Depression among Patients Presenting with Gastrointestinal Symptoms: Prevalence and Associated Factors.

Gastrointestinal diseases frequently affect patients' physical and emotional wellbeing as being heavily affected by stress. This study was conducted to find out prevalence and severity of depressive symptoms among patients presenting with gastrointestinal symptoms. This cross sectional study was conducted at Outpatients Department jointly by Department of Gastroenterology and Department of Psychiatry of a tertiary care hospital in north east part of Bangladesh from November 2011 to June 2012. Consecutive patients with gastrointestinal symptoms underwent psychiatric evaluation using HDRS and analyzed. 442 patients, 38(8.6%) were found normal. Among the rest 128(28.96%), 138(31.22%), 72(16.29%) and 66(14.93%) had mild, moderate, severe and very severe depressive symptoms respectively. Female sex (95.03% vs. 89.32%), married people (93.77 vs. 86.13%), older age (98.24%), rural people (94.26% vs. 84.36%), farmers (96.36%) and house wives (96.24%) were more affected. Prevalence of depression was also higher among patients with lower socioeconomic class, less educated people and rural background. Depressive symptoms are very common in patients presenting with gastrointestinal symptoms. Awareness regarding psychiatric assessment and intervention may reduce sufferings and thus improve wellbeing of these patients.

Irritable Bowel Syndrome: Prevalence and Dietary Factors in the Sylhet District of Bangladesh.

Irritable bowel syndrome (IBS) is a common functional bowel disorder. Along with other factors diet plays an important role in the causation of IBS. This population-based study was done to find out the prevalence of IBS and to find out the dietary factors associated with IBS from August 2011 to December 2011 in Sylhet district of Bangladesh. Nineteen hundred apparently healthy subjects selected by cluster sampling methods were interviewed by a validated bowel disease questionnaire. Dietary history of the subjects was also taken. Irritable bowel syndrome was diagnosed according to Rome III criteria. The prevalence of IBS was found 14.2% (n=269, M=15%, F=13.4%, p=0.365). Mean age of the IBS patients were higher than the study population (41.35 years vs. 34.74 years, p=0.000). Irritable bowel syndrome was found more in low education group (16.3%) with lower socioeconomic status (16.5%) and in single person (16.7%). IBSD was the most prevalent subtype (48.7%), IBSM was the next common subtype. Abdominal pain relieved by defecation (81%) and abdominal pain associated with loose stools (81%) were the two commonest symptoms. Age (OR 1.023, p=0.000), less intake of meat (OR 2.281, p=0.000) and pulses (OR 1.648, p=0.001) and more intake of tea (OR 1.524, p=0.009) and spices (OR 0.452, p=0.000) were found as independent predictor of IBS. Irritable bowel syndrome is a common disorder in our community. IBSD is the most prevalent subtype. Less intake of meat, pulses and more intakes of tea and spices are important associated factors for IBS.

Clinical Evaluation of Bucco-lingual Crestal Bone Remodeling in Mandibular Posterior Implants placed immediately and Delayed into Extraction Sites.

The objective of this cross sectional study was to evaluate the bucco-lingual crestal bone remodeling in mandibular posterior implants placed immediately and delayed into extraction sites and carried out in the department of Prosthodontics of Dhaka Dental College and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2010 to July 2014. Forty patients were evaluated in this study; of them 25(62.5%) patients were males and 15(37.5%) were females with age range from 24 to 70 years. At first surgery during implant placement the mean distance from buccal bone to lingual bone was 11.11mm for immediate implants and 9.265mm for delayed implants. At second-stage surgery the mean distance from buccal bone to lingual bone was 9.765mm for immediate implants and 6.25mm for delayed implants. The mean±SD change of bone reduction at second surgery was 1.28±0.31 for immediate implants and 3.01±0.33 for delayed implants. Unpaired t test was done for statistical analysis and p value was less than 0.05. So, the changes were statistically significant.

Evaluation of Body Mass Index Before and After Prosthetic Rehabilitation with Complete Denture Therapy.

The objective of this study was to compare body mass index (BMI) of the edentulous patients before and after complete denture therapy. Forty five (45) patients who had been edentulous for six months to one year and required complete dentures were selected for this study; of them 25(55.56%) were males and 20(44.44%) were females and age range was between 40 to 70 years. Every patient was provided with complete dentures fabricated with ethical standard procedures. Analysis of the body mass index (BMI) was done at base line; and at three and six months follow up. The mean BMI values were found 19.58±1.93; 20.63±1.89 and 22.02±1.80 at base line, at three months follow up and at six months follow up respectively. The differences of the BMI values were found to be statistically significant (p<0.05) both at 3 months and 6 months follow up compared to the base line value.

Clinical, biochemical, virological and sonographic profile of incidentally detected asymptomatic HBsAg positive subjects, in Bangladesh.

Chronic hepatitis B virus (HBV) is known to be the significant cause of Liver related morbidity and mortality, affecting 400 million people worldwide and a major public health problem in Bangladesh where carrier rates of HBV infection varies from 7.5 to 10%. In Bangladesh prevalence of asymptomatic HBV infection and incidentally detected HBsAg positive subjects were not well studied. The aim of this study is to evaluate the disease activity, replicative status of the virus and to find out the stages of chronic liver disease among incidentally detected asymptomatic HBsAg positive Bangladeshi subjects. Two hundred (200) incidentally detected healthy HBsAg positive subject were evaluated clinically, biochemically, serologically and ultrasonographically from January 2004 to June 2008. HBeAg was found positive in 17(8.5%), anti-HBe was positive in 174(87%), raised serum ALT (>45iu/L) in 45(22.5%), prothrombine time (PT) >3 sec of control in 33(16.5%). Ultrasonography showed coarse hepatic echotexture in 13(6.5%). Evidence of active viral replication and signs of chronic liver disease were observed among incidentally detected healthy HBsAg positive subjects. Such individuals should be followed up at regular interval to evaluate the replicative status of the virus and disease activity so that appropriate measures could be initiated in time.

Duodenal carcinoid tumor - a case report.

Carcinoid tumors are well differentiated neuroendochrine tumors which most frequently involve the gastrointestinal tract; however duodenal carcinoid tumors are rare. They can present with various clinical symptoms and are difficult to diagnose. A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. Polyp was removed by endoscopic resection and tissue was taken for biopsy. Histological findings of biopsy specimen shows carcinoid tumor. As duodenal carcinoid tumor is a rare presentation so we are going to present this case in this article.

Bioavailability and plasma concentration of omeprazole in healthy bangladeshi population after ingestion.

This cross-sectional observational study was conducted in the department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Plasma concentration of omeprazole was assayed in the quality control laboratory of Novartis (Bangladesh) Limited, Tongi, Gazipur, Bangladesh. The study was conducted from January 2006 to April 2007 and was designed to find out the bioavailability of omeprazole in capsule form in healthy Bangladeshi population and to compare this with that of the other population in the world. Twelve healthy volunteers were included in this study. The subjects were divided into two groups; six of them were randomly selected in each. One group received 40mg omeprazole intact capsule of one trade and other group received 40mg omeprazole intact capsule of another trade once daily for consecutive 8 days at 8.00 hours on each day. On the first and eight days of dosing, 10ml of blood sample was collected from each subject at 0.0, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 and 6.0 hours after dosing. Blood samples were centrifuged at 2500rpm for 15 minutes and plasma was stored at 20°C. Omeprazole concentration in plasma was determined using a reverse phase high performance liquid chromatography (HPLC). From the concentration, the area under the curve (AUC) of omeprazole was determined for each subject by the trapezoidal rule. From the result it was observed that the plasma concentration of omeprazole was increased up to 6 hours in both trade-A and trade-B in day 1 and 8. Thus the AUC of omeprazole was also increased. But most of the studies in western population showed that the maximum plasma concentration was within 0.5 to 2.0hours indicating a difference from that of western studies. In this study all the subjects exhibited increased plasma concentration and AUC which may be due to genetic variation of omeprazole metabolism as an Asian which may be due to slow or "Poor metabolizers" (PMs), of the study population, who are deficient in CYP2C19. It is revealed that the plasma concentration and AUCs of both the products after single and repeated doses of omeprazole capsule were higher in comparison to other studies in western population.