Vancomycin audit in the paediatric population: Patterns of use and appropriateness of therapeutic drug monitoring

AIMS

This study aims to investigate prescribing and therapeutic drug monitoring (TDM) practices for vancomycin in paediatrics at the Jordan University Hospital and to determine the impact of inaccuracies in TDM data on dosing decisions.

METHODS

Patterns of vancomycin prescriptions, appropriateness of vancomycin dosing, duration, TDM, and the accuracy of the recorded dosing/sampling times were determined prospectively based on prespecified criteria. Finally, Monte Carlo simulations were undertaken using the mrgsolve-package in R to assess the effect of inaccuracies in recording dosing/sampling times on subsequent dose adjustments.

RESULTS

Four hundred forty-two vancomycin courses were analysed. Vancomycin prescriptions were mainly empirical (77.4%). Initial vancomycin doses were appropriate in 73.1% of vancomycin courses. Prolonged use (>5 days) was found in 45.7% of admissions with negative cultures; this was related to the diagnosis of suspected sepsis unadjusted-OR: 1.8 (1.1-2.9). TDM was appropriately ordered in 90.7% of concentrations. Discrepancies between the recorded and actual times were noted in 83.9% and 82.7% of audited times of dose administration and sample collection, respectively. Based on simulations, these discrepancies were predicted to result in inappropriate dose adjustment in 37.9% of patients.

CONCLUSIONS

Inappropriate empirical and prolonged vancomycin use and inaccuracies in recording dosing/sampling times are important areas of improvement in the current clinical practice.

Multiband Rabi antenna using nest microstrip add-drop filter (NMADF) for relativistic sensing applications

A microstrip circuit is designed, constructed, and tested based on the nest microstrip add-drop filters (NMADF). The multi-level system oscillation is generated by the wave-particle behaviors of AC driven along the microstrip ring circular path. The continuous successive filtering is applied via the device input port. The higher-order harmonic oscillations can be filtered, from which the two-level system known as a Rabi oscillation is achieved. The outside microstrip ring energy is coupled to the inside rings, from which the multiband Rabi oscillations can be formed within the inner rings. The resonant Rabi frequencies can be applied for multi-sensing probes. The relationship between electron density and Rabi oscillation frequency of each microstrip ring output can be obtained and used for multi-sensing probe applications. The relativistic sensing probe can be obtained by the warp speed electron distribution at the resonant Rabi frequency respecting the resonant ring radii. These are available for relativistic sensing probe usage. The obtained experimental results have shown that there are 3-center Rabi frequencies obtained, which can be used for 3-sensing probes simultaneously. The sensing probe speeds of 1.1c, 1.4c, and 1.5c are obtained using the microstrip ring radii of 14.20, 20.12, and 34.49 mm, respectively. The best sensor sensitivity of 1.30 ms is achieved. The relativistic sensing platform can be used for many applications.

Population Pharmacokinetic Studies of Digoxin in Adult Patients: A Systematic Review

BACKGROUND

Digoxin is a cardiac glycoside that was introduced to cardiovascular medicine more than 200 years ago. Its use is associated with large variability, which complicates achieving the desired therapeutic outcomes.

OBJECTIVES

To present a synthesis of the available literature on the population pharmacokinetics of digoxin in adults and to identify the sources of variability in its pharmacokinetics.

METHODS

This is a PROSPERO registered systematic review (CRD42018105300). A literature search was conducted using the ISI Web of Science, Science Direct, PubMed, and SCOPUS databases to identify digoxin population pharmacokinetic studies of adults that utilized the nonlinear mixed-effect modeling approach.

RESULTS

Sixteen articles were included in the present analysis. Only two studies were conducted in elderly subjects as a separate population. Both the pharmacokinetics and pharmacodynamics of digoxin were investigated in one study. Furthermore, the reviewed studies were mostly conducted in East Asian populations (68.8%). Digoxin's pharmacokinetics were usually described by a one-compartment model because of the nature of the collected data. Weight, age, kidney function, presence of heart failure, and co-administered medications such as calcium channel blockers were the most commonly identified predictors of digoxin clearance. The value of apparent clearance in a typical study individual ranged from 0.005 to 0.2 l/h/kg, while the value of the apparent volume of distribution ranged from 3.14 to 15.2 l/kg. The quality of model evaluation was deemed excellent only in 31.3% of the studies.

CONCLUSION

This review provides information about variables that need to be considered when prescribing digoxin. The results highlight the need for prospective studies that allow two-compartment pharmacokinetic/pharmacodynamic models to be established, with a special focus on the elderly subpopulation.

Prevalence of potentially inappropriate prescribing in older adults in Jordan: Application of the STOPP criteria

OBJECTIVES

To measure the prevalence of cases of potentially inappropriate prescribing (PIP) for older patients and to identify the risk factors for identified cases of PIP.

METHODS

STOPP criteria version 2 were used for identifying cases of PIP for older patients (>65 years) who were admitted to a tertiary hospital in Jordan over a period of 18 months. Data were collected by prospectively reviewing the clinical and prescription records of included patients. Descriptive analysis, univariate analysis and multiple linear regression were used to analyse the results.

RESULTS

Upon admission, during hospitalisation and on discharge, 144, 182 and 156 cases of PIP were identified, respectively. There was a statistically significant association between the number of prescribed medications and cases of PIP during the hospital journey (P < .05).

CONCLUSION

Inappropriate prescribing of medications is highly prevalent among older patients. Application of validated (STOPP) criteria can help to detect and direct development of interventions to prevent PIP occurrence among older patients.

Effect of an educational intervention on public knowledge, attitudes, and intended practices towards diabetes mellitus: A quasi-experimental study

AIM

To assess the impact of educational workshops on the knowledge, attitudes, and intended practices (KAP) of the general public towards diabetes in Jordan in terms of symptoms, risk factors, complications, and prevention.

METHODS

A pharmacist led educational intervention and Propensity score matching was carried out for a convenience sample to assess Jordanians pre- and post-knowledge, attitudes, and practices towards diabetes mellitus (DM) using a validated questionnaire.

RESULTS

Among the 357 invited participants, 335 attended the educational workshops (response rate 93.8%). Prior to intervention, participants showed an overall knowledge score of 16.03 ± 4.88. About half of the participants knew that a sedentary lifestyle is a risk factor for getting DM (n = 172, 51.3%). Following educational intervention, knowledge scores significantly improved to be 21.36 ± 2.11 (P value < .001). A similar finding was obtained for attitude scores, where mean attitude scores significantly improved from 2.74 ± 1.94 before intervention to 4.40 ± 1.87 following the workshop (P value < .001). As for the intended practices, the educational intervention improved the participants' intent to exercise, eat healthy foods, and do annual screening.

CONCLUSIONS

Participants' knowledge, attitudes, and intended practices improved following a trained pharmacy led educational intervention. These encouraging results highlight the need for continuous national educational interventions about diabetes provided by trained health care professionals such as pharmacists. Future studies are needed to evaluate the impact of improved knowledge and perceptions on actual long-term practice.

Public knowledge, attitudes and practices toward diabetes mellitus: A cross-sectional study from Jordan

AIMS

To assess the knowledge and practices toward diabetes in the Jordanian community.

METHODS

This study was conducted as a public based cross-sectional study in different cities in Jordan. A previously published validated questionnaire about knowledge, attitudes, and practices (KAP) toward diabetes mellitus (DM) was translated from the Arabic version and used in this study with very minor modification to be suitable for this study of the Jordanian population.

RESULTS

A total of 1,702 participants were recruited in the present study. About half of the participants (53.3%) had good knowledge scores. The respondents' knowledge scores were significantly correlated with attitudes (p < 0.001). The education level (university or higher) and education related to a field were predictors for good knowledge and positive attitudes. About 46.3% of participants had positive attitudes toward the disease. As for practices, 37.7% of participants did not engage in regular exercise while more than half of the study subjects had never checked their blood glucose level on an annual basis. The factors influencing the practice of checking blood glucose level have been investigated.

CONCLUSION

This study has highlighted the need for more educational interventions to address negative attitudes and promote healthy lifestyle practices and regular health checks especially in certain subgroups of patients, such as those not having a degree related to the medical field and not having a first-degree relative with DM.

Enhanced photocatalytic dye degradation and hydrogen production ability of Bi25FeO40-rGO nanocomposite and mechanism insight

A comprehensive comparison between BiFeO3-reduced graphene oxide (rGO) nanocomposite and Bi25FeO40-rGO nanocomposite has been performed to investigate their photocatalytic abilities in degradation of Rhodamine B dye and generation of hydrogen by water-splitting. The hydrothermal technique adapted for synthesis of the nanocomposites provides a versatile temperature-controlled phase selection between perovskite BiFeO3 and sillenite Bi25FeO40. Both perovskite and sillenite structured nanocomposites are stable and exhibit considerably higher photocatalytic ability over pure BiFeO3 nanoparticles and commercially available Degussa P25 titania. Notably, Bi25FeO40-rGO nanocomposite has demonstrated superior photocatalytic ability and stability under visible light irradiation than that of BiFeO3-rGO nanocomposite. The possible mechanism behind the superior photocatalytic performance of Bi25FeO40-rGO nanocomposite has been critically discussed.

An Echocardiographic Study of the Right Ventricular Diastolic Function in Systemic Hypertension and Its Relation with the Left Ventricular Homologous Changes

Diastolic dysfunction is a major predictor of mortality and morbidity in hypertensive patients. Not only LV, the RV is also expected to be affected in this overall procedure. To observe the Echocardiographic changes of diastolic function of the RV in systemic HTN and their relation with similar parameters of the LV was the objective. TDI was used in association with standard Doppler modality. In this cross-sectional study, 50 hypertensive subjects were studied who were devoid of any other conditions that may influence the diastolic function of the RV from 01 May 2012 to 31 October 2012 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. In addition to 2D and M-mode evaluation, standard Doppler and pulsed tissue Doppler assessment of both ventricles were performed. Measurements were obtained for diastolic as well as systolic function of both ventricles. The RV diastolic parameters were impaired in both standard Doppler and tissue Doppler analysis in association with LV parameters. Systolic functions (LV FS and RV TAPSE) were preserved. Doppler-derived tricuspid peak E and E/A were related negatively to septal thickness, but tissue Doppler-derived RV Em/Am showed negative association with both RVAWT and septal thickness. RV RTm was related positively to RVAWT. The RV diastolic parameters showed positive relation with the LV similar parameters both in standard Doppler (E peak velocity, E/A ratio and EDT) and tissue Doppler (Em peak velocity, Em/Am and PCTm) assessment. So, in systemic HTN, LV diastolic dysfunction is also associated with diastolic disturbances of the RV. Pulsed tissue Doppler is a useful tool to detect the changes. RV diastolic parameters correlate well with those of the LV. Prolongation of the active relaxation (RTm) phase of RV is due to its increased wall thickness.

An exploration of parents' knowledge, attitudes and practices towards the use of antibiotics in childhood upper respiratory tract infections in a tertiary Jordanian Hospital

Objectives

The present study aimed to evaluate the parents' knowledge, attitudes and practices (KAP) towards the use of antibiotics for childhood upper respiratory tract infections (URTIs), at the Jordanian University Hospital.

Methods

This was a cross-sectional study. During the study period, 1301 parents of young children completed a validated – structured questionnaire.

Results

Gaps in common knowledge related to antibiotics and their use were noted among participants. Nearly half of respondents believed that antibiotics are void from adverse effects, while 72.4% of them believed that a child should be given an antibiotic if it develops fever, even though 60% they were aware that most URTIs were viral in nature. Parents reported that they administered antibiotics to children without medical advice most of the time for various causes, including using a previously prescribed antibiotic for a similar illness (27.1%), or based on pharmacist's recommendation (23.8%).

Conclusion

The results demonstrated the need for educational interventions to increase the awareness of parents about antibiotics to reduce inappropriate use and its consequences.

Genetic Polymorphism of Thiopurine S-methyltransferase in Children with Acute Lymphoblastic Leukemia in Jordan

Background and Aims:

It has been demonstrated that homozygote and heterozygote mutant allele carriers for thiopurine S-methyltransferase (TPMT) are at high risk of developing myelosuppression after receiving standard doses of 6-mercaptopurine (6-MP). The aim of this study was to determine the frequency of TPMT deficient alleles in children with acute lymphoblastic leukemia (ALL) in Jordan and to compare it with other ethnic groups.

Methods:

We included 52 ALL childhood cases from King Hussein Cancer Research Center in Jordan. Genotyping of the rs1800460, rs1800462, and rs1142345 SNPs was performed by polymerase chain reaction (PCR) followed by sequencing. Comparisons were made with historical data for controls and for both volunteers and cases from other middle-eastern countries.

Results:

Mutant TPMT alleles were present in 3.8% (2/52) of patients. Allelic frequencies were 1.0% for both TPMT*B and TPMT*C. None of the patients were heterozygous or homozygous for TPMT*3A or TPMT *2. We did not find statistically significant differences in the distribution of mutant alleles between Jordan and other middle-eastern countries for both healthy volunteers or ALL patients.

Conclusions:

The overall frequency of TPMT mutant alleles was low and did not exhibit differences compared to other middle-eastern countries, including Jordanian studies assessing TPMT mutant alleles in healthy volunteers. The current results question the value of TPMT genotyping in the Jordanian population.

Reliability and validity of Arabic translation of Medication Adherence Report Scale (MARS) and Beliefs about Medication Questionnaire (BMQ)-specific for use in children and their parents

OBJECTIVES

to evaluate the reliability and discriminant validity of Arabic translation of the Medication Adherence Report Scale (MARS) and the Beliefs about Medication Questionnaire-specific (BMQ-specific).

METHODS

Having developed Arabic translations of the study instruments, a cross-sectional study was carried out between March and October 2015 in two multidisciplinary governmental hospitals in Jordan. An expert panel monitored the forward and backward translation of the MARS and BMQ. Standard Arabic was used (with no specific dialect inclusion) to allow greater generalisability across Arabic speaking countries. Once the Arabic translations of the questionnaires were developed they were tested for consistency, validity and reliability on a group of children with chronic diseases and their parents.

RESULTS

A total of 258 parents and 208 children were included in the study. The median age of participated children and parents was 15 years and 42 years respectively. Principle component analysis of all questionnaires indicated that all had good construct validity as they clearly measured one construct. The questionnaires were deemed reliable based on the results of Cronbach alpha coefficient. Furthermore, reliability of the questionnaires was demonstrated by test-retest intraclass correlation coefficients (ICC) which ranged from good to excellent for all scales (ICC>0.706). The Pearson correlation coefficient ranged from 0.546-0.805 for the entire sample which indicated a significant moderate to strong positive correlation between MARS and BMQ items at time 1 and 2. Reported adherence was greater than 59% using MARS-children and MARS-parents scales, and was correlated with beliefs in necessity and independent of the concerns regarding medications.

CONCLUSION

The Arabic translations of both BMQ and MARS for use in children and their parents have good internal consistency and proved to be valid and reliable tools that can be used by researchers in clinical practice to measure adherence and beliefs about medications in Arabic speaking patient populations.

Potential interaction between zinc ions and a cyclodextrin-based diclofenac formulation

Complexes of diclofenac sodium (DF-Na) with hydroxypropyl betacyclodextrin (HPβCD) were prepared by co-evaporation in a 1:1 ratio and characterized in light of previously reported data. Phase solubility diagrams were obtained for DF-Na with HPβCD in the presence and absence of zinc ions. Dissolution profiles were obtained for DF-Na and its HPβCD complex at acidic (pH 1.2) as well as in phosphate buffer (pH 6.8), in the presence and absence of zinc. HPβCD, as expected, was shown to improve the dissolution of DF-Na in acidic medium but not in phosphate buffer (pH 6.8). The presence of zinc ions decreased the in vitro dissolution of DF-HPβCD complex in acidic medium (pH 1.2) but not in phosphate buffer (pH 6.8). It was confirmed that the precipitate that was formed by zinc ions in the presence of HPβCD and DF-Na contained no cyclodextrin and most likely it was a mixture of the complexes: DF2-Zn and DF-Zn with some molecules of water. In vivo experiments on rats have shown that HPβCD has no statistically significant effect on absorption or bioavailability of DF-Na in spite of the observed improvement of its in vitro dissolution by HPβCD. Moreover, zinc ions were shown to decrease the absorption rate of DF-Na in rats model but did neither significantly alter the absorption nor bioavailability of DF-HPβCD complex. The zinc induced precipitates of DF were shown to have significantly different crystalline properties when HPβCD was present. Therefore, the pharmaceutical details of a DF-Na preparation should be considered when designing the formulation and predicting possible interaction between DF-Na (or other potential NSAIDs) and zinc metal.

Abdominal cystic echinococcosis in Bangladesh: a hospital-based study

Introduction: Cystic echinococcosis (CE) is reported from nearly all geographic areas of Bangladesh, but little information is available on its epidemiologic and clinical features. The aim of this study was to describe the clinical manifestations of hepatic and abdominal CE cases presenting to tertiary referral hospitals in Dhaka, Bangladesh. Methodology: A retrospective study was conducted via chart reviews of hepatic and abdominal CE patients under care at tertiary referral hospitals in Dhaka, Bangladesh, between 2002 and 2011. Age, sex, education level, occupation, urban versus rural residence, drinking water source, history of dog ownership, cyst type and location, and clinical manifestations were recorded for all patients. Results: Of the 130 patients enrolled, 92 (70.8%) were female and 38 (29.2%) were male. The majority of patients were from rural (76.2%) rather than urban (23.8%) areas. All cases were from the northern part of the country, with no cases reported from the south or southeast. Most patients were between 21 and 40 years of age. A total of 119 patients (91.5%) had cysts only in the liver, with the remaining 8.5% having cysts in both the liver and lungs or in the abdominal cavity. Seventy-six (58.5%) of the hepatic cysts were stage CE1, indicating recent infection. Conclusions: Active transmission of Echinococcus granulosus appears to be occurring in Bangladesh, as indicated by the high number of CE1 hepatic cysts seen at tertiary care hospitals. Community ultrasound screening studies are warranted to better define the distribution of cases and risk factors for parasite transmission.

Acne vulgarism treatment using ultra-short laser pulse generated by micro- and nano-ring resonator system

Acne vulgaris is adebilitating dermatologic disease, and is conventionally treated by laser therapy using a microring resonator system. An evolving understanding of laser-tissue interactions involving Propioni bacterium acneproducing porphyrins, and the development of lasers to target the sebaceous glands, has led to the development of an escalating number of laser light for acne treatment. The results show that the full width at half maximum of the proposed laser pulse of 0.15 nm can be generated using a microring resonator system. The power of the laser is 200 W and the wavelength laser is 1,032 nm, which is proposed as a treatment of acne vulgaris diseases.

Ultra-short laser pulse generated by a microring resonator system for cancer cell treatment

A microring resonator (MRRs) system incorporated with a add/drop filter is proposed in which ultra-short single, multi-temporal, and spatial optical soliton pulses are simulated and used to kill abnormal cells, tumors, and cancer. Chaotic signals are generated by a bright soliton pulse within a nonlinear MRRs system. Gold nanoparticles and ultra-short femtosecond/picosecond laser pulses' interaction holds great interest in laser nanomedicine. By using appropriate soliton input power and MRRs parameters, desired spatial and temporal signals can be generated over the spectrum. Results show that short temporal and spatial solitons pulse with FWHM = 712 fs and FWHM = 17.5 pm could be generated. The add/drop filter system is used to generate the high-capacity, ultra-short soliton pulses in the range of nanometer/second and picometer/second.

Optical manipulation of nano-micro needle array for large volume molecular diagnosis

Optical vorticesare generated and controlled to form trapping tools in the same way as optical tweezers. By using the intense optical vortices generated within the PANDA ring resonator, the required atoms/molecules can be trapped and moved (transported) dynamically within the wavelength router or network. The advantage of the proposed system is that a transmitter and receiver can be formed within the same system, which is available for atoms/molecules storage and transportation based on methods that have been proposed to deliver drugs into cells for specific diagnosis.

Drug trapping and delivery for Alzheimer's diagnosis

In this investigation, a new design based on a PANDA ring resonator as an optical trapping tool for tangle protein, molecular motor storage, and delivery is proposed. The optical vortices are generated and the trapping mechanism is controlled in the same way as the conventional optical tweezers. The trapping force is produced by a combination of the gradient field and scattering photons. The required molecular volume is trapped and moved dynamically within the molecular network. The tangle protein and molecular motor can be transported and delivered to the required destinations for Alzheimer's diagnosis by molecular buffer and bus network.

Generation of THz frequency using PANDA ring resonator for THz imaging

In this study, we have generated terahertz (THz) frequency by a novel design of microring resonators for medical applications. The dense wavelength-division multiplexing can be generated and obtained by using a Gaussian pulse propagating within a modified PANDA ring resonator and an add/drop filter system. Our results show that the THz frequency region can be obtained between 40–50 THz. This area of frequency provides a reliable frequency band for THz pulsed imaging.

Molecular diagnosis using multi drug delivery network and stability

By using a pair of tweezers to generate the intense optical vortices within the PANDA ring resonator, the required molecules (drug volumes) can be trapped and moved dynamically within the molecular bus networks, in which the required diagnosis or drug delivery targets can be performed within the network. The advantage of the proposed system is that the proposed diagnostic method can perform within the tiny system (thin film device or circuit), which can be available for a human embedded device for diagnostic use. The channel spacing of the trapped volumes (molecules) within the bus molecular networks can be provided.

Multi-access drug delivery network and stability

A novel design of a multi-drug delivery network and diagnosis using a molecular network is proposed. By using a pair of tweezers to generate the intense optical vortices within the PANDA ring resonator, the required molecules (drug volumes) can be trapped and moved dynamically within the molecular bus networks, in which the required drug delivery targets can be achieved within the network. The advantage of the proposed system is that the diagnostic method can be used within a tiny system (thin film device or circuit), which is available as an embedded device for diagnostic use in patients. In practice, the large molecular networks such as ring, star, and bus networks can be integrated to form a large drug delivery system. The channel spacing of the trapped volumes (molecules) within the bus molecular networks can be provided by using the appropriate free spectrum range, which is analyzed and discussed in the terms of crosstalk effects. In this work, crosstalk effects of about 0.1% are noted, which can be neglected and does not affect the network stability.

Molecular network topology and reliability for multipurpose diagnosis

This investigation proposes the use of molecular network topology for drug delivery and diagnosis network design. Three modules of molecular network topologies, such as bus, star, and ring networks, are designed and manipulated based on a micro- and nanoring resonator system. The transportation of the trapping molecules by light in the network is described and the theoretical background is reviewed. The quality of the network is analyzed and calculated in terms of signal transmission (ie, signal to noise ratio and crosstalk effects). Results obtained show that a bus network has advantages over star and ring networks, where the use of mesh networks is possible. In application, a thin film network can be fabricated in the form of a waveguide and embedded in artificial bone, which can be connected to the required drug targets. The particular drug/nutrient can be transported to the required targets via the particular network used.

Proposal for Alzheimer's diagnosis using molecular buffer and bus network

A novel design of an optical trapping tool for tangle protein (tau tangles, β-amyloid plaques) and molecular motor storage and delivery using a PANDA ring resonator is proposed. The optical vortices can be generated and controlled to form the trapping tools in the same way as the optical tweezers. In theory, the trapping force is formed by the combination between the gradient field and scattering photons, and is reviewed. By using the intense optical vortices generated within the PANDA ring resonator, the required molecular volumes can be trapped and moved dynamically within the molecular buffer and bus network. The tangle protein and molecular motor can transport and connect to the required destinations, enabling availability for Alzheimer's diagnosis.

Blood cleaner on-chip design for artificial human kidney manipulation

A novel design of a blood cleaner on-chip using an optical waveguide known as a PANDA ring resonator is proposed. By controlling some suitable parameters, the optical vortices (gradient optical fields/wells) can be generated and used to form the trapping tools in the same way as optical tweezers. In operation, the trapping force is formed by the combination between the gradient field and scattering photons by using the intense optical vortices generated within the PANDA ring resonator. This can be used for blood waste trapping and moves dynamically within the blood cleaner on-chip system (artificial kidney), and is performed within the wavelength routers. Finally, the blood quality test is exploited by the external probe before sending to the destination. The advantage of the proposed kidney on-chip system is that the unwanted substances can be trapped and filtered from the artificial kidney, which can be available for blood cleaning applications.

Molecular buffer using a PANDA ring resonator for drug delivery use

A novel design of molecular buffer for molecule storage and delivery using a PANDA ring resonator is proposed. The optical vortices can be generated and controlled to form the trapping tools in the same way as the optical tweezers. In theory, the trapping force is formed by the combination between the gradient field and scattering photons, which is reviewed. By using the intense optical vortices generated within the PANDA ring resonator, the required molecules can be trapped and moved (transported) dynamically within the wavelength router or network, ie, a molecular buffer. This can be performed within the wavelength router before reaching the required destination. The advantage of the proposed system is that a transmitter and receiver can be formed within the same system, which is available for molecule storage and transportation.

Pregnancy causing gallstone disease

A cross sectional study was done on patient, who were diagnosed and admitted with gallstone disease in different hospitals during June 1997 to June 2001. The aim of the study was to determine any significant association between pregnancy and cholilithiasis in female. A standard written questionnaire, which is duly filled by, concerned doctor and examination done. Records were made about age at marriage, first pregnancy after marriage and number of pregnancies. Incidence of gallstone shows that in 21-30 years age group 05 (1.37%) patient having no pregnancy, 35 (9.62%) patient having one pregnancy, 26 (7.14%) patient having two pregnancies, 22 (6.04%) having three pregnancy and 12 (3.30%) patient having four and more pregnancies. In 31-40 years age group 02 (0.55%) having no pregnancy, 05 (1.37%) patients having one pregnancy, 22 (6.04%) patient having two pregnancies, 30 (8.24%) patients having three pregnancies and 46 (12.64%) patients having four and more pregnancies. In 41-50 years age group 3 (0.82%) patients are having no pregnancy, 2 (0.55%) patient having one pregnancy, 16 (4.40%) patient having two pregnancies, 16 (4.40%) patient having three pregnancies and 47 (12.91%) patient having four and more pregnancies. In 51-60 years age group, 02 (0.55%) patient having one pregnancy, 04 (1.10%) patients having two pregnancy, 09 (2.47%) patient having three pregnancies, 52 (14.29%) patient four and more pregnancies. The numbers of pregnancy is associated with gall stone diseases. The risk of developing gall stone disease increases in association with increased number of parity, particularly among the younger women.

Oral contraceptives in gall stone diseases

A cross sectional study was under taken to evaluate the prevalence of gallstone in fertile women who are taking oral contraceptives. The aim of study was to determine any significant association between oral contractive use and Cholelithiasis. Total number of patient was 340. A standard written questioner, which is dully filled by concerned doctor and examination done. History of use of oral contraceptive pills, duration of use and time of taking oral contraceptives drugs whether before, in between pregnancy or after family completion is recorded. Total number of patient was 340 of them 186 patient taken contraceptives and 154 patients without contraceptives. Incidence of gallstone shows that with contraceptives the 21-30 years age group 72(39.13%) without contraceptives 22(14.28%), in 31-40 years age group with contraceptives 74 (40%), without contraceptives 28(18.8%) where as in 41-50 years age group with contraceptives 37(20.10%) and without contraceptives 44(28.57%), 51 years and above age group with contraceptives is 01(0.54%) and without contraceptives is 60(38.96%). Significantly higher incidence of gallstones found in younger patient taking oral contraceptives than without contraceptives, but in older age group incidence is more in-patients without contraceptives than with contraceptives. Oral contraceptives increase the incidence of gallstones disease in younger women especially in early part of their use of oral contraceptives.

A randomized controlled trial on the efficacy of alternative treatment regimens for uncomplicated falciparum malaria in a multidrug-resistant falciparum area of Bangladesh--narrowing the options for the National Malaria Control Programme?

We performed an open, randomized chemotherapy trial comparing the recommended first-, second- and third-line drug regimens, as well as mefloquine, for uncomplicated falciparum malaria in Bangladesh in 1996-97. The regimens were chloroquine for 3 days (CQ, Group I), quinine sulphate for 3 days followed by single-dose sulfadoxine-pyrimethamine (Q3 + SP, Group II), quinine for 7 days (Q7, Group III), and mefloquine 20 mg/kg single dose (MEF, Group IV). Subjects were symptomatic patients, aged > or = 12 years, with parasite density 500-250,000/mm3 and no history of taking antimalarials during the previous week. Drug administration was supervised and subjects were followed clinically and with blood slides in the hospital for 8 days, then as outpatients on days 14, 21 and 28. A total of 413 subjects (149, 145, 49 and 70 in Groups I-IV, respectively) completed the study. Early treatment failures (persistent or worsening clinical manifestations by day 3 confirmed with parasitological examinations) occurred only in the chloroquine group. RII and RIII parasitological failures occurred in 56%, 12%, 8% and 14% in Group I-IV, respectively. There were significantly more clinical and parasitological failures with chloroquine than with Q3 + SP, which we now recommend as a better (but far from ideal) choice for first-line therapy. The alternative compounds show parasitogical evidence of Plasmodium falciparum resistance. Further studies are needed to determine the optimum treatment for malaria in Bangladesh.

Effect of oral and injectable contraceptives on serum calcium, magnesium and phosphorus in women

BACKGROUND

This study aims at evaluating serum calcium, magnesium and phosphorus levels in women taking oral and injectable contraceptives.

METHODS

Serum calcium, magnesium and phosphorus were measured in 50 women taking oral contraceptives (Lofeminal) and 50 women taking injectable contraceptive (Depo-medroxy progesterone acetate and Norigest). These women were used as controls before starting these contraceptives.

RESULTS

There was significant decrease in serum levels of calcium, magnesium and phosphorus in women taking oral contraceptives but there was significant increase in these minerals in women taking injectable contraceptives.

CONCLUSIONS

It is suggested that these contraceptives should be used with due care and with proper investigations of the women before and during the therapy.

Identification of two novel mutations in the SLC25A13 gene and detection of seven mutations in 102 patients with adult-onset type II citrullinemia

Adult-onset type II citrullinemia (CTLN2) is characterized by a liver-specific deficiency of argininosuccinate synthetase (ASS) protein. We have recently identified the gene responsible for CTLN2, viz., SLC25A13, which encodes a calcium-binding mitochondrial carrier protein, designated citrin, and found five mutations of the SLC25A13 gene in CTLN2 patients. In the present study, we have identified two novel mutations, 1800ins1 and R605X, in SLC25A13 mRNA and the SLC25A13 gene. Diagnostic analysis for the seven mutations in 103 CTLN2 patients diagnosed by biochemical and enzymatic studies has revealed that 102 patients had one or two of the seven mutations and 93 patients were homozygotes or compound heterozygotes. These results indicate that CTLN2 is caused by an abnormality in the SLC25A13 gene, and that our criteria for CTLN2 before DNA diagnosis are correct. Five of 22 patients from consanguineous unions have been shown to be compound heterozygotes, suggesting a high frequency of the mutated genes. The frequency of homozygotes is calculated to be more than 1 in 20,000 from carrier detection (6 in 400 individuals tested) in the Japanese population. We have detected no cross-reactive immune materials in the liver of CTLN2 patients with any of the seven mutations by Western blot analysis with anti-human citrin antibody. From these findings, we hypothesize that CTLN2 is caused by a complete deletion of citrin, although the mechanism of ASS deficiency is still unknown.

Monitoring efficacy of commonly used antimalarials by a 14-day in-vivo test in a new settler's camp in endemic zone at Cox's Bazar

The study was done in a new settler's camp "Barachara" under Sadar thana of Cox's Bazar district. It has a total population of 784 of all age groups, registered in the middle of the study period. A prospective evaluation of all cases of fever were done over 12 months, to see the pattern of febrile illness among the population and to compare the therapeutic efficacy of two alternative drug regimens for uncomplicated falciparum malaria (UM). Blood for malarial parasite (MP) was done in all cases of fever and was treated in line with the new clinical case definitions and treatment guidelines for malaria in Bangladesh. Slide positive UM cases were subjected to a "14-day in-vivo test" for therapeutic efficacy testing of antimalarial agents. The two drug regimens were randomised by lottery--a) 3 days oral chloroquine plus single dose sulphadoxin/pyrimethamine (CQ + SP) and, b) 3 days oral quinine plus single dose sulphadoxin/pyrimethamine (Q3 + SP). Drug administration was supervised by the field assistant and was followed up on days 3, 7 and 14 for blood slide examinations and clinical assessment. Sensitive response was observed in 79% of the cases in the CQ + SP group and 84% in the Q3 + SP group. Early treatment failure (persistently febrile and parasitaemic on days 3 or 7) was observed in 16% in the CQ + SP group and 9% in the Q3 + SP group. Both the evaluated drug regimens had less than 20% failures and can be used as alternative first line agents and Q3 + SP regimens can also be used as the second line agents for treatment failure (to chloroquine and/or SP) UM cases in the study area.

Impact of massive doses of vitamin A on nutritional blindness in Bangladesh

Impact of 6-monthly massive dosings of preschool-age children with oral vitamin A (VAC: 200,000 IU of oil soluble retinyl palmitate with 40 IU vitamin E) was evaluated in Bangladesh. In 100 sites, 11,889 households were visited and eyes of 22,335 children aged 3-71 mo were examined. About half the rural target population and less than 20% urban slum population were being reached. Risk of night blindness was halved for children reportedly given VAC, although 2.5% of the reportedly protected population were still night blind. There was no significant reduction in prevalence of Bitot's spot. Risk of corneal ulcers or keratomalacia (X3A/B) was 2.7 times higher in children not given VAC. Based on reported coverage, efficacy of protection against potentially blinding corneal lesions was 63%. For maximum impact on eye lesions, massive dosing with vitamin A at ideally less than 6-monthly intervals needs to be combined with other nutrition and health interventions.

Landholding, wealth and risk of blinding malnutrition in rural Bangladeshi households

The 1982-1983 Bangladesh nutritional blindness study visited 11,618 rural households and examined 18,660 preschool-age children in an effort to determine the prevalence and determinants of eye lesions and loss of sight due to vitamin A deficiency (xerophthalmia). Risk of xerophthalmia was significantly higher for children from households without any of the indicators of relative wealth used. Almost 80% of blind children from landless households, and even a very small garden reduced considerably the chances of a household having a xerophthalmic child. Poorer households with access to less than 0.3 acres land or no garden or without a tin roof, wristwatch, radio or cycle were at least twice as likely as their more fortunate neighbours to have a young child with any type of xerophthalmia. Taking account of such socio-environmental risk factor weightings would direct the scarce resources of intervention programmes to households and children who most need them.

Further study on the effect of norethisterone enanthate, an injectable contraceptive on body functions

One hundred and fortythree healthy Bengali women have received norethisterone enanthate, as injectable contraceptive in doses of 200 mg. intramuscularly at intervals of 10 to 12 weeks. The drug have been found to be almost 100 percent effective in the control of fertility. Menstrual disturbance, e.g. amenorrhoea, irregular bleeding and spotting, appeared to be the main complaints of the clients during the initial period of the therapy; but these did not persist long. There was no ill effect of the drug on lactation. No significant change in body weight, blood pressure, platelet count, fasting blood sugar, serum cholesterol and total plasma protein level was observed following administration of norethisterone enanthate over one year.