A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India

Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion.

Prevalence of Iron-deficiency Anaemia among University Students in Noakhali Region, Bangladesh.

Iron-deficiency anaemia (IDA) is a common health problem in rural women and young children of Bangladesh. The university students usually take food from residential halls, and the food value of their diets is not always balanced. This cross-sectional study was conducted to estimate the prevalence of irondeficiency anaemia among the university students of Noakhali region, Bangladesh. Haemoglobin level of 300 randomly-selected students was measured calorimetrically, using Sahli’s haemoglobinometer during October to December 2011. Statistical analysis was done by using SPSS software for Windows (version 16) (SPSS Inc., Chicago, IL, USA). In the study, 55.3% students were found anaemic, of whom 36.7% were male, and 63.3% were female. Students aged 20-22 years were more anaemic (43.4%) than other age-groups. Majority (51.3%) of male students showed their haemoglobin level in the range of 13-15 g/dL, followed by 26.0% and 21.3% with 10-12 g/dL and 16-18 g/dL respectively. Although 50.5% anaemic and 51.1% non-anaemic female students showed normal BMI—lower percentage than anaemic (60.7%) and nonanaemic (71.9%) male students, the underweight students were found more anaemic than the overweight and obese subjects. Regular breakfast-taking habit showed significant (p=0.035, 95% CI 0.5-1.0) influence on IDA compared to non-regular breakfast takers. Consumption of meat, fish, poultry, eggs, or peanut butter regularly; junk food; multivitamins; and iron/iron-rich food showed insignificant (p=0.097, 95% CI 0.5-1.1; p=0.053, 95% CI 1.1-2.3; p=0.148, 95% CI 0.6-1.2; and p=0.487, 95% CI 0.7-1.4 respectively) role in provoking IDA. In the case of non-anaemic subjects, all of the above parameters were significant, except the junk food consumption (p=0.342, 95% CI 0.5-1.2). Our study revealed that majority of university students, especially female, were anaemic that might be aggravated by food habit and lack of awareness. The results suggest that anaemia can be prevented by providing proper knowledge on the healthful diet, improved lifestyle, and harmful effect of anaemia to the students.

Comparative Phytochemical Screening and In vitro Evaluation of Biological Activities between Aqueous and Ethanolic Extract of Momordica charantia L. Fruits.

Aims: The study was conducted to compare the presence of different phytochemicals and biological activities like cytotoxicity, anthelmintic activity, antioxidant and free radical scavenging activities between aqueous and ethanolic extract of Momordica charantia L. Fruits. Methodology: The cytotoxic assay was undertaken using brine shrimp lethality test (BSLT) while the anthelmintic activity was carried out with the determination of time of paralysis and death of earthworm (Pheritima posthuma) at five different concentrations. Antioxidant and free radical scavenging activities were measured by 1,1-diphenyl-2-picrylhydrazyl (DPPH) method and determining the total phenolic contents. Results: Study revealed that several phytochemicals were found common for both of the extracts, though proteins and amino acids were only found in ethanolic extract. Both the extracts showed mild cytotoxic activity where the ethanolic extract showed better potency (LC50=24.245 μg/ml) than aqueous extract (LC50=24.515 μg/ml). In case of anthelmintic activity, ethanolic extract was also found significantly potent than aqueous extract at five different concentrations. IC50 values for the total antioxidant activity were 304.41±0.903 μg/ml and 479.05±1.393 μg/ml for ethanolic and aqueous extract, respectively. Ethanolic extract contained a significantly higher concentration of total phenols (71.08 ± 0.380 mg of GAE/g of extract) in comparison to aqueous extract (57.33±0.520 mg of GAE/g of extract). Conclusion: Therefore, in all aspects of the study, ethanolic extract was found more potent than aqueous extract. It can be concluded that M. charantia fruits are abundant of various phytochemicals and possess versatile biological activities.

In vivo analgesic, antipyretic, and anti-inflammatory potential in Swiss albino mice and in vitro thrombolytic activity of hydroalcoholic extract from Litsea glutinosaleaves

BACKGROUND: The study was conducted to evaluate the in vitro thrombolytic activity, and in vivo analgesic, anti-inflammatory and antipyretic potentials of different hydrocarbon soluble extracts of Litsea glutinosaleaves for the first time widely used in the folkloric treatments in Bangladesh. This work aimed to create new insights on the fundamental mechanisms of the plant extracts involved in these activities. RESULTS: In thrombolytic activity assay, a significant clot disruption was observed at dose of 1 mg/mL for each of the extracts (volume 100 µL) when compared to the standard drug streptokinase. The n-hexane, ethyl acetate, chloroform, and crude methanolic extracts showed 32.23 ± 0.26, 37.67 ± 1.31, 43.13 ± 0.85, and 46.78 ± 0.9% clot lysis, respectively, whereas the positive control streptokinase showed 93.35 ± 0.35% disruption at the dose of 30,000 I.U. In hot plate method, the highest pain inhibitory activity was found at a dose of 500 mg/kg of crude extract (15.54 ± 0.37 sec) which differed significantly (P <0.01 and P <0.001) with that of the standard drug ketorolac (16.38 ± 0.27 sec). In acetic acid induced writhing test, the crude methanolic extract showed significant (P <0.01 and P <0.001) analgesic potential at doses 250 and 500 mg/kg body weight (45.98 and 56.32% inhibition, respectively), where ketorolac showed 64.36% inhibition. In anti-inflammatory activity test, the crude methanolic extract showed significant (P <0.001) potential at doses 250 and 500 mg/kg body weight (1.51 ± 0.04 and 1.47 ± 0.03 mm paw edema, respectively), where ketorolac showed 1.64 ± 0.05 mm edema after 3 h of carrageenan injection. In antipyretic activity assay, the crude extract showed notable reduction in body temperature (32.78 ± 0.46°C) at dose of 500 mg/kg-body weight, when the standard (at dose 150 mg/kg-body weight) exerted 33.32 ± 0.67°C temperature after 3 h of administration. CONCLUSIONS: Our results yield that the crude hydroalcoholic extract has better effects than the other in all trials. In the context, it can be said that the leaves of L. glutinosa possess remarkable pharmacological effects, and justify its traditional use as analgesic, antipyretic, anti-inflammatory, and thrombolytic agent.

Corpora amylacea deposition in the hippocampus of patients with mesial temporal lobe epilepsy: A new role for an old gene.

BACKGROUND: Mesial temporal lobe epilepsy (MTLE) is the most common medically refractory epilepsy syndrome in adults, and hippocampal sclerosis (HS) is the most frequently encountered lesion in patients with MTLE. Premature accumulation of corpora amylacea (CoA), which plays an important role in the sequestration of toxic cellular metabolites, is found in the hippocampus of 50–60% of the patients who undergo surgery for medically refractory MTLE-HS. However, the etiopathogenesis and clinical importance of this phenomenon are still uncertain. The ABCB1 gene product P-glycoprotein (P-gp) plays a prominent role as an antiapoptotic factor in addition to its efflux transporter function. ABCB1 polymorphism has been found to be associated with downregulation of P-gp expression. We hypothesized that a similar polymorphism will be found in patients with CoA deposition, as the polymorphism predisposes the hippocampal neuronal and glial cells to seizure-induced excitotoxic damage and CoA formation ensues as a buffer response. MATERIALS AND METHODS: We compared five single nucleotide polymorphisms in the ABCB1 gene Ex06+139C/T (rs1202168), Ex 12 C1236T (rs1128503), Ex 17-76T/A (rs1922242), Ex 21 G2677T/A (rs2032582), Ex26 C3435T (rs1045642) among 46 MTLE-HS patients of south Indian ancestry with and without CoA accumulation. RESULTS: We found that subjects carrying the Ex-76T/A polymorphism (TA genotype) had a five-times higher risk of developing CoA accumulation than subjects without this genotype (Odds ratio 5.0, 95% confidence intervals 1.34-18.55; P = 0.016). CONCLUSION: We speculate that rs1922242 polymorphism results in the downregulation of P-gp function, which predisposes the hippocampal cells to seizure-induced apoptosis, and CoA gets accumulated as a buffer response.

Drug resistance in epilepsy and the ABCB1 gene: The clinical perspective.

Multidrug resistance is one of the most serious problems in the treatment of epilepsy that is likely to have a complex genetic and acquired basis. Various experimental data support the hypothesis that over-expression of antiepileptic drug (AED) transporters may play a pivotal role in drug resistance. Hyyt 6however, key questions concerning their functionality remain unanswered. The idea that P-glycoprotein, encoded by the ABCB1 gene, might mediate at least part of the drug resistance was met with both enthusiasm and skepticism. As in oncology, initial optimism has been clouded subsequently by conflicting results. The first study reporting a positive association between genetic variation in the P-glycoprotein and multidrug-resistant epilepsy was published in 2003. Since then, several other genetic association studies have attempted to verify this result. However, taken overall, the role of P-glycoprotein in drug resistance in epilepsy still remains uncertain. We intend to critically review the inherent problems associated with epilepsy pharmacogenetic studies in general and with ABCB1 polymorphisms studies in particular. The lessons learnt from the ABCB1 studies can help us to guide future association genetics studies to investigate AED resistance, and thereby taking us closer to the cherished dream of personalized AED therapy.

Public-private partnerships for providing healthcare services.

The public-private partnership is an initiative to improve efficiency, effectiveness and equity in the provision of healthcare services. This essay comments on the lessons that should be learned from some examples of such partnerships in various Indian states.