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Helicobacter pylori (HP) is a vital element in the etiology of peptic ulcers and gastric cancer. This research aimed to determine the frequency, distribution, and determinants of HP infection in adults and adolescents with gastric symptoms in district Haripur, Khyber Pakhtunkhwa, Pakistan. This cross-sectional study was performed from June 2018 to June 2020 at the Medical Laboratory Technology Department, The University of Haripur, Pakistan. Presence of HP was a research variable, while sex, age groups, education status, overcrowding, dining habits, milk intake, drinking water source and animal contact were grouping variables. Immuno-chromatographic technique (ICT) was used to for serological detection of HP antibodies. All variables were represented by frequency and percentage with 95%CI. Prevalence of HP and its distribution by eight socio-demographic variables was testified by the chi-square goodness-of-fit test while association was testified by chi-square test of association. Out of total 1160 cases, 557 (48%) were positive for HP. Population prevalence was higher in men, in the age group 20-40 years, illiterate, family size ≤ 10 persons, taking restaurant food, using tetra pack, using municipal water, and having animal contact. The observed prevalence of HP was similar to its expected prevalence in the population. The observed distribution of HP in the sample was different from its expected distribution in population by eight socio-demographic variables. Presence of HP was associated with all eight socio-demographic variables besides age groups. Resumo Helicobacter pylori (HP) é um elemento vital na etiologia de úlceras pépticas e câncer gástrico. Esta pesquisa teve como objetivo determinar a frequência, distribuição e determinantes da infecção por HP em adultos e adolescentes com sintomas gástricos no distrito de Haripur, Khyber Pakhtunkhwa, Paquistão. Este estudo transversal foi realizado de junho de 2018 a junho de 2020 no Departamento de Tecnologia de Laboratórios Médicos da Universidade de Haripur, Paquistão. A presença de HP foi uma variável de pesquisa, enquanto sexo, faixas etárias, escolaridade, superlotação, hábitos alimentares, ingestão de leite, fonte de água potável e contato com animais foram variáveis de agrupamento. A técnica imunocromatográfica (TIC) foi utilizada para a detecção sorológica de anticorpos para HP. Todas as variáveis foram representadas por frequência e percentual com IC 95%. A prevalência de HP e sua distribuição por oito variáveis sociodemográficas foi comprovada pelo teste de ajuste do qui-quadrado, enquanto a associação foi verificada pelo teste de associação do qui-quadrado. Do total de 1.160 casos, 557 (48%) foram positivos para HP. A prevalência populacional foi maior em homens, na faixa etária de 20 a 40 anos, analfabetos, família ≤ 10 pessoas, consumindo comida de restaurante, usando tetra pack, usando água municipal e tendo contato com animais. A prevalência observada de HP foi semelhante à sua prevalência esperada na população. A distribuição observada de HP na amostra foi diferente de sua distribuição esperada na população por oito variáveis sociodemográficas. A presença de HP foi associada a todas as oito variáveis sociodemográficas além das faixas etárias.

Purpose: Intracavitary brachytherapy is one of the important methods of gynecological cancer treatment. The effect of attenuation is not considered in the dose calculation method released by the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report (TG-43). In this study, the effect of high-dose rate (HDR) brachytherapy applicators on dose distribution was measured using Gafchromic films and well-type ionization chamber. Materials and Methods: A plan created by the treatment planning system was first executed using a well-type ionization chamber with a water equivalent elasto-gel in place for charge collection. Again, same plan was executed using central tandems of various angulations with different diameters of vaginal cylinders and charge collection was measured. For in vitro dose measurements this plan was also executed on tandem and vaginal cylinder assembly with Gafchromic films fixed on the surface of vaginal cylinder. Results: The results show that the central tandem when used with different vaginal cylinders resulted in increase in effective attenuation of the beam. The central tandem of 300 angulations when used with a 35-mm diameter vaginal cylinder results in maximum attenuation whereas the 0º tandem when used with 20-mm diameter vaginal cylinder results in least attenuation of the beam. Conclusion: Due to the attenuation by various applicators used in brachytherapy for the treatment of gynecological cancers, it can be concluded that the difference between practical dose and the treatment planning system calculated dose should be considered for the correct estimation of the dose to the target and the organs-at-risk.

Marine phospholipids (PLs) rich in ω-3 polyunsaturated fatty acids (ω-3 PUFAs) have drawn keen interest recently among researchers and consumers and could be assumed as a “miracle drug”. Substantial amount of EPA and DHA, amazing and unique chemical properties and super bio-functional activities of marine PLs make it superior compared to terrestrial PLs, which lack long chain ω-3 PUFAs. Many comparative studies revealed that marine PLs showed higher health beneficial activities compared to PLs obtained from land sources. Marine PLs are not only beneficial in containing a high amount of ω-3 PUFAs but also in absorbing and assimilating ω-3 PUFAs in different tissues. Synergistic effects of PL compounds and ω-3 PUFAs in marine PLs showed super bio-functional performances like anti-atherosis and cardioprotective, anti-inflammatory, neuroprotective, immunological, and liver functions. A number of in vivo and in vitro studies on the administration of marine PLs extracted from fishes, mollusks, crustaceans, echinoderms reduced triacylglycerol (TAG) level and enhanced cardioprotective functions, demonstrated anti-inflammatory activity, reduced cell proliferation and tumor, increased cognitive functions and memory, and prevented hepatic damages. Therefore, this review paper provides detailed accounts on the present research status of critical biological and nutritional functions of marine ω-3 PUFAs rich phospholipids focusing on the origin, animal models, treatment, and roles.

Funding Acknowledgements Type of funding sources: None. Background Little has been reported on the impact of the COVID-19 pandemic and the new delta variant, on cardiology services and catheterization volumes in South Asia, during the second year of the pandemic. Purpose We aimed to assess this impact during the second year of the pandemic on cardiology services, procedures and catheterization volumes at a tertiary cardiac centre in Bangladesh. Methods Data on patient visits (outpatient and emergency), admissions, procedures and catheterization volumes were collected for January to June 2020 and 2021 via hospital electronic records. Comparisons for each corresponding month were made between 2021 and 2020. The differences were expressed as a percentage (%Δ). Results Trends showed that admissions in cardiology and cardiac surgery units, outpatient visits, procedures and cardiac catheterization volumes had reached almost pre-pandemic levels in the first quarter of 2021, as compared to 2020. However, ER visits showed >50% reductions in February (Δ-58.7%) and March (Δ -51.9%) 2021, compared to 2020. Admissions and procedures showed a steep decline from March to April 2021, coinciding with the COVID19 surge owing to the Delta variant. A gradual increase in numbers of admissions, patient visits, and procedures were seen in May and June 2021, as compared with corresponding months in 2020. In terms of catheterization volumes, a sharp decline was seen in angiographies and percutaneous coronary intervention (PCI) from March to April 2021, similar to 2020. Cath lab procedures showed an increasing trend in May-June 2021, and were greater in numbers, compared to corresponding volumes in 2020 [May: Δ+36.9%; June: Δ+33.2% in 2021]. A greater increase was seen for PCI (May Δ+ 46.8%; June Δ+367%) than angiographies (May Δ+32.5%; June Δ+32.5%). Conclusion Cardiology services and cath lab volumes had reached almost pre-pandemic levels in January and February 2021. The surge caused by the delta variant resulted in reduced admissions, outpatient and cath lab volumes beginning from April 2021, however numbers remained greater in 2021 than corresponding months in March-June 2020, possibly indicating an adaptation of the healthcare system to the prevailing pandemic.

Background The COVID-19 pandemic resulted in reduced numbers of patients presenting with and undergoing procedures for cardiac conditions worldwide. This impact, specifically looking at the changes in patient visits, admissions and procedure volumes, has not been recorded thus far, in terms of a South Asian LMIC setting. Purpose We aimed to assess the impact of the pandemic on emergency room (ER) visits, cardiology admissions, out-patient and in-patient procedures at a LMIC tertiary cardiac centre. Methods Data on ER visits, specific in-patient and out-patient procedures (echocardiography, exercise stress tests, electrocardiography [ECG]) were collected via hospital electronic records from January to December 2020, and compared with corresponding data for the same months in 2019. The difference or deficits were expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value Results There were significantly reduced numbers of out-patient visits (Δ −31.2%; p=0.007), ER visits (%Δ −59.5%; p=0.0), in-patient admissions (Δ −33.1%; p=0.005), total out-patient procedures (%Δ −31.9%; p=0.008) and catheterization volumes (%Δ-29.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). Among out-patient procedures, adult trans-thoracic echo, ECG and stress tests showed greatest deficits in April 2020. No trans-oesophageal echocardiograms were performed in April to July 2020. The greatest deficits were observed in April 2020, as compared with 2019 (out-patient visits: Δ-92.7%; out-patient procedures: %Δ-94.5%; in-patient admissions: %Δ-85.9%; catheterization procedures: %Δ-85.2%), except for ER visits, where the greatest deficit was seen in June 2020: %Δ-90.7%). Numbers continued to remain extremely low in May 2020, coinciding with the nation-wide lockdown measures. Out-patient visits, procedures and in-patient admissions have gradually increased since July 2020. However, the greatest impact seems to have been on ER visits, continued to remain low, with significantly reduced volumes in both 2nd and 3rd quarters of 2020. The lowest deficits in outpatient visits (Δ-4.9%), ER visits (Δ-31.9%) and out-patient procedures (Δ-0.9%) were seen in December 2020, while for in-patient admissions (Δ-7.9%) and catheterization procedures (Δ-6.5%) this was in October 2020. Conclusion There was a significant reduction of out-patient and in-patient cardiology services volumes in 2020, with the greatest reduction in April and May, coinciding with a general “lockdown”. ER visits were the most greatly affected. Trends show a steady increase in out-patient and catheterization procedures, beginning from July, but have not yet reached pre-COVID volumes, even by the end of 2020. These findings indicate that, the pandemic has resulted in significantly fewer ER visits; however, patients still present as outpatients, both for procedures and catheterization. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

Dear EditorThe COVID-19 pandemic had a significant impact on the delivery of medical education across the UK, with the majority of face-to-face teaching cancelled during the first wave, and medical...

Background: Growth and differentiation factor 15 (GDF-15), a divergent member of the TGF-β protein superfamily, shows low physiological baseline expression. GDF-15 is, however, strongly upregulated during pregnancy. It is further induced in stressed and damaged tissues, where it limits immune infiltration and inflammation. In solid tumors, GDF-15 was shown to be a key inhibitor of T-cell infiltration. While this might already explain the strong correlation between GDF-15 overexpression and poor survival with or without checkpoint-based immunotherapy, effects of GDF-15 on dendritic cells and monocytes may further shape the tumor microenvironment. Methods: To analyze the impact of GDF-15 in murine tumor models, GDF-15 was either deleted by CRISPR/CAS9 gene editing or neutralized by administration of a blocking antibody. Effects on tumor growth were recorded and the composition of the tumor microenvironment was characterized by flow cytometry. More detailed insight into tumor-immune interactions was obtained via the CrownBio Mouse I/O RNA-Seq Panel. Specific effects on polarization of innate and on antigen-specific priming of adaptive immune cells were confirmed in cellular assays in vitro. Results: Tumor-derived GDF-15 modulates the tumor microenvironment by inhibiting infiltration and activation of myeloid cells. GDF-15 thereby impairs the induction of antitumoral immune responses. Deletion of GDF-15 enhances infiltration of innate cells into immune-excluded tumors, supports the priming of naïve T cells by dendritic cells and generates a pro-inflammatory tumor microenvironment. In vitro, GDF-15 inhibits DC maturation and synapse formation, thus preventing successful T-cell activation. Moreover, GDF-15 interferes with M1 polarization of macrophages. Conclusion: GDF-15 secretion helps tumors to generate a microenvironment that is poorly infiltrated by immune cells. GDF-15 further polarizes myeloid cells towards a tumor-promoting, anti-inflammatory phenotype. By inducing a more pro-inflammatory tumor phenotype, anti-GDF-15 antibodies may synergize with other immunotherapeutic agents. A clinical trial combining anti-GDF-15 (CTL002) with anti-PD-1 (NCT04725474) is ongoing. Citation Format: Markus Haake, Beatrice Haack, Sabrina Genßler, Julia Weigandt, Marlene Auer, Vincent Thiemann, Wahid M. Haq, Melanie Haag, Florian Wedekink, Birgitt Fischer, Kathrin Klar, Matthias Wölfl, Christine Schuberth-Wagner, Jorg Wischhusen. Tumor-derived GDF-15 promotes immune escape of tumors by functional alteration of the myeloid compartment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6118.

Objectives: This study aimed to examine the effects of wet-to-dry bandages for the treatment of surgical wounds in goats. Materials and Methods: Three types of bandages, i.e., the calcium alginate gel, the homogenous platelet-rich plasma (PRP) gel dressing, and saline dressing, were used to promote the healing process for the management of wounds. Artificial circular wounds were created and treated with bandages to evaluate their effects on the wound healing process in 12 goats. The morphological parameters, i.e., diameters (cm), duration of healing, and wound contraction (cm), were evalu¬ated to differentiate the postoperative sequelae on wound healing process up to day 30 in three different treatment groups of goats. Tissue specimens from the wounds were examined histo¬pathologically on 1st, 3rd, 7th, and 30th postoperative days. Finally, the obtained data were ana¬lyzed using the Statistical Package for the Social Sciences 19 software. Results: The current study revealed that the contraction diameter was higher in calcium alginate gel and PRP gel treated group when compared to the saline dressing group. Aggregation of immu¬noreactive cells (neutrophils, macrophages, and lymphocytes), collagen fiber bundles among the cells, and proliferation of blood vessels were observed in the epidermis of calcium alginate gel, PRP gel treated and saline dressing wounds, which promote the healing process of wounds. In visual inspection, the number of reactive cells and proliferation of blood vessels were higher in the calcium alginate gel and PRP gel treated group than the saline dressing. Conclusion: In terms of epithelialization, epidermal characteristics, neovascularization, and infil¬tration of immunoreactive cells, the calcium alginate gel and the homogenous PRP gel dressings showed the best healing performance. Therefore, the present study suggests that clinicians could consider the calcium alginate gel dressing and homogenous PRP gel dressing as beneficial for wound care. [J Adv Vet Anim Res 2020; 7(4.000): 647-654]

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiologypacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Berunok has been a commodity with low economic value, so it is necessary to use Berunok which has high nutritional value. This study aims to determine the proximate content of P. australis. Parameters measured were yield value and proximate analysis of berunok flour. This study consisted of two stages, namely sample preparation and manufacture of berunok flour, analysis of the chemical composition of berunok flour. The research design used a completely randomized design (CRD). The results showed that berunok flour had a dry texture, very smooth, and brownish in color. While the chemical composition contained in Berunok flour is water content of 8.19%, ash content of 37.21% (db), protein content of 48.78% (db ), fat content of 3.44% (db), and carbohydrate content by a difference of 10.57% (db). The average yield value of 83.34%.

Lymph node enlargement is a common presenting complaint in outpatient and inpatient department. The present observational cross sectional study was conducted in department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from December 2014 to May 2016 to evaluate etiologies of significant lymphadenopathy by clinical, histopathological and microbiological assessment. Biopsy/FNA materials of 177 patients of 18-75 years age range with significant lymphadenopathy were sent for histopathology/cytology, Gram stainculture, AFB stainculture and Gene Xpert. Among them, 102(57.62%) were granulomatous lymphadenitis, 52(29.38%) were lymphoma, 12(6.78%) reactive lymphadenitis, 7(3.95%) metastatic malignancy, 2(1.13%) atypical lymphoid hyperplasia, 1(0.57%) myeloid sarcoma and 1(0.57%) chronic sialadenitis. Growth of MTB was on 23(22.55%) cases; among 102 granulomatous lymphadenitis and Gene Xpert was positive in 73(71.56%) cases with 100% Rif. sensitive. Gene Xpert is an important tool for diagnosis of tuberculous lymphadenitis. Time of symptoms to diagnosis of most of the TBL patients was within 2-8 months.

Objective:Doctors experienced unprecedented levels of workload and pressure since the outbreak of COVID-19, making them more vulnerable to adverse psychological outcomes. While frontline healthcare workers face a substantially higher risk of susceptibility to infection due to excessive COVID-19 exposure, little is known about its impact on doctors not directly posted with COVID-19 patients. Our study was focused on studying the impact of COVID-19 pandemic on mental health of this subgroup of doctors.Materials and Methods: From April 1st to July 31st, 2020, a cross sectional web-based survey was conducted at a COVID-19 dedicated tertiary care hospital. The study was conducted using standard questionnaires measuring adverse psychological outcomes including DASS-21 and WHO-5. Univariate and multivariate logistic regression were used to examine the determinants of adverse psychological outcomes.Results and Discussion: 145 doctors completed the survey questionnaire with over 71% females and 29% males. The overall prevalence of anxiety, depression and stress among doctors was 38.6%, 41.37% and 32.42% respectively. The overall well-being score was found to be 52.77 + 24.19 with a median [IQR] of 52.Conclusion: A high incidence of adverse psychological outcomes are observed amongst doctors during COVID-19 pandemic, even when they are not directly involved in the care of COVID-19 patients. Stress, anxiety and depression have an inverse relationship with age and marital status. Anxiety has an inverse relationship with religious beliefs.International Journal of Human and Health Sciences Vol. 05 No. 03 July’21 Page: 297-306

PURPOSE To compare the efficacy of two different doses of labetalol for attenuation of haemodynamic response during laryngoscopy and endotracheal intubation - A randomised control trail. MATERIALS AND METHODS 90 patients of either sex, aged 18–60 years, of ASA (American Society of Anaesthesiologist) class I or II, posted for elective surgical procedures requiring general anaesthesia with intubation were selected. Patients were randomly allocated to any of the three groups (30 each). In Group C, i.e. control group, 5 mL 0.9% saline; in Group L1, Inj. Labetalol 0.1 mg/kg diluted with 0.9% saline with total volume of 5 mL; and in Group L2, Inj. Labetalol 0.2 mg/kg was diluted with 0.9% saline with total volume of 5 mL. The study drug was administered to subjects intravenously 5 min. prior to intubation. All the patients were subjected to the same standard anaesthetic technique. The vital parameters i.e. heart rate, systolic blood pressure and diastolic blood pressure were recorded, mean arterial pressure was calculated prior to induction at time of intubation and 1 min., 3 min., 5 min., and 10 min. after intubation. RESULTS A significant attenuation response of haemodynamics was seen in group L1 and L2 when compared to control group C. No significant difference was observed between the group L1 and L2 at intubation, 1 min., 3 min., 5 min. and 10 min. postintubation. CONCLUSION Both doses of Inj. Labetalol (0.1 mg/kg and 0.2 mg/kg) attenuate haemodynamic response to laryngoscopy and intubation in dose dependent manner.

Optimal glycaemic control before and during pregnancy improves both maternal and fetal outcomes. This article summarizes the recently published guidelines on the management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units produced by the Joint British Diabetes Societies for Inpatient Care and available in full at www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Hyperglycaemia following steroid administration can be managed by variable rate intravenous insulin infusion (VRIII) or continuous subcutaneous insulin infusion (CSII) in women who are willing and able to safely self‐manage insulin dose adjustment. All women with diabetes should have capillary blood glucose (CBG) measured hourly once they are in established labour. Those who are found to be higher than 7 mmol/l on two consecutive occasions should be started on VRIII. If general anaesthesia is used, CBG should be monitored every 30 min in the theatre. Both the VRIII and CSII rate should be reduced by at least 50% once the placenta is delivered. The insulin dose needed after delivery in insulin‐treated Type 2 and Type 1 diabetes is usually 25% less than the doses needed at the end of first trimester. Additional snacks may be needed after delivery especially if breastfeeding. Stop all anti‐diabetes medications after delivery in gestational diabetes. Continue to monitor CBG before and 1 h after meals for up to 24 h after delivery to pick up any pre‐existing diabetes or new‐onset diabetes in pregnancy. Women with Type 2 diabetes on oral treatment can continue to take metformin after birth.

Breast cancer is the most common non-skin cancer amongst women worldwide and is the fifth leading cause of cancer-related mortality overall. It is also the foremost reason for cancer-related mortality in Hispanic females in the United States (US). Although the current incidence of breast cancer is significantly lower in Hispanics compared to that of non-Hispanic Whites (NHW) and Blacks, (91.9, 128.1, and 124.3 per 100,000, respectively, annually), this may increase if Hispanics develop similar lifestyle behaviors to other American women, in categories such as weight management, age at first birth, number of children, and breastfeeding habits. Stage-for-stage mortality for Hispanics is similar to NHWs, but the mortality rate is not declining as rapidly in this ethnic group. Hispanic women share many of the same risk factors for developing breast cancer as NHWs and Blacks. This suggests that many of the risk reduction strategies used in other racial populations may also benefit this group. Providing education about breast cancer and implementing risk reduction strategies in culturally-aware environments could help keep incidence low and reduce cancer-related mortality. Since Hispanics are the largest minority group in the US, this could have a significant impact on the incidence and mortality nationally.

Background The pharmacy internship program is designed to provide comprehensive training for interns to perform various roles in pharmacy practice. In Malaysia, the current internship program has been in place since 2004 in public health facilities, but has never been extensively evaluated. Aim To assess the level of job satisfaction and perception of Provisionally Registered Pharmacists (PRP) towards the internship training provided. Methods A cross-sectional nationwide survey was conducted amongst all PRPs undergoing training between December 2015 and February 2016 to assess their level of job satisfaction and perception towards the training requirements stipulated by the Pharmacy Board of Malaysia. Results A total of 733 PRPs participated in the survey and the response rate was 95.8%. On the basis of the response received, 92.5% (n = 678) felt that the one year training period was ‘just nice’, 30.5% (n = 223) felt that the logbooks were ‘too complicated’, and 33.2% (n = 241) said the targets set by the Pharmacy Board of Malaysia were ‘too high’. On a scale of 1 to 5, respondents rated 3.32 (SD 0.54) for mean score of job satisfaction. Significant factors influencing mean score of job satisfaction were: perceived fairness at the work place; perceived self-competence after one year of training; preceptors' competence; and pharmacy as a chosen career pathway. Conclusion Intern pharmacists were fairly satisfied with the internship training in government facilities in the Ministry of Health, Malaysia. A review of the internship logbooks and the practicality of targets set by the Pharmacy Board warrant further improvement.

The objective of the study was to determine the efficacy of vitamin C in reducing serum uric acid (UA). This study was a double-blind placebo-controlled randomized trial conducted in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh from July 2007 and August 2008. Study participants were included from out patient department (OPD) of Rheumatology of BSMMU suffering from various Rheumatological problems other than gouty arthritis. All of the participants were non-smokers, non-alcoholics, and randomized to take either placebo or vitamin C (500 mg/day) for 12 weeks. A total of 98 subjects were enrolled in the study; 71 completed the trial, with 34 in the placebo group and 37 receiving vitamin C. Serum uric acid levels were not significantly reduced in the experimental group and they increased in the placebo group. In the vitamin C group, the mean change was -0.32mg/dl [95% confidence interval -0.73, 0.77], whereas in the placebo group, the mean change was +0.12mg/dl [95% confidence interval was -0.22, 0.47]. Subgroups were defined by sex, body mass index, and quartiles of baseline serum uric acid levels. In a subgroup analysis, vitamin C lowered serum uric acid significantly in those who had comparatively higher baseline uric acid levels. Although vitamin C did not lower serum uric acid significantly, participants with higher baseline serum uric acid levels experienced a significant uric acid lowering effect, but as the sample size was very small, it is difficult to draw any definitive conclusion.

Background: Nearly 40% of patients presenting with Non ST-Segment Elevation Myocardial Infarction (NSTEMI) have Chronic Kidney Disease (CKD). CKD is a powerful predictor of adverse events among NSTEMI patients. The purpose of the present study was to evaluate the in-hospital outcome of patients with Chronic Kidney Disease presenting with Non ST-Segment Elevation Myocardial Infarction. Methods: In this prospective observational study a total of 128 patients with NSTEMI were enrolled. They were divided equally in group I (NSTEMI with CKD) and group II (NSTEMI with normal renal function) on the basis of estimated glomerular filtration rate. Patients were considered to have CKD if he/she had documented history of CKD or estimated glomerular filtration rate

Background Heat treatment is the most common method for reducing pathogen load, but it remains controversial in reducing the incidence of hyperimmune reactions. The aim of this study was to compare the allergenicity of caseins (CSN) and whey proteins (WP) of thermally processed cow and buffalo milk in a mouse model. Swiss albino mice were sensitised by intraperitoneal injections (administered in three doses at weekly intervals) of CSN or WP from cow or buffalo milk for the evaluation of humoral response and splenocyte stimulation index. Results After 3 weeks of intraperitoneal stimulation of mice with milk proteins, the sterilised milk protein group displayed significantly lowered (P ≤ 0.05) serum IgG and IgE levels, while considerably increased cow milk protein-specific responses (IgE) were shown by proteins of pasteurised milk compared with those of raw milk. The stimulation index of splenocytes induced by CSN or WP of boiled and sterilised milk was also lower (P ≤ 0.05) than that of raw milk of both cow and buffalo. Conclusion The experiment showed that boiling and sterilisation of cow and buffalo milk clearly affect the allergenicity by decreasing the humoral and cell-mediated responses in mice. All results indicated that CSN and WP of sterilised milk are less allergenic than those of raw milk in mice. © 2013 Society of Chemical Industry

This work aims to identify the pattern of antimalarial use in Malaysia as a baseline data on common drugs used in the local setting. Data on malaria prevalence and drug use pattern over the past 10-years was collected retrospectively from Vector Borne Disease Sector and Pharmaceutical Services Division, Ministry of Health. The defined daily dose/inhabitant/years is used to describe the antimalarial utilization pattern. We observed a decline of 42% malaria cases within a span of 10 years despite a steady increase in the number of P. knowlesi cases noted in Malaysia. Infections caused by the P. falciparum and P. vivax species demonstrated a reduction in cases within the span of 10 years. Between 2005 and 2013 both chloroquine and primaquine were noted to be the most common antimalarial drugs used, followed by pyrimethamine-combination and quinine. Artemisinin in particularly artesunate and mefloquine use were found to be limited during the study period. Despite being one of the oldest drugs, the quinolines were found to be the most common antimalarials used. The use of primaquine is highlighted due to the gradual increase in the use of the drug in recent years. Indeed, the general decrease in antimalarial use is attributed to the distinct reduction in malaria cases in the country.

Objective Little is known about the burden of osteoarthritis (OA) in Canada. This study was undertaken to estimate the excess burden of OA in Ontario, the largest province in Canada. Methods The records of Ontarian respondents to the Canadian Community Health Survey (CCHS) who provided consent to data linkage were linked to the Ontario Health Insurance Program physician claims database and the Discharge Abstract Database Inpatient and Day Procedure databases. Patients with OA (n = 1,474) were identified using CCHS 1.1 and the physician claims database. To determine the excess burden of OA, a control group matched by age, sex, and rural/urban status was created, with 3 controls per case (n = 4,422). Sociodemographic and medical characteristics, health-related quality of life, and 1-year physician, day (outpatient) procedure, and hospitalization costs were compared between the 2 groups. Regression analyses were performed to identify predictors of medical characteristics, health utility, and cost. Results The mean age of the OA patients and the control subjects was 66 years, and 74% of all study subjects were women. Several differences were observed between patients with OA and subjects without OA in terms of socioeconomic and medical characteristics. On a scale of 0–1, the mean utility value associated with OA was 0.68, compared to 0.84 for the control group (P < 0.0001), representing a utility decrement of 0.16. The 1-year physician, outpatient procedure, and hospitalization costs were significantly higher in the OA group than in the non-OA group ($2,233 Canadian versus $1,033 Canadian, respectively; P < 0.0001). Conclusion These results indicate that the excess burden of OA in Ontario is considerable.

Ventricular lead perforation is an infrequent but it's a critical complication of pacemaker implantation. Perforation was usually associated with the use of small-caliber active fixation leads, and can occur beyond the first few days (sub acute) or even more than a month after implantation (late). We report the case of right ventricular perforation by a ventricular fixation lead in 61 years old man detected more than two months after implantation. Radiology and echocardiography can confirm the perforation by revealing progression of the lead beyond the cardiac silhouette or indirectly visualizing the presence of pericardial effusion. However, its pathophysiology and optimal management are currently unclear.

Different essential radiographic parameters were studied in order to assess radiographic image quality ensuring reduction of radiation exposure in some diagnostic X-ray facilities of Bangladesh. Different parameters for developing and fixing liquid were investigated in order to eliminate improper film processing techniques. General information about intensifying screen, radiography and mammography film was also collected. X-ray tube voltage, output radiation dose and exposure time for diagnostic X-ray machines were tested to achieve significant dose reduction without loss of diagnostic information. It is found that output radiation dose varies in different diagnostic X-ray installations. 70% X-ray installations achieve the recommended value for tube voltage while 87.5% measure the exposure time appropriately. Radiation dose level at patient waiting room, dark room and around control panel was also measured. About 92.5, 85 and 77.5% installations show their results within the acceptance limit at these positions respectively which provide radiation safety for patients, workers and public in diagnostic radiology.DOI: http://dx.doi.org/10.3329/jbas.v35i1.7967Journal of Bangladesh Academy of Sciences, Vol.35, No.1, 7-17, 2011

A novel macrocycle 1,16-diaza-7,10-diamino-6,11-dioxo-1,17-bis[2′-hydroxy-5′-aminobenzyl]-piperazine-4,12-cyclododecadiene, [H4L] has been synthesized by a multistep process. The interaction of 5-amino salicylic acid, piperazine and formaldehyde in ethanol gave PC-1, which was reduced into a chloro-derivative PC-2. PC-2 by reacting with ethylenediamine gave a new macrocyclic ligand titled [H4L]. Its binuclear complexes with Mn(II), Co(II), Ni(II), Cu(II) and Zn(II) ions have also been synthesized. The ligand and all metal complexes have been characterized by elemental analysis, IR, 1H NMR, 13C NMR and U.V.Visible spectroscopy. Molar conductance and magnetic moment measurements have also been determined. Microanalytical data revealed 1 : 2 molar ratio of ligand to metal in all the complexes. The spectral and magnetic data indicate that Mn(II), Co(II), Ni(II) complexes show octahedral geometry with two water molecules while Cu(II) and Zn(II) complexes exhibit square planar and tetrahedral environments, resp...

Causality assessment of reported adverse drug reactions (ADR) is an important component of pharmacovigilance as they contribute to better evaluation of the risk-benefit profile of drugs. The main objective of the present study was to evaluate the agreement of causality assessments of ADR between the spontaneous ADR reporters, the expert panel and the Naranjo algorithm. We retrospectively reviewed ADR reports received by the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) between January to June 2003. Causality assessments were categorized as Certain, Probable, Possible, Unlikely and Unclassifiable. A total of 384 reports were included. Spontaneous reporters assessed 30.4% as Certain, 46.1% as Probable, 21.9% as Possible and 1.6% as Unlikely. MADRAC panel assessed 21.9%, 13.0%, 64.6% and 0.5% as Certain, Probable, Possible and Unlikely, respectively. Using the algorithm, 16.4%, 83.1% and 0.5% were categorized as Probable, Possible and Unlikely, respectively. No reports achieved the Certain/Definite category using the algorithm. The total percentage of agreement between spontaneous reporters, MADRAC and Naranjo’s algorithm in causality assessment was 15.1%. Among the three groups, no agreement was found in the Certain and Unlikely categories. Spontaneous reporters attributed a higher level of causality compared to MADRAC and Naranjo’s algorithm. The difference in aims and methods in causality assessment among the three methods of assessment could be the main reason of disagreement.

N-N′-tetracarboxydiethyloxamide (hereafter abbreviated as H6L) was prepared by using L-aspartic acid and diethyl oxalate (DEO). A series of binuclear complexes of divalent metal chlorides viz. Mn(II), Co(II), Ni(II), Cu(II), and Zn(II) with H6L have been prepared. Spectral studies (IR, UV and NMR) magnetic susceptibility, elemental analysis and molar conductance measurements confirm the formation of binuclear complexes, [M2H2L]/[M2H2L · 4H2O]. Electronic absorption spectra and magnetic susceptibilities suggest square-planar stereochemistry for Cu(II) and tetrahedral for Zn(II) complexes. Mn(II), Co(II), and Ni(II) coordinate two molecules of water and consequently show octahedral geometry. The in vitro antimicrobial activity of the synthesized compounds is discussed against bacterial strains such as S. aureus, S. epididermis, K. pneumonia, S. typhi, P. aerugenosa, and B. subtilis A. brasilense. The metal complexes show higher activity against all the microorganisms than the ligand.

Vibrio vulnificus septicemia is the most common cause of fatality related to seafood consumption in the United States. It occurs predominantly in patients with chronic liver disease following consumption of raw oysters. V. vulnificus is a highly virulent human pathogen, normally found in warm estuarine and marine environment. It lodges in filter feeders like oysters. The onset of this illness is abrupt, rapidly progressing to septic shock with a high mortality. Clinicians managing patients with chronic liver disease need to educate their patients of the risk associated with the consumption of raw seafood, especially oysters. A high index of suspicion is necessary for appropriate treatments, as doxycycline, the antibiotic of choice, is not usually a part of the empiric therapy for septicemia. The high mortality associated with this septicemia demands aggressive preventive measures: susceptible individuals must be forewarned by signs displayed in restaurants; physicians must educate patients with chronic liver disease about the risk of raw oyster consumption; and harvesting methods which reduce contamination by V. vulnificus must be utilized.

The new ligands, 1,5,8,12‐tetraaza‐4‐(1′,1′‐dimethylethyl)‐2‐(1″,1″,2″,2″,3″,3″,3″‐heptafluoropropyl)‐9,11‐(dimethyl)‐cyclotetradeca‐1,4,8,11‐tetraene (L1) and 1,5,9,13‐tetraaza‐4‐(1′,1′‐dimethylethyl)‐2‐(1″,1″,2″,2″,3″,3″,3″‐heptafluoropropyl)‐10,12‐(dimethyl)‐cyclohexadeca‐1,4,9,12‐tetraene (L2), have been prepared by the reaction of 1,1,2,2,3,3,3‐heptafluoro‐7,7‐dimethyl‐4,6‐octanedione with ethylenediamine and acetyl acetone (L1) and 1,1,2,2,3,3,3‐heptafluoro‐7,7‐dimethyl‐4,6‐octanedione with 1,3‐diaminopropane and acetylacetone (L2), respectively. Their complexes with Cr(III), Mn(II), Fe(III), Co(II), Ni(II), Cu(II), and Zn(II) ions have also been synthesized and characterized by elemental analyses, magnetic susceptibility measurements, molar conductance measurements, IR, EPR, 1H NMR, and UV‐Visible spectra. The molar conductance values show that the complexes of Fe(III) and Cr(III) are 1:1 electrolytes, the Ni(II) and Cu(II) complexes are 1:2 electrolytes while those of Mn(II), Co(II), and ...

The sodium salts of pyrimidinetrione dithiocarbamate (NaL1) and pyrimidinetrione dithiocarbamate (Na2L2) and their first row‐transition metal complexes of the type [M(L1)2], [M′(L1)3] and [M2(L2)2], where M=Mn(II), Co(II), Ni(II), Cu(II), Zn(II) and M′=Cr(III), Fe(III) have been synthesized and characterized. Spectroscopic studies suggest that the interaction of L2 with a divalent metal ion forms binuclear dithiocarbamate macrocyclic complexes. Conductivity measurements reveal that all of the complexes are non‐electrolytes. The magnetic moment values and electronic spectra suggest that the Mn(II) and Co(II) complexes are tetrahedral, the Ni(II) and Cu(II) complexes are square‐planar while the Fe(III) and Cr(III) complexes are proposed to have an octahedral structure.

Complexes of La(III), Nd(III), Pr(III), Sm(III), Tb(III), Dy(III), Ho(III), Er(III) and Yb(III) with hydridotris‐ and tetrakis(benzimidazol‐1‐yl)borate anions (L1 and L2) have been prepared and cha...

Two new macrocyclic ligands 1,4,7,9,12-pentaaza-10,11-dioxo-8,9,12,13-bis-(1′-oxo-3′-thio-2′-hydropyrimidine)-trideca-7,13-diene, (L1) and 1,4,7,9,12-pentaaza-10,12-dioxo-8,9,13,14-bis-(1′-oxo-3′-thio-2′-hydropyrimidine)-tetradeca-7,14-diene, (L2) and their complexes with CrIII, MnII, FeIII, CoII, NiII, CuII and ZnII have been synthesized, and characterized by elemental analysis, i.r., 1H-n.m.r., e.p.r., u.v.–vis. spectroscopy, magnetic susceptibility and conductance measurements. The conductivity measurements suggest that the complexes of divalent metal ions are 1:1 electrolytes whereas the trivalent metal ions are non-electrolytes. On the basis of electronic spectra and magnetic moment measurements the CrIII and FeIII complexes are octahedral, while the divalent metal complexes are tetrahedral except for the NiII and CuII complexes which are proposed to have square planar geometry. All the ligands and their complexes have been screened against gram-positive bacteria Staphylococcus aureus and gram-negative bacteria E. coli. The results show that they inhibit the growth of bacteria.

Trinuclear macrocyclic metal complexes having oxamide bridges have been synthesized by the interaction of the macrocycle 1,4,7,10-tetraazacyclotetradecane-2,3-dione with Cr(III), Mn(II), Fe(III), Co(II), Ni(II), Cu(II) and Zn(II) chlorides and were characterized.by elemental analyses, EPR, electronic, IR, 1H NMR spectra, conductivity and magnetic susceptibility measurements. The conductivity measurements suggest that the complexes of the divalent metal ions are nonionic while those of the trivalent metal ions appear to be 1:3 electrolytes. On the basis of electronic spectra and magnetic moment values an octahedral geometry is proposed for all of the prepeared complexes.

Kinetics and mechanism of the reaction of Cr(VI) with oxalic acid have been studied in presence and absence of H2SO4, HClO4, and CH3COOH by monitoring the formation of Cr(III)-oxalic acid complex at 560 nm. The effect of total [oxalic acid], [Cr(VI)], [H2SO4], [HClO4], and [CH3COOH] on the reaction rate was determined at 30°C. Formation of carbon dioxide was also confirmed. The oxidation rate increases with [oxalic acid] and [CH3COOH] while it decreases with [H2SO4], [HClO4], and pH. The rate law governing the oxidation of oxalic acid over a wide range of conditions is rate=k1Kes1 [oxalic acid]T [Cr(VI)]T 1+Kes1 [oxalic acid]T, where only undissociated oxalic acid is kinetically active. Kinetic evidence for the formation of a Cr(VI)(SINGLEBOND)oxalic acid 1:1 complex has been obtained and the equilibrium constant for their formation has been determined. The 1:1 complex exists most likely in an open chain form. The rate-limiting step of the oxidation reaction involves the breaking of the C(SINGLEBOND)C bond in the 1:2 complex. Oxidizing ability of Cr(VI) species have been discussed. Mechanism with the associated reaction kinetics is assigned. © 1998 John Wiley & Sons, Inc. Int J Chem Kinet 30: 335–340, 1998

Background and objective: In 1984 a therapeutic drug monitoring (TDM) service was established in Hospital Universiti Sains Malaysia (HUSM) and gentamicin concentrations were measured and used to design optimal regimens for the antibiotic. In this study we report on a 6-year follow-up audit since our first assessment of the service. Method: Records of 733 requests for gentamicin monitoring were reviewed. Results: Of the 592 patients involved, 39% were neonates and 42% were adults. Peak gentamicin concentrations were within the therapeutic range in 65% of the patients at first monitoring and 79% of the corresponding trough concentrations were within the non-toxic range. After dosage adjustment, 81% of the peak concentrations were within the therapeutic range and trough concentrations rose to levels regarded as toxic in 7% of patients. In patients with therapeutic peak concentrations at the first monitoring point, the average duration of gentamicin therapy was statistically shorter than in those patients who failed to achieve a therapeutic peak concentration. The distribution of gentamicin peak and trough concentrations in terms of therapeutic ranges were also better than those found in 1990. Conclusion: TDM for gentamicin is well accepted in HUSM and its application has contributed to improved gentamicin administration. Furthermore, our physicians are now able to choose more appropriate dosage regimens for their patients because the majority of gentamicin concentrations attained even at the first monitoring were within the therapeutic range.