Comparative assessment of nutritive values and safety characteristics of bread sold in Bangladesh

Safe and good quality food products are essential to minimize human health risks and to facilitate business. The objective of this study was to assess the nutritional quality and defects of bread produced in Bangladesh. A total of sixty different types of bread sold in Bangladesh were collected by stratified random sampling and categorized as Brand shop (A), Local shop (B), and Street shop (C) bread. The samples were assessed for their nutritive values, microbiological contaminations, aflatoxins, heavy metals content, and sensory attributes. Nutrient composition and microbial quality were analyzed by using standard methods of the Association of Official Analytical Chemists (AOAC) and the American Public Health Association (APHA). High-Performance liquid chromatography method was used for aflatoxins determination. All categories of bread were low in macro and micronutrients (protein, fat, calcium, and iron) and high in sodium and alcoholic acidity. The heavy metals detected in bread (lead, cadmium, nickel and arsenic) were within the specification. Microbiological results showed that Salmonella spp. and Bacillus spp. were detected in many of the bread samples, whereas Escherichia coli and coliform were found in significant amounts in all categories of bread. Another important health concern that aflatoxins B1 and B2 were found in three bread samples of the local shops. In terms of sensory attributes, the brand shop bread had acquired the highest score for taste, texture, color, and overall acceptability. The study results showed that many of the bread samples were not suitable for healthy consumption, and special awareness should be taken for public health concern; it also warrants further research on safety and manufacturing practices of bread in Bangladesh.

Bezold–Jarisch reflex-mediated asystole during dobutamine stress testing: a case report

Background

The Bezold–Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography.

Case summary

We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20 μg/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal.

Discussion

This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.

Pharmaco-invasive Therapy for STEMI in a Patient with COVID-19: A Case Report

Coronavirus disease 2019 (COVID-19) is a pandemic that started in the Wuhan province of China in December 2019. It is associated with increased morbidity and mortality mainly due to severe acute respiratory syndrome 2 (SARS-Cov-2). Cardiac manifestations related to COVID-19 include demand ischemia, fulminant myocarditis, myocardial infarction and arrhythmias. In this report, we present a case of ST-segment elevation myocardial infarction (STEMI) in a 68-year-old man with COVID-19 who initially presented with chest pain and shortness of breath. Patient's STEMI was managed with pharmaco-invasive strategy with tissue plasminogen activator (t-PA). He then developed acute hypoxic respiratory failure that was managed in the intensive care unit (ICU), together with multi-organ failure from which the patient died 2 days after presentation. Although the pathophysiologic mechanisms of STEMI in COVID-19 patients has not been clearly established, we hypothesize that interrelated pathogenetic factors, that we highlight in this report, can play a role in the development of STEMI, including plaque rupture secondary to systemic inflammation, increased pro-coagulants, endothelial dysfunction, impaired fibrinolysis and impaired oxygen utilization leading to demand/supply mismatch and myocardial ischemia.

Pulmonary Air embolism Associated with Pneumocephalus: A Case Report

Iatrogenic air embolism is associated with significant morbidity and mortality. Retrograde cerebral venous air embolism is most frequently associated with manipulation of venous access most commonly from central venous catheters. The ascension of air to the cerebral circulation is possibly due to the low specific gravity of air compared to blood and the performance of procedures in the sitting position. Increased right ventricular pressures in the setting of pulmonary thromboembolism may also contribute to the retrograde flow of air. We present the case of a 61-year-old woman who developed a massive pulmonary embolism and pneumocephalus, which was evident during contrast enhanced CT pulmonary angiography. Neurological deficits were not apparent and air resorption occurred after 48 hours of high flow oxygen therapy.

Quality of life of cervical cancer patients after completion of treatment - A study among Bangladeshi women

Cervical cancer is the main cause of malignancy-related death among women living in developing countries. The aim of this study is to evaluate the quality of life (QOL) among Bangladeshi cervical cancer survivors and its relationships with demographic and disease related factors A cross-sectional study was carried out onlone hundred nine consecutive cervical cancer survivors in National Institute of cancer Research and Hospital, Dhaka from September 2014 to february 2015 using European organization-for Research and treatment of cancer core Questionnaires (QOL-C30 and QOL- CX24). Demographic condition like education level, occupation and disease related factors like stages, treatment modality and duration of follow-up time were taken as investigating factors against functional scales. Cronbach's alpha was calculated to asses' internal consistency among items. Cervical cancer survivors stated a moderate QOL. Sub-domains of QOL score and global health status were significantly associated with physical function(PF) scales (p=.000), fatigue (p=.045), nausea and vomiting (p=.000), Appetite loss (p=.001), constipation (p=.005), symptom experience (p=.005) and menopausal symptoms (p=.015). QOL mean score were negatively associated with emotional function(EF) scales, pain, fatigue, nausea, appetite loss and financial problems. Education level showed significant association with physical function(PF) (p=.001), emotional function(EF) (p=.027), Cognitive function(CF) (p=.000) and sexual function (p=.001). Duration (Follow-up) time was significance association with PF (p=.005), EF (p=.012), symptoms experience (p=.001). Although, the QOL in cervical cancer survivors was moderate, treatment of related symptoms and improvement of demographic condition can influence the QOL and survivors improve the care of cervical cancer. So, improve the QOL among cervical cancer survivors.

Cor-triatriatum –A Rare Congenital Heart Disease Presented in Adulthoodsurgical treatment in Apollo Hospitals Dhaka

Abstract not available DOI: http://dx.doi.org/10.3329/pulse.v5i2.20268 Pulse Vol.5 July 2011 p.58-60

Differential expression of miRNAs in the visceral adipose tissue of patients with non-alcoholic fatty liver disease

BACKGROUND

Progression of non-alcoholic fatty liver disease (NAFLD) can be facilitated by soluble molecules secreted by visceral adipose tissue (VAT). MicroRNAs (miRNAs) are likely to regulate some of these molecular pathways involved in pathogenesis of NAFLD.

AIM

To profile miRNA expression in the visceral adipose tissue of patients with NAFLD.

METHODS

Visceral adipose tissue samples were collected from NAFLD patients and frozen. Patients with biopsy-proven NAFLD were divided into non-alcoholic steatohepatitis (NASH) (n = 12) and non-NASH (n = 12) cohorts controlled for clinical and demographic characteristics. Extracted total RNA was profiled using TaqMan Human MicroRNA arrays. Univariate Mann-Whitney comparisons and multivariate regression analysis were performed to compare miRNA profiles.

RESULTS

A total of 113 miRNA differentially expressed between NASH patients and non-NASH patients (P < 0.05). Of these, seven remained significant after multiple test correction (hsa-miR-132, hsa-miR-150, hsa-miR-433, hsa-miR-28-3p, hsa-miR-511, hsa-miR-517a, hsa-miR-671). Predicted target genes for these miRNAs include insulin receptor pathway components (IGF1, IGFR13), cytokines (CCL3, IL6), ghrelin/obestatin gene, and inflammation-related genes (NFKB1, RELB, FAS). In addition, two miRNA species, hsa-miR-197 and hsa-miR-99, were significantly associated with pericellular fibrosis in NASH patients (P < 0.05). Levels of IL-6 in the serum negatively correlated with the expression levels of all seven miRNAs capable of down regulating IL-6 encoding gene.

CONCLUSIONS

miRNA expression from VAT may contribute to the pathogenesis of NAFLD - a finding which may distinguish relatively simple steatosis from NASH. This could help identify potential targets for pharmacological treatment regimens and candidate biomarkers for NASH.

Liver dysfunction in pregnancy: an important cause of maternal and perinatal morbidity and mortality in Pakistan

The objective of this study was to evaluate the maternal and perinatal outcome of women with liver dysfunction during pregnancy. The study involved a prospective observational study design and was carried out at the Dow University of Health Sciences and Civil Hospital Karachi, Pakistan. A total of 800 women, who delivered during the study period from January 2006 to September 2006, constituted the study population. Pregnant women with liver dysfunction underwent evaluation for the aetiology of their liver dysfunction, including screening for hepatitis E. Thirty-five women were identified with liver dysfunction. Fourteen (40%) presented in the second trimester and 21 (60%) presented in the third trimester. Twenty-two of the 35 women (63%) had isolated acute hepatitis E; five (14%) had HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome; two (6%) had intrahepatic cholestasis of pregnancy (IHCP), two had acute fatty liver of pregnancy (AFLP) and two women had hepatitis A. A specific diagnosis was not reached in two women who died prior to delivery. In women with hepatitis E, the mean values of bilirubin and alanine transaminase were 12 mg/dL and 675 U/L, respectively. Abnormal coagulation parameters were present in 20 (57%) of the women and in 18 of 22 (82%) with hepatitis E. Fulminant hepatic failure (FHF) was seen in four patients. Seven women (20%) underwent caesarean section, 26 (74%) delivered vaginally and two women died undelivered. There were six maternal deaths in the study population; two were due to hepatitis E, one each from HELLP and AFLP, and two remained undiagnosed. The overall perinatal mortality within the group was 43%. Hepatitis E was the most common cause of FHF and maternal death in pregnant women with liver dysfunction.

Genetic influences on smoking cessation and relapse in pregnant women

Cigarette smoking during pregnancy continues to be a significant public health concern. Maternal smoking during pregnancy has been associated with low birth weight (<2500 g), fetal growth restriction, placental problems, pre-term delivery and spontaneous abortion. Mothers who smoke during pregnancy are twice as likely to give birth to low birth weight infants, and smoking during pregnancy is estimated to be responsible for 20-30% of all low birth weight infants. Smoking during pregnancy not only affects placental function, thus causing obstetrical complications, but nicotine also crosses the placenta and acts as a neuroteratogen. This in turn, elevates the risk of cognitive and auditory processing deficits, and has also been found to be negatively associated with long-term consequences on offspring behaviour. In addition, smoking has negative long-term health consequences for both mother and child, including respiratory conditions, cancer and cardiovascular problems. This review provides insight into the genetic influences on smoking behaviour in pregnant women. In particular, the roles of genes in the neurotransmitter pathways are highlighted. It also emphasises the need for further research in this area, and provides rationale for the importance of focusing on pregnant women who are highly motivated to quit when researching smoking behaviours in women.

Incidence of spontaneous echocontrast in left atrium in mitral stenosis detected by transoesophageal echo cardiography and related factors

The incidence of left atrial (LA) spontaneous echo contrast (SEC) and the clinical and echocardiographic variables related to it were prospectively evaluated in a series of 60 patients with mitral stenosis (MS) undergoing transoesophageal echocardiography (TEE) with a 5 MHz multiplane transducer. LA-SEC was found in 39 patients (65%) employing TEE. Statistical analysis showed a significant relationship between the presence of SEC and MS without mitral regurgitation (MR) (P < 0.05), MS with < or = MR grade II (P < 0.05), atrial fibrillation (P < 0.001) and increased left atrial dimension (P < 0.05). Age, sex, mitral valve area and ejection fraction did not show any positive association (P > 0.05). Thus, it is concluded that LA-SEC is a common finding observed in approximately 65% of MS patients undergoing TEE and associated with conditions favouring stasis of left atrial blood.

Unofficial fees in Bangladesh: price, equity and institutional issues

The widespread collection of unofficial fees at health facilities is a common form of rent-seeking behaviour in Bangladesh. Typically, unofficial fees come in the form of cash payments for the performance of required services, for direct purchase of drugs and medical-surgical requisites, and for service access. Using observational and interview methods, this study explores linkages between official and unofficial fees at three Bangladesh health facility levels; primary care Thana Health Complexes, secondary or district hospitals, and medical college hospitals. The study estimates payment levels for different income classes and different payor types at these facilities, thereby highlighting potential equity, price and institutional questions associated with unofficial fees. Not only does the practice have clear income and equity effects, there also appear to be direct effects upon patient satisfaction, perception of quality, and the ability to pay for health services. The article concludes with a discussion of 'rent capture' processes at Bangladesh facilities and the effect of unofficial fees in six areas of health sector reform: displaced official policies, reduced merit goods production, upward income redistribution, distorted human resource development, growth of facility inefficiency, and obstruction of market reforms.

Tobacco demarketing campaigns and role model selection in developing countries: the case of Bangladesh

Tobacco production and consumption is on the increase in developing countries. It is imperative that effective demarketing of tobacco products be initiated. This will call for effective and credible role models. A major study conducted in Dhaka, Bangladesh indicates that doctors are the most credible source of information concerning the dangers of tobacco consumption. Campaigns utilizing elderly male doctors as role models are called for in working to correct to problem of tobacco used in developing countries.