Evaluation of outcome of Coronavirus disease 2019 patients receiving RAAS inhibitors (OCRAS study): a prospective observational study of Bangladeshi hypertensive patients

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Beximco Pharmaceutical Limited, Bangladesh

OnBehalf

Cardiology Study Group (Bangladesh)

Background

The fact that SAARS-Cov2 virus enters cells through ACE2 receptors and the Renin-Angiotensin-Aldosterone System Inhibitors (RAASi) upregulate the ACE2 receptors, there was speculation that use of RAASi may lead increased cellular entry of the virus.  There was a pause for a brief period of the use of RAASi in COVID 19 patients. But clinically the speculation has been found to be incorrect. Different professional societies come up with the assertion to continue to use RAASi. As the hesitancy among the clinicians appears to continue and there is no first hand data regarding the safety of the use of RAASi in Bangladeshi population, the study was undertaken to evaluate the safety of RAASi in COVID 19 patients.

Aims & Methods

This study was a prospective, observational multi-center study to evaluate the outcome of COVID-19 patients receiving RAAS inhibitors. Adult Hypertensive patients (age ≥18 years) with diagnosed COVID-19 confirmed by RT-PCR test who have a history of taking either ACE inhibitor/ARB or any other anti-hypertensive medication. Evaluation of outcome was assessed by rate of hospitalization, requirement of oxygen therapy, requirement of high flow nasal cannula, admission to ICU and mortality between two groups. All statistical analyses were performed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA).

Results

We collected data from 147 Covid-19 positive patients confirmed by RT-PCR. Among them, 117 (79.6%) had a history of taking RAAS inhibitor and 30 had history of taking other antihypertensive medications. Of them, two-third patients had more than 50 years of age and more than half of the patients had overweight or obesity. Other than hypertension they had several comorbidities such as Diabetes Mellitus (45.4%), Ischemic Heart Diseases (35.4%), Asthma or COPD (15%) etc. Rate of hospitalization had no statistical difference between RAAS inhibitor group and other hypertensive group (48.7% vs 46.70% respectively; p-value - 0.841). There was no statistical difference between two groups in terms of requirement of oxygen therapy (p-value - 0.297), High Flow Nasal Cannula (p-value - 0.430), intensive care unit (p-value - 0.194) and death (p-value – 0.383) also. Almost half and one-third of the patients had persistence of symptoms even after 14 days and 28 days respectively. Fatigue, cough, breathlessness, loss of appetite and taste were the most common symptoms among those.

Conclusion

In our study we found that RAAS inhibitor treatment had no adverse effect on the outcome of COVID-19 patients compared with other antihypertensive drugs. Patients may continue receiving ACEIs and ARBs for the treatment of any indication for RAASi without an increased risk of worse outcomes.

Prostaglandin-endoperoxide synthase (PTGS2) and Defensin beta 1 (DEFB1) gene polymorphisms are not associated with periodontitis in Malays

INTRODUCTION

In line with the association of prostaglandin-endoperoxide synthase 2 (PTGS2) and defensin beta 1 (DEFB1) single nucleotide polymorphisms (SNPs) with periodontitis among the Chinese and European populations, the current study was aimed to assess the same association among the Malays in Malaysia.

METHODS

Blood samples of individuals with periodontitis (PD) (n=72) and periodontally healthy (PH) (n=62) donors were obtained from Malaysian Periodontal Database and Biobanking system (MPDBS). Genomic DNA samples were analyzed for three PTGS2 SNPs (rs5275, rs20417, rs689466,) and one DEFB1 SNP (rs1047031) using Taqman SNP genotyping assays. Notably, rs20417 and rs689466 were located in the promoter region while rs5275 and rs1047031 were located in the 3' untranslated region of the transcript. Association between the SNPs and PD were then analyzed using genotypic association analysis (additive, dominant and recessive models).

RESULTS

The allelic frequency for the rs689466-G was higher in PD group (35.2%) compared that in PH group (29.0%). However, the association of rs689466-G and other SNPs with PD was not statistically significant (at 95% CI). No associations were observed for genotypic associations between the PTGS2 and DEFB1 SNPs with PD susceptibility.

CONCLUSIONS

PTGS2 (rs5275, rs20417, and rs689466) and DEFB1 (rs1047031) polymorphism was not associated with PD in Malays, unlike the Chinese, Taiwanese & European population. This suggests that other causal variants might be involved in the development and progression of PD among Malays.

Mapping the Antimicrobial Supply Chain in Bangladesh: A Scoping-Review-Based Ecological Assessment Approach

A standardized method for evaluating antimicrobial supply chains in the context of access and use could be a useful tool in assessing national capacity to implement programs that address antimicrobial resistance. We present both a novel ecological approach comprising mapping and the use of indicators that can be used to characterize national antimicrobial supply chains as well as benchmark countries and, for the first time, a country-level assessment of Bangladesh.

Introduction:

Maintaining access to antimicrobials while preventing misuse is essential to combating the threat of antimicrobial resistance (AMR). The study objectives are to propose a framework of 16 indicators that can be used at the national level to assess the capacity to ensure access and curtail inappropriate use and to profile the antimicrobial supply chain for Bangladesh.

Methods:

Using a framework based on a rational construct, we assessed the antimicrobial supply chain of Bangladesh, with a focus on key players and products using a scoping review to obtain and describe information on 16 indicators. With players, we mapped linkages, manufacturers’ production capacity, and ownership, among others, and demand point characteristics—pharmacy and pharmacist density, pharmacy/medicine outlets dispersion, veterinary clinic/hospitals, veterinarians’ density, product quality, and regulation. We assessed product characteristics including listing on the World Health Organization (WHO) Model Essential Medicines List (EML) and WHO Access, Watch, and Reserve (AWaRe) classification of the major (top 10) antibiotics for human use; the proportion of medically important antimicrobials (MIAs) in veterinary use; and pricing. Production capacity and price controls were used to assess access and listing on the WHO EML, AWaRe/MIA classification, and a calculated pharmacy-to-pharmacist ratio to assess use.

Results:

Bangladesh has a high (98%) local antibiotic production capacity with pricing controls indicating the ability to ensure access. The presence of a high proportion of medicine outlets not under the control of pharmacists (4:1) and the high percentages of WHO Watch (54%) and MIAs (90%) of the major antibiotics are indicators of possible misuse.

Discussion:

Most of the data used in the framework were publicly available. Bangladesh has the capacity to ensure access but needs to strengthen its ability to regulate the quality of antimicrobials and prevent their inappropriate use through antimicrobial stewardship at the community (medicine outlet) levels to check AMR. There may also be a need for more regulations on licensing of MIAs.

Diagnosis of COVID-19 in symptomatic patients: An updated review

A group of pneumonia patients was detected in Hubei Province, in China in December 2019. The etiology of the disease was unknown. Later, the researchers diagnosed the novel Coronavirus as the causal agent of this respiratory disease. On February 12th 2020, the World Health Organization (WHO) officially named this disease Coronavirus disease 2019 (COVID-19). Consequently, the disease spread globally and became a pandemic. As there is no specific treatment for the symptomatic patients and several vaccines are approved by WHO, the efficacy and effectiveness of these vaccines are not fully understood yet and the availability of these vaccines are very limited. In addition, new variants and mutants of SARS-CoV-2 are thought to be able to evade the immune system of the host. So, diagnosis and isolation of infected individuals is advised. Currently, real-time reverse transcription-polymerase chain reaction (RT-PCR) is considered the gold standard method to detect novel Coronavirus, however, there are few limitations associated with RT-PCR such as false-negative results. This demanded another diagnostic tool to detect and isolate COVID-19 early and accurately. Chest computed tomography (CT) became another option to diagnose COVID-19 patients accurately (about 98% sensitivity). However, it did not apply to the asymptomatic carriers and sometimes the results were misinterpreted as from other groups of Coronavirus infection. The combination of RT-PCR and chest CT might be the best option in detecting novel Coronavirus infection early and accurately thereby allowing adaptation of measures for the prevention and control of the COVID-19.

Multidrug-resistant tuberculosis in Bangladesh: results from a sentinel surveillance system

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh.

METHODS

Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Löwenstein-Jensen medium.

RESULTS

Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged 65 years.

CONCLUSIONS

The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.

MOLECULAR IDENTIFICATION AND ANTIBIOGRAM PROFILES OF ESCHERICHIA COLI ISOLATED FROM APPARENTLY HEALTHY AND DIARRHEIC GOATS

The present study was designed for the cultural, biochemical characterization and molecular detection of E. coli from apparently healthy and diarrheic goats in and around BAU campus including their antibiogram study. A total of 50 fecal samples were collected among which 13 originated from diarrheic goat and 37 from apparently healthy goats. Out of 50 samples, 35 were found positive for E. coli i.e., overall 70% occurrence. Occurrences of E. coli from diarrheic and apparently healthy goats were 92% and 62% respectively. Occurrences were 60%, 80% and 70% in case of BAU Goat Farm, Veterinary Teaching Hospital and Boyra respectively. On age basis 93%, 54%, 66% and 54% samples originated from 6 months, 7-12 months, 13-18 months and 19 months aged goats were found positive respectively. Occurrences of E. coli on the basis of sex were 78% for male and 62% for female. In case of breed, the occurrences were 69% in Black Bengal and 100% in for Jamunapari. Molecular detection was done by PCR and 13 out of 20 isolates tested gave the bands at the 585 bp specific for E. coli 16S rRNA gene. All the isolates (100%) were found sensitive to ciprofloxacin and norfloxacin; 100% and 35% were intermediately resistant to tetracycline and gentamicin respectively and 25% isolates were resistant to streptomycin. Ciprofloxacin and norfloxacin were found to be the best choice of antibiotics for the treatment of colibacillosis in goats in the study area.

Current knowledge of dengue pathogenesis and potential role of Carica papaya and vitamins in dengue fever

A number of biological molecules such as inflammatory enzymes and cytokines are altered during dengue virus (DENV) infection, many of which are attributed to the pathogenesis of the DENV infection. Papaya (Carica papaya) based extracts (PBE) and certain vitamins have been proven beneficial for dengue fever (DF) patients. The extract of papaya leaves were shown to improve platelet count in dengue patients. Extracts of papaya pulp based was also shown to induce in vitro IL-6 and stem cell factor in human peripheral blood mononuclear cells and stem cells of mesenchymal origin. Different vitamins such as D, E, and C have shown promise to treat dengue disease when taken in small supplementation trials. However, the exact molecular mechanisms on the beneficial roles of either PBE or vitamins are yet to be defined. Hence, the aim of this review is to link the cellular and molecular responses of DENV pathogenesis and pharmacological actions of the bio-active components of PBE or vitamins. It has also been shown that the beneficial roles of PBE and vitamins in DF are linked to thrombopoiesis, prevention of the viral entry and replication, decrease in oxidative damage assisted thrombocytopenia, and the reduction in vascular leakage. The DENV mediated fatalities are expected to expand it's geographic boundary whilst an efficient drug and the most likely candidate vaccine against DENV are still in progress. Findings on the molecular mechanisms of food and nutrient supplement might reinforce ongoing research to treat the increasing number of DENV infected patients using natural products while waiting for the right drug and vaccine.

EFFECT OF KALO JEERA SEEDS AND PAPAYA LEAF SUPPLEMENTATION ON THE PERFORMANCE OF BROILER

This experiment was conducted to determine the effect of papaya leaf (Carica papaya) and kalo jeera (Nigella sativa) seeds powdered supplementation in drinking water as a growth promoter in broiler chickens. A total of 20 Cobb-500 broiler chicks (day-old) were purchased from local hatchery (Nourish Poultry and Hatchery Ltd.) and after seven days of acclimatization chicks were randomly divided into two groups, A (n=10) and B (n=10). The group A was kept as a control and not treated. The group B was supplemented with papaya leaf and kalo jeera powder with feed and water. Weekly observations were recorded for live body weight gain up to 5th weeks and hematological tests were performed at 35th day’s age of broiler to search for hematological changes between control (A) and treatment (B) groups. The initial body weight of groups A and B on 1st were 41.00±0.56 gm and 41.50±0.35 gm, respectively and after 35th day of experiment final body weight were 1470±57.35 gm and 1720±58.56 gm, respectively and economics of production were analyzed and found that net profit per broiler was Tk. 8.91 and Tk. 20.69, respectively. The treatment group B was recorded statistically significant (at 1% level) increased (17.00%) for live body weight than that of control group A. The hematological parameters total erythrocyte count (TEC), erythrocyte sedimentation rate (ESR) and hemoglobin (Hb) estimation value of treatment group shows significant difference, while hemoglobin estimation does not show significant difference from control group. The results suggest that better growth performance could be achieved in broilers supplemented with papaya leaf and kalo jeera seeds.

Developing control points for halal slaughtering of poultry

Halal (permissible or lawful) poultry meat production must meet industry, economic, and production needs, and government health requirements without compromising the Islamic religious requirements derived from the Qur'an and the Hadiths (the actions and sayings of the Prophet Muhammad, peace and blessings be upon him). Halal certification authorities may vary in their interpretation of these teachings, which leads to differences in halal slaughter requirements. The current study proposes 6 control points (CP) for halal poultry meat production based on the most commonly used halal production systems. CP 1 describes what is allowed and prohibited, such as blood and animal manure, and feed ingredients for halal poultry meat production. CP 2 describes the requirements for humane handling during lairage. CP 3 describes different methods for immobilizing poultry, when immobilization is used, such as water bath stunning. CP 4 describes the importance of intention, details of the halal slaughter, and the equipment permitted. CP 5 and CP 6 describe the requirements after the neck cut has been made such as the time needed before the carcasses can enter the scalding tank, and the potential for meat adulteration with fecal residues and blood. It is important to note that the proposed halal CP program is presented as a starting point for any individual halal certifying body to improve its practices.

Non-Hodgkin lymphoma of the female genital tract mimicking primary gynecological tumors: a single-center series of 3 cases

INTRODUCTION

Malignant lymphoma of the female genital tract is quite rare and its presentation may resemble that of other, more common tumors, causing confusion for clinicians.

CASE HISTORY

The authors report three patients with a non-Hodgkin lymphoma (NHL) involving the female genital tract: two cases involved the ovary and one involved the uterus. In all patients, the genital tract was the initial site of clinical presentation of a B cell lymphoma. One patient was diagnosed postoperatively and subsequently received chemotherapy; the other two patients were diagnosed by imaging-guided biopsy and were successfully managed by chemotherapy without resection surgery. Two patients were alive, without evidence of disease, and one patient was alive with disease at their most recent follow-up visit.

CONCLUSION

The authors' experience emphasizes that lymphoma should be in the differential diagnosis of pelvic gynecological malignancies, and its clinical, biological, and radiological signs must be actively sought. Imaging-guided biopsy should be performed to avoid unnecessary surgery.

Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC.

Maternal and fetal outcome of mothers with gestational diabetes mellitus attending BIRDEM Hospital

Gestational diabetes mellitus, most of which progress to type-2 diabetes mellitus is increasing worldwide. Identification of gestational diabetes and control of glucose can reduce such complications and improve maternal and neonatal health. A hospital based cross sectional study was conducted to find out maternal and fetal outcome of gestational diabetes from January to July 2011. Data were collected from 109 gestational diabetes mothers attending Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital for delivery. Study revealed that gestational diabetes was more common among mothers aged >25 years old and multiparaous women. Mean gestational age of diagnosis was 16.82±9.54 weeks. Sixty eight (68%) mothers were diagnosed before 20 weeks of gestation and more than 90% mothers with gestational diabetes delivered by caesarean section. Mean pregnancy weight gain was 6.8±1.18kg. Adverse maternal outcome observed in 24% cases and adverse fetal outcome was present in 34% cases. In univariate analysis weeks of delivery and fasting blood sugar were statistically significantly associated with adverse pregnancy outcome. Babies born to mothers with only diet restriction had less birth weight than mothers with insulin therapy. Pregnancy thought to be the most vulnerable stage of women's life and protecting her health along with her fetus during this period yields a positive impact on the health of future generation. Particular attention should be given during antenatal period to initiate screening programme and treatment protocol for gestational diabetic mothers.

Therapy-related myelodysplastic syndrome and acute myeloid leukemia following chemotherapy (paclitaxel and carboplatin) and radiation therapy in ovarian cancer: a case report

In recent years, the incidence of therapy-related myelodysplastic syndrome (t-MDS) and therapy-related acute myeloid leukemia (t-AML) that occur during chemotherapy for ovarian cancer has increased. While alkylating agents and topoisomerase II inhibitors are particularly mutagenic and have strong leukemogenic potential, paclitaxel and combination chemotherapy/radiation therapy also appear to induce t-MDS. The present authors report a case of t-MDS that developed during chemotherapy and radiation therapy for ovarian cancer. The patient was a 75-year-old woman who received six courses of cyclophosphamide/doxorubicin/cisplatin (CAP) therapy after initial surgery for Stage IIIc grade ovarian cancer in 1995. Beginning in February 2005, the patient experienced multiple recurrences due to sternal metastasis. Chemotherapy, including paclitaxel and carboplatin (TC), was administered intermittently and was combined with radiation therapy to a sternal metastatic lesion. Pancytopenia was observed in December 2008, and she was diagnosed with t-MDS (WHO subtype, refractory cytopenias with multilineage dysplasia [RCMD]): the time from first chemotherapy to t-MDS onset was 106 months. Without evidence of blast crisis, the recurrent lesions continued to grow and caused multiple cerebral infarctions, from which she eventually died. The cumulative doses of paclitaxel and carboplatin administered to this patient were 1,968 mg and 6,480 mg, respectively.

Serum zinc level and prostatic lesion

To find out if there is any association of serum zinc level with different prostatic lesions like - benign prostatic hyperplasia (BPH), prostatic intraepithelial lesion (PIN) and frank prostatic carcinoma. Serum zinc level was measured by colorimetric method using RA50 semi autoanalyser from 49 patients having different prostatic pathology (BPH 13, PIN 31, carcinoma 5) and 30 age matched control who had no prostatic complaints. Statisticaly significant (p<0.01) gradual increased zinc level were found in patients having prostatic lesions. In BPH the serum (mean ± SD) zinc level was 101 ± 26.15, in low grade PIN 116 ± 21.34, high grade PIN 117 ± 20.95 and in frank prostatic carcinoma it was 139 ± 11.09 μgm/dl. Our results show statistical significant gradual increase of serum Zinc in BPH, PIN and frank prostatic carcinoma patients. Serum zinc level estimation can be routinely used as adjuvant for evaluation of prostatic lesion.

Molecular epidemiology of tuberculosis in rural Matlab, Bangladesh

OBJECTIVE

To characterise and classify clinical isolates collected from tuberculosis (TB) patients in rural Bangladesh and to investigate the mode of transmission.

DESIGN

An epidemiological study using a combination of conventional and molecular methods was performed in a rural population of Bangladesh. A total of 168 clinical isolates were collected from TB patients. Deletion analysis, used for rapid differentiation of members of the Mycobacterium tuberculosis complex, spoligotyping and variable number tandem repeats of mycobacterial interspersed repetitive units (VNTR-MIRU) typing were used.

RESULTS

Deletion analysis identified all isolates as M. tuberculosis and further divided them into 109 strains (65%) carrying the M. tuberculosis deletion region 1 (TbD1-intact or 'ancestral' strains) and 59 strains (35%) lacking this region (TbD1 or 'modern' strains). MIRU analyses showed that 149 strains (89%) had unique patterns, whereas 19 strains (11%) clustered into eight groups. The largest cluster comprised five TbD1 strains of the Beijing type. The rate of recent transmission was estimated to be 6.5%.

CONCLUSIONS

Our results suggest that TB in rural Bangladesh is caused primarily by reactivation of latent infections involving TbD1 intact strains, overlaid with the recent emergence of Beijing strain clusters that include multidrug-resistant isolates.

Feasibility study of rainwater harvesting system in Sylhet City

In rural areas in Bangladesh, groundwater is the principal source of water supply. This underground water is available in considerable amount in shallow aquifers. It is free from pathogenic microorganisms and hence water-borne diseases. In plain lands, other than hilly areas, water supply to 97% rural population comes from tube-wells, which is regarded to be a phenomenal achievement in preserving public health. Besides, a dependable water supply system all throughout the country is offset by two factors: (a) high salinity in surface plus groundwater in coastal areas; (b) want of suitable groundwater aquifers in hilly areas and the high cost of setting up tube-wells due to deep underground water table and stony layers. However, presence of arsenic in underground water now poses a serious threat to the success once made in water supply by setting up of manually operated tube-wells in the village areas-the achievement is now on the brink of total collapse. In about 61 districts out of 64, presence of arsenic exceeds a quantity of 0.05 mg/1, a permissible limit as per Bangladeshi water quality standard. Harvesting rainwater can be a pragmatic solution to this problem, which is common in many places in Sylhet especially in the hilly areas on the north eastern part of the city. This can be an alternative source of drinking water because of availability of rainwater from March to October. Heavy rain occurs from end of May till mid September, which is commonly known as the rainy season. This paper focuses on the possibility of harvesting rainwater in rural communities and thickly populated urban areas of Sylhet. It also demonstrates the scopes of harvesting rainwater using simple and low-cost technology. With setting up of a carefully planned rainwater storage tank, a family can have all of its drinking water from rain. Planned use of rainwater through rainwater harvesting in the roof catchments may fulfill the entire annual domestic water demand of a family in the rural areas of Bangladesh.

Clinicopathological profile of patients with abdominal tuberculosis

BACKGROUND

Tuberculosis (TB) is not a uncommon problem throughout the world particularly in the developing countries like Nepal, India and Bangladesh. Abdominal Tuberculosis accounts for nearly 2% of tuberculosis worldwide. The aim of this study was to evaluate the clinicopathological profile with the help of other investigations in the diagnosis of patients with abdominal TB and their response to anti-tubercular therapy. This was a prospective cross-sectional study conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of October 2002 to June 2009.

METHODS

Total 53 patients with abdominal TB diagnosed on the basis of clinical profile and supported investigation data like gross morphological findings at endoscopy, colonoscopy, diagnostic laparoscopy , laparotomy or histologically proven caseating granulomas were selected for this study. Detailed demographic, clinical profile, investigations and treatment response were recorded properly in a predesigned data collection sheet which were analyzed and compared with other studies.

RESULTS

Out of the 53 patients, 33 were males and 20 females with age ranging 16-70 (Mean 30.01±11.7) years. Abdominal pain was the most common presenting symptom in 47 (88.68%), fever in 45 (84.9%) and weight loss in 37 (69.81%) cases. Anemia was found in 41 (77.36%), cachexia 40 (75.47%), ascites 20 (37.74%), palpable abdominal mass in 14 (26.42%) and features of intestinal obstruction in 5 (9.43%) cases. Five patients had positive family history of TB and five had past history of pulmonary TB. The diagnosis of abdominal TB was confirmed microscopically in 5 (9.43%), histopathologically in 31 (58.49%) and the remaining 17 (32.07%) cases were diagnosed by a positive response to anti-TB therapy. According to site of involvement, 31 (58.51%), patients had intestinal TB, 9 (16.98%) had peritoneal TB and disseminated TB in 20 (37.74%) of the case. Twenty seven patients were given 3 drugs regimen for 12 months and 26 patients received 4 drugs regimen for 9 months under close supervision. By 9 months of therapy 51 patients become symptom free and no pathological findings were observed thereafter at follow up visits after 6 months. Response was not satisfactory in two patients and subsequent follow up investigation revealed to have crohn's disease rather than TB and none of them died.

CONCLUSIONS

Abdominal TB is an important clinical entity having varied mode of clinical presentation. So the diagnosis of abdominal TB is difficult and careful approach to the patients and supportive investigation data are necessary to make the final diagnosis. Neither clinical features, laboratory, radiological and Endoscopic methods nor bacteriological and histopathological findings by themselves provide a gold standard in the diagnosis of abdominal TB. In this series of abdominal TB, intestinal TB was the most frequent clinical type and the common presenting symptoms were abdominal pain, fever and weight loss. If diagnosed early, it can be treated successfully with anti-TB drugs.

EGFR gene amplification is related to adverse clinical outcomes in cervical squamous cell carcinoma, making the EGFR pathway a novel therapeutic target

Background:

The aim of this study was to investigate the patterns of epidermal growth factor receptor (EGFR) overexpression, EGFR gene amplification, and the presence of activating mutations in the tyrosine kinase domain of this gene in squamous cell carcinomas and adenocarcinomas/adenosquamous carcinomas of the uterine cervix.

Methods:

The EGFR expression, amplification, and mutation in cervical carcinomas were assessed by immunohistochemistry, fluorescence in situ hybridisation, and PCR–SSCP, respectively, and correlated with clinical data collected by a retrospective chart review. A functional assessment was performed by inactivating EGFR in cervical cancer cells with the potent inhibitor AG1478.

Results:

Immunohistochemical analysis revealed that 6 out of 59 (10.2%) cervical squamous cell carcinomas showed significant amplification of the EGFR locus, whereas none of the 52 adeno/adenosquamous cell carcinomas had detectable EGFR amplification (P<0.05). The EGFR amplification significantly correlated with shorter overall survival (P=0.001) in cervical squamous cell carcinomas. Multivariate analysis showed that EGFR gene amplification was an independent prognostic factor for overall survival (P=0.011). None of the squamous cell carcinomas (0%: 0 out of 32) had detectable oncogenic mutations in EGFR exons 18 through 21. The frequencies of KRAS and BRAF mutations were very low in both squamous and adeno/adenosquamous cell carcinomas. Sensitivity of cervical cancer cells to AG1478 depended on the presence of EGFR overexpression. AG1478-induced EGFR inactivation in cell lines with EGFR overexpression significantly suppressed tumour development and progression in a mouse xenograft model.

Conclusion:

Our data suggest that EGFR signalling is important in a subset of cervical squamous cell carcinomas and that anti-EGFR therapy may benefit patients who carry the 7p11.2 amplicon in their tumours.

A comparative study between microwave endometrial ablation and conventional surgical procedures for treatment of menorrhagia

OBJECTIVE

To compare microwave endometrial ablation (MEA) using a new curved applicator with conventional surgical procedures in 26 patients with menorrhagia.

STUDY DESIGN

Ten patients received MEA and 16 patients received conventional surgical procedures. Using a visual analog scale (VAS). MEA patients rated their menorrhagia, dysmenorrhea, and feelings of satisfaction from the procedure. The patients' intraoperative blood loss, operating time, and length of hospital stay were compared.

RESULTS

Following MEA, the VAS scores were significantly decreased in the MEA patients for menorrhagia (p < 0.0001) and dysmenorrhea (p = 0.0002). The average VAS score regarding feelings of satisfaction for MEA was 8.9 (full score = 10). Mean blood loss, operating time, and mean length of hospital stay were significantly decreased in the MEA group compared to the conventional surgical procedure group (p < 0.0001).

CONCLUSION

MEA successfully controlled menorrhagia and achieved a high rate of satisfaction among patients.

Skin biopsy and psoriasis

A total of 33 skin biopsies were sent to Bangladesh institute of health Science (BIHS) hospital at Mirpur, Dhaka by Consultant skin for histopathological diagnosis between a period of one year and three months. Out of these 33 skin biopsies histopathological diagnosis of psoriasis was made for 13(39.39%), chronic non specific dermatitis (eczema) in 4(12.12%), lichenoid lesion 4(12.12%). Ashy dermatosis 3(9.09%), Nevus 2(6.06%) and corn, hemangioma, prurigo simplex, pityriasis rubra pilaris (PRP), dermatofibroma, 1(3.03%) each. The main presenting feature of these patients were erythematous, prurituc, silvery, scale, plaques or papules for a period between 2 months to 15 years. It is evident from the present study that among different skin lesions sent for histological diagnosis, Psoriasis is common skin pathology in dermatological practice.

Light microscopic study of cervical smear in a tertiary hospital at Dhaka

This light microscopic retrospective study of 798 cervical smear were done to see the pattern of cervical lesions and main presenting complaints of the women who attended the Gynae & Obstetrics department of BIRDEM hospital for medical and surgical advice. Out of these 798 smears examined light microscopically 274(34.34%) was normal, 453(54.26%) were inflammatory smear, 49(6.14%) showed Gardrenella, 9(1.13%) revealed the presence of Candida, 3(0.38%) showed Trichomonial infection, 6(0.76%) showed the presence of atypical cells (5ASCUS, 1 CIN) and 2(0.26%) were positive for malignancy, (1 adenocarcinoma, 1 squamous cell carcinoma). The mean age+/-SE of the women were 43.12+/-9.18 years, mean+/-SE age of the last child was 14.19+/-7.99 years; mean+/-SE of para was 3.5+/-7.34 pregnancies. The common presenting complains of these women Menorrhagia (17.92%), Menopausal Symptoms (17.42%), Lower Abdominal pain (15.78%), White PV discharge (15.78%), Dysmenorrhoea (7.52%), Pruritus/Itching vulva (7.14%), Prolapse (4.39%), Fibroid (2.01%), Infertility (1.13%), Post coital bleeding (0.75%) respectively. Pap's smear is reconfirmed as an established major screening tool for diagnosis of different cervical lesions.

Histopathological changes of pancreas in patients with fibrocalculous pancreatopathy

A total of 20 pancreatic biopsy samples taken from Fibrocalculous Pancreatopathy previously known as Fibro Calculus Pancreatic Diabetes (FCPD) patients, a variant of Malnutrition Related Diabetes Mellitus (MRDM) or under 30 young diabetes attending hepatobiliary, surgical and out patient department of Bangladesh Diabetes, Endocrine and Metabolic (BIRDEM) hospital were processed for light microscopic examination. Four samples were subjected to Immunohistochemistry (IHC) staining using antibodies to T cell marker (CD3), B cell marker (CD20), anti apoptotic markers (bcl-2) and tumour suppressor gene marker p53. Light microscopic findings and IHC indicate an immune mediated injury of pancreatic tissue and increased evidence of apoptosis which possibly results in the development of diabetes in these patients.

Seropositivity and pattern of dengue infection in Dhaka city

Bangladesh is experiencing resurgence of' dengue endemic since 2000. In an attempt to see the pattern of' dengue infection we analyzed retrospectively results of 225 blood samples from patients having fever and clinically suspected to have been suffering from dengue fever who were tested for dengue IgM and IgG in Health Care Development Project (HCDP), Dhaka, an enterprise of Diabetic Association of Bangladesh (DAB) one of the largest private health care facility provider in Bangladesh. Out of 225 samples tested, a total of 156(69.33%) cases were serologically positive for dengue and 69(30.67%) were negative. Of the positive cases, 70(44.87%) were positive for Dengue IgM and 86(55.13%) were positive for Dengue IgG. which showed statistical difference between male and female (p<0.05). Both IgM and IgG, were positive in 23(14, 74%) cases. The mean age +/-SD of affected is 36.86+/-17.60 years and the maximum number of positive cases 114(73.08%) diagnosed were in the months between July-December. It is evident from the present study that dengue is endemic in Dhaka city particularly during monsoon and rainy season. Secondary dengue is more common than primary dengue and both preventive and curative measures are needed to combat this menace.

Metallothionein in human thrombocyte precursors, CD61+ megakaryocytes

The in vitro biosynthesis of metallothionein (MT) was investigated in thrombocyte precursors (megakaryocytes) isolated from human cord blood. Biosynthesis and induction of MT in magnetic cell sorting-separated CD61(+) megakaryocytes was confirmed by immunohistochemical staining using monoclonal mouse anti-MT. The presence of MT was detected both in the nuclear and in the cytoplasmic area. Using RT-PCR, in vitro upregulation/induction of total MT transcripts was observed in CD61(+) cells at 48 h post-treatment with 100 micromol/L of zinc supplement. Seven isoform-specific mRNAs namely, MT-1A, MT-1B, MT-1E, MT-1G, MT-1H, MT-1X, and MT-2A were detected in the similar cell populations left untreated with zinc.

Assessment of neuropharmacological activities of Pandanus foetidus (Pandanaceae) in mice

The methanol extract of the leaves of Pandanus foetidus Roxb. (Pandanaceae) was assessed for neuropharmacological activities in mice using a number of experimental models. The extract dose-dependently inhibited acetic acid-induced writhing in mice when given at the doses of 250 and 500 mg/kg body weight. At the same dose levels, it significantly prolonged the pentobarbitone-induced sleeping time in mice, and showed mild to moderate central nervous system depressant activity when assessed by the hole cross and the open field tests in mice model. On the basis of these findings, it can be assumed that the extract exerts its depressant effect on the central nervous system in mice by interfering with the cortical function.

Antidiarrhoeal activity of Cyperus rotundus

The methanol extract of Cyperus rotundus rhizome, given orally at the doses of 250 and 500 mg/kg b.w., showed significant antidiarrhoeal activity in castor oil induced diarrhoea in mice. Among the fractions, tested at 250 mg/kg, the petroleum ether fraction (PEF) and residual methanol fraction (RMF) were found to retain the activity, the latter being more active as compared to the control. The ethyl acetate fraction (EAF) did not show any antidiarrhoeal activity.

Extradural spinal cord and intraabdominal ganglioneuroblastoma

We report a rare case of a giant extradural and intraabdominal ganglioneuroblastoma in a young Malay girl who presented to a paediatrician initially at 5 days of life with a palpable abdominal mass. Unfortunately, the parents refused any form of surgical intervention until the child was 3 years old. She subsequently underwent vascular embolisation followed by the removal of this large tumour both via the abdomen and through a laminectomy approach and subsequently refused chemotherapy. The c-myc amplication in this patient was absent and there were no chromosomal aberrations, During the 2 year folow-up the patient remained well, and ambulatory with no tumour recurrence.

Antidiarrhoeal activity of the methanol extract of the barks of Xylocarpus moluccensis in castor oil- and magnesium sulphate-induced diarrhoea models in mice

The methanol (MeOH) extract of the barks of Xylocarpus moluccensis, and different fractions of this extract were studied for antidiarrhoeal activity using castor oil- and magnesium sulphate-induced diarrhoea models in mice. At the doses of 250 and 500 mg/kg, the MeOH extract showed significant antidiarrhoeal activity in both models. The EtOAc fraction (EAF) and the residual MeOH fraction (RMF) exhibited similar activity using a dose of 250 mg/kg in both models. No antidiarrhoeal activity was observed with the chloroform fraction (CHF) at the test doses. When tested for antibacterial effect, the MeOH extract displayed moderate inhibitory activity against Escherichia coli, Vibrio cholera, Staphylococcus aureus, Staphylococcus epidermis, Shigella dysentery, Staphylococcus pyogenes, Salmonella typhi, Pseudomonas aeruginosa and Enterobacter aerogenes. While the CHF inhibited the growth of Escherichia coli, Vibrio cholerae, Shigella dysenteriae, Shigella sonnei, Staphylococcus epidermis, Staphylococcus pyogenes and Pseudomonas aeruginosa, the EAF was active against all test organisms except Vibrio cholera and Staphylococcus epidermis. The RMF inhibited the growth of all the test organisms with moderate zone of inhibition. On the basis of these findings, it can be assumed that Xylocarpus moluccensis could be a potential source for novel 'lead' discovery for antidiarrhoeal drug development.

Oral histoplasmosis presenting as oral ulcer in a non-HIV patient

A 40-year-old man presented with chronic mouth ulcer for the last six months. Histopathological examination of the biopsy from the lesion confirmed a diagnosis of histoplasmosis. Although histoplasmosis commonly manifests in immunocompromized patients, like HIV, the present case was negative for HIV. Histoplasmosis is endemic in certain parts of the world and it is comparatively rare in the South Asian region, particularly Malaysia. Thirty-seven cases of histoplasmosis were reported from Malaysia (Ng and Siar, 1996), between July 1967 and October 1997. Despite the apparent rarity of the disease, clinicians and pathologists should be aware of the possibility of histoplasmosis when cases of oral ulcer are encountered.

Mature cystic teratoma: unusual presentation as anterior neck swelling

The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in a 29-year-old Malay woman is reported.

Evaluation of neuropharmacological effects of Rumex maritimus Linn. (Polygonaceae) root extracts

Hexane, ethyl acetate and methanol extracts of the root of Rumex maritimus Linn. (Polygonaceae) were evaluated for neuropharmacological activities in different models. All the extracts significantly and dose dependently inhibited acetic acid induced abdominal constrictions in mice. The hexane and methanol extract exhibited significant central analgesic activity in the radiant heat method. Only the methanol extract showed statistically significant mild to moderate central nervous system depressant activity assessed by hole cross, open field and hole board test in the mice model.

Partial genome sequencing of Rhodococcus equi ATCC 33701

Preliminary analysis of a partial (30% coverage) genome sequence of Rhodococcus equi has revealed a number of important features. The most notable was the extent of the homology of genes identified with those of Mycobacterium tuberculosis. The similarities in the proportion of genes devoted to fatty acid degradation and to lipid biosynthesis was a striking but not surprising finding given the relatedness of these organisms and their success as intracellular pathogens. The rapid recent improvement in understanding of virulence in M. tuberculosis and other pathogenic mycobacteria has identified a large number of genes of putative or proven importance in virulence, homologs of many of which were also identified in R. equi. Although R. equi appears to have currently unique genes, and has important differences, its similarity to M. tuberculosis supports the need to understand the basis of virulence in this organism. The partial genome sequence will be a resource for workers interested in R. equi until such time as a full genome sequence has been characterized.

Antinociceptive activity of the aerial parts of Solanum xanthocarpum

The methanolic extract of Solanum xanthocarpum aerial parts, given orally at 125, 250 and 500 mg/kg, showed significant antinociceptive activity in mice.

Evaluation of antidiarrhoeal activity Rumex maritimus root

The partitioned n-hexane, ethylacetate and residual methanol extracts of the root of Rumex maritimus were evaluated for antidiarrhoeal activity in mice using castor oil and serotonin induced diarrhoea and also charcoal motility test at 50, 100 and 200 mg/kg body weight dose. Among these, the methanol extract most significantly prolonged the time for induction of diarrhoea, reduced the frequency of diarrhoeal episodes and also decreased the propulsion of charcoal meal through the gastrointestinal tract.

Antidiarrhoeal activity of the bark extract of Careya arborea Roxb

The methanol extract of the Careya arborea Roxb. bark significantly reduced castor oil-induced diarrhoea in mice. This effect supports the local traditional use of the plant against diarrhoea.

Antinociceptive activity of Clausena excavata leaves

The ethanolic extract of Clausena excavata leaves, given orally at doses of 125.25 and 500 mg/kg body weight, showed significant antinociceptive activity on acetic acid induced writhing in mice.

Analgesic activity of Enhydra fluctuans

The methanol extract of Enhydra fluctuans, given orally at the dose of 250 and 500 mg/kg, was evaluated for its analgesic activity using the acetic acid induced writhing and the tail-flick methods. The extract showed promising activity in both tests.

Antinociceptive activity of Polygonum hydropiper

The hexane, ethylacetate and methanol extracts of Polygonum hydropiper whole plant administered to mice at doses of 250 and 500 mg/kg, showed a significant activity on acetic acid-induced writhing. Within the tested extracts, the ethylacetate one showed the most significant activity.

Analgesic principle from the bark of Careya arborea

Bioactivity guided isolation of the bark of Careya arborea afforded piperine--an alkaloid chemically known as 1-[5-(1,3-benzodioxol-5-yl)-1-oxo-2,4-pentadienyl]piperidine, which was found to possess significant central and peripheral analgesic activity. At oral doses of 10, 20 and 30 mg/kg body weight, piperine exhibited 41 (p < 0.01), 45 (p < 0.01) and 53% (p < 0.001) inhibition of acetic acid induced writhing in mice respectively. At doses of 20 and 30 mg/kg body weight, the compound also showed 31.8 (p < 0.05) and 52.4% (p < 0.01) prolongation of tail flicking time of mice 30 min after the treatments determined by the radiant heat method.

Antinociceptive and antidiarrhoeal activity of Zanthoxylum rhetsa

The methanolic extract of the Zanthoxylum rhetsa Roxb. stem bark, given by oral route to mice at doses of 250 and 500 mg/kg, significantly reduced the abdominal contraction induced by acetic acid and the diarrhoeal episodes induced by castor oil in mice.

Analgesic sesquiterpene dilactone from Mikania cordata

The crude extract of Mikania cordata (1 and 3 g/kg, p.o.) and deoxymikanolide (1) (10 mg/kg, p.o.) significantly inhibited acetic acid-induced writhing in mice. Three other sesquiterpene dilactones isolated from the same plant, namely mikanolide, dihydromikanolide and scandenolide, did not show significant analgesic activity.

Gallstone disease in a rural Bangladeshi community

BACKGROUND

The prevalence of gallstone disease (GSD) in Bangladesh is not known. We evaluated the prevalence of GSD and its relation with certain factors in a rural community in Bangladesh.

METHODS

A total of 1332 persons aged 15 years and above from two villages were invited to participate in the study; 1,058 (80%) subjects responded after three invitations. Each subject answered a questionnaire, including demographic features, and underwent an upper abdominal ultrasound examination.

RESULTS

GSD (current cholelithiasis and history of cholecystectomy) was detected in 5.4% of subjects. The prevalence was higher in women (7.7%) than in men (3.3%; p=0.002) The prevalence rates increased from 0.9% to 10% (p=0.0124) from those aged <30 years to those >50 years. A larger proportion of obese subjects (25/52; 48.1%) had GSD than non-obese subjects (32/1006; 3.2%). Prevalence in low, middle and high socio-economic classes was 1.5%, 5.7% and 13.4%, respectively (p=0.000). A majority (71.9%) of subjects with GSD were asymptomatic.

CONCLUSION

Approximately 5% of the Bangladeshi rural community evaluated have GSD. Higher age, female gender, presence of obesity and higher socio-economic class were associated with higher prevalence of GSD.

Analgesic, diuretic, and anti-inflammatory principle from Scoparia dulcis

Scoparinol, a diterpene, isolated from Scoparia dulcis showed significant analgesic (p < 0.001) and anti-inflammatory activity (p < 0.01) in animals. A sedative action of scoparinol was demonstrated by a marked potentiation of pentobarbital-induced sedation with a significant effect on both onset and duration of sleep (p < 0.05). Measurement of urine volume after administration of scoparinol indicated its significant diuretic action.

Seroprevalence of Helicobacter pylori among the diabetic population in Bangladesh: a comparative serological study on the newly diagnosed and older diabetics

This prospective study was designed to find out the prevalence of H. pylori infection among the diabetic population in Bangladesh with a comparison between the newly diagnosed and older diabetics. For this study 520 diabetic patients: 152 (29%) newly diagnosed and 368 (71%) older diabetics of both sexes (250 male, 270 female) with a mean age of 58.5 +/- 12.04 years (range 10-70 years), were selected randomly from out and in-patient departments of BIRDEM, Dhaka. Mean fasting and 2 hours post load blood glucose level of the studied population was 10.53 +/- 4.08 mmol/L and 18.35 +/- 9.44 mmol/L respectively. The mean duration of the newly diagnosed diabetics was 0.44 +/- 0.35 years (range 2 days-1 year) and 6.78 +/- 5.45 (range 1-30) years for the older diabetics. H. pylori infection was defined as a true positive ELISA test result of > 1.5 standard deviation above the cut-off values of 15 AU/ml for adults and 10 AU/ml for children for anti H. pylori IgG. Of the studied population 441 (84.8%)--132 newly diagnosed and 309 (83.96%) older diabetics were seropositive for H. pylori infection. No significant differences were observed between the newly diagnosed and older diabetics (86.84% Vs 83.96%; p > 0.05).

Metallothionein biosynthesis in human RBC precursors

The in vitro biosynthesis of metallothionein (MT) has been investigated in RBC precursors from human cord blood in order to support the hypothesis for the nucleated precursor origin of MT in human red blood cells (RBC). Human RBC precursors are obtained by (i) separating glycophorin A(+) (gly A(+)) cells using a magnetic cell sorting (MACS) technique and by (ii) ex vivo expansion of precursors BFU-E (burst forming unit-erythroid) on methylcellulose semi-solid culture media from mononuclear cells of cord blood. Biosynthesis of MT is detected at the protein level, by immuno-histochemical staining using a mouse monoclonal antibody (E9) in ex vivo expanded RBC precursors obtained from BFU-E. Expression of MT is also detected at the mRNA level by MT specific reverse transcriptase polymerase chain reaction (RT-PCR) both in ex vivo expanded precursors from BFU-E and in MACS separated gly A(+) cells. In addition, the expression of the fetal form of MT, MT-0 (also known as MT-1H) at the mRNA level in glycophorin A(+) cells, is also confirmed by cDNA sequencing. With these observations, to our knowledge, MT biosynthesis in human erythroid precursors is reported for the first time. Moreover, the current findings of MT-0 expression at the mRNA level in gly A(+) RBC precursors of hCB has added one more member in the list of cells/organs like fetal liver, human monocytes, non-neoplastic tissues of adenocarcinoma etc., in which the expression of the human fetal form of MT, i.e. MT-0, has also been reported.

Metallothionein isogene transcription in red blood cell precursors from human cord blood

The in vitro transcription patterns for 10 functional metallothionein (MT) isogenes have been investigated in red blood cell (RBC) precursors from human cord blood. Active transcription status of the isogenes, MT-0, MT-1A, MT-1B, MT-1E, MT-1G, MT-1X, and MT-2A, was detected in both ex vivo expanded RBC precursors (burst-forming unit-erythroid) and glycophorin A(+) and CD71(+) cells separated by magnetic cell sorting. Transcription patterns of these isogenes were analyzed at different times of incubation with the addition of Zn supplement. In neither the ex vivo expanded precursors nor glycophorin A(+) and CD71(+) cells could MT-1F and MT-3 be detected. Transcripts of MT-4 were detected in glycophorin A(+) and CD71(+) cells. Erythropoietin-responsive constitutive transcription of MT-1X and possible interleukin-3-responsive downregulation of MT-2A in ex vivo expanded precursors reveal their effect on MT biosynthesis. Biosynthesis and induction of MT at the protein level in the RBC precursors was also demonstrated by immunoblotting.

Predictors of duodenal ulcer healing in sucralfate treated patients

The objective of the study was to assess the efficacy of sucralfate in promoting duodenal ulcer healing and to assess the value of some variables in predicting outcome of such therapy. Following variables were tested for predicting the outcome: age at onset, age at presentation, duration of symptoms, sex, periodicity, smoking, nocturnal pain, relief by food, relief by antacid, gastric stasis like symptoms, associated irritable bowel syndrome, site, size and number of ulcers and degree of deformity of bulb. Sixty patients with uncomplicated DU confirmed at endoscopy were treated with sucralfate one gram before three major meals and 1 g at bedtime for two months. Endoscopy was repeated at the end of the trial. There were four drop-outs. Complete, partial and no healing occurred in 45 (80.36)%, 3 (5.36%) and 8 (14.28%) subjects. Ulcer healing rate was higher in those without gross bulbar deformity (41/46) than in those with gross deformity (4/10), (Odd's ratio 12.3, 95% ci 1.98 to 78.44). Other variables were not found to be associated with ulcer healing.