Clinical and Hematological Features of Visceral Leishmaniasis at Mymensingh Medical College Hospital

Visceral Leishmaniasis is the most severe form of leishmaniasis and can be fatal in the absence of treatment. Mortality is very high in untreated cases 90%. Clinical case series document a 5% case fatality rate for kala-azar patients in the hospital as complication of the disease. Nepal, India, Bangladesh, Brazil and Sudan constitute five countries of the world where more than 90% of visceral leishmaniasis occurs. Mymensingh accounted for more than 50% of total kala-azar case reported in Bangladesh. This observational study was done at SKKRC under Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st august 2013 to 28th February 2014, to find out various clinical features and hematological picture in visceral leishmaniasis. Total 100 diagnosed case of visceral leishmaniasis was taken. Among total patient male and female were nearly equally affected by kala-azar. All age group were affected by kala-azar from below 2 years to above 50 years. Poor people in the society were affected more by kala-azar. Mymensingh was the highest incidence of kala-azar among different district in Bangladesh. Pyrexia, pallor, weight loss were the main symptoms of visceral leishmaniasis. Abdominal distension, jaundice, vomiting, cough, bleeding manifestation were less frequent symptoms of kala-azar. Hepatosplenomegaly were the frequent sign of kala-azar. Majority of patient had anemia, leucopenia and thrombocytopenia. ESR was frequently raised in kala-azar patient among those patient many had high ESR more than 100 mm in 1st hour. In conclusion prolong fever, progressive pallor, anorexia, weight loss, hepatosplenomegaly in endemic area were the main clinical features of visceral leishmaniasis. Anemia, leucopenia, thrombocytopenia, bi-cytopenia, pancytopenia and high ESR were frequently found hematological pictures in visceral leishmaniasis.

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Biochemical Predictors in Patients with Type-2 Diabetes Mellitus

Non-alcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition in the Western world and it is commonly associated with type 2 diabetes mellitus (DM). The aim of this study to determine the prevalence of NAFLD and identify the predisposing factors in type 2 DM patients with NAFLD. Total of 258 patients of type 2 DM were included in this observational study in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 11th May 2013 to 11th November 2013. Patients with characteristic findings on ultrasonography were considered as having fatty liver. They were divided into fatty liver (Group I) and non-fatty liver group (Group II) and were further evaluated by measurement of body mass index, liver function tests and lipid profile. Out of 258 type 2 diabetic patients, 167 (64.7%) patients had fatty liver on ultrasonography. BMI, waist-hip ratio and triglyceride levels in the Group I was significantly higher than Group II. An increase in the levels of ALT, AST, total cholesterol, LDL and a decrease in HDL was observed in Group I as compared to Group II. The prevalence of NAFLD is common among in type 2 diabetic patients and it increases with the rising incidence of obesity. Obesity as well as elevated liver enzymes, triglyceride and cholesterol are significantly raised in NAFLD patients with type 2 DM. It highlights the importance of routine liver function test and lipid profile in subjects with type 2 DM and should be more closely observed for NAFLD and liver complications.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

Plant diversity of Dhaka University campus, Bangladesh

The present article focuses the status of plant diversity of Dhaka University campus. A total of 541 plant species have been recorded from the campus area. These species are assigned to 117 families. For each species local name, scientific name, family and habit have been provided. Species presentation in the families varied from 1 to 26. 47% species belongs to 16 families and 53% species belongs to others 101 families. Euporbiaceae is the largest family in the Dicotyledon having 26 species whereas Liliaceae is the largest family in Monocotyledon having 18 species. Among the recorded species, 37% are represented by herbs, 29% by trees, 21% by shrubs, 11% by climbers, 2% by epiphytes and 0.2% by parasites. Plant species recorded in the campus categorized into different purpose groups. The result showed that 59% plant species represented by native species whereas 41% plant species represented by exotics. The survey spotted the presence a number of threatened species of Bangladesh in the gardent of the campus. Such species are Corypha taliera, Podocarpus nerifolia, Mangifera sylvatica, Willoughbia edulis, Hydnocarpus kurzii, Gloriosa superva, Entada redii, Hedychium coccinium and Vandopsis gigantea.J. Asiat. Soc. Bangladesh, Sci. 42(1): 49-68, June 2016

Preliminary Biological Investigations of Lophopetalum fimbriatum and Calophyllum inophyllum

The crude methanol extracts of the leaf of Lophopetalum fimbriatum (non Wight) F. Vill. and Calophyllum inophyllum L. as well as their pet-ether, carbon tetrachloride, chloroform and aqueous soluble fractions were evaluated for antioxidant, cytotoxic, thrombolytic, membrane stabilizing and antimicrobial activities. The antioxidant potential was evaluated by DPPH and Folin-Ciocalteau reagent using butylated hydroxytolune (BHT) and ascorbic acid as standards, respectively. Among the extractives of L. fimbriatum and C. inophyllum, the chloroform soluble fraction and methanolic crude extract demonstrated the highest free radical scavenging activity (IC50 = 175.57 ± 0.02 ?g/ml and IC50 = 1.0 ± 0.22 ?g/ml) which could be correlated with their total phenol contents 82.15 ± 0.89 and 32.19 ± 0.81 mg of GAE /g of extractives, respectively. In the brine shrimp lethality bioassay, the carbon tetrachloride soluble fractions of L. fimbriatum (LC50 = 0.515 ± 0.03 ?g/ml) and C. inophyllum (LC50 = 0.77 ± 0.18 ?g/ml) revealed general toxicity. During assay for thrombolytic activity, the carbon tetrachloride soluble materials of L. fimbriatum and the chloroform soluble fraction of leaf of C. inophyllum revealed clot lysis by 8.89 ± 1.410% and 27.84 ± 0.94%, while the standard streptokinase and water, used as positive and negative controls, demonstrated 66.77% and 3.79% clot lysis, respectively. In hypotonic solution and heat induced conditions, the crude methanol extracts of L. fimbriatum and C. inophyllum inhibited haemolysis of human erythrocyte by 68.14 ± 2.05% & 40.00 ± 1.6% and 57.67 ± 0.26% and 28.12 ± 0.38%, respectively. Here, acetyl salicylic acid (0.1 mg/ml) was used as reference showing 72.79% and 42.12% haemolysis of RBCs in hypotonic solution and heat induced conditions, respectively. The antimicrobial activity was assessed by the disc diffusion method and the chloroform soluble fraction of L. fimbriatum demonstrated 16.0 mm zone of inhibition against Sarcina lutea. Different extractives of C. inophyllum inhibited microbial growth with zone of inhibition ranging from 10.0 mm to 22.0 mm. Among the different extractives of C. inophyllum, the pet-ether and carbon tetrarchloride soluble fractions demonstrated 22.0 mm zone of inhibition against Vibrio parahaemolyticus and Pseudomonas aeruginosa, respectively. DOI: http://dx.doi.org/10.3329/bpj.v16i2.22305 Bangladesh Pharmaceutical Journal 16(2): 205-209, 2013

Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation

Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2μgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex.

A case of Conn's syndrome presenting with painfull muscular weakness

We present a case of 30-year-old lady presenting with gradual difficulty in standing up from sitting position for 6 months, pain in arms and thighs, tingling sensation and numbness in palms and soles, increased fluid intake and increased frequency of micturition for the same duration. She was hypertensive for 12 years. On general examination patient seemed depressed and on nervous system examination her power of muscles in both upper and lower limb of both side was 3/5. Plasma sodium at the upper normal range 144mmol/l (normal range 135-146), lower level of serum potassium 1.7mmol/L (normal range 3.5-5.0), high urinary potassium 26.7mmol/l (normal range 1-10), very high serum CPK 4269U/L (for female normal range 10-79), low normal plasma rennin 1.58mg/ml/hr (normal range standing 0.40-8.80, supine 0.30-3.0), high serum aldosterone 1326.39pg/ml (normal range 25-315), high pH 7.45 (normal range 7.36-7.44) and on imaging evidence of an adrenal adenoma on left side was found and the patient was diagnosed as a case of Conn's syndrome.

Relation of different grades of esophageal varices with Child-Pugh classes in cirrhosis of liver

This cross-sectional observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of 6 months from October 2011 to April 2012 and was carried out to evaluate the relation of different grades of esophageal varices with Child-Pugh classes of cirrhosis of liver patients. A total 37 patients were included. Child-Pugh score and esophageal varices of each patient were noted. Relation was carried out using the Chi-square test through determining the association of different variables. P value <0.05 was considered significant. Among 37 patients, 27(73%) were male and 10(27%) were female and their frequency of age were found, 7(18.9%) from 18-38 years, 18(48.7%) from 39-59 years and 12(32.4%) from 60 years of age and above. The etiology of liver cirrhosis revealed 18(48.7%) hepatitis B virus, 3(8.1%) hepatitis C virus and 16(43.2%) others causes. Child-Pugh classes were observed 3(8.2%) Class A, 17(45.9%) Class B and 17(45.9%) Class C and grades of esophageal varies were 13(35.1%) F1, 20(54.1%) F2 and 4(10.8%) F3 patients among total. A statistically significant positive relation was found that higher grade of esophageal varices was seen in the more advanced class of Child-Pugh classes with a p value 0.001.

Ethnobotanical, phytochemical and toxicological studies of Xanthium strumarium L

The present study describes the ethnobotanical, phytochemical, and toxicological evaluations of Xanthium strumarium L. growing in Bangladesh. In toxicity evaluation on rats, the methanol extract of seedlings showed mortality, while both seedling and mature plant extracts raised the serum alanine transaminase and aspartate transaminase values and produced significant abnormalities in the histopathology of liver and kidney of rats. On the other hand, the aqueous soluble fraction of methanol extract of mature plant (LC50 = 0.352 microg/mL) and methanol crude extract of seedlings (LC50 = 0.656 microg/mL) demonstrated significant toxicity in the brine shrimp lethality bioassay. A total of four compounds were purified and characterized as stigmasterol (1), 11-hydroxy-11-carboxy-4-oxo-1(5),2(Z)-xanthadien-12,8-olide (2), daucosterol (3) and lasidiol-10-anisate (4). The present study suggests that X. strumarium is toxic to animal.

Fatal outbreak from consuming Xanthium strumarium seedlings during time of food scarcity in northeastern Bangladesh

BACKGROUND

An outbreak characterized by vomiting and rapid progression to unconsciousness and death was reported in Sylhet Distrct in northeastern Bangladesh following destructive monsoon floods in November 2007.

METHODS AND FINDINGS

We identified cases presenting to local hospitals and described their clinical signs and symptoms. We interviewed patients and their families to collect illness histories and generate hypotheses about exposures associated with disease. An epidemiological study was conducted in two outbreak villages to investigate risk factors for developing illness. 76 patients were identified from 9 villages; 25% (19/76) died. Common presenting symptoms included vomiting, elevated liver enzymes, and altered mental status. In-depth interviews with 33 cases revealed that 31 (94%) had consumed ghagra shak, an uncultivated plant, in the hours before illness onset. Ghagra shak was consumed as a main meal by villagers due to inaccessibility of other foods following destructive monsoon flooding and rises in global food prices. Persons who ate this plant were 34.2 times more likely (95% CI 10.2 to 115.8, p-value<0.000) than others to develop vomiting and unconsciousness during the outbreak in our multivariate model. Ghagra shak is the local name for Xanthium strumarium, or common cocklebur.

CONCLUSIONS

The consumption of Xanthium strumarium seedlings in large quantities, due to inaccessibility of other foods, caused this outbreak. The toxic chemical in the plant, carboxyatratyloside, has been previously described and eating X. strumarium seeds and seedlings has been associated with fatalities in humans and livestock. Unless people are able to meet their nutritional requirements with safe foods, they will continue to be at risk for poor health outcomes beyond undernutrition.