Safety and efficacy of dexpramipexole in eosinophilic asthma: a comparative study in a tertiary care hospital in Bangladesh

Introduction: Eosinophilic asthma is characterized by elevated eosinophil levels and frequent exacerbations, which are difficult to control with standard therapies. Dexpramipexole, an oral small molecule, has shown promise in reducing eosinophil counts, but data on its long-term efficacy and safety are limited. This study aimed to evaluate the efficacy and safety of Dexpramipexole in patients with eosinophilic asthma, focusing on changes in blood eosinophil counts, lung function, quality of life, and asthma exacerbation rates. Methods: This was a cross-sectional observational comparative study conducted at the department of Reparatory Medicine during January-2021 to December-2021, in Uttara Adhunik Medical College Hospital, Dhaka Bangladesh. A total of 200 confirmed cases with eosinophilic asthma were purposively employed to receive Dexpramipexole (n=100) and placebo (n=100) for 12 months follow up. The collected data were analyzed using Statistical Package for Social Sciences (SPSS), version-23.0. Results: The Dexpramipexole group achieved a 75% reduction in eosinophil counts compared to 12% in the placebo group (p<0.001). FEV1 improved by 15% in the Dexpramipexole group versus 2% in the placebo group (p<0.01). Quality of life scores increased by 1.5 points compared to 0.3 points in the placebo group (p<0.001). A 30% reduction in asthma exacerbations was observed (p=0.03). Conclusion: Dexpramipexole demonstrated significant improvements in eosinophil reduction, lung function, quality of life, and exacerbation rates over a 12-months period, with a favorable safety profile. These results suggest Dexpramipexole may be a promising long-term therapeutic option for eosinophilic asthma

Comparative Study on Evaluation of Results of DHS/PFN in Management of Intertrochanteric Fracture of Femur

Introduction:  38–50% of all femur fractures and 5–20% of fractures in their entirety are intertrochanteric fractures. The prevalence of these fractures is 180/10000, making them prevalent in the senior population. While intramedullary devices like PFN are thought to be superior implants for unstable intertrochanteric fractures, dynamic hip screws are still the gold standard for managing intertrochanteric fractures. Their function in treating these fractures remains questionable. Materials and Methods: The study was conducted on 100 patients with intertrochanteric fracture of femur attending the outpatient and emergency department of National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka between May 2019 to April 2020. Following a clinical and radiological evaluation, the patients were split into two groups at random, A and B. Patients in group A received treatment by ORIF using a dynamic hip screw, whereas patients in group B received treatment via closed/open reduction and internal fixation with PFN. The working proforma below contains the following information of the patient: personal information, clinical findings, radiological findings, and follow-up findings. The outcomes were assessed and contrasted. Results: The mean age in both the groups was 58.88 ± 15.76 years, In DHS group, there were 8(16%) females and 42(84%) males. In PFN group, there were 15(30%) females and 35(70%) males. There was a male preponderance in both the groups in comparison to the females. In PFN group, there were 24(48%) patients who injured because of fall, while 26(52%) were injured due to RTA. In PFN group, higher number of fall patients were there, while in DHS group, higher number of RTA patients were there. The comparison of mean blood loss in both the groups showed a statistically significant difference (P < 0.0001), with a higher mean blood loss in DHS group in comparison to PFN group. In DHS group, 48(96%) patients had no complications, 2(4%) had DVT and 1(2%) had cut out of screw, 3(6%) had infection. In PFN group, 2(4%) had infection, 48(96%) shows no complication. The difference in mean union time was significant (P < 0.0001) with a higher union time in DHS group in comparison to PFN group. DHS group functional outcome assessment by Harris Hip score, there were 22(44%) patients had Excellent and the PFN group functional outcome assessment by Harris Hip score, there were 26(52%) patients had Excellent. Conclusion: PFN provides stability and aids in biological reduction. Excessive collapse and limb shortening are avoided by PFN. As a result, it aids in obtaining a positive functional outcome overall. PFN is a load-bearing implant that provides stability to the fracture area both proximally and distally. As such, it is a more biomechanically sound implant option for fixing peri-trochanteric femoral fractures. When it comes to bleeding during surgery and the early stages of recovery, PFN is a superior implant option than DHS. Consequently, we support the use of PFN rather than DHS in intertrochanteric fractures, with the exception of fractured trochanteric entry points for the PFN

Prospect of Polypill in the Management of Cardiovascular Diseases in Bangladesh

Cardiovascular disease (CVD) is one of the most prominent health issues responsible for global death currently. Just like the diverse causes of its pathophysiology, a plethora of medicines from different classes are used for the treatment and management of CVDs. However, in low and middle income countries like Bangladesh, it’s extremely difficult for patients to adhere to their treatment regimen consisting of multiple drugs from different classes as it is both expensive and inconvenient. In such scenario, a polypill or a combination of drugs containing different type of cardiovascular drugs could significantly improve the management of cardiovascular diseases in Bangladesh. Our aim was to get a real-life perspective of the prospect of commercially available polypill in Bangladesh keeping all its stakeholders such as patients, physicians and retailers in mind. A survey was conducted in two different cities (Dhaka and Comilla) and the data were correlated. We got positive response from patients, physicians and retailers. Also, the physicians came up with various combinations of drugs such as – ACEI (ngiotensin-converting enzyme inhibitors) and ARB (angiotensin II receptor blockers) (35%); ARB and CCB (calcium channel blockers) (25%) and ACEI and CCB (15%). However, disease patterns, available drugs and comorbidities in the two regions showed significant deviations as metro city based patients suffered from more severe form of CVDs. Therefore, further survey in different regions should be conducted to understand the overall disease pattern and to come up with optimum combinations for CVD patients. Beyond this discussion, it was evident that commercially available polypill has a great prospect in Bangladesh against CVDs.&#x0D; Bangladesh Pharmaceutical Journal 23(1): 17-25, 2020</jats:p

Pattern of Burn Injury in Children Presented to Dhaka Shishu (Children) Hospital

Background: Children are mostly affected in burn injury at our country like other low and middle income countries (LMICs). Approximately 90% of the burns occur in under developed countries, which generally lack the necessary infrastructure to reduce the incidence and severity of burns.&#x0D; Objectives: This study was done to investigate the pattern of burn cases admitted to Dhaka Shishu (Children) Hospital (DSH).&#x0D; Methods: This was a retrospective study conducted over the period of one year from January 2019 to December 2019 at Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. The data was collected from the patients record section of the hospital. Patients characteristics (e.g. age, sex), causes and severity of injury, outcome, hospital stay and seasonal variation were analized in this study.&#x0D; Results: A total of 91 patients were admitted during study period of one year. This study consisted of 53 male patients (58.24%) and 38 female patients (41.76%) with male to female ratio of 1.3:1. The most frequently hospitalized burn patients were in the age group 3-5 years, which accounted for 30.77% of patients. Burns were more common during winter season followed by autumn season, with 43 cases (47.25%) and 18 cases (19.78%) respectively. The highest number of admissions was during the month of December. Scald burn was the most common cause of burn injury in our study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn. Scald burn was the most common cause of burn injury in this study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn.&#x0D; Conclusion: The most frequently hospitalized burn patients were in the age group 3-5 years and more common during winter season. Most of the burn occured in children are scald in our country due to accidental fall of worm liquid. Superficial epidermal and dermal burns are treated conservatively, but deep burns may require surgical treatment.&#x0D; DS (Child) H J 2020; 36(2): 134-137</jats:p

Retrospective Analysis of Congenital Neonatal Intestinal Obstruction in a Tertiary Care Hospital in Bangladesh

Introduction: Patients with congenital neonatal intestinal obstruction are the main bulk of neonatal surgical departments. The incidence is approximately 1 in 1500-2000 live birth. Commonly caused by anorectal malformation (ARM), intestinal atresia, hirschsprungs disease (HD), meconium ileus, malrotation of gut, volvulus neonatorum, necrotizing enterocolitis (NEC) and rarely bands adhesion. These patients presented with vomiting, gradual abdominal distension and delayed or no passes of meconium. Usually, an abdominal radiograph is all that is necessary to make the diagnosis, since the gas pattern is distinctive and often will be a clue to the site of obstruction. The aim of the study is to detect the type of congenital neonatal intestinal obstruction, initial surgical approaches, and their outcome in our hospital. Materials and methods: This is a retrospective study conducted at the division of pediatric surgery in Bangladesh Shishu hospital &amp; institute, Dhaka, Bangladesh. The study period was 2 years from January 18 to December 19. All the neonates who underwent surgery for congenital neonatal intestinal obstruction were included. In this study only initial diagnosis, surgical procedure and outcome were included. Results: Our surgical department operated on a total of 246 neonates with congenital neonatal intestinal obstruction during this study period. Out of them, 139(56.50%) patients were male and 107 (43.50%) were female. The male-female ratio is 1.3:1. Gestational age was varied from 31 weeks to 40 weeks (Mean 36.2 weeks). Birth weight was from 1300 gm to 3800 gm (mean 2100gm). The most common cause of intestinal obstruction was ARM 72(29.27%), followed by hirschsprungs disease 53(21.54%), atresia 41(16.67%), meconium ileus 37(15.04%), malrotation of gut 28(11.38%) and other like bands adhesion, etc 15(6.09%). In case of atresia ileal atresia was common 16(39.02%) then jejunal 13(31.70%) and duodenal 9(21.95%). Only 3(7.31%) colonic atresia was found. ........</jats:p

An Approach of Adjusting the Switch Probability based on Dimension Size: A Case Study for Performance Improvement of the Flower Pollination Algorithm

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Numerous meta-heuristic algorithms have been influenced by nature. Over the past couple of decades, their quantity has been significantly escalating. The majority of these algorithms attempt to emulate natural biological and physical phenomena. This research concentrates on the Flower Pollination algorithm, which is one of several bio-inspired algorithms. The original approach was suggested for pollen grain exploration and exploitation in confined space using a specific global pollination and local pollination strategy. As a “swarm intelligence" meta-heuristic algorithm, its strength lies in locating the vicinity of the optimum solution rather than identifying the minimum. A modification to the original method is detailed in this work. This research found that by changing the specific value of “switch probability" with dynamic values of different dimension sizes and functions, the outcome was mainly improved over the original flower pollination method

Assessment of Knowledge Regarding Congenital Hypothyroidism Among Doctors in Dhaka City

Background: Congenital hypothyroidism (CH) is the most common congenital endocrine disorder seen in the newborn (1 in 4,000 births). It causes irreversible mental &amp; physical disability if remains undetected. Diagnosis and treatment of CH before 3 months are mandatory to avoid CH.&#x0D; Objectives: The study was aimed to assess the level of knowledge regarding congenital hypothyroidism among the doctors in selected hospital in Dhaka city.&#x0D; Methods: A descriptive cross-sectional study was conducted and data was collected by using self-administered questionnaire. Data was analyzed using SPSS.&#x0D; Results: The mean age of the respondents was 40.5 years. Close to three-fifth (59.5%) of the respondents were in the age group 30-40 years. Above seventieth (71%) of the respondents were males and the rest were females.71% of the respondents knew that Infants born with congenital hypothyroidism may show no effects, or may display mild effects that often go unrecognized as a problem. The findings of this study revealed that more than half of the respondents have attended a training related to congenital hypothyroidism. It also reveals that more than half of the respondents had average knowledge regarding sign and symptoms of congenital hypothyroidism.&#x0D; Conclusion: In this study it has been reported that age of the respondents was associated with knowledge on sign and symptoms of congenital hypothyroidism.&#x0D; DS (Child) H J 2019; 35(1) : 27-32</jats:p

Aetiology and Pattern of Presentation of Upper Gastrointestinal Tract Ulcers among Patients Attending the Gastroenterology Department of BSMMU-A Tertiary Level Hospital

Background: Upper gastrointestinal endoscopy is the most common procedure performed in Gastroenterology department for numerous indications and ulceration of the upper GI tract is one of the major pathological findings during endoscopy. Early diagnosis of upper GI ulcers with definite cause is the mainstay of therapy for patient’s cure and prevention of complications. Different clinical features are observed in different types of ulcer. Objective: The objective of this study is to find out the causes of different types of ulceration in the upper gastrointestinal tract along with their clinical presentation. Methods: This cross-sectional study was conducted in the Department of Gastroenterology, BSMMU, Dhaka, Bangladesh during the period of July 2016 to April 2017. Patients referred for upper GI endoscopy for different indications were primarily selected. Consecutive 220 patients having ulcers anywhere in the upper GIT were finally included in the study. Ulcer diseases were diagnosed through analysis of morphology of the ulcers, histopathology of biopsy materials, relevant clinical history and further investigations if required. All the findings were documented in predesigned data collection sheet. Any association between various types of ulcers with age, gender, BMI, lifestyle, location of ulcer, different signs and symptoms was assessed. Results: Out of 220 patients duodenal ulcer was found in 45.9%, gastric ulcer in 30.0%, oesophageal ulcer in 7.7%, ulceration at multiple sites in 13.6%, and stomal ulcer in 2.7% cases. Among the aetiologies H. pylori infection (62.8%), NSAIDs (14.6%) and malignant ulcers (9.1%) were found in majority of cases. Less common causes were tubercular ulcer, lymphoma, GIST, Crohn’s disease and caustic injury. Aetiology could not be identified in 6.8% cases. Among various presenting complaints epigastric pain, early satiety, anorexia, vomiting and GI bleeding were the symptoms that differ significantly in patients with ulcers ...........</jats:p

Ethnomedicinal survey of plants used by the folk medicinal practitioner (FMP) in the Jamalpur sadar Upazila, Jamalpur district, Bangladesh

The Folk medicinal practitioner (FMP) or Kabiraj plays a key role to provide health support mainly to village people. They are mainly dependent on the pants parts available around them and many modern medicines are being synthesized by extracting the active chemicals from plants. The main objective of this study is to document the plants used by the FMPs of two villages of Jamalpur sadar upazila. For this study, we conducted a survey based on semi structured method. We found they use mainly 31 plants belonging to 25 families. The part mostly used is leave (31.75%) and the least used is the flower (6.34%). It is found that almost 18 types of diseases are being cured by their formulation. This study also suggested that, the FMPs treat many common disorder like gastro intestinal disorder, Respiratory tract infection, diabetes, Skin disorder etc. and also various complicated disorder such as debility, anemia, neural disorder etc. This study may be helpful to create scientific view about the plants used by the FMPs of Jamalpur sadar upazila and these plants might be used to synthesize drug molecule of interest.&#x0D; Asian J. Med. Biol. Res. December 2018, 4(4): 422-426</jats:p