Assessment Of Drug Utilization Among Pediatric Patients In Private Clinic And Public Hospital Of Bangladesh

Objective: Aim of the study was to assess drug utilization among pediatric patients in both private practice and hospital settings in Rajshahi city, Bangladesh. Methods: This observational study was conducted during a period of two months (March to April) in 2017. Prescriptions were randomly collected from patients and recorded in a predesigned questionnaire form. The data analysis was carried out by using a statistical software package GraphPad Prism. Results: The study involved a total of 185 patients, of which 62.70% were male and 37.30% were female. The patient’s age ranges from 1 mo-12 y and highest number of patients visited physicians belong to group 1 mo-1 y (47.57%). Most commonly occurring disease conditions were pneumonia (24%), the leading cause of hospitalizations among the children's age group of 1 mo-1 y. The results indicated that physician’s handwriting was not clear and legible in 50 (27.03%) prescriptions. A total of 468 drugs were prescribed with an average of 2.53 per prescription. However, none of the drugs were prescribed by generic name. The most commonly prescribed drugs were antibiotics 173 (93.5%). About 78% patients were exposed to antibiotics, of which single antibiotic was prescribed in 116 (62.70%) and two antibiotics in 23 (12.43%) prescriptions. Among the drugs, NSAIDS 65 (35.14%), anti-histamine 57 (30.81%), anti-asthmatic 49 (26.49%) drugs were assigned in prescriptions followed by vitamin and minerals 51 (27.57%). Steroids 57 (30.81%) and hypnotics 26 (14.05%) were also accounted in many prescriptions. Interestingly, antibiotics were indiscriminately prescribed in private practices without any bacteriological examinations, whereas in hospital settings, most of the treatment was initiated after culture and sensitivity tests. Conclusion: Children were highly exposed to antibiotics, steroids and hypnotics in both private practice and hospital settings.  So Medical practitioners should be aware of current guidelines for prescriptions of antibiotics and drugs in child.

Hepatitis A virus vaccination strategy and pre-immunization screening of Bangladeshi children.

Background: HAV infection is endemic in many developing countries like India, Pakistan, Nepal etc. Several seroprevalence studies show high rates of sero-positivity among children by sub-clinical infection. Therefore mass vaccination against HAV has not been recommended in endemic countries. Objective: To determine whether routine hepatitis A vaccination is indicated for all Bangladeshi children & also to know whether pre-vaccination screening is necessary. Materials & Methods: Serum samples from 254 children aged between 1-15 years were tested for antibody (IgM & IgG) against hepatitis A virus (HAV) to determine the seroprevalence of HAV antibody and do a cost-benefit analysis for decision making about vaccination against HAV among the children of Bangladesh. Results: Hepatitis A virus antibody was positive in 141 (55.5%) of 254 children. Age-specific sero-prevalence was 13 (23.2%) of 56 in 1-3 year,64 (55.2%) of 116 in 3-5 year, 39 (70.9%) of 55 in 5-10 year & 25 (92.6%) of 27 in 10-15 year age group. Cost benefit analysis showed that the total cost of screening followed by vaccination was almost 1.8 times less than the total cost of vaccination of all children without screening. Conclusions: Majority of the children were found sero-positive against HAV around 15 year of age. Therefore mass vaccination against HAV may not be required for Bangladeshi children.

Antimicrobial Sensitivity Pattern of Helicobacter pylori Isolates among Subgroup of Bangladeshi Patients.

This cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU) and International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009. Aim of the study was to find out the antimicrobial susceptibility profile of Helicobacter pylori isolates from dyspeptic patients. Total 224 dyspeptic patients from Out Patient Department (OPD) of BSMMU were initially enrolled after informed written consent. After upper GI endoscopy 157 patients were finally included who had erosions, ulcers or atrophic changes in the stomach or duodenum. Two biopsy samples were taken from each of them. Samples were incubated at 370C in a double gas incubator with 5%O2, 10%CO2 and 85%N2. Total 82 (52.23%) samples were found positive for H. pylori. Isolated organisms were then tested for sensitivity to Amoxicillin, Clarithromycin, Tetracycline, Levofloxacin and Metronidazole by Agar dilution method. Among 82 patients 51(62.2%) were male and 31(37.8) were female with a male:female ratio 1.6:1. Patients were categorized into two groups one having gastric or duodenal ulcer (30.5%) and other having no ulcer (69.5%). Among these isolates 92.7% were sensitive to Amoxicillin, 89% to Clarithromycin, 81.7% to Tetracycline, 80.5% to Levofloxacin and only 26.8% to Metronidazole. Beside these, 81.7% isolates were sensitive to both Amoxicillin and Clarithromycin, 74.4% to Amoxicillin and Tetracycline, 73.2% to Amoxicillin and Levofloxacin, 72% to Clarithromycin and Tetracycline, 59% to Clarithromycin and Levofloxacin and 51% to Tetracycline and Levofloxacin.

Efficacy of Different Laboratory Tests to Diagnose Helicobacter pylori Infection.

Helicobacter pylori is a Gram negative bacteria which causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. There are a set of laboratory tests to diagnose H. pylori infection with a variable accuracy, they are divided into non-invasive tests and invasive tests. Non-invasive tests include serology, urea breath test (UBT) and stool antigen test (SAT). Invasive tests include rapid urease test (RUT), histology and culture. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and H. pylori laboratory of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009 to evaluate the efficacy of RUT, SAT and Culture as a diagnostic tool for H. pylori. Dyspeptic patients were collected from outpatient department of BSMMU. Out of 224 dyspeptic patients 149 patients had ulcers or erosions in the stomach or duodenum. Stool sample could be collected from 139 patients. RUT has sensitivity of 100%, specificity 80.28%, positive predictive value 85% and negative predictive value 100%. Regarding culture, sensitivity is 100%, specificity 94.37%, positive predictive value 95% and negative predictive value 100%. Stool antigen test has sensitivity 95.94%, specificity 92.31%,positive predictive value 93% and negative predictive value 95%.

Effects of Griseofulvin in the Treatment of Lichen Planus -A Study in BSMMU.

Lichen Planus (LP) is an inflammatory disorder of skin, mucous membranes, nails and hair. There are various modalities of treatment but none is curative. This prospective therapeutic trial was done among patients with lichen planus at the outpatient department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between November 2001 and April 2002. Total 20 patients were taken of them 12 were male and 8 were female with male to female ratio 3:2. Age of the patients was between 10 to 50 years. Patients were diagnosed clinically & confirmed histologically. They were treated with griseofulvin 500 mg daily for 6 months. Out of 20 patients, 8 had only oral lesions, of them 2 (25%) showed complete response, 3(37.5%) showed moderate improvement and 4 (37.5%) showed no response. Other 12 patients had lichen planus involving skin without oral mucosa, of them 4 (33.3%) showed moderate improvement, 4 (33.3%) showed no response and 4 (33.3%) patients worsens with treatment. So, success in patients with cutaneous lichen planus is less likely; however, griseofulvin may afford relief in selected patients with oral lesion. This study indicates that further prospective placebo controlled studies are needed to clarify the efficacy of griseofulvin in lichen planus.

Profile Of Clinically Suspected Encephalitis Patients Admitted To Faridpur Medical College Hospital, Bangladesh.

Encephalitis is a relatively common clinical diagnosis of admitted patients in Faridpur Medical College Hospital. This is significant because there was an outbreak of Nipah Virus (Ni-V) encephalitis in Faridpur district in 2004 with 34 cases including 26 deaths. Recent death of an intern doctor of FMCH from Ni-V encephalitis further emphasizes the gravity of situation. In this study a total number of 100 cases of clinically suspected encephalitis patients were studied for different clinical parameters. This is a retrospective study using data from hospital records. Majority of patients presented with neurological features (85%), 6% with pulmonary, 7% with combined neurological and pulmonary, and 2% with other features. 5-18 years age group comprises the highest number 44%, followed by >18 years age group 34%. Male-female ratio was 33:17. July to November was the period of maximum number of admission, the highest being in August. Patient from all upazillas of Faridpur were admitted, the highest being from Sadar Upazilla. 48% of the patients recovered, 19% expired and 7% were referred. In this context, further prospective study is urgently required to find out the epidemiological characteristics of Nipah virus encephalitis in Faridpur region.

Chrozophorin: a new acylated flavone glucoside from Chrozophora tinctoria (Euphorbiaceae) / Crozoforina: uma nova flavona glicosilada e acetilada de Chrozophora tinctoria (Euphorbiaceae)

Preparative reversed-phase HPLC analysis of the methanol extract of the aerial parts of Chrozophora tinctoria (Euphorbiaceae) yielded five flavonoid glycosides, quercetin 3-O-rutinoside (1, rutin), acacetin 7-O-rutinoside (2), apigenin 7-O-b-D-[(6-p-coumaroyl)]-glucopyranoside (3), apigenin 7-O- b-D-glucopyranoside (4) and apigenin 7-O-b-D-[6-(3,4-dihydroxybenzoyl)]-glucopyranoside (named, chrozophorin, 5), the last one being a new natural product. The structures of these compounds were elucidated unambiguously by UV spectroscopic analyses using shift reagents, ESIMS, and 1D and 2D NMR spectroscopic techniques. The free-radical scavenging activity of the methanol extract (RC50 = 2.24 x 10-1 mg/mL) as well as the isolated compounds (1-5) (RC50 = 4.38 x 10-3, 2.26 x 10-2, 7.69 x 10-4, 8.71 x 10-3 and 3.19 x 10-4 mg/mL, respectively) were assessed by the DPPH assay.

Análise das partes aéreas de Chrozophora tinctoria (Euphorbiaceae) através de HPLC preparativa com coluna de fase reversa produziu cinco glicosídeos de flavonóides, quercetina 3-O-rutinosídeo (1, rutina), acacetina 7-O-rutinosídeo (2), apigenina 7-O-b-D-[(6-p-cumaroil)]-glicopiranosídeo (3), apigenina 7-O-b-D-glicopiranosídeo (4) e apigenina 7-O-b-D-[-(3,4-diidroxibenzoil)]-glicopiranosídeo (chamado crozoforina, 5), sendo o último um novo produto natural. As estruturas dessas substâncias foram inequivocamente elucidadas por análise de espectrofotometria de UV com o uso de reagentes de deslocamento, ESIMS, e técnicas de RMN 1D e 2D. A atividade de captura de radicais livres do extrato metanólico (RC50 = 2,24 x 10-1 mg/mL) bem como das substâncias isoladas (1-5) (RC50 = 4,38 x 10-3, 2,26 x 10-2, 7,69 x 10-4, 8,71 x 10-3 e 3,19 x 10-4 mg/mL, respectivamente) foram analisados pelo método DPPH.

Chenoalbuside: an antioxidant phenolic glycoside from the seeds of Chenopodium album L. (Chenopodiaceae)

In addition to three known phytoecdysteroids, a new phenolic glycoside (named, chenoalbuside) was isolated from the methanol extract of the seeds of Chenopodium album. While the structures of all phytoecdysteroids were elucidated by direct comparison of their spectroscopic data with published data, the structure of chenoalbuside was determined unequivocally by a combination of UV, MS and 1D and 2D NMR spectroscopic analyses. The antioxidant potential of the new compound was assessed by the DPPH assay, and the RC50 value was found to be 1.4 x 10-4 mg/mL.

Low osmolar oral rehydration salts solution in the treatment of acute watery diarrhoea in neonates and young infants: a randomized, controlled clinical trial.

To compare the efficacy and safety of low osmolar oral rehydration salts solution (ORS-75) (mmol/L: Na+ 75, osmolarity 245) with that of World Health Organization-recommended ORS (ORS-90) (mmol/L: Na+ 90, osmolarity 311 ) in the treatment of acute watery diarrhoea in neonates and very young infants, a randomized double-blind, controlled clinical trial was carried out at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh, during January 1998-December 1999. Infants, aged < or = 2 months, presenting with a history of watery diarrhoea of < or = 72 hours, with no or some dehydration and without any systemic illness, were randomly assigned to receive either ORS-75 or ORS-90 for the correction and subsequent prevention of dehydration. Infants were studied for a maximum of five days. Total stool output, stool frequency, and requirement for ORS were outcome measures. Serum electrolytes were measured at 24 hours after admission to monitor serum sodium imbalance. Seventy-three infants received ORS-75, and 71 received ORS-90. Both the groups were comparable in their baseline characteristics. Diarrhoea resolved within five days in 53% and 66% of infants receiving ORS-75 and ORS-90 respectively (p = 0.3). Total stool volume [median (inter-quartile range) 132 (65-280) vs 139 (70-259) g/kg, p = 0.9], during the study period, was not significantly different between the two groups. Total stool frequency [31 (16-51) vs 35 (16-53), p = 0.9] and total ORS intake [192 (96-374) vs 209 (134-317) mL/kg, p = 0.7] were similar between the groups. No infants developed late evidence of hypernatraemia, irrespective of treatment. The results of the study indicate that ORS-75 is as safe as standard ORS-90 in the treatment of acute watery diarrhoea in neonates and very young infants and is effective in correcting and preventing dehydration.

Characteristics of children hospitalized with severe dehydration and persistent diarrhoea in Bangladesh.

The study analyzed data from a systematic sample of children, aged less than five years, who presented with persistent diarrhoea (diarrhoea of more than 14 days duration). It aims to differentiate (a) non-severe persistent diarrhoea (with no or mild dehydration) and (b) severe persistent diarrhoea (with moderate or severe dehydration), and to identify individual characteristics associated with severe persistent diarrhoea. In total, 7,505 patients, who represented a 4% systematic sample of the patient population, were seen during January 1993-December 1995. Of them, 297 (4%) presented with persistent diarrhoea. The male:female ratio was 2:1. Eighty-three percent of them had mild or no dehydration, and 17% had moderate or severe dehydration. Severe malnutrition of the study patients defined as weight-for-age z-score < -3, weight-for-length z-score < -3 and length-for-age z-score < -3 were 33.9%, 9.7%, and 22.7% respectively. Only 3% had oedematous malnutrition, and 11% had xerophthalmia. Factors independently associated with severe persistent diarrhoea by logistic regression analyses were: number of watery stool > 10 times during the last 24 hours prior to admission (OR, 10.0; CI, 1.2-87, p = 0.03), lower respiratory tract infection (OR, 111; CI, 4.2-2955, p = 0.004), and lack of mothers' education (OR, 7.8; CI, 1.4-41.9, p = 0.016) after controlling for confounders. Awareness and health education of mothers or caregivers and better case management during acute diarrhoeal episode might prevent the development of severe persistent diarrhoea in young children. In addition, children with severe persistent diarrhoea might need special attention to have adequate rehydration and control of extraintestinal infections, including respiratory tract infection.

A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum.

The merits of stapled versus hand sewn anastomosis were evaluated in a prospective randomized study of 60 patients undergoing resection for rectal cancer. The analysed factors included the time required for construction of anastomosis, post operative complications, local recurrence, disease free state and survival. Hand sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases. The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group. Five post-operative complications occurred in each group. Six patients of the hand sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group. The average time of study was 41 months. No significant difference was found in the overall survival pattern of the two groups.

Experience in elective hepatic resection.

A study was conducted on 35 elective hepatic resections performed by one surgical team over a period of 5 years with 14% postoperative mortality. The indications for hepatic resection were primary hepatocellular carcinoma in 20 cases (57%) and metastatic tumours from colorectal cancer in 12 cases (34%). Underlying cirrhosis of liver was found co-existent in 35% of patients of hepatocellular carcinoma. The 3-year actuarial survival rate after resection for HCC and metastatic tumour was 30% and 42% respectively.

Gastric cancer: a critical analysis of surgical treatment and long term survival.

Results of consecutive study of 120 cases of carcinoma stomach treated by one surgical team over a period of 10 years (1980-89) are presented. Maximum cases were in the sixth and seventh decades with male to female sex ratio of 2.5:1. The lesion in most cases were in the gastric antrum. Distal tumours were more of poorly differentiated histology compared to proximal tumours. Eighty-three out of 120 (69%) patients underwent surgical resection. In 50 patients it was in the form of a subtotal and distal gastrectomy. Only 5 patients underwent a total gastrectomy. In 70 cases the resection which involved en bloc removal of involved part of stomach including adequate proximal and distal free margins, omenta and perigastric lymph nodes and considered absolutely curative in 8 cases being no disease. The overall 5-year-survival figure was 18%. However, taking only the resected cases into account, the 5-year survival rate was 27%. The low survival figure can be attributed to a very small number of early cases encountered.