Prevention of Ovarian Hyper stimulation Syndrome by using gonadotrophic releasing hormone analogue to induce final ovulation trigger in invitro fertilization cycles

Objectives: To find out occurrence of ovarian hyperstimulation in patients who were hyper responders in in vitro fertilization cycles. Secondary outcome was to assess number of metaphase II oocyte and fertilization rate, cleavage rate and pregnancy outcome when GnRHa is used for final maturation and triggering ovulation. STUDY DESIGN, SIZE, and DURATION: This is retrospective descriptive analysis of cases managed at single center from June 2017 till May 2018. PATIENTS & METHODS: Twenty patients were identified as hyper responders based on baseline, ovarian reserve characteristics, that is antral follicle count, (AFC) > 25, AMH > 4ng/ml and on day  of  trigger,  follicles  >-25  in  number  of  ≥  11mm  were administered GnRHa trigger and 1500IU hCG on oocyte retrieval day while luteal phase was supported with daily vaginal  progesterone and twice daily estradiol valerate. Sixteen patients underwent fresh transfer while four patients had their embryos frozen. MAIN RESULTS: Twenty patients were identified as high risk and their baseline characteristics were, mean age 31.7 ± 4.50, mean antral follicle count 25.7 ± 5.01, Anti Mullerian hormone level mean 4.64 ± 2.52 and PCOS was present in 35% cases. Peak estradiol level mean 13455-± 6632pmol/l and mean follicles count of 25.45 ± 8.78 confirmed a high response. Oocyte yield was 11.45+ Metaphase oocyte retrieved were 85.5% and cleavage rate of 93%. No case of early onset OHSS was identified. Only one patient developed moderate OHSS. Pregnancy rate was 31.25%. Miscarriage rate was 6.3% and ongoing pregnancy was 25%. CONCLUSION:  This small retrospective descriptive analysis supports the view of current literature that GnRH trigger not only prevents early onset OHSS also achieves increase of M11 oocytes. In addition, pregnancy outcome is not statistically different to those cycles where hCG is used as trigger.

Effects of cigarette smoking on erythrocyte sedimentation rate, platelet count, total and differential leucocyte counts in adult male smokers: Blood parameters effected by cigarette smoking in males

Smoking is one of the leading causes of death worldwide. Smokers have higher risk for coronary heart disease, atherosclerosis, acute myocardial infarction, hypertension, clotting disorders, inflammation, respiratory diseases, cancers, etc. A cigarette smoker is exposed to a number of harmful substances. In this study we hypothesized that smoking causes inflammatory reactions and induces hyperthrombic state in the body which may be reflected in erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count values. The purpose of the study was to study the effects of cigarette smoking on erythrocyte sedimentation rate, total leucocyte count and platelet count in adult male smokers and to compare the results with non-smokers and to establish a relationship between the duration and quantity of smoking with the change in ESR, TLC, DLC and platelet count. A cross sectional study was conducted in the department of Pathology on 86 healthy male subjects (smokers=43 and non-smokers=43). ESR was estimated using Westergrens method. TLC, DLC and platelet counts were estimated using HORIBA Pentra ES60 autoanalyser. TLC and basophil counts were significantly higher in smokers than in non-smokers (p<0.05). The mean value of ESR was higher among smokers than non-smokers but it was statistically insignificant. Platelets counts showed no significant difference between smokers and non- smokers. No correlation was observed in various blood parameters and smoking (in pack years). We conclude that smoking initiates an inflammatory response as evidenced from raised TLC, monocyte and basophil counts

Variation in carotid-femoral pulse wave velocity, augmentation pressure and augmentation index during different phases of menstrual cycle: Indicators of arterial stiffness during phases of menstrual cycle

Physiological variation of estrogen and progesterone during menstrual cycle is well known.  They not only have an effect on blood pressure control, but also seem to have a role in regulating arterial compliance. This study was done to find out whether there are any changes in central arterial parameters during different phases of menstrual cycle. Thirty female  subjects  in the  age  group  of  18-22  years  with  normal,  regular menstrual  cycles  participated in this prospective observational study at our teaching hospital. Anthropometric parameters were recorded.  Blood pressure in all 4 limbs was recorded using cardiovascular risk analyzer-Periscope™ on Day 3rd to 5th (follicular phase), Day 12th to 14th (ovulation phase), Day 22nd to 24th (luteal phase) of their menstrual cycle. We collected blood samples during these three phases for estimation of estradiol and progesterone by ELISA technique. Analysis of variance and correlation statistics were done using SPSS 17.0 statistical software. No significant statistical changes were observed in systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, aortic systolic pressure, aortic diastolic pressure, aortic augmentation pressure, aortic index and pulse wave velocity during the three recorded phases of the menstrual cycle. There are many studies which correlate changes in peripheral artery blood pressure with different phases of menstrual cycle. But there is scarcity in data available which correlates central arterial pressures and arterial stiffness with natural hormonal variations in different phases of menstrual cycle. However, our results show that although there are subtle changes in blood pressure parameters along with estrogen and progesterone levels throughout the menstrual cycle, yet these were not statistically significant

Cytokine changes in colonic mucosa associated with Blastocystis spp. subtypes 1 and 3 in diarrhoea-predominant irritable bowel syndrome

We determined cytokines (e.g. interleukin-8, 10, 12 and TNF-α) expression by peripheral blood mononuclear cells (PBMCs) and in rectal mucosa in diarrhoea-predominant irritable bowel syndrome (D-IBS) with Blastocystis spp. Eighty patients with D-IBS and Blastocystis spp. infection were classified as \u27cases\u27 and 80 with D-IBS without Blastocystis spp. infection were classified as \u27control\u27. Cases were subdivided into D-IBS and Blastocystis sp. defined type 1 (subtype-specific primer SB83) and type 3 (SB227). Stool microscopy and culture were performed. Rectal biopsies were obtained for histology and cytokines by real-time PCR for mRNA expression of cytokines. PBMCs IL-8 was similar in different groups but in type 1, IL-8mRNA was increased compared with type 3 (P = 0·001) and control (P = 0·001). In type 1, IL-10 by PBMCs had a low mean value (14·5±1·6) compared with (16·7±1·5) type 3 and (16±2·3) in controls (

Frequency of vitamin d deficiency in multiple sclerosis patients: a cross sectional study.

Vitamin D deficiency is linked to poor treatment response in patients with Multiple S clerosis. The aim of this study is to define the frequency of Vitamin D deficiency for early detection and timely intervention leading to improved morbidity rates

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Effect of compound Unani Drug in the management of cervical spondylosis (Wajaur Raqaba): A case study

Cervical spondylosis is also known as cervical osteoarthritis. It is a disorder characterised by alterations in the bones, discs, and joints of the neck. These changes are induced by the regular wear and tear of ageing, which leads to intervertebral disc degeneration and osteophyte production. The most common complaints are pain in the head, neck, and shoulders, as well as tenderness in these areas. There is also pain radiation and a reduction in cervical range of motion. Wajaur Raqaba (cervical spondylosis) is treated through Ilaj bit Tadbeer (Regional therapy), Ilaj bid Dawa (Pharmacotherapy), and Ilaj bil Yad (Surgery). The purpose of this case study was to assess the efficacy of Unani formulations Habbe Asgand and Habbe Gul-e-akh in the treatment of cervical spondylosis. A 24-year-old female patient with cervical spondylosis presented to the OPD of Ajmal Khan Tibbia College, Aligarh. Treatment was given to the patient for a period of one month. The Northwick Park Neck Pain Questionnaire (NPQ) is used for the assessment of cervical pain. As assessed by NPQ, Unani formulations were proven to be safe and effective in the management of cervical spondylosis. Keywords Cervical spondylosis, Wajaur Raqaba, Unani formulations, Habbe suranjan and Habbe gul-e-akh

Prevalence of CTX-M β lactamases among Gram negative bacteria in a tertiary care hospital in Bangladesh

Extended spectrum beta lactamases (ESBLs) produced by Gram negative bacteria are mainly mediated by three important genes, namely TEM, SHV and CTX-M. In this study, we used a multiplex PCR to determine the prevalence of CTX-M and its subgroups CTX-M-3, CTX-M-14, among the members of Enterobacteriaceae family and in Pseudomonas spp that were isolated from different clinical samples in a tertiary care hospital in Bangladesh. A total of 300 culture positive clinical isolates were selected for the study. Out of these, 216 from urine, 45 from wound swab, 39 from pus aspirates. The ESBL status was determined by double disc diffusion test (DDDT) as recommended by Clinical Laboratory Standard Institute 2010 (CLSI) and by multiplex PCR for TEM, SHV and CTX-M, CTX-M-3, CTX-M-14 genes. Out of 300 isolates tested, 71.3% were positive for ESBL production by DDDT. The rate of positivity for TEM, SHV and CTX-M genes in 107 randomely selected isolates was 83.2%. Among these, 56.2% (50/89) was positive for CTX-M. Among the CTX-M positive isolates, CTX-M-3 and CTX-M-14 were 78.0% (39/50) and 80.0% (40/50) respectively. Our study demonstrated that CTX-M variants were common in Enterobacteriaceae and Pseudomonas spp prevalent in the hospital of Bangladesh. Ibrahim Med. Coll. J. 2015; 9(1): 26-3

Determinants of COVID-19 Vaccine Acceptance among the Adult Population of Bangladesh Using the Health Belief Model and the Theory of Planned Behavior Model

Vaccination is undoubtedly one of the most effective strategies to halt the COVID-19 pandemic. The current study aimed to investigate the acceptance of COVID-19 vaccination and its associated factors using two health behavior change frameworks: the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). A total of 639 Bangladeshi adults (mean age: 24 years) participated in a cross-sectional online study between July and August 2021. The questionnaire covered questions regarding vaccine intentions, sociodemographic features, health status, perceived trust in/satisfaction with health authorities, reasons for vaccine hesitancy, and factors related to the health behavior change frameworks. Hierarchical logistic regression was employed to determine associations between these predictors and vaccine acceptance. The intention to get a COVID-19 vaccination was expressed among 85% of the participants. In fully adjusted models, students and respondents with more normal body weights reported higher intentions to get vaccinated. Respondents were also more likely to seek vaccination if they reported greater levels of perceived susceptibility, benefits, and cues to action, as well as lower levels of barriers and self-efficacy. Fear of future vaccine side effects was the most common reason for COVID-19 vaccine hesitancy and was expressed by 94% of the vaccine-hesitant respondents. These factors should be considered by health authorities in Bangladesh and perhaps other countries when addressing the plateauing COVID-19 vaccination rates in many populations