リバスチグミンの抗うつ様効果の作用機序に関する神経薬理学的研究

Tohoku University福永浩司課

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

Surgical Outcome of Short Segment Instrumentation including Fracture Vertebrae of Thoracolumbar Burst Fracture

Background: Fractures of the thoracolumbar region are the most common injuries of the spine; among them burst fractures are the most frequent. Several studies were done to see the surgical outcome in thoracolumbar burst fracture hence surgery was recommended for better outcome. So, the current study was aimed to evaluate the clinical, functional and radiological outcome of short-segment pedicle screw fixation including the fractured vertebral body. Objectives: The aim of the study was to evaluate the surgical outcome of short segment pedicle screw fixation including fracture vertebrae of unstable thoracolumbar burst fracture with incomplete spinal cord injury. Methods: In this prospective observational study, a total of 62 cases were studied from May 2019 to May 2021 through non randomized purposive sampling. All the patients were between 15 to 60 years of age and operated within 21 days of fracture by posterior decompression & stabilization by short-segment pedicle screw fixation including the fractured vertebral body. Postoperative functional outcome was assessed clinically by ASIA, ODI, VAS, Denis Work Scale, Macnab criteria and radiologically by Cob’s kyphotic angle, kyphotic deformation, Beck index & Bridwell criteria. Postoperative follow up was conducted at 6th, 12th & 24th weeks. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The mean age was 31.42±11.2 years with male dominancy (74.19%). Most of the cases were manual workers (51.61%). FFH was the most common cause of injury (80.65%) and L1 was the most common level of injury (54.84%). The mean duration between injury and operation time was 14.45±3.72 days. Regarding improvement of ASIA grade, 1 grade in 46 (74.19%) cases, 2 grade in 2 (3.23%) case, no improvement in 14 (22.58%) cases were seen. Complications were hemorrhage 2(3.23%), dural tear 2(3.23%), CSF leak 2(3.23%), urinary retention 4(6.45%), skin infection 2(3.23%) and bed sore 2(3.23%). Conclusion: Thoracolumbar burst fracture with incomplete spinal cord injury can be treated with short-segment pedicle screw fixation including the fractured vertebral body effectively. This method offered a better kyphosis correction, no instrument failures, appraisable clinical and functional recovery, reduce pain and improve working status with early rehabilitation

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