionally, this experiment included the in silico molecular docking and ADME/T property analyses of some phytochemicals. Formalin- induced paw licking test and acetic acid-induced writhing test for analgesic activity, carrageenan-induced paw edema test for anti-inflammatory potential and Brewer’s yeast-induced pyrexia test for antipyretic activity were applied. Antinociceptive and antineoplastic activity for breast cancer were revealed with PASS program. Schrodinger suite 2015 was used to evaluate the binding interaction and ADME/T properties of selected phytoconstituents with estrogen receptor alpha. In formalin-induced paw licking test, EETI at the doses of 200 and 400 mg/kg BW showed highly significant inhibition of writhing in both neurogenic and inflammatory phases. While EETI also exhibited highly significant, compared to control, writhing inhibition for both the doses in acetic acid-induced writhing test. Moderate anti-inflammatory effect at a dose of 400 mg/kg BW was noticed in paw-edema test. It also showed 77.51% of maximum antipyretic effect which was significantly effective compared to standard drug paracetamol (150 mg/kg) in Brewer’s yeast-induced pyrexia test. The EETI showed potential cytotoxic activity with LC50 value of 114.46 μg/mL. The PASS prediction revealed the potential antinociceptive and antineoplastic activity of target compounds. The compounds betulinic acid, quercetin-3-α-arabinoside, catsanogenin were found to be effective in molecular docking study. It is evident that the EETI possesses highly significant analgesic activity with remarkable anti-inflammatory and antipyretic activity. The phytoconstituents have potential antinociceptive and antineoplastic (breast cancer) activity.

Identifying the Components of Acidosis in Patients With Severe Plasmodium falciparum Malaria Using Metabolomics

Abstract: BACKGROUND Acidosis in severe Plasmodium falciparum malaria is associated with high mortality, yet the pathogenesis remains incompletely understood. The aim of this study was to determine the nature and source of metabolic acids contributing to acidosis in patients with severe falciparum malaria. METHODS A prospective observational study was conducted to characterize circulating acids in adults with P. falciparum malaria (n = 107) and healthy controls (n = 45) from Bangladesh using high-resolution liquid chromatography-mass spectrometry metabolomics. Additional in vitro P. falciparum culture studies were performed to determine if parasites release the acids detected in plasma from patients with severe malaria acidosis. RESULTS We identified previously unmeasured plasma acids strongly associated with acidosis in severe malaria. Metabolomic analysis of P. falciparum parasites in vitro showed no evidence that these acids are released by the parasite during its life cycle. Instead, 10 of the plasma acids could be mapped to a gut microbial origin. Patients with malaria had low L-citrulline levels, a plasma marker indicating reduced gut barrier integrity. Longitudinal data showed the clearance of these newly identified acids was delayed in fatal cases. CONCLUSIONS These data suggest that a compromise in intestinal barrier function may contribute significantly to the pathogenesis of life-threatening acidosis in severe falciparum malaria. CLINICAL TRIALS REGISTRATION NCT02451904.

Amino acid derangements in adults with severe falciparum malaria.

Abstract: Amino acid derangements are common in severe falciparum malaria and have been associated with endothelial dysfunction (L-arginine), metabolic acidosis (alanine and lactate), and disease severity (phenylalanine and tryptophan metabolites). Whether these amino acid perturbations reflect isolated pathogenic mechanisms or if they are part of overall changes in amino acid metabolism is unclear. To investigate this, we prospectively simultaneously quantified a broad range of plasma free amino acids (PFAA) using HPLC-MRM-Mass spectrometry in relation to presenting symptoms in adults with severe malaria (n = 88), septicaemia (n = 88), uncomplicated malaria (n = 71), and healthy controls (n = 48) from Bangladesh. The total plasma concentration of measured amino acids was significantly reduced in each of the patient groups when compared to normal levels observed in healthy local controls: uncomplicated malaria −54%, severe malaria −23%, and sepsis −32%, (p = <0.001). Inspection of amino acid profiles revealed that in each group the majority of amino acids were below normal levels, except for phenylalanine. Among patients with severe malaria, L-lactate was strongly associated with an increase of the total amino acid concentration, likely because this reflects tissue hypoxia. Our data confirm previously described amino acid abnormalities, likely resulting from overall changes in the concentration of PFAA.

Short-term glucose dysregulation following acute poisoning with organophosphorus insecticides but not herbicides, carbamate or pyrethroid insecticides in South Asia.

Abstract: Background: Ingestion of organophosphorus (OP) insecticides is associated with acute hyperglycaemia. We conducted a prospective study to determine whether glucose dysregulation on admission associa...

Cell-free hemoglobin is associated with increased vascular resistance and reduced peripheral perfusion in severe malaria

Abstract: Background In severe falciparum malaria, unlike sepsis, hypotension on admission is uncommon. We hypothesized that low nitric oxide bioavailability due to the presence of cell-free hemoglobin (CFH) increases vascular tone in severe malaria. Methods Patients with severe malaria (n = 119), uncomplicated malaria (n = 91), or suspected bacterial sepsis (n = 56), as well as healthy participants (n = 50), were recruited. The systemic vascular resistance index (SVRI) was estimated from the echocardiographic cardiac index and the mean arterial pressure. Results SVRI and hematocrit levels were lower and plasma CFH and asymmetric dimethylarginine levels were higher in patients with malaria, compared with healthy participants. In multivariate linear regression models for mean arterial pressure or SVRI in patients with severe malaria, hematocrit and CFH but not asymmetric dimethylarginine were significant predictors. The SVRI was lower in patients with suspected bacterial sepsis than in those with severe malaria, after adjustment for hematocrit and age. Plasma CFH levels correlated positively with the core-peripheral temperature gradient and plasma lactate levels and inversely with the perfusion index. Impaired peripheral perfusion, as reflected by a low perfusion index or a high core-peripheral temperature gradient, predicted mortality in patients with severe malaria. Conclusions CFH is associated with mean arterial pressure, SVRI, and peripheral perfusion in patients with severe malaria. This may be mediated through the nitric oxide scavenging potency of CFH, increasing basal vascular tone and impairing tissue perfusion.

Nitazoxanide – A New Option in Biliary Ascariasis

Abstract: This prospective study was conducted in the in-patient department of medicine, Chittagong Medical College Hospital (CMCH), Chittagong, Bangladesh from February 2016 to September 2016. The study included 70 patients admitted to emergency department of medicine. Clinical assessment was performed in all the cases. Detailed history was taken as per site, severity and nature of pain. Nitazoxanite is a newly recommended antihelminthic agent elicits its activity by interfering with pyruvate: ferredoxin oxidoreductase (PFOR) enzyme dependent electron transfer reaction, which is essential for anaerobic energy metabolism. It is given by the oral route with good bioavailability and is well tolerated, with primarily mild gastrointestinal side effects. Nitazoxanide (500mg) tablet was given twelve hourly for 3 days. Relieve of pain after taking antihelminthic was observed and serial ultrasonogram was performed to determine the worm present or absent in biliary tree. In this study majority of the patients presenting biliary ascariasis were females (74.3%) and the most common age group affected was within 18 to 35 years of age. Among the total respondents, 88.57% were cured, while only 11.43% were not cured off their diseases

Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study.

Abstract: Lactic acidosis with an elevated lactate–pyruvate ratio suggesting anoxia is a common feature of severe falciparum malaria. High lactate levels are associated with parasitized erythrocyte sequestration in the microcirculation. To assess if there is an additional contribution to hyperlactataemia from relatively inadequate total oxygen delivery, oxygen consumption and delivery were investigated in patients with malaria. Adult Bangladeshi and Indian patients with uncomplicated (N = 50) or severe (N = 46) falciparum malaria or suspected bacterial sepsis (N = 27) and healthy participants as controls (N = 26) were recruited at Chittagong Medical College Hospital, Chittagong, Bangladesh and Ispat General Hospital, Rourkela, India. Oxygen delivery (DO2I) was estimated from pulse oximetry, echocardiographic estimates of cardiac index and haematocrit. Oxygen consumption (VO2I) was estimated by expired gas collection. VO2I was elevated in uncomplicated median (IQR) 185.1 ml/min/m2 (135–215.9) and severe malaria 192 ml/min/m2 (140.7–227.9) relative to healthy persons 107.9 ml/min/m2 (69.9–138.1) (both p < 0.001). Median DO2I was similar in uncomplicated 515 ml/min/m2 (432–612) and severe 487 ml/min/m2 (382–601) malaria and healthy persons 503 ml/min/m2 (447–517) (p = 0.27 and 0.89, respectively). The VO2/DO2 ratio was, therefore, increased by similar amounts in both uncomplicated 0.35 (0.28–0.44) and severe malaria 0.38 (0.29–0.48) relative to healthy participants 0.23 (0.17–0.28) (both p < 0.001). VO2I, DO2I and VO2/DO2 did not correlate with plasma lactate concentrations in severe malaria. Reduced total oxygen delivery is not a major contributor to lactic acidosis in severe falciparum malaria.

Hypothyroidism following hemithyroidectomy: a study in a tertiary care hospital, Chittagong, Bangladesh

Abstract: Background: Hypothyroidism results from insufficient production and secretion of thyroid hormones. This may be due to disturbance within the thyroid gland itself (primary hypothyroidism) or within the hypothalamic-pituitary-thyroid axis (secondary hypothyroidism). The objective of this study is to determine the incidence, risk factors and management of hypothyroidism occurring after hemithyroidectomy for benign non-toxic thyroid disease. Methods: We conducted a prospective cross sectional study of 50 euthyroid patients with benign non-toxic thyroid disease who had undergone hemithyroidectomy from January 2012 to December 2012 admitted in the department of otolaryngology and Head Neck Surgery, Chittagong Medical College Hospital. All patients were evaluated for age, sex, pre-operative and post-operative TSH levels, histopathology and follow up. Time of diagnosis and therapeutic dose of thyroid hormone were determined for patients with hypothyroidism. Results: As per this study, the incidence of permanent nerve damage was zero whereas the incidence of temporary neuropraxia was found to be around 0.5%. The incidence of temporary and permanent hypocalcemia was found to be around 0.7% and 0.2% respectively. These complications were found more in obese patients and those with malignancies. Conclusions: Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.

Evaluation of intrarenal resistive index by duplex color doppler ultrasonography in patients with diabetic nephropathy – comparison between healthy adult control subjects

Abstract: Background: Renal Doppler Ultrasonography (USG) has become a useful adjunct to gray scale sonography in the evaluation of renal function in various pathophysiological conditions like diabetic nephropathy. We can diagnose diabetic nephropathy by serum creatinine level and creatinine clearance rate. But early stage diagnosis of diabetic nephropathy is not always possible. In this study we have focused on resistive index of interlobar arteries of kidney to see changes of renal parenchyma for early stage diagnosis of diabetic nephropathy. Objectives: To observe the difference between values of intrarenal resistive index measured by duplex color Doppler USG in type 2 diabetic patients having diabetic nephropathy and in healthy adult control subjects. Materials and methods: This cross sectional observational study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 65 diabetic nephropathy patients were taken as study group and 65 healthy subjects were included as healthy control subjects. Duplex Color Doppler Ultrasonography of interlobar artery was carried out in both groups to measure the peak systolic velocity, the end diastolic velocity and arterial Resistive Index. Results: The Resistive Index of interlobar artery of left kidney in control group was 0.58±0.08 and the mean RI of interlobar artery of left kidney in diabetic nephropathy patients was 0.74±0.53. The difference of Resistive index of interlobar artery of left kidney in the two groups were statistically significant and the RI of right kidney of control & that of case groups were 0.60±0.09 and 0.76±0.03 respectively. In between control and case groups the RI of right kidney were statistically significant. So, resistive index of interlobar artery was increased in type 2 diabetic nrphropathy patients compared to control group. Conclusion: It can be concluded in present study that resistive index remains significantly higher in patients with diabetic nephropathy than in controls. Thus Duplex Doppler ultrasonography allows the rapid, noninvasive evaluation of the intrarenal vasculature and can be used as an easily available parameter of the evolution and a predictor in patients with clinical diabetic nephropathy. Keywords: Doppler Ultrasonography, Intrarenal Resistive Index, Diabetic Nephropathy

Ab0917 pattern of serum cholecalciferol (vitamin d3) level among the female in relation to clothing’s

Abstract: Background Both clinical and subclinical low level vitamin D is common1. Various kinds of health hazard including musculoskletal symptoms are frequently seen among the Vitamin D deficients. It is also not uncommon even in a sunny country. Lack of sun exposure, particularly female using veil may be an important cause. Objectives To assess the relationship between using veil and serum vitamin D3 (cholecalciferol) level Methods This prospective cross-sectional descriptive study was conducted during July 2017 to June 2018. Patients with common complaints related to lack of Vitamin D (muscle cramp, myalgia, fatigue, bone pain, generalized weakness, difficulty in getting up, climbing stairs and pain in weight bearing joints) were enrolled. Patient having other disease were excluded from study. Serum cholecalciferol was measured for each patient. Race, occupation, educational status, skin complexion, body mass index, sunlight exposure, covering of body with clothing’s and use of sunscreen were taken under consideration in final analysis. Correlation of serum cholecalciferol level with different types of veils (Burkha, halve sleeve, full sleeve, quarter sleeve and Hijab) of individual’s was analyzed. Results A total 79 female patients were enrolled after screening 108. All of them were of multi-ethnic Asian origin. Age distribution of them is 17 to 39 years 34.2%, 40 to 50 years 38%, 51 to 70 years 26.6% and above 70 years 1.3%. Maximum (93.7%) of them were house wife, 91.1% had no adequate sun exposure and 81% had no skin exposure to sunlight. Among clothing 79.7% used Burkha, 5.1% halve sleeve, 2.5% full sleeve and 12.7% quarter sleeve. Among Burkha 28.6% (18), 55.6% (35) & 15.9% (10) and among quarter sleeve 50% (5), 40% (4) & 10% (1) had deficient, insufficient & sufficient vitamin D level respectively while 2 (100%) female with full sleeve and 4 (100%) female with halve sleeve had deficient and insufficient vitamin D level respectively. The cholecalciferol level among the users of veil is shown in Table-1. There was no significant difference between different types of clothing’s (Table: 2). Conclusion Main source of Vitamin D is sunlight. Proper exposure to sunlight is essential for adequate vitamin D level even in a sunny country. Regarding in vitamin D absorption from sunlight, there may be no difference between Burkha and other covered dressings. Further study needed to have a conclusion. Reference [1] Jones AN, Hansen KE. Recognizing the musculoskeletal manifestations of vitamin D deficiency.J Musculoskelet Med. 2009; 26(10): 389 – 96. Disclosure of Interests None declared