Physical activity levels in Bangladeshi adults: results from STEPS survey 2010

Objectives

Physical inactivity is an established risk factor for non-communicable diseases (NCD) and identified as the major public health concern worldwide. However, nationally representative and internationally comparable data on physical activity (PA) are lacking in Bangladesh. The objective of this paper was to determine nationally representative prevalence of PA levels among Bangladeshi adults.

Study design

Cross-sectional survey.

Methods

Data, on PA for this paper, were analysed from the NCD risk factors survey 2010 in Bangladesh. A standardized approach known as STEPS (STEPSwise approach to Surveillance for NCD risk factors) was followed for this survey. A total of 9275 adults (aged ≥ 25 years) were interviewed. Data on PA were processed and analysed according to Global Physical Activity Questionnaire (GPAQ) version 2 analysis framework.

Results

Of total 9275 respondents 4312 were men and 4963 women with a mean age of 42.4 (±13.5) years. Median MET-minutes of total PA in a typical week was double in rural areas (3360) than urban (1680) areas. The overall country wide prevalence of low PA was 34.5% (95% confidence interval, 33.5–35.5), urban 37.7% (36.3–39.1) and rural 31.6% (30.3–32.9). Women in general were more inactive (women, 53.6% [52.2–55.0], men 15.4% [14.9–17.1]). The main contributions to total PA were from work (urban 47.0%, rural 61.0%), and active commuting (38.0%, 30.0%) domains. Leisure-time PA represented only a small proportion (15.0%, 9.0%).

Conclusions

Insufficient physical activity is highly prevalent among the Bangladeshi adult population. Promoting overall PA at leisure-time and commuting considering country context can be feasible options with special attention to the women.

Development of standard operating procedure and standardization of Habb-e-Banafsha Qawi-A Unani polyherbal formulation

Introduction:

Herbals drugs became a boon for mankind since ancient times and still are used worldwide for the treatment of various human ailments. The safety of alternative medicinal preparations has been questioned due to reports of unwanted side effects. To maintain the quality and efficacy of these drugs, it is essential to standardize them in order to avoid the use of substandard or adulterated medicines in the market. Unani system of medicine mainly focuses on the treatment by natural drugs. Habb-e-Banafsha Qawi is useful in a cough, catarrah, and coryza.

Materials and Methods:

Physiochemical constants of Habb-e-Banafsha Qawi were determined through organoleptic characters, macro- and micro-scopic characters, ash value, solubility, pH values. Chromatographic fingerprints were developed using thin layer chromatography method. Aflatoxin (AF) contamination, heavy metal, and pesticide residues were also evaluated by standard methods.

Objectives:

In the present study, an attempt has been made to develop standard operating procedure and physiochemical parameters to monitor the quality of a Unani poly-herbal formulation, Habb-e-Banafsha Qawi.

Results:

The tablets tasted sweetish bitter with a pleasant odor, water soluble and acidic in nature. R_f values were almost same in all the extracts. No AF, heavy metal, and pesticide residues were observed.

Conclusions:

It may be concluded that the values and chromatographic fingerprints obtained can be used for quality evaluation and to set new pharmacopoeial standards for the preparation of Habb-e-Banafsha Qawi.

Effect of detoxification (tadbeer) in content of toxic metabolites of Strychnos nux-vomica: A Unani approach for its use in human

Background:

Azaraqi (Strychnos nux-vomica, Loganiaceae) has been the important Unani medicine since long time as a stimulant, anti-inflammatory, and blood purifier. It has been used very frequently by the Unani practitioner. But the Unani system recommends application of azaraqi in medicine only after its detoxification (tadbeer) may be because of the presence of its deadly poisonous alkaloids (strychnine and brucine). In the present investigation, an attempt has been made to quantify the actual content of their toxic alkaloids before and after the tadbeer.

Materials and Methods:

A sensitive high-performance thin layer chromatographic (HPTLC) method has been developed for estimation of strychnine and brucine in different samples of azaraqi before and after tadbeer. Precoated HPTLC silica gel plates were used as stationary phase and (toluene: Ethyl acetate: Dietylamine 7:2:1 v/v/v) was used as mobile phase.

Result:

The R_f value of strychnine and brucine was found as 0.53 and 0.41, respectively. Detection and quantification were performed by densitometry at 270 nm. The calibration plot was linear in the range of 50–1000 ng of strychnine and brucine, respectively, with the correlation coefficient (r²) 0.993 and 0.991 for strychnine and brucine, respectively, which confirms good linearity. The content of strychnine was 0.175, 0.07, 0.18, 0.051, and 0.075% w/w whereas brucine was 0.16, 0.117, 0.061, 0.045, and 0.057 in crude azaraqi, azaraqi without outer cover, azaraqi outer cover only, azaraqi mudabbar and azaraqi mudabbar by fried in ghee, respectively.

Conclusion:

The detoxification results in sharp decrease in content of toxic metabolites. The process by boiling in milk was found much effective but tedious as compare to frying method.

A report of heat stroke in two Nigerian siblings

Infants and children are at higher risk of heat stroke for several reasons. We report these cases to highlight the danger of leaving children unsupervised in vehicles, aid prompt diagnosis, and management of heat stroke. Two Nigerian siblings aged ranges 5 and 3 years old, were trapped inside an unlocked vehicle and subsequently developed heat stroke. Both children presented with hyperthermia, severe dehydration, convulsions, and loss of consciousness. One of them also had hematuria. They were treated by spraying water onto their bodies to bring down the temperature, intravenous fluid resuscitation, oxygen therapy, and anticonvulsants. Both eventually recovered and were discharged with no obvious neurologic sequalae, but are being followed-up.

Improving mass-transfer in controlled pore glasses as supports for the platinum-catalyzed aromatics hydrogenation

Mass-transfer improvement in the Pt-catalyzed aromatics hydrogenation by increasing the pore width of controlled pore glasses as supports.

Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation

Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2μgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex.

Haemodynamic and end tidal CO₂ changes during laparoscopic cholecystectomy under general anaesthesia

A prospective observational study was done on 50 patients to investigate the haemodynamic and end tidal CO₂ (EtCO₂) changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in head up position under standard protocol of general anaesthesia. During surgery, intra abdominal pressure was maintained at 15 mmHg by a CO₂ insufflator and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. Haemodynamic parameters, EtCO₂, SpO₂ and ECG were recorded before and after induction and positioning of the patients and at 5 minutes interval for the first 30 minutes, then 10 minutes interval for the rest of the period. Highly significant increase (p<0.001) in pulse rate, systolic, diastolic and mean arterial pressure occurred at 30 minutes after insufflations and positioning of the patient. A very highly significant (p<0.001) increase in EtCO₂ from the base line was at 40 minutes after insufflations and positioning of the patients. There was no change in SpO₂ and ECG. This study supports the significant physiological changes in terms of haemodynamic and EtCO₂ during laparoscopic cholecystectomy and recommends the meticulous monitoring of these parameters during the surgery and balance the benefit of laparoscopy against the intra operative risk.

Surgical maneuvers placing the sciatic nerve at risk during total hip arthroplasty as assessed by somatosensory evoked potential monitoring

The sciatic nerve in 52 hip arthroplasties was evaluated using intraoperative somatosensory evoked potentials (SSEPs). Twenty-nine of these cases involved the lateral transtrochanteric approach, and 23 involved the posterior approach. A total of 11 incidents of SSEP changes occurred in eight patients. Six episodes occurred during lateral retraction of the proximal femur, and three occurred during anterior retraction of the proximal femur. Tracings returned to baseline with prompt cessation of femoral retraction in each case. One SSEP change occurred in a revision following reduction of the prosthetic components, and this resolved with shortening of the prosthetic neck to less than anatomic length. One change occurred during tightening of cables securing strut allografts to the femur and this resolved spontaneously. No correlation was found between frequency of SSEP changes and age, sex, limb lengthening, or preoperative range of motion. It is concluded that routine lateral or anterior retraction may place the sciatic nerve at risk.

Ontario gold miners with lung cancer. Occupational exposure assessment in establishing work-relatedness

Because of inherent errors in exposure data as well as a requirement in the Workers' Compensation Act of Ontario that all claims must be considered on the merits and justice of the individual case, the criteria for assessing work-relatedness of Ontario gold miners who had primary lung cancer could not be based upon any strict occupational exposure criteria. However, a relationship between exposure to silica, arsenic, and radon progeny was derived from results of the epidemiologic studies. A retrospective occupational exposure assessment of silica dust, arsenic, and radon decay products was made in individual cases presented in this paper. The assessment results of 11 gold miners presented in this paper illustrate that the exposure parameters could provide persuasive evidence when the data were consistent with the key epidemiologic findings, eg, the miner's age at first exposure, length of dusty exposure, and latency.

Severe protein energy malnutrition in Lesotho, conditioning factors and death and survival in hospital

Information was obtained on infants and children admitted for severe protein energy malnutrition (PEM) to Lesotho's central hospital in 1981 and 1982 as regards feeding pattern, socio-economic, environmental factors and vaccination status. Acute gastroenteritis (GE) appeared to be a major precipitating cause in the development of severe PEM. Of children 13-24 months of age only 13% was still breast fed. Compared to kwashiorkor significantly more children with marasmus or marasmic kwashiorkor had never been breast fed, or were early weaned and bottle fed. Above age nine months, children had a similar diet during the last three days before admission. Children of nevermarried single mothers appear to be more at risk for severe PEM. Absence of the father's support and a grandmother as caretaker may be other risk factors as well. The vaccination status was poor. In marasmus death was significantly (p less than 0.01) associated with bottle feeding and survival (p less than 0.05) with breast feeding. In kwashiorkor death was significantly (p less than 0.01) associated with an unprotected source of drinking water and survival (p less than 0.05) with consumption of green vegetables in the last three days before admission and employment of the mother. Data collection in hospital may provide a rationale for interventions in the development of severe PEM and identify those at risk to die from it.

Lactose malabsorption and giardiasis in Basotho school children

The prevalence of primary, adult-type, lactose malabsorption was assessed by means of the hydrogen breath test after intake of 360 ml of full cream milk (approximately 18 g lactose) in 96 randomly selected Basotho school children, aged 5-15 years. Of 86 children who did not have diarrhoea in the previous week 82 (85%) were lactose malabsorbers, while 4 (5%) could not be classified because of undetectable hydrogen excretion. Milk intolerance presenting as diarrhoea was significantly (p less than 0.01) more common in children who associated previous abdominal complaints with milk intake and/or did not like milk. A negative hydrogen breath test was significantly (p less than 0.05) more often observed in children who had diarrhoea in the previous week. Giardia was present in 18 (19%) of 93 children. The incidence of giardiasis did not correlate with the presence of lactose malabsorption in children without diarrhoea in the previous week. However, milk intolerance presenting as diarrhoea was significantly (p less than 0.05) more common in children with giardiasis. The findings support the use of physiological quantities of milk in Basotho school children.

Severe protein energy malnutrition in Lesotho, death and survival in hospital, clinical findings

In Lesotho's central hospital 55 (25%) of 218 admissions for severe PEM died during 1981 and 1982. Most deaths (62%) occurred in the first week. The most important causes of death were acute GE and pneumonia in marasmus and kwashiorkor, respectively. The cause of death remained obscure in 16 children, however. In marasmus a poor prognosis was significantly associated with the finding on admission of a temperature less than 36.5 degrees C (P less than 0.05), apathy (P less than 0.01) and a depigmented skin (P less than 0.05), while in marasmic kwashiorkor only the finding of the latter was significantly (P less than 0.05) associated with death. In non-survivors with kwashiorkor the following characteristics were observed significantly more often: complaints of diarrhoea and/or vomiting on admission (P less than 0.05), the finding of apathy, pallor, skin defects and hepatomegaly on admission (P less than 0.01), and the finding of a low serum albumen, Na+ and K+ in the first days (P less than 0.05). Irritability was significantly (P less than 0.05) more common in survivors with kwashiorkor. Xerophthalmia was observed only once. Infections were diagnosed in 86% of all and giardiasis in 28% of 146 children. Twenty-eight children contracted measles of whom 5 died. Severe PEM still carries a high mortality despite hospitalisation. The findings confirm the need for intensive management of severe PEM.

Incomplete lactose absorption from breast milk during acute gastroenteritis

The incidence and degree of incomplete lactose absorption was investigated in breast fed infants and children up to two years of age during acute gastroenteritis (GE). Lactose absorption was assessed in 50 patients by means of the hydrogen breath test (HBT), approximately 5.5 days after the admission to hospital. HBT detected incomplete lactose absorption of marked (lactose malabsorption) and probably mild degree in 8 and 6 patients respectively. Incomplete lactose absorption appeared to be transient in all 5 patients retested after discharge. HBT failed to identify 8 cases of lactose intolerance which were detected by investigation of the stools. In 31 breast fed controls of a similar age range incomplete lactose absorption of only mild degree was probably present in 2 and lactose intolerance in 1, which too was only detected by investigation of stools. During acute GE the use of HBT is appropriate to detect milder forms of incomplete lactose absorption than lactose intolerance. For the detection of lactose intolerance the measurement of pH and reducing substances in the stools remains the method of choice. The findings are in favour of the continuation of breast feeding during acute GE.

Carbohydrate malabsorption in children with severe protein energy malnutrition

To determine the incidence of carbohydrate malabsorption, particularly lactose malabsorption in Basotho children with severe PEM during treatment with a dry skim milk (DSM)-sucrose-oil mixture, 105 children with PEM were submitted to a Hydrogen Breath Test (HBT) after administration of the mixture. Carbohydrate malabsorption occurred more frequently in children with kwashiorkor (28/58) than in those with marasmus (5/33), marasmic kwashiorkor (3/15) and healthy controls (8/34). The positive HBT appeared to be due to lactose malabsorption in at least two thirds of the children with kwashiorkor as it turned negative when the challenge was repeated with a lactosefree mixture. In controls malabsorption of carbohydrate (usually lactose) appeared at the age of 22 months, nearly a year later than in PEM. Diarrhoea occurred in 23 children with PEM and particularly in those with carbohydrate malabsorption. In 20 children Giardia was found in the stools without any observable effect on carbohydrate malabsorption, however. The findings support the cautious use of physiological doses of lactose in the treatment of severe PEM.

Comparative vitamin B-6 bioavailability from tuna, whole wheat bread and peanut butter in humans

Relative bioavailability of vitamin B-6 from tuna, whole wheat bread and peanut butter was investigated in eight men. The study was divided into a 10-day adjustment and three, 14-day experimental periods in a 3 X 3 Latin square design. Vitamin B-6 intake was set at 1.6 mg/day, with 50% of the intake coming from one of the three experimental foods and 50% from a basal diet. Daily complete urine and fecal collections were made. Urine was analyzed for 4-pyridoxic acid (4PA) and vitamin B-6, fecal samples for vitamin B-6 and plasma (sampled every 5 days) for pyridoxal 5'-phosphate (PLP). Mean values +/- SD for the adjustment, tuna, whole wheat bread and peanut butter periods were: 5.65 +/- 1.76, 4.89 +/- 1.10, 3.62 +/- 0.66 and 2.80 +/- 0.50 mumol/day for 4-pyridoxic acid; 0.98 +/- 0.34, 1.05 +/- 0.20, 0.76 +/- 0.09 and 0.68 +/- 0.19 mumol/day for urinary vitamin B-6; 2.72 +/- 0.94, 3.08 +/- 0.73, 3.80 +/- 0.78 and 4.42 +/- 1.03 mumol/day for fecal vitamin B-6 and 65.0 +/- 23.30, 64.8 +/- 29.80, 49.3 +/- 14.40 and 48.4 +/- 20.20 nM for plasma pyridoxal 5'-phosphate, respectively. 4PA and urinary vitamin B-6 excretion were significantly (P less than or equal to 0.01) higher in the tuna period than in either the whole wheat bread or peanut butter periods.(ABSTRACT TRUNCATED AT 250 WORDS)