Positivity of COVID -19 Cases among the Patients Attending Flu Corner of Emergency and Casualty Department of Mymensingh Medical College Hospital

Recent COVID-19 pandemic has changed health resource disposal plan and urged relocation of work force to defend the world from devastation of this emerging disease. This cross-sectional observational study aims to categorize and rationalize COVID-19 testing of all patients attending flu corner of One Stop Service (OSS) in the department of Emergency and Casualty (E&C) in Mymensingh Medical College Hospital (MMCH) during 15th April 2021 to 14th May 2021 on 2627 patients as per inclusion and exclusion criteria. Out of 2627 patients 920(35%) were symptomatic cases and 1707(65%) attended for testing without symptom. Out of 920 symptomatic cases 175(19%) were confirmed COVID-19 cases. Among the confirmed cases 38(21.71%) was admitted whereas, from suspected cases 100(13.42%) got admitted, remaining patients from both categories were advised for home isolation. Coverage and justification of COVID-19 testing should be done precisely to ensure proper disease control and COVID care during this pandemic.

Phytochemical Constituents and Pharmacological Activities of Picrasma javanica: Quassinoids Interest

Picrasma javanica Blume is a plant belonging to Simaroubaceae. It is known for its secondary metabolites, namely quassinoids, offering various pharmacological properties including antitumor, antimalarial, and antiviral. The plant is traditionally used as a source medicine for different diseases in Myanmar, Thailand, and Indonesia. Despite the extensive studies on P. javanica, there is no concise and conclusive information regarding the phytochemical and phytochemistry of the plant has been reported. Thus, we aimed to discern the phytochemical constituents and pharmacological activities of P. javanica. The phytochemical constituents and pharmacological benefits of P. javanica were reviewed and supported from previous in vivo and in vitro studies. The literature used in this review were retrieved from electronic database such as Scopus, Semanticscholar, Sciendirect, Google scholar, Researchgate, Pubmed, and websites. P. javanica possesses several phytochemical constituents, such as quassinoids, alkaloids, and triterpenoids. The compounds of the plant have been isolated and studied for their pharmacological activities, encompassing antimalarial, antiproliferative, antiviral, antimicrobial, and membrane-stabilizing activities. It was found that the pharmacological activities in the plant were attributable to the key ingredients of quassinoids and alkaloids present. However, further extensive studies must be carried out to explore more potential benefits that the plant could offer.

Efficacy and Safety of the Awake Prone Positioning in Patients with COVID-19 Related Respiratory Distress: A Scoping Review

Prone positioning (PP) is becoming an important treatment modality for the management of COVID-19 related respiratory distress syndrome. The aim of this scoping review was to evaluate effectiveness and safety of awake PP in non-intubated patients with COVID-19 related acute respiratory distress at different care settings. The study was conducted during December 1, 2019 to August 30, 2020 using health science electronic databases and grey literature. A PRISMA flow diagram was used and finally 06 studies with 187 patients were included for review. Male patients were predominating with the mean age of approximately 55 years. Oxygenation was improved in 79.14% patients. One hundred fifty seven (83.95%) patients with COVID-19-related hypoxemic respiratory distress tolerated the procedure. Intubations required 25.41% of the patients or mechanical ventilation and 6(3.2%) patients expired. Number of patients in the reported studies could tolerate more than 3 hours of PP without a major side effect. Awake proning improved oxygenation of the patients suffering from COVID-19 related respiratory hypoxia in different care settings. Early instituted prone positioning may be an effective alternative method of treating COVID-19 related respiratory distress. Patient compliance and small size cohort studies are the limitations of this review. Multicenter controlled studies are warranted before conclusions are made about safety and the settings.

Factors Associated with Delayed Hospital Arrival of Patients Presenting with Acute Myocardial Infarction: A Cross-Sectional Study in Bangladesh

Delay in seeking medical care of the patients with acute myocardial infarction (AMI) could affect the outcome. Therefore, it is important to recognize and reduce pre-hospital in initiating treatment of these patients. The objective of the study was to evaluate the factors associated with delayed hospital arrival of patients with AMI. This cross-sectional study was carried out among 385 patients with AMI attended in the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The delay in arrival to the hospital was recorded along with socio-demographic data, conditions of the patients during onset and other relevant data. The mean age of the patients 59.7±9.9 years with a male-female ratio of 2.4:1. About 22% of patients with AMI arrived at the hospital within 6 hours of symptoms onset and only around 13% arrived within 2 hours of onset of symptoms. Comparatively younger (p=0.037), unmarried (p=0.008) and Muslim (p=0.008) patients were more likely to present for hospital care sooner (p=0.037). Patients coming from upper middle class of socioeconomic status (p<0.001) and those with college or post college level of education (p<0.001) were more likely to present earlier for hospital care. Prehospital delay was larger in non-manual worker patients (p<0.001) as well as in patients with onset of chest pain during rest period (p<0.001) and while at home (p<0.001). Pre-hospital delay was shorter in patients with onset of chest pain from 12am to 6am and 6am to 12pm (p<0.001). Lack of awareness of AMI symptoms and benefits of its early treatment, long distance and mode of transport were shown as the most common causes of delayed arrival of patients at hospital (p<0.001). This study has identified the factors associated with AMI in context of Bangladesh. Effective measures including increasing awareness of AMI symptoms should be taken for better outcome of the patients.

Association of Echocardiographic Epicardial Fat Thickness with the Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Estimation of visceral adipose tissue is important as it carries high cardiometabolic risk and several methods are available as its surrogate. Epicardial fat thickness (EFT) is a direct measure of visceral fat rather than anthropometric measurements. EFT can be accurately measured by two-dimensional (2D) echocardiography. It tends to be higher in patients with Acute Coronary Syndrome (ACS). The present study was intended to find out the association between echocardiographic EFT and severity of Coronary Artery Disease (CAD) in patients with ACS. This cross-sectional observational study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from October 2017 to September 2018. Sampling technique was purposive sampling. Comparison between groups was done by unpaired-t test & dichotomous variables were compared by chi-square test. A total of 164 patients was enrolled in the study, prospectively examined EFT on echocardiography and patients were divided into 2 groups, Group I patients with EFT >4.65mm and Group II patients with EFT ≤4.65mm. Coronary angiograms were analyzed for the extent and severity of CAD using Gensini score. The mean EFT (mm) was found 6.1±1.0 in Group I and 3.5±0.7 in Group II (p<0.001). Patients with a higher EFT were associated with a high Gensini score (Group I vs. Group II, 50.3±24.1 vs. 21.9±20.0; p<0.001). Multivariate analysis showed that EFT (OR 6.07, p<0.001) and smoking (OR 2.66, p=0.03) were independent factors affecting significant coronary artery stenosis. By ROC curve analysis, EFT >4.65mm predicated the presence of significant coronary stenosis by 76.1% sensitivity and 69.9% specificity. EFT measured using Transthoracic echocardiography (TTE) significantly correlates with the severity of CAD. It is sensitive, easily available, and cost-effective and assists in the risk stratification and may be an additional marker on classical risk factors for CAD.

Role of Rotaviral Antigen Detection by ICT in Acute Diarrhoeic Children below 5 Years in a Tertiary Care Hospital of Bangladesh

Rotavirus is responsible for acute severe watery diarrhoea in young children. Early and rapid detection of Rotavirus infection can help to reduce inappropriate administration of antibiotics and has future positive impact on prevention of drug resistance. This cross-sectional study was designed to determine the role of Rotaviral antigen detection by ICT from stool sample of acute diarrhoeal children below five years admitted in Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology in collaboration with the Department of Paediatrics during the period from 1st January 2018 to 31st December 2018. Total 184 children of under five years of age with acute watery diarrhoea were enrolled in this study. Rotaviral antigen was detected by ELISA (Enzyme Linked Immunosorbent Assay) and ICT (Immunochromatographic test) from stool samples. Out of 184 stool samples, Rotaviral antigen was found positive in 84 and 86 cases by ICT and ELISA methods, respectively. ICT showed sensitivity of 90.70% and specificity of 93.88% when compared with ELISA. The Rotavirus infection was found highest in male children (61.90%) and in age group of 7 to 12 months (51.89%). Considering the importance of Rotaviral diarrhoea, rapid detection of Rotavirus infection by ICT is essentially needed and might be practiced routinely as it is relatively reliable, easy to perform and cost-effective. It is particularly important in Bangladesh, where diarrhoea is still contributing a significant proportion of morbidity and mortality in under five children.

Short Term Outcome of Therapeutic ERCP in the Management of Biliary Ascariasis in a Tertiary Care Hospital of Bangladesh

The history of ascariasis is very old. It is endemic in various parts of Bangladesh. Hepatobiliary ascariasis is a well-known complication of the intestinal ascariasis. Although cosmopolitan, it predominantly affects people in Asia, Africa, and South America. This was a prospective observational study conducted from July to December 2014 to explore the short term outcome of therapeutic ERCP in the treatment of biliary ascariasis in a tertiary care hospital of Bangladesh. A total of 60 cases of biliary ascariasis were selected conveniently in this study. Data were collected by face-to-face interviews and observation with the help of data sheet. Data were checked for quality control and analyzed by computer using SPSS software. The mean±SD age of the patients was 30.96±7.66 years. All the patients were aged between 17 and 55 years and predominantly affect women in the 3rd and 4th decades. The most common presentation was upper abdominal pain in 47(83.32%) of the patients. Ultrasound was the diagnostic tool of choice, where biliary ascariasis was found in 40(66.7%) of patients. ERCP is reserved mainly for therapeutic purposes and found successful in 57(95%) of the patients.

Mechanistic insight into immunomodulatory effects of food-functioned plant secondary metabolites

Medicinally important plant-foods offer a balanced immune function, which is essential for protecting the body against antigenic invasion, mainly by microorganisms. Immunomodulators play pivotal roles in supporting immune function either suppressing or stimulating the immune system's response to invading pathogens. Among different immunomodulators, plant-based secondary metabolites have emerged as high potential not only for immune defense but also for cellular immunoresponsiveness. These natural immunomodulators can be developed into safer alternatives to the clinically used immunosuppressants and immunostimulant cytotoxic drugs which possess serious side effects. Many plants of different species have been reported to possess strong immunomodulating properties. The immunomodulatory effects of plant extracts and their bioactive metabolites have been suggested due to their diverse mechanisms of modulation of the complex immune system and their multifarious molecular targets. Phytochemicals such as alkaloids, flavonoids, terpenoids, carbohydrates and polyphenols have been reported as responsible for the immunomodulatory effects of several medicinal plants. This review illustrates the potent immunomodulatory effects of 65 plant secondary metabolites, including dietary compounds and their underlying mechanisms of action on cellular and humoral immune functions in in vitro and in vivo studies. The clinical potential of some of the compounds to be used for various immune-related disorders is highlighted.

Role of neurotoxicants in the pathogenesis of Alzheimer's disease: a mechanistic insight

Alzheimer's disease (AD) is the most conspicuous chronic neurodegenerative syndrome, which has become a significant challenge for the global healthcare system. Multiple studies have corroborated a clear association of neurotoxicants with AD pathogenicity, such as Amyloid beta (Aβ) proteins and neurofibrillary tangles (NFTs), signalling pathway modifications, cellular stress, cognitive dysfunctions, neuronal apoptosis, neuroinflammation, epigenetic modification, and so on. This review, therefore, aimed to address several essential mechanisms and signalling cascades, including Wnt (wingless and int.) signalling pathway, autophagy, mammalian target of rapamycin (mTOR), protein kinase C (PKC) signalling cascades, cellular redox status, energy metabolism, glutamatergic neurotransmissions, immune cell stimulations (e.g. microglia, astrocytes) as well as an amyloid precursor protein (APP), presenilin-1 (PSEN1), presenilin-2 (PSEN2) and other AD-related gene expressions that have been pretentious and modulated by the various neurotoxicants. This review concluded that neurotoxicants play a momentous role in developing AD through modulating various signalling cascades. Nevertheless, comprehension of this risk agent-induced neurotoxicity is far too little. More in-depth epidemiological and systematic investigations are needed to understand the potential mechanisms better to address these neurotoxicants and improve approaches to their risk exposure that aid in AD pathogenesis.Key messagesInevitable cascade mechanisms of how Alzheimer's Disease-related (AD-related) gene expressions are modulated by neurotoxicants have been discussed.Involvement of the neurotoxicants-induced pathways caused an extended risk of AD is explicited.Integration of cell culture, animals and population-based analysis on the clinical severity of AD is addressed.

Wild epiphytic Bangladeshi orchids Cymbidium aloifolium (L.) Sw. and Papilionanthe teres (Roxb.) Lindl. potentially modulates the immune functions in Swiss albino mice

Objective

This research investigated the immunomodulatory potentials of two medicinally important wild epiphytic Bangladeshi orchids Cymbidium aloifolium and Papilionanthe teres using Swiss albino mice.

Materials and Methods

Orchid extracts were prepared using a cold methanol extraction procedure. To assess the immunomodulatory action, Swiss albino mice of either sex weighing 25-35 gm were divided into five groups each with six animals. Sheep red blood cells (SRBC) of 0.5 × 10⁹ cells/ml were used to immunize all mice on the 7th day, and a booster dose of the same quantity of SRBC was given on the 11th day of the experiment. After 14 days of oral treatment with 100 and 200 mg/kg bw of orchid extract, the mice were sacrificed to collect serum and organs. Hematological assays, delayed type of hypersensitivity assays, phagocytic index (PI), and histopathological investigations were used to assess in vivo immunomodulatory efficacy.

Results

The body weight changes of the experimental animals were considerably greater at 100 mg/kg bw than at a higher dose (200 mg/kg bw). There was a substantial improvement of relative organ weights of the thymus and spleen at the low dose, but no effect on kidney weights was evident. The liver weight increased significantly (p < 0.05) at both doses. Total neutrophil, leukocyte, and lymphocyte counts, hemoglobin percentage, delayed hypersensitivity reaction, and PI were all significantly (p < 0.05) increased in mice receiving the lower dose. In contrast to the control group, the higher dose reduced immunological response, suggesting the negative influence of a higher dose of extracts on the immune reaction.

Conclusions

The results demonstrate that orchid extracts can potentially modulate the innate immune system in the experimental animal.

Epiphytic Acampe ochracea orchid relieves paracetamol-induced hepatotoxicity by inhibiting oxidative stress and upregulating antioxidant genes in in vivo and virtual screening

Orchids are basically ornamental, and biological functions are seldom evaluated. This research investigated the effects of Acampe ochracea methanol extract (AOME) in ameliorating the paracetamol (PCM) induced liver injury in Wistar albino rats, evaluating its phytochemical status through UPLC-qTOF-MS analysis. With molecular docking and network pharmacology, virtual screening verified the inevitable interactions between the UPLC-qTOF-MS-characterized compounds and hepatoprotective drug receptors. The AOME has explicit a dose-dependent decrease of liver enzymes acid phosphatase (ACP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), total bilirubin, as well as an increase of serum total protein and antioxidant enzymes catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GSH) with a virtual normalization (p < 0.05-p < 0.001) and the values were almost equivalent to the reference drug silymarin. After pretreatment with AOME, PCM-induced malondialdehyde (MDA) levels were considerably decreased (p < 0.001). Histopathological examinations corroborated the functional and biochemical findings. The AOME upregulated the genes involved in antioxidative (CAT, SOD, β-actin, PON1, and PFK1) and hepatoprotective mechanisms in PCM intoxicated rats. An array of 103 compounds has been identified from AOME through UPLC-qTOF-MS analysis. The detected compounds were substantially related to the targets of several liver proteins and antioxidative enzymes, according to an in silico study. Virtual prediction by SwissADME and admetSAR showed that AOME has drug-like, non-toxic, and potential pharmacological activities in hepatic damage. Furthermore, VEGFA, CYP19A1, MAPK14, ESR1, and PPARG genes interact with target compounds impacting the significant biological actions to recover PCM-induced liver damage.

Natural Compounds from Hatikana Extract Potentiate Antidiabetic Actions as Displayed by In Vivo Assays and Verified by Network Pharmacological Tools

BACKGROUND

Hatikana is a traditional medicinal plant used to treat inflammation, urolithiasis, goiter, cancer, wounds and sores, gastrointestinal, tumor, tetanus, arthritis, hepatic damage, neurodegeneration, and other ailments. The goal of this study is to investigate the antidiabetic properties of Hatikana extract (HKEx) and to construct the effects of its natural constituents on the genes and biochemical indices that are connected with them.

METHODS

HKEx was evaluated using GC-MS and undertaken for a three-week intervention in fructose-fed STZ-induced Wistar albino rats at the doses of HKEx50, HKEx100, and HKEx200 mg/kg bw. Following intervention, blood serum was examined for biochemical markers, and liver tissue was investigated for the mRNA expression of catalase (CAT), glutathione peroxidase (GPx), and superoxide dismutase (SOD1) by RTPCR analysis. Most abundant compounds (oleanolic acid, 7α, 28-olean diol, and stigmasterol) from GC-MS were chosen for the network pharmacological assay to verify function-specific gene-compound interactions using STITCH, STRING, GSEA, and Cytoscape plugin cytoHubba.

RESULTS

In vivo results showed a significant (P < 0.05) decrease of blood sugar, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine kinase (CK-MB), and lactate dehydrogenase (LDH) and increase of liver glycogen, glucose load, and serum insulin. Out of three antioxidative genes, catalase (CAT) and superoxide dismutase (SOD1) were found to be few fold increased. Oleanolic acid and stigmasterol were noticed to strongly interact with 27 target proteins. Oleanolic acid interacted with the proteins AKR1B10, CASP3, CASP8, CYP1A2, CYP1A2, HMGB1, NAMPT, NFE2L2, NQO1, PPARA, PTGIR, TOP1, TOP2A, UGT2B10, and UGT2B11 and stigmasterol with ABCA1, ABCG5, ABCG8, CTSE, HMGCR, IL10, CXCL8, NR1H2, NR1H3, SLCO1B1, SREBF2, and TNF. Protein-protein interaction (PPI) analysis revealed the involvement of 25 target proteins out of twenty seven. Cytoscape plugin cytoHubba identified TNF, CXCL8, CASP3, PPARA, SREBF2, and IL10 as top hub genes. Pathway analysis identified 31 KEGG metabolic, signaling, and immunogenic pathways associated with diabetes. Notable degree of PPI enrichment showed that SOD1 and CAT are responsible for controlling signaling networks and enriched pathways.

CONCLUSION

The findings show that antioxidative genes have regulatory potential, allowing the HKEx to be employed as a possible antidiabetic source pending further validation.

Virtual screening of functional foods and dissecting their roles in modulating gene functions to support post COVID-19 complications

COVID‐19 has become the focal point since 2019 after the outbreak of coronavirus disease. Many drugs are being tested and used to treat coronavirus infections; different kinds of vaccines are also introduced as preventive measure. Alternative therapeutics are as well incorporated into the health guidelines of some countries. This research aimed to look into the underlying mechanisms of functional foods and how they may improve the long‐term post COVID‐19 cardiovascular, diabetic, and respiratory complications through their bioactive compounds. The potentiality of nine functional foods for post COVID‐19 complications was investigated through computational approaches. A total of 266 bioactive compounds of these foods were searched via extensive literature reviewing. Three highly associated targets namely troponin I interacting kinase (TNNI3K), dipeptidyl peptidase 4 (DPP‐4), and transforming growth factor beta 1 (TGF‐β1) were selected for cardiovascular, diabetes, and respiratory disorders, respectively, after COVID‐19 infections. Best docked compounds were further analyzed by network pharmacological tools to explore their interactions with complication‐related genes (MAPK1 and HSP90AA1 for cardiovascular, PPARG and TNF‐alpha for diabetes, and AKT‐1 for respiratory disorders). Seventy‐one suggested compounds out of one‐hundred and thirty‐nine (139) docked compounds in network pharmacology recommended 169 Gene Ontology (GO) items and 99 Kyoto Encyclopedia of Genes and Genomes signaling pathways preferably AKT signaling pathway, MAPK signaling pathway, ACE2 receptor signaling pathway, insulin signaling pathway, and PPAR signaling pathway. Among the chosen functional foods, black cumin, fenugreek, garlic, ginger, turmeric, bitter melon, and Indian pennywort were found to modulate the actions. Results demonstrate that aforesaid functional foods have attenuating roles to manage post COVID‐19 complications.

Frequency of Osteoporosis among Chronic Obstructive Pulmonary Disease Patients Attending Respiratory Medicine Out Patient Department, BSMMU

Osteoporosis is an important systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD). Osteoporosis is a systemic disease of bone which may present as low bone mass and micro-architectural disarray that increases the risk of fracture. The World Health Organization defines osteoporosis as bone density ≥2.5 standard deviations below the bone density of a normal young adult. Osteopenia, a less severe form of bone loss, is defined as a bone density between 1 and 2.5 standard deviations below that reference point. The aetiology of osteoporosis in COPD patients remain unclear, but several factors significantly correspond to reduced bone density in COPD, including older age, female sex and body mass index (BMI). However, the relationship to other factors, such as FEV₁, tobacco smoking, physical inactivity and corticosteroid therapy, are still an unresolved issue. This cross-sectional study was done in the Department of Respiratory Medicine, BSMMU from March 2018 to March 2019. A total of 86 patients of which prevalence of osteoporosis is 29.1%, osteopenia 50% and normal BMD in 20.9%, majority of them was belonging to age group 51-60 years. Male were predominant with male-female ratio of 3.5:1. The frequency of osteoporosis was 32.0%, 64.0% and 4.0% in moderate, severe and in very severe COPD patients, respectively. The frequency of osteopenia was 14.0% in mild, 53.5% in moderate, 20.9% in severe and 11.6% were in very severe COPD patients. The p value (p=0.018) was significant for prevalence osteoporosis and osteopenia with increase in severity of COPD. The prevalence of osteoporosis and osteopenia was high in COPD patients under study. The frequency of osteoporosis and osteopenia was more with severity of COPD.

P14.09 BORTEM-17: A Phase IB/II Single-Arm, Control Non-Randomized, Multicentre, Open Label Clinical Trial for Recurrent Glioblastoma with unmethylated MGMT promoter (NCT03643549)

BACKGROUND

Glioblastoma (GBM) is the most malignant primary brain tumor in adults where median survival in unselected patients is approximately 10 months. There is no standard treatment for patients who progress on temozolomide and patients are best treated within investigational clinical protocols. Patients harbouring tumours with functional O⁶ methylguanine DNA methyltransferase (MGMT) DNA repair enzyme have particularly poor prognosis with median overall survival of 12.7 months, compared to 21.7 months for patients with hypermethylated MGMT promoter. The pre-clinical studies have shown that Bortezomib depletes the MGMT enzyme, restoring the tumour ´s susceptibility to Temozolomide, if the chemotherapy is administered in the precise schedule when the MGMT enzyme is depleted. Additionally, Bortezomib shows an antitumour effect by blocking autophagy flux. Based on the promising pre-clinical results, a non-randomized, open label phase IB/II clinical trial was designed. The primary endpoints include assessment of safety of Bortezomib administered with Temozolomide for phase IB and median progression free survival, overall survival as well as progression free rate at 6 months.

MATERIAL AND METHODS

Recurrent glioblastoma patients with unmethylated MGMT promotor, progressing at least 12 weeks after completion of postoperative radiotherapy, with adequate organ function, performance status Karnofsky 70 or better and radiologically measurable lesions are screened for study inclusion. The experimental treatment consists of Bortezomib 1.3mg/m² administered IV on days 1, 4, 7, during each 4-week chemotherapy cycle with per oral Temozolomide at 200mg/m² 5 days/week every 4 weeks starting on day 3. Study group will be compared to historical controls on conventional management. The sample size was calculated to 63 patients, ten of them were included in the phase IB.

RESULTS

The phase IB of the trial was completed in 2019 and the combination of Temozolomide and Bortezomib was shown to be safe and well tolerated. Until April 2021 a total number of 23 patients were included into the trial. The patients are treated at 4 different referral university hospitals in Norway. A clinical treatment benefit with both radiological tumor volume response and stable disease were observed. The patient inclusion in the trial is delayed due COVID-19. The majority of observed side effects are mild or moderate. The grade 3 or 4 adverse effects included thrombocytopenia, ataxia, muscle weakness, delirium and hyperglycemia. Patients that progressed under the treatment received another line of therapy according to the institutional practice.

CONCLUSION

A combination of Bortezomib and Temozolomide administered in a defined time sequence to achieve sensitization of glioblastoma to alkylating agent is safe and feasible and may represent a novel treatment option for patients with this devastating disease.

P14.65 Survival in a consecutive series of 467 glioblastoma patients: impact of prognostic factors and recurrent treatment at two independent institutions

BACKGROUND

Glioblastoma (GBM) is an aggressive primary brain tumor with median overall survival (OS) of less than one year in unselected adult patients. There is no standard therapy at recurrence. We aimed to evaluate OS in a consecutive series of GBM patients from Norway’s two largest regional health authorities, compare the effect of physicians’ choice of antineoplastic treatment upon recurrence and identify prognostic and predictive factors.

MATERIAL AND METHODS

Clinicopathological data from n=467 patients with histologically confirmed GBM diagnosed and treated at Haukeland and Oslo university hospitals from January 2015 to December 2017 was retrospectively collected. Data included tumor location, methylation status of the methylguanine-DNA methyltransferase (MGMT) promoter and mutation of the isocitrate dehydrogenase (IDH) genes, patient age and sex, extent of tumor resection at primary diagnosis, and treatment at first, second and third tumor recurrences. Cox-proportional hazards regression with pairwise analyses adjusted for multiple testing with Scheffé’s post-hoc test were used to adjust effect of multiple risk factors on mortality.

RESULTS

Median OS was 12.1 months and 21.4 % and 6.8 % of patients were alive at 2 and 5 years, respectively. Treatment at recurrence varied between institutions but did not impact OS (p=0.201). Median time to progression was 8.2 months. Age, MGMT promoter methylation, tumor location and extent of tumor resection were all independent prognostic factors for OS. Patients receiving radiotherapy to 60 Gray with concomitant and adjuvant temozolomide at primary diagnosis had best outcome with median OS of 16.1 months and 9.3% were alive at 5 years. At first recurrence patients eligible for gammaknife/stereotactic radiosurgery (GK/SRS) or surgery, alone or combined with chemotherapy, had superior survival compared to chemotherapy alone (p&lt;0.0001 and p=0.014, respectively). On Scheffé’s post-hoc analyses only GK/SRS was superior to chemotherapy (p=0.01). At second and third recurrence none of the antineoplastic strategies came across as superior or inferior to each other using Cox. On Scheffé’s post-hoc analyses chemotherapy alone and combined with bevacizumab were superior at second recurrence (p=0.008 and p=0.042, respectively) and chemotherapy combined with bevacizumab was superior at third recurrence (p=0.043), compared to no antineoplastic treatment. Our retrospective study is limited by small sample sizes and heterogeneous treatment groups, especially at second and third recurrences, as well as patient selection.

CONCLUSION

Recurrence treatment differed between the two institutions but there was no difference in OS. Our findings underline the lack of standard therapy upon GBM recurrence and the urgent need for novel therapeutic strategies.

Thunbergia laurifolia leaf extract partially recovers lead-induced renotoxicity through modulating the cell signaling pathways

This research investigated the reno-protective effect of Thunbergia laurifolia Linn. (TL) in a lead-induced toxicity test through the modulation of cell signaling pathways. The study carried out to evaluate the effect of TL leaf extracts in Swiss Albino mice exposed to lead acetate (PbAc). Prior to in vivo study, a probable kidney-protective effect of the plant leaf extract was presumed through an activity-specific (PASS) molecular docking analysis. In animal model study, albino mice were divided in seven groups and co-treated with PbAc and TL (100, 200 mg/kgBW) or vitamin E (100 mg/kgBW) for 38 days, whereas the untreated control, TL control, and vehicle control groups received sodium acetate, PbAc, sodium acetate plus mineral oil, respectively. At the end of treatment, blood and kidney tissue were collected for investigating Pb concentration, estimating biochemical profile, evaluating oxidative stress and inflammatory parameters. The histopathological change of kidney along with apoptosis was assessed from kidney sections using H & E staining and TUNEL assay. Pb-exposed mice were found to be increased concentration of Pb in the blood and kidney sample, which further led to increased MDA levels in the plasma, blood, and tissue. Followed by kidney damage, increased expression of TNF-α, iNOS, and COX-2 in kidney tissues were noticed, which were related to elevated TNF-α in the systemic circulation of Pb-treated mice. Co-treatment with TL or vitamin E significantly reduced altered structure and apoptosis of kidney tissues. Downregulation of inflammatory markers especially TNF-α, iNOS, and COX-2 with simultaneous improvement of renal function through reduced plasma BUN and creatinine levels demonstrate that TL act as a potential dietary supplement to detoxify Pb in kidney showing an antioxidant and anti-inflammatory effect.

Realization of Structural Colors via Capped Cu-based F-P Cavity Structure

Structural colors with tunable properties have several applications in the beautification of mobile devices, surface decoration, art and color filters. Herein, we propose an asymmetric F-P cavity design to systematically tune structural colors by changing the thickness of the top metal and intermediate insulator. In this study, Cu and Si₃N₄ were chosen as the top metal and intermediate insulator layers, respectively, various reflection colors being realized on the Cu surface. Various capping layers-that is, SiO₂, polymethyl methacrylate (PMMA), and a commercially available clear coat named ProtectaClear-were used to protect the Cu surface from scratching and oxidation. PMMA coatings can protect Cu from corrosive environments without degradation of the color quality. The colors can be tuned by controlling the thickness of either the metal or intermediate insulator layers, and vivid structural colors-including orange, bright orange, red, purple, violet, light blue, green-yellow, and yellow-green-can be printed. The colors obtained can be attributed to thin-film interference.

Pleurotus highking mushrooms potentiate antiproliferative and antimigratory activity against triple-negative breast cancer cells by suppressing Akt signaling

In this study, we evaluated the antiproliferative and antimetastatic effects of the Pleurotus highking mushroom on the human triple-negative breast cancer cell lines MDA-MB-231 and HCC-1937 and attempted to elucidate the underlying molecular mechanisms. The antiproliferative effects of P. highking purified fraction-III (PEF-III) were investigated using colony formation and MTS assays. The antimigratory effects of PEF-III were determined by wound healing, transwell migration, and matrigel cell invasion assays. The protein expression levels were evaluated using Western blot analysis. The effect of PEF-III on tumor-sphere formation was examined in a 3D sphere-forming medium, and the mRNA expressions of proliferation- and migration-related genes in the cells from the tumor spheres were determined using RT-qPCR. PEF-III treatment caused a potent and concentration-dependent decrease in the numbers of colonies and viable cells. It also remarkably suppressed the migratory ability of the cells. Mechanistically, PEF-III treatment reduced the expression of pAkt, matrix metallopeptidase-9 (MMP-9), and vimentin. Furthermore, PEF-III reduced the number and size of the tumor spheres in the 3D culture system. It also significantly reduced the mRNA expression of Ki-67, MMP-9, and vimentin in the PEF-III-treated tumor-sphere cells. PEF-III exerted promising antiproliferative and antimigratory effects in triple-negative breast cancer cell lines by suppressing Akt signaling. Therefore, P. highking mushrooms may be considered a potential source for the development of potent anticancer drug(s) for the treatment of breast cancer.

Pharmacoinformatics and UPLC-QTOF/ESI-MS-Based Phytochemical Screening of Combretum indicum against Oxidative Stress and Alloxan-Induced Diabetes in Long-Evans Rats

This research investigated a UPLC-QTOF/ESI-MS-based phytochemical profiling of Combretum indicum leaf extract (CILEx), and explored its in vitro antioxidant and in vivo antidiabetic effects in a Long-Evans rat model. After a one-week intervention, the animals' blood glucose, lipid profile, and pancreatic architectures were evaluated. UPLC-QTOF/ESI-MS fragmentation of CILEx and its eight docking-guided compounds were further dissected to evaluate their roles using bioinformatics-based network pharmacological tools. Results showed a very promising antioxidative effect of CILEx. Both doses of CILEx were found to significantly (p < 0.05) reduce blood glucose, low-density lipoprotein (LDL), and total cholesterol (TC), and increase high-density lipoprotein (HDL). Pancreatic tissue architectures were much improved compared to the diabetic control group. A computational approach revealed that schizonepetoside E, melianol, leucodelphinidin, and arbutin were highly suitable for further therapeutic assessment. Arbutin, in a Gene Ontology and PPI network study, evolved as the most prospective constituent for 203 target proteins of 48 KEGG pathways regulating immune modulation and insulin secretion to control diabetes. The fragmentation mechanisms of the compounds are consistent with the obtained effects for CILEx. Results show that the natural compounds from CILEx could exert potential antidiabetic effects through in vivo and computational study.

Natural compounds from Leea macrophylla enhance phagocytosis and promote osteoblasts differentiation by alkaline phosphatase, type 1 collagen, and osteocalcin gene expression

The current study investigated the immunomodulating and osteoblast differentiation potential of the natural compounds from Leea macrophylla (LMN). Immunomodulatory effects have been investigated by the phagocytosis of Candida albicans using polymorphonuclear neutrophil cells in the in vitro slide method. A bioactivity-guided fractionation technique was used to evaluate the stimulating effect of L. macrophylla methanol extract on osteoblast differentiation using mouse osteoblastic cells. A low dose of LMN was found to stimulate the phagocytic effect better than a higher dose. The natural compounds from L. macrophylla have significantly increased alkaline phosphatase (ALP) and osteocalcin activities. The LMN promoted the osteoblast differentiation through upregulation of ALP, osteocalcin, and type 1 collagen in a dose-dependent manner. These natural compounds also upregulated ALP, osteocalcin, and type 1 collagen gene expressions. The data suggest that LMN has potential anabolic sequel on bone formation and osteoblast differentiation.

Pulmonary Rehabilitation: A Weapon to Fight against COVID-19

No Abstract.

Correlates of Children's Nutritional Status in Bangladesh: Does Mothers' Education Matter?

This paper intends to identify the correlates of Bangladeshi children's nutritional status. The primary focus of the paper rests on mothers' education, especially to understand whether different level of mothers' education has varying extent of effect on child nutrition. Data for the empirical analysis of this paper are obtained from a relatively recent national survey: Multiple Indicator Cluster Survey (MICS) 2012-13. Based on a sample of 14,482 children of the age of below 5 years and by using the multiple linear regression analysis, this paper finds evidence to suggest that mothers' education matters for children's both long-term and overall nutritional status in Bangladesh. Nevertheless, education at the lower end has imperceptible effect; while the incremental benefit of below primary education on child nutrition is subtle. Importantly education at the higher end i.e., secondary or more has pronounced effect on children's nutritional status. This finding is worthy of policy attention because girls' dropout at the secondary education in Bangladesh is still very high, which may hinder realising the benefit of the costly public policy of educating girls for the sake of combating widespread child under-nutrition in the country.

Efficacy of Clotrimazole 1% Solution Compared to Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% Cream in Patient with Otomycosis

Fungal infection of the ear canal is called Otomycosis. It is more common in hot and humid condition. There are many modalities of treatment or therapeutic agent for treatment of otomycosis. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream is a topical antifungal agent described to be effective in the treatment of otomycosis. This study was performed to compare the efficacy of topical application clotrimazole 1% solution and Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream in the treatment of otomycosis. A controlled, randomized and open clinical trial was carried out in ENT department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to July 2020. Patients diagnosed with fungal otitis externa who were treated with topical antifungals were included in this study. They were randomized into two treatment groups: i) Clotrimazole 1% solution, 2) Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream. Patients were microscopically evaluated at two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed, follow up and final outcomes (absence of infection) were compared between two groups. One hundred & two (102) patients were included, 51 in the clotrimazole 1% solution group and 51 in the Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group. Predominant symptoms are pain, pruritus, aural fullness and hearing loss. Aspergillus organism was isolated most frequently (63.73%). Treatment with clotrimazole 1% solution groups resulted in 88.23% resolution vs. 80.39% resolution with Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream at 2 weeks of treatment. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group demonstrated higher treatment failure 11.76 and 19.60 respectively. Clotrimazole 1% solution is more effective than Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream for uncomplicated otomycosis. More study is needed to corroborate our results.

Bioactive metabolites of Blumea lacera attenuate anxiety and depression in rodents and computer-aided model

Blumea lacera is an edible plant with imperative medicinal values. However, the anxiolytic and antidepressant roles of B. lacera have not been well-explained. Therefore, the current study aims to explore the impending bioactive metabolites and roles of B. lacera methanol leaf extract (Me-BLL) in attenuating anxiety and depression through several experimental and computer-aided approaches. The chemical characterization of Me-BLL was performed through standard phytochemical and GC-MS analyses. To explore the neuropharmacological insights, Swiss albino mice were treated with Me-BLL at doses of 200-400 mg/kg, p.o. The anxiolytic effects were observed employing elevated plus maze (EPM), light-dark box (LDB), and hole-board (HBT) tests, while antidepressant effects were evaluated using forced swimming (FST) and tail suspension tests (TST). Diazepam (1 mg/kg, i.p.) and fluoxetine HCl (20 mg/kg, p.o.) were used as the reference standard. The phytochemical analyses revealed several bioactive metabolites, including higher contents of total phenolics and flavonoids. The EPM and LDB tests demonstrated an increased time spent in open arms and light box, and the HBT showed an increased number of head dipping, indicating the anxiolytic effects of Me-BLL. The TST and FST revealed a decrease in immobility time, meaning the persuasive antidepressant effects. The antioxidative effects of Me-BLL have also been observed prominently. Correspondingly, the computer-aided investigation confirmed several bioactive lead molecules. Specifically, thymol and cuminol revealed potential anxiolytic and antioxidant effects, while stigmast-5-en-3.beta.-ol and gamma-sitosterol possessed promising antidepressant effects. Taken these results as a base, the plant has imperative potentials in managing anxiety and depression-like disorders.

Tendencies and attitudes towards dietary supplements use among undergraduate female students in Bangladesh

BACKGROUND

Dietary supplements (DS) are products that improve the overall health and well-being of individuals and reduce the risk of disease. Evidence indicates a rising prevalence of the use of these products worldwide especially among the age group 18-23 years.

AIM

The study investigates the tendencies and attitudes of Bangladeshi undergraduate female students towards dietary supplements (DS).

METHODS

A three-month (March 2018-May 2018) cross-sectional face-to-face survey was conducted in undergraduate female students in Chittagong, Bangladesh using a pre-validated dietary supplement questionnaire. The study was carried among the four private and three public university students of different disciplines in Chittagong to record their prevalent opinions and attitudes toward using DS. The results were documented and analyzed by SPSS version 22.0.

RESULTS

Ninety two percent (N = 925, 92.0%) of the respondents answered the survey questions. The prevalence of DS use was high in undergraduate female students. The respondents cited general health and well-being (n = 102, 11.0%) and physician recommendation (n = 101, 10.9%) as a reason for DS use. Majority of the students (n = 817, 88.3%) used DS cost monthly between USD 0.12 and USD 5.90. Most of the students (n = 749, 81.0%) agreed on the beneficial effect of DS and a significant portion (n = 493, 53.3%) recommended for a regular use of DS. Highly prevalent use of dietary supplements appeared in Chittagonian undergraduate female students. They were tremendously positive in using DS. The results demonstrate an increasing trend of using DS by the undergraduate females for both nutritional improvement and amelioration from diseases.

CONCLUSION

Dietary supplements prevalence was so much higher in students of private universities as compared to students of public universities. Likewise, maximal prevalence is indicated in pharmacy department compared to other departments. Students preferred brand products, had positive opinions and attitudes towards dietary supplements.

Glycaemic Status of Asthma Patients Using Inhaled Fluticasone

Inhaled fluticasone is used in asthma for long duration. However, it's adverse effect on glycaemia is debatable. This study observed the outcome of inhaled fluticasone in asthma patients. A cross sectional comparative study was conducted among the normoglycaemic asthma patients aged 18 years and above attending outpatient department of Internal Medicine and Respiratory Medicine department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from June 2017 to May 2018. Study group were getting inhaled fluticasone for minimum three months whereas comparative group were not on any steroids. Each group had 35 eligible participants (n=70). Spirometry and plasma glucose at fasting and 2-hour after 75gm oral glucose intake were measured along with HbA1c%. Statistical analysis was done using SPSS 21.0. In study group mean plasma glucose at fasting was 5.27±0.48mmol/L, 2-hour after 75gm oral glucose was 6.04±1.21mmol/L and mean of HbA1c was 5.57±0.41% whereas in comparative group these were5.17±0.59mmol/L, 5.69±1.09mmol/L, 5.47±0.40% respectively (p=0.25, 0.20, 0.75 respectively). There was no specific co-relation between duration of use of fluticasone inhaler and glycaemic parameters like plasma glucose at fasting, 2-hour after 75gm oral glucose and HbA1c% (r=0.016, p=0.46; r=0.015, p=0.47; r=0.019, p=0.42 respectively). Use of inhaled fluticasone for 3months or more has insignificant effect on plasma glucose levels of asthma patients. Duration of use of inhaled fluticasone has no specific correlation with plasma glucose and HbA1c values.

Proportion of Low Back Pain among Physicians Working in a Tertiary Level Hospital of Bangladesh

Low back pain (LBP) is a common problem and is an important public health issue. A major proportion of LBP is concomitant with prolong and repetitive awkward postures, related with occupation like miners, health workers and professional drivers. Physicians are exposed to a wide range of occupational risk factors which results in LBP. A variety of occupational and personal factors are responsible for increased risk of low back pain among physicians. This cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018, to estimate the proportion of LBP among physicians. Data were collected from purposively selected 102 physicians of different levels by face to face interview using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 20.0. The study results revealed that majority (60.8%) of the physicians were in the age group of 31-50 years. Mean age of the physicians was 49.9 years with a standard deviation (SD) of 3.61 years. More than three fourth (79, 77.5%) of the physicians were male and 23(22.5%) were female. Out of 102 physicians more than two third (70, 68.6%) had LBP while 32(31.4%) did not have any LBP. Proportion of low back pain among physician was 68.6%. Low back pain was found in all age group. Among the physicians having low back pain, 55(78.6%) were male and 15(21.4%) were female. Among 102 physicians, 45(44.1%) had different types of comorbidities while 57(55.9%) did not have any comorbidities. Among the co-morbidities HTN, DM, Dyslipidemia, CHD and asthma were common. Results of the study concluded that 68.6% physicians had low back pain. Physicians of age group 31-60 years (88.5%) and male (78.6%) experienced LBP more. Further multi-centric large scale case control study is recommended to determine the risk factors of LBP among physicians of Bangladesh.

Hyponatraemia in Adult Patients with Pneumonia in a Medical College Hospital of Bangladesh

Pneumonia is an acute on chronic infection involving the pulmonary parenchyma. Most cases are caused by microbial pathogens usually bacteria or viruses and less often fungi or parasites. Hyponatraemia on admission is associated with greater risk of death and increased length of hospital stays. Hyponatraemia is usually related to severe disease and specially occur in old aged people. This study is designed to identify proportion of hyponatraemia in patients with pneumonia and to determine the association of hyponatraemia with the severity of pneumonia. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to December 2018. Data were collected from purposively selected 73 admitted patients with pneumonia by interview, clinical examination and laboratory investigations using a pre-tested case record form. Data were analyzed by using SPSS version 20.0. Quantitative variables were summarized by mean and standard deviation. On the other hand qualitative variables were summarized by percentage. Necessary bivariate analysis was done. Majority (68.5%) of the patients were in the age group of 21 years to 50 years. Mean age of the patients was 41.9 years with a SD of 17.4 years. More than three fourth (57, 78.1%) were male and 16(21.9%) were female. More than two third (51, 69.9%) of the patients were smoker and 45(61.6%) was abuse of chewable tobacco or ghul. All the patients had fever (73, 100.0%); 70(95.9%) had cough, 50(68.5%) had chest pain, 10(13.5%) had respiratory distress and 8(11.0%) had haemoptysis. Vomiting was present in 9(12.3%) patients and 3(4.1%) had impaired level of consciousness. About one third of patients (32, 43.8%) had comorbidities. On chest X-ray consolidation was found in 59(80.8%) of patients with pneumonia. In 35(47.9%) patients serum Na⁺ level was normal and 38(52.1%) had different level of hyponatraemia; 26(35.6%) patients had mild hyponatraemia, 7(9.6%) had moderate hyponatraemia and 5(6.8%) had severe hyponatraemia. Majority (58, 79.5%) had lobar pneumonia and 71(97.3%) had community acquired pneumonia. Severity of pneumonia was assessed according to CURB 65. Less than half (35, 47.9%) of the patients had mild (score 0-1) pneumonia; 33(45.2%) had moderate (score 2) pneumonia and 5(6.8%) patients had severe (score ≥3) pneumonia. Average duration of hospital stay was 6.5±3.2 days. Maximum (69, 94.5%) patients were cured after treatment. In case of 3(4.1%) patients pneumonia was unresolved. One (1.4%) patients died due to pneumonia. In this study hyponatraemia was not associated with the severity of pneumonia (p>0.05) and outcome on discharge from the hospital (p>0.05). Difference in mean duration of hospital stay between patients of pneumonia with or without hyponatraemia was not significant (>0.05). The study results revealed that 52.1% patients with pneumonia developed different level of hyponatraemia. Hyponatraemia was not associated with the severity of pneumonia, duration of hospital stay and outcome of pneumonia.

Pretreatment of Blumea lacera leaves ameliorate acute ulcer and oxidative stress in ethanol-induced Long-Evan rat: A combined experimental and chemico-biological interaction

Blumea lacera (Burm.f.) DC. is described as a valuable medicinal plant in various popular systems of medicine. The aim of the experiment reports the in vivo antiulcer activity of methanol extract of Blumea lacera (MEBLL) and in silico studies of bioactive constituents of MEBLL. In this study, fasted Long-Evans rat treated with 80 % ethanol (0.5 mL) to induce gastric ulcer, were pretreated orally with MEBLL at different doses (250 and 500 mg/kg, p.o., b.w) and omeprazole (20 mg/kg, p.o.) and distilled water were used as a reference drug and normal control respectively. In silico activity against gastric H+-K+ATPase enzyme was also studied. The findings demonstrated that the treatment with MEBLL attenuated markedly ulcer and protected the integrity of the gastric mucosa by preventing the mucosal ulceration altered biochemical parameters of gastric juice such total carbohydrate, total protein and pepsin activity. Additionally, the experimental groups significantly (p < 0.001) inhibited gastric lesions and malondealdehyde (MDA) levels and upregulated antioxidant enzymes level. Furthermore, nine compounds were documented as bioactive, displayed good binding affinities to against gastric H+-K+ATPase enzyme while these compounds illustrated inhibitory effect. From these studies, it is established MEBLL has ulcer healing property as unveiled by in vivo and in silico studies.

Therapeutic Potentials of Syzygium fruticosum Fruit (Seed) Reflected into an Array of Pharmacological Assays and Prospective Receptors-Mediated Pathways

Syzygium fruticosum (SF), a valuable Bangladeshi fruit, is considered an alternative therapeutic agent. Mainly, seeds are used as nutritional phytotherapy to ease physical and mental status by preventing chronic diseases. Here, we scrutinized the S. fruticosum seed's fundamental importance in traditional medicine by following an integrated approach combining in vivo, in vitro, and in silico studies. The SF was fractionated with different solvents, and the ethyl acetate fraction of SF (EaF-SF) was further studied. Mice treated with EaF-SF (200 and 400 mg/kg) manifested anxiolysis evidenced by higher exploration in elevated plus maze and hole board tests. Similarly, a dose-dependent drop of immobility time in a forced swimming test ensured significant anti-depressant activity. Moreover, higher dose treatment exposed reduced exploratory behaviour resembling decreased movement and prolonged sleeping latency with a quick onset of sleep during the open field and thiopental-induced sleeping tests, respectively. In parallel, EaF-SF significantly (p < 0.001) and dose-dependently suppressed acetic acid and formalin-induced pain in mice. Also, a noteworthy anti-inflammatory activity and a substantial (p < 0.01) clot lysis activity (thrombolytic) was observed. Gas chromatography-mass spectrometry (GC-MS) analysis resulted in 49 bioactive compounds. Among them, 12 bioactive compounds with Lipinski's rule and safety confirmation showed strong binding affinity (molecular docking) against the receptors of each model used. To conclude, the S. fruticosum seed is a prospective source of health-promoting effects that can be an excellent candidate for preventing degenerative diseases.

COVID-19 Rehabilitation Response in Bangladesh: Ongoing Efforts and Future Directives

COVID-19 pandemic brings significant number of post-acute and chronic disabilities requiring attention to Physical Medicine and Rehabilitation (PMR) services. Total Health and Rehabilitation sector in Bangladesh is overwhelmed; patient care and academic activities are seriously impacted by this pandemic. Rehabilitation team works and academic calendar is disrupted. Bangladesh PMR working to manage COVID-19 imposed rehabilitation challenges with adjustment and adaptations of the existing facilities. There is an urgent need to undertake additional measures promptly, including rehabilitation capacity building anticipating the potential challenge that would be faced by the hospitals in the estimated upsurge of COVID-19 cases and its complications thereafter. This topic highlights the activity log for COVID-19 preparedness and mitigation for rehabilitation services in Bangladesh with a message for other rehabilitation settings in the world.

Comparison between Efficacy of Combined Use of Hyaluronidise and Triamcinolone versus Hyaluronidise, Triamcinolone Acetonide and Oral Colchicine in the Treatment of Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) is a chronic complex potentially pre-malignant condition caused by chewing areca nut and other irritants. It is an insidious process characterized by Juxta-epithelial deposition of fibrous tissue in the oral cavity and pharynx. OSF is very common in Southeast Asia and also now a days increase in Europe and North America. The aim of this study to compare the effectiveness of intralesional injection of triamcinolone and hyalurunidase versus intralesional injection of triamcinolone plus injection hyalurunidase with oral colchicine. The study included 60 patients of clinically diagnosed case of oral submucous fibrosis. Patients were divided into two Groups A and B. Group A patients received combination intralesionsl injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml. 15 days interval in 3 months and Group B received intralesional injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml in each 15 days interval for 3 months with oral colchicine 0.5mg twice daily for 3 months. Diagnosis based on burning sensation of mouth, blanching of mucosa, ulceration in oral cavity and also reduced mouth opening. Follow up assessment was done at intervals 1st follow up on 21st days after starting of treatment then 2nd follow up after 3 months and last 3rd follow up after 6 months. Before starting of treatment all patients were properly explained about the study and took their written consent. Much more improvement occurred in Group B patients, reducing in burning sensation and also increases in opening of mouth. In both groups blanching mucosae were improved. Treatment regimen of Group B is more effective in increasing mouth opening and improves burning sensation of oral cavity. No side effects were seen in both groups' patients.

Association of Low Thyroid Hormone with Migraine Headache

This cross sectional comparative study was done to investigate the association between low thyroid hormone level and migraine headache in adults patients. The study was conducted in Mymensingh Medical College Hospital, a tertiary level hospital of Bangladesh. Study period was from November 2017 to April 2018. The study subjects consisted of 50 patients with migraine headache as case, compared with 50 patients of headache other than migraine as control, seen in Neurology out patient department (OPD). Thyroid function test was performed by new automated immuno-chemiluminometric assay. Mean age was 29.80±9.87 years in migraine group and 34.18±11.82 years in non migraine group. Male female ratio was 1:2.3 and 1:1.7 in two groups. Level of TSH was significantly higher in migraine patients (3.52±2.53 vs. 2.25±2.13) than other headache patients (p=0.008). Thyroid disorder especially subclinical hypothyroidism was significantly higher (28% vs. 08%) in migraineurs than non migraineurs (p=0.032). No significant relationship was found between thyroid hormone level and headache characteristics of migraine patients (p>0.05). Migraine headache is associated with low thyroid hormone and thyroid disorder can be considered as comorbidity of migraine headache.

Level of Serum Vitamin D, To Which People Are at Risk of Developing Acute Myocardial Infarction in Bangladesh

Incidence of Myocardial Infarction is increasing day by day in developing countries. Most of the patients who sustain myocardial infarction have coronary atherosclerosis. There are several risk factors for the development of atherosclerosis. Among all the risk factors, vitamin D deficiency has been proposed to play an important role in the development of atherosclerosis. With this aim, a case-control study was carried out to explore the association of serum vitamin D with acute myocardial infarction. The enrolled study subjects were categorized into Group A which comprised of STEMI, Group B, comprised of NSTEMI and Group C comprised of age and sex matched individuals free from acute myocardial infarction. The mean values of serum vitamin D (in ng/ml) were 20.17, 20.8 and 24.77 respectively in STEMI, NSTEMI and control groups. It differed significantly among groups (p<0.001) and it was significantly low in STEMI and NSTEMI groups compared to control group (p<0.001 and p=0.004). From this study it can be concluded that low serum vitamin D is an independent risk factor for developing acute myocardial infarction. Individuals with serum vitamin D <20ng/ml have higher chance of developing acute myocardial infarction compared to those with serum vitamin D >20ng/ml.

Titanium (IV) complexes of some tetra-dentate symmetrical bis-Schiff bases of 1,6-hexanediamine: Synthesis, characterization, and in silico prediction of potential inhibitor against coronavirus (SARS-CoV-2)

Symmetrical bis‐Schiff bases (LH₂) have been synthesized by the condensation of 1,6‐hexanediamine (hn) and carbonyl or dicarbonyl. One of the synthesized Schiff bases has been subjected to the molecular docking for the prediction of their potentiality against coronavirus (SARS‐CoV‐2). Molecular docking revealed that tested Schiff base possessed high binding affinity with the receptor protein of SARS CoV‐2 compared with hydroxychloroquine (HCQ). The ADMET analysis showed that ligand is non‐carcinogenic and less toxic than standard HCQ. Schiff bases acting as dibasic tetra‐dentate ligands formed titanium (IV) complexes of the type [TiL(H₂O)₂Cl₂] or [TiL(H₂O)₂]Cl₂ being coordinated through ONNO donor atoms. Ligands and complexes were characterized by the elemental analysis and physicochemical and spectroscopic data including FTIR, ¹H NMR, mass spectra, UV‐Visible spectra, molar conductance, and magnetic measurement. Optimized structures obtained from quantum chemical calculations supported the formation of complexes. Antibacterial, antifungal, and anti‐oxidant activity assessments have been studied for synthesized ligands and complexes.

Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma

This prospective study was conducted at Department of ENT, Mymensingh Medical College Hospital, a tertiary care center in Bangladesh January 2017 to December 2018 to report hearing results and post operative complications of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma where ossicular chain is eroded or has to be removed either partially or totally. Total 42 patients underwent Intact canal wall (ICW) tympanoplasty for cholesteatoma with at least intact stapes footplate and in conjunction, cartilage ossiculoplasty was done during the same procedure. Patients were followed up regularly at 1 week, 1 month, 3 month, 6 month and at 1 year as usual follow up protocol to note complications and hearing status in 1 year follow up. In intact stapes suprastructure group, in the preoperative period, the mean air conduction thresholds (AC), bone conduction threshold (BC) and air-bone gap (ABG) were 48.3db, 9.5db and 38.8db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG were 27.6db, 9.7db and 17.9db respectively. In missing stapes supra structuregroup, in the preoperative period, the mean air conduction thresholds (AC), Bone conduction threshold (BC) and air-bone gap (ABG) were 57.4db 13.5db and 43.9db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG, were 33.9db, 14.2db and 19.7db respectively. For management of cholesteatoma cases, cartilage ossiculoplasty can be done effectively in conjunction with of intact canal wall tympanoplasty in a single setting. Complications are a few and easily manageable. Hearing results are at least as good as with other prosthesis and helps in avoiding subsequent surgery, discomfort and cost to the patients.

SHadow Under the Lamp (SHUL): Smoking behavior of the health professionals

Background

Smoking cessation is the best option a health professional can offer to the patients for averting the preventable causes of mortality and morbidity.

Purpose

To determine smoking behavior, preferred cessation methods, and attitudes towards smoking cessation amongst health professionals.

Methods

The cross-sectional study, conducted in six countries, included doctors and nurses working at different hospital settings. Participants responded anonymously to an online questionnaire.

Results

Among 1109 participants, 36% were from Saudi Arabia, 14% from Nepal, 14% from Indonesia, 12% from Australia, 12% from Jordan, and 12% from Pakistan. Mean age was 33 years, 61% were females and 58% were nurses. One in eight (12%) was daily smoker. Among current smokers, 42% smoked 2-9 cigarettes/day, and 26% had their first cigarette within 5-30 minutes after waking up. Half of the smokers perceived it as 'very important' to quit smoking, 30% had tried to quit in the last six months, and 31% preferred to have a group quit program with the same health professionals. Only 17% had formal training on smoking cessation, but 57% were interested to receive one. Half of the participants said they (53%) 'always' asked patients if they smoked, but 89% said they advised to quit, 76% said they assessed intention to quit, 28% said they assisted by providing materials on cessation, and 33% said they arranged follow up for cessation. Compared to current smokers, never smokers were more likely to 'always' ask patients if they smoked (78% vs. 22%, p = 0.044, ORs 1.39, 95%CIs 1.01-1.91), assist smokers by setting quit dates (74% vs. 26%, p = 0.039, ORs 1.54, 95%CIs 1.03-2.29), arrange follow up (77% vs. 23%, p = 0.044, ORs 1.40, 95%CIs 1.01-1.94).

Conclusions

Health professionals reported moderately good behavior around advice to smokers, but it is much worse among current smokers. Health professionals who smoke should be both encouraged to quit and to better support their patients to do so.

Key messages

Smoking cessation support for patients was not good among health professionals, who were smokers. Health professionals need to quit smoking in order to provide better cessation support for patients.

Phytochemistry, Traditional Use and Pharmacological Activity of Picrasma quassioides: A Critical Reviews

Picrasma quassioides is a member of the Simaroubaceae family commonly grown in the regions of Asia, the Himalayas, and India and has been used as a traditional herbal medicine to treat various illnesses such as fever, gastric discomfort, and pediculosis. This study aims to critically review the presence of phytochemicals in P. quassioides and correlate their pharmacological activities with the significance of its use as traditional medicine. Data were collected by reviewing numerous scientific articles from several journal databases on the pharmacological activities of P. quassioides using certain keywords. As a result, approximately 94 phytochemicals extracted from P. quassioides were found to be associated with quassinoids, β-carbolines and canthinones. These molecules exhibited various pharmacological benefits such as anti-inflammatory, antioxidant, anti-cancer, anti-microbial, and anti-parasitic activities which help to treat different diseases. However, P. quassioides were also found to have several toxicity effects in high doses, although the evidence regarding these effects is limited in proving its safe use and efficacy as herbal medicine. Accordingly, while it can be concluded that P. quassioides may have many potential pharmacological benefits with more phytochemistry discoveries, further research is required to determine its real value in terms of quality, safety, and efficacy of use.

COVID 19: Importance of Physical Rehabilitation Medicine Capacity Building

No Abstract.

Oral Mucosal Graft Augmented Anastomotic Urethroplasty for Post Traumatic Urethral Stricture and Distraction Defect: Outcome in 100 Patients

The surgical procedures of post traumatic posterior urethral stricture and distraction defects range from the extremely simple to the extremely radical. In oral Mucosal Graft Augmented Anastomotic Urethroplasty (OMG AAU) the stricture segment is excised followed by partially re-anastomosis of the dorsal or ventral urethral wall then the reconstruction is completed by placement of oral mucosal graft into the remaining urethral defect. The aim of this study is to determine the impact and assess the effectiveness of this technique, discuss the procedure and outcome and to refine them where found lacking. A prospectively collected review of records was done from September 2010 to April 2019. A total 100 patients with post traumatic urethral stricture and distraction defect were treated by dorsal onlay oral mucosal graft augmented anastomotic urethroplasty by same surgeon in a single centre. All were followed up every 3 and 6 monthly for 1-2 years with uroflowmetry. Retrograde urethrogram/Micturating cysto-urethrogram (RGU/MCU) and cystoscopy were reserved for those who had complained of obstructive symptoms and uroflowmetry evidence of outflow obstruction. The etiology of trauma was road traffic accident (RTA) (69%), falling astride (28%) and traumatic catheterization (3%). Mean excised stricture length was 1.5cm (Range 1.0-2.2). The mean length of dorsal onlay considering excised stricture length and 1cm spatulations was 4.25cm (range 2.0-6.5). The successful recovery was observed in 94% cases. On conclusion the technique of OMG AAU is very easy to do, reliable and has high success rates. This is also the procedure of choice for long segment obliterative strictures. For post traumatic obliterative strictures and distraction defects we strongly recommend the procedure for successful and patient satisfactory outcome.

Supplements of an aqueous combination of Justicia adhatoda and Ocimum tenuiflorum boost antioxidative effects and impede hyperlipidemia

BACKGROUND

Justicia adhatoda and Ocimum tenuiflorum, locally known as bashok and tulsi, are two ethnomedicinally important herbs that have been using as dietary supplements for several therapeutic applications. This study evaluated the combined effect of both the herbs as an antioxidative and antihyperlipidemic agent.

METHODS

Antihyperlipidemic effect was assessed in a high-fat diet-induced hyperlipidemic model in Wistar albino rats. The rats were treated orally with extracts of bashok (J adhatoda, 200 mg/kg bw), tulshi (O tenuiflorum, 200 mg/kg bw), and a combination of bashok and tulshi (50:50), as well as with a reference drug, atorvastatin (10 mg/kg/day), with or without high-fat diet for 14 days. The antioxidative effect was studied using established in vitro models. The studies were supported by experimentally testing the effects of the extracts on membrane stabilization and inhibition of protein denaturation.

RESULTS

The results showed that the serum lipid profile was significantly decreased in the different treatment groups, with bashok having the greatest effect. Body weights, total serum protein, LDH, and relative liver and adipose tissue weights were markedly restored towards baseline values, the lowest atherogenic index being achieved with the combined extract. The combination treatment significantly enhanced total phenolic content and antioxidative capacity and greatly potentiated membrane stabilization, but inhibition of protein denaturation was not significantly affected.

CONCLUSION

The data demonstrate that a combination of Justicia adhatoda and Ocimum tenuiflorum could be developed as a food supplement with antioxidative and antihyperlipidemic benefits.

Intervention in Neuropsychiatric Disorders by Suppressing Inflammatory and Oxidative Stress Signal and Exploration of In Silico Studies for Potential Lead Compounds from Holigarna caustica (Dennst.) Oken leaves

Holigarna caustica (Dennst.), a popular plant used in folk medicine in Bangladesh, is often used by the local folk practitioner to treat a variety of chronic diseases. The present research is an attempt to find out an innovative therapeutic prospect for the management of neuropsychiatric disorders. The methanol extract of H. caustica leaves (MEHC) were utilized on various behavioral tests for assessing anxiolytic, anti-depressant, and anti-inflammatory activities. The antioxidant potentials and quantitative phytochemicals were evaluated through spectrophotometric methods. Results revealed that treatment of MEHC (200 and 400 mg/kg) significantly reduced anxiety like behaviors in mice, particularly, 400 mg/kg efficiently improved % of entries and time spent (p < 0.05) in the open arms in elevated plus maze test, whereas, superior head dipping tendency (p < 0.05) was observed in hole-board test. In contrast, mice treated with 200 mg/kg revealed better anxiolytic effect in both open field and hole-cross tests. During antidepressant evaluation, mice administrated with MEHC exhibited active behaviors (swimming and struggling) in forced swimming and tail suspension tests. In parallel, MEHC manifested a noteworthy (p < 0.001) suppression of inflammatory response induced by histamine. The MEHC also showed strong antioxidant activities in 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) (IC50: 57.64 μg/mL) scavenging, H2O2 (IC50: 51.60 μg/mL) scavenging, and ferric reducing power assay. The levels of total phenol, flavonoid, flavonol, condensed tannin, and antioxidant were estimated as higher in MEHC. Moreover, 11 compounds were documented as bioactive, displayed good binding affinities to potassium channel receptor, human serotonin receptor, cyclooxygenase (COX-1 and 2), and xanthine oxidoreductase enzyme targets in molecular docking experiments. Furthermore, ADME/T and Prediction of Activity Spectra for Substances (PASS) analyses exposed their drug-likeness, nontoxic upon consumption, and likely pharmacological actions. Overall, the H. caustica is potentially bioactive as evident by in vivo, in vitro, and computational analysis. Our findings support the folkloric value of this plant, which may provide a potential source towards developing drug leads.

Comparison between Outcomes of Endoscopic Sinus Surgery and Surgical Excision in Case of Rhinosporiodiosis

Rhinosporiodiosis is a chronic granulomatous infection of the mucus membranes caused by Rhino sporidium seeberi that manifest as vascular friable polyps and arise in the nasal mucosa. The mode of infection is probably trans-epithelial penetration. Rhinosporiodiosis is endemic in India, Pakistan and Srilanka. It occurs sporadically in the United States of America. The aim of this study was to compare betweenthe outcomes of endoscopic sinus surgery andsurgical excision in rhinosporiodiosis. The cross sectional comparative study was conducted among 40 patients with rhinosporiodiosis from January 2018 to April 2019 in the department of Otolaryngology and Head-neck surgery of Mymensingh Medical College Hospital, Bangladesh. All the patients were following up to 6 month after surgery. Most of them are male 24(60.0%) and female are 16(40.0%). Age of the patients in this study was (Mean±SD) 34.8±13.5 years. More than half of the patients had rhinosporiodiosis in the inferior turbinate (25, 62.5%) followed by 8(20.0%) in nasal septum and 7(17.5%) in the nasal floor. Endoscopic Sinus Surgery was done purposively among 20 patients and surgical excision was done purposively among another 20 patients. At the time of operation no complication occurs in case of endoscopic sinus surgery but in case of surgical excision small of amount bleeding was present. All the patients were followed up to 6 month after surgery. No recurrence was found in patients with endoscopic sinus surgery but 7(35.0%) patients who underwent surgical excision had recurrence of rhinosporiodiosis at follow up after six months of surgery. Chi-square test showed that the incidence of recurrence after 6 months of surgery was significantly lower in endoscopic sinus surgery (p=0.004). The study results concluded that endoscopic sinus surgery is better option for rhinosporiodiosis.

The impact of ZnO configuration as an external layer on the sensitivity of a bi-layer coated polymer optical fiber probe

Salinity magnitude changes are a critical factor for determining the chemistry of natural water bodies and biological processes. Label-free refractive index sensors are promising devices for detecting these changes. A polymer optical fiber (POF) sensor modified with cladding treatment and a bi-layer zinc oxide/silver (ZnO/Ag) nanostructure coating to determine sodium chloride concentration changes through refractive index variations in water is experimentally demonstrated. The use of three ZnO nanostructure shapes, nanoparticles and horizontally and vertically oriented nanorods, as an external layer and a broad spectrum light source from the visible (Vis) to the near infrared (NIR) region are investigated to achieve optimum sensitivity. The rms roughness, optical band-gap and zeta potential (ZP) value for the vertically oriented sample are 148 nm, 3.19 eV and 5.96 mV, respectively. In the NIR region the wavelength–intensity sensitivity values of probes coated with ZnO nanoparticles and horizontally and vertically oriented nanorods are 104 nm RIU⁻¹–12 dB RIU⁻¹, 63 nm RIU⁻¹–10 dB RIU⁻¹ and 146 nm RIU⁻¹–22 dB RIU⁻¹, respectively, and in the Vis area the values are 65 nm RIU⁻¹–14 dB RIU⁻¹, 58 nm RIU⁻¹–11 dB RIU⁻¹ and 89 nm RIU⁻¹–23 dB RIU⁻¹, respectively. The maximum amplitude sensitivity is obtained for the probe coated with vertically aligned ZnO nanorods in the NIR area due to the deeper penetration of evanescent waves, a higher surface-volume ratio, better crystallinity, more adhesive interactions with salt molecules, larger surface roughness and higher-order dispersion compared to the other coated ZnO nanostructures.

Detecting the salinity magnitude changes as a predominant factor for determining the chemistry of natural water bodies and biological process via label-free refractive index modified optical fiber sensors.