Evaluating the Efficacy of Topical Phenytoin in the Healing of Neuropathic Diabetic Foot Ulcers: A Comparative Study.

OBJECTIVE: This study aims to observe the outcomes of topical phenytoin treatment in healing neuropathic diabetic foot ulcers with mild infection and compare these outcomes with those obtained from conventional dressing methods. METHODS: A retrospective observational study was conducted by reviewing the medical records of patients with neuropathic diabetic foot ulcers treated at a tertiary care center from 2015 to 2020. Two groups were identified: (1) patients treated with topical phenytoin (for ulcers measuring less than 5 cm, a dosage of 100 mg was used; for ulcers measuring between 5 cm and 9 cm, a dosage of 150 mg was used; for ulcers measuring between 10 cm and 15 cm, a dosage of 200 mg was used; and for ulcers measuring greater than 15 cm, a dosage of 300 mg was used. The tablets were crushed and dispersed before administration) and (2) those were treated with conventional dressings (the conventional method includes wound wash with 0.9 normal saline and betadine solution with application of sterile gauze dressing). Data on wound healing rate, time to achieve complete healing, and recurrence rates were collected. RESULTS: The study included 120 patients, with 60 receiving topical phenytoin and 60 receiving conventional dressings. Preliminary findings indicated that the topical phenytoin group experienced a 27 (45%) reduction in ulcer size by week four, compared to a 15 (25%) reduction in the conventional group. The median time to complete healing was significantly shorter in the phenytoin group (eight weeks) compared to the conventional dressing group (12 weeks; p < 0.05). Additionally, granulation tissue appeared earlier in the phenytoin group, with an average onset of 10 days, compared to 18 days in the conventional group (p < 0.01). The incidence of ulcer recurrence was lower in the phenytoin group (6, 10%) compared to the conventional group (18, 30%; p < 0.05). CONCLUSIONS: Topical phenytoin demonstrated a promising enhancement in the healing of mildly infected neuropathic diabetic foot ulcers compared to conventional dressings. Further studies are recommended to substantiate these findings and explore the mechanisms underlying the observed benefits.

Phytofabrication, characterization of silver nanoparticles using Hippophae rhamnoides berries extract and their biological activities.

Introduction: Fabrication of plant-based metal nanoparticles has yielded promising results, establishing this approach as viable, sustainable, and non-toxic in the biomedical sector for targeted drug delivery, diagnostic imaging, biosensing, cancer therapy, and antimicrobial treatments. Methods: The present work demonstrates the suitability of Hippophae rhamnoides berries for the instant green synthesis of silver nanoparticles to check their antioxidant, lipid peroxidation, and antimicrobial potential. The preliminary characterization of Hippophae rhamnoides-mediated AgNPs was validated by monitoring the color shift in the solution from pale yellow to reddish brown, which was further confirmed by UV-vis spectroscopy and the plasmon peaks were observed at 450 nm. Field Emission Scanning Electron Microscopy (FESEM) and X-ray diffraction (XRD) were used to evaluate the surface topography and structure of AgNPs. Herein, the antioxidant potential of synthesized AgNPs was investigated using DPPH free radical assay and the antimicrobial efficacy of similar was checked against E. coli and S. aureus by following MIC (minimum inhibitory concentration) and MBC (Minimum bactericidal concentration) assay. Along with the inhibitory percentage of lipid peroxidation was analysed by following TBARS (Thiobarbituric acid reactive species) assay. Results & discussion: The results revealed that the AgNPs were spherical in shape with an average size distribution within the range of 23.5-28 nm and a crystalline structure. Negative zeta potential (-19.7 mV) revealed the physical stability of synthesized AgNPs as the repulsive force to prevent immediate aggregation. The bioactive functional moieties involved in reducing bulk AgNO3 into AgNPs were further validated by FTIR. TBARS was adapted to test lipid peroxidation, and Hippophae rhamnoides-mediated AgNPs showed a 79% inhibition in lipid peroxidation compared to Hippophae rhamnoides berries extract as 65%. Furthermore, the antibacterial tests showed 37 ± 0.01 mm and 35 ± 0.0132 mm, zones of inhibition against E. coli MTCC 1698 and S. aureus MTCC 3160 with MIC and MBC values of 1 mg/mL, respectively.

Evaluation of diethyl 4-(5-bromo-1H-indol-3-yl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate: synthesis, anti-corrosion potential, and biomedical applications.

The pursuit of advanced multifunctional compounds has gained significant momentum in recent scientific endeavours. This study is dedicated to elucidating the synthesis, rigorous characterization, and multifaceted applications-encompassing anti-corrosion, antimicrobial, and antioxidant properties-of Diethyl 4-(5-bromo-1H-indol-3-yl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate. The 1,4-dihydropyridine derivative was meticulously synthesized through a strategic reaction of ethyl acetoacetate, ammonium acetate, and 5-bromoindole-3-carboxaldehydein the ethanol medium at 60  C. Subsequent spectral validations were conducted using sophisticated techniques, namely FTIR, NMR, and Mass spectrometry, resulting in data that perfectly resonated with the hypothesized chemical structure of the compound. Its anti-corrosive potential was assessed on mild steel subjected to an aggressive acidic environment, employing comprehensive methodologies like gravimetric analysis, Tafel polarization, and EIS. Concurrently, its antimicrobial prowess was ascertained against a spectrum of bacterial and fungal pathogens viz., Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Pseudomonas, Candida albicansandAspergillusniger, leveraging the disc diffusion method and using Gentamicin as a reference standard.The empirical results illustrated a substantial decrement in corrosion rates with ascending concentrations of the organic compound, achieving an apex of anti-corrosive efficacy at 81.89% for a concentration of 2 × 103 M. Furthermore, the compound outperformed Gentamicin in antimicrobial screenings, manifesting superior efficacy against all tested pathogens. The antioxidant potential, quantified using the DPPH free radical scavenging assay against ascorbic acid as a benchmark, was found to have an IC50 value of 113.964 ± 0.076 µg/ml.This comprehensive investigation accentuates the paramount potential of the synthesized dihydropyridine derivative in diverse domains-from industrial applications as a corrosion inhibitor to therapeutic avenues given its pronounced antimicrobial and antioxidant capabilities. The compelling results obtained pave the way for expansive research and development initiatives cantered around this multifaceted compound.

Evaluation of the Braden Scale Implementation by nurses: A Case Study in a Specialized Hospital in the Dhaka City.

Objective: The aim of this routine to research (R to R) developmental study was to implement the Braden Scale (BS) to identify risks of pressure ulcer (PU) development among hospitalized patients with spinal cord injury admitted in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Methods: Roger’s Diffusion of Innovation Theory and PU related literature were used to guide the development of the implementation. The subjects were 10 nurses and 13 doctors who were working at the NITOR. Different strategies were provided for the implementation of the BS including workshops to provide knowledge, persuasion, and decision making to implement the BS for the nurse participants. The outcomes of this study were to determine: (a) nurses’ adoption in terms of the rate of using the BS and the accuracy of using the BS to identify PU risks, (b) nurses’ satisfaction to use the BS, and (c) doctors’ satisfaction on the implication of the BS to identify the risks of PUs in hospitalized adult patients with paraplegia. Data were analyzed by descriptive statistics and percentage of agreement. Results: Weekly proportions of nurses’ adoption in terms of the rate of using the BS ranged from 96% to 100%. The accuracy of using the BS yielded percentage of agreement between 70.6% to 100% for each item of the BS. Nurses’ and doctors’ satisfactions were at very high levels. Mean score of nurses’ satisfaction was 98.5% (SD=1.23) and mean score of doctors’ satisfaction was 89.79% (SD=4.17). Conclusion: Nurses are capable to assess PU risks of paraplegic patients independently by using the BS and may be incorporated to identify PU risks in addition to their work protocol. After identifying the PU risks, effective nursing care should be implemented to the patients in order to prevent the PU formation.

A rare case of disseminated cysticercosis: Case report and literature review.

Cysticercosis is a common tropical disease. One of the uncommon manifestations of cysticercosis and a rare complication is its disseminated form. We report an immunocompetent patient with disseminated cysticercosis who had involvement of the brain, subcutaneous tissues, lungs and skeletal muscles and presented with arthritis. He was otherwise asymptomatic in spite of the extensive involvement of multiple organs. A planned approach to therapy is necessary to prevent complications.

Short Term Urinary Catheterized Patients in Intensive Care Unit (ICU) – A Need to Screen.

Catheter-Associated Urinary Tract Infection (CAUTI) is the second most commonly reported healthcare associated infection, accounting for upto 40% of all nosocomial infections. Silent catheter associated bacteriuria comprises a huge reservoir of resistant organism in hospitals particularly in critical care units. We prospectively studied 100 newly short term catheterized patients in a tertiary care hospital. Samples collected on day three and daily thereafter for semi quantitative urine culture and pus cell count. Antibiotic sensitivity was tested using Kirby-Bauer disc diffusion method. Out of hundred patients, 32 showed growth on fifth day and remaining 68 samples were culture negative up to seventh day. None of the culture positive samples had pus cells. Escherichia coli (35%) was the predominant isolate followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecium, Candida spp (15% each) and Coagulase negative Staphylococcus (5%). Among the Gram negative organisms, four strains of Escherichia coli and two strains of Klebsiella pneumonia were Extended Spectrum Beta Lactamases (ESBL) producers and 33.3% were Multidrug resistant Pseudomonas aeruginosa. Multidrug resistant pathogens in an asymptomatic short term catheterized patient are a major reservoir in hospitals. This emphasizes the importance of periodic surveillance for nosocomial infections in hospital and the periodic screening will also help us to frame antibiotic policy in a new tertiary care hospital.

Prevalence of diabetes and impaired fasting glucose in urban population of Bangladesh.

We investigated the prevalence of type 2 diabetes (T2DM) and impaired fasting glycemia (IFG) and their risk factors in the urban population of Bangladesh. The study was carried out in Dhaka City Corporation with a population of 99,12,908 in 20,89,336 households distributed in 95 wards. Using a multistage cluster sampling, we investigated 5265 eligible participants of 20 age years and above for height, weight, waist-girth, hip-girth, blood pressure and fasting blood glucose. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. We used WHO diagnostic criteria of 1999. The overall prevalence of T2DM was 11.2% and IFG was 5.9%. The age-standardized prevalence of T2DM (95% CI) was 10.5% (9.37-11.13) and IFG was 5.2% (4.51-5.84). Compared with the slum dwellers, the non-slum dwellers had significantly higher prevalence of both T2DM (7.4 vs. 13.4%, p<0.001) and IFG (4.1 vs. 7.4%, p<0.001). Logistic regression analysis showed that family history of diabetes, higher family income, sedentary lifestyle and higher quartiles of age, BMI and WHR were significantly related to diabetes. The prevalence of diabetes in the urban population has increased alarmingly in recent years. Older age, obesity, higher income, family history of diabetes and reduced physical activity were proved to be the significant risk factors for diabetes and IFG.

Blood pressure and glycemic status in relation to body mass index in a rural population of Bangladesh.

A cluster sampling of five villages in Dohar thana were selected for screening of hypertension and diabetes in relation to age structure and body habitus. All the subjects over 15 years of age were enlisted for investigation. The response rate was more than 70%. Height, weight, blood pressure (BP) and capillary blood glucose (fasting and 2-hPG) were measured. Diagnostic criteria of international standard were used for hypertension and diabetes. Out of 1005 participants 106 subjects (10.5%) had systolic blood pressure (sBP) more than 140 mmHg and 9% of them had diastolic blood pressure (dBP) more than 90 mmHg. The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) was 2.1% and impaired glucose tolerance (IGT) was 13.3%. The mean body mass index (BMI) of men was 20.39 (SD = 2.91) and that of women was 20.11 (SD = 2.92), having no significant difference between them. Increased age (> or = 50 yr), high BMI (> or = 23.0) and hyperglycemia (2-hPG > 7.8 mmol/L) were the risk factors for both systolic (sBP > 140 mmHg) and diastolic (dBP > 90 mmHg) hypertension. Likewise, increased age, high BMI and hypertension showed significant association with glucose intolerance. Moreover, significant correlations were observed between age and BP (sBP, r = 0.328 p < 0.001; dBP, r = 0.187 p < 0.001) BMI and BP (sBP, r = 0.193 p < 0.001; dBP, r = 0.192 p < 0.001) and 2-hPG and BP (sBP, r = 0.188 p < 0.001; dBP, r = 0.134 p < 0.001).

Prevalence of hypertension in Bangladesh: effect of socioeconomic risk factor on difference between rural and urban community.

Several studies reported that migrant Bangladeshis had greater risk for hypertension, diabetes and coronary heart disease compared with the Europeans and other migrant South Asians. So far, there has been no such study among the native population. This paper reports the hypertension prevalence and related risks among native Bangladeshis. A total of 2,361 subjects over 20 years of age were investigated. Overall prevalence rates of systolic and diastolic hypertension in the study population were 14.4 and 9.1 percent respectively. The prevalence of systolic hypertension was significantly higher in rural than in urban participants (P < 0.001). Compared with the poor the rich class had significantly higher prevalence of both systolic (P = 0.002) and diastolic (P = 0.041) hypertension. With increase of age, body mass index (BMI) and blood glucose level were significantly related to hypertension (P < 0.0001); whereas the trend for increasing waist-to-hip ratio (WHR), adjusting for social class, was not significant. Regression analysis showed that age, BMI, rural area and rich class were the strong predictors for hypertension. This study explored that hypertension prevalence in the native Bangladeshis is almost comparable to that of other Asian populations and South Asian migrants.

Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia.

Body mass index (BMI, kg/m.sq) and waist-to-hip ratio (WHR) are widely used as obesity indices for diabetes and cardiovascular risks. Lower adult height was related to diabetes and stroke. Waist-girth was proved important for visceral obesity. Incorporating waist-girth and height as waist-to-height ratio (WHtR), we reported earlier--"Waist-to-height ratio is an important predictor of hypertension and diabetes". We readdressed this index in a larger sample with two-sample OGTT and lipid profiles. In a cluster sampling of 16,818 rural inhabitants, considering age > or = 20 y, 5713 subjects were found eligible. Of them, 4923 (M/F=2321/2602) volunteered for height, weight, blood pressure, waist-girth and hip-girth. Fasting venous blood (5 ml) was drawn for plasma glucose, total cholesterol (T-chol), Triglycerides (TG) and high-density lipoprotien (HDL-c). Overall, 1565 participants were undertaken for OGTT. The mean (SD) values of BMI, WHR and WHtR for subjects with diabetes and hypertension were significantly higher in either sex. The level significance was highest for WHtR. The prevalence of diabetes and hypertension increased significantly with higher quintiles of BMI, WHR and WHtR (chi sq values were largest in WHtR for both events). Partial correlation coefficients, controlling for age and sex, showed that BMI, WHR and WHtR significantly correlated with systolic and diastolic BP, FBG, T-chol and TG. In the entire correlation matrix, the 'r' values were the highest for WHtR. Taking diabetes and hypertension as dependent variables, logistic regression also showed the highest odds ratio in higher WHtR than BMI and WHR. We conclude that WHtR was proved again a valuable obesity index for predicting diabetes, hypertension and lipidemia.